Do you need a digital detox?

Social media is the phenomenon of our time.

It has allowed each one of us to connect with new and old friends and companies like never before and it has become an integral part of our lives.

A couple of weeks ago, my wife took us both to Rome to celebrate my birthday.  This is me in the photo, caught in the act by my wife, checking social media in the middle of one of the world’s great historical sites – the Colosseum in Rome. Is this not addictive behaviour?

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There are pitfalls and dangers with social media as with any aspect of life and these are well documented. However, for the majority of people, social networks allow greater integration and sharing of our lives with friends and family than has ever been previously possible. From seeing family holiday photos to speaking to friends from years ago or miles away, connecting with people has never been easier. Suddenly the world is a much smaller place.

As a doctor, I have seen social media be a pathway to improving a patient’s health. One young patient had been quite social during their early years in school but had become more reclusive due to bullying. They rarely left the house and had no social interaction other than with their own family.

My patient’s one and only interest was sport. They continued to watch their favourite sport and over time, due to their enthusiasm, started a weekly iTunes podcast which proved quite successful. As part of the promotion for the podcast, they found they had to engage with social media including Instagram and Facebook. Slowly they found they were starting to talk to people online and, over the following months, started to form online friendships. This progressed into face to face friendships and attending sporting events together. From living their life alone in their bedroom to attending large sporting events with friends; the positive power of social networks is easy to see.

I think we engage with social media because as human beings we are inherently social animals. We like to keep up to date with what people are doing because by nature we are interested in what is happening in our surroundings.

Earlier this year, a study of 14-24 year olds found that Instagram was beneficial in terms of self-expression and self-indentity but that it could negatively impact their body image, sleep and lead to a fear of missing out.

Another study suggested that a Facebook addiction could be seen on brain scans of those reportedly affected – showing changes in the same parts of the brain that is affected by cocaine use.

Here are our top tips for spotting a social media addiction:

  1. As soon as you open your eyes in the morning you are already reaching for your phone to check out what has happened over night.
  2. You check in at the bus stop, the tube, your desk, at starbucks (with a selfie of you looking wistful with your coffee – or a boomerang of your coffee), you then update your status as you’re waiting for the work day to end and repeat the check in process on your way home before providing a running commentary in Instagram stories of you preparing your dinner.
  3. When someone tells you a joke you respond with lol instead of an actual laugh.
  4. You use the phrase “hashtag” in normal conversations. #fail.

So you’re worried you might be addicted, or you might need to take a step back from social media – how do you go about doing it? In truth in can be incredibly difficult to digitally detox your life.

  • Start by trying to set some limits – like not checking your phone in bed or after a certain time at night, not taking your phone to the bathroom etc.
  • Try turning off the push notifications – these little messengers of social activity constantly draw us back to our accounts.
  • Try having a device amnesty in your house eg for a few hours in the evening or even for a whole day, and spend time instead with your family

Sure, there are some people who live and die by the number of likes a post or picture gets, but the rest of us just enjoy looking at photos of our friends as they have too much to drink and falling over don’t we?
 

 

 

 

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.

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.