The reception at Preventicum’s London clinic

London’s Preventicum has been at the forefront of preventative healthcare – where you see and anticipate potential health risks – for almost two decades.  Here, Preventicum’s Medical Director, Dr Ying-Young Hui speaks to Samantha Welsh about how about the importance of early detection, and how a holistic approach can give a complete picture of health, guiding on lifestyle changes and potential clinical interventions; and we present some frankly chilling case studies  

LUX:  What brought about Preventicum’s early start in the competitive health diagnostic space?

Dr Ying-Young Hui:  Preventicum launched its pioneering preventive health assessments in London in 2005 at its luxury London clinic. We developed our detailed health assessments to give clients the ultimate reassurance and peace of mind, enabling them to live their lives to the full. Instead of addressing health concerns when they arise, we can detect the earliest signs of and risk factors for heart disease, cancers, stroke, diabetes and many other conditions. This proactive approach allows us to create tailored health and lifestyle plans so that our clients can stay in optimal health and well-being.

Preventicum offers preventive healthcare, using state of the art technology

LUX:  What breakthroughs differentiate Preventicum services from those of competitors?

Dr Y-YH:  For over 19 years, Preventicum has been at the forefront of preventive health and we have developed the most advanced and safest health assessments in the world. We combine pioneering cardiac and brain analysis, laboratory tests, state-of-the-art, radiation-free MRI (Magnetic Resonance Imaging) and ultrasound scans with detailed GP and Radiologist consultations, as well as referrals to a network of specialists.

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Preventicum offers the only doctor-led, non-invasive health assessments that are completed on a single day, under one roof, with results available before our clients leave. By consistently researching and introducing new clinical developments, we ensure that Preventicum remains at the forefront of preventive healthcare, offering our clients the very latest, gold-standard tests and technology.

LUX:  With the curated approach to the hospitality experience, what does this show about values and clienteling?

Dr Y-YH:  At Preventicum, our clients’ experience extends well beyond the medical tests and scans included in their health assessment. Many of our clients describe their experience as “spa-like” thanks to our beautiful environment and our dedicated team who provide unparalleled service and build long-lasting relationships.

Dr Ying-Young Hui, Preventicum’s Medical Director

With a tailored approach, our client’s Preventicum Doctor oversees the tests and scans that are included in their health assessment and along with two detailed consultations, they create a detailed clinical report and lifestyle prescription

LUX:  How do you structure the detailed client consultations at the beginning and end of the day?

Dr Y-YH:  Each client meets a dedicated Preventicum Doctor who guides them through their assessment and addresses any health concerns. The day begins with up to an hour with their doctor to discuss their current health, medical and family history and any specific concerns they may have. We also assess key lifestyle factors such as diet, physical activity, alcohol intake and sleep, all which are crucial in determining current health and future risks. This consultation also includes a comprehensive physical examination and a guide as to what will happen throughout the day.

Following the client’s tests, MRI and ultrasound scans, and cardiac assessment, clients have a unique opportunity to review their MRI scans in a consultation with one of our Consultant Radiologists, including viewing their beating heart. The day concludes with a consultation with the client’s Preventicum Doctor to discuss the day’s findings and results, provide reassurance and where clinically indicated, arrange referrals to specialists within our network.

‘Preventicum remains at the forefront of preventive healthcare, offering our clients the very latest, gold-standard tests and technology’ – Dr Ying-Young Hui

LUX:  Lifestyles in the developed world are contributing to rising rates of diverse cancers.  Where have you had successes in early detection, and how can we help ourselves?

Dr Y-YH:  Cancer rates are increasing, including in the younger population, with approximately 375,000 new cancer diagnoses per year in the UK. It is estimated that 1 in 2 people in the UK currently under 65 years old will be diagnosed with some form of cancer during their lifetime. Our doctors are able to detect the earliest stages of cancers thanks to the combination of their expertise and our technology.

Recently, we have found clients who showed early stages of kidney, lung, thyroid and prostate cancer.  Detecting and diagnosing these cancers at an early stage usually means shorter and less invasive treatment plan and most cancers have far higher survival rates if found early.

To reduce the risk of cancer, we recommend lifestyle changes such as stopping smoking, reducing alcohol intake, increasing physical activity and maintaining a healthy diet. Annual Preventicum health assessments also play a crucial role in identifying signs of and risk factors for cancers, further aiding early detection and prevention.

‘Each client meets a dedicated Preventicum Doctor who guides them through their assessment and addresses any health concerns’ – Dr Ying-Young Hui

LUX:  What is the approach to cholesterol management?

Dr Y-YH:  Cholesterol management is crucial for a long and healthy life with a reduced risk of cardiovascular diseases including heart disease and stroke.  Effective cholesterol management requires a multifaceted approach, combining lifestyle changes with medication and regular monitoring.

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During the client’s initial consultation, we spend up to an hour gathering vital information about their lifestyle, personal medical history, family history and any symptoms. This data, along with results from detailed blood tests, blood pressure, stress echocardiograms, cardiac MRI, oxygenation-sensitive cardiac MRI (OS-CMR) and carotid artery ultrasound allows us to create a personalised cholesterol management programme.

We provide specific and tailored advice about changes which can improve High Density Lipoprotein (HDL) cholesterol and lower Low-Density Lipoprotein (LDL) cholesterol, such as reducing the consumption of saturated fats, increasing consumption of foods high in omega-3- fatty acids (such as oily fish and avocado), setting targets for moderate and high intensity exercise and optimising sleep quantity and quality.

Our approach emphasises reducing future risk with dietary changes, regular physical activity and when necessary, the use of cholesterol-lowering medications, with referrals to lipid specialists when clinically indicated.

Client room at Preventicum

LUX:  Hereditary conditions can be the ‘silent killer’, what is your experience with investigation and proactive intervention?

Dr Y-YH:  Hereditary conditions often develop without symptoms until they reach an advanced stage, making early detection and regular health assessments even more important. At Preventicum, clients complete a detailed medical questionnaire that includes a full family history, discussed during their hour-long initial consultation. Our Preventicum Doctors oversee all test and scan results and therefore have a complete view of our client’s health.

This proactive approach has allowed us to identify conditions such as cardiomyopathies, heart valve anomalies, and familial hypercholesterolemia early, leading to timely interventions that reduce the risk of severe health issues. Over the past 19 years, we have successfully identified and managed these hereditary conditions in many clients. We also have a partnership with an expert Clinical Geneticist who we can refer to if clinically indicated.

LUX:  What other diagnostic areas offer opportunities for innovations in partnership?

Dr Y-YH:  Preventicum is committed to remaining at the forefront of preventive health by partnering with leaders and experts in many clinical specialisms.  We have worked with Perspectum to offer LiverMultiScan, which provides a comprehensive view of liver health, including detailed measures of inflammation and fibrosis.

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In 2023, we introduced our Optimal assessment, the world’s most clinically advanced health assessment, featuring partnerships with BrainKey for detailed brain analysis of over 25 regions of the brain including brain age and Area19 for a world first in health screening – pioneering Oxygenation-Sensitive Cardiac MRI (OS-CMR). Additionally, our collaboration with Medical iSight allows clients to interact with 3D Augmented Reality visuals of their brain scans using Microsoft HoloLens.

LUX:  Can some investigations be unnecessarily invasive for the client, for example, cardiac diagnostics?

 Dr Y-YH:  All Preventicum assessments are safe and non-invasive. Our innovative OS-CMR technology, the most advanced cardiac assessment in the world, is non-invasive and requires no stress or medication. We rely on radiation-free MRI and ultrasound imaging, ensuring our clients avoid any adverse side effects and are not exposed to potentially harmful radiation.

‘Many of our clients describe their experience as “spa-like”’ – Dr Ying-Young Hui

This approach makes our assessments suitable for annual health screenings and also demonstrates our commitment to delivering the most advanced health assessments in the safest and most comfortable way for our clients.

Case studies: Some chilling real life case studies of lives saved and lifestyles altered from the Preventicum team.

High-grade atrioventricular block

A female client in her mid-fifties booked a Preventicum assessment after experiencing shortness of breath climbing stairs and was anxious about her health. During both the exercise stress echocardiogram and cardiac MRI scans, abnormalities were seen. Urgently referred to see a Cardiologist by her Preventicum Doctor. Further investigation revealed a high-grade atrioventricular block and a pacemaker was successfully fitted. Our client reported an upturn in her health and general wellbeing after this procedure.

Large aortic aneurysm

A healthy Orthopaedic surgeon in his late sixties booked a Preventicum assessment. He was known to have high blood pressure. During our client’s ultrasound scan, a 7cm abdominal aortic aneurysm (ballooning of the major artery running down the centre of the abdomen) was seen which had a high risk of rupturing. He was immediately referred to see a Vascular Surgeon who performed an urgent repair to the aneurysm through the main artery of his leg. Normally, large aortic aneurysms remain undetected with sudden death being the first symptom. Five years on, our client is doing very well, having made a good recovery with follow-up monitoring revealing the aneurysm to be fully repaired.

Lung cancer

A 61-year-old Company Director, returned to Preventicum for his third assessment. He was fit and well, living an active and busy life. The Consultant Cardiac Radiologist saw a 6mm lung nodule in the background of the cardiac MRI scans. The client was urgently referred for a follow-up CT scan. He attended an appointment with a specialist who made the decision to watch this for three months.

During this time, the nodule grew from 6mm to 12mm. A specialist biopsy operation at St. Batholomew’s Hospital then confirmed this was lung cancer. An operation at The Royal Brompton followed where 55% of his lung was removed. He was active straight after his operation and within three months was back to riding a bike, playing golf and running at 80% of his previous fitness.

A radiologist consultation at Preventicum

Severe heart disease

A male client in his early seventies visited Preventicum for a third time. All his cardiac investigations were normal and he was generally in good health, but experiencing shortness of breath during bursts of intense activity. Our client’s resting ECG showed severe heart rhythm abnormalities and a further resting echocardiogram showed a dilated left ventricle with poor cardiac efficiency and function.

This was confirmed in his cardiac MRI and indicated the possibility of dilated cardiomyopathy. We referred our client for review with a Consultant Cardiologist and he had an urgent coronary angiogram. He is now under ongoing specialist care.

Kidney cancer

A 54-year-old Finance Director booked his first Preventicum assessment, feeling in generally good health with no specific concerns to address. During his abdominal ultrasound and MRI scans, a suspicious kidney lesion was seen. Following a comprehensive discussion he was referred to a Consultant Urologist for further investigation. Under the expert care of this specialist, a malignant kidney tumour was diagnosed. He had a successful operation to remove the tumour and thanks to our very early detection, he has not needed any further treatment as the surgery was wholly curative.

Large brain aneurysm with no symptoms

A Property Director in his early forties, booked a Preventicum assessment. He had no symptoms and was generally in good health. During his MRI scans, a large 11mm brain aneurysm was seen. The Preventicum Doctor immediately referred him to a leading Neurosurgeon who performed a catheter angiogram to examine the anatomy of the aneurysm in more detail.

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Interestingly, the year before his visit to Preventicum our client saw a Neurologist who had carried out an MRI brain scan, but the aneurysm had not been seen. The possibilities for intervention were thoroughly discussed and he opted for open surgery to the aneurysm which was a great success.

Coronary artery disease

A client attended his Preventicum assessment and mentioned a four-week history of chest pain during exertion. During his assessment, he was found to have high blood pressure, high cholesterol and a significantly abnormal ECG. The client was urgently referred to a Cardiologist who performed a cardiac CT, revealing a dangerous blockage in the main artery taking blood to his heart.

Following immediate admission into hospital, our client underwent an emergency primary angioplasty procedure to open the blockage and two stents were put into his main coronary artery. He made an excellent recovery and was put on long-term medications to control his blood pressure and cholesterol levels. Prior to his Preventicum assessment, the client had a very high risk of having a sudden, fatal heart attack.

Thyroid cancer

A 28-year-old male client booked his first Preventicum assessment as he was concerned about his general wellbeing, was feeling tired and had been experiencing night sweats. During his assessment, our client’s full blood count and inflammatory markers were normal. However, during his ultrasound examination, our sonographer noted an abnormal looking lymph node in his neck.

An urgent referral was made to a Head and Neck Consultant and following a lymph node biopsy, the client was diagnosed with a medullary carcinoma (cancer) of the thyroid gland. He had surgery to remove the thyroid gland and 50 additional lymph nodes. The client has fully recovered from this curative surgery.

preventicum.co.uk

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Medical blog by Leyla Sanai
Uncertainty in medicine
Launching our new online series, LUX medical columnist Dr Leyla Sanai discusses two medical books revealing why patients should be aware of the risks and benefits of treatments, and why sugar is our real enemy

Most people believe that there is little uncertainty in medicine. Evidence-based trials show doctors what works, and from there it’s a simple matter of either recommending X or not – where X could be a screening test on a healthy patient, a test on an ill patient, or a treatment. But it isn’t as simple as that, as Steven Hatch’s new book Snowstorm in a Blizzard (Atlantic Books, £14.99) shows.

In this lucidly written account, Dr Hatch, Assistant Professor of Medicine at the University of Massachusetts Medical School, reveals to the reader how to liaise with your doctors to ascertain if the benefit of the proposed procedure or treatment is worth the risk. Of course, the benefits and risks vary from individual to individual based on a whole host of factors such as age, gender, smoking history, family history, and many other variables.

One of the elegant examples Hatch talks us through is the value of routine screening for prostatic specific antigen (PSA), a blood test carried out to detect the presence of prostate cancer. In the years following the popularisation of this test in the early 1990s, the number of cases of men diagnosed with prostate cancer doubled compared with the incidence 15 years earlier. Yet the death rates remained almost the same.

This is because many men have prostate cancer that is never diagnosed and never causes them any harm. In one study, 40% of men who died had evidence of prostate cancer that had not been diagnosed and that had not contributed to their death. In the oldest age group, the incident was around 80%.

In fact, out of every 1000 men over fifty years old screened for PSA, only one life will be saved because of the diagnosis and treatment of prostate cancer as compared to 1000 men over 50 who are not screened. And yet, of 1000 men screened, more than 200 will be found to have an increased level of PSA. These men will all be referred for biopsy. Of the men biopsied, 90 will be diagnosed with prostate cancer. In comparison, in an unscreened group of 1000 men over fifty years old, 70 men will be diagnosed with prostate cancer, either because they present with symptoms or because of a chance finding of a hard prostate on rectal examination for some other reason.

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All of those diagnosed will be given the option of treatment for prostate cancer, which comprises one or more from the list of surgery, radiotherapy, and hormone therapy. But note that 20 more men have been diagnosed with prostate cancer in the PSA screened group then in the unscreened group. Which means that 20 more men in the screened group than the unscreened group will receive treatment for prostate cancer – a cancer that might never have come to light if they had not been screened, and might never have caused them any harm. So twenty men out of the 1000 screened will be put through all the risks of treatment of prostate cancer – a treatment that carries risks such as surgical blood loss, or the small risk of incontinence or impotence – and yet only one of them will have their life saved as a result of the screening picking up a cancer.

And yet – although the doctor in me recognises the distress, effort, side effects, and expense that 1000 patients have to be put through in order to save one extra life from prostatic cancer, the patient, or patient’s relative, in me, screams ‘go for it!’ to my husband and my brother. Because the truth is that although the abstract concept of 1000 patients having to be screened in order to save one extra life might seem excessive to the doctor, to that one patient, that screening test has been – well, life-saving. And this is why the vast majority of patients will choose screening for themselves and their loved ones even if the chance of personal gain is very small. Because what’s a bit of discomfort or even a serious side effect like anaemia or infection compared to the difference between life and death for yourself or someone you love? Only when the risks of screening become so serious as to potentially cause life threatening disease themselves do most patients baulk.

The answer to uncertainty in medicine is education, education, education. If the patient reads up about the risks and benefits of procedures, they can have discussions with their specialists. And of course, much depends on individual preference. One individual may be adamant that they want their PSA checked, even though screening only saves one life in a thousand compared to a nonscreened group. Another may prefer not to undergo the psychological distress of a test and discomfort/risks of a biopsy that, even if positive, may simply be diagnosing a cancer that would never have caused their death anyway. This excellent book does not try to dictate answers – it merely seeks to raise awareness that even with all the technological and pharmacological advances in medicine, the correct answer is not always black or white, but various shades of grey.

* * * * * *

Eat Salt, Not Sugar

The general public has long been chastised to lower their salt (sodium chloride) intake. Some of us forgo a sprinkle of it on food, and, as a result, eat bland and unseasoned meals. In The Salt Fix (Piaktus, £13.99), Dr James DiNicolantonio, a cardiovascular research scientist and doctor of pharmacy in Kansas City, Missouri, tells us that we have been demonising the wrong white crystal. Sugar is far worse for our health than salt. In fact, he explains to us that low salt diets actually cause all sorts of harmful physiological effects. They increase the heart rate, which puts more strain on the heart. They increase triglycerides, and increase insulin secretion, since insulin helps the kidneys to retain sodium. Insulin stimulates the laying down of fat, and it lowers blood sugar, leading to sugar cravings. In addition, when the body over-secretes insulin, cells can develop resistance to the effects of the hormone, paving the way for the development of type 2 diabetes mellitus, with its attendant risks of heart attack, stroke, and poor leg circulation, and problems in kidneys, eyes and nerves.

We are constantly told that salt raises blood pressure, but approximately 80% of people with a normal blood pressure are not sensitive to the blood pressure-raising effects of salt at all. Of those with borderline raised blood pressure, still 75% will not increase their blood pressure if they ingest salt. And even of those with full hypertension, 55% of them are totally immune to salt’s effect on the blood pressure. The author’s message is that in most people, eating normal levels of sodium is not harmful. In fact, studies suggest that eating between 3 and 4 g of sodium a day does not cause a problem in individuals whose kidneys are working properly, since any excess is excreted, and the high levels protect against the aforementioned risks of low salt diets.

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But national guidelines are slow to follow research. In fact, nutritional guidelines have consistently lagged so far behind research over the past few decades that sugar has had a free pass, despite the many trials showing its deleterious health effects. Risibly, as recent as 2000, US guidelines assured the public that sugar did not predispose to type 2 diabetes. And in the UK, it wasn’t until July 2015 until the government reduced the maximum percentage of daily calories that it recommended could be taken in by free sugars from 10% of total calories to 5%, following consultation with the Scientific Advisory Committee on Nutrition. In fact, the best percentage of free sugars to ingest if you have a sedentary lifestyle is 0%.

Why has it taken so long for public guidelines to match what research has shown for decades? Perhaps it’s because the sugar industry sponsors a lot of research. In 2013, a systematic review of studies published in PLOS Medicine showed that in those studies which were partially or wholly funded by the food industry, or had other similar conflicts of interest with it, 83.3% found no link between sugary drinks and obesity. By contrast, in those studies which have no conflict of interest with the food industry, 83.3% of them showed a definite connection between sugary drinks and obesity. It seems remarkable that even in the 21st-century, research can become befuddled by the influence of industry and politics.

While I would be more circumspect about recommending a dietary intake of salt as high as that which the author recommends, it certainly seems as if very low salt diets do more harm than good. And it is clear to see that it was sugar, not salt, that was the bogeyman at the banquet all along.

Dr Leyla Sanai MBChB MRCP(UK) FRCA(Lond)
Retired consultant anaesthetist

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