Well Man clinic

Prostate cancer screening in the D2 Medical

Should I be screened for prostate cancer?

Men who are screened run some risks from the biopsy test, and may not benefit from treatment even if they do have cancer. In fact, by diagnosing and treating cancers that might not need to be treated, the risk of reduced quality of life from treatment complications may be higher than if they were not screened. This does not stop men asking to be screened and a test (the PSA test) is available if you request it. You may know or have heard of someone who swears by the PSA test (for more on this see Screening tests heading below). However there are a number of factors that mean the test would not be helpful to everyone. Right now there is no evidence that screening a man without symptoms will help him to live longer.
If you feel well but have some concerns about prostate cancer, or if you have symptoms, a discussion of the options will help you decide on a course of action. The things to be considered are any family history of cancer, your age, your general health and how a diagnosis of cancer may affect you. The D2 Medical Centre can advise you of the potential risks and benefits of being screened, and also of the treatment options for cancer if it was to be detected. It is possible that you might not be seriously affected, even if you have cancer. Possible symptoms include difficulty starting to pass urine, a slow flow, dribbling, blood in the urine, having to get up often at night, or having to rush to get to the toilet. Remember that these symptoms can be caused by a number of medical problems.

What is prostate cancer?

Prostate cancer is a cancer that develops in the prostate gland. The prostate sits just below the bladder and is about the size of a walnut. Problems begin when the gland grows bigger, which commonly happens as you get older. Half of all men over 50 have enlargement of the prostate gland. Only one in 10 men with prostate symptoms will have cancer; in the rest, the cause of symptoms is usually a non-cancerous enlargement known as benign prostatic hypertrophy. Benign enlargement of the prostate gland tends to occur at the same age as prostate cancer, but there is no evidence that one leads to another. Prostate cancer is one of the most common causes of death from cancer in Irish men. Every year about 2000 to 3000 cases of prostate cancer are diagnosed, three quarters in men over 70. About 500 men die from the disease every year, nearly half of them over 80 years old. The figures are not as worrying as they seem. More men who have been diagnosed as having prostate cancer die from other causes than die from the cancer itself. However, it is difficult, even with screening, to identify tumours that are going to develop rapidly.

What screening tests for prostate cancer are available?

The term screening refers to tests that pick up disease at an early stage. The most common test for prostate cancer is the PSA test, which measures a substance called Prostate Specific Antigen (PSA) in the blood. This is available in the D2 medical.

PSA is a normal product of the prostate gland, but raised levels suggest cancer or other prostate problems. Doctors looking for prostate cancer will do a PSA test in conjunction with a rectal examination of the prostate gland itself. If the PSA test is positive, other tests and investigations will have to be done before a definite diagnosis of cancer can be made. This usually requires an ultrasound test and a needle biopsy of the prostate gland. Three quarters of men who have a positive PSA test will not have cancer, so the PSA test is not itself a reliable diagnosis. There is also a small risk of infection and bleeding from a biopsy, so the test is only done if there is a suspicion that a cancer is present.

How is prostate cancer treated?

The main ways to treat prostate cancer that has not spread are either radical surgery to remove the whole prostate gland (radical prostatectomy) or radiotherapy. Because both forms of treatment carry significant risk of complications like impotence, incontinence and bowel problems, 'watchful waiting' can be considered as an alternative option. The current evidence is that treating some prostate cancers does not improve your likelihood of survival, and may reduce the quality of your remaining life.

Cholesterol testing

A cholesterol test is a blood test that measures your total blood cholesterol level and its components, which include:

  • high-density lipoprotein (HDL) cholesterol - 'good cholesterol'
  • low-density lipoprotein (LDL) cholesterol - 'bad cholesterol'
  • triglycerides
  • total cholesterol
  • total cholesterol/HDL ratio.

Together, the results are known as your blood lipid profile. Lipids are just another name for the fatty substances in the body and bloodstream.

Why is it useful?

The cholesterol test is not used to diagnose a disease. Instead, measuring cholesterol and knowing the levels of these lipids provides important information on your health and your long-term risk of heart disease and stroke. Together with other cardiovascular risk factors (such as blood pressure, and bodyweight), your cholesterol results can give us an overall picture of your health.

If the blood test results are not within normal limits , this 'early warning' allows you to make lifestyle changes and consider treatments to lower your future risk of heart attack and stroke. Making changes on the advice of our doctors can greatly alter your risk.

How is it carried out?

Some cholesterol tests can be conducted with a finger-prick blood sample, but more detailed testing requires a blood sample collected from a vein in the arm. You will need to fast (go without food and most drink apart from water) for a specified period (usually at least 12 hours) before taking the test. You should still be allowed to drink water and take your normal medications - do not stop taking these unless your doctor advises you to (eg, if the medications would interfere with the test result). People taking blood-thinning medications (eg, aspirin or warfarin), or those with bleeding or clotting problems, should also inform the nurse or laboratory staff of this before the blood sample is taken. If you have previously experienced problems having blood taken, inform the the clinic so we can use a butterfly needle.

Erectile dysfunction

What is erectile dysfunction?

Erectile dysfunction means a man is unable to maintain an erect penis sufficient for satisfactory sexual intercourse. It may have a psychological or a physical cause, either way it is distressing and may cause loss of confidence and self-esteem or depression, as well as relationship problems. There are several solutions, but recognising the problem and talking about it with your doctor are the first essential steps.

Is erectile dysfunction common?

Many men have (often temporary) erection problems at times, and the likelihood increases with age. Estimates seem to be increasing as more careful studies are done and as men become more prepared to seek help. Some estimates indicate that about 40% of men over 40 will have erection problems. For some men erection problems occur suddenly but for most there is progressive difficulty. It may mean you are completely unable to get an erection, can get only a partial erection or can keep it for a short time.

How does an erection happen?

The veins that allow blood to leave the penis are only so wide. During an erection, the blood vessels that let blood into the penis relax and widen (dilate). This lets more blood in – more than can escape – which causes the sponge-like tissues of the penis to swell and harden. Complex biological mechanisms are involved in allowing these blood vessels to relax and redirect blood to the penis. Your thoughts and senses (touch, hearing, smell and sight) influence a part of the brain that can trigger an erection. In addition, hormones and other substances determine how your nerves transmit ‘sexual signals’ and how blood vessels respond to the received signals. Arousing thoughts or nervous mechanisms (eg, touch reflexes) are two ways an erection is initiated.

What causes an erection to fail?

Erectile dysfunction occurs when sexual stimulation or arousal (you may still ‘have the urge’) does not result in sufficient blood flow to the penis. For most men there is a physical or medical reason for this, for others the problem is psychological. Even when there is an initial physical reason, a man may still feel anxious about having sex, and this can compound the problem.

Physical and medical reasons

Recent illness, such as a heart attack, or injury to the brain or spinal cord can be a cause. Many other medical conditions can also lead to nerve damage or reduced blood supply to the penis – the most common of these is diabetes (men with diabetes are much more likely to have problems with erections). Other factors that can reduce blood flow to the penis include:

  • excess alcohol
  • smoking
  • narrowing of blood vessels caused by a high blood cholesterol level.

A wide range of drugs used to treat some health conditions (eg, heart failure, high blood pressure and depression) can also affect your ability to get an erection. If you are taking medication and have erectile dysfunction you should talk to your doctor about your drugs – there may be others without this side effect.

Psychological reasons

  • existing values or attitudes towards sex
  • stress, guilt, depression or fatigue
  • anxiety about your performance during sex
  • relationship problems (possible anger, power or control issues with your partner)
  • problems with intimacy and communication.

If you still have erections at times (eg, when you wake) this usually means psychological reasons are involved.

Do I need help?

Most aging men manage to get erections, but only with more stimulation. It is up to each man to decide whether his erection is adequate. You can consider (with your partner) how important sexual intercourse is to your relationship – there are other aspects to intimacy, and not all couples require an active sex life to have a fulfilling relationship.

You can help yourself by cutting down on alcohol, stop smoking and reducing the stress in your life.

Getting help from your doctor

Tests by your doctor might include:

  • a physical examination, which may include the genitals and prostate gland
  • checking your medications for side effects
  • blood and urine tests for hormones, blood lipids, liver and kidney function and diabetes.

Many men are unhappy with their ability to get or maintain an erection, but only 5% of these men seek help. This is because men, in general, are unwilling to discuss their sex life, even when it is going well.

Understanding that erectile dysfunction could have a medical cause, just as asthma or arthritis do, can allow you to feel more at ease in mentioning it to your doctor. By opening up this discussion, which is confidential, your doctor can help you in a number of ways.

Your doctor can check your health and any current medications for likely side effects. If psychological reasons are suspected, your doctor can advise you on the appropriate action and help you access counselling services you (and your partner) may benefit from.

If your erection problems have a medical cause, your doctor can explain the treatment options, the techniques needed to make them work and their suitability for your needs in the light of your overall health.

Overcoming erectile dysfunction

Oral medications

The drugs sildenafil, tadalafil and vardenafil (also called PDE5 inhibitors) ‘prime’ the penis by allowing the blood vessels to relax, while another drug apomorphine acts by enhancing the brain’s response during arousal.

These tablets usually allow an erection to occur, but only when the man is stimulated or aroused. They can, however, cause headaches, dizziness and nausea, and PDE5 inhibitors can cause flushing or rarely some visual disturbance. Men with certain heart conditions or those taking nitrates for angina can’t use PDE5 inhibitors as this combination has proved fatal in some circumstances.


Injecting a prostaglandin drug into the base of the penis allows most men to get an erection, which may last beyond ejaculation. Some men may be put off by this method, but the injector devices are simple and convenient to use and the procedure is virtually painless.

Treatments for erectile dysfunction

Available treatments are summarised below. Your doctor can advise you on the benefits and drawbacks of each.

  • psychological counselling (whether or not there is a medical cause)
  • oral tablets
  • self-injection or penile insertion of a drug
  • vacuum pump devices
  • rigid or inflatable surgical penile implants
  • testosterone replacement (only for men with low levels of this hormone

Testicular self examination

Why should men check their testicles?

It is common knowledge that a monthly breast self-exam for women is an effective part of early breast cancer detection. For men, starting at age 15, monthly self-exams of the testicles are also an effective way of getting to know this area of your body and thus detecting testicular cancer at an early - and very curable - stage.

How to do a testicular self-exam

The self-exam for testicular cancer is best performed after a warm bath or shower. (Heat relaxes the scrotum, making it easier to spot anything abnormal.)

The D2 Medical Centre advises Stand in front of a mirror. Check for any swelling on the scrotal skin.

  • Examine each testicle with both hands. Place the index and middle fingers under the testicle with the thumbs placed on top. Roll the testicle gently between the thumbs and fingers - you shouldn't feel any pain when doing the exam. Don't be alarmed if one testicle seems slightly larger than the other, that's normal.
  • Find the epididymis, the soft, tubelike structure behind the testicle that collects and carries sperm. If you are familiar with this structure, you won't mistake it for a suspicious lump. Cancerous lumps usually are found on the sides of the testicle but can also show up on the front. Lumps on the epididymis are not cancerous.
  • If you find a lump on your testicle, see a doctor, preferably a urologist, right away. The abnormality may not be cancer, it may just be an infection. But if it is testicular cancer, it will spread if it is not stopped by treatment. Waiting and hoping will not fix anything. Please note that free-floating lumps in the scrotum that are not attached in any way to a testicle are not testicular cancer.
  • When in doubt, get it checked out - if only for peace of mind!

Other signs of testicular cancer to keep in mind are:

  • Any enlargement of a testicle
  • A significant loss of size in one of the testicles
  • A feeling of heaviness in the scrotum
  • A dull ache in the lower abdomen or in the groin
  • A sudden collection of fluid in the scrotum
  • Pain or discomfort in a testicle or in the scrotum
  • Enlargement or tenderness of the breasts.

We hesitate to mention the following list, since anything out of the ordinary down there should prompt a visit to the doctor, but you should be aware that the following symptoms are not normally signs of testicular cancer:

  • A pimple, ingrown hair or rash on the scrotal skin
  • A free-floating lump in the scrotum, seemingly unattached to anything
  • A lump on the epidiymis or tubes coming from the testicle that kind of feels like a third testicle
  • Pain or burning during urination
  • Blood in the urine or semen.

Remember, only a doctor can make a positive diagnosis.

For that matter, only a doctor can make a negative diagnosis too. If you think something feels strange, go and see the doctor! Finally, embarrassment is a poor excuse for not having any problem examined by a doctor.

If you think there is something wrong or something has changed, please see your doctor!

Alcohol - do you have a problem?

Think about how much you drink, and how often

  • Do you drink regularly?
  • Do you drink in binges?
  • Do you have a criterion/measure for getting drunk?
  • How often are you unsafe to drive?
  • Does the amount of alcohol you drink seem to be enough to call your drinking a problem or not?

The following questions are a guide to deciding whether you think you may have an alcohol problem.

Psychological effects

  • Do you think your drinking is out of control?
  • Does the prospect of missing a drink make you anxious or worried?
  • Do you worry about your drinking?
  • Do you wish you could cut down, or stop?
  • How difficult would you find it to cut down, or stop?

Physical effects

  • Do you need increasing amounts of alcohol to get the same effect from it?
  • Do you start to withdraw or hang out for it if you go without alcohol?
  • Have you ever been sweaty, shaky or confused when you have gone without alcohol for any length of time?
  • Do you have to drink throughout the day to keep your body physically stable?
  • Do you ever have to have a drink as soon as you wake up to stop the shakes (this is sometimes called an 'eye opener')?
  • In these ways, does it now seem that your body is controlling your drinking?

Other negative effects of drinking

Some people may never drink above accepted safe limits and may never become hooked either psychologically or physically.

Alcohol can cause a number of disruptions or problems in many areas of life.

Some of these include:

  • Legal problems, eg, trouble with the police through drinking, or drink-driving charges.
  • Relationship problems, eg, with your partner, friends, or other family and whanau members, or at work.
  • Family problems, such as violence, disruptive relationships, financial difficulties through drinking.
  • Social problems, eg, social embarrassment because of drunkenness.
  • Occupational problems, eg, time off work, poor work performance, job loss.
  • Physical health problems. Moderate drinking can be protective for middle-aged men and women who are at risk of some forms of heart disease. However, alcohol affects every part of the body, the heart included, and excessive amounts of alcohol can cause physical damage and a wide range of physical diseases.
  • Other health problems. Alcohol can cause brain diseases (eg, a dementia similar to Alzheimer's disease); it can trigger illnesses like depression and schizophrenia, and its use can make the management of almost all psychiatric problems more difficult.

Think, then about any problems that might be caused by, or through, your drinking. Is your drinking causing problems for people you love or care about? Are you in legal or money trouble because of your drinking? Is your drinking causing any kind of health problem? Is your drinking endangering your job? Are you concerned about how much you drink?

If you think you may have a problem with alcohol

It is useful to draw up a list of the good things and the less good things that you experience with your own drinking. Write down all the good things you can think of, eg, that drinking alcohol makes you feel better; that it means you have a good time with your friends, or whatever. Make up your own list and include everything good you can think of.

In terms of the less good things, consider any of the negative effects that might be affecting your life. Consider what your family or whanau is saying about your drinking. Consider the effect your drinking might have on them. Consider any effects that alcohol might be having on your health.

Look at the balance of the good things and the less good things. Is your drinking a problem for you or for other people? Do you need to change something about it? If your drinking is causing problems in your life, are you ready to do something about it?

What you do about your drinking may depend on your answers to the above questions.

Causes of alcohol problems

A number of factors can contribute to alcohol problems. There can be a genetic component to severe alcohol problems, that is, we can inherit a tendency to develop them. This does not mean it will always happen, but severe alcohol problems do tend to run in families and, if you have a family member who has been dependent upon alcohol, you are at greater risk of developing a problem with alcohol yourself.

Certainly, our physical make up can contribute to the development of drinking problems as life progresses. People who become very sick when they first drink alcohol (or who cannot hold their drink) are unlikely to go on and develop a regular drinking pattern. On the other hand, people who drink heavily and who can hold their booze are more likely to carry on drinking and therefore to possibly develop problems.

Social patterns are important too. You are less likely to drink heavily if no one in your peer group, family or social group drinks heavily.

How we are conditioned towards alcohol is important. If we grow up in a family or society that drinks, we are more likely to drink. If we get drunk at a party and make fools of ourselves in front of our friends, we might not drink so much the next time. Advertising can have powerful effects on our thinking, attitudes and behaviour.

Some people develop drinking problems simply because they develop an unchanging regular pattern of drinking. They always drink at the same time and place, every day, rarely changing the type or amount of drink. Others drink because they are stressed, depressed, or they have some other kind of problem in their life. Drinking can start as a way of coping with problems or trauma but, unless properly controlled, it can develop into a problem in its own right.

Testicular awareness

Why do I need to regularly check my testicles?

You probably don't realise it, but cancer of the testicles affects more men each year. It is the most common cancer among men aged 15 to 24 years of age, but men of any age can get it.

No-one is sure what causes testicular cancer. Most men don't know about it, so they ignore the first warning signs, hoping everything will just come right.

But it won't, and it's dangerous to ignore warning signs. With early treatment, there's a good chance there will be no further problems.

Warning signs

With testicular cancer the early clues are found in one of your testicles. They're usually obvious and easy to find, so watch out for any one or more of these signs:

  • a hard lump on the front or side of a testicle
  • swelling or enlargement
  • an increase in firmness
  • pain or discomfort
  • an unusual difference between one testicle and the other.

The other warning signs

  • heavy or dragging feeling in the groin
  • dull ache in the lower stomach or groin.

What's normal anyway?

If you're going to pick up signs of trouble you need to know what your testicles normally feel like. The best time to check is in the shower or bath. Hold your testicles in your hands so you can feel their size and weight. It's quite normal to have one larger than the other, or higher than the other, but they should be about the same weight.

Feel each testicle and roll it between your thumb and finger. It should feel smooth. You'll feel a soft, tender tube towards the back of each testicle.

Take action

If you notice anything unusual about your testicles, you should go and see a doctor as soon as possible. Act now, don't wait a week or two.

Chances are it won't be cancer, but it's better to be safe than sorry. It's foolish to delay because of embarrassment or fear. Your doctor will give you a thorough check-up. If it's cancer and you delay going to the doctor, the cancer can spread to other parts of the body. Then you'll need more extensive treatment. Testicular cancer is a serious disease, but when it's discovered, and treated early, there's usually a complete cure.

Heart disease - diagnostic tests

What tests are there for heart disease?

There are several tests available to diagnose possible heart disease. How the physician decides which tests to perform (and how many) depends on factors such as your risk factors, history of heart problems, current symptoms and the physician's interpretation of these factors.

The tests usually begin with the simplest and may progress to more complicated ones. Specific tests depend on your particular problem(s) and the physician's assessment.

Tests that do not involve inserting needles, instruments or fluids into the body are termed non-invasive. Those that do, are called invasive tests.

Non-invasive tests

Electrocardiogram (ECG)
This is the most common test for heart conditions. It is a simple, painless test that takes about 10 minutes.

Every time the heart beats, natural electrical currents can be picked up by electrodes placed on various points around the body. These natural electrical currents are recorded on paper. The tracing records the heart rate and rhythm and whether the muscle is conducting the electricity normally. Damaged heart muscle, or muscle that is short of oxygen, will result in a different appearance on the tracing.

The resultant tracing can give the doctor a lot of information about your heart, but, like most tests, the ECG is not infallible. If you have angina your heart tracing may be normal if it is recorded at rest when you are free of pain. In this case you may need an exercise ECG.

Holter monitoring
The purpose of Holter monitoring is to look for heart rhythm problems over a 24 to 48-hour period.

The Holter monitor is a small, portable, battery powered ECG machine worn when at home. It will record your heart rate and rhythm over a period of time. You will be asked to keep a diary of activities and any symptoms that you experience while the Holter monitor is being worn. At the end of the time period, the monitor needs to be returned to the hospital and a technician will view the recorded information.

This test uses sound waves to study the movement of the heart's chambers and valves. This is particularly useful as you can assess different areas of the heart while it is beating. The echo sound waves create an image on the monitor as an ultrasound transducer probe is passed over the chest and heart.

Exercise stress test (treadmill test or exercise ECG)
Some heart problems only show up when the heart is working hard. To assess this, it is necessary to monitor the heart when you are exercising. A continuous ECG is done to achieve this. The test takes a maximum of 10 minutes.

You will be connected to an ECG machine and blood pressure monitoring facilities. You then walk on a treadmill which will slowly increase in speed and incline. At various stages you will have blood pressure and ECG recorded.

Invasive tests

Echocardiogram stress test
This is similar to a resting echo test. It is performed on people who need to have a exercise ECG but are unable to walk any great distance due to mobility problems. Medication is given via an IV cannula to simulate exercise. Heart function and rhythm are monitored.

Cardiac catheterisation (angiogram)
Coronary angiography is an x-ray procedure used to examine the arteries of the heart. An introducing sheath is inserted into an artery, usually in your groin or sometimes an arm.

A catheter is threaded through this to the part of the aorta near the heart, where the coronary arteries start. A special dye is injected through the catheter, into your bloodstream.

X-rays of the heart and coronary arteries are then taken. The dye in your bloodstream helps highlight the coronary arteries and the narrowings in them. Your cardiologist will then review the X-rays and discuss the results with you.

Electrophysiological studies (EPS)
Your cardiologist might refer you for electrophysiology studies if you have an abnormal heart rhythm or palpitations. Fine tubes called electrode catheters are introduced through a vein and/or artery, usually in the groin. They are then gently moved into position in the heart, where they stimulate the heart and record electrical impulses. This type of investigation assists the doctor to make a definitive diagnosis and plan treatment for arrhythmia management.

Blood tests
Various blood test may be performed depending on your type of heart disease. These all help to build a picture of the nature of your disease.

Included might be assays for:

  • electrolytes
  • full blood count
  • hormone levels
  • blood clotting times
  • cardiac enzymes.

In recent years the most commonly used blood test to measure the level of cardiac muscle damage are proteins called troponins. The level of troponins in the blood helps to give a quick and accurate idea of the amount of muscle damage after a heart attack.

Cardiac troponins
Cardiac troponin measurements help either confirm or exclude a heart attack in a person who may be having, or recently had, a cardiac event. They also help decide what treatments a person with unstable angina may need.

Troponin T and Troponin I are proteins that are part of the heart or cardiac muscle. When heart muscle injury occurs, these proteins are released. Troponin T and I are more sensitive to heart muscle damage than the enzyme creatine kinase (CK). This makes them a valuable test to detect mild heart attacks. They can be detected in blood as early as three hours after a heart attack associated chest pain starts. The levels peak at 10 to 24 hours and can still be detected up to five to 10 days later. This means that if you have had chest pain for several days a heart attack can still be detected.

Risk factors you can change:

  • raised blood cholesterol
  • obesity
  • nutrition
  • cigarette smoking
  • lack of physical activity
  • raised blood pressure (hypertension)
  • diabetes
  • stress.

Risk factors you cannot change:

  • age
  • gender
  • previous history of heart disease
  • family history of heart disease.

Keeping blood cholesterol levels low

Lowering the levels of cholesterol in your bloodstream will lower your heart risk. The best things you can do to favourably affect your cholesterol levels are to:

  • eat and cook with less fat, especially saturated (animal) fat which is hidden in many snacks and foods
  • achieve and maintain a healthy body weight
  • be physically active.

Blood cholesterol is best measured as part of an overall assessment of your cardiovascular risk. This involves a simple blood test arranged by your doctor. Most people with heart problems should aim for a blood cholesterol level of less than 4 mmol/L (or even lower depending on your medical history and other heart risk factors). You can get more advice from your doctor, practice nurse or dietitian, or ask your doctor for our topic on High Blood Cholesterol.

How do I maintain a healthy weight?

If you are already overweight, you need to reduce your heart risks by losing weight and trimming your waistline. To do this you need to cut down, slowly and properly, on your food intake (particularly fats) and start to increase the amount of regular physical activity in your life. Avoid diets that promise rapid weight loss, and do not starve yourself or miss meals. You can ask for more advice from your doctor or a dietitian, or ask your doctor for our topic on Healthy Weight Control.

How does smoking affect my heart?

If you smoke, your chances of a heart attack are two or three times more than for a non-smoker, and you have a higher risk of stroke and many other diseases. Lifetime smokers have a 50% chance of dying from smoking-related diseases, and their lives are shorter by an average of 14 years. Smoking also affects the health of others around you. If you stop smoking, all the above risks soon become much less – quitting lowers the risk of a heart attack to that of a non-smoker within five years.

Why should I be physically active?

Active people have fewer heart attacks and have a better chance of recovery than inactive people. They also feel good and are less tired, more relaxed and better able to cope with stress. You can do more with less effort, have better heart function and possibly lower blood pressure. Regular activity helps control weight and lower blood cholesterol levels. Find different activities you enjoy and take opportunities to add physical activity to your day. You need not join a gym – regular brisk walking for half an hour can do the job.

Healthy physical activity should be:

  • regular – daily is ideal, three times a week is good, but anything is better than nothing
  • brisk – enough to increase your heart and breathing rates, not so hard it is painful or unenjoyable
  • sustained – the longer the better, but at least 15 to 30 minutes without stopping is good.

Why is blood pressure important?

High blood pressure can enlarge and weaken the heart. It also damages the blood vessels which, if they become narrow or blocked, may result in a heart attack or stroke. Get your blood pressure checked regularly – and more often if you are older, taking any medication (including the contraceptive pill), overweight, or if you have diabetes or a family history of heart disease. To keep your blood pressure down you should maintain a healthy diet and body weight, exercise regularly, use less salt and, if you drink alcohol, do so in moderation.

Is controlling diabetes important?

People with diabetes are at greater risk of developing heart disease. Diabetes can affect vessels that supply blood to the heart. Working with your doctor to develop a plan to control your diabetes is the first step in safeguarding your heart. Many of the lifestyle changes suggested for keeping your heart healthy (ie, diet and physical activity) are important in controlling diabetes. Medication may be needed – ask your doctor.

Should we be stressed about stress?

Although it is now clear that factors such as family history and lifestyle are the primary problems, it is advisable for general health and wellbeing to know what stresses us unduly, and to find ways of dealing with it:

  • identify the cause
  • exercise regularly
  • relax physically and mentally
  • maintain healthy eating habits
  • establish regular sleep patterns.

Dr John J Ryan Medical Director.

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