We recently helped organised a fibroids awareness event and one issues that was raised at this event was that many women aren’t aware of the various treatment options available and in this week’s blogs we  provide an overview of treatment options.

It is first important to note that the treatments offered for fibroids depend on the size of a woman’s fibroids, the symptoms they are causing, and if they are likely to affect her fertility. Most women with fibroids will not have symptoms, or the symptoms may be very mild and therefore no treatment may be required.  However, a significant number of women with fibroids will need treatment because they have severe symptoms and/or their fibroids may interfere with pregnancy or fertility.

Treatment options for fibroids may include:
· Watchful waiting
· Medication to treat symptoms
· Medication to shrink fibroids
· Surgery or medical procedures

Watchful Waiting

A woman may not realise that she has fibroids until her doctor detects them after a routine pelvic exam. Therefore she may have no symptoms or very minor symptoms. Or her minor symptoms may have led her to visit her doctor who then went on to diagnose her fibroids. Either way, if a woman has no symptoms or mild symptoms that are not a major problem, her best option is ‘watchful waiting’. This may involve her:
· Keeping an eye on her symptoms and if they get worse or new symptoms develop then the next step will be a visit to her doctor.
· Being regularly monitored by her doctor. This may involve having regular (yearly) ultrasound scans to keep an eye on the size of the fibroids.

It is hard to predict if the fibroids will grow or whether symptoms will develop. It is only through watchful waiting that this can be determined. The benefit of watchful waiting is that unnecessary treatment can be avoided or delayed. Delaying treatment may allow a woman to start her family before having treatment which may affect her fertility.

Women nearing menopause may consider watchful waiting until after menopause as fibroids tend to shrink after menopause and symptoms may ease or disappear completely on their own after menopause.  If symptoms don’t improve after menopause then a woman can speak to her doctor about other options.

Medication to treat fibroid symptoms

Some of the symptoms of fibroids may be treated with over-the-counter or prescription drugs. Women should speak to their doctors before taking any medication, and make sure that they are aware of any side effects.

If fibroids are causing pelvic or abdominal pain, pain-killers may be an effective way to treat that. Or, if fibroids have caused severe period pain, anti-inflammatory drugs such as ibuprofen and mefanamic acid can be effective at easing period pain.

Sometimes fibroids can cause heavy flow during periods. If this is the case, a woman can speak to her doctor about the contraceptive pill.  This can make periods lighter and also ease period pain. An alternative to the pill for treating heavy periods is tranexamic acid, a drug that is used in many different conditions to control bleeding.

Medication to shrink fibroids

There are treatments available that may be effective at shrinking fibroids. These types of drugs are usually used before surgery, meaning that less extensive surgery may be required because they make it easier for fibroids to be removed.  These are hormonal drugs that reduce a woman’s hormone levels. This means that there will be less hormones available in a circulation to stimulate the growth of fibroids, causing them to shrink.

Drugs that can shrink fibroids include goserelin (Zoladex®) or leuprorelin acetate (Prostap® SR).  They reduce oestrogen levels, and can cause menopause symptoms, so sometimes patients are given Hormone Replacement Therapy (HRT) to combat any menopause symptoms. The patient will be started on a course of treatment three to four months before surgery.
Another drug that may be offered is ulipristal acetate (UPA or Esmya®), which lowers progesterone levels. Typically, if this drug is prescribed, it will be given to the patient before surgery and it can be taken for a maximum of up to three months.

Surgery or medical procedures

In many cases, women with symptoms will need some form of surgery or a medical procedure to treat their fibroids. The options here include:
· Hysteroscopic Resection
· Myomectomy
· Hysterectomy
·  Endometrial Ablation
·  Embolisation
·  MRI treatments

Hysteroscopic Resection

A hysteroscopic resection (transcervical resection of fibroids) is a procedure that removes fibroids that develop on the inside of the womb (submucosal/intracavity fibroids).  It is usually performed under general anaesthetic (where a woman is put to sleep for the entire procedure). A small device with a camera and a light on the end of it (a hysteroscope) is inserted through the vagina, past the cervix and into the womb. The camera allows the doctor to see the womb on a video screen. On the end of the hysteroscope is a device that allows the doctor to remove the fibroids.

A hysteroscopic resection takes 20 to 80 minutes and is likely to be a day-case or one that might require an overnight stay in the hospital. Recovery time will be 1 to 2 weeks. After-care advice is given to prevent infection, and to help with any pain that a patient may experience.  Within a couple of months, there should be improvements in the symptoms that were caused by the fibroids, such as heavy bleeding or irregular periods.

This procedure is a good option as it avoids the removal of the womb and allows a woman to preserve her fertility. As with any medical procedure, there is a small risk of complications

Myomectomy

A myomectomy is a surgical procedure used to remove fibroids without removing the womb, and therefore helps to preserve fertility. A myomectomy can be carried out in two ways; either via keyhole surgery (laparoscopic myomectomy) or an abdominal myomectomy (laparotomy).

Keyhole surgery is usually performed when you have one or two fibroids that are five centimetres or smaller that grow on the outside of the womb (pedunculatedand subserosalfibroids). It involves a small hole being made in or near the belly button and then a narrow tube with a camera (laparoscope) is inserted into the abdomen. Through this hole, and other holes in the abdomen, a surgeon is able to cut the fibroids into small pieces and then remove them through the holes.

The benefit of keyhole surgery is that because the operation occurs via the small holes, it is less invasive. This means that there is less blood loss and pain, and recovery is quicker than a full-blown operation – 1 to 2 weeks. It also requires minimal stay in the hospital (either a day case or for one night).

Despite this, there is a small risk of developing complications. These include: excessive bleeding, an adverse reaction to the anaesthetic, a puncture to the womb, blood clots and infection. And, there is a 40% chance that fibroids will re-grow within five years of the keyhole surgery.

An abdominal myomectomy is performed under general anaesthetic. A surgeon will make a fairly large incision in a woman’s abdomen in order to gain access to the womb and will then remove the fibroids. This procedure is used to remove large fibroids from the wall of the womb and may require a 2 to 4 day stay in hospital and takes anywhere from 4 to 6 weeks to recover.  There is a small risk of complications which include infection, damage to internal organs like the bowel, and weakening of the womb. There is also a 10 to 50% chance that fibroids will re-grow.

Hysterectomy

A hysterectomy is a surgical procedure to remove the womb. It is performed under general anaesthetic and is a permanent solution to resolving any symptoms which are caused by fibroids. Removal of the womb means that a woman will not be able to have children, making this option best for women who have completed their families. If the ovaries are also removed during the hysterectomy, a woman will go through menopause immediately. But if the ovaries are not removed, then a woman may go through the menopause within five years of having her womb removed.

Depending on the size of the fibroids, a hysterectomy can be conducted in three different ways. Smaller fibroids can be removed by a vaginal hysterectomy (the womb is removed through the vagina via a small cut at the top of the vagina), or by a laparoscopic hysterectomy (where the womb is removed through small holes in the abdomen). Alternatively, for larger fibroids, an abdominal hysterectomy can be performed where a fairly large incision is made in the abdomen and the womb is removed through the incision.

A hysterectomy is considered to be major surgery and as such takes longer to recover from than other procedures. It takes about 6 to 8 weeks and requires about 1 to 7 days stay in hospital depending on the way in which the hysterectomy was performed.

A woman will be given an after-care plan on how to care for her wounds and will have a follow up appointment to ensure that she is healing properly.
As with any surgical procedure there is a small risk of complications

Endometrial Ablation

Endometrial ablation is a procedure that is used to address heavy menstrual bleeding caused by fibroids or to remove small fibroids (less than 5cm) that have formed in the lining of the womb. This procedure removes the lining of the womb using either a laser beam, radiofrequency waves, microwaves, hot saline, electrical current or freezing.
A small device with a camera and a light on the end of it (a hysteroscope) is inserted through the vagina, past the cervix and into the womb. The camera allows a doctor to see the womb on a video screen. The doctor will then use specialist instruments to remove the lining of the womb by one of the methods described above (i.e. either laser beam, radiofrequency waves etc.).
Because the lining of the womb is removed it is highly unlikely that a woman will be able to get pregnant after this procedure. However, even if her periods stop, there is a small chance that she may become pregnant. And, because of the removal of the lining of her womb, her pregnancy is likely to be a risky one for both her and her baby, and she will probably be advised to use birth control after her endometrial ablation.

An endometrial ablation takes 20 to 45 minutes to perform, and is performed either under local or general anaesthetic. Patients are usually discharged from hospital on the same day and take about 2 weeks to fully recover.

There is a small risk of complications, these include: burns to the womb and surface of the bowel, fluid build-up in the lungs, tearing of the cervix, a womb puncture and a blockage of the major blood vessel in the lung (pulmonary embolism).

Embolisation

Embolisation, or Uterine Artery Embolisation (UAE), is a procedure that blocks the blood vessels (uterine arteries) to the fibroids, starving them of oxygen and therefore causing them to shrink.  This procedure is carried out by an interventional radiologist who makes a small cut in the groin area and then inserts a tube (catheter) through the cut, using live x-ray images on a monitor to guide the tube into the uterine arteries. Tiny plastic beads (the size of fine sand particles) are then injected into the artery supplying the fibroid and these tiny embolic particles block the artery.  Over the next few hours, the fibroids ‘die’ and then shrink over the next few months and years.

An embolisation is carried out under local anaesthetic and patients will have to stay in hospital for 1 night and recovery will take 1 to 2 weeks.

Complications from embolisation are rare and tend to be fairly minor, for example: bruising, pain, fever and vaginal discharge.  Submucosal and particularly intra cavity fibroids can become detached. These can either pass through the cervix and vagina on their own or, if they get stuck, can rarely require a hysteroscopic removal by a Gynaecologist.

Fertility after embolisation has been maintained in many women, and premature menopause is very rare. Recurrence rates are low, being around 15% by 5 to 10 years.

UAE can be used in combination with various forms of myomectomy to get the best of both treatments and maintain fertility.

MRI Treatments

There are two fairly new procedures that may be considered to treat fibroids which make use of MRI (magnetic resonance imaging).  These are:

• MRI-guided percutaneous laser ablation
• MRI-guided transcutaneous focused ultrasound

These treatments are not widely available in the UK and only a handful of specialist centres perform these procedures.

In MRI-guided percutaneous laser ablation, an MRI scan is used to locate the exact location of fibroids and fine needles are inserted through the skin and into the fibroid. A cable is then passed through the needle and light is targeted at the fibroids. The heat from the light shrinks or destroys the fibroids. MRI-guided transcutaneous focused ultrasound also uses MRI to find fibroids, but uses ultrasound energy to target them.

Both of these procedures take 3 to 4 hours to perform and requires only about a two hour stay in hospital after the treatment. Recovery should take a few days during which the patient may experience some pain and nausea.  There are rarely any complications in the short-term. However, the long-term effects and risks are unknown, as are the effects on fertility.

Conculsion

We hope that above has been useful to providing a summary of the various treatments that are available for fibroids. Again, it’s important to note that the treatment a woman receive will depend on various factors. We encourage women who have to have treatment for their fibroids to have an informed discussion with their doctor.

*************
This blog is based on our fibroids booklet which was reviewed by experts in the field.

On 30^th September we teamed up with Black History Walks to help organise a Queen Nzingha Lecture on fibroids.  The Queen Nzingha lecture series is a regular event developed by Black history Walks and is a series  of lectures  delivered by black women  with expertise in a particular topic. It aims to achieve three things: give black professional women a platform to discuss their area of expertise;  give audiences the opportunity to learn about a specific topic; and provide a forum to debate topical issues.

We were delighted to be asked to help organise the most recent event which focused on fibroids. This was a great opportunity to raise awareness and also give women affected by fibroids the opportunity to learn more about this condition, share their experiences and meet other women with fibroids.

On the day we were delighted to have an interesting agenda which included an overview of fibroids by Abi Begho of The Lake Foundation, a really inspiring presentation by Amanda Epe on her personal experience of fibroids and finally a presentation by Dr Sydney Dillard on treatment options.

Lifestyle, this word brings thought to mind of daily tasks, particularly professional and pastimes, hobbies, activities or lack of them. As a former Cabin Crew member the work had a strong influence and was my lifestyle. I was a long haul stewardess, which entailed trips to far distance lands for a few days at a time or a week. My whole life activities were based on where I was going and for how long. I had wonderful opportunities for sight seeing, exploration, shopping or relaxation.  At times though, my peers and I weren’t motivated to go out or it was mundane to re-visit some locations. It became standard to stay in the hotel and meet for a drink or two with my peers. I had to keep myself motivated to use the gym and spa facilities, which were the perks of lodging in five star hotels. My health had deteriorated as A Fly Girl and prior to leaving the job I had a surgical removal of a uterine fibroid.

I had uterine fibroids since I was in my early twenties, prior to working in the airline, and have no history of fibroids in the family. I was also raised on a diet which was balanced and healthy; minimal dairy and red meat. During my twenties my lifestyle had changed and when I reflect back to this I can pick out the decline in a totally healthy lifestyle, it was not drastic however it may have been significant to the cause.

Some key points that I should mention are that in my twenties, and since childhood, I craved sugar and water was not a friend of mine. Until recently I admit water isn’t medicine, but in my twenties instead of water I increased my daily dinner red wine with red meat.

During my youth my menstruation was a curse on my well-being. It came with severe dysmenorrhea, nausea and occasional vomiting. No matter what pain killing medication the doctor prescribed, nothing worked, my stomach looked enlarged on my small and athletic frame. The appearance was a minor, the pain was major.

Although my fibroid was present before being a cabin crew member, my new lifestyle fed the fibroids, my symptoms worsened and my distended stomach gave me the appearance of a second trimester pregnancy.

In my memoir, A Fly Girl, there are many incidences in my tales that reflect on the toxic lifestyle.

Just before leaving the airline I had a myomectomy, the surgical removal of fibroid through an intense operation. It was intense compared to today’s procedure as I had an incision whereas technology now uses laser surgery. It was done privately as I had waited for this operation since my initial diagnosis on the NHS for several years.

I was driven to have the operation because of various new symptoms which accompanied my period; the abdomen swelling was severe and I suffered with menorrhea, the haemorrhaging  would leave me extremely weak and anaemic. I felt quite emotional after surgery however I recovered well and speedily. I became fully conscious from then as to what triggers fibroid growth from a holistic perspective, nutrition, spiritual and physical.

I began to write poetry as a means of self- expression, my diet improved and water became my friend again. I eliminated a lot of foods and it was a turning point in building self-esteem and self-expression. Spiritually I was more expressive as the true me, and being a writer has aided this. I engaged in a lot more exercise, road running, and for a year I was training in Thai boxing to release anger, energy and develop mental strength and finally relaxation in the spa with sauna and steam to eliminate further toxins. I started to enjoy being a creative cook so that my dinners where healthy and whole.

The complete change, spiritual, nutritional and physical was agreeing with me and my body was in balance with no extraordinary monthly pain. Over the years and I started to slip, unconsciously, old habits die-hard and gradually unsavoury patterns took hold. Many years later the fibroid growth returned with vengeance, it came with not just swelling of the abdomen but when menstruating many parts of my body would swell including my face and eyelids. I also experienced restless leg syndrome. I was haemorrhaging and clotting heavily and it had an affect on my work life, I couldn’t commit my presence at work, neither guarantee attending social events and I was fully exhausted because of anaemia. It got to the point where I was emotionally drained and hit rock bottom. I had tried again over the last few years several remedies of natural treatments and some therapies had adverse affects. However determined not to give up, neither to go back to the medical approach, I had a vision that the pain at least should be over and started a six month change programme this year.

I worked on the spiritual and nutritional aspect alone, and I am currently getting back into the physical component. It was a worthy sacrifice to officially eliminate specific foods in my diet for the last six months and gradually experiment with herbs that balance the hormones and strengthen the womb. It has been the best introduction to well being adding herbal remedies to a wholesome diet. Also the spiritual freedom of expression this year has given me joy as I spoke from the heart being part of a national book tour. Having a 90% reduction of symptoms that over the years have accompanied my menstruation and now have disappeared is an amazing testimony, it verifies that there are options for healing in this earth, one must have resilience to overcome and to know that healing isn’t a linear progression.

I am thankful for my diverse experiences in life and I can say that having the fibroid has been a catalyst for my behaviour change. To focus on holistic health can be one of the most self-loving expressions a human can do.

I will update my progress in another six months with the inclusion of physical activity, and this can be found on my blog at www.msroseblossom.org

My experience in treating and healing fibroids or to prevent the onset of them begins with living a spiritual fulfilled life, and includes ways to balance health holistically, along with help from experts and support networks.

***************************************

Amanda Epe is a health promotion coach and author.

The Lake Foundation would like to thank Amanda for helping us raise awareness of fibroids and its challenges by sharing her story through this blog piece.

Last week, we attended Croydon Clinical Commissioning Group’s (CCG) Annual General Meeting. This was an interesting meeting that gave us the opportunity to learn more about the work of the CCG and what health challenges residents of Croydon face.

What are Clinical Commissioning Groups (CCGs)?

For those of you who might not be familiar with Clinical Commission Groups they are groups of GPs who work together to plan and develop local health services in England. They do this by buying health and care services such as planned hospital care, urgent and emergency care, community health services and mental health and disability services. CCGs are a fairly new concept and were established in 2012 partly replacing Primary Care Trusts. There are 211 CCGs in England covering the 8,000 GP practices across the country.

Connecting with the Public Through their AGMs

Each CCG holds an annual general meeting (AGM), which is open to the public, to provide an overview of their work during the previous financial year.  We decided to attend Croydon CCG’s AGM to get a feel for what health conditions need a bit of focus and to understand if The Lake Foundation can address any of the challenges that might exist.

Croydon CCG’s AGM

Croydon CCG’s annual general meeting began with a welcome by Dr Tony Brzezicki, the clinical chair of the CCG, and this was followed by short presentation from Paula Swann, the Chief Executive, who gave an overview of the CCG’s achievements and performance for the 2014/2015 year. From Ms Swan’s presentation we learnt that the CCG has been focusing on community and mental health services and has been transforming the way that care is delivered in Croydon by developing new care pathways for cardiology, COPD, diabetes, musculoskeletal and falls. Additionally they have provided better access  to care for people with mental health problems through a range of new initiatives and have supported patients with diabetes through their diabetes management course. Furthermore patients with heart problems are now seen and treated more quickly in community clinics and children with asthma have better support through Croydon’s paediatric asthma service.

Ms Swan stated that the areas that need focus include improving waiting times in A&E, ambulance response times and  the quality of care for people with learning disabilities.

The focus then switched to mental health and this was a very interesting and eye opening session that highlighted the extent to which Croydon residents are affected by mental illness. Firstly we heard from a patient who talked about her long journey with mental illness, she spoke of her ups and downs and commended that great work that local charities have played in providing her with support. She specifically mentioned Mind In Croydon whose many services have helped her manage her condition and “live well with my mental health needs.” This really inspired us and clearly demonstrated the  significant impact that local charities can have.

We then heard from Dr Bobby Abbot a GP and the CCG’s clinical lead for mental health. He provided an overview of the impact of mental health in Croydon stating that 1 in 6 Croydon (67,000 people) residents have a mental health problem at any one time, half of all lifetime mental health problems begin before the age of 14 and that poor mental health affects a person’s physical health, education, employment, relationships, finances and housing. When he discussed who was most at risk it made for grim reading (or should I say listening) for the black community. He stated that the black community are seven times more likely to be affected by psychosis. Additionally he mentioned that anxiety and depression are the most common mental health issues in Croydon and these problems are projected to increase by 5% over the next couple of years.

To address the aforementioned mental health problems a number of services are being developed or expanded and these include: Personality Disorder Service, Early Detection Service, Primary Care Mental Health Support and Extension Home Treatment, just to name a few.

Finally we heard about the CCG’s work on Out of Hospital and Integrated Care. This work included developing or improving the following: co-ordinated care, roving GPs (for fast support), rapid response,  rapid acute medical unit (for integrated care), end of life care and the pharmacy discharge pathway.

Our Thoughts

This was a very interesting meeting giving a good overview of some of the health issues facing residents in Croydon. It once again highlighted the need to address mental health in the black community and we’re now going to go away and think about this and explore what approach we can take on this matter.

You Can Get Involved

You can get involved in the work of the CCG and help shape the way that health and social care is delivered in Croydon. The CCG has a Patient and Public Forum which meets regularly. We encourage you to attend to ensure that the views of the African and African-Caribbean community are represented as services are being developed. For more information please email  getinvolved@croydonccg.nhs.uk

September is Sickle Cell Awareness Month in the US and this gives us the perfect opportunity to focus a bit of attention on this condition which is more common in the black community. In this week’s blog we provide a quick introduction.

What is Sickle Cell?

Sickle cell anaemia is an inherited condition where the red blood cells which carry oxygen around our body develop into an abnormal shape. Instead of being round they form into a sickle shape i.e. a semi-circle. These abnormally shaped blood cells are sticky and stiff and they can block blood flow into your tissues and organs. The reduction in blood flow to your organs can cause pain, organ damage  and increase a person’s chance of developing infections.

What Causes Sickle Cell?

It is caused by  faulty gene which will have been inherited from the patient’s parent. The person would have inherited one copy of the gene from their father and another copy of the gene from their mother. If you only inherit one of the faulty genes you will not develop full-blown sickle cell, you will  be a carrier of the gene, but you can pass this gene down to your children.

If you are a carrier of the sickle cell gene you have enough normal blood cells to ensure that your blood flows adequately throughout your body but as a carrier you do have to be careful in situations where oxygen levels are low like when mountain climbing and scuba diving.

Complications of Sickle Cell

People with sickle cell may experience a number of symptoms and complications; everyone is different so each individual will have a different experience with sickle cell.  You may experience any of the following:

Episodes of pain (Sickle cell crisis)
This is the most common complication of sickle cell and occurs when sickle shaped blood cells block the blood vessels that supply a particular tissue. This means oxygen is unable to get to that tissue and it becomes starved of its energy source. This causes tissues to become damaged – this causes the pain. Repeated episodes eventually lead to organ damage. The episodes can affect your ribs,  spine, pelvis, abdomen, chest, legs and arms.

Anaemia
Anaemia is a decrease in the number of red blood cells in the body. Sickle cells do not live for a long time and when they die they are not replaced quickly enough so sickle cell sufferers will have a low red blood cell count which can lead to:
· Shortness of breath
· Feeling tired all the time
· An irregular heart beat

Infections
Children with sickle cell are prone to developing infections such as pneumonia, bone infections and meningitis. If your child has sickle cell they may need to have some additional vaccinations or be given antibiotics as a precaution.

Jaundice and Gallstones
The rapid break down of the sickled cells can lead to the build up of a  yellow waste product called bilirubin. This causes the yellowing of the skin and the whites of the eye, this is called jaundice.  The bilirubin can also solidify forming gallstones.

Stroke and Acute Chest Syndrome
If sickle cells block the blood flow to the brain this can lead to a stroke, and if it blocks the blood flow to the lungs this can result in acute chest syndrome where patients experience chest pain and difficulty breathing.

Treating Sickle Cell

Sickle cell cannot be cured and a treatment plan is developed to help sickle cell sufferers manage their disease. The aim of any treatment is to:
·  Prevent episodes of pain
·  Relieve pain
·  Minimise any complications
· Treat any other symptoms

Diagnosing Sickle Cell

Sickle cell is diagnosed through a blood test.  When a person has sickle cell this will become apparent when they are a child.  If you are worried that your child has sickle cell you can arrange for them to have the blood test by making an appointment to see your GP.  For couples who are expecting a baby and may be concerned that their baby may inherit sickle cell, your unborn baby can be tested from eleven weeks into your pregnancy. You can speak to your GP or obstetrician about this.

More Information

For more information on sickle cell please visit the Sickle Cell Society’s website

Our cycling group have had a great time over the past two months building up their confidence to cycle on the road, learning cycling techniques, getting some exercise and discovering new and interesting places in Croydon.

Since our last update where we shared our experience cycling from Croydon to Catford we’ve had quite a few cycling adventures. We started off with a lovely 16.3km ride through South Norwood, Beckenham and Crystal Palace.  This route saw the group take on quite a few hills and busy roads as well as beautiful parks like Crystal Palace Park where we discovered the park’s Darwin and the Dinosaurs trail, a collection of life-size dinosaur models created by leading scientist Richard Owen.

Our second cycling adventure was a 16.4km route from Croydon Arena to Central Croydon and then on to Lloyd Park, Addiscombe and South Norwood Country Park. This was a really lovely route taking us through some beautiful, quiet neighbourhoods and along a number of green spaces.

Our most recent adventure was a 14km ride to West Wickham this was a challenging and sometimes dramatic ride as we battled scary roundabouts , rush hour traffic, and numerous buses.

These last three cycling sessions were great fun. Altogether we cycled 46.7km and burnt about 600 calories and we look forward to next week’s adventure.

High blood pressure is a major challenge for the black community in the UK with 33% of black adults having high blood pressure compared to 16% of white adults. When we look at the actual numbers, to understand the scale of the problem, the black community makes up 3.3% of the UK’s population so a staggering 625,503 black people in the UK are known to have high blood pressure; we have to do something about this.

What is high blood pressure?

Blood pressure is a measure of how much force (pressure) our blood exerts on our blood vessels (our arteries and veins). High blood pressure, medically known as hypertension, occurs when the force our blood exerts on our vessels is consistently higher than what is considered to be a healthy level, which is generally 120/80mmHg.  If a person has several blood pressure measurements, on separate occasions, which are 140/90mmHg or higher then they are considered to have high blood pressure. This is a major concern because it is associated with a number of health complications with people suffering from high blood pressure being twice as likely to have a heart attack or stroke. This is because the high pressure can damage our arteries affecting the blood supply to our heart or brain.

What causes high blood pressure?

The exact cause of high blood pressure is unknown but there are a number of factors that increase a person’s risk of developing high blood pressure and many of these factors are associated with lifestyle and these include: lack of physical activity,  an unhealthy diet (especially a diet high in salt), being overweight or obese, drinking too much alcohol, stress and smoking. Furthermore, your risk of developing high blood pressure increases as you get older, and you’re at a higher risk if you have a family history of high blood pressure, are from the black community and suffer from sleep apnoea. Additionally there are a number of health conditions that increase a person’s risk of developing high blood pressure so for example people who have diabetes, kidney disease and adrenal and thyroid disorders are at increased risk of developing high blood pressure.

Why is the black community at higher risk of developing high blood pressure?

We know that the black community in the UK are twice as likely to develop high blood pressure as their white counterparts and are more likely to develop it at a younger age, but the question is: why?  Research suggests that there may be several reasons for this and here are just four key reasons:

Salt Sensitivity

We now know that people respond to salt differently so some people who consume large amounts of salt will not go on to develop high blood pressure whilst others will.  This has led to a term called salt sensitivity which is a measure of how a person’s blood pressure responds to salt. A person who is salt sensitive is likely to develop high blood pressure from consuming salt whilst a person who is salt resistant is unlikely to develop high blood pressure from consuming salt.

Sodium (salt is sodium chloride), blood pressure and fluid balance are controlled by the renin-angiotensin-aldosterone system in our body. In this system hormones control the absorption of sodium by the blood and therefore control our blood pressure. People who are salt sensitive have genetic variations in some of the genes involved in the renin-angiotensin-aldosterone system which makes them less able to handle salt and maintain a normal blood pressure.

Members of the black community are more likely to be salt sensitive particularly black Americans and black Caribbeans who are thought to have inherited the aforementioned genetic variations.

Salt Intake

Work by the Consensus Action on Salt and Health has found that:

“The majority of salt consumed by people of black African descent is from salt added in cooking and/or at the table. This is in contrast to the rest of the UK population (and indeed the Western world) where 75% of salt intake comes from processed foods. A health survey in England found that 83% of black men and 85% of black women added salt in cooking. Over a quarter (28%) of the same population add salt at the table. Salted meats and fish like salt-fish and salt-beef, and heavily seasoned meats such as fried chicken, stews and curries can contain a lot of salt.”

 This suggests that the black people may consume more salt than their white counterparts and when this is coupled with the salt sensitivity phenomena this is a recipe for disaster when it comes to high blood pressure.

Increased Risk of Diabetes

Diabetes is a key risk factor for high blood pressure with about 80% of type 2 diabetics suffering from high blood pressure.  When we look at how diabetes affects the black community data suggests that the black community is three times more likely to develop diabetes than their white counterparts, and this will mean that as a result of diabetes black people will be more likely to develop high blood pressure. Again, if we put this into numbers, to understand the scale of the problem, it is estimated that 5.3% of the UK’s black population have type two diabetes compared to 1.7% of the white population which means that  50,000  black people in the UK are affected by diabetes and hence are at a higher risk of developing high blood pressure.

Lifestyle

We also know that the black community are at increased risk of high blood pressure due to other lifestyle factors, for example black African women in the UK have been found to have the highest prevalence of obesity and obesity is a risk factor for high blood pressure. Additionally, the black community are less likely to be physical active with  NICE reporting  that:

“African-Caribbeans aged 16 to 74 years, 62 per cent of men and three quarters of women do not participate in enough physical  activity to benefit their health* (HEA 1995a), compared with the general population (59 per cent of men and 68 per cent of women (HEA 1995b).”

Physical inactivity is a key risk factor for high blood pressure and the above shows that many black people are not achieving their recommended level of physical activity putting us at a higher risk of developing high blood pressure.

What can we do?

In order to tackle this problem we clearly need to make some changes to our diet and lifestyle.  We can make a significant difference by looking at our salt intake. The government recommends that adults consume no more than 6g of salt a day. To achieve this we have to:

• Avoid adding salt to our food and use herbs and spices to season our food
• Avoid processed foods
• Ask restaurants to  prepare low-salt versions of the dishes on their menu

For some great tips on how to reduce your salt intake visit Consensus Action on Salt and Health’s website

Additionally we have to get more active and aim to do 30 minutes of physical activity every day and we have to tackle diabetes. We can reduce our risk of developing diabetes through lifestyle changes, – a healthy diet, being active and maintaing a healthy weight.

Finally, there needs to be collaboration between the government, the food industry, the public and charities to ensure that it is easy for all of us to achieve a healthy lifestyle or else this problem of high blood pressure will not go away.

---

References

1. Ageymang C & Bhopal R. Is the blood pressure of people from African origin adults in the UK higher or lower than that in European origin white people? A review of cross-sectional data. Journal of Human Hypertension. 2003; 17(8). 523-534
2. Blood Pressure UK.
3. D Lane, D G Beevers and G Y H Lip. Ethnic differences in blood pressure and the prevalence of hypertension in England Journal of Human Hypertension (2002) 16, 267-273. DOI: 10.1038/sj/jhh/1001371
4. Diabetes UK. Diabetes: Facts and Stats (2014)
5. Diabetes UK. Diabetes in the UK 2011/2012: Key Statistics on Diabetes. Diabetes UK, 2011
6. Fuchs FD. Why Do Black Americans Have Higher Prevalence of Hypertension? An Enigma Still Unsolved. Hypertension.2011; 57: 379-380
7. Gatineau M, Mathrani S. Obesity and Ethnicity. Oxford:  National Obesity Observatory, 2011
8. NICE. Promoting Physical Activity Among Black and Minority Ethnic Groups
9. Scarborough P, Bhatnagar P, Kaur A, Smolina K, Wickramasinghe K and Raynew M.Ethnic Differences in Cardiovascular Disease. Oxford:  University of Oxford/British Heart Foundation, 2010
10. Sullivan JM.1991. Salt sensitivity. Definition, conception, methodology, and long-term issues. Hypertension. 17(1 Suppl):I61-8. PMID:1987013.
11.  The Stroke Association. Stroke in African Caribbean People. London: The Stroke Association, 2012
12. 2011 UK Census

On Wednesday 5^th August we were delighted to take part in TWYLYTE VIP’s Creative Arts, Entertainment and Networking Summer Event.  This was an excellent event that brought together representatives from the music, film, fashion and media industries and gave us the prefect opportunity to raise awareness of a very important health issue, cervical cancer.

The event was hosted by Jaye of TWYLYTE PR and recording artist Kele Leroc who started the night’s proceedings with live interviews featuring actor Femi Oyeniran (Kidulthood and Anuvahood); Emmanuel Anyiam-Osigwe, the director of the British Urban Film Festival; Nadine Woodley and Dani Mosely writers of the stage play The Forty Elephants; and Martina Barnett from Inside Out.

After the inspirational and informative live interviews we moved on to the ‘FASHION Meets AWARENESS’ Magnetic Fashion Show.  FASHION Meets AWARENESS is the brain child of Celena of Magnetic Fashion Connections and it aims to showcase creative designers whilst highlighting important health issues – an excellent idea. The fashion show featured a collection of creations from a new wave of fashion designers that included Erwin Michalec, Sonia Funnell and Dee Naturals. Following the fashion show we delivered the awareness part of FASHION Meets AWARENESS  with a short presentation on cervical cancer covering what is cervical cancer, what causes it, risk factors, screening, the HPV vaccination and the symptoms.

This was a really fun event and we were very grateful to be given the opportunity to raise awareness of cervical cancer and we’d like to say a big thank you to Celena from Magnetic Fashion Connections for inviting us to take part in this event.

In this week’s blog we speak to Paul Lowe co-founder of Cycling Instructor, a bikeability organisation that we’ve teamed up with to lead our summer cycling sessions. Our cycling sessions run weekly over the summer months and are open to everyone.

Can you tell us about the Cycling Instructor and why it was started?
Cycling Instructor Ltd was set up by Michael Poole and myself in 2005.  We had both worked for another cycle training provider and thought we could start our own business doing the same thing.

Can you tell us about the work you’re doing with Croydon Council?
We provide Bikeability training in Croydon borough schools, for adults over the age of 16 and various special projects with voluntary sector groups, such as The Lake Foundation.

What has been your favourite cycling project so far?
We really enjoyed the bench opening project with a local school and sustrans.

 How long have you been cycling and what do you enjoy most about cycling?
I have been cycling since I was about 6 and what I love doing is cycle camping or youth hostelling by bike.   After a few days on a trip the world falls away and you enter a ‘bubble’. Also due to the exercise your physiology changes and you can eat as much as you want all the time.

What advice would you give to anyone new to cycling in terms of equipment, technique and building confidence?
Just get a good second hand bike, get a lesson and a map and get going.  You learn about cycling by doing it.

Where can people find out more about the Cycling Instructor
There is lots of information about us on our website:  www.cyclinginstructor.com

Our summer cycling sessions have been running since the beginning of July and we’re now half way through the sessions which will run until the end of August. This year we’ve had a lovely group of people come along to the sessions; all very friendly and eager to build their confidence in cycling and get some exercise.

Friday’s session was excellent. We had ten in the group and were led, once again, by Brian from the Cycling Instructor who was supported by Matthew.

In previous weeks we focused on cycling technique and riding safely on the road and this week it was time to put it all into practice with a ride from Croydon to Catford and back (about 9 miles).

Our journey to Catford took us along Route 21 which is part of the UK’s National Cycle Network  and is a 94 mile route from Greenwich to Crawley and then on to East Bourne via East Grinstead and Heathfield.

We began our journey at the beautiful South Norwood Country Park and joined Route 21 at Elmers End. The cycling path took us through the picturesque green spaces and quiet neighbourhoods of  Beckingham, Sydenham and Lewisham and included riverside cycling along the Waterlink Way.

This session was a lovely experience. The weather was perfect – sunny and mild, and the beauty of route was really impressive.  Many South Londoners, myself included, are certainly missing out on the beauty of our city as the pressures of city life mean we aren’t able to take the time to explore and appreciate the beauty that is right on our doorstep. Cycling really addresses this as it creates endless opportunities to explore the city of London in a fun way.

We encourage everyone to give cycling a try, you’ll be surprised at how fun and relaxing it is and at the journey of discovery you can have; you’ll see your city in a whole new light! And we love it because it provides you with a great way to get some exercise. It’s a win-win.

---

Joins us next week Friday at Croydon Arena, all are welcome. For more information visit our events page or email events@thelakefoundation.com