From various nationals or national magazines.

Suffering from depression: 'It was touch and go – but I didn’t jump’
Bestselling author Matt Haig, 38, is about to have two more books published. Here he explains how he only started writing to cope with his sudden, life-threatening depression
15 Apr 2014
I can remember the day the old me died. It started with a thought: something was going wrong. And then, a second later, my brain started to have something pumped into it from the inside. And then my heart started to go. And then I started to go. It would be more than a year before I would feel even half-normal again.
Until that point I’d had no real understanding or awareness of depression, except that I knew my mum had suffered from it for a little while after I was born, and that my great grandmother on my father’s side had committed suicide. So there had been a family history, but it hadn’t been a history I’d thought about much.
When depression reached me, I was 24, and was standing in the most beautiful place I’d ever lived. It was in Ibiza, where I worked for the Manumission club and hotel empire from 1997 to 1999. The villa that my girlfriend Andrea and I shared with the owners of the club was behind me and, in front, was the Mediterranean, looking like a turquoise tablecloth scattered with tiny diamonds.
And yet, the most glorious view in the world could not stop me from wanting to kill myself. I was going to do it even while Andrea was in the villa behind, oblivious, thinking that I just needed some air.
I walked, counting my steps, then losing count, my mind all over the place.
I made it to the cliff edge. I could stop feeling this terrible simply by taking another step. It was so preposterously easy – a single step versus the pain of being alive.
But, actually, it wasn’t easy.
The weird thing about depression is that even though you might have suicidal thoughts, the terror of death remains the same. The difference is that the terror of life has rapidly increased. So when you hear about someone killing themselves it’s important to know that death wasn’t any less scary for them. It’s just that life had become so painful that death was the lesser of two extremely bad evils.
I stood there for a while, summoning the courage to die, then summoning the courage to live.
It was touch and go, but I didn’t jump. I had my parents, my sister Phoebe, and Andrea. Four people who loved me. I wished like mad, in that moment, that I had no one at all. Also, if I’m honest, I was scared. What if I didn’t die? What if I was paralysed and was trapped in this state forever?
And so I kept living. I turned back towards the villa and was sick from the stress of it all.
A doctor put me on diazepam to help control my anxiety, and I moved back to my hometown of Newark in Nottinghamshire to live with Andrea and my parents.
When you’re depressed – unable to leave the house, or the sofa, or to think of anything but the depression – it can be unbearably hard. However, bad days are not all equally bad. The really bad ones, though horrible to live through, are useful for later. You store them up in a bank so that if you’re having another bad day, you know there have been worse: the day you were so depressed your tongue wouldn’t move; the day you made your parents cry; the day you almost threw yourself off a cliff.
And even when you can think of no worse day, you at least know that the bank exists and that you’ve made a deposit.
Depression is an illness. There may be triggers, but we can’t see them. Sometimes it just happens. It acts like an intense fear of happiness, even as you consciously want that happiness more than anything.
The period that followed was, from the outside, the least eventful phase of my life. My parents would leave for work, and Andrea and I would spend long days talking in the house. Occasionally we would venture to the nearest shop, about 250 yards away, or walk by the River Trent. That was about it. Life at the lowest possible volume that two 24-year-olds could manage.
Yet those days were the most intense I’ve lived because they contained thousands of tiny battles. They’re filled with memories so painful that I can only now, with the distance of 14 years, look at them head-on. People say “take it one day at a time”. But days were mountains and a week was a trek across the Himalayas.
We spent three long months at my parents’ house, then the rest of that winter in a cheap flat in Leeds. Andrea did freelance PR work and I tried not to go mad.
But from April 2000, good stuff gradually started to become available, though it amounted to about 0.0001 per cent of what I felt. The bad stuff was still there most of the time, but from that point on I knew life was available to me again and, by May, 0.0001 per cent became 0.1 per cent.
In June, we moved to a flat in the city centre. The thing I liked about it was the light – the walls were white and the windows made up most of the walls. Light was everything but so, increasingly, were books. I started to read with an intensity I’d never known. I needed books. I read more in the following six months than I had during five years of university, and I’d certainly fallen deeper than I ever had into the worlds conjured on the page.
There’s an idea that you read either to escape or to find yourself, but I don’t see the difference. I think we find ourselves through the process of escaping.
“Is there no way out of the mind?” asked the writer Sylvia Plath. If there is a way out (that isn’t death), I believe the exit route is through words. But rather than leave the mind entirely, words help give us the building blocks to build another mind, very often with a better view.
My mess of a mind needed shape, and external narratives I found in films, television dramas and, particularly, books, offered hope and became reasons to stay alive.
Every time I read a great book I felt I was reading a kind of a treasure map, and the treasure I was being directed to was, in actual fact, myself. But each map was incomplete, and would be complete only if I read all the books, and so the process of finding my best self was an endless quest.
One cliché attached to bookish people is that they’re lonely, but for me books were a way out of being lonely. In my deepest state of depression I felt trapped in quicksand, but books were about movement, quests and journeys. They were about starting new chapters and leaving old ones behind. And because I’d only recently lost the point of words and stories altogether, I was determined never to feel like that again.
I used to sit with the bedside lamp on, reading for hours until my eyes were dry and sore. I was always seeking, but never quite finding, despite feeling tantalisingly close.
Then Andrea sat me down in front of an old PC and forced me to write. I started with what I felt, and then writing became a kind of therapy. A way of externalising things.
I wrote a story called The Last Family in England, written from the point of view of a family’s dog about the disintegration of the family and the dog’s attempts to stop it. It was published in 2004, became a bestseller and the film rights were sold to Brad Pitt. It felt surreal, but for once it was in a good way.
I married Andrea in 2007 and we now have two children, Lucas, six, and Pearl, four. Seven more novels followed that first. I am still prone to the odd dip, or spell of anxiety, but nothing on the scale of my breakdown. The process of writing, combined with an increase in self-esteem that being published gave me, has helped more than I can say. It was a defence mechanism. It gave me purpose. It might have even saved my life.
Interview by David Hurst
*Echo Boy by Matt Haig (Random House, RRP £12.99) is available to order from Telegraph Books at £11.99 + £1.35 p&p. Humans (Canongate Books, RRP £7.99) is available at £7.99 + £1.10p&p. Call 0844 871 1514 or visit books.telegraph.co.uk
*If you or someone you know needs help, contact the Samaritans: 08457 909090; jo@samaritans.org; samaritans.org

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Reacher across America: Author Lee Child on why the US is an ideal crime tale setting
By LEE CHILD
PUBLISHED: 19:02, 6 May 2012
Growing up in the Midlands was great, but like many British people I have a restless streak. I like the idea of moving around the world and America was always my dream habitat, so when I got the chance to make it my home, I jumped at it.
Fourteen years later it's still an exciting place to live - and an ideal setting for my series of Jack Reacher thrillers.
From the first, I found Americans welcoming, generous and optimistic. While our daughter Ruth headed for college in Connecticut, my wife Jane and I bought a house in Pound Ridge, an isolated town with a population of about 5,000 in upstate New York.
We had a dog then, Jenny (a lurcher-labrador mix found abandoned in Morecambe Bay, Lancashire), and we wanted places to take her on long countryside walks.
But we tired of the rural life after a while, and when Jenny died we moved to an apartment in the heart of Manhattan, in 2004. Now I use that first apartment as an office, and we live 18 floors above it.
I love New York's energy and, in a funny way, the lack of concession to human scale: everything is huge and brutal, including the architecture, the pace, and the weather. It's also a humbling yet reassuring place.
However busy you think you are, there's someone who is busier, or smarter or dumber, richer or poorer, and so on, so ultimately you feel average, which is very reassuring.
From my first Reacher novel, Killing Floor, published in 1997, I have set my stories in the US.
I've published 16 Reacher novels now, all international bestsellers. They are set in America because Reacher - a former US military policeman - is a loner, a wanderer, a mysterious stranger: you need big, lonely continents for his character to work.
My stories have been set all over the US. Reacher ends up in some strange places. We've seen him in Georgia, Chicago, Montana, Florida, New York, Washington (DC and State), Texas, Wyoming, Maine, North Carolina, Indiana, Colorado, South Dakota, Nebraska and Mississippi.
I love travelling aimlessly too, but I never research specific locations. Instead, I rely on my memories and first impressions of places I've already been - for work or pleasure. I think fresh research shows up as a bit too clunky and obvious.
My wandering in America has meant I've played pool with longhaul truckers in remote roadhouses in Idaho; seen 3,000-strong handgun collections in Arkansas; driven four hours in Montana without seeing another car; and shopped at a West Texas store where the only other customer had driven 250 miles to get there - it was her nearest shop.
America is a giant continent, and there are a thousand places worth seeing. There are primeval forests where it's possible to believe no human has ever set foot, and amazing deserts.
Then Las Vegas and LA are filled with bars and clubs the like of which you can't imagine. But be quick: they'll be gone next week and replaced by something even weirder.
Flying in the US has become boring and miserable, so to travel around I'd recommend taking your time and sticking to the road. Greyhound buses - the 'Big Dogs' - are great for seeing life and people. Or you can hitchhike, as Reacher does, or simply rent a car.
You can find great places to stay at any price - from no-name roadside motels all the way up to the luxury hotels in the big cities. I once stayed at the Mondrian in LA: their entire front-of-house staff were pairs of twins. That's LA! I'm not a gourmet, so pretty much any food is OK with me - and across America I've eaten everything from plain sandwiches in diners to ultra-fancy restaurant meals.
I do get back to the UK often, so I don't really miss anything about it. America is too big to generalise about differences between the countries. Yes, New York is bustling compared to a sleepy Cotswold village, but so is London in comparison to a remote farm crossroads in Iowa.
I'm never usually sure where I'm going to be next - and that's the way I like it - but I do know that my next work trip to the UK is to Bristol for CrimeFest later this month.
It's an excellent annual crime-fiction convention. I was there for the first one in 2006, and it attracts international bestselling crime writers to speak and sign books for fans.
This year I'm appearing alongside great authors such as Frederick Forsyth, author of The Day Of The Jackal, and Jeffery Deaver, who wrote the most recent James Bond novel, Carte Blanche.
I'm looking forward to the event. The organisers are full of enthusiasm and the crowd they attract is always fun. And I like Bristol - it's a city with plenty of history as well as contemporary cool.
Also, in a way, I drive through Bristol almost every day in America. New York City's East River Drive is built on bomb rubble from Bristol docks, brought over as ballast in empty Lend-Lease ships during the war.
My next book, A Wanted Man, will come out at the end of September.
It picks up right from the previous Reacher novel, Worth Dying For, at the end of which he was trying to hitch a ride east. At the beginning of the new one a car stops for him...
Then, at Christmas, the movie adaptation of my novel One Shot, which stars Tom Cruise, is coming out. This is the first film in a projected trilogy based on my novels.
My book took place in Indiana city, but the movie was shot in Pittsburgh, Pennsylvania - a tough, gritty town with big iron bridges. I visited the set four times and had fun hanging out with Mr Cruise. I'm even in the movie: they gave me a tiny cameo role as a desk sergeant in a police station.
The movie should be a great spectacle - a lot like America itself. Lee Child was speaking to David Hurst. Find out more about Lee Child and the Jack Reacher novels at leechild.com.
Travel Facts
Return Virgin Atlantic flights from Heathrow to New York cost from £375 (0844 209 7310, www.virgin-atlantic.com). For more information about the US, go to www.discoveramerica.com.
The Mondrian Los Angeles (00 1 323 650 8999, www.mondrianhotel.com) offers nights from $350 (£230) for two, B&B.
Lee Child joins Jeffery Deaver, Frederick Forsyth, Sue Grafton, P.D. James and many other authors at the Bristol Marriott Royal Hotel for the international crime fiction convention CrimeFest from May 24 to 27. For tickets and more information, visit www.crimefest.com.

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‘This is it, I thought. My life really did flash before me’

Best-selling author Simon Kernick tells David Hurst how his first-hand experience – including being kidnapped as a teenager – feeds into his thrillers

Briton Simon Kernick is one of the world’s most exciting thriller writers, having released 11 international best-sellers. He arrived with his highly acclaimed debut The Business of Dying, a book about a policemen who moonlights as a hitman, in 2002.
But his big breakthrough came with his novel Relentless, which reached number three on the Sunday Times best-sellers list and went on to become the best-selling paperback thriller of 2007.
Extensive research is one of the aspects that make Simon’s stories stand out. The 45-year-old who was born in Slough, Berkshire, regularly talks (on and off the record) to members of the UK’s Counter Terrorism Command as well as the Serious Organised Crime Agency. The books he writes are about ordinary people who are suddenly thrust into terrifying, life and death situations for which they are completely unprepared. It’s something he experienced first-hand as he was kidnapped when he was 16.
“I’d been out for the evening at a friend’s house in a neighbouring town with two friends when our car broke down on a country road. Unable to get it started again we began walking back to town,” he recalls.
“Then a car stopped. There were three men inside, they were big guys, especially the ones in the front. They offered us a lift and seemed friendly. They chatted with us as we drove into town, then the driver pulled up on a quiet stretch outside one of the local boatyards. I thought they were going to drop us off there. Then it happened. Just like that. ‘Empty your pockets,’ said the front passenger.”
Simon was still wondering whether he’d heard him right when the driver punched him. Then more punches started coming thick and fast. Since they were jammed in the car, they were in no position to fight back.
“I think we were too shocked to do much anyway,” continues Simon, who now lives near Oxford with his wife and two daughters. “The car pulled away again, and the front passenger once again told us to empty our pockets. We did what we were told but we were kids, so we hardly had a thing.
“It wasn’t enough for our attackers. The car pulled off the main road and headed down a track into the woodland, then stopped. We were herded out one at a time and lined up in a row at the back of the car, not knowing what was to come next, but fearing the worst.
“And then our worst fear was confirmed. ‘Where’s the shotgun?’ said the driver, reaching under one of the seats. This is it, I thought. The end. My life really did flash before me. In hindsight, I think they were just trying to scare us. There was no shotgun, but at the time I genuinely believed it. So we started running and managed to get away.”
The men got away with it too as it was Simon and his friends’ word against theirs. But Simon says knowing what it felt like to have your life threatened out of the blue like that has definitely influenced his writing in a good way.
Although he had a passion for writing from a young age, before he was published he worked as a labourer, fruit picker, Christmas- tree uprooter, barman and computer software salesman. He has also done his fair share of globe-trotting, including living and travelling in Canada, the US and Australia.
“I visited Dubai some years ago with my family when my children were small. We were staying in Abu Dhabi for a short holiday and did a day trip to Dubai, taking in the fantastic Wild Wadi waterpark. It was great fun, although some of the slides were pretty terrifying. My abiding memory is, however, of the magnificent, space-age architecture, and particularly the Burj Al Arab.”
Perseverance pays off
After writing two novels that were rejected in the 1990s Simon persevered and wrote another. That was The Business of Dying. It has since been translated into 15 languages, including Japanese, Greek and Russian.
Travelling is still a large part of Simon’s life, but now it’s to research his stories. One country he’s visited a couple of times is the Philippines. It features in his books A Good Day To Die and The Payback. As part of his research Simon has stayed in the small tourist town of Sabang, several hours south of Manila.
“Funnily enough, although the books set in the Philippines were my fourth and tenth novels it was all down to my first book, The Business of Dying, that I ended up setting them there. At the end of the first one the main character has to flee the UK; I was trying to think of the place I’d go if I wanted to disappear without a trace, and I decided the Philippines seemed as good a location as any.
“At the time, it never occurred to me that I’d ever need to travel out there, but then I got the idea for A Good Day To Die, and that’s when I first visited for research purposes. There’s still an element of danger there as it’s still largely off the beaten track although some of its 7,000 islands are getting more touristy.
“I’ve been there twice now, and have spent a total of a month in the various locations I used for The Payback and A Good Day To Die, talking both to locals and expats. I wouldn’t say I know it really well as I think you need to live in a country to get to know it better. However, I think I got enough first-hand experiences to write authentically about it. I enjoy researching, particularly when it involves travelling to exotic locations.”
However, his latest book Siege is set much closer to home. It’s about London under attack as a group of highly trained gunmen storm a hotel in the city. The gunmen have given the government just five hours to meet their demands before they blow up the hotel.
One thing that readers admire about Simon’s books is his consistency over the past decade to come up with fast-paced stories. He says the two writers who’ve influenced his work most are Agatha Christie and American mystery writer Lawrence Block.
“I also admire Harlan Coben, Dennis Lehane, Peter James, Lee Child and Michael Connelly. They produce quality books year on year. I know from experience how difficult that can be. I’ve no clue how I keep coming up with story ideas. I’m just glad I do. I usually like to plan one book ahead. By the time I finish a book, I already know what the next one is going to be about.”

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Talking crime with author Karin Slaughter
Best-selling American crime writer Karin Slaughter - and no, her name didn't inspire her chosen genre! - talks about her inspirations, handling dark subjects and her literary influences
As told to David Hurst, for Friday magazine
Published: 00:00 February 10, 2012
"I think writers should approach violence with a focus," says Karin Slaughter.
My new book Fallen starts out with a gripping opening when Special Agent Faith Mitchell is driving home from work. She’s heading to her mother’s house to pick up her four-month-old baby daughter.
The problem is, she can’t get her mother on the phone. Everyone’s been in this situation where you can’t reach someone and you don’t know whether to panic or just laugh at yourself. But by the time Faith pulls into her mother’s driveway, she’s closer to the former.
Then she realises that her baby daughter has been locked in the shed. She sees that her mother’s gun safe is empty. Then, she sees a blood trail to the house. After that, she notices a bloody handprint on the door.
Being a good cop, Faith calls 911, grabs her shotgun and heads into the house to find her mother. That’s the first 20 pages. Hopefully, readers will keep reading to discover what happens next.
A love of reading
Growing up in Georgia in the southeastern United States, I was always reading and always kept to myself. I never felt isolated though; I just liked being alone. I think some people are good at being alone and some people aren’t, and as a child I really liked it.
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I’ve always been drawn to dark stories. I enjoy reading Flannery O’Connor, Patricia Highsmith and Margaret Mitchell. These days I never miss a book by Denise Mina or Mo Hayder. I love what they’re doing. I read their books and they make me want to write even more because I feel challenged by what they’re doing – the risks they take as well as the obvious fun they have doing it. I am such a huge fan of these writers. I love reading almost as much as I love writing.
The dark side
I think writers should approach violence with a focus. For example, Flannery O’Connor used violence as a way to talk about the social condition; Patricia Highsmith used violence to show the humanity of her characters. Modern writers such as Barbara Vine, Lee Child and Mark Billingham are doing the same thing.
Violence in context says something new about the world; violence for the sake of violence is a bit dull.
Readers throughout history have always loved stories about crime. Dickens was full of crime. Crime and Punishment wouldn’t work without crime. The Great Gatsby, Water for Elephants, The Lovely Bones, Gone With the Wind – all these books have crimes in them. I think writers should write what they’re comfortable with. I’m not one of these writers who say, “You shouldn’t do that.” I am, however, a reader who says, “That’s not the kind of book that’s for me.”
Unfortunately, I’m not very disciplined at writing. I’m more of a ‘run off into the mountains and write until I collapse’ kind of author. I wish I could be more structured, but it’s been working well for me so far, so who am I to judge?
When I’m on a good run, I can do 12 to 13 hours of writing. I write in a small office at home in Atlanta, or else in a log cabin my father built for me in the mountains up near the Tennessee border. The view from the cabin is beautiful and deer run through the front yard, but I never look at the view or the deer when I’m writing. Mind you, I could sit and type in a closet and be fine. It’s just a case of cocooning myself, so that it’s just me and the story.
Private investigations
For research I’ve got a friend who’s a cop who tells me some procedural stuff and a kind doctor friend who fills me in on medical details.
Mostly, it’s a matter of me thinking up some plot point and then emailing them and asking. I think I would do this even if I weren’t writing thrillers because I just find it so interesting.
I will say that for every book or paper I read, or hour I spend doing research, I end up putting in a line or two at the most in the books.
I really wish I knew where I get my ideas from! The stories form in my mind over a period of time, and before I know it, I’m sitting down at my computer writing. Mostly, it’s a matter of thinking of a crime and then wondering how my characters will respond.
I’m also interested in seeing how the town my stories are set in will respond. It’s very important to me that the town of Grant County seems like a fourth narrator in the story. The everday things I feel and see, the emotional element of it all, will certainly be incorporated into some of my stories. We’re the sum of our experiences, and so are the characters we create.
There’s no set time it takes to write one of my books – it depends on what the book is about and how much research is involved. I would say on average the whole process takes around 10 to 12 months. Sometimes it goes more quickly, sometimes slowly. I never want to be in a position where I am rushing a story, and thankfully my publishers are very patient.
It’s hard to say which is my favourite book of the ones I’ve written. Usually it’s the one I’m going to be working on next. Readers can start my Grant County series of books with any one, not necessarily the first.
I’m very aware of how lucky I am to have success. There are so many writers out there, and so many good books, that it’s shocking any of us manage to pull away from the herd. But I’ll keep doing it so long as I’m enjoying it and my readers are too.
Karin Slaughter, 40, has written 12 books since her first novel Blindsighted. Her latest, Fallen, is also available in Nook and in Kindle. www.karinslaughter.com

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Roald Dahl's fantasy factory
By David Hurst

Children's favourite Dahl still sells in excess of three million books a year

When a writer left his tranquil Chilterns home to address more than 1,000 teenage boys at a nearby school it could have been a daunting experience. But Roald Dahl was unfazed.

At the age of 15, I was one of the Aylesbury Grammar School pupils he spoke to that day in 1981 and I have never forgotten how he captivated us with his every word.

He talked so wonderfully about his life - telling us of his years in the RAF during the Second World War, how he would write in his garden hut, and of his love of the beautiful Buckinghamshire countryside and its characters.

Then he tried out a new story on us, about a shy man who harboured a secret passion for his downstairs neighbour, whose only love was for her tortoise, which, to her dismay, would not grow. Her suitor hatched a cunning plan to trick her into thinking the pet was growing by regularly swapping it for a slightly larger animal.

Overjoyed that her neighbour appeared to have solved the problem of her non-growing tortoise, she agreed to marry him. This quirky romance became Esio Trot (try saying it backwards!). It was first published in 1990 and is still delighting children today, as are Dahl's many other stories. Indeed, next month sees the release of a new film of his Charlie And The Chocolate Factory, starring Johnny Depp.

This enduring popularity has led to the opening of The Roald Dahl Museum And Story Centre in Great Missenden, where he lived.

Housed round a courtyard in a 16th Century former coaching house, the museum, which cost £4.5 million to build, is pure 21st Century inside, all interactive and brightly coloured informative fun.

Walking through the Willy Wonka gates (replicas from the new film), past the cafe, Dahl shop, crazy crocodile bench and through the fantastic chocolate doors - you can even smell chocolate - visitors arrive at the Boy Gallery, named after the first instalment of Dahl's autobiography.

The gallery features huge plasma screens showing Dahl as a boy and also displays some of the letters he wrote to his mother. The museum's Archive Room houses 900 more letters, as well as original and edited drafts of most of Dahl's stories.

Throughout the building, huge artworks by Dahl's principal illustrator, Quentin Blake, adorn the walls. The Solo Gallery - a reference to a later autobiography - shows Dahl's life as a man and is marvellously decorated with giant objects: books, a reading lamp, a pencil and a dream bottle as used by his Big Friendly Giant (BFG) who would surely have described the museum as gloriumptous.

There are also screens showing Dahl interviews, film extracts and footage from his RAF service.

In the Story Centre, among giant cartoon trees by Blake, is the museum's centrepiece, a replica of Dahl's hut in which he sat writing most days.

Great Missenden itself is chock full of places that inspired Dahl's stories. The hilltop behind Gipsy House, the Georgian mansion where he lived and his widow Felicity still resides, is where he imagined Fantastic Mr Fox had his home.

Opposite the museum is Crown House, a building Dahl described as Sophie's orphanage in The BFG (his granddaughter, model and author Sophie Dahl, was the only family member's name he used in stories).

Next to Crown House stand two old petrol pumps and it is here that Danny The Champion Of The World lived with his garageowning-father. Down the road is Samways sweetshop, which gave Dahl the name of the same book's village bobby, Sergeant Samways.

For refreshments on this Dahl trail, try The Nag's Head, mentioned in Ah, Sweet Mystery Of Life ('We drove through the little narrow High Street of Great Missenden and caught a glimpse of old Rummins going into The Nag's Head for his morning pint.')

It is said that Dahl used to draw his hut's curtains while working or he would have been too distracted by the stunning Chilterns countryside. For the best view I would direct visitors to Princes Risborough, where I grew up.

Overlooking the town is Whiteleaf Hill and from here, on a clear day, you can see more than 20 miles to Oxford. Dotted around are delightful villages and towns with traditional flint cottages and medieval churches.

Wendover is one such place and Dahl was describing Wendover Woods when Danny The Champion Of The World and his father go poaching. Nearby Cobblers Hill is also visited in the story of Danny. Keep an eye out here for red kites soaring high, successfully reintroduced into the Chilterns in recent years. Then get a kite's eye view from the highest point of the Chilterns at nearby Coombe Hill.

Old Amersham is another tranquil place and Dahl lived here for a while. It was through his friendship with a local butcher that he developed Claud, the likeable rogue in Ah, Sweet Mystery Of Life.

Finally, the market town where the writer visited my school that day also features in several of his books - in Matilda, her mother goes to Aylesbury to play bingo. In Aylesbury, Dahl fans can visit the Roald Dahl Children's Gallery and the town hosts the Roald Dahl Festival, a procession of giant Catalan-style puppets based on his characters, on July 2.

Fifteen years after his death, aged 74 (his grave is in Great Missenden's St Peter & St Paul's parish churchyard), Roald Dahl is more popular than ever, selling in excess of three million books in Britain alone last year, and now it seems as though Sophie Dahl may have inherited some of his storytelling genes. Now she would have no trouble captivating an audience of 1,000 teenage boys.

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Author Lee Weeks on her one-way ticket to success
The best-selling author on why she has always travelled on one-way tickets
By David Hurst for Friday magazinePublished: 00:00 February 3, 2012

“Get serious about it, get motivated and get moving. It’s all possible.” This is the advice that best-selling British crime-thriller author Lee Weeks gives to aspiring writers. It’s the advice she heeded herself when she wrote her first novel, The Trophy Taker, five years ago.
Since then the 52-year-old – tagged as the female James Patterson – has had three more novels published: The Trafficked, Death Trip and Kiss & Die, all featuring her detective Johnny Mann, a cop she describes as “a damaged hero type”.
Although fans will have quite a wait for the next instalment in the Johnny Mann series – she expects this will be published in 2014 – they will be heartened to know she does have another novel – as yet untitled – in the pipeline, due out towards the end of this year.
Stranger than fiction
After leaving school at the age of 17 and travelling around the world on a series of one-way tickets, Lee’s own life is the stuff of novels.
In fact, it was her often terrifying experiences in Hong Kong, where she was during her early 20s, that formed the basis for The Trophy Taker. “After I left school in England I became an au pair in Sweden for a year and then decided to travel without a map, got hideously sick in France and was taken in and looked after by an old Parisian couple.
“I then went to Germany and worked as a barmaid and a DJ. When I came back to England I couldn’t settle, so went to Hong Kong and worked in a nightclub. It was here that I had some scary experiences involving the Triads and these became part of The Trophy Taker.
“When I travelled it was always on one-way tickets, so, as you can imagine, there’s not much in life that I haven’t had a taster of, good and bad. The most shocking thing to me is that my plots are nothing on what is actually going on every second in the world.”
The Trophy Taker – about a killer nicknamed The Butcher – was Lee’s first attempt at novel writing. For years the vague idea of writing a book ran around her head, but with a failing marriage and the need to earn a living, she never really got past constantly rewriting the first few chapters.
When her 20-year marriage finally ended, she had to find a job, try to save the house and look after her children. So she reworked the first few chapters and sent them off to an agent thinking she’d give it a go.
The agent was Darley Anderson, who also represents authors Lee Child, Martina Cole, John Connolly, Michelle Harrison and Tim Weaver. He loved the story, but made some suggestions and a year later, Lee delivered the reworked story.
He secured her a two-book deal. She says having her first book published has given her more satisfaction than anything else in her life – apart from her two grown-up children, Ginny and Robert.
As a creative child herself, Lee was often to be found immersed in poetry and novels when growing up.
“In my teens and twenties I tended to go for the classics such as Dickens and Hardy, or Henry Miller. But The Last of the Mohicans by James Fenimore Cooper is my all-time favourite book. For me it still has everything: unrequited love, massive fight scenes, the chase and the tragedy. It’s perfect.
“My own books are aimed at the commercial market rather than the literary end. So I try to make sure there’s a shocking first chapter that hooks, short chapters throughout, a surprise on every second page and a shock every fourth page.
“I always end each chapter with a hook so that readers have to read on. An author should always put the reader first – this is entertainment. Nothing must get in the way of the pace. Absolutely nothing must be written unless it moves the story forward and is necessary. And it must have lots of dialogue, punctuated by action, which helps move the story. So don’t go on about the weather!”
Top tips for writers
By her own admission she’s still relatively new to the business of novels, but Lee has sound advice for anyone writing a book in addition to her suggestion to “get serious about it, get motivated and get moving.”
She is very disciplined about her writing, getting up early most mornings and starting to write by seven. She continues to write until something interrupts her, such as a gym class scheduled or her dogs needing walking.
“Analyse what kind of a writer you are,” says Lee, who has now settled in England’s West Country after her travels and 15 years spent living in London.
“Ask yourself if the plot is vital to you. If the answer’s ‘yes’ then you need to plan your story meticulously. If it’s not, then you can let your characters grow and just see what happens along their road.
“They say write about what you know, but that loosely means write about what you’re interested in and what is within your capabilities. You have to be a good journalist, be able to listen to people and put yourself in their shoes. We’ve all had that instance when someone describes something so vividly that we think we’re there too. Just write that down and use it.
“You must have a theme too, such as jealousy, greed, justice or envy… Then, make sure you know everything about your characters: their star sign, favourite colour, where they went to school, their sayings and habits and hobbies, and what motivates them.”
For more details on the author, visit www.leeweeks.co.uk

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Marcia Willett on writing about romance
'It's extraordinary to see my books in so many languages and get wonderful letters from all over the world," says the author
By David Hurst for Friday magazine
Published: 00:00 January 20, 2012
Best-selling British romance author Marcia Willett, whose latest novel The Christmas Angel was published last month, has become one of the world's best-loved writers, with 25 novels published in 18 countries. No mean feat for someone who wrote her first book at the age of 50. And that too, not because of some deep-rooted passion for getting published, it was more to do with needing the money!
When disaster struck - her husband Rodney's business failed (he was a partner in a financial services business that went down in the early 90s recession in Britain) and their house was repossessed - he asked several times if there was something she could do to help with their crisis. It was the start of a completely new phase in her life.
"We'd lost our home and were living at a friend's while we worked out what on earth we could do," says Marcia, now aged 66. "It was not a good time.
"Until then I hadn't really worked. I'd been a full-time mother to my son Charles, who's now aged 40. But I was always an avid reader. I'd never considered writing though.
"So when Rodney said, ‘How often have I said that you really could write a novel?' I honestly didn't think I could. I told him, ‘I have no idea even how to start the first sentence.'
"But after months of nagging I agreed, for the sake of peace and quiet. It was also because I felt I had to at least try doing something to help. After four months I handed Rodney the manuscript of my first story, Those Who Serve, and said: ‘There, I've written it - now you sell it.' And he did!"
Rodney called a publisher based in London, Hodder Headline. When the receptionist answered his call, one of the commissioning editors happened to be standing nearby and something she heard interested her. She grabbed the telephone just before the receptionist ended the call. The editor said to Rodney, "It does sound interesting. Why don't you send it in?"
But even then Marcia knew it was a world away from getting published. After weeks of waiting - and with their situation getting no better - a letter arrived. The editor wrote that she liked the book, but just as Marcia and Rodney went to jump for joy they read on… she wanted Marcia to write in a new character and make it 40,000 words longer.
"I was so near - and yet so far," she says Marcia. "But I did as she asked. After a few more weeks I posted it. So began another long wait. Weeks later I'd not heard anything and couldn't stand the suspense, so I called the editor. ‘I don't want to talk about it,' the editor said. ‘There's a letter in the post for you.'" That night Marcia could hardly sleep, as she convinced herself it must be a rejection letter. She spent most of the night wondering what they were going to do to get everything back on track financially.
"Next morning the letter was in my hands," she says "And I couldn't believe it - they wanted to publish my story! At the age of 50 I was going to become a published author.
International success
"But even then I had another worry - my contract with the publisher stated that I had to deliver another story within 12 months. What if that first story had been a one-off? I must have had all these stories stored up inside my mind though, because I actually managed to deliver four novels in two years! Perhaps because I started so late, there was a lifetime of stuff in there.
"It's extraordinary to see my books published in so many different languages and when I get wonderful letters from all over the world. I wonder, ‘Can this really be happening to me'?" says Marcia.
Since that first fortuitous phone call, Marcia's had 25 novels published, including her latest, The Christmas Angel, which is available in hardback or as an ebook in Epub and Kindle formats. Her books - all set in Marcia's home area of Devon in south-west England where she lives in a large cottage with Rodney and their dog Jossie - have been translated and sold in 18 countries, including Greece and Germany where they have made the best-seller lists.
Rodney is also now a writer, mostly non-fiction although he has written two novels. "Neither were worth publishing, to be honest," he says candidly.
The differences between their writing is best illustrated by their replies to the question, ‘What are the last three books you've read?' Marcia's list is: At The Source, a book of poetry by Gillian Clarke; Learning To Dance by Michael Mayne and Cloud Atlas by David Mitchell. Rodney's list reads: Super Cooperators by Martin Nowak and Roger Highfield; Early One Morning by Robert Ryan and The Flamingo's Smile by Stephen Jay Gould.
"Rodney's writing has always been a huge asset," Marcia says. "It's his always constructive criticism, his readiness to enter into the ‘parallel universe' of my stories and the respect he accords this particular work ethic - which includes allowing me brood time and the space I need - accompanied by a toughness which drives me back to the computer when I don't much feel like it!
"‘Start hitting the keys' is his favourite expression. He always seems to know when it's important to stop brooding and start writing. But we are different too. He is a political animal. I am not. I love poetry. He just doesn't get it.
"Also, Rodney never waits for anything ‘to come to him'. I prefer the contemplative way: listening, waiting. We've learned to work with this. I listen to him, but continue to wait, though often the germ of his plots and plans filter through into the waiting. And, of course, I'm so thrilled that Rodney persuaded me to write - because it has been a total and wonderful life change."
To keep up with the Willetts, go to www.rodney-willett.blogspot.com

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In search of the real Augusta Falls
By R.J. Ellory, The Mail On Sunday
Aside from marriage and fatherhood, my trip to Georgia ranks alongside the most profound experiences of my life. But it was also unsettling in more ways than one. My latest novel, A Quiet Belief In Angels, has been selected for this year's Richard and Judy Book Club, and as part of a short film about the book for the couple's Channel 4 show I found myself walking in the footsteps of my central character, Joseph Vaughan.
During the trip we were looking for locations evocative of the book, looking for the spirit of Augusta Falls, the fictional town in southern Georgia where A Quiet Belief In Angels is set.
My editor, Jon Wood, and I flew to Atlanta, the capital of Georgia, and from there to Jacksonville, just across the Florida state line. Here we found Amelia Island, a former haunt of smugglers and pirates. Until the late Sixties it was the only beach in the area that blacks could use.
We stayed at the Hampton Inn & Suites, a hotel overlooking the stunning harbour front. It was the epitome of Southern hospitality, where all individual meals were sufficient to feed a whole family. There was a similar scenario at Sliders Restaurant, a little way up the coast. There, 25 chicken wings were served with salad and a selection of dips and sauces - and that was just a starter.
After Sliders, we ventured into The Hammerhead Bar, a watering hole for blue-collar paper-mill employees. As heavy rock music played, we were challenged to a game of pool by the locals. When we asked them to guess where we were from, their answers ranged from the Czech Republic to Israel. When I said I was from Birmingham, one man sneered and asked why I was so far from Alabama. He clearly didn't know about England's second city.
As for our chosen filming locations, they were all over southern Georgia. Despite having never visited Georgia before, they were just as I imagined them to be when I wrote the book.
There were wooden-turreted houses, rocking chairs on plankboard verandas, churches everywhere and Confederate flags on white gravestones.
The cemetery was perhaps the most remarkable thing we found on our journey. It was on the way to Folkston, the small town we used as our 'stand-in' for Augusta Falls. The cover of my novel features a church surrounded by gravestones and crosses. Driving along the highway, we suddenly stumbled upon an identical site. It was all we could do to stop the car in time.
We passed by stunning red cedar trees, a variety of pines, oaks, maples, sweetgum and white hickories, much of it draped with Spanish moss. The bayous seemed to stretch for miles. We visited Okefenokee Swamp, an endless wildlife refuge populated by cranes, mosquitoes, wild pigs and vultures. There's an earthy, waterlogged scent that almost seems to marinate you.
The sense of isolation was amazing. A boat tour is a great way to see it but I recall thinking that if I went 50 yards the wrong way I'd be lost - and never be seen again.
In fact for the entire trip I experienced a strange emotional effect - it was mysterious, tinged with a continual sense of deja-vu, perhaps even a sense of homesickness that I wasn't aware I possessed until I was there. In hindsight I realise I had an emotional hollow after writing this novel, a hollow ordinarily filled as I complete my writing. But with A Quiet Belief In Angels, it was as if I had to walk where Joseph Vaughan had walked, had to see what he had seen, to resolve that inner emptiness that the book had left behind.
A Quiet Belief In Angels started with geographical, social and cultural characteristics.
It started with the feeling that Georgia was the ideal place to set this story, with the sense of rural community, the predominance of religion and the importance of family.
Aged 12 at the outbreak of the Second World War, Joseph Vaughan is dogged by tragedy. Beginning in 1939 with the murder of a classmate, he is witness to a subsequent nine murders over the next decade. In 1949 a local farmer is found hanged, around him the trinkets of the murdered girls. Joseph Vaughan moves to New York, his dream of being a writer before him, but the murders begin again and he returns to Georgia to face his own ghosts.
Years ago I studied photography and so the Georgian scenery was a dream. The roads were wider and the sheer quantity of space made England appear claustrophobic and contained.
I am city-born and bred - I still live Birmingham with my wife, Vicky, and my 11-year-old son, Ryan. Georgia was a world apart and it gave me a completely different perspective.
The city of Savannah, dubbed the Queen of the South, has magnificent architecture. With its timeless ambience and tree-lined squares, you feel that you could only take the cars away you would be back in 1850. Once characterised by Lady Astor as 'a beautiful woman with a dirty face', Savannah is one of the most aesthetically stunning cities I have seen. It's an incredible place, welcoming, warm and friendly, but somehow you know you're a visitor, a guest of the South, for when the stores close and the lights go down, Savannah is for the Savannahians.
Now I'm back home but it was an experience I will never forget. I've written two more books since A Quiet Belief In Angels - a Washington-based CIA thriller and a serial-killer novel set in New York. But Georgia haunts me, like remembering an old friend. And the book I have just started writing for publication in 2010 will have Georgia centre-stage, the old friend exhumed and revived.
My journey to Georgia gave me so much, I believe I now need to give just a little bit back.
Travel Facts
A Quiet Belief In Angels by R.J. Ellory is out now, published by Orion at £7.99. For further information visit www.rogerjonellory.com, www.orionbooks.co.uk or www.richardandjudybookclub.co.uk.

British Airways (0870 850 9850, www.ba.com) offers return flights to Atlanta from Gatwick from £359.40, from Manchester from £455.10 and from Glasgow or Edinburgh from £453.80 if booked online. Hampton Inn & Suites, 9 S. Second Street, Fernandina Beach, Florida (00 1 904 491 4911, www.hamptoninnandsuites.net) caters to individuals and families. For further information on Georgia visit www.deep-south-usa-com or call 01462 440766.
R.J. Ellory was speaking to David Hurst.

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Author Mark Billingham on crime and comedy
British author Mark Billingham speaks to David Hurst about his journey from stand-up comedy to topping The Sunday Times' best-seller list
By David Hurst for Friday magazinePublished: 00:00 June 8, 2012
Mark Billingham's first novel was 2001's Sleepyhead.
There aren't many authors who can say they write about crime and murder by day and make people laugh as a successful stand-up comedian by night. But that's exactly what Mark Billingham did for several years - and he thinks the two roles have definite similarities
"Whether you do stand-up comedy or write a story you have a duty to deliver," says the 50-year-old father of two teenagers, who lives with his wife Claire in North London.
"As a comedian you walk out on stage and you have a minute to hook them or they'll start booing. As a writer it's very similar. A reader doesn't have time to say, ‘I'll give him 50 pages as it's not very good yet, but I hope it'll get better'."
Mark Billingham is obviously doing something right - he is a hugely popular crime-fiction writer, growing in stature book by book, especially since his first two Sleepyhead and Scaredy Cat were made into a TV series. Since his first novel Sleepyhead was published in 2001, Billingham has had nine more best-sellers featuring no-nonsense detective Tom Thorne as the main character.
A few years ago Billingham stopped doing stand-up comedy to write crime fiction full-time - apart from speaking at the occasional book event, when those in attendance see that, despite his claims of being a "very average comedian", he is actually an exceptionally funny man.
From an early age, Billingham says he can remember writing "funny" stories. As he grew older, he moved on to crime stories. Inspired by the comic-crime writing of American Carl Hiaasen, he attempted to combine his experience as a stand-up comedian and crime-novel fan to write a similar novel, set in his native Birmingham, UK. But he abandoned this unfinished project to focus on his other idea: the book that became Sleepyhead, where a case of ‘locked-in syndrome' - a condition in which someone is awake but cannot move or communicate due to complete paralysis - reveals the depths of a dark mind, as fond of toying with the novel's detective-inspector chief protagonist as with the victims.
Since that first novel his books have gone on to be translated into many languages and the first two have been made into a successful television drama series starring Natascha McElhone (of Californication fame), Sandra Oh (Grey's Anatomy), Aiden Gillen (The Wire), Eddie Marsan (Sherlock Holmes) and David Morrissey (Captain Corelli's Mandolin) starring as DI Tom Thorne.
Getting under Thorne's skin
It's the character of Thorne that's central to the appeal of the TV series and the books. "Thorne is stubborn and, as his name implies, can be prickly and tough to get rid of," Billingham says. "But if he doesn't know when he's not wanted, his tragedy is that he doesn't always know when he is.
"I have always wanted him to be a character who carries the events of his past with him; who's scarred, inside and out by the cases, and the people that have shaped him. Those of us who write crime fiction cannot put our characters through these dreadful ordeals without writing about how they are affected.
"Thorne is someone who deals with violent death, with terrible grief, and it would be ludicrous, inhuman, if he remained untouched by such things. I've often said the reader knows every bit as much about Thorne as I do. When I created him for Sleepyhead I was determined he should be a character who would develop, book by book, change and grow as we all do, and who - crucially - would be unpredictable.
"As I write each new Thorne novel, I'm determined that whatever is happening plot-wise, a new layer of the onion will be peeled away and reveal something about Thorne that is surprising to me as much as anyone else. If I can remain interested in the character, then hopefully the reader will stay interested too. The day a character becomes predictable is the day a writer should think about moving on - because the reader certainly will."
Basing fiction on fact
Not many of Billingham's readers know that Thorne has a bad back because Billingham used to suffer from one. "It started after one of my comedy appearances," he recalls. "I jumped off the stage, slipped and twisted my ankle. That probably got the biggest laugh of the night!"
But it was no joke for Billingham as he couldn't sit to write or even lie down without feeling excruciating back pain. Unable to sleep properly, he became irritable and found it more difficult to concentrate - a nightmare for his stand-up comedy and writing. In the end, after several painful months, an operation cured it.
"Until the operation the pain was always there, which is why I gave Thorne his own bad back, when I was writing my novel Buried. Writers are told to write about what they know and I certainly knew all about back pain. So I made sure that Thorne suffered with it as well!"
Literary Dubai
Now with both Billingham and Thorne very much up and running again, the author reflects on his recent return to Dubai to attend the literary festival, where he says he met a lot of interesting people - both writers and readers.
"This was my third visit to the Emirates Airline Festival of Literature, although I also visited Dubai some years ago to perform as a stand-up comedian. I always get such a warm welcome and I love the place.
"For the third year I had an amazing time at the festival in March. It really is unique, not only in the emphasis it places on education and integration, or in its truly international scope, but in the way it fosters a wonderful bond between the many writers invited. How often can you watch a world-famous poet on the back of a camel or enjoy a night-time desert safari with acclaimed novelists and biographers? It's a festival that I would recommend unreservedly to anyone - reader or writer."
Info
Mark Billingham's latest novel Good As Dead is out now, also available on Kindle. His new novel Rush Of Blood will be published in August. For more details see www.markbillingham.com.

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Diving in with sharks got the heart pumping in Australia!
By KARIN SLAUGHTER
Last updated at 11:00 AM on 10th March 2009

What my doctor would have made of it I'm not quite sure. Just weeks after he'd diagnosed me with dangerously high blood pressure and cholesterol, here I was, my ticker doing twenty to the dozen, swimming with 12ft sharks.
Actually it was all part of a master plan to get back to fitness following my doctor's admonishments. I was due to head off on a round-the-world book tour and I decided it would provide the perfect opportunity to try out some strenuous extreme sports.
That opportunity came while visiting Australia. In Melbourne I met someone who mentioned swimming with the sharks and stingrays at the city's aquarium, and my first thought was: 'That should really get the heart pumping.' Besides, I always sneak off to a zoo or aquarium when I'm touring because I love animals and it's so relaxing to be among them.
Before I could get in with the sharks, however, I had to go to the local community swimming pool to practise diving. It was fun getting used to the equipment and, as I'm somewhat small, it was very challenging manoeuvring around with what felt like six tons of equipment on my back.
Then it was off to the aquarium. Even though it was not too long after Steve Irwin had died after being pierced in the chest by a stingray spine while snorkelling at the Great Barrier Reef, I didn't really think twice about getting in because I'm one of those stupid people who believe nothing bad will ever happen to them.
Afterwards, of course, I thought: 'Hmm, you should've been a tad more concerned...' But in situations like that, you just have to jump in because you'd never do anything if you thought about the risks - and, actually, we got to pet the stingrays. How cool is that?
When you walk along the side of the aquarium and see the sharks circling below, it gives you an unbelievable rush.
I had some difficulty with the oxygen tanks because they were so heavy. Once I was in the tank it was fine, though it was a bit of a shock how cold the water was, even through my wetsuit. Getting to the bottom was hard, too, but slowly I sank there. We had these weighted belts on and mine wasn't heavy enough, so I had trouble sitting on my knees.
The dive instructor fiddled with the belt and finally I was able to plant my knees in the sand and just look. It was fascinating. The sharks were nurse sharks, harmless unless provoked, and they kept eyeballing us. They have incredibly strong jaws, stout bodies that are about 12ft long and a wide head with obvious barbels. It's hard to describe what it's like to have their giant, bottomless black eyes staring at you from just a few feet away. I should have been scared but was actually gripped by how magnificent they were.
When you think about how long their species has been around, how little they've had to evolve because they're so well adapted to what they do, it's breathtaking.
Then there were the stingrays, which were actually amazingly friendly. They would flutter over my head and zoom by at an angle as if to show off. The other fish in the aquarium were schooling and at one point I got caught up in a crowd of them. I just kept still and they floated by like a breeze.
I stayed underwater for about 15 minutes, and it flew by. As we were preparing to go up I realised I was carrying too much weight, so the dive instructor helped me make my way upwards. At one point I became detached from him and turned around just in time to see a giant fin coming my way. So, now when people ask me about the experience, I have a great way to end the story: I was whacked in the head by a giant shark. It was certainly hard enough to skew my goggles.
Later that night, I felt exhausted, but I think that was just from the swimming and lugging around all the equipment. It was such a wonderful time and when I slept, I dreamt about being in a current in the ocean and floating along with the sharks.
While you're in Australia, I'd definitely recommend the Melbourne Aquarium experience - where I also met a seal and took a wonderful otter for a walk - as well as, at the opposite extreme, the Sydney Harbour Bridge walk, which takes you 440ft up, right to the top of the world-famous landmark. It is well worth the climb.
When I'm at home in Atlanta, I'm pretty boring. Running on the treadmill at the gym is about as adventurous as I get. I tried rock-climbing, but it hurt my fingers. I also did fencing, but the instructor was scary and kept talking about using my body as a deadly weapon, so that petered out very quickly.
If you're the sort of person who's right on the edge, who has always wanted to try something extreme but hasn't had the opportunity, you should seek out that opportunity.
I think it's really beneficial to invigorate the mind and body, so I'll be looking out for more extreme sports to try around the world.
And, while I might not have the characters in my crime stories jumping into a shark tank, the things I felt and saw - the emotional element of it all - will certainly be incorporated.
That said, I've been pushing my publisher for years to send me to South Africa so I can 'research' a new book - and perhaps go on a wildlife safari or two.

Karin Slaughter was speaking to David Hurst. Her novel Fractured is published in paperback by Arrow Books on March 26, price £6.99.
Getting there
Qantas is offering a special fare of £606 return on flights from London to Melbourne between April 10 and June 15, if booked in March. For details visit www.qantas.com or call 08457 747 767.

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Welcome to Washington: America's inspirational capital city made as easy as DC
By GEORGE PELECANOS
Last updated at 8:34 PM on 3rd April 2011

When my dad moved over from Greece to the US, he headed straight to Washington DC. I'm really pleased he did as it was a great place to grow up.
I doubt I'd be a writer if I had not lived in DC. I worked here as a cook, dishwasher, bartender and woman's shoe salesman before my first novel, A Firing Offense, was published in 1992. I've had 15 more crime novels published since then and they're all set in and around this city.
DC also influenced my writing for the TV drama series The Wire (although that is set in Baltimore).
There's so much to see here and write about. When I was growing up in the Sixties, 80 per cent of people in DC were black. Back then there was still separation between the races and the civil rights movement was going on. In the US capital, in a country founded on equality, there was plenty of inequality for everyone to plainly see.
Then, in the nineties, DC became America's murder capital. In 1991 there were 479 murders among a population of fewer than 600,000.
But things have got so much better now, and last year the murder rate was under 150. My books reflect that the city has become much safer. Generally it's a really friendly city and in any case people will advise you where not to go.
We have hard winters here (5ft of snow this time) and hot summers (with temperatures in the 90s Fahrenheit) so I would say the best time to visit is spring when it's warm. It's glorious, with beautiful flowers and DC's famous cherry blossom everywhere. People come from all over to see it in April and May.
Another draw is the fantastic culture and food that DC's racial mix has created. There's the black go-go music, which is a mix of rap and funk with heavy percussion. The live shows are incredible.
The city is also well known for its punk scene. Small venues such as The Black Cat and the 9:30 Club host popular bands. For nightlife, food and music it has to be U Street, DC's equivalent of new York's Greenwich Village. It's lined with fantastic bookstores, restaurants and bars, and has a great mix of people from all social backgrounds and races.
Ben's Chili Bowl is one of my favourite places to eat. Try the chilli dogs or half smokes - sausages with hot mustard, chilli and onions. It also has the best jukebox in town. I also love the Florida Avenue Grill nearby. It's the city's best soul food diner and I recommend a breakfast here with a plateful of eggs, half smokes and grits.
If you're stopping in DC, I'd recommend The Henley Park hotel as it's in the heart of the city and has rooms with classic English-style decor.
There are plenty of ways to enjoy DC without spending a dime, too. The city's museums are free, so you can spend all day in places such as the Smithsonian Institution, the National Air and Space Museum or the National Museum of the American Indian.
And our monuments are among the best in the world. Washington Monument in the centre of the National Mall park is a must-see. It was built in the 1880s to commemorate the first President, George Washington. Made of marble, granite and sandstone, it's DC's tallest structure and the world's tallest obelisk, at 555ft.
Also absolutely worth a trip, especially at night, is the Jefferson Memorial on the banks of the Potomac. It's a neoclassical building completed in 1943 in honour of the third President, Thomas Jefferson. You can spend a good few hours sharing a bottle of champagne with a lady by the water here!
Also romantic is Hains Point, a peninsula between the main branch of the Potomac and the Washington Channel at the southern tip of the east Potomac Park in south-west DC. This is one of the best places to see the spring cherry blossoms.
Jefferson wanted to make Washington an 'American Paris', so DC has lots of 'circles' - grand city squares that are round in shape. Neighbourhoods worth visiting include Dupont Circle in the Old City, with lots of cool bars and restaurants and a Sunday farmers' market, and Adams Morgan, which has a great mix, including Ethiopian and Hispanic restaurants, that give the real flavour of this vibrant city.
If you want a taste of rural life in the city, head for Rock Creek Park, which stretches from north to south DC. I cycle about 80 miles every week, and in this park you can go for 25 miles and not even know you're in a city as there's only the one road through the middle. It's not like new York's Central Park, where you'll see loads of people and cars. It's much like being in the country - even the air is fresh.
So DC's great, but I've also got to know and love Baltimore. It's the largest city in the state of Maryland and about an hour's drive from DC.
I always get a great taste of my heritage in the neighbourhood of Highlandtown/Greektown, especially at Zorba's restaurant. It looks like a dive, but the Greek food is authentic. And if you love seafood, you're in crab country, as Baltimore is a major seaport.
For a taste of US sport, catch a match at Camden Yards. It's home to the Baltimore Orioles and has a capacity of about 50,000. The team stinks, but this is the best baseball stadium in America.
I'm obsessive about details in anything I write and always check things out to make sure they're accurate. In actual fact, you could use The Wire as an alternative guide to Baltimore and my books as a road map of DC. With everything I write, I feel I'm leaving a record of these wonderful cities.
More on George Pelecanos at www.hachettebookgroup.com/features/georgepelecanos.
George Pelecanos was speaking to David Hurst.
Travel Facts
British Airways (www.ba.com) offers return flights from Heathrow to either Washington or Baltimore from £527. For more information about the cities, see www.washington.org or www.baltimore.org.
The Henley Park Hotel is at 926 Massachusetts Ave NW (00 1 202 638 5200, www.henleypark.com); Ben's Chili Bowl, 1213 U Street NW (00 1 202 667 0909, www.benschilibowl.com).
The Black Cat, 1811 14th St NW (00 1 202 667 4490, www.blackcatdc.com; Smithsonian Institution, www.si.edu; Washington Monument, www.nps.gov/wamo; Jefferson Memorial, www.nps.gov/thje; Rock Creek Park, www.nps.gov/rocr; Baltimore Orioles, www.theorioles.com.

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Superintendent Roy Grace's Brighton: Crime writer Peter James heads home to explore Brighton by the book
By PETER JAMES
Last updated at 2:09 PM on 25th April 2010
I was born and raised in Brighton and Hove. At that time there was a lot of snobbery between the two - Hove was considered 'genteel' and Brighton rather seedy and racy.
As much as I loved it, in the Fifties and Sixties Brighton had an image of being shabby, downmarket and crime-infested. If anyone asked where I was from, I always said Sussex rather than admit to Brighton.
But about 25 years ago Brighton and Hove started to transform into what it is nowadays - one of the coolest, hippest cities on the planet.
Today, with the two towns now melded into one place - The City of Brighton and Hove - I am proud to tell people I'm from Brighton and I'm passionate about the place.
I live about 12 miles from the city centre now and visit Brighton a lot - almost every week I spend time with Sussex Police researching my crime novels featuring Brighton detective Roy Grace.
My first Grace novel, Dead Simple, was published in 2006 and five others have followed. I'm now working on the seventh. All the stories are centred on Brighton, and aspects of the city are always pictured on their covers. They've become international bestsellers.
The sense of place in my books is crucial in the way that Oxford is important to Morse, Edinburgh is to Rebus and Los Angeles to James Ellroy.
I am published in 33 languages and each country loves the setting. In Germany and France, for instance, I am a Top 10 bestseller - I recently had to do a tour for 12 German journalists of Roy Grace's Brighton - and I have almost rock-star status in Russia. It is bizarre. I get letters from all over the world from readers wanting to come to see the city - some of them asking if they will be safe.
My favourite novel as a child was Graham Greene's Brighton Rock. After reading it at the age of 12, I dreamed of one day writing a crime novel set in my town. For a crime writer it is the perfect environment.
In 1932, after a series of dismembered bodies were found in trunks in left-luggage lockers, it was christened the 'crime capital of England', a soubriquet it has never lost. Three previous chief constables have told me that Brighton today is the favourite place to live for Premier League criminals.
It is an almost perfect criminal environment. Brighton has an unguarded coastline - perfect for importing drugs and exporting stolen goods - and it has masses of escape routes close to hand: all the coastal ports, Eurotunnel, Gatwick Airport, London 50 minutes away by train and a great road network.
It has the largest number of antiques shops in the UK - perfect for fencing stolen goods.
And with two universities, a huge student population, a very large arty community, the largest gay community in the UK - all great consumers for the recreational drugs industry - it has something the tourist board doesn't like me mentioning: for nine years running, Brighton has held the unwelcome title of Injecting Drug Death Capital Of The UK. It is also the only place where a serving chief constable has been murdered ...
It was the late playwright and actor Noel Coward who said: 'Ah, dear Brighton - piers, queers and racketeers!' And it was the late novelist and newspaper columnist Keith Waterhouse, one of its best-known residents, who famously said: 'Brighton has the air of a town that is perpetually helping the police with their inquiries.'
But before I frighten everyone off, I do have a theory that it is the cities with a dark underbelly that are the most vibrant - in the USA, New York, Chicago, Los Angeles, San Francisco, New Orleans and Miami are the ones that are most fun to visit. In Australia, Melbourne, which has had 37 gangland shootings in the past decade, is by far the buzziest city.
One of the delights of Brighton is its vibrancy. Thankfully, as Brighton and Hove's population is only 250,000, one of our blessings is that although we have all the best elements that make a city, we don't have innercity gun and knife crime. And thanks to its superb police it is a safe place day and night.
One aspect I love is the legacy of tolerance that goes back to the Regency days. Louche behaviour has always been accepted and today Brighton hosts the amazing annual Gay Pride event - the biggest in the UK, if not the world. Best of all is that the city is a vast combination of so many things. It's close to London but has a glorious coastline and is surrounded by some of the most beautiful countryside in the world.
Devil's Dyke is stunning. Then there's Firle Beacon. I frequently go for a run up there and on a clear day the view is breathtaking. I've not seen a better view anywhere in the world.
The undercliff walks from Brighton Marina and Rottingdean were a childhood favourite of mine, and have now become a favourite of Grace's too. These walks are particularly wonderful and dramatic when big waves are rolling in. And Rottingdean, where Kipling lived, an idyllic village at the eastern extremity of Brighton, reminds me of what Brighton might have been like hundreds of years ago when it was a fishing and smuggling village.
Anyone visiting Brighton must see the Pavilion, and not just from the outside. A walk around inside is definitely worth doing. Other must-sees are the narrow streets of Kemp Town and of the North Laine district - a fabulous area full of individual shops - as well as The Lanes, with its maze of narrow walkways and twittens (an old Sussex word for alleyways) filled with antiques shops, pubs and restaurants. I've always especially loved the Colin Page antiquarian bookshop where I could get lost for hours.
My favourite restaurants in the city are the Hotel du Vin because it has a sense of style and occasion, good food, a great bar, really pleasant outside spaces and a fine cigar humidor; Havana Restaurant & Cocktail Bar also offers great food and drinks in
stylish surroundings; Sam's in Kemp Town is good too. The Karma Bar in the Marina is another great venue - funky and classy, and I also like the bar at Browns.
A Hotel du Vin vodka martini cocktail followed by smoked salmon from the famous Sussex smokery Springs, then a Dover sole - with a wine from Sussex winery Breaky Bottom, where I set one of my earlier novels - would be my perfect evening out.
Kelly Brook's Brighton favourite: Hotel du Vin brims with seaside style.
You'll always see plenty of stars around Brighton, too, such as Chris Eubank driving his massive truck, Norman Cook (Fatboy Slim) and Zoe Ball, authors James Herbert, Lynne Truss and Julie Burchill, and broadcaster Simon Fanshawe.
Heather Mills has just opened a health-food restaurant by Hove Lagoon called VBites, and Cate Blanchett has a house there. Lord Olivier had a home in Brighton for many years.
Arty, naughty, graced by royalty and celebrity and past scandals, the Grand Dame of seaside resorts is still busy transforming itself into a hip global player, a supercity. And maybe its lack of perfection is part of its appeal.
Like most cities, Brighton has its problems. I would definitely not recommend West Street on a Friday or Saturday night as it is full of drunks and thugs. And although the city has some very chic, individual hotels like the Royal York (now the Radisson-Blu) and the Park Inn, which was formerly called Lansdowne Place, it badly needs a major five-star hotel.
Incredibly, for a city of its stature, it has no major department store, either.
Meanwhile, imbecilic policies of successive councils have turned driving in Brighton into a nightmare, and city-centre car parks charge rip-off fees.
Luckily, there's the regular train service from London. That's what transformed Brighton when it opened in 1841, and there is always something really special about arriving at Brighton station with its fine old clock.
But for me, nothing beats the magical feeling of driving from London and seeing the rolling South Downs ahead and then passing the famous stone gate pillars that are known as the Pylons, with their 'Careful drivers are welcome to Brighton' sign. I know I'm almost home.
One aspect of the success of my Roy Grace novels I'm really enjoying is that it's giving me the chance to give something back to a place that I love so much. I'm often asked when we'll see Grace as a television series. This should happen soon and it will be set in Brighton.
Whether you stroll past its grand Regency facades and swanky crescents - many originally built, like the Pavilion, to house the mistresses of rich Londoners - or beneath its crumbling cliffs or along its dark and narrow and mysterious alleys, the smell of salt and the cry of gulls will accompany your every step.
Everything about the Roy Grace novels is everything about this city that I love. And it just gets better.
Peter James was speaking to David Hurst
Peter James's new Detective Superintendent Roy Grace novel, Dead Like You, is published on June 2 (£18.99, Macmillan).
For details, go to www.peterjames.com.
Travel Facts
Brighton Tourist Board: 03003 000088, www.visitbrighton.com.
London Gatwick: 0844 335 1802, www.gatwickairport.com.
National Rail Enquiries: 0845 748 4950, www.nationalrail.co.uk. Eurotunnel: 08443 353535, www.eurotunnel.com.
Hotel du Vin: 2-6 Ship Street, Brighton BN1 1AD, 01273 718 588, www.hotelduvin.com. Standard double room from £170 per night. Radisson Blu Hotel: Old Steine, Brighton BN1 1NP, 01273 766700, www.radissonblu.co.uk. Standard double from £94 per night.
Park Inn (formerly Lansdowne Place Hotel), Lansdowne Place, Brighton BN3 1HQ, 01273 736266, www.lansdowneplace.co.uk. A standard double room including breakfast costs from £85 per night.
Havana Restaurant & Cocktail Bar: 32 Duke Street, Brighton BN1 1AG, 01273 773388, www.havana.uk.com.
Sam's of Brighton: 1 Paston Place, Brighton BN2 1HA, 01273 676 222, www.samsofbrighton.co.uk.
The Karma Bar: Waterfront, Brighton Marina, Brighton BN2 5WA, 01273 818000, www.karmabrighton.co.uk.
Browns Bar & Brasserie: 3-4 Duke Street, Brighton BN1 1AH, 01273 323501, www.browns-restaurants.co.uk.
Royal Pavilion: 4-5 Pavilion Buildings, Brighton BN1 1EE, 01273 292820, www.royalpavilion.org.uk.
North Laine: www.northlaine.co.uk. Rottingdean: www.rottingdean.uk.com.

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Carcassonne, my towering inspiration
By Kate Mosse, The Mail On Sunday
Last updated at 10:50 25 June 2008

Carcassone's citadel overlooking the River Aude
The first time I visited the medieval city of Carcassonne in south-west France was in November 1989. It was raining and deserted in a way only French towns can be in winter after the shops have shut.
Not a soul about. I walked through the lower town towards the river and I had my first glimpse of the citadel, or Cité as it is known. One glance was all it took. I've been head over heels in love with the place ever since.
The Cité of Carcassonne sits on a hill overlooking the River Aude. To the north, it looks out over the Montagne Noire, purple at dawn. To the east are the vineyards of the Minervois, and beyond are the plains of the Narbonnais and the Mediterranean. South lies the wild and rocky landscape of the Pyrenees.
This extraordinary fortress was at the heart of my bestselling novel Labyrinth and features in my latest book, Sepulchre - it's my passion for the history and landscape of the Languedoc region, and Carcassonne's medieval citadel in particular, that inspires my storytelling. Whenever I see its 52 turrets and towers, the mellow stone against the blue sky, I can hardly believe it is real.
Carcassonne is a town of two halves. The Bastide Saint-Louis, founded in the 14th Century, has a predominantly 19th Century character - six-storey townhouses, wrought-iron balustrades, market squares and impressive public buildings.
It was in these streets that I discovered the themes and plotlines that came together in Sepulchre. It was from the banks of the Canal du Midi, serene and picturesque, that, in my imagination, I first saw a boatman pull a well dressed woman's body from the sluggish water.
Beside the canal is the railway station. On these platforms I pictured my 19th Century heroes, Leonie and her brother Anatole, arriving hot and bothered, but happy, from Paris, watched by the Gothic stone angels and silent tombs of the Saint-Vincent cemetery that overlook the station.
From a vantage point between the ornate tombs there's an unbroken view south, the whole history of Carcassonne laid out to see. In the foreground is the elegant Hotel du Soleil le Terminus, built in the early 1900s. In the middle distance are the battlements of the biscuit coloured fortress Cité, and beyond them the eternal green hills and snowbound peaks of the Pyrenees.
It is to the mountains that Leonie and Anatole head, their destination a mysterious estate dominated by a beautiful manor house on a thickly wooded hillside above the spa village of Rennes-les-Bains.
An air of the ghost town hangs over Rennes-les-Bains today. The elegance of the 1890s spa has gone but it is still a beautiful, peaceful place. In this region, no storyteller could ever be lost for inspiration, nor could any visitor fail to be charmed by the natural landscape sculpted by time and adorned with forests and rivers.
My own history with Carcassonne began when my husband, Greg, and I - then struggling writers preparing to start a family - heard about somewhere for sale there through friends of friends.
Greg had spent many years in Paris after university and we always wanted to keep a French connection.
Neither of us had been to the Languedoc or knew much about it, but Greg and his mother, Rosie, went out together in August 1989 (I was pregnant at the time and feeling too grim to travel) and came back having bought a tiny two-up, two-down house in the shadow of the medieval Cité.
Looking back, knowing now what an essential part the citadel has played in our lives - not least as the spirit of Labyrinth and Sepulchre - it's as if it was always meant to be. Serendipity? Coincidence? Who's to say? And even though we mostly live now in Chichester, West Sussex, where we grew up, I still have this visceral sense of coming home every time I arrive in Carcassonne.
The Cité had fallen into disrepair over the centuries, but a massive renovation programme was put in hand in the 1850s. Now, its past is clear to see. The outer walls date from the 13th Century. The inner ramparts reveal varying legacies - from the marks left by the Romans in the 1st Century BC and the Visigoths in the 5th Century right up to the 20th Century scars of the Nazi occupation.
When you walk around Les Lices, the space between the inner and outer walls where jousting takes place in the summer, you get a real sense of the present being informed by the past, especially in the oldest, northern side at the Tour de la Charpentiere or the Moulin d'Avar. You can see history, layer by layer, brick by brick.
As Ryanair started direct flights from Britain and Ireland to Carcassonne a decade ago, it's no surprise that you hear more English now as you wander around or sit outside at the many restaurants and bars.
Here, people live outside as much as they can, and the smells of food are delicious. A couple of dishes you have to try are cassoulet, the most regional of all Languedocian fare, and goat's cheese served with mountain honey and fresh figs.
Two of our favourite restaurants within the Cité walls are Le Trouvère and Le Jardin de la Tour. The first sits in the Place Marcou, the small and bustling central square filled with restaurants and their brightly coloured awnings - I have many fond memories of summer lunches under lime and clipped plane trees, omelettes by the fountain with buskers playing guitar, and bright winter mornings of tartine and buttered baguette, dipped in strong black espresso.
Le Jardin de la Tour, meanwhile, occupies a beautiful 19th Century building in the lee of the western section of the medieval walls and the Tour du Justice. It is perfect for a stylish dinner and has an excellent wine list and menu with plenty of local specialities.
Another reason there are more visitors to Carcassonne is that in 1997 the citadel was put on the list of World Heritage Sites. Since then, there's been a major investment in preserving its history. The climate has also changed in the past 20 years, almost as if it, too, is reverting to its 13th Century past.
It is greener year-round now. There's still plenty of sunshine, but summer thunderstorms and flash floods have become more frequent as the hot wind, the Cers, blows in from the mountains, turning the sky from blue to black in an instant.
I'd suggest any visitor should start in the Bastide, at the top of the town by the railway station and Canal du Midi. Watch the barges saunter through the lock for a while, then walk through the town, pausing at the Hotel du Soleil le Terminus to take in its amazing balustrades and staircases and to imagine the palm court orchestra playing for gentle tea dances a century ago. Walk down into the once-cobbled streets. Above the older shops, you can see faded 19th Century signs advertising haberdashers, paper shops and antiquities.
There's a market in Place Carnot on Tuesday, Thursday and Saturday mornings, with stalls of fresh fruit and local produce as well as live chickens, flowers and watermelons the size of footballs. Pause here to take it all in with a glass of local rosé in Bar Felix.
Next, visit the cathedrals of Saint-Vincent and Saint-Michel, ornate and imposing, yet living places where local people often pop in for five minutes of quiet contemplation or prayer.
From here, head to the river and you'll suddenly see the medieval city ahead of you, as I did when I fell in love with the place 20 years ago. This view is even more stunning at night, when the ramparts and towers are majestically floodlit. It looks like a film set - and indeed was the backdrop for Robin Hood, Prince Of Thieves, starring Kevin Costner.
Go over the Pont Vieux (the old bridge) and into the narrow streets that wind up through the Quartier Trivalle to the Cité - the walk gets steeper the closer you get. To your left is the magnificent cemetery. To the right, in contrast, is a bright and garish two-tiered carousel full of life and children. In the summer, the piazza it occupies is where the caleches, the horse-drawn carriages, start their tours of the citadel.
Over the drawbridge - a 19th Century addition - and through the Porte Narbonnaise and you are in the Cité itself. On the far side, built into the inner walls, is the Chateau Comtal. Dating from the mid-11th Century, it is constructed on the foundations of a much older property. Make sure you see its two courtyards and the beautiful 12th Century murals, which were uncovered only in 1926.
Carcassonne has become increasingly crowded over the years but in some ways it's a return to its medieval past - people lived on top of each other, which is what it feels like now in the busy summer months.
It is just what the 19th Century city fathers were aiming for. In 1902, Carcassonne opened one of the first tourist offices in France, repackaging its medieval history as an alternative to the fashionable resorts of Cannes or Nice.
Postcards and guides were mass produced in English and French, quoting a line from a popular 1860s song 'Il ne faut pas mourir sans avoir vu Carcassonne' or 'Do not die without seeing Carcassonne'.
I couldn't agree more.
Travel facts
Ryanair (www.ryanair.com) flies to Carcassonne from Stansted, East Midlands, Liverpool, Cork, Dublin and Shannon. One-way fares from §10. Carcassonne's airport is three miles from the town centre. A taxi into town costs about £7. Rail Europe (0844 848 4070, www.raileurope.co.uk) travels from London to Carcassonne via Paris (total journey time from nine hours) from £88 return. For details of accommodation in Carcassonne, contact Carcassonne Tourist Office on 00 33 (0)468 102 430 or visit www.carcassonne.org.
Kate Mosse was speaking to David Hurst

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I was struck deaf in an instant - but a quick diagnosis might have saved my hearing
Bestselling author David Hewson interviewed by David Hurst
Last updated at 9:26 PM on 1st November 2008

In the world of crime novels, the annual Audible Sounds of Crime awards are a pretty big deal and I was thrilled to be shortlisted for my fifth novel in my bestselling Nic Costa series.

But I turned down the invitation to attend. Much as I would have loved to get together with other crime writers and readers, since losing my hearing suddenly four years ago I find crowded places too much to handle.

Although I'm deaf in only my left ear, when there is noise all around I'm unable to distinguish sounds and can't hear anything.

The irony of the literary category I was nominated in is not lost on me either - Audio Crime Book of the Year. And as it turned out, I won.

I'd had a cold all winter and two weeks earlier had flown back from a book event in Portugal to my home near Canterbury, where I live with my wife Helen, 55, and daughter Kate, 21.

I'd taken Eddie, my wire fox terrier, for his daily walk up on the North Downs when I began to feel lightheaded. Then, an unexplainable buzzing noise - almost like high-pitched radio static - started in my left ear.

I completely lost my balance. I'm not sure if I blacked out but the next thing I knew I was face down on the grass, with Eddie licking my ear.

I managed to struggle to my feet and stagger the 200 yards back to my house where I crawled into bed.

Within an hour I felt fine, and that afternoon I got up and did some writing. However, in the evening, while watching TV, I noticed I couldn't hear in my left ear. And the buzzing remained.

When it was still there the next morning I went to my GP. He said it was probably catarrh - an excessive build-up of mucus in an airway that can sometimes cause temporary hearing loss - and I'd be fine in a week.

I'd never had any problems with my hearing so I trusted the doctor. But it didn't go away. I still had the hum inside my head and couldn't hear much at all with my left ear.

But week after week I went back to the doctor and for three months my GP told me it was catarrh and it would clear up on its own.

Eventually, I saw a different GP who arranged a hearing test with an NHS consultant from the William Harvey Hospital near Ashford.

The hearing test, which involved sitting in a quiet room listening to noises of various pitch played through headphones, confirmed the worst. I had no hearing in my left ear whatsoever.

The Ear Nose and Throat consultant diagnosed sudden sensorineural hearing loss (SSHL). If it's not dealt with promptly it's often incurable and can strike anyone out of the blue, regardless of age, fitness or any other factors.

Permanent hearing loss is caused by damage to the sensory cells, known as 'hair cells', lining the coiled cavity of the inner ear (cochlea).

They naturally 'die' over time - we all lose hearing as we age. Prolonged exposure to loud noise can also cause damage.

Viral infections, such as mumps, rubella and meningitis, cause inflammation of the inner ear or auditory nerve resulting in permanent damage.

A temporary blockage of the blood vessels supplying the inner ear - due to a build-up of cholesterol or calcium - can also permanently damage the hair cells, leading to deafness.

Similar damage can be caused by a brain tumour, but an MRI scan ruled that out.

In most cases of SSHL - as in mine - doctors don't know the cause. I now also have severe tinnitus, which means it sounds as if someone is constantly tuning a radio in my left ear day and night - sometimes it's so bad at night I can't sleep.

Although they don't know why, doctors believe it's caused by the brain ' trying to hear' in the deaf ear.

The first few months of coming to terms with it were extremely difficult and there is the constant worry that I might lose hearing in my right ear.

It's an invisible disability. Those who meet me have no idea. In conversation with two or three people in a quiet room I manage fine.

More than that and it gets tricky and people often think I'm being rude if I don't respond.

However, there has been one great advantage. I believe my writing has improved since I went deaf. It's easier to focus and immerse myself in my fictional world - and the sales of my books are also up.

• Royal National Institute for Deaf People (RNID), www.rnid.org.uk; www.deafnessresearch.org.uk.


Sudden loss can strike anybody

Inner space: The workings of the ear can get infected

1. Sudden sensorineural hearing loss (SSHL) can affect anyone, but for unknown reasons it happens most often to people between the ages of 30 and 60.

2. Hearing loss affects only one ear in 90 per cent of people who experience SSHL.

3. Many patients notice it first when they wake in the morning or when they attempt to use the deafened ear, such as trying to make a phone call. Others describe a loud, alarming 'pop' just before hearing disappears.

4. Those with SSHL often experience dizziness or a ringing in their ears (tinnitus), or both.

5. Some sufferers recover without any medical help, but many cases are permanent and cannot be resolved through drug treatment (steroids to reduce inflammation or antivirals) or surgical intervention.

6. Fifteen per cent of those with SSHL experience a hearing loss that deteriorates over time.

7. There are hundreds of possible causes and it is rare for a specific cause to be precisely identified. Only ten to 15 per cent of patients with SSHL know what caused their loss.

8. Diagnosis is made after a standard hearing test and from medical history.

9. Possible causes include viral infections of the inner ear, such as mumps or measles, or auditory nerve, such as rubella; trauma, such as a head injury; abnormal tissue growth, including tumours; circulatory problems; and neurologic causes such as multiple sclerosis.

10. A delay in treating this condition will decrease the chance that medication might help reduce the hearing loss.

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Boyzone tour gave me life-threatening hernia, reveals Keith Duffy
By DAVID HURST
Last updated at 5:06 PM on 20th July 2010

At the age of 34, Keith Duffy could be forgiven for feeling daunted at the prospect of a reunion tour with the boyband that made his name almost two decades ago.
'Dancing around without your shirt in front of an audience of screaming girls is all very well in your teens and early 20s,' he says. 'But it's a different matter when you've got two kids and can't spend every moment working on your six-pack.'
After notching up a remarkable six No1 UK singles, four No1 albums and 20million record sales, Boyzone disbanded in 2000. Now a father of two, he was also known more recently as ladies man Ciaran McCarthy in Coronation Street. He admits: 'I had let myself go a bit.'

Keith Duffy with his Boyzone colleagues Stephen, Mikey, Ronan and Shane
The turning point came when the group did a photoshoot last year to announce their comeback, only to face uncharitable comments about how time had not been so kind to them.
'That really hurt,' says Keith. 'But when I saw the pictures, I had to agree. During the band years, I trained a lot. But after the split, I relaxed. I was content and had a bit too much of the good life.
'You don't realise the weight going on, it happens so gradually. But to be brutally honest, I had gone from a 32in waist to a 38in.'
So, before heading back out on the road, along with bandmates Ronan Keating, Stephen Gately, Mikey Graham and Shane Lynch, Keith hit the gym - but, as he was to discover to his cost, a little too hard.
The singer, who lives in Dublin with his wife Lisa, 38, son Jordan, 13, and daughter Mia, nine, first noticed something was wrong while he was running the Flora London Marathon in April to raise money for the National Autistic Society.
The charity has been close to his heart since Mia was diagnosed with the learning disability, which can affect speech, behaviour, motor and social skills, in 2002.
'In hindsight, along with the all the weight training I was doing to get back in shape, I was asking for trouble. But I am the type of person who really goes for it when it comes to exercise,' he says.
He was 16 miles into the 26.5-mile race when he felt an agonising pain to the left of his groin.
'I had just taken off my sunglasses and tucked them into the waistband of my shorts when it happened and at first I thought I'd stabbed myself with the arm of the glasses.
'I was almost doubled over, but I told myself I'd just pulled a muscle. Somehow I carried on running through gritted teeth. I knew if I stopped I wouldn't be able to start again.
'The pain dissipated into a dull ache in my lower stomach - it felt a bit like I'd been kicked where it hurts.'
Astonishingly, despite this, Keith completed the race in three hours and 52 minutes. 'I was elated to finish and sure the discomfort was just a muscle strain that would disappear. Besides, everywhere ached.'
But over the following days of rehearsals with Boyzone back in Dublin, the pain got worse.
'I was doing my best during the dance routines but the guys could see I was wincing with agony. There was the constant dull aching and a sharp stabbing pain on the left side and a slight twinge on the right, too, every time I tried to sit or stand. In the end, Ronan forced me to go to A&E.'
Keith was immediately taken for an ultrasound scan, which revealed he was suffering from not one but two inguinal hernias.
'I was shocked,' he says. 'I thought it was something only old men got.'
Hernia is the catch-all name given to a protrusion of body tissue or part of an organ through the surrounding muscles by which it is normally contained. Most develop in the abdomen, when fatty tissue or abdominal organs are able to push through a natural weakness in the abdominal wall.
It is not known exactly why they happen but experts believe they occur because of a weakness in the muscles that exists from birth.
They can be triggered by increased pressure on the abdominal muscles due to anything from heavy lifting, exercise, or even a coughing fit. They may also develop through the diaphragm, the oesophagus - known as a hiatus hernia - the spine, and even the brain.
Inguinal hernias specifically occur through a sheet of muscle in the lower abdomen that supports the reproductive organs, known as the inguinal canal, and about 27 per cent of men will suffer from one at some point (only three per cent of women, whose inguinal muscles are smaller, will suffer a hernia in this place).
'The doctors told me it had been brought on because I had been training too heavily for the tour,' says Keith. 'I was in the gym most days, as well as jogging every day to prepare for the marathon. I'd been pushing myself too hard.
'In hindsight I'd felt twinges of pain for months and during the marathon the hernia fully ruptured, which was why I felt such pain.'
Hernias often cause a visible or palpable lump. In some cases, there are other symptoms resulting from pressure on an organ or an obstruction caused by the hernia.
'Apparently, lumps can disappear and reappear as the tissue slips back into place and then protrudes again, so I never felt a lump,' says Keith.
If left untreated, complications can arise if they become ' strangulated', meaning blood supply to the organ becomes restricted, leading to gangrene, organ failure and even death.
The doctors decided Keith needed an emergency operation to repair the hernias.
During surgery, a small incision is made near the site. The escaping tissue is then pushed back and the weakness in muscle tissue mended. The hour-long keyhole operation is called herniorrhaphy. About 100,000 are performed each year and it is the most common surgical procedure in the world.
The muscle used to be pulled together and stitched under tension - but 20 per cent of these hernias recurred through the same site.
Now, three incisions are made - one in the navel, one an inch below and another an inch below that, through which the camera and surgical instruments are inserted. Modern techniques also involve a fine plastic mesh prosthesis placed over, or under, the defect.
'It's similar to the way your mum would patch the knee of your trousers rather than pulling the edges together,' says surgeon Martin Kurzer, an expert in hernia repairs.
Unless a hernia has already caused complications that make it a medical emergency, as it did in Keith's case, a repair operation is considered elective (non-urgent) surgery. Patients should expect to wait six to eight weeks for surgery on the NHS.
Desperate to get back to rehearsals, and against his doctors' advice, after two days in hospital Keith discharged himself.
'I was sore in my tummy around where the incisions had been and I felt an odd tugging-like tension at the site of the hernias,' he says.
Three days after his operation, Keith was back at rehearsals.
'At first, I just sat with my feet up on the sofa watching the boys do the routines. After a week, I felt able to walk through some of the numbers.
'I was speaking to my doctor all the time. He told me to just listen to my body and not do anything that hurt. Of six weeks of rehearsal, I managed about three.
'By the opening night, I still felt some tension down there but to the naked eye I think it looked like I was completely fit.'
He was also able to take his top off with complete confidence. 'My trainer devised a programme that didn't cause any further damage.
'Sit-ups are out of the question because of the strain they put on the lower abdomen. But today I think I'm in better shape than I was in my 20s.
'Now the tour is over, we'll continue working on our new album, due out in 2010.'
Having had hernias, it is not unlikely that Keith might suffer another one. Less than five per cent of patients experience a hernia in the same place, but about one in five suffer a recurrence in a different place.
He also discovered that it wasn't the first time he'd suffered from one. 'When I called my mum to tell her she said, "Oh, that's happened to you before". When I was a baby, I'd had an operation to fix the exact same thing. So I was predisposed to it happening again.'
About five per cent of male infants will suffer from an inguinal hernia.
'Still today I can feel a bit of tension down there but no pain. I think because I worked so hard straight after the operation, I slowed down the healing process,' says Keith.
Today, his health is paramount and he has left the rock 'n' roll lifestyle behind him.
Enlarge
How Keith Duffy's hernia operation was carried out
Mia, one of an estimated 500,000 UK autism sufferers, is also a source of inspiration. Having attended a special school for children with learning disabilities, she is now in mainstream education.
'She has come on in leaps and bounds, considering she didn't speak until she was five,' he says. 'I want to be my best for her.'
He sticks to a diet low in saturated fats, fried food and refined carbohydrates (such as white bread and pasta). 'I do love my steak and chips, and Mexican food, though. And I have a weakness for Jelly Babies,' he admits.
Keith, who is currently on holiday with the family in Florida, says: 'I'm 35 this year. I can't party like I used to. If I stay up until 5am, my performance the next day will suffer. And to be honest, I want to be able to spend all my spare time with my wife and children, not recovering in bed.
'I'm in the best shape of my life. I feel great, and I want to stay that way now. I might even try another marathon next year - if I can forget just how painful the last one was.'
• To donate to the National Autistic Society visit www.nas.org.uk.

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MELANIE SLADE : ME AND THEO WALCOTT ARE THE PERFECT MATCH

Melanie is studying to become a physiotherapist and has no interest in being a WAG
Wednesday January 27,2010
By David Hurst
MELANIE Slade is not your typical WAG. She is a down-to-earth student with a modest taste in motors and she couldn’t be happier with her superstar boyfriend Theo Walcott.
Melanie Slade doesn’t want fame – or even think she deserves it.

“Pop stars or footballers have a reason to be celebrated, but I don’t,” says the 21-year-old girlfriend of England and Arsenal star Theo Walcott. “I have no interest in being famous just for the sake of it.”

Since the couple met four years ago (she was working in a shop when he gave her his number) Theo has risen from playing for lowly Southampton to being one of the world’s best-known footballers, earning a reported £3 million a year.

In 2006, at just 17, he became the youngest ever player for England, and in September 2008, the youngest to score a hat-trick for England (against Croatia).

These record-breaking feats rocketed him to superstardom – and took Melanie up there, too.

“It’s easy to get carried away in the world of Premiership football,” says Melanie, chatting in Theo’s Hertfordshire home, where she’s waiting for him to return from Arsenal’s training ground.

“But both my family and Theo’s are really grounded. They wouldn’t let us get full of ourselves.”

Her father, John, is boss of a PR company and was mayor of Southampton in 2006, while her mother, Sheila, is a teacher.

One of four siblings, Melanie says she’s very close to her sisters, Sarah, 24, and Emma, 22, and 26-year-old brother Steven.

While technically a “WAG”, Melanie is clearly uncomfortable with the tag. And to be fair to her, she’s far from a natural fit for the term.

“Just because I started dating Theo, it didn’t mean I was going to go shopping for the rest of my life,” says Melanie, who is studying for a physiotherapy degree at St George’s, University of London.

“It’s never been on my agenda to quit my studies and move in with Theo. It’s important to have something to fall back on. I study hard at uni and wear jeans and trainers there just like everyone else – and I am treated just
the same, which is exactly how it should be.”

In fact, Melanie’s so conscious of fitting in with her fellow students that she rejected her recent 21st birthday present from Theo – a £140,000 Ferrari.

Apparently, she felt too conspicuous driving the luxurious car, preferring to stick with her far-less-flashy white VW Beetle.

Melanie currently shares a flat in Merton, south London, with her sister Sarah, who was diagnosed with kidney cancer at the age of 17.

Fortunately Sarah recovered, but her stay in hospital would change the course of Melanie’s life.

“I saw physios helping Sarah move and noticed how important it was to her recovery,” she recalls. “I’d love to help people in the same way.”

These days, she is an active supporter of Cancer Research UK and is often seen on the charity’s sponsored runs.

And thanks to her sporty image, Melanie’s also the face for outdoor clothing company Helly Hansen, promoting its new range and the opening of its first UK shop in Manchester last year.

Speaking to her, you get the sense that she inhabits two very distinct worlds.

She can spend all day studying, then go to Wembley in the evening to watch her boyfriend at work, before going to swanky players’ parties where she’ll mingle with some of the world’s biggest celebrities.

She describes Arsenal manager Arsène Wenger as “very polite and proper, a real gentleman”, while England manager Fabio Capello “has a real sense of awe about him. You really know he’s the boss.”

Of course, she’s met all the big-name players –Wayne Rooney, Rio Ferdinand, Michael Owen – and been to the Beckhams’ for dinner. And she has nothing but praise for her fellow WAGs.

“They’re all fine and not shopaholics like they’re portrayed,” she says. “Cheryl Cole has been really helpful and Victoria Beckham has been very supportive, especially when Theo was picked for the 2006 World Cup and I suddenly found myself in the spotlight.

We spoke about how she and David manage all the attention. She told me it was essential to keep some things personal.”

Of all his Arsenal team-mates, Melanie says they are closest to Gaël Clichy and his partner, Charlene Suric.

“We’ll go to restaurants and bars, usually down-to-earth places. I’m lucky as Theo isn’t bothered about nightclubs.”

Family, it seems, is the most important thing to the footballer – and it’s the same for Melanie. So does she envisage having one of her own sometime soon?

“I’d really love to, but only after I’ve established myself as a physio,” she says. “We’re really happy together, but I’ve got some serious studying to do, so having a wedding to organise as well would be really difficult. We’ll wait until after I’ve graduated.”

Until then, it’ll be business as usual for the grounded couple.

“Theo’s a chilled-out person who takes everything in his stride,” says Melanie.

“When he comes back from training or a match we have a cuppa and a chat. He’s not some international star, he’s Theo my boyfriend. I think we’re evidence that, if you want to, you can be a part of the football world and still lead a normal life.”

Melanie is the face of Helly Hansen’s new luxury lifestyle range Ask & Embla (www.hellyhansen.com). For details on Cancer Research UK, visit www.cancerresearchuk.org.

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It was just a small scratch from a cat - but six days later my heart stopped
By DAVID HURST
Last updated at 10:41 PM on 12th December 2011

A week after Jon Taylor was scratched by his mother-in-law’s cat he was undergoing emergency surgery — and given just 48 hours to live.

Bacteria from the claw had entered his bloodstream, triggering septicaemia.

Jon recalls: ‘I was in the kitchen when the cat jumped from our oven on to my foot and left two 6cm scratches. After putting TCP and a bandage on, I thought nothing more of it.’


'Six days after being scratched, I was jaundiced and very unwell. I had a raging fever and was very weak,' said Jon Taylor

In fact, the break in his skin had allowed a strain of streptococcus bacterium from the cat’s claw into Jon’s bloodstream.

It multiplied, settling on the aortic valve in his heart — which controls the flow of blood around the rest of the body.

Two days later Jon, 44, thought he was coming down with flu. The day after that, he felt so ill he took to his bed.

‘I’m usually resilient — but I was surprised at how much this “flu” had knocked me for six,’ says Jon, who lives with his wife Stephanie and their three children near Okehampton, Devon.

The next night he was woken by a pulsating pain in his left ring finger — by the next morning it was swollen and had turned purple.

Even then, market wholesaler Jon wasn’t unduly concerned, thinking he might have damaged it at work. But swellings like this, away from the original site of injury, is a typical symptom of septicaemia (or blood poisoning).

Septicaemia occurs when bacteria multiply in the blood, causing widespread inflammation that damages vital organs. If not treated promptly, septic shock can develop, where bacterial toxins cause blood pressure to plummet.

Eventually, the organs start to fail, and it results in death in more than half of patients. Bacteria can enter the bloodstream via open surgery and tooth abscesses, as well as burns — and scratches.


The doctor told Jon he had just 48 hours to live

‘I still didn’t think my symptoms were anything to do with the scratches, as they looked like they were healing,’ says Jon.

‘But six days after being scratched, I was jaundiced and very unwell. I had a raging fever and was very weak.’

His family became so concerned they called an ambulance and Jon was rushed to hospital.

‘By this point I was drifting in and out of consciousness, and my memory of being admitted is hazy,’ he says.

Jon was taken to intensive care, where tests showed his heart, lungs, liver and kidney were about to fail — at one stage his heart stopped beating for a few seconds and had to be restarted.

He was told his aortic valve needed replacing.

Jon says: ‘The doctor didn’t mess about, he told me if I didn’t have the surgery, I’d be dead in 48 hours. My wife was terrified and even in my state I was pretty frightened.’

It is important to pay attention to scratches, no matter how small, advises Dr Suranjith Seneviratne, an immunologist at the Royal Free Hospital, London.

An infected scratch will usually start to look red and infected, and the lymph node will start to swell near the wound after ten days. This will be followed by fever, fatigue, headaches and, in some cases, a loss of appetite, enlarged spleen and sore throat.

Worryingly, Dr Seneviratne adds: ‘A scratch can look like it’s healing, but the bacteria could have travelled to another site. Symptoms can often be seen away from the scratch, because of the incubation period — usually a few days — as the bacteria multiply and divide.’

The bacteria can settle on the heart, liver, brain, kidney and lungs, with those with a low immune system — such as the elderly, babies or someone with an existing illness such as cancer or diabetes — being most at risk.

Certain medications can suppress the immune system, including chemotherapy and steroids (used for conditions including rheumatoid arthritis and multiple sclerosis).

‘With otherwise healthy people, normally their immune system would kill off the bacteria,’ says Dr Seneviratne.

Jon had been diagnosed with a heart murmur in his mid-30s, caused by a weak valve, and doctors believe that bacteria from the cat’s claw had settled on this weak spot.


It is important to pay attention to scratches, no matter how small

After his operation, Jon was given six weeks of intravenous antibiotics — but it took a further 11 months until he was fit enough to return to work.

It’s not just animal scratches that can cause problems — so, too, can splinters or thorns.

Debbie Penwill, who runs a livery stable, developed a bacterial infection after scratching herself at a wedding reception.

‘Someone messing about lobbed a chair cushion that was backed by a thin piece of wood,’ says Debbie, 29, from Tavistock, Devon.

‘It hit me between my ankle and knee, causing a painful bump and scratch just a couple of millimetres long. It didn’t look deep, so I didn’t wash it and thought nothing more of it.’

But six days after the wedding in September, she woke up with a rash all over her body.

‘I’d had a flu-like virus a few weeks before and put it down to that.

‘But the next day the rash was really red and I was sick. I went to the local hospital where one doctor said it could be scarlet fever, but his colleague said it wasn’t.’

She was given moisturising cream, as her skin felt dry. But that night she couldn’t sleep because of the pain. ‘It was like I’d been dragged through stinging nettles — itchy and burning. I was scared as I didn’t have a clue what it was.’

At 4am she went to Derriford Hospital in Plymouth.

‘I had a blood test and nine different doctors had a look at me. They decided it wasn’t an allergy, but they still didn’t know what it was.’

Debbie was sent home with steroid tablets and some other skin creams.

In a couple of days the rash had calmed down, but then it merged into purple and black patches — which she later discovered was due to bacterial toxins circulating in her body.

Debbie’s skin became sore and tender for a few days.

‘I felt like a 90-year-old, as I was in pain when I walked and could barely get out of bed,’ she says.

Debbie saw another doctor after about three weeks, and by then her symptoms were a faded rash. A blood test showed she’d had the streptococcus bacteria.

It must have entered her bloodstream through the small scratch — the rash was scarlatina, a bacterial illness linked to scarlet fever. It develops only if someone is susceptible to the toxins produced by the streptococcus bacteria.

‘I had to take three weeks off work, and as I’m self-employed I lost a lot of money,’ she says.

‘My skin is still peeling nine weeks later. But I’m just glad to know what it was. I’ll definitely clean any scratches from now on.’

THE DANGER SIGNS OF SEPTICAEMIA
If a scratch becomes swollen, hot or inflamed and you start getting chills or a fever, seek immediate medical attention as this could mean it is infected.

‘The dirtier and deeper the scratch the more likely there will be an infection,’ explains Hilary Longhurst, consultant immunologist at St Bartholomew’s Hospital, London.

‘The classic case we might see is the old lady doing her roses who gets a thorn scratch after putting manure down.’

She adds: ‘With septicaemia, look out for hot swelling, pain, feeling unwell, or swollen lymph glands near the scratch. If it’s not improving go to your doctor or A&E immediately.

‘Depending on its severity, oral or intravenous antibiotics will usually clear up an infection, but the sooner it’s caught the better.’

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Mould in your home can kill as actress Brittany Murphy's death linked to fungus in LA mansion
By DAVID HURST
Last updated at 8:06 PM on 28th July 2010

A more unlikely end to the Hollywood dream could not seem possible - but this week it was reported that the deaths of actress Brittany Murphy and her British screenwriter husband Simon Monjack might have been caused by mould growing in their luxury Los Angeles home.
Murphy, who starred in such films as Clueless and Sin Sity, was only 32 when she died last December - at the time there was speculation her death was linked to drug abuse or an eating disorder.
When Monjack died in May at the age of 40, his death was blamed on heart failure.
Now, in both cases, the cause of death has been recorded as pneumonia and anaemia, and experts have suggested mould could be to blame, damaging the couple’s respiratory systems.
U.S. public health officials are said to be inspecting the mansion Murphy and Monjack lived in.
It may seem extraordinary, but in fact mould in the home is a common health problem, affecting tens of thousands of people in the UK, explains Malcolm Richardson, Professor of medical mycology (the study of mould) at the University of Manchester.
‘Britain is especially prone to moulds, due to it being damp and cold so often, and because a lot of the housing is old,’ he says.
‘Yet compared with countries such as America and Finland, there’s not much awareness of mould or the health damage it can cause - it can be fatal.’
There are hundreds of thousands of types of mould, he says, but only about ten types cause health problems, commonly sinusitis, bronchitis and other respiratory conditions, as well as allergies.
Mould is a form of fungus which forms anywhere there’s moisture trapped in the air — typically around showers, dishwashers, washing machines, tumbledryers and in kitchens, although it is also often found in the moist soil of pot plants.
Any flooding is likely to lead to mould. If it is growing rapidly, the evidence will be visible in months - but it can take years to form and to be noticed.
Stachybotrys chartarum, which is also known as the toxic mold. This fungus may produce spores which are poisonous by inhalation
‘The common places for mould to grow in houses is wallpaper, flooring, behind wall tiles and on window frames,’ explains Professor Richardson.
He adds: ‘It can form in any poorly ventilated house, no matter how grand or ordinary, but it’s especially likely where there is moisture leaking.’
A leaking radiator is often a mould hotspot - you may not even be able to see that a radiator is leaking, but even a small leak can be enough to wet the back wall and the carpet beneath.
Professor Roy Watling, an authority on fungi and formerly head of mycology at the Royal Botanic Garden, Edinburgh, says: 'When you walk around on the damp carpet, mould spores are released into the atmosphere, which you can then inhale.
'Normally the immune system detects the spores and helps you to get rid of them by coughing or sneezing.
‘But some people with poorer immune systems are unable to reject the spores, and so they germinate in their lung tissue, causing inflammation.
‘Those most at risk of health problems caused by household moulds are children and babies, the elderly and those in poor health.’
Breathing in mould spores can have one of two effects - it can cause an infection, which usually strikes people with a weakened immune system.
‘Mould is an opportunistic fungus, and grows aggressively in the body, stopping the organs working properly - so it can be lethal,’ says Professor Richardson.
Mould can also cause allergic reactions, particularly asthma, as the immune system reacts to the spores when they make their way into the upper airways and sinuses.
Symptoms of a mould problem include coughing, constant tiredness, eye and throat irritation, headaches, skin irritation or nausea.
TIPS TO PROTECT YOUR HOUSE
The best way to prevent mould is to open windows every day, use extractor fans and repair anywhere damp is getting in or lingering - such as roofs, cracked wall tiles and windows. ‘Once mould has formed bleach is the best way to get rid of it,’ says Professor Richardson. ‘There are biocides - a pesticide for fungus - that are effective. You do have to be careful with these as they in themselves can be dangerous to health.'
You can also scrub down black moulds in the bathroom or kitchen with a copper fungicide, found at garden centres, adds Professor Watling. These can be diluted and dabbed on affected areas.
In bathrooms and kitchens, use paints that contain mould inhibitors, says Professor Watling.
In lofts, wasp, and bird nests can be prime spots for mould formation. Spores in lofts can drift down into bedrooms. Contact environmental agencies for help.
For Christine and John Frost, from mansfield in Derbyshire, it comes as no surprise to learn that mould can have a devastating effect on health.
Christine, 62, first noticed black mould on a wall in their living room three-and-a-half years ago.
Environmental health experts told her that the bungalow they have lived in for seven years was riddled with two types of mould due to condensation.
‘The mould had spread everywhere except the bedroom. It was even in our carpets, curtains and some of our furniture that was only a few years old,’ she says.
She adds: ‘We had to get rid of our armchairs, even though you couldn’t see the mould because it was inside. It was heartbreaking.
‘I was told that it was caused by moisture in the air due to cooking and bathing, but I have windows open all day, even on the coldest days.’
John, 77, a former transport manager, has suffered from chronic obstructive pulmonary disease for eight years, a progressive illness that affects the lungs and makes it hard to breathe.
The mould problem in his home has been extremely worrying. As his wife, a retired traffic warden explains, this means breathing in mould through the air in their home ‘could be lethal’.
‘At one point our doctor told John to stay in his bedroom because it was too dangerous for him to breathe the air in the rest of our house,’ she says.
‘Last year, I also developed a dreadful cough which hasn’t gone away. I’ve never had a cough like this before.
‘The mould in our house totally destroyed us. It was just horrendous.’
Then, last year the couple had their roof retiled and the mould miraculously disappeared. The Frosts’ home has now been mould-free for several months.
It means John can access the entire house, but both he and Christine still have the health problems that they believe mould caused or exacerbated.
‘Lots of people have mould in this country, and it can cause a lot of health problems as it’s always in the air.
‘If only we’d known the risks, we’d have had the roof done sooner,’ she says.

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Can't stop cat napping? Here's how to stay awake
By DAVID HURST
PUBLISHED: 23:25, 28 January 2013 | UPDATED: 07:53, 29 January 2013
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Your eyelids have become irresistibly heavy, you feel your limbs losing strength as you sink back into your chair.
You’re not alone — 34 per cent of us fall asleep during the day without intending to, or struggle to stay awake while doing things, according to the Great British Sleep Survey.
From the snorer at the theatre to the noble men and women nodding off in the House of Lords, we just can’t keep our eyes open. So what’s causing your daytime drowsiness — and should you fight the urge to snooze? Here, experts reveal the latest thinking.
If you find yourself nodding off uncontrollably or feel sleepy all day, you may be sleep deprived
WE’RE PRIMED TO FEEL DOZY AFTER LUNCH...
The natural energy slump in the afternoon is down to our internal body clock. The moment we first wake up our bodies start releasing the sleep hormone melatonin in preparation for sleep.
Meanwhile, the part of our body clock that drives wakefulness tends to build in the late afternoon. There may be a window of time when the drive for sleep has been building for hours and the drive for wakefulness has not yet kicked in.
‘We’re not being told yet to keep awake by the body clock, so we feel like dozing,’ says Russell Foster, professor of circadian neuroscience at Oxford University.
Genes may play a part, says Dr Guy Meadows, director of The Sleep School in London. ‘People will know if they’re an owl or a lark. I’m a lark, wide awake at 6am, but come the afternoon I’m prone to feel like I need a doze. Owls are more likely to doze in the morning.’
...BUT WORRY IF YOU FEEL SLEEPY ALL DAY
If you find yourself nodding off uncontrollably or feel sleepy all day, you’re probably sleep deprived. ‘Being dozy all day is indicative of disturbed or inadequate sleep,’ says Professor Jim Horne from the Sleep Research Centre at Loughborough University.
If you’re not getting the required amount of sleep (which for adults is between seven and eight hours), the next day will reflect on the previous night.
Your first port of call should be to tackle anything that’s disturbing your sleep, such as checking your emails in bed, says Dr Meadows. ‘Get such distractions sorted, and you’ll often find the urge for daytime dozing goes.’
Excessive sleepiness, napping or falling asleep in the daytime is often a sign of a sleep disorder such as bruxism (teeth grinding) or insomnia — the Epworth Sleepiness Scale questionnaire helps assess this.
This measures tiredness by asking how likely you are to doze in situations such as reading, so you can work out if you need help from a GP or sleep clinic. Find the questionnaire at britishsnoring.co.uk.
IT COULD BE YOUR MEDICINES
Some medications can cause daytime drowsiness — these include anti-depressants, anti-histamines and cold remedies.
Products containing older sedating antihistamines such as diphenhydramine are most likely to cause drowsiness. Doxylamine (found in Syndol and Propain Plus) or promethazine (Night Nurse, Avomine) can cause sleepiness, too.
Some people have a genetic susceptibility to these ingredients that makes them more prone to this effect. Taking medication at night may cause drowsiness the next day as some drugs take hours to disappear from the body.
...OR BEING A WOMAN
‘Women suffer more from insomnia than men at a ratio of 65:35,’ says Dr Meadows. ‘This is partly because women have more hormonal disruptions affecting their sleep and they also tend to worry more. This not only means that their minds are more likely to race at night, but it could also result in higher levels of the stress hormone cortisol, which can make it harder to fall asleep.’
However, daytime dozing is more common among men than women — and more common among lower earners than higher earners, according to a 2009 survey from the Pew Research Centre in the U.S.
The survey of 1,500 adults found 38 per cent of men and 31 per cent of women said they’d taken a nap in the past 24 hours. Among those over 50, 41 per cent of men doze, while just 28 per cent of women do.
Among people earning more than £62,000, 33 per cent said they doze regularly, while 42 per cent of those making less than £19,000 nap during the day.
...OR YOUR AGE
It’s a common misconception that older people fall asleep in the day because they need more sleep. In fact, it’s largely because they don’t get enough sunlight that helps them stay awake.
‘Also, as we get older our body clock is likely to get less sensitive to light and its alerting factors,’ says Professor Foster.
‘Then there’s the fact older people suffer more from bad backs, arthritis and weaker bladders that mean they don’t get a good night’s sleep.’
BEWARE THAT WEEKEND LIE-IN
Many of us can’t resist a lie-in on the weekends, but be warned: by getting your sleep cycles out of rhythm, you could be putting yourself at risk of daytime tiredness. ‘Most tiredness happens because we are bad at sticking to regular bedtimes,’ says independent sleep expert Dr Neil Stanley.
The body has an accurate natural clock — this is why we sometimes wake up just before our alarm goes off. If the body clock is in rhythm, in the hour before waking we start to enter a lighter cycle of sleep known as REM.
‘Being woken abruptly outside of REM sleep, such as by an alarm clock, can leave us feeling groggy from this deep sleep we’ve been in,’ says Professor Foster.
And if you’re sitting on the train 30 minutes later, you might feel a strong urge to doze — to finish off your sleep properly so you wake at the right part of it.
SNORING CAN BE A DANGER SIGN
If you feel sleepy in the day no matter how early you go to bed at night, it could be a sign of Obstructive Sleep Apnoea — especially if you snore, too. The condition affects up to 4 per cent of the population, says sleep specialist nurse Beccy Mullins.
‘It’s common in overweight people. As they sleep, their airways start to collapse, often starting with loud snoring when the airway vibrates as it narrows, before total collapse, and they stop breathing for anything from ten to 60 seconds.
‘Their oxygen levels drop so low the brain initiates breathing to begin again. Sufferers are not usually aware of the problem, but they don’t get refreshing sleep due to the interruptions.
‘Despite thinking they’ve had a good night’s sleep, they wake feeling tired, un-refreshed and it persists throughout the day, day after day.’ Long-term, it’s been linked to a greater risk of high blood pressure, type 2 diabetes, heart attack and stroke. As well as loud, persistent snoring, it’s more likely in people who are overweight — seek advice from a GP.
Treatment is with Continuous Positive Airway Pressure — you wear a mask over the nose at night, while a bedside blower unit pumps in air to ensure the throat remains open.
STEER CLEAR OF JACKET POTATOES
So if it’s not related to a medical problem, how can you tackle the sleepiness? If you’re facing a big meeting and are worried you’ll get that familiar urge to nod off, Dr Meadows advises getting lots of natural light by going outside.
‘This informs the brain it’s still daytime and releases cortisol, the waking hormone.’
Think about what you eat, too. ‘If you have a high-carb lunch, such as a jacket potato and beans, blood sugar levels will go up but then fall,’ says Dr Meadows. ‘We enter a state of hypoglycemia, which is a deficiency of glucose in the bloodstream.’
Colin Espie, professor of clinical psychology at Glasgow University and director of the Sleepio Clinic, advises drinking plenty of water: ‘If dehydrated, we slow down to conserve the hydration we have.’
FINALLY, OPEN YOUR WINDOWS
‘Your environment might not be conducive to wakefulness, such as if it’s hot or stuffy,’ says Professor Espie.
‘Or you’re under-stimulated with not enough to do. If these factors are combined with when you’ve hit your body clock low point, you are vulnerable to dozing.’


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Electrodes in the brain put Alyce back in the saddle: Pioneering op offers normal life to young rider who had 100 epileptic seizures a day
By DAVID HURST
Last updated at 10:03 PM on 17th December 2011

From the time she was a toddler, Alyce Jayne Stockdale endured up to 100 epileptic seizures a day.

Now aged 21, she hopes a pioneering operation that involves inserting electrodes into the brain could give her a normal life. Following recent approval for the technique’s use in Europe, Alyce Jayne became the first epilepsy patient in Britain to have the procedure.

And although it may be a year before the full benefits are felt, she has recently experienced a seizure-free day – something that had become almost unimaginable. A keen horserider, she plans to be back in the saddle this weekend.

Alyce Jayne, from Burnley, Lancashire, has suffered with epilepsy since she was 18 months old. Last year, her condition worsened and she started to have difficulty speaking. She now needs round-the-clock care from her mother Ann, 54.

Alyce Jayne says: ‘My major seizures were brought under control 14 years ago by medication. But I still get between 50 and 100 drop attacks every day, where I lose consciousness and slump for a second. It’s like a puppet having its strings cut. It’s affected my social life, education, hobbies – everything.’

Epilepsy affects more than 450,000 people in the UK. Most frequently starting in childhood, it is a long-term incurable neurological condition but seizures can often be controlled using medication. Sometimes, though, there can be severe side effects, such as nausea and depression.

An epileptic seizure is caused by a burst of excess electrical activity in the brain, creating a temporary disruption in the normal message-passing between brain cells. About a third of patients, including Alyce Jayne, do not respond to drugs or cannot have traditional surgery that removes the part of the brain causing epilepsy, because in these patients it would hinder normal brain functioning.

The six-hour operation under general anaesthetic involves a surgeon making two small incisions in the scalp, an inch above the ears. Using a device similar to a dentist’s drill, two holes are made in the skull

But Alyce Jayne’s future has been transformed after she underwent a pioneering operation – known as deep brain stimulation – at Newcastle’s Royal Victoria Infirmary last month.

The six-hour operation under general anaesthetic involves a surgeon making two small incisions in the scalp, an inch above the ears. Using a device similar to a dentist’s drill, two holes are made in the skull.

The surgeon then cuts through the brain membrane by inserting a scalpel through the holes. Using long hollow needles, a thin lead is passed down into the brain. Under X-ray, the surgeon places the two ends, containing four titanium electrodes, in the brain. A small titanium plate is fitted to the skull to hold the electrodes in place. Next, a 3in incision is made in the chest to insert a titanium-cased battery under the skin. Leads from the electrodes are threaded under the skin to connect with the battery.

‘This operation won’t cure Alyce Jayne but we hope it will give back her quality of life,’ says neurosurgeon Claire Nicholson, who carried out the procedure. ‘We hope there’s at least a 50 per cent reduction in her seizures.


The six-hour operation under general anaesthetic involves a surgeon making two small incisions in the scalp

‘Some patients see an improvement in the weeks after the operation simply because the electrodes are in place. That’s why we waited a few weeks until we switched on the system, on December 1 in Alyce Jayne’s case. Then, using a wireless device, we find the best level of electrical pulses for the patient.

‘Some might see an immediate improvement, but in most the best possible effect takes a year. It’s a completely new operation that doesn’t replace any others, but gives a new option to patients who have not responded to other treatments.’

In US research published last year, 41 per cent taking part in a trial showed a reduction in seizures after 13 months. In this country, there are already plans to perform the procedure on at least four other patients in the coming months. It is estimated there are 40,000 epilepsy patients in Europe who could benefit.

Alyce Jayne simply hopes for a normal life – with a job, a driving licence, and time to ride. ‘We’re hoping the operation will bring my seizures under control,’ she says. ‘For the first time, I can look forward to the future.’

www.epilepsy.org.uk

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I had to reboot my heart: The A-ha star with the same cardiac condition as Tony Blair
By DAVID HURST
Last updated at 11:59 PM on 5th September 2009

'I have a restless heart,' announces A-ha keyboardist Magne Furuholmen.
'Sometimes it flutters or skips, and occasionally it beats wildly and out of control.'
They could almost be lyrics from one of the earnest power ballads that propelled the Norwegian pop trio to the top of the UK charts in the Eighties.
After all, it was words like these that featured in hits such as Take On Me and The Sun Always Shines On TV - and helped A-ha to sell in excess of 32 million records worldwide.
But in fact, the 46-year-old former teen heart-throb is talking about the terrifying symptoms of atrial fibrillation (AF), the cardiac condition he was diagnosed with ten years ago after fainting while driving.
Attacks of AF are the result of an electrical fault in the heart muscle that causes it to contract irregularly. This can be due either to a congenital - existing from birth - defect or it can develop as a result of heart disease.
Nearly 50,000 cases are diagnosed each year in the UK and in 2004, then Prime Minister Tony Blair underwent surgery for it.
Sufferers can experience a racing pulse of more than 140 beats per minute - normal resting heart rate for a healthy adult male is between 60 and 80 - as well as fainting and dizzy spells, breathlessness and chest pains.
Attacks can start and stop after seconds or go on for days. If left untreated it can bring about a stroke, heart failure and even death.
The only hope of a cure is risky surgery, so Magne now controls his condition with medication, having twice undergone a procedure in which his heart was artificially stopped and then restarted - 'a sort of reboot', he says.
On tour with bandmates Morten Harket and Paul Waaktaar-Savoy to promote their 'reunion' album, Foot Of The Mountain, he is pragmatic, even good-humoured, about the challenges posed by his health problems.
Magne, who lives with his wife Heidi and their sons Thomas, 19, and Filip, 15, in Norway, says: 'It is sort of ironic that we write ballads about broken hearts and, well, my heart really is broken. Having AF has meant some big lifestyle changes, but you have to carry on living as normally as possible or you'd end up locking yourself away and not experience anything.'
Looking back, Magne believes he had been suffering symptoms for years before his diagnosis. 'I had been prone to fainting for a long time,' he admits. 'I remember once, while we were recording our second album in 1987, ending up on the floor of the studio without knowing how I got there. It sounds strange but I didn't worry that much, as I felt well otherwise. I just put it down to "one of those things" and got on with it.
'I'm a bit of an adrenaline junkie and enjoy climbing and trekking in my spare time, and in the early Nineties I was hiking up a 2,000-metre, glacier-covered mountain when I suddenly felt extremely breathless and dizzy.
'My heart was racing, and I saw dots flickering before my eyes. It should have been particularly scary as I was miles from medical help, but at the time I assumed it was caused by the altitude. I just sat down, waited for it to pass and after an hour continued my hike.'
But things came to a head in 1999, while Magne was driving home following a meeting with record executives. 'Suddenly, I had a strange feeling of drifting away, a bit like I was falling asleep although I wasn't tired. My head lolled forward and then I jerked awake again in shock. I pulled over immediately and realised my heart was racing. Luckily, I was only doing 30 miles per hour so there was no accident. But it was frightening.'
The musician immediately went to a nearby A&E, where nurses discovered his pulse was three times the normal rate. Further tests, including an ECG (electrocardiogram), chest X-rays and a heart ultrasound, revealed Magne was suffering from AF.
'It felt like some kind of sick joke,' he reveals. 'I considered myself fit and healthy - more than that, I took pride in my good health. And I was being told I had a serious heart problem. It didn't really sink in at first.'
AF occurs when normal co-ordination between the atria and the ventricles is lost, causing the heart to beat erratically --arrhythmia. Aside from being alarming and uncomfortable, this starves parts of the body of blood - and therefore oxygen - causing symptoms such as fainting.
If an attack lasts more than 24 hours, the ineffective pumping can allow blood to pool within the atria. This can then coagulate and form clots that can be pumped round the body. Clots may block arteries in the brain to cause a stroke.
Those with AF have double the normal risk of having a stroke.
Doctors initially prescribed Magne the blood-thinning drug warfarin, to prevent such clots from forming. He was also given beta-blockers, drugs that slow the release of the hormones that raise the heart rate. In mild cases, however, aspirin may be all that is needed.
'I was kept in overnight, by which time my heart had slowed down,'
explains Magne. 'The next day I was allowed home, but over the next week I kept having mild attacks.
'I would be sitting doing nothing and suddenly my heart would race and I would feel faint. It was scary.'
After two weeks, the beta-blockers had still failed to control the attacks, so Magne returned to hospital where he underwent a procedure known as cardioversion, in which controlled electrical shocks are administered via pads placed on the chest to stop then restart the heart muscle - Magne's 'reboot'.
It takes about ten minutes and is successful in stopping an attack in 90 per cent of cases. However, it is not a cure and most patients will go on to have another attack.
'They told me if they shocked my heart, it would reset itself and start beating normally,' explains Magne.
'I was awake but sedated so I couldn't feel anything. It didn't work the first time as my heart continued beating wildly, so they had to do it again straight away. That time it worked. Afterwards I felt an aching soreness. It felt like someone had hit me hard in the chest.'
The procedure was a success, and Magne was able to return to the usual rounds of rehearsing, recording and family life. But later that year he suffered another prolonged attack, and was rushed back to hospital to receive further cardioversion.
'I was told if an attack lasted more than 48 hours I would have to have the shock treatment again. The attack started after a Press event and I felt the familiar breathlessness.
'When it didn't go away after a day, I went to A&E, where they gave me warfarin and kept me in for observation. The next day, I was given another reboot, which did the trick.'
Although he has not suffered another long attack since, there have been numerous minor ones. Today his condition is controlled with a drug called flecainide which works by decreasing the sensitivity of the heart muscle cells to electrical impulses.
Magne explains: 'It's been on and off. For the past six months, while promoting the new album, I've had an attack almost every night. I pop a pill and normally it goes away after a few hours. Usually, I'll just read or do some work.
'I always know when one is coming because I start to feel short-tempered. Then my heart starts to beat heavily in my throat, and I feel jittery. Also, I get extremely cold feet and fingers because of the effect on my circulation.'
Paradoxically, Magne has found it is not stress itself that brings on attacks, but that relaxing after a stressful event is the trigger. 'In fact, stress seems to actually override attacks sometimes,' he says. 'Often I can be having one and it will magically disappear just before I go on stage, as the adrenaline kicks in.'
Consultant cardiologist Dr Vias Markides, at the Royal Brompton & Harefield NHS Foundation Trust, one of the country's largest centres for the treatment of heart-rhythm problems, explains: 'AF is a complex condition. It can happen with age, as the heart naturally wears out, or because of an abnormality in the structure of the heart. In some patients the atria become stretched, possibly due to a heart attack, high blood pressure or other heart disease.
'But it can also occur in healthy individuals in their 30s for apparently no reason - this is commonly known as vagal-AF, as it is related to the action of the vagus nerve which electrically links the base of the brain to our heart in a circuit and sends messages to the heart to slow down.
'In fact, we often see this type of AF in very fit individuals, as exercise activates
the vagus nerve. In most cases, we can control the condition and patients can lead relatively normal lives.'
However, the severity and frequency of attacks can increase over time. If drug treatment and cardioversion are ineffective, surgery is an option. During the complex procedure, a catheter is threaded up into the heart via a vein in the groin. A flexible filament is inserted through the tube which is used to heat the area of the heart in spasm. This produces a small scar that blocks nerve impulses, so disconnecting the cause of the abnormal rhythm.
This is seen as a last resort, as about three per cent of patients suffer serious complications --including internal bleeding, a stroke or nerve damage. About one in 1,000 patients die as a result of the operation.
If attacks become debilitating, a pacemaker can be fitted - but this is usually considered only when other options have been exhausted.
'I hope I don't have to go down these roads,' says Magne. 'But I suppose I will have to accept that there may be no other option in the future. Morten and Paul have been great about it - they don't treat me differently. They understand we can't argue too much over songs, because it could end up with me having an attack later.
'Heidi was obviously very worried. She thinks I should avoid touring but understands why I do it. After my family, music is my passion.'
Despite the heavy burden such a condition represents, Magne remains philosophical about his predicament. 'I know it sounds corny, but I'm actually grateful for the experiences AF has given me,' he says. 'After the initial shock wore off I was more than a little depressed.
'I spent a lot of time staring into the fireplace and pondering my imagined lack of a future.
'But it also prompted a much healthier lifestyle: a balanced diet, regular exercise, absolutely no alcohol or coffee for almost three years. The result is that, overall, I'm in much better physical health than before. It has made me more aware of my limitations.
'It's also taught me that I must not internalise stress. I live a much healthier life. I've learned never to turn down a glass of water and to enjoy walking in the woods. I've come to regard my condition as a blessing wrapped as a curse.'
• A-ha's new single, Nothing Is Keeping You Here, is released on September 21 on Universal. www.a-ha.com

What is an AF attack?
'The heart has four chambers: the ventricles, two muscular chambers in the lower part of the heart that pump the blood out, and the atria, the two top chambers which hold the blood returning to the heart,' explains Dr Vias Markides.
'When we talk of the heart beating, we are really referring to the sudden tightening of the muscles so that the chambers become smaller, squeezing the blood out.
'The control of the heartbeat starts with a small clump of muscle cells in the right atrium, called the sinoatrial node. This acts as a natural pacemaker by transporting electrical impulses to the atrioventricular node, located between the atria and ventricles.
'This node determines the rate of contraction of the ventricles. It is the contraction of the left ventricle that produces the pulse rate.
'Atrial fibrillation occurs when the atrioventricular node receives more nerve messages than it can handle. These erratic impulses cause irregular squeezing of the ventricles, the result of which is an irregular pulse.
'In turn, this can cause dizziness, breathlessness and chest pains - although some sufferers do not feel anything until the condition is advanced.
'If the heart rate associated with AF is rapid enough and persists for several months, patients may develop cardiomyopathy - disease of the heart muscle - and ultimately suffer heart failure.
'Initial treatment includes drugs to thin the blood, and medication to bring the heart beat under control.
'If this is unsuccessful, and if the condition is caught early, cardioversion is used. Only in extreme cases is surgery or a pacemaker considered.'
www.bhf.org.uk

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A faulty boiler. A trip to the pool. Even cat fur... What's behind your dizzy spells?
By DAVID HURST
PUBLISHED: 01:15, 12 June 2012
Most of us have felt dizzy at some point, but can usually put it down to something harmless.
It might be from standing up too quickly — causing a momentary lack of blood and oxygen flowing through the head — or low blood sugar, where the brain doesn’t have enough fuel.
It’s estimated that a third of adults suffer from severe dizziness at some stage and there are many reasons for it, from the side-effects of certain medications, to heart conditions and even hay fever.
Here, DAVID HURST investigates some of the most common causes of those funny turns.
MEDICATION
Tablets used to treat high blood pressure, known as ACE inhibitors, can cause dizziness while your doctor is working out which dosage is appropriate for you — as can antidepressants such as amitriptyline.
Both drugs lower blood pressure which in turn trigger feelings of light-headedness.
‘And for some people taking a diuretic medicine (such as furosemide and bumetanide) for a heart condition can sometimes result in dehydration and may lead to dizziness,’ adds Natasha Stewart, senior cardiac nurse at the British Heart Foundation.
‘Therefore it’s important to get the right type and dose to suit your needs.’
Dehydration occurs as the diuretics cause the kidneys to get rid of extra water and salt.
Sedatives are another common culprit; they work by depressing the central nervous system, which in turn slows down brain activity.
Meanwhile, decongestants for a blocked nose work by narrowing blood vessels, which can affect how much oxygen reaches the brain.
IRON DEFICIENCY
Tiredness is the main symptom of anaemia, which occurs when the number of red blood cells is reduced because the body doesn’t have enough iron to produce them.
But the condition can also be characterised by vertigo-like feelings.
This is because red blood cells carry oxygen around the body in a substance called haemoglobin, so anaemia means insufficient oxygen may reach the brain.
MIGRAINE
Migraine sufferers appear to experience dizziness more often than non-sufferers
Migraine sufferers appear to experience dizziness more often than non-sufferers, says Susan Haydon, of the Migraine Trust.
‘It sometimes occurs as part of the “aura” — or warning signs — that many people with migraine have before their headache develops.
‘These may include visual problems such as flashing lights and stiffness in the neck, shoulders or limbs. Each dizzy spell can last from a few hours to several days.
‘Migraines may be caused by blood vessels narrowing in the brain, which may cause the dizziness by reducing blood flow to the area.’
BODY SCANS
The powerful magnetic fields that create detailed images of our insides during a magnetic resonance imaging (MRI) scan can also cause dizziness.
Our balance system is controlled by the inner ear, which comprises a system of narrow fluid-filled tubes called the labyrinth. When we move our head, the fluid in the labyrinth moves, too.
This sends messages to the brain, informing it about the movements and position of the head. You feel dizzy when the right and left balance systems do not work in symmetry and the brain thinks the head is moving when it’s not.
Now researchers from Johns Hopkins University in the U.S. have found the strong magnetic field in MRI scans push on fluid within the labyrinth, causing a feeling of dizziness.
DEHYDRATION
If you’re feeling dizzy, it can be worth drinking a big glass of water to see if it helps.
The brain is mostly made of water, so dehydration means it doesn’t function as well.
Even a 1.5  per cent loss in normal water volume can alter our mood, energy level and ability to think clearly, according to research from the University of Connecticut.
Women are particularly sensitive to the adverse effects of dehydration.
‘Women’s blood is thicker, their body temperature is higher and their heart rate is faster, which might be why they are more sensitive to dehydration than men,’ suggests Professor Lawrence Armstrong, a nutritionist and physiologist from the university.
HEART AND BLOOD CONDITIONS
Many attacks of dizziness are caused by brief drops in blood pressure, leading to a fleeting reduction in the blood — and oxygen — supply to the brain.
This typically happens when getting up suddenly from a sitting or lying position, known as postural hypotension.
However, an arrhythmia — an abnormal heart rhythm — can also disrupt the blood supply to the brain, as can a heart rate that’s too fast or too slow.
In mini strokes (which affect around 50,000 Britons a year), a blood clot passes through the brain (in a full stroke there is a complete blockage) and can cause dizziness due to the temporary slowing down in the circulation of blood and oxygen.
SWIMMING
Water inside the ears is a fact of life for swimmers. But if it interferes with the finely balanced workings of the inner ear, dizziness can last for hours or days until the water has drained out.
Wearing earplugs during a swim will help prevent this. And according to the American Academy of Otolaryngology (ear, nose and throat), feeling tense before or during swimmimg can reduce the blood circulation to your brain, resulting in dizziness.
ALLERGIES
Certain allergies, including those to peanuts, cats, dust and grass pollen, can make us feel rather wobbly
Certain allergies, including those to peanuts, cats, dust and grass pollen, can make us feel rather wobbly.
‘If you have a hay fever with sinus and middle ear congestion, then you probably would feel dizzy,’ says Dr Adrian Morris, principal allergist at the Surrey Allergy Clinic, Guildford.
‘In this case, the allergy has lead to mucus production in the sinuses and middle ear; they are now blocked and this affects balance and can cause dizziness.’
MENIERE’S DISEASE
Around 40,000 people in the UK suffer from Meniere’s disease, which causes attacks of dizziness lasting anything from several minutes to 24 hours.
‘It can take months, or years, to diagnose this awful condition as doctors can’t see into the inner ear to determine whether it is Meniere’s or not,’ says Sarah Lucas of the Meniere’s Society.
‘It can be a very scary condition.’
The cause is not yet known, although it is possibly caused by a problem with pressure in the inner ear caused by fluid build-up.
Bone abnormalities in the middle ear and infections may also play a part. There is no established cure.
Another condition that can make you feel dizzy — BPPV, or Benign Paroxysmal Positional Vertigo, is thought to be caused by small fragments of debris that, for unknown reasons, break off from the lining of the inner ear and brush against the sensitive hairs, sending confusing messages to the brain.
CARBON MONOXIDE
Poorly-maintained heating appliances such as boilers can produce dangerous amounts of this gas, which can also build up to dangerous levels when flues, chimneys or vents are blocked.
Carbon monoxide prevents the bloodstream from absorbing oxygen.
Early symptoms of carbon monoxide poisoning are related to the fact that the brain can’t function correctly — dizziness is one of the first signs, as well as headache, fatigue, nausea and chest pains.
A study by University College London in 2007 found a fifth of all homes in the UK had at least one gas appliance rated as ‘at risk’ or ‘immediately dangerous’, leaving residents open to the possibility of breathing in carbon monoxide.

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Underarm implant that jump-starts an irregular heart
By DAVID HURST
PUBLISHED: 02:05, 15 May 2012 | UPDATED: 09:46, 15 May 2012
A million Britons suffer from an irregular heartbeat, or arrhythmia, and every year 70,000 die as a result.
All ages are affected, as was shockingly demonstrated by the collapse of Bolton Wanderers footballer Fabrice Muamba in March, and the death of charity runner Claire Squires at the London Marathon last month.
The 30-year-old hairdresser from Leicestershire had reportedly been diagnosed with an irregular heartbeat but refused to let it stop her running.
Now a new implant is set to transform the lives of patients with arrhythmia, even allowing them to take part in ‘stressful’ events, such as marathons.
In a healthy heart, electrical signals cause it to contract and pump blood at a regular speed.
If there is a problem with these signals, the heart beats too slowly, too quickly or irregularly, which is known as an arrythmia.
They are mostly harmless but can sometimes lead to a fatal sudden cardiac arrest, often during strenuous activities because the heart has to work harder, which can cause the electrical signals to go out of rhythym.
Arrhythmia frequently affects people who have a history of congenital heart disease.
However, the number of people with these ‘heart flutters’ is on the rise, especially among younger people, possibly caused by an increase in factors such as excessive drinking or stress.
The Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) is positioned under the armpit.
It detects when the heart is beating irregularly, and has a built-in defibrillator to zap the patient back to life by giving them a controlled electric shock.
Implanted defibrillators such as this have been used since the Eighties.
But there are key differences between the conventional devices and the new one.
The conventional version is implanted under the collarbone and monitors the heartbeat via wires that are passed through a vein directly into the heart.
These wires pose a risk of serious infection and, because the heart muscle moves constantly, there is also a chance that the wires could fracture and need to be replaced.
Consequently, one in five leads will have problems in fewer than ten years — and the surgery to repair this carries a further risk of infection.
The new implant, by contrast, has just one 3mm diameter wire going across the chest under the skin outside the rib cage, meaning there is less risk of infection.
Another advantage with the new device is that patients are less at risk from a ‘false’ shock — around a third of the shocks given by ICDs are unnecessary, triggered by variations in heartbeat that pose no immediate danger to the patient.
However, these shocks can be extremely painful and cause anxiety — some patients have described them as feeling like a horse kick from inside the chest.
‘A patient will physically jerk with shock from either the standard ICD or the S-ICD,’ says Dr Adrian Morley-Davies, a cardiologist at University Hospital of North Staffordshire in Stoke. ‘It feels very painful.’
With the new device, the wire is positioned further away from the heart, so it is less likely to pick up the organ’s electrical ‘noise’, which can trigger a false alarm.
‘The new S-ICD device doesn’t appear to give the false shocks that the old one did,’ confirms Dr Andrew Grace, a cardiologist at Papworth Hospital, Cambridge, who helped to develop the new implant.
‘And it’s not touching the heart, so if an infection did happen, you can take it out without any problems.’
Furthermore, because the wire is not attached to the heart, but is positioned a short distance away, the impulse can spread across the heart, giving a shock that is two-and-a-half times more effective than the standard implant, which gives only a direct ‘hit’.
The battery is also designed to deliver higher energy.
Fitting and maintenance of the new device is also simpler — and cheaper.
Doctors say placing the implant is a more straightforward, one-hour procedure than with the traditional ICD, which is actually half the size but which can take up to three hours to fit (the new device is matchbox-sized).
Studies at Papworth and in New Zealand, published in the New England Journal of Medicine, found the new device — which has been available on the NHS for the past two years — was 100  per cent successful in treating severe arrhythmias.
Sean Rodgers, 43, was among the first in the country to have one fitted.
The housing repair manager and seasoned runner had a cardiac arrest in March 2009, and was effectively ‘dead’ for 15 minutes.
He was saved only because his wife Maria knew how to give chest compressions.
Even so, he remained in a coma for a week. Maria and their two teenage children were warned it was unlikely he would survive.
When Sean recovered, he was told he had Long QT Syndrome, a condition affecting 6,000 Britons, where the heart takes longer than normal to reset its electrics after each beat.
He had the device fitted in January 2010 at the Northern General Hospital, Sheffield.
Ten months later, he had another cardiac arrest. Luckily, this time, he’d had the S-ICD fitted.
‘The S-ICD saved my life,’ says Sean, of Mexborough, South Yorkshire.
‘I got up off the sofa and suddenly felt my eyes rolling into the back of my head before it went dark. But then the device must have kicked in.’
An implanted defibrillator is not the same as a pacemaker, which sends regular electrical pulses to help keep the heart beating regularly.
Instead, it’s like a portable defibrillator that will kick-start the heart back to life if it stops beating, explains William McKenna, professor of cardiology at London’s Heart Hospital and president of the Cardiomyopathy Association.
‘The S-ICD can’t pace the heart, so is unsuitable for those with advanced disease or older patients who also need pacing.’
However, it is suitable for most younger people who have arrhythmias.
‘They are particularly suitable for younger people who are at risk of sudden death but who are very active,’ he adds.
That is something that Sean Rodgers can now appreciate only too well.
‘The S-ICD has given me the confidence to get on with life,’ he says.
‘I even completed the London Marathon this year.
‘It has given me the security of knowing that, if needed, my heart will be given a jump-start.’
For more information, visit bhf.org.uk and arrhythmiaalliance.org.uk


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Why a hot bath could turn your daily pills into a killer dose
By DAVID HURST
Last updated at 12:48 AM on 20th December 2011

When it comes to taking medication, most of us are aware that certain conditions can alter their effectiveness.
For instance, some pills should be taken with or after food, while some are best swallowed on an empty stomach.
But there are other surprising factors that can also influence how a drug works — and some may have fatal consequences.
Be aware that any medication exposed to hot temperatures might cause physical changes that mean they lose potency
Reports this month of the death of Barbara Reynolds, 67, highlights the need to check how we take medication.
The heat of a bath she was taking sped up the absorption of her painkilling fentanyl patches (when she put on a new patch without removing the old), causing a surge of the drug that stopped her heart.
Dr Tim Johnson, a consultant in pain management, says: ‘The effect of the heat on the patches would provide a surge of fentanyl which would anaesthetise you.’
Professor Simon Maxwell, a clinical pharmacologist at the University of Edinburgh and a member of the British Pharmacological Society, says: ‘Many factors can influence the successful treatment of someone on medications.’
Here, with Professor Maxwell’s help, we list what to look out for to ensure medications work safely and effectively.
HOT WEATHER AND BATHS
Medicines absorbed through the skin via patches are done so more quickly in the heat because the blood vessels dilate, increasing blood flow and speeding up the transport of the drug away from the skin and into the body.
This is known to be a risk with painkillers taken this way, such as fentanyl, oxycodone and buprenorphine. So be aware of hot baths and other hot conditions, such as sunny days.
‘This is theoretically true for any patch — from nicotine to HRT patches,’ says Professor Maxwell.
Be aware that any medication exposed to hot temperatures might cause physical changes that mean they lose potency.
Freezing temperatures can cause similar problems. Drugs such as insulin might lose their effectiveness.
‘Freezing destroys the insulin molecules,’ says Professor Maxwell. ‘This could, in theory, stop the drug being absorbed as quickly.’
CRUSHING PILLS BEFORE USE
Some pills have special coatings that affect how they are released
Crushing pills to make them easier to swallow can cause serious — even fatal — side-effects.
Some pills have special coatings that affect how they are released (so they act slowly or regularly).
‘Drugs with a special coating should not be crushed or chewed,’ says Professor Maxwell.
‘This only increases its surface area and so its speed of absorption.’
Specially coated drugs that should not be crushed include morphine, as it could lead to a fatally fast release of the drug.
Nifedipine, used for angina and blood pressure, can cause dizziness, headaches and an increased risk of stroke or heart attack when crushed.
Never take tablets that stick together, are chipped, or have changed colour or consistency, as they may have been affected.
‘Check expiry dates on medication, too,’ adds Professor Maxwell.
EATING THE WRONG FRUIT
Cranberries and its juice can interact with the blood-thinning medication warfarin, given to patients with atrial fibrillation (irregular heart beat).
Cranberries contain large amounts of salicylic acid, present in aspirin, which also thins the blood.
‘Excess blood-thinning can lead to life-threatening bleeding,’ says Professor Maxwell.
Meanwhile, grapefruit and some other citrus fruits such as Seville oranges can interfere with enzymes that break down some medications in the digestive system.
Naringin, naringenin and bergapten — compounds found in citrus fruits — can knock out an enzyme in the gut that usually partially destroys a drug as it is absorbed, transforming a safe medication into a potential overdose.
‘More medication stays in the body, which can increase their strength to dangerous levels,’ says Professor Maxwell, adding that some people have died as a result.
Grapefruit can also affect medications such as high blood pressure drugs and statins, and some antihistamine treatments.
Orange and apple juice can combine badly with tablets such as the anti-cancer drug etoposide, beta blocker atenolol, celiprolol and talinolol, and antibiotics ciprofloxacin, levo-floxacin and itraconazole.
Experts stress that eating a few segments of the fruit is thought to be safe; it is the concentration of the chemicals in the juice that causes adverse reactions. Speak to your GP if unsure.
THOSE EVENING GLASSES OF WINE
Drinking alcohol regularly speeds up the rate at which our liver breaks down compounds — but this also means it processes some drugs more swiftly.
This means the concentration of a medicine in the body is lower than expected, so may not work as well.
Alcohol depresses the nervous system, tranquillising the effect from medications
‘It’s difficult to say how much alcohol will affect things, as we all differ, but as little as two glasses per day could increase the rate at which drugs are metabolised,’ says Professor Maxwell.
‘Warfarin used to treat atrial fibrillation is the best example of a drug prone to this.’
Alcohol also depresses the nervous system, tranquillising the effect from medications. This means the sedation from drugs such as diazepam (Valium), prescribed to treat anxiety, may cause drowsiness and make accidents or falls more likely.
Smoking can have a similar effect on medication. However, its effect is less noticeable.
REACHING YOUR 70s
Age has a major effect on medication.
‘Due to the ageing process our kidney function deteriorates,’ says Professor Maxwell.
‘At 70, our kidneys function two-thirds less efficiently than at 20. As drugs are removed from the body by excretion in urine, medication doses need to be frequently assessed to ensure the right one is being taken — otherwise too much of a drug can build up.’
If someone is taking a medication long-term, the dose will need to be considered at regular intervals.
For example digoxin — which slows heart rate and strengthens heart contractions in people with atrial fibrillation or is used to treat heart failure — can slow the heart, causing nausea and faintness, if taken in excess.
OTHER MEDICATIONS
‘Harmful interactions when more than one type of medication is taken at the same time are common and sometimes lead to admission to hospital,’ says Professor Maxwell.
One medication can change the way another is carried in the blood. This may have an impact on how effective a particular medication is at fighting the condition for which it was prescribed.
Also, the way in which one medication is broken down by the body can be altered by another drug.
If medicines that can have similar side-effects are taken together, there may also be a chance that the side-effects will be additive.
One of the main problems seen is with warfarin, as its effect can be increased by some antibiotics.
Also, some drugs for acid reflux, called cimetidine, which reduces acid production in the stomach, can also cause thinning of the blood. When taken with more blood–thinner warfarin, it can lead to bruises and bleeding.
In rare cases, this could be fatal, as it reduces the ability for the blood to clot and so stop bleeding.


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Remote retreats
By David Hurst, Evening Standard

Last updated at 16:41 03 September 2004

I recently returned from a pilgrimage where I came upon a travesty. Uncle Monty's Cumbrian cottage in the stunning Lake District is in danger of demolition. For those unacquainted, Uncle Monty's countryside getaway is the leading location in the cult 1987 British film Withnail and I. It was 18 years ago that writer and director Bruce Robinson began filming Richard E Grant (Withnail) and Paul McGann (I) as two struggling and spaced-out actors who decide to escape the squalor of their 1969 Camden flat. 'We are drifting into the arena of the unwell. What we need is harmony, fresh air and stuff like that'; says Withnail. Harmony, they decide, is a visit to the remote Cumbrian retreat of Withnail's ruddy, rotund and outrageously camp Uncle Monty (Richard Griffiths). It is known as Crow Crag in the film but is actually a derelict farmhouse called Sleddale Hall, with magnificent views of Wet Sleddale reservoir, 12 miles south of Penrith. Rather excitingly, I discovered on my recent trip that the hall is owned by United Utilities and is, say locals, 'open to offers'. To experience the utter joy of inviting friends to 'Uncle Monty's for the weekend'; would cost you about £180,000, plus more than £100,000 to renovate the property. However, there is a stumbling block. United Utilities wants planning permission granted by the National Park Authority in order to gain maximum profit from the building. A United Utilities spokesperson said: "We continue to explore all options open to us for the future of Sleddale Hall' Locals also say that United Utilities does not really want to sell it to Withnail fans, fearful that thousands of visitors will spoil the beauty spot. In the meantime, Uncle Monty's is falling into such a state of disrepair that it may soon have to be demolished. Like many Londoners, swapping urban foppery for rural foraging didn't come easy for Withnail and I. But in the aftermath of a sodden August and with the promise of a sunny September, the relaxation of a trip to the Lake District and a walk to Uncle Monty's cottage is an enjoyable prospect. To find Uncle Monty's, take the lane out of the village of Shap (M6, junction 39) and park by the dam at Wet Sleddale reservoir. The property is a dot on the hillside across choppy waters. You can almost hear Monty's voice drifting on the wind as he reminisces about 'sensitive crimes in a punt with Norman, who had a book of poetry stained with butter drips from crumpets';. Crow Crag is an hour's walk around the reservoir, past cows that stop munching to stare, mossy dry-stone walls and untouched fields. You can cross the ancient bridge where Withnail attempted fishing with a shotgun. From here it's a steep climb and halfway up is Uncle Monty's dilapidated cottage, complete with a stream running by. The fresh air, peace, views and solitude are quite overwhelming. For hardened Withnail fans this is just the start of the tour. The bull scene was shot on a footpath that leaves the narrow road between Shap and Bampton, and nearby is the farmer's house. Where Withnail hollers: 'I'm going to be a star!'; overlooks Haweswater shores. The spectacular morning view from Crow Crag was filmed between Mardale Banks and Whiteacre Crag. Sadly, The King Henry pub in Penrith - where the two actors blew Monty's money for Wellington boots on quadruple whiskies - was shot at The Crown in Stony Stratford near Milton Keynes. For directions to Withnail locations, visit: pages.zoom.co.uk/peterd/withnail.htm For Withnail-friendly lodging, visit www.mardaleinn.co.uk/with.htm

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Wild about dolphins? Try one of these magical boat tours... By DAVID HURST

To see a wild dolphin leap beside your boat is spectacular. To look one in the eye as it surfs the bow waves is to have a magical sea spell cast that can never be broken.
I had my first encounter in the Shannon Estuary off the West Irish coast. Skipper Geoff Magee told us that the dolphins here had easy meals due to currents sweeping small fish their way and, with appetites satisfied, they liked nothing better than a spot of recreation.
But, he emphasised, they would only show if we appeared exciting enough, and so our exhilaration started.
Our converted fishing boat chugged out into the dark waters, misty drizzle marinating us, all eyes alert to see if the dolphins would turn up.
Geoff told us about the 100 bottlenose dolphins that live here all year round. He thought they performed their spectacular mid-air arches to get a closer look at us. But, after 25 minutes, we had not even had the hint of a sighting.
As we rued our misfortune, Geoff bellowed for us to look ahead and there I saw, for the first time, the wonder of wild dolphins, a swirl of about ten dark fins. Five seconds later, one suddenly leapt to our side, causing a group shrill of delight as it splashed down.
Then these super sea mammals were leaping majestically beside our boat, probably curious at the little land mammals jumping around the deck. Next morning, infected with dolphin fever, I drove to Dingle, visited for decades due to its Irish charm but even more popular since 1984, when a dolphin moved into its bay.
He was named Fungie, after a local fisherman, and it's a wonder that Dingle has not been renamed after him such is the number of dolphin souvenirs and Fungie boat trips.
He must enjoy the attention judging by how often he is there.
I have walked the headland on three occasions and each time Fungie has surfaced in the bay within a minute.
My most recent dolphin trip was to Husavik, Iceland. Here I witnessed several white-beaked dolphins swimming powerfully round our boat, then swiftly with it, for 30 invigorating minutes.
One swam at the bow long enough for me to have a special eye-to-eye moment, the dolphin's smile as broad as mine.
SHANNON ESTUARY, COUNTY CLARE, IRELAND
Setting off in a new 52ft boat from Carrigaholt's harbour, you have a 98 per cent chance of seeing dolphins.
If you are unlucky, you get a second trip free or half your money refunded. Journeys last two hours (up to five daily between April and October) or there's the three-hour Sunset Trip.
Dolphinwatch, Carrigaholt, Co Clare, Ireland. 00 353 65 9058156; www.dolphinwatch.ie; info@dolphinwatch.ie. Adults £12.50 ('18), 16 years and under £6.25 ('9), two years and under free.
DINGLE BAY, COUNTY KERRY
There is only one dolphin here but he's handsome, omnipresent and, along with Hollywood's Flipper, the world's greatest celebrity cetacean.
From spring until autumn, choose from several one-hour boat tours on the quayside (prices vary, but all refund if Fungie doesn't show) or boats can be chartered.
Dingle Tourist Office, The Quay, Dingle, County Kerry, Ireland. 00 353 66 9151188; www.corkkerry.ie/dingletio
HUSAVIK, ICELAND
May to September is the best time to see the dolphins (and whales) and North Sailing takes 20,000 people out a year for trips of up to three hours.
Nordur-Sigling (North Sailing), Gamli baukur, PO Box 122, 640 Husavik, Iceland. 00 354 4642350; www.nordursigling.is; info@nordursigling.is Adults £30, 15/16-year-olds £15, 14 years and under free.
ST DAVIDS, PEMBROKESHIRE,WALES
Cruise into the Irish Sea in search of dolphins, whales and seals. This two to three-hour voyage is comfortable as well as breathtaking and sails three times a day in high season.
Thousand Islands Expeditions, Cross Square, St Davids, Pembrokeshire SA62 6SL. 01437 721721 / 721686; www.thousandislands.co.uk. Adults £50, children £25.
MORAY FIRTH, INVERNESS, SCOTLAND
See the most northerly bottlenose dolphins in the world, sailing from Inverness into the Moray Firth. Trips of six hours are run seven days a week from March to October.
For even more intimate groups of 12 on two-andahalf-hour trips, try the nearby Dolphin Ecosse in Cromarty. Out of season, dolphins can also be seen from the Firth shore at Fortrose, near Inverness.
Inverness Dolphin Cruises, Shore Street Quay, Shore Street, Inverness IV1 1NF. 01463 717900; www.invernessdolphincruises.co.uk; info@invernessdolphincruises.co.uk. Adults £10, students £8, senior citizens £8, children over three £7.50, under-threes free, family £40. Dolphin Ecosse, Harbour Workshop, Victoria Place, Cromarty IV11 8YE. 01381 600323; www.dolphinecosse.co.uk; info@dolphinecosse.co.uk. £20pp, under-threes free.
PERUVIAN AMAZON RAINFOREST
For those who prefer not to sail, Dolphin Corner lodges by the Yarapa River are ideal because the pink river dolphins live in front of the camp most of the year. The best time to see them is from November to June.
International Society for the Preservation of the Rainforest (ISPTR), 3302 N. Burton Avenue, Rosemead, CA 91770, USA. 00 1 626 5720233; www.isptr-pard.org/corner.html; info@isptr-pard.org. Dolphin Expeditions from £1,000pp per week.
PEARL RIVER DELTA, HONG KONG
The Pearl River Delta, between Hong Kong and Macau, is home to 1,000 pink humpback dolphins. Three-hour boat trips from Tung Chung or Tuen Mun have a 97 per cent viewing success rate.
Hong Kong Dolphinwatch, 1528A, Star House, 3 Salisbury House, Tsimshatsui, Kowloon. 00 852 29841414; www.hkdolphinwatch.com; booking@hkdolphinwatch.com. Adults £22 (HK$320), children under 12 £11 (HK$160); under-threes free.
TANGALOOMA WILD DOLPHIN RESORT, QUEENSLAND, AUSTRALIA
A 75-minute cruise from Brisbane, on which you can hand feed the likes of Bobo, Echo and Tinkerbell, some of a pod of wild dolphins that swim by the jetty each night.
Tangalooma Wild Dolphin Resort, PO Box 1102, Eagle Farm, Qld. 4009, Australia. 00 61 7 32686333; www.tangalooma.com; bookings@tangalooma.com. Cruises from Brisbane: adults £34 ($85), children under 14 £18 ($45), under-threes free.

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MY SEX HELL

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Sex addiction is often seen as a licence to behave badly. Tom, 39, a charity worker, is actually typical of the thousands of ordinary people who battle this compulsion. Here, he tells his story to David Hurst

July 2002
I am 32 and a manager of a centre for disabled clients. I have family and lots of friends, but I can’t stop looking at porn online; bondage and ‘rape’ scenes. I rationalise it: I’m a single man with a high sex drive, I’ll stop when I meet someone.

Then I meet Stephanie at a friend’s wedding. We start dating. Most of my relationships before have been based around drink or drugs. Ever since my teens I’d been a heavy drinker and, when I hit 30, I knew I had to do something about it so I went to Alcoholics Anonymous and managed to stop. After that, I dabbled with smoking heroin, but soon the penny dropped that this was another symptom of the same addictive illness, so I went to Narcotics Anonymous. With Stephanie, though, I’m sober, and it feels great. I’m ecstatic about meeting someone who loves me, rather than someone looking for another loser to get off their face with. After five months, I move into her place and we redecorate.

We do normal things: cook, watch films, listen to music, go for long walks. She’s beyond my wildest dreams in every way and makes me laugh loads. I fancy her like mad which is amazing, too.

Now I have Stephanie, I hope that all this darkness and obsession with sex will abate. I’ve been plagued by violent sexual fantasies since I was 13. I’ve no idea where they come from – I’ve never been violent and I have no memory of being abused. After each fantasy, I would feel terrifying remorse. Right up to my thirties, I had as much sex as I could. Drunken one-night stands were ideal – I’d have really dark fantasies during sex and wouldn’t even look the woman in the eye afterwards.

After moving in with Stephanie, I still look at internet porn whenever I get the chance. I stay up until the early hours, mesmerised. When I creep into bed, I cannot hold her. She’s so beautiful, yet I choose to look at depraved images rather than cuddling her.

Then my behaviour escalates. As soon as I get to my office in the mornings, I look at porn. One morning I get caught by a colleague; he’s a bit of a lad and jokes that he gets all his women online. I find myself in a phone box scanning the prostitute cards. I’ve always thought blokes who see prostitutes are sad, but the high, starting from when I dial the number, is better than anything.

I go to a basement studio flat. There are two girls there, presumably for safety. I pay one and go to the bedroom with the other. She’s blonde, early twenties and surprisingly sexy. I act as though I’m chatting to someone in a shop. She’s friendly, but not too chatty. Getting undressed is very clinical, but I just go for it during the sex. It feels amazing to be doing this because it’s forbidden and just sex.

Afterwards, I want to run out of there. I’m shaking with remorse. When I get home, I lie to Stephanie, tell her I had a coffee on the way home. My skin crawls. I vow never to do it again.

January 2007
I’m seeing prostitutes a few times a week. But it’s not about the sex; it’s the preparation, the raw excitement as I tell Stephanie I need some fresh air and rush out. I see prostitutes on the way home from work, when we’ve just finished watching a film or eating our dinner, sometimes when Steph’s gone to bed before me and is asleep. When I get the pull to go, it’s as if I turn into someone else. The high is like being totally out of it on drink or drugs, only more so.

I like younger prostitutes who do anal best, but I’ve tried all sorts. I’m in debt, but I can’t stop. I rationalise that it’ll help save my relationship. I love Steph and we have great sex; it’s more intimate with her. I’m pushing her for anal sex, but she doesn’t want it.

For months now, I’ve been restless. It’s like I have a noose fitted round my neck and each time I’m led by my urges, it pulls tighter. I lie awake thinking about taking my life. It’s the only way I can stop this. The relief I feel at the thought scares me.

I take Steph away for her birthday and propose. I do it because I love her and because I think it will make me change. As we fall asleep cuddling, I try to stop the thoughts, like a poison, seeping through me. I can’t understand why I do things that go directly against the way I feel about commitment. But there it is again, within the hour, that gnawing. I lie awake for most of the night. One evening soon afterwards, Stephanie tells me she’s pregnant. I’m the happiest man alive – until I remember what a lowlife I am.

May 2007
Our wedding is fantastic, but on our honeymoon I discover my compulsions don’t give a shit that I’m now married and soon to be a daddy. I sneak away while Steph’s asleep and drive for hours in search of a prostitute. This is really difficult for me to remember and I’ve tried to blank it out. I saw two prostitutes during our honeymoon.

When we get back, I confess to my AA sponsor. I feel fear and relief. He says that many people are cross-addicted, that he is, too. I ask why we’re sex addicts. He thinks we’re born with addictive minds. I tell him about my dark thoughts and ask where they come from. He says some people think most sex addicts have been abused. I say I haven’t. He explains that if abuse happens before we’re three, we can’t recall it, yet
it will still have an effect.

That evening, he takes me to my first Sex Addicts Anonymous meeting. The people look like the average bunch you’d see at a supermarket. About a third are women and I find this ‘triggers’ me, so from then on, I go to male-only meetings. I relate to most of what I hear, not necessarily the details, but the feelings of compulsion, terror, bewilderment and despair.

One man tells how he called in at gay saunas every evening before going home to his wife and three children; he missed his daughter’s first school play because he was at a sauna.

June 2007
I’ve been free for four weeks now. My recovery’s the most important thing in my life; if I let my addictions win, I’ll lose everything. It’s fairly simple, too, so long as I go to meetings each week and talk to recovering sex addicts every day.Sex addiction isn’t about too much sex or the wrong kind. It’s when sex becomes the organising principle, when every moment is devoted to fantasising, planning, ritualising, enacting – then agonising. The cycle begins when a sexual experience relieves painful anxiety. The first time I had an orgasm, I realised that it could remove me from reality for a while. The next time you feel anxious, lonely, hurt or inadequate, you repeat the process. The sex is doubly intoxicating because of the Russian roulette you’re playing with your job, your relationship, your life. You have to continually raise the stakes to get the same high.

Fear of intimacy is at the heart. Sex addicts are frightened of abandonment, betrayal and rejection. Sharing who we are is a problem because, at our core, we feel unlovable. AA and NA really help; I now realise my main addiction was always sex. Dealing with it directly is why life is taking a much better turn.

I’m advised by my sponsor to confess to Stephanie. It was easy telling her I was a recovering junkie and alcoholic, but a sex addict? It’s an extremely difficult conversation, but eventually she admits to not being surprised. On my sponsor’s advice, I don’t go into details and Stephanie doesn’t ask. We agree to stay married because I’ve committed to recovery.

At times, I feel really low about my past behaviour. I’ve slept with over 100 prostitutes. My sponsor says that all the will in the world can’t change that, but I can ensure I behave decently today.

September 2007
Our baby is born. He’s perfect, but his arrival makes me feel vulnerable. Sex addicts are very susceptible to relapse. We don’t have to buy drugs; we can create the chemicals.

Three months into recovery, I slip. I hardly remember buying the porn magazine, the high was so great. The next day, I find myself in a phone box. I’m shaking as I dial. The girl says she does anal. When I put the receiver down, I cry. I pray for the craving to go away, but it doesn’t. I pick up the phone again. I dial. My sponsor. Twenty minutes later, he’s with me. He reminds me of things to watch out for: anger, loneliness, self-pity… the list is long. I must be vigilant because this illness won’t take a holiday.

I still go to two AA and two Sex Addicts Anonymous meetings a week. I will not be a husband who goes to prostitutes. I love Steph, she has stood by me through all of this. My gratitude for having such a wonderful wife who understands that I am trying to deal with this on a daily basis can’t be put into words.

Contact Sex Addicts Anonymous on
020-8946 2436 or log on to sexaa.org.

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How fit do you think you are?
Whether you work out regularly or are a stranger to exercise, it's best to know what your general fitness level is and identify the areas that need attention. Start with these simple tests. By David Hurst
David Hurst
The Guardian, Tuesday 7 October 2008

Sit-ups reveal abdominal strength.
If you're not a gym member, or don't obsessively wear Lycra and heart monitors while pounding pavements, how do you know how fit you are? Do these DIY tests at home and use them as a guide to your general fitness level, and to identify areas that you need to work on. They have been devised with the help of leading sports scientist Rob Wood and Len Almond, a former senior adviser to the British Heart Foundation National Centre for Physical Activity & Health. It is recommended that you try these at least twice a year. Take note of your scores each time to measure your progress. Make sure you rest enough between each test and don't overdo it - they are tests, not torture. If you have any health concerns, speak to a doctor first. And if you find that you keep getting "poor" in the results tables, you should be seeing your doctor for advice, and considering exercising more regularly.

1 Aerobic fitness three-minute step test

Three-minute step test:women

Three-minute step test:men

Age Excellent to above average Average Below average to poor Age Excellent to above average Average Below average to poor
18-25 <85-108 109-117 118->140 18-25 <79-99 110-105 106->128
26-35 <88-111 112-119 120->138 26-35 <81-99 100-107 108->128
36-45 <90-110 111-118 119->140 36-45 <83-103 104-112 113->130
46-55 <94-115 116-120 121->135 46-55 <87-105 106-116 117->132
56-65 <95-112 113-118 119->139 56-65 <86-103 104-112 113->129
65+ <90-115 116-122 123->134 65+ <88-103 104-113 114->130

You need a watch and a step, 20-25cm high. Keeping a straight back and your stomach tucked in, begin stepping on and off, alternating your feet. Maintain a steady pace for three minutes (perhaps two if you are not sure of your fitness or are over 50), aiming to take around 40 steps per minute. Try to keep a steady four-beat cycle - it's easier if you say, "Up, up, down, down". Rest for 30 seconds, then take your pulse for 15 seconds (place your index and middle fingers together on the opposite wrist's underside). Multiply it by four to get your pulse rate per minute. "The average resting heart rate for a man is about 70 beats per minute, and for a woman 75 beats," says Wood. "As you get fitter, your resting heart rate should decrease."

2 Thirty-second chair stand

Sit in a chair (with a seat height of approximately 40cm) with your feet flat on floor. Cross arms over chest. Count the number of times you can come to a full stand in 30 seconds. This indicates lower body strength.

Women/Men

Good 17+ / 19+

Average 12-17 / 13-19

Poor >12 / >13

The above are indicators for 40- to 50-year-olds. For those aged 20-40, add three to each score. For those aged 50-60, take three off each score, while for those aged 60-plus take five off.

3 Lower-body flexibility

This tests how flexible you are in your hamstring muscles and lower back. Healthier people have better flexibility, resulting in less back pain and fewer strain injuries. Remove your shoes and sit on the floor with your bottom and back against a wall. Keep your legs together and extended in front of you, with the backs of your knees touching the ground. Keeping your chest lifted, slowly reach forward with both hands towards your toes without straining your neck.

If you can reach

Excellent Your ankles or beyond

Good Shins

Average Knees

Poor Thighs

4 Body-fat distribution

(Waist measurement/waist-to-hip ratio)

Use a tape measure to assess waist circumference, measuring around the biggest part, which is usually at belly-button level. This indicates your risk of obesity, which increases the chance of developing illnesses such as diabetes, coronary heart disease, having a stroke and respiratory problems.

Women/Men

Very high risk 110-plus cm / 120-plus cm

High 90-109cm / 100-120cm

Low risk 70-89cm / 80-99cm

Very low <70cm / <80cm

Body-fat distribution is a health indicator as fat stored around the waist poses a greater coronary disease risk than fat stored elsewhere. To reveal your waist-to-hip ratio, measure the waist at its narrowest point, then measure the hips at the widest point. Divide waist measurement by hip measurement. So a woman with a 76cm waist and 106cm hips would do the following calculation: 76 divided by 106 equals 0.72. Women with waist-to-hip ratios of more than 0.8 or men with waist-to-hip ratios of more than 1 are at increased health risk because of their fat distribution.

5 Sit-ups to reveal abdominal strength

Sit-up test: women

Sit-up test: men

Age Above average to excellent Average Very poor to below average Age Above average to excellent Average Very poor to below average
18-25 33->43 29-32 <18-28 18-25 39->49 35-38 <25-34
26-35 29->39 25-28 <20-24 26-35 35->45 31-34 <22-30
36-45 23->33 19-22 <7-18 36-45 30->41 27-29 <17-26
46-55 18->27 14-17 <5-13 46-55 25->35 22-24 <9-21
56-65 13->24 10-12 <3-9 56-65 21->31 17-20 <9-16
65+ 14->23 11-13 <2-10 65+ 19->28 15-18 <7-14

This is an indication of abdominal strength and endurance, which is important for core stability and back support. Lie on a carpeted floor with your knees bent at approximately right angles, with feet flat on the ground. Your hands should be resting on your thighs. Squeeze your stomach, push your back flat and raise high enough for your hands to slide along your thighs to touch the tops of your knees. Don't pull with your neck or head and keep your lower back on the floor. Then return to the starting position. Count how many you can do in one minute and then check the chart for your rating.

6 Skipping skill test

This will show your stamina level. Using a regular skipping rope, try to skip for five minutes (allowing for stops if you get tangled in the rope). How many minutes do you manage?

Excellent 5 minutes

Good 3-4 minutes

Average 2 minutes

Below average 1 minute

Poor less than a minute

7 Walk a mile

Walk for a mile and time it. Try the walk and talk test - if you can walk and talk at the same time, it's likely that you're exercising within your limits.

Good 15 minutes

Average 15-20 minutes

Poor 20+

8 Reaction test

This web-based test allows you to time your reactions. Having quick reactions can help to avoid accidents and improve many sporting performances. Take the reaction test at: www.topendsports.com/testing/reactiontest.htm

9 Upper-body strength

"To measure upper-body strength, count how many press-ups you can do in 60 seconds," says Wood. "Do as many as you can, ensuring your chest touches the floor each time before you push back up. Don't let your back arch." Women with slighter strength can lower their body until their chest is 30-35cm off the floor, or using a kneeling position.

Excellent 25+ Average 10-14

Good 15-24 Poor <10

10 Agility

This indicates how well you can change direction at speed - useful in sports such as football and rugby. It's also a guide to your balance levels, again useful for performing well in many sports. Both are strong pointers to good general health. Stick two 40cm lengths of tape on the floor, parallel and about 40cm apart. Stand with your right foot on one marker and your left foot off the ground. Hop from line to line on your right foot as many times as possible in 15 seconds. It does not count if you miss the marker. Repeat on left foot. Add scores and divide by two for the average.

Excellent 26+ Average 15-20

Good 21-25 Poor <15

• Top End Sports Fitness Training, rob@topendsports.com; topendsports.com

• British Heart Foundation National Centre for Physical Activity and Health, School of Sport and Exercise Sciences, Loughborough University, Loughborough, Leicestershire LE11 3TU. 01509 223259; BHFNC@lboro.ac.uk; bhfactive.org.uk

• If in doubt about any of the tests, consult your doctor beforehand.Remember, if it hurts or you feel faint, stop immediately. If you are over 35 or have a history of heart disease, gain clearance from your doctor before attempting these tests. Always breathe normally and don't hold your breath. Don't exercise if you have a fever or temperature, sore throat (do not exercise for three days), are feeling off-colour or have any medical condition that is unstable. Stop exercising if you have laboured breathing, feel faint, have a racing heart rate that is unusual, experience pains or any signs of distress. It's also more fun and safer to try these exercises with someone else on hand.

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My heart has gone haywire - and all because I'm so tall
By DAVID HURST
Last updated at 9:51 AM on 15th December 2009

When the England rugby legend Bill Beaumont went for a routine knee op, the last thing he expected was to be told he had a heart problem.
'I'd only gone in to have some painful cartilage in my knee trimmed off and was meant to go home that day,' says Bill, 57. 'But just before I was discharged, I was told I needed to see a cardiologist.
'Because I'd had a general anaesthetic, they'd run an ECG - a test that measures your heart's electrical activity - and mine wasn't beating properly.'
Further checks a week later showed Bill had atrial fibrillation, an irregular heart beat. Around a million Britons have the condition, which becomes increasingly common with age.
More than 1 per cent of people over 60 are affected, with the number rising to nearly 10 per cent of those over 80. Symptoms include dizziness, palpitations and breathlessness, though often there are no signs.
Bill was one of the lucky ones because his atrial fibrillation was diagnosed. 'Many people like me have this condition without knowing it,' he says.
Untreated, it can be fatal - as many as 5,000 people die every year as a result. Atrial fibrillation is a condition that can be detected easily by taking your own pulse. But like many people, it had never occurred to Bill that he should do this.
'I was lucky that I'd had a heart scan for a different reason,' he says. 'I may never have known until it was too late. Now, I check my pulse a couple of times in the morning and a couple of times in the evening.'
Though Bill was not aware of having any symptoms, looking back he realises he'd had some early warning signs.
'I'd been slightly out of breath sometimes over the previous few years when I was doing exercise,' says the former England rugby union captain.
'But I'm not an excessive smoker or drinker - I might have a few pints after watching rugby at the weekend, but that's all.
'At the time, I'd put it down to getting older and being a couple of stone overweight.'
Bill's reaction to his diagnosis was practical. 'I thought: "Right, they've found I've got it, so now they'll get it sorted.'''
In fact, it's taken eight worrying years of different treatments to finally correct the problem.
Atrial fibrillation is caused by faults in the heart's electrical system. In a healthy heart, the electrical impulses are fired off at regular intervals of 60 to 100 per minute when resting and faster during exercise.
These impulses cause the atria, the upper chambers in the heart, to contract and pump blood.
In atrial fibrillation, these impulses are fired off randomly. As a result, the atria only partially contract, but do so rapidly (up to 400 times a minute) with varying force.
The heart's efficiency is reduced and oxygenated blood can't get to the areas that need it, causing symptoms such as dizziness and breathlessness.
While the exact cause of atrial fibrillation is unknown, family history can play a part and lifestyle factors are implicated - drinking too much alcohol or caffeine can be a trigger, as can being overweight and smoking.
But it seems that Bill's well-built 6ft 3in frame might also have been to blame.
'One of the interesting things about atrial fibrillation is that it affects bigger men,' says Dr Adam Fitzpatrick, a consultant cardiologist at the Manchester Royal Infirmary. 'This is because they have a larger area of the heart surface to go wrong.'
For six weeks immediately after his diagnosis, Bill took warfarin, a drug that interferes with chemicals in the blood to 'thin' it and reduce the risk of a stroke.
He then underwent cardioversion, where an electrical current is applied to the chest to 'shock' the heart and restore normal rhythm. This works initially in more than 90 per cent of cases, though half of these patients find the problem recurs within a year. The treatment didn't work for Bill.
'At that point, I wasn't particularly worried, even though I was travelling for work a lot,' he says.
'Sometimes I got out of breath if I did something that made my heart rate increase, such as exercising. I could feel it beating really fast - it was going about a third faster than it should, a bit like driving down the motorway in second gear. I wouldn't say it was painful, but it was uncomfortable.'
Then a friend mentioned that his own heart problem had been treated successfully by Dr Fitzpatrick. He recommended a procedure called catheter ablation - this involves inserting a catheter through a vein in the groin (under X-ray guidance) and up to the blood vessels of the atrium.
Intense heat is then used to scar the area of the heart sending the faulty signals - this means they are no longer transmitted.
When Bill had the procedure five years ago, it was still experimental, but it's now the best way to get rid of atrial fibrillation.
'Around 75 per cent of patients will be treated successfully, though some require more than one procedure. Others are cured completely,' says Dr Fitzpatrick.
It took three ablations to stop Bill's atrial fibrillation. And he still had an atrial flutter - a less common type of abnormal heart rhythm, where the atria can beat up to 350 times a minute.
Some patients have both forms of arrhythmia. Bill's heart flutter was eventually fixed after three further ablations. He must continue taking anti-clotting medication - possibly for life - to reduce the risk of stroke.
'I've cut down on my drinking and drink only decaff coffee,' says Bill. 'I'm not getting any attacks, but you never know when it's going to strike. I want to avoid them, but I try to live normally.'
Meanwhile, Bill has become patron of the Arrhythmia Alliance and is helping to promote greater awareness of the condition and the need for people to learn to take their own pulse.
Though the condition is officially diagnosed with an ECG, chest X-rays and an echocardiogram (heart ultrasound scan), one of the easiest ways to detect the problem is by feeling the pulse.
'It's so easy and it really could save your life,' says Bill. 'I did not check mine before I was diagnosed and that minute could have made all the difference.
'Sudden unexpected death can affect people in the prime of life. That's why I'd urge anyone to spend a minute taking your pulse.'
HOW TO TAKE YOUR OWN PULSE
For an adult, a normal resting heart rate is between 60 and 100 beats a minute. If your pulse isn't steady - for example, a succession of rapid beats is followed by a long space - ask your GP to check your pulse in case you have atrial fibrillation.
• HOLD one hand out with your palm facing up and your elbow straight.
• PUT the index and middle fingers of your other hand together.
• PRESS the pads of your fingers lightly on the underside of your wrist, just below the base of your thumb (in the squashy bit). Or use the same two fingers on the side of your neck, just underneath your jaw.
• KEEPING a firm pressure, count the beats in a minute.
www.atrialfibrillation.org.uk; 01789 451837.
www.arrhythmiaalliance. org.uk; 01789 450787.

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20 years of migraines cured by a pacemaker in my tummy
By DAVID HURST
Last updated at 3:12 AM on 27th December 2011

Six million people in the UK suffer from migraines, but painkillers are not always effective.

Debbie Hounslow, 44, a customer services adviser from Buckinghamshire, underwent a new procedure.

THE PATIENT

'It was an excruciating pain, like my skull was being crushed,' said Debbie Hounslow of her migraines

My migraines started when I was 18. My left eye developed blind spots, then I saw flickering lights and a really bad headache came on.

It was scary, but my Nan and Mum had migraines so I knew what it was.

My GP advised me to take over-the-counter painkillers if another came on.

I would have a couple a year, but in my early 30s they started coming every few months. They were much more intense and lasted from one to three days.

It was an excruciating pain, like my skull was being crushed; an agonising throbbing throughout my whole head. I also felt nauseous and sometimes was physically sick.

I started taking beta-blockers as well as painkillers, which helped a little to begin with, but the migraines carried on.

By 2005, I was having one a week. Even when I wasn’t having an attack, they made my life miserable because the medication I was on had side-effects — I felt ‘foggy’ and found it hard to watch TV, read or look at a computer.

Even simple things like cooking, driving and walking were impossible.

My partner Bob and my family and friends were really supportive, but it must have been difficult as I couldn’t make any firm plans.

At first my work was understanding about all the time off I took, then it started to be at least two weeks every month. In the end I took redundancy in February 2009, aged 42.

I felt desperate. I was offered Botox, which is supposed to work because it paralyses the muscles in the neck and forehead that can set off the condition. But I didn’t like the thought of it as it’s a poison in your system.

Then, in January 2010, I was referred to Alexander Green at John Radcliffe Hospital in Oxford.

He told me about Peripheral Nerve Stimulation, a new procedure where they implant electrodes in the back of the neck, close to the nerves they think send signals to the brain that cause migraines.


'I've only had three migraines in the 18 months since the procedure,' said Debbie

The electrodes would be connected by wires running under my skin to a tiny battery implanted under the skin in my stomach. The battery would send off little electrical pulses to jam the signals.

He said some people had seen their migraines virtually disappear after this operation. I thought I had nothing to lose.

My operation was in July last year under local anaesthetic.

After the hour-long procedure, it was sore where they’d inserted the electrodes and the battery on the left side of my stomach. I was allowed home after a few hours.

I took painkillers for a week, though the soreness in my stomach took six weeks to go away. You can’t see the wires, but the battery (which is about the size of a stopwatch) is visible as I’m quite slim.

When everything had settled, I went back to hospital for Mr Green to set the electrical pulses. It felt like pins and needles, and was strange at first, but now I’ve got used to it.

The pacemaker can either work constantly or it can be switched on when I feel a migraine coming. I have mine on all the time, but I do turn the stimulation up when I sense an attack approaching.

I’ve only had three migraines in the 18 months since the procedure, and even those were much shorter and far less intense than before — I only had to take painkillers for one of them.

Compared with how it was, this is a miracle.

I’m back working, can cook and go on walks again. This Christmas was the first in more than 20 years that I felt confident enough to arrange to meet people for social events. I’m in control of my migraines, rather than my migraines controlling me.

THE SPECIALIST

Alexander Green is a neurosurgeon at the Oxford University Hospitals NHS Trust.

Migraine is a complicated, life-long condition. Symptoms range from intensely painful headache to disturbed vision, nausea, vomiting and a dislike of light and sound at normal levels. Attacks can last anything between four hours and several days.

More than half of sufferers have one or more attacks every month. It can have a debilitating effect on work, family and social life.

No one really knows the cause, but a genetic link was identified for the first time in 2010. We also know migraines are more common in young pre-menopausal women.

More than half of migraine sufferers have one or more attacks every month

Some people have triggers, others don’t. These can include red wine, cheese, chocolate, citrus fruits, stress, alcohol, tea and coffee.

Drugs called triptans can help — migraines are thought to be caused by the widening of blood vessels in the brain, and triptans reverse this. But they need to be taken at each attack, and at £8 per tablet, they are expensive.

There are other options, including anti-epileptic medications and painkillers, such as gabapentin.

There is also the option of Botox injections to the scalp, or rhizolysis — deliberately damaging the occipital nerves at the back of the neck, which have been associated with chronic migraine.

However, these do not work in all patients and the effects are temporary. Many of the drugs can have severe side-effects, such as drowsiness, rashes and nausea.

Peripheral Nerve Stimulation (PNS) was developed in Seattle, in the U.S., in the 1990s to treat occipital neuralgia, a chronic pain in the back of the head, upper neck and behind the eyes. It was first developed as a treatment for migraine in 2003.

It involves implanting two electrodes and a pulse generator, much like a cardiac pacemaker. But instead of sending mild electrical pulses to the heart, the pulses are carried to the occipital nerves.

The pulses influence the way the nerves communicate with the brain. The exact mechanism is not understood, but somehow it jams the transmissions that cause migraine.

It’s been used on only about 200 patients in the UK — so far restricted to those whose drugs do not work or whose drug prescription is at a toxic level.

Just under half of patients who have PNS will experience more than a 50 per cent reduction in attacks, although the results are much more dramatic in some.

The operation can be performed under local or general anaesthetic and takes an hour.

Two incisions are made at the top of the neck, pockets are made under the skin and fat layer, and the electrodes are inserted, tested and anchored with a stitch.

The two thin wires from the electrodes are tunnelled just below the skin to the pulse generator or battery, which is placed in a pocket also under the skin.

The pulses can be switched on as a migraine starts using a remote device, or constantly generated, which is what most patients have.

Patients can go home the next day. Six weeks later the device is ‘fine-tuned’. We wait a few days to see if the voltage, frequency and length of pulse is working.

Patients can have a battery which is recharged once a week from a charger placed on the skin for an hour or so, or a non-rechargeable unit, which is replaced in a minor operation every three to five years.

The procedure is available on the NHS.

Privately it costs £15,000. Further information from migraine.org.uk, 0116 275 8317.mshire, underwent a new procedure.

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I haven't had a real meal in two years because my stomach's paralysed
By DAVID HURST
Last updated at 12:10 AM on 30th August 2011

When Hannah Westworth first started losing weight, people commented on how good she looked.
But when the weight continued to fall off, she and her family realised that the situation was beyond her control.
In the past two years Hannah, now 20, has nearly halved her body weight, and plummeted from 14st to 7½ st.
Hannah Westworth, 20, has nearly halved her body weight in two years due to gastroparesis - or stomach paralysis
Her parents have watched as their bright, bubbly daughter faded away.
But Hannah’s weight loss is not the result of some extreme diet — although doctors initially did suspect an eating disorder. Instead, like hundreds of thousands of other Britons, she suffers from gastroparesis — or stomach paralysis.
This means her stomach can’t move food along the digestive system and into the intestines, due to the muscles that usually perform this function not working.
As a result, food remains in the stomach, where it can ferment or clump together, triggering vomiting. At one stage, Hannah was being sick up to 50 times a day.
‘For more than two years I’ve been dying slowly,’ says Hannah, a BT apprentice who lives in Morecambe, Lancs, with her parents John and Mai and 22-year-old sister Jenny.
The 5 ft 6 in former sports lover loses up to 2lb a week. Malnourishment has meant her hair has started to fall out and she’s lost some of her toenails.
But a new procedure, where a pacemaker was fitted into the stomach, might have saved her life.

Hannah was 17 when she first developed symptoms, and suffered severe stomach pains. It took two years for her to be diagnosed with gastroparesis
Hannah says: ‘I just hope this operation lets me eat.’
Gastroparesis makes the stomach digest food too slowly or, as in Hannah’s case, not at all.
Usually, the stomach contracts to send food into the small intestine for digestion. Here, it is moved on through peristalsis — waves of muscle contraction that move food through the digestive tract. The vagus nerve controls the contraction of the stomach and intestines.
Although the exact cause of gastroparesis is unknown, it’s thought this nerve is damaged and the muscles of the stomach and intestines become paralysed.
The lack of movement caused by this triggers a mechanism in the body that regurgitates the food. Symptoms include heartburn, nausea, vomiting, weight loss, bloating and acid reflux.
The most common cause is diabetes. Half of the 450,000 people in the UK with type 1 diabetes suffer from gastroparesis to varying degrees, because high blood sugar levels damage the vagus nerve.
It can also strike people with type 2 diabetes, which affects 2.5 million in the UK.
‘For more than two years I’ve been dying slowly,’ says Hannah
Cancer treatment, such as chemotherapy and radiation, can also trigger it, as can opiate-based painkillers such as morphine and codeine, possibly because they affect the vagus nerve. But in many cases — like Hannah’s — the cause is never found.
Hannah was 17 when she first developed symptoms, and suffered severe stomach pains. She was rushed to the Royal Lancaster Infirmary where doctors were unable to find a cause, but on hearing of her weight loss they suggested a psychological reason or eating disorder.
Three months later, days after her 18th birthday, she was back in hospital with severe pains and vomiting. She remained there for three weeks, and was being sick so much that she was badly dehydrated and malnourished.
An allergy was thought most likely, but none could be identified.
Still no food or drink stayed down — the last time she ate a full meal without vomiting was March 2009.
It was only in May this year, two years on, that she was finally diagnosed with gastroparesis.
The condition is confirmed by measuring how long it takes food to move through the stomach. In the most common test, a scanner is placed over the abdomen to monitor the rate at which food leaves the stomach.
An upper endoscopy — a tube with a camera passed down the throat to the stomach — helps rule out other conditions.
For Hannah and her family, it was a relief to know what was wrong.
‘I’ve really been to hell and back,’ says Hannah. ‘Since 2009 I’ve been given many different anti-sickness medications, and also had countless endoscopies and ultrasound scans. I’ve been fed via feeding tubes into my lower bowel.
‘I’ve lost my independence, have struggled with my job and have become almost housebound.’
Treatment depends on the condition’s severity, says Dr Anton Emmanuel, consultant gastroenterologist and senior lecturer in neurogastroenterology at University College Hospital, London.
‘First, diet is looked at — a low-fibre, low-fat, primarily liquid-based diet is tried,’ he says. If this doesn’t help, drugs are given to speed up emptying the stomach.’
The last time Hannah ate a full meal without vomiting was March 2009
He adds that Botox injections into the stomach can help by relaxing it, so allowing food to pass through more easily.
However, it needs re-injecting every three to six months and in some patients, such as Hannah, the jabs don’t work. The drugs given can also cause side effects.
Another option is gastroenterostomy surgery, which creates a new opening between the stomach and small intestine. But it carries risks such as infection, bleeding and even cardiac arrest.
Hannah was, however, told about a new operation that involves a special pacemaker being attached to the stomach. The credit card-sized device is implanted under the skin above the navel, with wires going down into the muscle walls of the stomach.
When the patient eats something, tiny muscle movements trigger the pacemaker to send a small electrical impulse to the nervous system, ‘tricking’ the body into thinking it is full and boosting the strength of the muscle contractions in the stomach and gut.
A pacemaker remains in place for the rest of the patient’s life.
In January, Hannah was referred to University Hospital Aintree in Liverpool to see if she could have the procedure. But because the operation is so rare, doctors had to apply for the £20,000 funding.
They got the go-ahead, but Hannah was devastated to learn the operation could be months away.
Her father, John, who also works for BT, says: ‘We discovered a private surgeon who could do the operation within ten days.
'If we’d waited much longer, Hannah would fade away. I need to do the very best for my daughter.’
Hannah and her family hope the operation she had this month is the end of a long nightmare.
‘She’s slowly recovering from the operation, but she has been so very poorly,’ says John.
Now, the family and Hannah’s friends are trying to repay the £20,000 they borrowed for the operation. Events such as a sponsored skydive and fun day are planned.
‘I know this operation’s not going to fix me 100 per cent, but it could change my condition massively — and allow me to get my life back again,’
Hannah says. ‘We can’t be sure the operation will fully work, but even if it reduces the amount of times I’m sick, I’ll be so grateful.’
To donate to Hannah’s operation fund and see event details, visit hannahwestworth.com

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How watching 3D films can be bad for your brain
By DAVID HURST
Last updated at 8:05 AM on 5th May 2010
Half an hour after seeing the film Alice In Wonderland in 3D, Josh James blacked out on his way home and rolled his car. Could 3D have been to blame?
There are growing concerns about the side effects of the technology, with experts warning of altered vision, confusion, dizziness and even convulsions.
Josh himself needs no convincing that 3D was behind his accident.
Just before it happened, the 18-year-old A-level student from Plymouth went to the cinema with a group of friends; during the film he wore the 3D glasses handed out to cinema-goers and found them extremely unsettling.
‘It took ten minutes for my vision to adjust to 3D,’ recalls Josh, who has normal eyesight.
‘My sight was unfocused - blurry one minute, fine the next. I also had a pain in my temples.’
Josh says he looked away from the screen a few times to try to prevent this.
After ten minutes, the effect subsided and he was able to watch the film. When it ended, it took another ten minutes for his vision to return to normal.
‘I was aware during this time that my judgment of distances was out,’ says Josh.
‘It was difficult to work out how far away the kerb, signs and other people were - enough for me to be cautious about where I stepped.
‘But by the time I’d reached the car park, my sight had recovered enough for me to stop worrying. I thought I’d be fine to drive.’
Just minutes after dropping his friends off, Josh crashed.
‘I didn’t feel tired, so I can’t have fallen asleep,’ he says.
‘But the next thing I remember was standing in this country lane in the pitch dark and looking at my mangled car on its roof. Every panel and window was smashed in.’
The roof on the passenger side had caved in so much it was level with the base of the passenger window. Josh thinks the car veered off the road into a ‘Devon hedge’ - a six-foot sloping bank of rocks and mud - which caused it to flip back into the road and land on its roof.
‘Thankfully, I only had cuts on my hands and bruises on my head and face. I also had concussion. I can clearly remember the film and the drive back, bar 30 seconds before the crash.’
People from a nearby farm called emergency services.
‘Apparently I was talking coherently to everyone, but I don’t remember any of what I said. Police breathalysed me, but all I’d had to drink was a milkshake.
‘The paramedics were going to take me to hospital, but when they discovered my dad was a GP and my mum a nurse they suggested they keep an eye on me instead for the rest of the night.
‘I’m lucky to be alive,’ says Josh. ‘I definitely think watching a 3D film played a major part, especially as I know other people who have had strange after-effects, too.’
There has been much talk recently about a ‘3D revolution’. Millions flocked to cinemas to see 3D films such as avatar and Alice In Wonderland, the first live football match was screened in 3D in January and manufacturers are anticipating a rise in demand for 3D televisions ready for the World Cup next month.
But concerns are emerging about the effects of the technology. Last month, electronics company Samsung warned that pregnant women, the elderly, children, those suffering from serious medical conditions and people who have been sleep-deprived or drinking could be at risk of confusion, nausea, convulsions, altered vision and dizziness.
Meanwhile a recent study at the University of California, Berkeley found that 3D can cause headaches and eyestrain. So what could be triggering these symptoms?
The technology itself is hardly new; it was first developed in the Thirties and enjoyed periods of popularity in the fifties and Eighties.
But it’s now much more sophisticated - the speed at which the images are projected, and the ‘active shutter’ glasses being used bombard the eyes and brain, putting unusual strain on them, say experts.
As Professor Martin Banks, the Californian optometrist who led the study, explains that when we normally look at an object, two things happen at once.
‘You converge and focus your eyes to the same distance,’ he says.
‘But with 3D, you may have to converge your eyes to one distance, while focusing to another. So with 3D films you’re taking that normal relationship which has been in the brain for years and changing it.’
In some ways, the 3D effect is similar to motion sickness, in which the brain is confused by the messages it’s getting from the eyes and inner ear (where our balance system is located).
However, with 3D the effect may be more powerful, leading potentially to eye problems, convulsions, or in Josh’s case, it seems, blackout.
‘It’s probably more problematic for teenagers and young adults,’ says Professor Banks.
‘By the time we reach our 50s and 60s, the eyes lose the ability to focus to different distances - a condition called presbyopia that’s a natural part of the ageing process.’
So when you’re older, you experience this problem of different convergence and focus distance all the time, but have simply adjusted to it.
Samsung explains that with children, the problem may also be to do with the distance between their eyes.
‘Most people have a 2.5-inch distance and they won’t have a problem, but small children who have a smaller distance may not see the 3D image properly,’ a spokesman said.
As for pregnant women, ‘watching a 3D movie is a lot more realistic than watching something in 2D, so people who have medical conditions or are pregnant may find the images slightly disorientating’.
But are the rest of us at risk? ‘The majority of people are not going to have any difficulty while watching 3D,’ says neurologist Michael Gross.
‘However, people who might are those predisposed to headaches, particularly migraines.’
Any one who suffers from eye convergence problems may also be at risk. There is no evidence that the effects are long-term, but if you do notice vision problems or headaches, the obvious message is stop watching immediately.
As for Josh, a month after his accident he says the experience won’t stop him going to see other 3D films. ‘But I’ll definitely consider ways of getting home other than driving.’

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'GOD MADE ME THIN' THE DIETERS TURNING TO PRAYER

Sunday July 18,2010
By David Hurst
THEY'VE tried everything from Atkins to cabbage soup but when all else fails, some dieters are turning to Jesus to help them shed weight.
Married couple Andy and Maggie Sorrells have lost 39 stone between them but they didn’t achieve their astounding weight loss through conventional diets… they asked God to make them slim.
Andy had spent his life being ridiculed because of his weight and by his 20s weighed 36st. “All I heard were insults and I hated life,” says the 33-year-old bank worker. “When I was 18 I stopped going to church and started taking drugs.”
Meeting Maggie turned his life around. The couple married in 2002 but were soon heading towards the divorce courts, influenced in no small part by their weight. Maggie was also obese, hitting 31st at her heaviest, and both had tried numerous diets but to no avail. Then she heard about a different type of dieting, one that asked God for help and the pair enrolled on the courses.
“With the Weigh Down Diet, people focus on God rather than food and within 17 months I had lost 18st and Maggie had lost 21,” says Andy, who lives with his 36-year-old wife in Tennessee. “I stopped using drugs and I’ve never looked back. Now God, not food, soothes my soul.”
Although the couple’s weight before their transformation is extreme, they are far from unusual. It is predicted that in five years more than 40 per cent of Americans will be obese and Britain isn’t far behind: already almost a quarter of adults here are obese. Not only does being overweight affect self-esteem, it can cause high blood pressure, diabetes, cancer, heart disease and osteoarthritis.
Having started in the US, these God-centred diets are arriving in the UK under the slogan Get Slim For Him! and faith-based weight loss groups are starting up across the country, with sales of books such as the Hallelujah Diet and the God Diet on the rise.
The principle common to all these diets is that dieters must identify why they overeat before they can hope to lose weight. The largest group, Weigh Down, was launched in Tennessee in the Eighties by Christian nutritionist Gwen Shamblin. Today there are 30,000 Weigh Down groups in America and the concept recently crossed to Britain, with the creation of a UK website and new Facebook fan group. Until classes are established in the UK, Britons are enrolling on Weigh Down USA’s online classes, which cost approximately £100, and buying its DVDs, CDs and books.
Those taking part can eat any food but cut the amount. They’re taught that exercise is not necessary to lose weight and is unnecessary apart from for physical fitness.
Initially, non-believers are advised to merely shift their focus from food. Any desire to eat other than for physical hunger is termed “head hunger” and participants gradually learn how to turn to God with these desires rather than to food. Reverend David Muir, a Church of England pioneer minister from Devon, believes having faith can work in helping people lose weight. “Faith takes our hearts and minds off ourselves and gives us something else to live for, something greater,” he says. “You need to discover the ‘bigger something’ in the process, so that your weight problem is put into a wider perspective.”
Ann Saville, one of the first people in Britain to try the Weigh Down diet, is finding it a success after losing 8lb in six weeks. “Conventional dieting is getting the food to behave rather than the person,” says Ann, 62, from Pinner in Middlesex, who works on a project for the homeless. “My overeating was habit, a reward after having a busy day,” she says. “It was difficult admitting I was, in fact, just being greedy. I had to ask God for help.”
One Christian weight loss programme already established on these shores is Fit For Life Forever. Started by minister Sue Prosser in 2006, it is a 12-week, non-profit-making course run in more than 100 British churches. The course costs £14 for materials and can be taken individually or as a group.
Sue herself lost 4st in 13 months after turning to God. “Most of us overeat for emotional reasons that normal dieting can’t begin to address,” says Sue, 61, from Burton-on-Trent. “I’d always yo-yo dieted but I realised that if I wanted to lose weight permanently I needed to address the root causes of emotional pain, low self-esteem and of food being reward and comfort.
“I realised I was eating to also feed my head and heart. This course enables people to slim from the inside out.”
Retired teacher Hilary Hawley is proof the scheme works. She had also been a yo-yo dieter since her teens. She started the course three years ago and quickly lost one-and-a-half stone. “None of the diets I tried before could have worked as they didn’t address the cause of my overeating,” says Sue, 54, from Matlock, Derbyshire. “As a church-goer asking God for help was a natural thing to do but I know of two non-Christians who have lost weight on the course, too.”
It is not the ingredients but how much is eaten, explains Weigh Down founder Gwen Shamblin. “We show you how to use God’s strength rather than your willpower.”
This principle bears a similarity to the Alcoholics Anonymous 12-step programme, which also requires members to trust in a higher power. Overeaters Anonymous is run along the same lines, with Step Three of both programmes stating: [We] made a decision to turn our will and our lives over to the care of God as we understand Him.
As with many institutions that mention God, Weigh Down has been accused of being a cult. Shamblin is also the founder of the Remnant Fellowship Church and some critics claim her modern church is cultish and uses Weigh Down as a method to recruit members to the congregation.
Despite these accusations Shamblin is undeterred, driven by her own experiences battling with weight from the age of 13.
“We’re born with a void that God placed inside of us so that we’d search for and find Him but often people turn to overeating in an attempt to fill that void,” she explains.
“Our approach fixes the heart first and the body follows.”
Learn more at weighdown.com

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Rick Parfitt: I wept with fear when told I had cancer
by DAVID HURST, Daily Mail
Last updated at 23:41 19 June 2006

Last December, Rick Parfitt was diagnosed with suspected throat cancer. Here, the Status Quo guitarist and singer tells DAVID HURST what this meant for him and the group, who have had more hit singles than any other band in British chart history. Rick, 57, lives in Teddington, Middlesex, with his wife Patty and their son Harry, 16. He says:
We were in the middle of our annual tour when I started to notice my voice wasn?t working properly.
There was a gravelly quality to it which made it hard to hit the right notes.
It was the band?s 40th anniversary together, every show was sold out and we were really enjoying it.
We were in Plymouth for a gig and I thought I?d go to see an Ear, Nose and Throat (ENT) specialist as a precautionary measure.
I wasn?t worried - in the old days when I got a sore throat, a doctor would just puff a spray down it and the next day I?d be singing again. But it wasn?t that easy this time.
The specialist pushed a camera on a tube up one of my nostrils and down into my throat ? which was horrible ? and he then said he was 90 per cent sure I had a tumour on my larynx, and the chances were it was cancerous.
The larynx is also known as the voice-box because it?s where our sound comes from. It contains the vocal cords - stretched bands of membrane which vibrate against each other and produce sound. So that?s why I hadn?t been able to get to the top notes as usual.
The consultant recommended I see another throat specialist immediately.
My world fell apart. I thought: ?What am I going to do? My career is over and I?m going to die or have my voice-box taken out.? Then I cried my eyes out.
So did several of our road crew when I told them. ?It?s going to be all right,? I said to them, but I didn?t know what to think. My head was buzzing.
I think everyone associates the word tumour with dying, and when a specialist puts your name next to it, it?s so frightening. Being told I almost certainly had cancer was the most terrifying thing in the world.
I knew I had to stop smoking and drinking. I?ve done both for years, but there was no option this time.
It?s not the first time my rock ?n? roll lifestyle has conspired against my body ? it was a major reason why I had to have a quadruple heart bypass in 1997.
The vocal pounding I?ve given my voice over 40 years had also finally caught up with me. Vocally, my role has always been to sing the high harmonies above our main singer Francis Rossi.
I?m the screaming voice of the band, if you like, and over the years I?ve given my throat a hell of a battering.
Francis said: ?What are you going to do? If you suspect you?ve got cancer of the throat, are you going to go out on the stage and say, ?Right, let?s rock!? with a big grin on your face??
So we had to cancel the tour. Letting the fans down was awful, but there was no way round it. I felt too anxious to go on stage.
It was also really frightening for my wife Patty and my sons Richard, 28, and Harry, 16. And it was a whole week before I could get an appointment with another throat specialist in London.
So for seven days I sat with my head in my hands, thinking: ?Is this the end of everything?? When I finally saw the specialist at the Princess Grace Hospital in London on December 15, he put another camera down my throat and told me he thought there was a tumour on my right vocal cord and a lesion on the left vocal cord.
The next day, at 8am, I went into the operating theatre to have the growth removed by laser, as Patty waited outside.
When I woke up an hour later, the doctor said: ?You?ll be pleased to know the growth is benign.? It was the best possible news ? I felt such relief.
He told me if I hadn?t had it checked when I did, the next stage could have been cancer.
It turned out that my vocal cords had swollen so much from all my singing over the years, combined with smoking and drinking, that they had stuck together. Consequently, I had no vibration there to make my voice.
By 11.30am the next day, I was home having a cup of tea. It had all happened so quickly, and it wasn?t even sore.
The doctor told me not to talk for two weeks and even though I didn?t have much voice I still forgot the next day when the phone rang. I went to answer it and, when I opened my mouth to speak, nothing came out.
Slowly, though, my voice started to return, but as the days went by I was still struggling to make myself understood, which I found very frustrating.
I had regular sessions with a voice coach in which he got me to do gentle low-key humming, graduating to scales. He also steamed my throat every day, which I still do.
I boil some water in a container that has a tube coming out of it, put that in my mouth and breathe in the steam.
The vocal cords need to be moist, because if they get dry they tend to stick together, and that?s when your voice doesn?t work. Steaming frees up the vocal cords so they can vibrate and make a noise.
My throat problems have been far worse than my quadruple heart bypass.
I?d woken up with chest pains and my doctor sent me straight to hospital, where tests revealed I had narrowing in the arteries.
I had to have immediate surgery because the doctors said a heart attack was imminent. It was terrifying, but it all happened so quickly. I was in and out of hospital in 11 days, and 12 weeks later I was back on stage.
I didn?t have time to think about it, while with my throat I had an agonising week of sitting around worrying I had cancer.
Since the throat operation, I?ve had to learn to sing from my diaphragm to take the strain off my throat.
The diaphragm is a dome-shaped muscle under the lower ribs that contracts to draw air into the lungs.
To sing from it, you need to take a deep breath into your stomach. This ?stomach breath? is your diaphragm pulling your lungs down and out so increasing lung capacity, which pushes your stomach out to make room for the extra lung space. This means you can hold your breath longer and control it better.
My first gig since the operation was in April in Switzerland. But I got a shock at my first solo ? nothing came out except a croak! It was the worst moment of my rock career.
I fought through the gig and my voice improved slightly, but there was no tone or pitch. I had to talk instead of sing.
I thought: ?This is it: I can?t sing any more ? my career is over and Status Quo will have to pack it in for good.? Our next gig was in Australia a month later. I developed insomnia and was very stressed in the lead-up.
But neither the other band members nor my voice coach advised me to pack it in, so I thought I would just go for it.
As it turned out, my voice was OK, not 100 per cent, but not far off. And since then, we?ve played in the Middle East and my voice has started to get stronger. I?d say it?s 97 per cent there now.
Now I feel my voice is repaired ? and that I don?t have cancer ? I?ll even have the odd social drink. My vocal coach said that?s OK as long as I don?t overdo it.
After my heart bypass I felt my heart was renewed and ready to go again, and that?s the way I feel about my voice now.
I?m due for a check-up when I?m back home in London later this month, but I don?t think there?s anything to worry about.
I had thought I was going to have to say: ?That?s it.? But once again I?ve come through ? and Status Quo can keep rockin? all over the world.
Cancerbackup 0808 800 1234; www.cancerbackup.org.uk
For details about Status Quo?s British tour, which started last week, visit www.statusquo.co.uk

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The hidden heart timebomb: After Fabrice Muamba's collapse, how thousands are in danger from undetected heart problems

By DAVID HURST
PUBLISHED: 02:08, 20 March 2012 | UPDATED: 02:08, 20 March 2012

When Deb Coleman arrived at hospital to give birth to her second son, she’d been in labour for 12 hours. Doctors said her baby was in distress and she needed an emergency Caesarean.
‘The next thing I recall is waking up and a doctor saying: “Your heart stopped — you’ve been on life support for 18 hours and a medically induced coma for another two days,” ’ says Deb, a photo-journalist from Swindon, Wiltshire.
‘I couldn’t take it in. I was 32, healthy, went to the gym regularly, ate organic food, didn’t smoke and rarely drank. So I told the doctor he was wrong, that I’d just had a baby — not a cardiac arrest.’
‘In fact, you’ve just had both,’ the doctor told her, explaining that it was lucky she’d been in the operating theatre when it had happened, otherwise neither she nor her baby would have survived.
Unbeknown to her, Deb was born with dilated cardiomyopathy, a condition that causes the heart muscles to stretch, making them unable to pump blood effectively.
The exertions of labour had put unbearable pressure on her heart and it had stopped.
Deb was one of the lucky ones — like Bolton Wanderers footballer Fabrice Muamba, who collapsed during a match on Saturday, she was close to medical staff and equipment.
Every year at least 600 young people die as a result of Sudden Death Syndrome, an umbrella term for the many different causes of cardiac arrest in younger people.
‘A cardiac arrest is when a person’s heart stops pumping blood around their body and they stop breathing normally,’ says Natasha Stewart of the British Heart Foundation.
It’s different from a heart attack, where one of the arteries supplying the heart is blocked with a blood clot, starving the heart muscle of oxygen-rich blood.
Often these deaths in young people are triggered by sporting activities, which put pressure on the heart. High levels of adrenaline associated with sport may also be a trigger.
Among those who’ve suffered a sudden cardiac arrest are the son of former Wales football manager Terry Yorath. Daniel died aged 15, soon after signing for Leeds United.
In 2003, Manchester City and Cameroon footballer Marc-Vivien Foe, 28, died after collapsing on the pitch during an international match. British Olympic rowing hopeful Scott Rennie, 25, suffered a fatal cardiac arrest during training in 2009.
However, while athletes may be more at risk, any strenuous activity or even a shock can trigger attacks in those with undetected heart conditions.
Kasia Ber, a 17-year-old from Co Durham, died in 2005 after she was woken by the alarm on her mobile phone. She was later discovered to have Long QT syndrome, which affects the heart’s electrical system.
A year later the death of Lisa Browne, a nurse from Stoke-on-Trent, was linked to the shock of her alarm clock going off — she, too, had undiagnosed Long QT.
Often, death is the first sign that anything is wrong with the person’s heart.
What worries experts is that an estimated 200,000 people under 35 have such an undiagnosed heart problem.
The Cardiac Risk in the Young (CRY) charity has campaigned for all young people aged 14-35 to have their hearts screened.
‘An ECG or ultrasound scan could detect abnormalities before they prove fatal,’ says the charity’s Dr Steven Cox.
But the NHS doesn’t offer routine screening because there are so few cardiologists with expertise in this field, says Sanjay Sharma, professor of clinical cardiology at St George’s University Hospital, London, who is screening the Tottenham Hotspur players who were playing Bolton when Muamba collapsed.
He says the screenings, which include an electrocardiogram (ECG), pick up 80 per cent of conditions causing sudden death.
The most common is cardiomyopathy — a thickening or abnormal development of the heart muscle.
There are four types of cardiomypathy, the most common of which is hypertrophic cardiomyopathy (HCM), a genetic defect. If one parent carries the gene for HCM, a child has a 50 per cent chance of inheriting the condition.
While about 10,000 British people are known to have it, experts think up to 120,000 could be living with it, but don’t know it.
Dilated cardiomyopathy (DCM) — which is what caused Deb Coleman’s heart to stop in labour — affects 20,000 Britons, with men twice as likely to suffer.
Less common forms of cardiomyopathy include arrhythmogenic right ventricular cardiomyopathy, which is usually picked up before a cardiac arrest as patients experience palpitations, fatigue, breathlessness and blackouts.
Another cause is myocarditis, when bacterial and viral infections such as flu, ear and chest infections get into the bloodstream and affect the heart.
If the condition is spotted quickly, anti-inflammatory drugs can treat it. But once the heart muscle becomes enlarged, little can be done, says consultant cardiologist Dr Nigel Durham of York Hospital.
‘Myocarditis is something we are diagnosing more as the tools we use — scans and ultrasounds — become increasingly sophisticated. It’s a major cause of Sudden Death Syndrome.’
Though there are often no warning signs for all these conditions, sometimes there may be symptoms. These include exercise-related chest pain, breathlessness, palpitations, dizziness or fainting.
But 80 per cent of the 600 young people who die suddenly each year experienced none of these — or so mildly that they dismissed them.
The tragedy is that if the problem is detected, it is easy to prevent a cardiac arrest.
Cardiomyopathy can be managed with the use of beta-blockers to slow the heart and treat palpitations; ACE inhibitors, which improve the heart’s pumping action; or anti-arrhythmic drugs to reduce irregular rhythms.
Those at risk of developing a lethal heart rhythm can be fitted with an internal defibrillator, which shocks the heart into a normal rhythm if needed. Pacemakers are also used to improve the heart’s efficiency.
The problem is spotting the defect in time.
‘I’ve heard of chest pains being explained away as muscular aches by GPs, and palpitations being attributed to exam stress,’ says Professor Sharma.
‘I would like doctors to explore the possibility of heart conditions, too.’
Because the conditions causing sudden death are often inherited, the NHS offers free ECG scans to anyone with a close relative who has been diagnosed.
For the rest of us, CRY, with the help of volunteers such as Professor Sharma, runs mobile screenings for heart conditions. The process is heavily subsidised by the charity and individuals are asked to pay £35 towards running costs.
An ECG takes around five minutes. Electrical leads from the machine are taped to the chest, legs and arms and a recording is made of the electrical activity of the heart.
‘An ECG or ultrasound scan could detect these abnormalities before they prove fatal,’ says Dr Cox.
Cardiomyopathies tend to become apparent only after puberty, so the charity would like to see annual ECGs for everyone aged between 14 and 18.
Professor Sharma says one in 300 people they screen is found to have a condition capable of causing sudden cardiac death.
For those diagnosed with a condition, it can be hard to adjust. Often it means giving up strenuous activity. For others it can mean a lifetime on medication such as beta-blockers.
For Deb Coleman, she worries most about her son, Cameron, now 17. After her cardiac arrest, she underwent an ECG, which revealed her dilated cardiomyopathy. Then tests showed that her newborn son also had the condition.
‘I was distraught and felt so guilty,’ says Deb, 50. ‘My husband Gary and I were devastated as we came to terms with the fact two people in our family had incurable heart conditions.’
Every day Deb takes an ACE inhibitor and two diuretic tablets — these stop fluid building in the lungs, which can happen if the heart is not working efficiently.
But she doesn’t let her condition rule her life.
‘I’ve tried kickboxing and am always up for a dance when we go out. If I get breathless, I just stop,’ she says.
‘Of course, I worry about Cameron. He loves playing football, so I worry when I know he’s playing a match, and yes it is hard not to be over-protective.
'However, I explain to my children that life is for living.’
Professional footballer Andy Scott played more than 400 matches in his career for teams including Sheffield United, Brentford and Oxford — with no idea that every time he kicked a ball he was dicing with death.
For more information about heart conditions, contact the British Heart Foundation: 0300 330 3311; bhf.org.uk.
For details on conditions that can lead to sudden death, call CRY on 01737 363 222 or visit c-r-y.org.uk

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Pete was told he had groin strain - eight months later, he was dead: He had testicular cancer at aged 28
By DAVID HURST
PUBLISHED: 01:34, 3 July 2012 | UPDATED: 02:14, 3 July 2012
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When Pete Banks noticed a small lump in his testicle, he wasn’t particularly worried.
The 28-year-old engineer from Leamington Spa was in excellent health and, indeed, his GP suggested it was just an infection or a pulled muscle.
But within weeks Pete started having back pain.
Blood tests revealed he had testicular cancer, which had spread to his lower abdomen and lungs.
'Because Pete was so young, cancer was simply not something he would even have considered, especially as he was never ill,' said Anna Haywood
He died eight months later.
Every year, 2,000 men in Britain are told they have testicular cancer. It’s the most common form of cancer in men aged between 15 and 44.
But even though testicular cancer is highly treatable, 70 men die from it each year.
As Pete’s girlfriend Anna Haywood explains: ‘Testicular cancer is 97 per cent curable — but only if it’s caught early.
‘Because Pete was so young, cancer was simply not something he would even have considered, especially as he was never ill.
'But if he had checked himself regularly, I have no doubt he’d be alive today.’
The incidence of the disease is rising.
According to the cancer charity Everyman, the rate has more than doubled over the past three decades.
A particular high risk factor is undescended testes at birth, says Dr Robert Huddart, honorary consultant in urological oncology at the Royal Marsden Hospital, London.
‘This condition may increase the risk of testicular cancer by five to ten times.
'Around one in 20 male babies are born with an undescended testis.’
It’s not known for sure why testicular cancer is on the rise, but there’s some evidence to suggest undescended testes are linked to exposure to chemicals in the womb.
It’s thought high levels of compounds in plastics and pesticides can disrupt the balance of male hormones.
One study published in the International Journal of Andrology in 2009 found Danish men were four times more likely to have testicular cancer than those in neighbouring Finland.
Anna and Pete had been together for five years, and had talked about getting married and starting a family
The researchers had also found significantly higher levels of chemicals from pesticides in samples of breast milk from Danish women compared to Finnish women.
‘Because of how hormone-changing chemicals, including some pesticides, cause reactions in people, there should be concern over the rise in testicular cancer. It merits serious investigation,’ says Andrew Watterson, professor of environmental health at Stirling University.
Another known risk factor is family history. ‘If a brother has testicular cancer, you are up to ten times more likely to get it,’ says Dr Huddart.
Until the cause is identified, Dr Huddart says that the best way to improve results is earlier detection.
‘Regular self-examination will help you become more aware of the normal feel and size of your testicles so any abnormalities can be spotted early on,’ he says.
The abnormalities to look for are a lump in either testicle, which is often painless, or any enlargement of the testicle.
Other signs might be a feeling of heaviness in the scrotum; a dull ache in the abdomen or groin; or growth or tenderness of the chest area, caused by the cancer cells spreading into the lymph glands there.
It was two weeks before Christmas 2007 when Pete told Anna he’d noticed a lump on his right testicle.
‘He said it didn’t hurt and was only small,’ says Anna, 31, who was then a medical technical officer and is now studying for a master’s degree in geo-environmental engineering.
‘I thought at worst it might be an infection that could be treated easily.
'Pete was healthy, exercised regularly and he had never smoked.’
Three days later, Pete went to his GP, who prescribed a course of antibiotics.
‘But, in the new year, Pete didn’t have as much energy,’ says Anna.
‘He also had lower back pain. I did not connect the lump and his back pain — and if he did, he never mentioned it.
‘He was signed off from work and started taking painkillers.
'But within a couple of weeks the lump on his testicle grew astonishingly quickly — it was fist-size and felt tender.’
Pete went back to his doctor, who sent him for a blood test three days later.
Anna went with him, as by then they thought it could be something serious.
Just from looking at the lump, the urologist told them that Pete had testicular cancer.
After blood tests and an X-ray, there was even worse news.
‘The doctor said the cancer had spread to his lower abdomen and possibly his lungs,’ says Anna.
‘We just had a feeling of disbelief. Everything was happening so quickly.
'We just said: “OK, let’s get the treatment started. Let’s get this fixed.”
‘We went home in a daze and got his stuff ready to go into hospital the next day.
‘Even then I was certain he’d pull through. Pete was the sort of person who would set his mind to achieve something and would always succeed.’
If testicular cancer is caught early and the cancer has not spread, treatment is usually to remove the cancerous testicle.
‘If the cancer has spread, this will usually be followed by chemotherapy — it is extremely likely that fertility and sex life will recover after the end of this,’ says Dr Huddart.
The cancer was so advanced that Pete was given chemotherapy before the five-hour operation to remove his testicle and lymph nodes.
But despite this, the cancer continued to spread and Pete was transferred from Coventry to Barts Hospital in London to begin a more intensive course of chemotherapy.
‘Pete was really sick. As a side-effect of the chemo, he developed terribly painful mouth ulcers and couldn’t keep any food down.
'It was really hard to see him like that,’ says Anna.
The couple, who had been together for five years, had talked about getting married and starting a family.
‘His parents, brother and sister were going through all the emotions you could imagine, like I was. But we tried our best to be strong for him.’
Then Pete developed a stomach infection.
‘He was so weak from his treatment — he basically had no immune system and just couldn’t fight the infection,’ says Anna.
He died on September 16, 2008.
‘Everyone was devastated,’ says Anna.
‘Pete was the smartest person I’ve met. He was a really great person.’
At his funeral, instead of flowers, donations were made to male cancer charity Orchid.
Following his death, Anna carried out the vow she and Pete had made to raise funds and awareness for testicular cancer.
Almost immediately, she started organising sponsored walks and cycle rides.
‘Pete was more health aware than most men, yet he never checked himself for lumps,’ she says.
‘I do think his GP could have been more aware, too. He should have been alarmed, yet he didn’t even send him for a blood test.
‘My message to men is: check yourself every couple of weeks. And women should be encouraging them, too.
‘If there’s anything even remotely different, see a doctor immediately. Life’s too precious to ignore it.’
For more information, go to checkemlads.com;
everyman-campaign.org; and orchid-cancer.org.uk

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The hidden heart timebomb: After Fabrice Muamba's collapse, how thousands are in danger from undetected heart problems
By DAVID HURST
PUBLISHED: 02:08, 20 March 2012
When Deb Coleman arrived at hospital to give birth to her second son, she’d been in labour for 12 hours. Doctors said her baby was in distress and she needed an emergency Caesarean.
‘The next thing I recall is waking up and a doctor saying: “Your heart stopped — you’ve been on life support for 18 hours and a medically induced coma for another two days,” ’ says Deb, a photo-journalist from Swindon, Wiltshire.
‘I couldn’t take it in. I was 32, healthy, went to the gym regularly, ate organic food, didn’t smoke and rarely drank. So I told the doctor he was wrong, that I’d just had a baby — not a cardiac arrest.’
After her cardiac arrest, she underwent an ECG, which revealed her dilated cardiomyopathy. Then tests showed that her newborn son also had the condition
‘In fact, you’ve just had both,’ the doctor told her, explaining that it was lucky she’d been in the operating theatre when it had happened, otherwise neither she nor her baby would have survived.
Unbeknown to her, Deb was born with dilated cardiomyopathy, a condition that causes the heart muscles to stretch, making them unable to pump blood effectively.
The exertions of labour had put unbearable pressure on her heart and it had stopped.
Deb was one of the lucky ones — like Bolton Wanderers footballer Fabrice Muamba, who collapsed during a match on Saturday, she was close to medical staff and equipment.
Every year at least 600 young people die as a result of Sudden Death Syndrome, an umbrella term for the many different causes of cardiac arrest in younger people.
‘A cardiac arrest is when a person’s heart stops pumping blood around their body and they stop breathing normally,’ says Natasha Stewart of the British Heart Foundation.
It’s different from a heart attack, where one of the arteries supplying the heart is blocked with a blood clot, starving the heart muscle of oxygen-rich blood.
Often these deaths in young people are triggered by sporting activities, which put pressure on the heart. High levels of adrenaline associated with sport may also be a trigger.
Among those who’ve suffered a sudden cardiac arrest are the son of former Wales football manager Terry Yorath. Daniel died aged 15, soon after signing for Leeds United.
In 2003, Manchester City and Cameroon footballer Marc-Vivien Foe, 28, died after collapsing on the pitch during an international match. British Olympic rowing hopeful Scott Rennie, 25, suffered a fatal cardiac arrest during training in 2009. Bolton Wanderers footballer Fabrice Muamba collapsed during a match on Saturday
However, while athletes may be more at risk, any strenuous activity or even a shock can trigger attacks in those with undetected heart conditions.
Kasia Ber, a 17-year-old from Co Durham, died in 2005 after she was woken by the alarm on her mobile phone. She was later discovered to have Long QT syndrome, which affects the heart’s electrical system.
A year later the death of Lisa Browne, a nurse from Stoke-on-Trent, was linked to the shock of her alarm clock going off — she, too, had undiagnosed Long QT.
Often, death is the first sign that anything is wrong with the person’s heart.
What worries experts is that an estimated 200,000 people under 35 have such an undiagnosed heart problem.
The Cardiac Risk in the Young (CRY) charity has campaigned for all young people aged 14-35 to have their hearts screened.
‘An ECG or ultrasound scan could detect abnormalities before they prove fatal,’ says the charity’s Dr Steven Cox.
But the NHS doesn’t offer routine screening because there are so few cardiologists with expertise in this field, says Sanjay Sharma, professor of clinical cardiology at St George’s University Hospital, London, who is screening the Tottenham Hotspur players who were playing Bolton when Muamba collapsed.
He says the screenings, which include an electrocardiogram (ECG), pick up 80 per cent of conditions causing sudden death.
The most common is cardiomyopathy — a thickening or abnormal development of the heart muscle.
There are four types of cardiomypathy, the most common of which is hypertrophic cardiomyopathy (HCM), a genetic defect. If one parent carries the gene for HCM, a child has a 50 per cent chance of inheriting the condition.
While about 10,000 British people are known to have it, experts think up to 120,000 could be living with it, but don’t know it.
Dilated cardiomyopathy (DCM) — which is what caused Deb Coleman’s heart to stop in labour — affects 20,000 Britons, with men twice as likely to suffer.
Less common forms of cardiomyopathy include arrhythmogenic right ventricular cardiomyopathy, which is usually picked up before a cardiac arrest as patients experience palpitations, fatigue, breathlessness and blackouts.
Another cause is myocarditis, when bacterial and viral infections such as flu, ear and chest infections get into the bloodstream and affect the heart.
If the condition is spotted quickly, anti-inflammatory drugs can treat it. But once the heart muscle becomes enlarged, little can be done, says consultant cardiologist Dr Nigel Durham of York Hospital.
‘Myocarditis is something we are diagnosing more as the tools we use — scans and ultrasounds — become increasingly sophisticated. It’s a major cause of Sudden Death Syndrome.’
Though there are often no warning signs for all these conditions, sometimes there may be symptoms. These include exercise-related chest pain, breathlessness, palpitations, dizziness or fainting.
But 80 per cent of the 600 young people who die suddenly each year experienced none of these — or so mildly that they dismissed them.
The tragedy is that if the problem is detected, it is easy to prevent a cardiac arrest.
Cardiomyopathy can be managed with the use of beta-blockers to slow the heart and treat palpitations; ACE inhibitors, which improve the heart’s pumping action; or anti-arrhythmic drugs to reduce irregular rhythms.
Those at risk of developing a lethal heart rhythm can be fitted with an internal defibrillator, which shocks the heart into a normal rhythm if needed. Pacemakers are also used to improve the heart’s efficiency.
The problem is spotting the defect in time.
‘I’ve heard of chest pains being explained away as muscular aches by GPs, and palpitations being attributed to exam stress,’ says Professor Sharma.
‘I would like doctors to explore the possibility of heart conditions, too.’
Because the conditions causing sudden death are often inherited, the NHS offers free ECG scans to anyone with a close relative who has been diagnosed.
For the rest of us, CRY, with the help of volunteers such as Professor Sharma, runs mobile screenings for heart conditions. The process is heavily subsidised by the charity and individuals are asked to pay £35 towards running costs.
An ECG takes around five minutes. Electrical leads from the machine are taped to the chest, legs and arms and a recording is made of the electrical activity of the heart.
‘An ECG or ultrasound scan could detect these abnormalities before they prove fatal,’ says Dr Cox.
Cardiomyopathies tend to become apparent only after puberty, so the charity would like to see annual ECGs for everyone aged between 14 and 18.
Professor Sharma says one in 300 people they screen is found to have a condition capable of causing sudden cardiac death.
For those diagnosed with a condition, it can be hard to adjust. Often it means giving up strenuous activity. For others it can mean a lifetime on medication such as beta-blockers.
For Deb Coleman, she worries most about her son, Cameron, now 17. After her cardiac arrest, she underwent an ECG, which revealed her dilated cardiomyopathy. Then tests showed that her newborn son also had the condition.
‘I was distraught and felt so guilty,’ says Deb, 50. ‘My husband Gary and I were devastated as we came to terms with the fact two people in our family had incurable heart conditions.’
Every day Deb takes an ACE inhibitor and two diuretic tablets — these stop fluid building in the lungs, which can happen if the heart is not working efficiently.
But she doesn’t let her condition rule her life.
‘I’ve tried kickboxing and am always up for a dance when we go out. If I get breathless, I just stop,’ she says.
‘Of course, I worry about Cameron. He loves playing football, so I worry when I know he’s playing a match, and yes it is hard not to be over-protective.
'However, I explain to my children that life is for living.’
For more information about heart conditions, contact the British Heart Foundation: 0300 330 3311; bhf.org.uk.
For details on conditions that can lead to sudden death, call CRY on 01737 363 222 or visit c-r-y.org.uk

___________________________________________________________________________________________________________


Thinning on top? It could be high blood pressure
By DAVID HURST. PUBLISHED: 01:12, 9 April 2013

Life for balding men really is unfair, it seems.
Not only do they have to come to terms with their hair loss, but now new research suggests that they’re much more likely to suffer from heart disease.
Researchers in Japan have found that men going bald on the crown of the head were 52 per cent more likely to have coronary artery disease than those with a full head of hair.
Male hormones seem to be the link between coronary heart disease and baldness - and it's the more 'masculine' men who may suffer most
Men with the dreaded double whammy of hair loss — a receding hairline and crown baldness (known as severe vertex baldness) — were 69 per cent more likely to suffer from the condition.
Hair loss is a fact of life for most men.
Half have thinning hair by their 50s and 80  per cent have a degree of hair loss by the age of 70.
But should they all be anxiously considering their heart health? The Japanese researchers certainly think so.
‘Cardiovascular risk factors should be assessed carefully in men with vertex baldness and they should be encouraged to improve their cardiovascular risk profile,’ said lead researcher Dr Tomohide Yamada from the University of Tokyo.
His study was prompted by the fact his (balding) grandfathers died of heart disease.
‘We recommend a heart-healthy lifestyle that includes a low-fat diet, exercise and less stress,’ he says.
But how could coronary heart disease be linked to baldness in men?
After all, one relates to the health of your blood vessels, the other to hormones and genes (some evidence suggests that men with certain genetic markers have a 70 per cent increased risk of going bald).
In fact, male hormones seem to be the link — and it’s the more ‘masculine’ men who may suffer most.
Baldness is usually caused when hair follicles, the tiny scalp cavities from which hair grows, become exposed to too much dihydrotestosterone, or DHT.
This chemical is produced in the body by the male hormone testosterone and is important for development.
But if there is too much DHT in the blood, the follicles shrink, so the hair becomes thinner.
But as well as thinning the hair, high testosterone levels might thicken artery walls and increase blood pressure.
Another theory is that baldness is caused by poor blood supply to hair follicles, which causes them to die off.
So baldness could be a symptom of cardiovascular disease.
While scientists don’t yet know what might come first (what you might call the chicken and egghead question), what is clear is that treating baldness will not protect the heart.
‘The real issue is not baldness having a direct effect on the heart, but that it’s a warning of possible heart disease,’ says Dr Gregg Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles.
In fact, heart disease is not the only condition that may be revealed by men’s hairline.
Hypertension — high blood pressure — affects around 30 per cent of the population, but many people don’t realise they have it, as it rarely has obvious symptoms.
However, researchers have identified a link between hypertension and hair loss.
Scientists are unsure of the reasons behind the connection, but it’s possible that high blood pressure restricts blood supply to the hair roots.
Researchers have also found a link between type 2 diabetes and hair loss.
Diabetes is often linked to a hardening of the blood vessel walls, leading them to become narrow, according to Dr Erling Thom, a leading pharmacologist.
‘As these vessels become narrower, less oxygen is able to circulate and thereby results in symptoms such as shiny, thickened skin and hair loss,’ he says.
‘Hair loss in this case is not limited to one specific area of the body, as a circulatory impairment in the legs could often result in visible hair loss on the thighs and calves, for example.’
Hair loss can be a symptom of an underactive thyroid, when the thyroid gland doesn’t produce enough of the hormone thyroxine.
Though the condition is often associated with weight gain, it can affect the hair and skin, too.
‘Thyroid hormone speeds up your metabolism, so if you don’t have enough of it the condition of your skin worsens and you get less hair growth,’ says Dr Jan Wadstein, associate professor of medicine at Lund University in Sweden and medical director at Nourkrin.
Hair loss can also be a symptom of the opposite problem, an overactive thyroid, perhaps because this also causes the metabolism to go haywire.
While thyroid problems are most common in women, they can affect men, too.
Your hairline can be affected by medicine — unfortunately, this includes many commonly used prescription drugs, such as those for high blood pressure.
For instance, one Australian study found two types of beta-blockers, metoprolol and propranolol, are linked to hair loss.
Another type of high blood pressure drug, known as angio-tensin-converting enzyme inhibitors, may also trigger thinning hair (possibly by causing the hair to be shed before the end of its natural lifecycle).
So, too, can medicines to lower the risk of blood clots or stroke.
A study from the University of California highlighted a blood-thinning medication called low molecular weight heparin as a cause of hair loss.
Warfarin may also cause similar problems, though this is much less common.
Some antidepressants can also thin the hair, the Australian study found. These include fluoxetine — better known as Prozac — as well as tricyclic antidepressants.
The good news is that once you stop taking the medication, the hair usually grows back. However, doctors warn you should not stop taking medication without consulting your GP.
‘The loss of a few hairs is trivial compared with the loss of your mental health or the risk of stroke,’ says Sam Shuster, emeritus professor of dermatology at Newcastle University.
But if you’re not taking medication linked to hair loss, what action can a balding man take to protect his heart?
The key message is, don’t panic — because the science behind the latest findings is far from clear.
As Dr Alex Lyon, consultant cardiologist at the Royal Brompton Hospital, explains: ‘There is some evidence that higher testosterone is linked to heart disease, but conversely low levels of testosterone are, too.
‘All you can really do is try to live healthily — exercise, weight loss, a healthy diet and not smoking.
‘Balding or bald men should not be overly worried. I’m starting to thin on top — but I’m not running off to my cardiologist!’

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Ever think your other half's brain must be wired differently? New research reveals you're right
By DAVID HURST. PUBLISHED: 22:08, 22 April 2013 | UPDATED: 07:41, 23 April 2013

The brain is one of the last frontiers of medicine — we still don’t really know how all those blood vessels, brain cells and nerves work together to shape our lives and our health.
The average brain weighs 3lb (1.36kg) — or around 2 per cent of the total body weight. But it consumes up to 20 per cent of the body’s energy, more than any other organ, as well as 20 per cent of its oxygen.
One of the greatest enigmas of the brain is the role of gender. For instance, women seem to be more prone to dementia and depression, yet neurological conditions such as Parkinson’s disease strike more men.
'A woman's brain is never at rest, unlike the male brain - a woman is always on alert,' a leading neuropsychologist claims
Why is this so? More controversial is the suggestion that gender doesn’t just affect the health of your brain, but the way it works — and how effective it is at different tasks.
‘More and more research is revealing that male and female brains are much more different than we previously thought,’ says neuropsychiatrist Dr Louann Brizendine, author of The Female Brain And The Male Brain. Here, with the help of leading experts, we reveal some of the latest thinking about what your sex says about your brain.

Men have bigger brains (but they’re less active)
On average, men’s brains are 8 to 10 per cent bigger than women’s — hardly surprising, as men’s heads tend to be larger. But some areas of men’s and women’s brains are also different sizes.
A study in 2001 by researchers from Harvard University found that parts of the frontal lobe, which governs decision-making and problem-solving, is proportionally larger in women.
In men, the parietal cortex, involved in spatial perception, and the amygdala, which triggers fight or flight responses, covered a larger area — the researchers suggested this meant men would probably make their way round a building better and often sense danger quicker.
It could also be that the activity levels in women and men’s brains are different. ‘A woman’s brain is never at rest, unlike the male brain — a woman is always on alert,’ says British neuropsychologist Dr Anne Moir, the author of Brain Sex: The Real Difference Between Men And Women. ‘In evolutionary times, women were responsible for children who could get into grave danger, so they had to be extra alert.’
When U.S. neuroscientist Dr Daniel Amen compared 26,000 brain scans, women had increased activity — shown by increased blood flow — in 112 of the 128 regions of the brain measured. But more active doesn’t mean better, he says. ‘Male and female brains are different. Women have busy brains; men’s are a lot quieter. One pattern is not better than the other; they are just different.’

Who feels pain more?
Women feel pain more than men and are more sensitive to touch.
‘The pain mechanisms in our brains are different due to the sex hormones,’ says Dr Nick Losseff, consultant neurologist at The National Hospital for Neurology and Neurosurgery in London. ‘The male foetus is bathed in testosterone from the beginning, which may trigger these brain changes.’
Women process pain in a different way, as highlighted by recent research using MRI brain scans. It seems they are affected more emotionally by pain, suggests the lead researcher, Qasim Aziz, professor of neurogastroenterology at Barts and the London School of Medicine and Dentistry.
‘This may influence how they report pain. For instance, it’s known that certain chronic pain conditions such as irritable bowel syndrome and fibromyalgia are more common in women.
‘We think greater emotive response to pain may translate into more pain reporting in these conditions.’
This kind of research is cutting edge and controversial. Looking at brain activity is a difficult task. In the study carried out by Professor Aziz, for instance, functional MRI (fMRI) was used to identify changes in blood flow. When there is more in an area of the brain, this is taken to mean there is more activity there.
The female brain has an intrinsic excitability that predisposes women to migraines, according to research
It’s generally thought to be the best method available for analysing brain activity, but there are questions over its accuracy — some experts feel emphasising local activity ignores the fact that the brain is a network, with other regions also critical to any single brain function.
As Dr Moir says: ‘The ways of measuring the brain are improving. But they’re still limited. You can’t measure the brain in everyday circumstances because you have to be inside a massive machine and not moving for it to work.’

‘Excitable’ brains give women migraines
It’s well known that migraine affects up to three times more women than men. The standard explanation is that this is down to fluctuating hormones.
But there may be another factor — in women, it’s easier to trigger the brain waves linked to migraine, says Dr Andrew Charles, director of the headache research and treatment programme at the University of California.
His research, based on animal studies, suggests that in men the stimulus — including lights — needs to be three times greater to produce the same effect.
And while migraines are more frequent during the menstrual period, Dr Charles says his research indicates something else. ‘Our results suggest the female brain has an intrinsic excitability that predisposes women to migraine that may not be linked to the menstrual cycle.’

Dementia — it’s women who suffer most
‘Women generally remember things better for longer than men,’ says Dr Amen. His research showed that women have increased activity in the hippocampus, the area that helps memories go into long-term storage.
But longer term, the statistics for women don’t make for good reading: nearly 7 per cent of women aged 75 and over have some form of dementia compared with 5 per cent of men.
Among Alzheimer’s patients, women have faster cognitive decline than men. Twenty per cent more women than men die of Alzheimer’s.
Experts think it is due to the effect on the brain of oestrogen and testosterone — the hormones that determine the different sexual characteristics of men and women.
‘We are just beginning to realise how important differences in brain function between women and men might be to explain the common differences we see in illnesses such as Alzheimer’s,’ says Kathryn Abel, professor of psychiatry at the University of Manchester.
‘Men are at half the risk of Alzheimer’s compared with women before the menopause. And women who develop Alzheimer’s deteriorate more quickly.’
Pauline Maki, professor of psychiatry and Psychology at the University of Illinois in Chicago, who has a special interest in brain-hormone links and dementia, believes oestrogen may play a role in Alzheimer’s risk.
She cites the example of women who have undergone an early menopause (before 48) because their ovaries have been removed — they are 70 per cent more likely to develop Alzheimer’s.
‘Oestrogen seems to protect against neurodegeneration in women. In men, testosterone can have neuroprotective effects. Testosterone levels do not drop off as dramatically in men as oestrogen does in women.’
As a result, post-menopause, women are at greater risk of dementia than men.
But Dr Keith Laws, professor of cognitive neuropsychology at the University of Hertfordshire, believes the fact that women tend to stay at home and look after children may also play a role.
He and his team looked at 15 studies involving more than 2,000 men and women with Alzheimer’s.
‘Our findings indicated brain functions are more severely and more widely affected in women than men with Alzheimer’s. For some reason, men are able to resist Alzheimer’s for longer.
‘This is still being studied, but one theory is that men have better “cognitive reserve” — for the generation developing Alzheimer’s now, many of the women would have stayed at home while the men were working, which could have permitted them to keep their brains more active for longer. So, when the disease starts they can hold up better.’

Men CAN multi-task
The cliche that men can’t do two things at once is not, in fact, correct — at least not entirely.
‘The evidence on multi-tasking is inconclusive,’ says clinical psychologist Dr Genevieve von Lob at City Psychology Group in London.
‘Studies tend to show inconsistent results — some find that women show slightly more superiority while others find men show slightly more superiority, depending on the task.’
Women multi-task much more often. A study published two years ago in the American Sociological Review looking at 500 families found that both parents spent a lot of time multi-tasking, but women multi-tasked 48 hours a week compared with 39 for the men.
The women’s multi-tasking mostly involved housework and childcare. ‘So perhaps women multi-task more, not because they are naturally better at it, but because the need to juggle work and family life,’ says Dr von Lob.

Women are more prone to depression
Women are twice as likely to experience major depression as men and are particularly prone during hormonal changes.
‘The overall evidence suggests the sexes process emotions differently,’ says Dr Moir. ‘There are a few differences in the limbic area or emotional processing area of the brain that make it more likely that women take a more negative view of situations and are more likely to worry about problems.
‘This upsets sleep patterns, and if you don’t sleep you get depressed.’
Dr Abel adds that these differences may be due to hormones. ‘Differences in the physical structure of a woman compared to a man’s brain is in part caused by genes and in part by the differences in hormones the brain “sees”,’ she says. Women’s brains have more receptors for recognising the presence of oestrogen than men. They also have more of an enzyme that converts testosterone to oestrogen.
‘Hormones and chromosomes may be important in thinking about disease and health for women and men.
‘In adulthood, women are twice as likely to develop depression, while men are twice as likely to develop schizophrenia.’
And men seem to develop more severe schizophrenia symptoms. Professor Laws adds: ‘The course of illness tends to be more favourable in women than men, with women showing more rapid and greater response to antipsychotic medication, probably because of how it interacts with the female hormone oestrogen.
‘Women have fewer hospitalisations and a better chance of recovery.’

So that’s why men ignore health advice
In A fascinating study last year, University of Michigan researchers looked at how men and women responded to health messages. When they were shown poster adverts for exercise, men were more motivated by those that mentioned weight loss and health, women were motivated by those focused on wellbeing.
‘We know men have more visual brains and respond better to visual messages in adverts. Women response to detail, so are more likely to absorb the total picture,’ says Dr von Lob.
Acting on health messages and visiting the doctor could also be due to the fact that women have better planning skills and are more diligent, suggests Dr Amen.
‘Women have more pre-frontal cortex brain cells — the region controlling judgment, planning and conscientiousness. This also governs impulse control, which may explain why women tend to think before they leap.’

The women and chocolate thing
Men and women respond to eating chocolate with different parts of their brains, a Dutch study in 2005 found. In particular, women had reduced activity in the hypothalamus, which controls feelings of hunger, so they had to eat more to get a similar effect as men.
The researchers concluded their results ‘indicate that men and women differ in their response to satiation [feeling full] and suggest that the regulation of food intake by the brain may vary between the sexes’.
Dr David Katz, founding director of Yale University’s Prevention Research Centre, agrees. ‘There are clear differences between the sexes,’ he says. ‘Studies show women crave sugar and fat more while men are more likely to crave meat.’
And you can blame our cavemen ancestors. ‘All such differences tend to make sense in an evolutionary context,’ says Dr Katz. ‘Men need a bit more protein to build the muscle that makes them most capable of surviving, succeeding and passing on their genes.
‘Women do the harder work of procreation. They need more fat stores to get a baby through gestation and to produce sex hormones such as oestrogen. Those hormones, in turn, seem to affect dietary preferences.’ That is why women’s desire for chocolate can be affected by the menstrual cycle.

Stress makes men angry, women chatty
Stressful situations seem to activate an almond-sized part of the brain called the amygdala, which processes fear, aggression and action.
While in men it triggers the ‘fight or flight’ response, the women’s reaction has been dubbed the ‘tend and befriend’ system.
In one analysis of brains, Larry Cahill, professor of neurobiology and behaviour at the University of California, found the male amygdala appears to be more active on the right side, but a woman’s is more active on the left.
The left side is connected with the area that governs emotions and self-awareness. ‘So men under stress want to go for a run, let off steam or have space to themselves,’ says Dr von Lob.
‘Women under stress tend to activate the brain’s attachment system and release more of the hormone oxytocin, which is associated with feelings of love, calm, protection and safety. Women typically want to talk with friends for reassurance.’

And last but not least: sex
Oxytocin is a key hormone released in the brain to create feelings of love and safety during sex.
Women produce more of this hormone, while with men, the hormone released is dopamine — the pleasure hormone. ‘And this can be addictive,’ says Dr Arun Ghosh, a GP in Liverpool.
Having regular sex may help both sexes grow new brain cells, according to scientists from America’s Princeton University. And the more sex you have, the more cells can grow.
‘MRI scans have shown that during orgasm the neurons [nerve cells] in the brain are more active,’ says Barry Komisaruk, professor of psychology at Rutgers University in the U.S. ‘The more active the neurons, the more oxygen they draw from the blood — so more oxygenated blood is supplied, delivering more nutrients.’

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Starting the school of life

While other five-year-olds are starting school, Daniel will be exploring Europe with his family. His father, David Hurst, explains what lessons they all hope to learn along the way

DAVID HURST Wednesday 10 September 2014

Like any parents, we want what's best for our children. So instead of sending our five-year-old boy to start school this month, we're heading off with him in our motorhome to some beaches. There'll be cities and countryside, too – and most of all, there will be family and friends.

We're on a quest to visit as many Facebook friends and family members as possible until the new year, giving money to charity for each person we visit, in a project we've called Face2Facebook. For a few months, in our Swift Escape motorhome – which we downsized our house to afford – we're travelling around the UK and Ireland, then heading to the Netherlands, Germany, France and Spain.

My wife, Debs, and I decided that travel is the best form of education: Daniel and his three-year-old brother, Darley, will be learning the value of family and friendship; that the world is generally a wonderful place with decent people in it; and they'll learn about kindness and thinking of others. Travelling will also develop their self-confidence, and teach them about new languages, geography, geology, history, music, sport, religion, cooking and culture.

Thankfully, our travelling venture has the support of Daniel's future headteacher at a wonderful school near Exeter, where we live. When I went, somewhat apprehensively, to see whether we could defer Daniel starting school while we travelled, she explained that, by law, you can defer your child's primary-school place until the term after they turn five. Then she added with a smile that she thought it was an amazing idea – that she too had a camper van that she travelled in with her family.

The holiday that inspired the family's road trip The holiday that inspired the family's road trip It's a journey with a purpose. On our trip, we'll nominate everyone that we visit to see a loved one from among their Facebook friends whom they have not seen for at least a year, and they can then donate to charity for that visit. We hope that this friendship and family fiesta spreads swiftly. We're also organising one-off fundraisers in our motorhome with authors, chefs and musicians and are currently in discussions about teaming up with a charity (as well as seeking corporate sponsorship to make the project as big as possible).

It's an idea that started forming three years ago, after unexpectedly losing my uncle, David. He'd just got back from walking in the Highlands to celebrate his 67th birthday when he developed a sore throat. Three weeks later, he died from oesophageal cancer. I recall his wife, Alison, saying some months afterwards: "If anyone says to me that they're planning their dream trip for next year or visiting someone they've not seen for ages, I always say: 'Don't wait – do it now.'"

Six months after David died, Darley was born and spent the first week of his life in neonatal intensive care. Thank God for the NHS. Then, when he was six months old, my best friend, Tim – a 48-year-old Chicagoan I'd met two decades earlier – emailed me just before Christmas with a shocking, out-of-character message saying that he was suicidal. I spent two months chatting with Tim, thinking he was getting over the unplanned life events that had taken him into his depression. But that February, Tim took his own life.

Our stark realisation cried loudly that the most important things in life are not things at all, but family and friends. Yet we were taken aback when we realised how many of our family and friends we hadn't actually seen for years. While Facebook is fantastic for staying in touch, it can veil how infrequently many of us truly see those we love.

Then it seemed that every time we went out, an elderly lady would say something like: "It seems only yesterday when my two children were the age that yours are now. Make the most of it – they grow up so quickly; time passes so swiftly."

So a few months back, we were bewildered to realise that Daniel was due to start school soon. Darley would miss having him around, and so would we. We wondered about what children actually learn there at such a young age. We pondered whether such an early school start was, in many cases, mostly a convenience for parents where both go out to work all day. We're fortunate there: Debs is virtually a full-time mother and I work from home. Fortunate, but it's also down to choice. We may be about a million short of being millionaires, but we get to eat every meal together, and that is priceless.

We concluded that starting school aged five is too young – most countries leave it until six or seven. Our children are really only children for such a small fraction of our lives, and then the system wants to take them from us for the bulk of that time. We reached the decision that this is ludicrous.

Perhaps it's not best for a child's development, either. In the latest world-education ranking report, the Programme for International Student Assessment survey listed the top 10 countries, which included the Netherlands, Switzerland, Singapore and Japan. None of these top 10 countries starts children at primary school until they are at least six. The UK came 26th.

We figured that we could teach our boys more from being out there in the world. So we're going to see how it goes over the next few months. We are beginning to see why more parents are home-educating their children: surely, learning through experience is more effective (and more fun!) than rote learning. What better way to inspire English than in Stratford-upon-Avon, maths at Bletchley Park, and history at Hastings?

Daniel, being one of the older children in his year and a bright boy anyway, has already reached the school levels expected of him by January. But maybe there's something more important than reaching levels and passing exams anyway. This idea has prompted Michael Rosen, the author of popular children's books such as We're Going on a Bear Hunt, to write a book that reveals how everyday events are a better learning experience than tests: Good Ideas: How to Be Your Child's (And Your Own) Best Teacher (£11.89, hardback; £6, Kindle) is published by John Murray tomorrow.

Many teachers would agree with him. Tim and Kerry Meek, both teachers, are taking their daughters, aged 11 and nine, on a road trip around Britain this year, having sold their house to fund what they call their "edventure". Both have become disillusioned with a school system which they feel teaches to the test.

There seem to be a growing number with similar convictions. We know another young family from Devon who have just sold their house to travel and teach their little boy in their motorhome. Then last week, we read about a couple from Scotland who took their two teenage sons and their 10-year-old daughter travelling around the world for a year. Jen Taylor, 44, said of the trip with her 47-year-old husband, Neil: "It was a great chance for our children to see a bit of the world and learn about different cultures. We knew if we didn't do it now, we'd never get to do it together."

We want our boys to know that looking at scenery and living life is better than staring at a screen. And we hope that in years to come – when they are young men and we're elderly parents – they'll look back at the photographs and read again about what we did and still continue to grow from it. I guess we also hope they'll think: "Our mum and dad were pretty cool to do that!"

Follow the Hurst family's charity-fundraising travel adventures at face2fb.wordpress.com

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