If you work in private healthcare, what preventative measures should NHS patients know about for reducing future health risks?

[Primrosetulipcrocus]

I’m wondering because Davina McCall spoke to a cardiologist on Instagram who said she takes Atorvastatin as a prophylactic, and so do lots of her cardiologist colleagues. Acceptable parameters for total serum cholesterol are far lower in private healthcare, presumably because people have the option to pay for statins.

As an NHS patient, I had no idea that this was an option.

I’m now wondering what else I should know that I don’t. What else should I know in order to proactively reduce future health risks that I don’t know as an NHS patient?

I mean, I think it’s pretty obvious. Don’t drink alcohol. Don’t smoke or vape. Stay out of the sun. Be active and stay a healthy weight. You don’t need private healthcare to tell you that though (people don’t like to do it).

One thing I would do if I had the chance to go back and do it again is mole mapping to flag up my risk of skin cancer.

Brush your teeth.
Low carb low sugar diet.

I take statins prophylactically. My cholesterol levels were on the high end of normal but I’ve also had breast cancer and there is increasing evidence that statins also reduce the recurrence of some cancers. The tumour cells need cholesterol for growth ( simplified version) so reducing cholesterol can be adjunctive. My GP was happy to prescribe them even though my levels were below the level they normally advise taking them.

My GP has been very receptive to other drugs I’ve requested to reduce the side effects of the aromatase inhibitors I use. They usually refer me to the in house pharmacist who carries out drug reviews who is knowledgeable and up to date with all the latest research.

Taking prophylactic statins below the treatment threshold is great until you get one of the complications. But there may be justification for treatment initiationwith a lower cholesterol leve in some at risk individuals eg. type 2 diabetic with high risk ethnic background and strong family history of ischaemic heart disease.

I know of patients who have had colitis triggered by statins, rhabdomyolysis and liver dysfunction (not all the same patient).

I don't believe in taking medication unless you need it (I'm a doctor) but simple measures - exercise, good nutrition, no smoking, limited alcohol are all a good place to start.

The paid for screenings tests "whole body CT" are also a total whizz. They turn up loads of stuff that needs investigated for that would never have been an issue. The screening offered by the NHS has all passed a risk-benefit assessment that offered by private clinics hasn't.

And where there is a test that is missing - eg. spinal muscular atrophy on newborn blood spots professionals will agitate for this to be included (just been introduced in Scotland, rest of UK needs to follow suit).

I’ve often said this on here. All cardiologists I know start statins over 50.

I have also had breast cancer and recently started aromatase inhibitors. Since the cardiovascular risks are so high on it, I’m sure if the NHS could afford preventative measures, I’d be offered a statin.

What other drugs have you requested to reduce the side effects of the aromatase inhibitors?

…and so, to any cardiologist’s here who take statins, what are your thoughts on risk factors such as ulcerative colitis, from statins?

I would think that since heart disease is the bigger risk to health, they’re worth taking. What was your decision making process like?

The best preventative measure I know is not to take medical advice from random people on-line.

I’m not asking for random people to answer my questions though. I’m asking for replies from consultants who would offer more insight to private patients because they know they can pay for what is not available on the NHS.

FIT tests to help diagnose colorectal cancers, which are on the increase in younger age groups. By the time your routine NHS FIT test comes into play it's sometimes too late, as it was in my case. It's an easy non invasive test and not expensive.
I'd also recommend that anyone with bowel/digestion issues gets them thoroughly checked out and not be fobbed off with IBS etc as a baseless diagnosis.

Very interesting thread. For PPs who are cardiologists/drs, I thought the evidence base for statins unless a person has already had a cardiac event, isn’t strong on an individual level? I heard a cardiologist on social media explaining that the number to treat is high (as in number who need to be treated for 1 to benefit) is quite high, over 100, and number to harm (number who take it before one gets a side effect) is quite low, around 10? Is that right? I’m genuinely interested, especially to any well respected studies etc, as I think this is a confusing topic with misinformation out there.

Serum cholesterol on the NHS can be above 7mmol/L and considered acceptable. I believe the accepted private healthcare level is far lower.

NHS will not see fit to treat a ferritin level of 16 when, if you’re already taking a multivitamin, I doubt diet alone will increase.

After having a tricky time getting a pharmacist’s opinion (because they all say talk to a doctor who has said talk to a pharmacist) I am now guessing my own Ferrous Fumerate doses.

However, I do believe that with improved ferritin levels, and sound nutrition advice that I have come across, I am improving menopause symptoms.

This leads me to believe that if body systems are better supported, we wouldn’t need the healthcare system to support our multiple symptoms of underlying and untreated problems.

On cholesterol levels, there seems to be quite a lot of mixed messages and disagreement at the moment as to 1. Whether cholesterol is the main issue/cause of cardiac issues (or at least which type of cholesterol) and 2. Whether statins are an effective treatment for high cholesterol. I’ve put a question on this in the chat as I’m really interested to hear from Drs/cardiologists esp if they can refer us to any high quality studies. The issue that I have heard raised about statins, is that for an individual who hasn’t had a cardiac event, they don’t offer much protection (see above stats I’ve heard where 100 people would have to be treated for 1 to benefit but only 10 people would have to be treated for 1 to get side-effects.) I heard this from a cardiologist online however interested to know if this is generally accepted or not.

This is the cardiologist discussing statins and an article he wrote on the issue drsanjayguptacardiologist.com/blog/the-great-medication-lottery/

You can buy low dose statins over the counter.
@HealthyChoicesHard I'm familiar with Dr Gupta and had seen that video. I think it was a good explanation of the pros and cons of medication but primarily aimed at those who are averse to taking drugs. Statins have a bad reputation often fuelled by social media.
I was pretty reluctant though in my case it was because I already take so many drugs and they all have some side effect or interaction.
I agreed to take a low dose statin because I have a high qrisk even though my cholesterol is low.

Thanks for your response. I’ve just seen there has been a new review of statin studies (on BHF website) which suggests side effects are less than previously thought, which might be reassuring. It doesn’t look at effectiveness of statins though. Personally I’m not averse to all medications-I’m pro-vaccine, would take antibiotics if needed, but I’d 100% want to try lifestyle changes first before taking a drug like a statin. That’s just me though (I’ve also had problems with drug interactions/serious drug side effects.)

I don’t work in healthcare but take my health advice from doctors and from evidence-based sources eg Dr Michael Mosley’s series on Radio 4 called ‘Just One Thing’ - each programme is about one small change that you can make today to improve your health. For food, I follow the advice of the Zoe study.

Me too. Davina McCall must have been single handedly responsible for the national drugs bill rising 😂

Ooh yes I agree the Just One Thing program is really good

https://www.bbc.co.uk/sounds/play/m002tppx?partner=uk.co.bbc&origin=share-mobile

I listened to this today! Very interesting

Oh great, I’ll listen to this too.

I had the Zoe book for Christmas and I do think it’s been quite informative.

The nhs did prescribe statins preventatively. They are cheap and effective so everyone got them.

many people complained as they aren’t as no risk/all benefit as first thought, and a lot of people had side effects.

i think now they are balancing the side effects with the risk more, so not routinely prescribing.

just because it happens in a private healthcare setting doesn’t mean it’s best practice.

Well, this is an alarming thread

I haven't seen a doctor for ages because of bad experiences with the NHS

I was wondering if I ought to see a private doctor because I was hoping for a more holistic approach. There's nothing wrong with me except that chronic insomnia is harder to deal with as you get older - it's a problem that could be made so much easier by the occasional prescription but that's no longer possible to get. Certainly not on the NHS anyway.

So perhaps I should just stay out of it, if they're going to bang on me about blood test and what not.

I would just like to think about the holistic approach - but without any focus on prevent preventing heart disease or cancer or whatever

I don't want to end up like the side of my family that lives far too long (they have also had chronic insomnia since teenage years, I wonder if there's a link there)

I was on antidepressants for decades and my main concern is finding a nice doctor who actually understands how chronic insomnia affects my health and that occasional sleeping pills or tranquilizers are a huge boost for me and enable things like holidays, for example.

If they are also obsessing over things like statins, that's really not good news for me.

I don't really have any experience of private doctors so I don't know what to do. I'll probably just keep on keeping on.

Have good health insurance or be rich.

@EmeraldRoulette I don’t think they are obsessing over things like statins. They’re getting on with it after halting the progression of furred arteries.

I would like to have that choice too. My health issues might mean that the benefits of taking a statin outweigh the risks. I am on aromatase inhibitors for the next 5 years which raises cholesterol levels and increases all the cardiovascular risks. Personally, I don’t want to passively wait for problems to occur when I could put preventative measures in place.

As I said, it was only the conversation between someone receiving private healthcare (Davina) and a cardiologist who works in the NHS and privately that made me aware of the extra knowledge that gets shared in private healthcare. Also, higher standards of what good health looks like.

Therefore, I would like to know what preventative measures consultants in other fields have put in place that we all could benefit from doing too?

Diabetes is far far more damaging than people realise. Five times the risk of cardiovascular disease if male, six times if female.
And by the time someone is pre diabetic, they likely already have inflammatory processes going on.
Do all you can not to become diabetic. And don’t smoke!!