Wonder Woman/Super Man – what’s so great about them anyway?

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This post is inspired by a patient I have, we’ll call her Jane. In reality the patient I met today is like so many that I have, and your doctor has, met before. It could easily be John, or Jenny, or Jeff.

Jane is in a cycle of trying to care for family members and hold everyone together, but the cracks are starting to show. The strain of being everything to everyone is leaving little time to tend to her own needs. Her stress levels are through the roof, she isn’t sleeping well at the moment, her appetite is a little off, she is struggling to focus at work and feels like she is on the verge of tears or anger most of the time. Sound familiar?

It’s not Jane’s fault, she is doing what she knows best. She is trying to support her family whilst being a productive colleague, a good friend, a good spouse… She’s trying to be Wonder Woman and she’s mad at herself because she is struggling. She berates herself for not being “strong enough” and that she “needs to snap out of it” but try as she might, she doesn’t see how she can.

I talked with Jane about imagining ourselves in a house. For any house you need a solid foundation, and that foundation is our sense of self.  The walls of the house our are natural defences to protect us from the storms of life. Repeated adverse life events or stressors, just like a real storm, can chip away at the walls of the house, they might even break the windows.

If our house is built on solid foundations, and we have developed coping strategies that are effective for us then we can weather those storms. If our defences are low – perhaps we have lots of stressful things happening at the same time which are rocking the walls of our house, or our foundations are built on shallow ground, then our house is going to start tumbling down.

Without the house to protect us, we are exposed to the harsh realities in life.

This is where I found Jane today. Her walls are tumbling in, she is trying desperately to barricade the doors and windows but she cannot keep up with the demands that life is throwing at her. Simply put, she cannot be everything to everyone. She is not Wonder Woman.

Fortifying our proverbial houses is tough, especially as we often have to try and fight these fires whilst carrying on with our normal lives.
The first step is acceptance. Accept that you cannot do everything.

“Serenity is accepting the things we cannot change,

courage to change the things I can and

wisdom to know the difference”. 

Acceptance does not mean berating yourself for weakness. It is not a flaw to accept that you need help or that you are struggling. It takes strength of character to stand up and say to someone you need some support.

Next comes rebuilding. For those in caring roles this can be especially challenging. As a carer your focus is inherently on those your care for. Shifting your focus back to you can be unsettling, upsetting and hard to do. However to care for another in the way you want to, you have to be able to care for yourself.

One of my favourite analogies (and I have plenty) relates to a broken leg. If you have a broken leg, society at large knows how to react. They can see the plaster cast and the crutches, they can mentally apportion the right amount of sympathy and understanding. Bones heal, the injury is visible, and it’s much easier for people to get their head around.

Stress, burn-out, depression and anxiety all have few outwards signs. Unfortunately a stigma can still exist around these problems and society can sometimes feel unsure about how to ‘handle’ someone who is suffering. But just because it isn’t visible, and just because it isn’t physical, doesn’t make the problem any less real or relevant.

To rebuild takes time. Patience. Support. Effort. It isn’t easy. Remember that a difficult path can sometimes lead to beautiful destinations.

Talking therapies such as counselling and CBT should never be overlooked or dismissed. Having someone else, impartial to your situation, help you to talk through your current troubles can be a real life saver – and can help to set you up for your future.

Some patients might need medication from their GP. I would always encourage anyone who is facing difficulties in their life that are starting to overwhelm them to speak with their doctor.

Part of rebuilding is learning about yourself. Really understanding yourself is the key to your success. What are your warning signs that things are getting too much? What can you do when those signs start to appear? What strategies to do have to protect that proverbial house?

Whatever it might be, find what re-centers you. It might be yoga or meditation, it might be catching up with an old friend, watching a favourite film, reading a book, going for a run or taking the dog for a walk.  As long as its a positive action – that doesn’t mean opening a bottle of wine or similar.

Exercise can be an incredibly powerful tool at boosting how we’re feeling when we’re struggling. Physical activity is not only good for our physical health but for our mental health too. Not only does it increase endorphins that help promote good feelings, but it also can help with issues such as insomnia.

Being you is enough. You don’t need to be Super Man or Wonder Woman. Besides, they wore their pants over their clothes, and when you stop and think about it, what’s so great about that anyway?

 

 

 

“If a migraine is just a headache, then Godzilla is just a lizard”

One in seven of us will suffer from migraines, so there is a good chance that someone you know suffers with migraines – it might even be you.

It is estimated that there are nearly 200,000 migraines every day in the UK. More common in women than in men, it can affect us at any age – even as children.  On average, a migraine sufferer will have 13 attacks a year, lasting up to 72 hours at a time.

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Migraine is a complex problem and the truth is that medical science isn’t entirely certain on its cause. Whilst many people with migraines will experience headaches (usually a severe, throbbing, one-sided headache), there are many other symptoms and features of a migraine, such as: flashing lights or visual changes or sensitivity to the light, sensitivity to sound or smells, nausea or vomiting, numbness or pins and needles, slurred speech, irritability or abdominal pain. Sometimes, someone with a migraine will not even have a headache.

Migraines are thought to occur in five stages: prodrome, aura, main attack, resolution, recovery.

The prodrome can be tricky to pick out from normal day-to-day life, but those who can recognise it will talk about feelings of lethargy or irritability, or just feeling a bit off.

For some this will be followed by an ‘aura’. This would typically happen up to an hour before the attack. Someone might notice flashing lights, changes to their vision or speech, or other neurological features such as tingling or numbness. Migraine aura’s do not happen with every migraine, and it is estimated around one-fifth of migraines are associated with an aura.

I suffer with migraines – thankfully very rare these days, but when I get one they wipe me out. I don’t usually suffer with an aura when I do have a migraine  – but it has happened. If I do get one, it will be flashing lights – strange flickering light towards the edge of my vision – just enough to make me wonder if I have seen it at all – and I get a bit muddled – almost as if my brain is suddenly wading through thick treacle and I feel I have to work hard just to think. 

The main stage of the migraine is the ‘attack’ phase – this is when a headache (if present) will occur and can last up to 72 hours.

In the resolution and recovery phases, the headache and any other symptoms start to ebb away but patients will often say they feel particularly tired or wiped out, sometimes for a couple of days.

So if you suffer with migraines, what can you do about them? First off, it’s really important that if you are experiencing new, changing or worsening headaches you get these checked out by your doctor. If your doctor agrees that you are suffering with migraines you might then want to think about ‘triggers’.

Many migraine sufferers have triggers unique to them and there are so many possible triggers out there. To be able to start working out what might be setting your migraine off, a headache diary can be a great tool. You can download pre-set diaries or just use your calendar on your phone. Do this for a month or so and then look back over the information you have collected and see if any patterns jump out at you.  For me, it’s lack of sleep – every time!

Common triggers are: emotional upheaval whether that be happy or sad, worry or anger, poor sleep or over tiredness, changes to environment, periods for women (as well as contraceptive pills and the menopause), dehydration, citrus, caffeine, cheeses, chocolate, alcohol, pork and monosodium glutamate.

Treatments vary depending on the type of migraine, how often they happen and your medical history, Broadly speaking these can be divided into ‘acute’ treatments – ones you take when an attack is happening and ‘preventative’ treatments – ones to take to try and stop attacks from happening. Simple measures such as paracetamol, anti-inflammatories such as ibuprofen and rest in a darkened, quiet room can be enough for some people. A word of warning about using codeine containing medications though – codeine and other opiates can can worsen or even cause headaches so should be avoided unless your doctor has advised you specifically to use them.

So if you’re one of the one in seven people in the UK who are thought to suffer from migraines, first off I feel for you and share your (head) pain. Secondly, don’t suffer in silence.

Migraines cannot be cured, but they can be managed. To talk about treatments that might help, speak with your doctor. As with so many medical conditions, there is a lot we can do to help ourselves – so why not consider keeping a headache diary and see what you can learn about your migraines.

Vitamin B

Next in our quick series of Vitamin FAQ’s we look at vitamin B (if you missed Vitamin A – you can read it here).

There are actually lots of different types of vitamin B, but for our bodies the main ones are:

  • B1 – thiamin
  • B2 – riboflavin
  • B3 – niacin
  • B5 – pantothenic acid
  • B6 – pyridoxine
  • B7 – biotin
  • Folate (folic acid)
  • B12

 

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In general, they all aid the process of breaking down key aspects of our food, releasing much needed energy into our system, as well as helping keep our eyes, skin and nervous system healthy.

Vitamin B6 has a specific role in using and storing the protein and carbohydrates we take in as part of our diet and helping our body to produce haemoglobin. Haemoglobin is what makes our blood look red and critically carries oxygen around the body.

Folic acid – most well known as the supplement that is needed in pregnancy – is crucial for reducing the risk of developmental defects of the central neural tube of unborn babies. The neural tube is the early form of our central nervous system. Developmental problems at this crucial stage of a baby’s growth can lead to problems such as spina bifida. However it’s not just pregnant women – it also helps all of us to make healthy red blood cells.

Perhaps the most well known is vitamin B12. This actually helps us to use folic acid. It also is vital in keeping the nervous system healthy and plays a key role in making red blood cells.

With so many types of B vitamins, the ways we can get this into our diet are varied. Importantly, some of these vitamins cannot be stored in the body – so we need a daily supply in our diet. Thiamin cannot be stored – and it’s recommended that men need around 1mg/day and women around 0.8mg/day. Similarly we need daily riboflavin at around 1.3mg for men and 1.1mg for women. Niacin also cannot be stored and men should aim for around 16.5mg and women around 13mg.

A word of caution about niacin – too much for a long time can lead to liver problems and cause skin flushes. Similarly B6 in excessive amounts  (e.g. more than 200mg) can lead to a problem called peripheral neuropathy. This is a problem of the nervous system where we can develop loss of sensation in our limbs (peripheries). Men should aim for around 1.4mg/day of B6 and women around 1.2mg.

Many foods are rich in a number of B vitamins including: eggs, fresh/dried fruit,  leafy green vegetables, broccoli, wholegrain bread, fortified cereals, milk (cow’s), nuts,

Some specific diets e.g. vegetarians and vegans can sometimes struggle with B vitamins, and B12 in particular. B vitamins are in abundance in animal products – meats, fish, eggs, cows milk etc. However with careful planning, it is possible to get all the recommended amounts in your diet without additional supplementation. However, a multivitamin can be a helpful addition to more restrictive diets and might be worth discussing with your doctor.

Folic Acid

As we have already learned, folic acid (or folate) is pivotal in a baby’s development and throughout our life by helping us produce red blood cells. The average adult needs 200micrograms of folic acid/day and it cannot be stored meaning you need a daily amount. An additional supplement is provided to pregnant women – either 400mcg of 5mg depending on their medical history. Caution is required with additional supplementation – too much can possibly cover up an existing B12 deficiency.

This is found in vegetables such as asparagus, peas, sprouts and broccoli. It is also prevalent in liver but this should be avoided in pregnancy.

B12

The most well known of all B vitamins is B12. A deficiency of B12 is something that has been in the media more of late. This is the vitamin that those who avoid animal products in their most struggle with – as it is only found naturally in animal products – meats, milks, eggs.  It is some fortified cereals however.

We need around 1.5micrograms/day and this is something we can store in the body.

Deficiency in B12 causes wide ranging symptoms including low mood, changes in mental state, altered or abnormal sensation, fatigue, irritability, anaemia and reduced fertility. Whilst some changes can be reversed with treatment, if left unchecked and untreated, some of the damage can be permanent.

Why am I so tired all the time?

“Doctor, I’m just exhausted. All the time. I’m so tired, there must be something wrong with me”

Pretty much every GP or family doctor will hear this several times a day. Tiredness is ubiquitous with our fast paced modern lives, but at what point is it more than just our lifestyle and an indicator that something is medically wrong?

Feeling tired all the time, that feeling that even after a long sleep you don’t feel rested. It’s feeling like you could nap at pretty much any time of day. It’s draining for patients and can have a real knock on impact on their quality of life.

 

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There many medical explanations for tiredness such as hypothyroidism, anaemia and depression but it’s important to also examine your own habits and patterns to work out if it’s anything you might be able to change.

 

In my clinic I tend to try approach both the biological and the behavioural aspects of tiredness simultaneously. Lets get you looked at, examined and tested if relevant, but lets take pause to look at you as a whole – how are your stress levels, are you worried about anything, whats happening with your weight and your appetite, when do you go to bed – to get a sense of anything else we might be able to improve upon.

Stress, anxiety and depression can all impact upon our sleep. Often it might be one of the first signs that you might be suffering one of these conditions. Whether it be that your mind is racing over the days events when you try and go to bed, or thinking about the events of tomorrow or the future. Some patients with anxiety report increased palpitations (a sense of the heart racing in the chest) in the evening/night time which enhances their difficulty sleeping. Patients with depression might experience ‘early morning wakening’ when they are unable to stay asleep and wake in the early hours.

Sleep hygiene is often overlooked in the 21st century, we’re more connected than ever with a myriad of devices and with the increasing advent of flexible working we’re checking work emails in the evening and working later and later at home. There is also some misunderstanding about how much sleep we actually need.

Our sleep pattern is regulated by something called a circadian rhythm, an evolutionary clock that tells us to be up when its light and sleep when it’s dark. In the days of our ancestors, this helped us to be productive in the hours when there was light and to rest to in the dark when light sources would have been limited.

Stimulants such as caffeine, alcohol and nicotine as well alarm clocks and devices plus the addition of later working and shopping hours can all interfere with our natural sleep/wake cycle.

How much sleep do we need?  How do you stack up to the numbers below?

  • Newborns (0-3 months ): 14-17 hours each day
  • Infants (4-11 months): 12-15 hours
  • Toddlers (1-2 years): 11-14 hours
  • Preschoolers (3-5): 10-13 hours
  • School age children (6-13): 9-11 hours
  • (14-17): 8-10 hours
  • Younger adults (18-25):  7-9 hours
  • Adults (26-64): 7-9 hours
  • Older adults (65+): 7-8 hours

Sleep is a priority, we need that time to allow our brains to hit the reset button.  Simple but effective techniques for a better night include: sticking to a schedule – set yourself a bed time and try and stick to it, if you are someone who runs through to-do lists for the next day, make a list before you go to bed and put it to one side, getting exercise daily will help to naturally tire you out, make your bedroom as restful as possible – limit those electronic devices and televisions in the room and turn off your phone
Techniques such as deep breathing or meditation can help to quieten your mind to prepare your body for sleep. Try inhaling for three seconds and exhaling for six. Repeat this five times. Then try to tense your toes as tight as possible, then relax, work up your body – tense and relaxing groups of muscles in turn. This helps to give the body a sense of relaxation.

When is tiredness caused by more than a few late nights? We’ve looked at a few of the more common reasons we see in clinic:

Iron deficiency anaemia.

This is the most common nutritional deficiency in the world and is common in women having regular, heavy periods. Blood loss causes us to lose iron, and if we are not able to get enough iron back in through our diet, we can build up a deficit. Besides tiredness, symptoms can include skin that appears more pale, feeling cold,  feeling dizzy or lightheaded, hair loss and brittle nails. Picked up on a blood test, your doctor can advice on a cause of replacement and may recommend further testing to discover the cause.

Hypothyroidism.

The thyroid, a small gland in the neck, is responsible for producing hormones required in many different bodily functions. Symptoms include an inability to tolerate the cold, weight gain, constipation, low mood and of course, tiredness. Again, picked up on a blood test and treatment involves replacing the deficient hormone – usually as a daily tablet.

Chronic fatigue syndrome

Something that has divided medics for years. A condition that causes long-term fatigue, it’s cause is not known. It is thought that it starts with a flu-like illness and there have been suggestions is can have links with mononucleosis, lyme disease and chlamydia. There are no definitive tests to confirm this, so often the process will start by looking for other conditions that might cause tiredness.

Coeliac Disease.

A gluten intolerance that can cause weight loss, bloating, bowel habit changes as well as tiredness. Gluten is found in foods such as breads, cakes and cereals. It’s thought around 1 in 100 people in the UK have coeliac disease, but 90% of those affected do not know they have. Diagnosis involved blood tests and biopsies and is most often managed by avoiding gluten in the diet.

Sleep apnoea.

More common in people with a higher body mass index, where the breathing tube is compromised when patients are lying down, but can also be linked to alcohol intake and smoking.  In sleep apnoea patients will have periods of interruption in their breathing when asleep. Partners might report snoring – or evening being able to hear the moments when breathing is interrupted. Testing involves sleep studies and oxygen monitoring during sleep. Patients with confirmed sleep apnoea will be given advice about how to reduce their risk factors and in more extreme cases a machine (CPAP – continuous positive airway pressure) to wear overnight which helps to move air into the lungs and keep the airways open.

 

We could all do with taking stock of our sleeping habits and taking steps to improve our sleep hygiene. But if you think that there might be something underlying the tiredness, you should always discuss this with your own doctor.