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.

“All that I am, or ever hope to be, I owe to my Mother”

It’s Mother’s Day today in the UK and this gives us a chance to show our mums how much they mean to us – whether they are still with us or not. There is an undeniable connection to your mother, no matter what is going on in life.

As babies we are conditioned to bond to the person who provides us with the most care – this can be our mother, father or anyone that provides us the majority of our care. This bond is what psychologists call ‘Attachment Theory’. It’s a biological instinct where we equate our safety with being close to this person and that this person will take away our discomfort and protect us.

We don’t know about you, but that definitely describes our mums.

 

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In honour of our mums, we wanted to share some of the most valuable lessons we have learnt from them:

 

“Grant me serenity to accept the things I cannot change, courage to change the things I can and wisdom to know the difference”.

This was something we had on an ornament in our house growing up – and it followed us from house to house and has always stuck with me. Learning to let go and move on, or dig in and work hard are crucial life skills we all need.

 

“When driving, you don’t have to run a race”

When someone approaches in your rear view mirror, whether it be in the car or in life in general, you can choose to put your foot down or carry on at your own pace. Life is not a race or a competition. Enjoy the journey and don’t put your foot down and miss the beauty and opportunities around you.

 

“Never let the sun set on an argument”

A quote taken from Ephesians 4:26, in the heat of a disagreement it can be hard to reach resolution. Feelings of anger or resentment can be destructive if not handled properly, both to our physical and emotional health, but also can have a wide reaching impact on our relationships and careers.

 

“You are in charge of your own feelings”

This would often come during a typical teenage temper tantrum and mum would tell me that I was in charge of how I felt. At the time, I never understood it, but as I have got older it makes sense. Yes, a certain event or circumstance may trigger emotions e.g. an argument might make us angry, but we are in charge of how we deal with that anger. Do we bottle it up, or do we move on and resolve and forgive? You are in control of how you handle and react to your feelings.

 

“If you can’t do it, learn to do it”

If there was something I wasn’t able to do, mum would always work out if there was a way to learn it. She always believed education, in all it’s forms, was the way to improve oneself. As doctors, we are somewhat infamous for our poor handwriting, but even growing up my handwriting was questionable. So mum would keep buying me handwriting books to try and practice and improve. When we come up against something we struggle with, we are faced with two options: we can give up, or we can adapt and work through it, and it was my mum taught me that we didn’t give up.

 

“One day you’ll thank me”

They were right. We’re incredibly thankful for all they have done and taught us. Abraham Lincoln told us that “All that I am, or ever hope to be, I owe to my Mother”, and we’re inclined to agree.

 

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Your sense of self: the magic five.

Self Confidence.

Self Esteem.

Self Worth.

Self Belief.

Self Respect.

All priceless. All fragile. All unique.

Our sense of self is intricately tied to our personalities, experiences, belief systems and the bubble we find ourselves in. It can take a life time to build and a second to shatter.

 

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On the face of it, the five S’s may all seem similar concepts but each one is a like a snowflake – outwardly uniform but subtly different to the next.

In today’s society when we are so often judged on how well we do our job, how many exams we passed, how productive we are, what material possessions we have or don’t have, it can be easy to conflate our self-confidence by listing our many achievements. However to face and accept our flaws and weaknesses takes real strength. It’s our self-esteem that allows us to look at these facets of our character and not be lessened by them. A robust sense of self esteem enables to us own our flaws, learn from them, use them, grow from them.
Alexander Pope wrote An Essay on Criticism in 1709 and told us “To err is human, to forgive is devine”. Whether you have faith in a higher power is immaterial, and whilst Pope may have been talking about literary critics, his words ring true when considering self-esteem.

Mistakes, flaws and errors are part of what makes us human. Being able to forgive ourselves is part of our ongoing development. We need to acknowledge and accept these to be able to move forwards.

Valuing what we can offer our friends, our family, our colleagues, the wider community or, more importantly, ourselves helps to re-affirm our sense of worth and place in the world. We all have a place.

What we do with that place, to a greater or lesser extent, has much to do with our self-belief. Einstein said that insanity is doing the same thing over and over and expecting different results. If we never change what we put in to something, how can we ever expect a different result?

At a couple of stages in my professional life I have had attacks of “Imposter Syndrome”, a pervasive feeling that at some point I would be uncovered as a fraud. I lacked the confidence and belief in myself and my abilities. The first was immediately after medical school. For years as I rotated through my house officer (residency) jobs, I kept all my old med school notes and textbooks – just in case the university called to tell me they had made a mistake and I hadn’t actually passed my finals!

The second time was shortly after I qualified as a GP. I worried all the time that I would be “found out” and that I wasn’t really “good enough” to do my job. Thankfully with time, supportive colleagues and a helpful husband, I learned to settle in my work. I still have moments when doubt starts to creep in, but using strategies I have developed over time to refocus my self-belief and confidence, I can pick myself back up.

Having a goal – whether it be in your work, your home life, weight loss or fitness goals – and the effort and drive it takes to reach it – all relies on your self-belief. That intense faith you place in yourself that you will reach your target. This one (as they all are) is tricky. It’s vulnerable to knocks along the way and this can lead you to deviate from your goals.

An analogy I often use with patients when we talk about goal setting is to imagine climbing a mountain. When you are in the foothills looking at the summit, it can seem an awful long way up. It’s easy to think of at least ten reasons not to start the journey – it’s a long way, it’ll be hard, I’m not prepared… But if you think of that same journey as a series of shorter journeys, perhaps from the foothills to base camp. From base camp to the next rest stop, and then to the next and so on until you reach the summit. Then at each rest stop allowing time to gather yourself and evaluate your progress. Whilst the journey might still seem a challenge, breaking it down to smaller chunks makes it more manageable.

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A buzz phrase in medicine, and education generally, is SMART. A tool for setting goals, it tells us that goals should be:

Specific (what are you going to achieve)

Measurable (how will you know when you achieve it)

Achievable (is it within your ability – if your idea of art is drawing is limited to stick people it might not be achievable to think you’ll open at the Tate Modern or MOMA in twelve months time)

Realistic (perhaps you are a great artist but accept it might take ten years for an opening in prestigious galleries) and

Time Specific (when are you going to achieve it by)

Either way to get to our goal takes self-confidence to learn our strengths, self-esteem to accept our weaknesses, self -worth to believe we have value and the right to dream and self-belief to push on and achieve it.

Which leaves the toughest one of all, self-respect.

Underpinning all of these is the respect we have for ourselves. Our esteem, worth, belief and confidence are, in general, internal concepts. They are what we think. Our respect is generally what we do to ourselves in the physical sense. Self-respect doesn’t care what happened in the past, it’s about what you are doing right now.

If the other four S’s are talking the talk, your self-respect is walking the walk.

No one, in any shape or sphere can or should take your self-respect. The only person who has any right to your self-respect is you. If you have a bad day, or week, or even a bad month your esteem, confidence, worth or belief might take a beating, but it’s your self-respect that will build you back up.

Self-respect is lifetime work. There will always be critical voices and adverse life events ready to knock you. However if you can ensure you respect you for you, you’ll make it through. Imagine your self-respect as a small seed, planted in the ground. To grow, it needs to be nourished and fed to flourish, ignore it and it will risk withering and decaying.

Having respect for yourself means taking care of your body, your mind and your actions. Be proud of you. Don’t settle for something that is less than you deserve. Forgive yourself, we have all done things we are not proud of, but berating yourself for these for the rest of your life won’t get you anywhere. Surround yourself with positive people and influences. Take care of your body – you only get the one. Don’t compare yourselves to others. Theodore Roosevelt told us that “Comparison is the thief of joy”. Treat others with respect but do not allow others to disrespect you.

“Self-respect cannot be hunted. It cannot be purchased. It is never for sale. It cannot be fabricated out of public relations. It comes to us when we are alone, in quiet moments, in quiet places, when we suddenly realize that, knowing the good, we have done it; knowing the beautiful, we have served it; knowing the truth, we have spoken it” Alfred Whitney Grisworld

 

–Alex

 

 

#BeBoldForChange on International Women’s Day

So today is International Women’s Day.

The theme for this year is to be bold and make a change for women’s rights.

As doctors, we are reasonably lucky that in many regards we are on an even footing with our male colleagues. Although recent amendments to junior doctors contracts in the UK have had my female peers up in arms. Penalising women for career breaks – whether for academic advancement or for children is never acceptable, especially in a profession that at it’s core is non-judgemental to all. Even my latent inner feminist was irked by the governments decisions.

The purpose of International Women’s Day is to reflect on the progress of women’s rights, celebrate those women who have stood up to fight for equality and for our benefit – whether it be in our local community or in the wider world.

Sometimes we can be accused of being cosseted in our own little bubble, immune to the problems “over there”. The sad reality is that the freedoms and opportunities we enjoy here are not universally shared and any chance to shed the spotlight on that cannot be a bad thing.

In honour of International Women’s Day, I would like to share a few of my female heroines:

Margaret Ann Bulkley (a.k.a. Dr James Barry)

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Dr. James Barry enjoyed an illustrious career as a military surgeon, working to save lives of wounded soldiers. He is famed for being the first British surgeon to perform a successful caesarean section in Africa. However all was not what it seemed with Dr. Barry. He was born Margaret Ann Bulkley and pretended to be a man throughout her entire professional career so as to allow her to study and practice Medicine and to be accepted by peers. It was only after her death that her gender was revealed.  She was the first medically qualified female in British history. As a female in medicine, she will always have a soft spot in my heart. To have that kind of guts and determination to strive for success and passion is awe-inspiring.

Michelle Obama

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There is much to say that hasn’t already been said about the former FLOTUS. From her stellar fashion sense to her commitment to advancing education for girls, she is a tough one not to admire. The former Princeton and Harvard grad turned lawyer turned wife and mother turned first lady is a modern lesson for how belief and work can make anyone an unstoppable force. In a speech in 2009, Michelle told us ” One, that as women, we must stand up for ourselves. The second, as women, we must stand up for each other. And finally, as women, we must stand up for justice for all.” #Obama2020

Cleopatra

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Perhaps the most inspiring women in history was Cleopatra.  She beguiles long after her death in 30BC. Depicted by famous beauties of stage and screen, she is credited of using her feminine wiles for the benefit of her country. Her legend is one of beauty, wit, charm, intellect, independence and determination. It is thought she spoke as many as a dozen languages and was a political dynamite. She was also a fierce warrior, having personally led an Egyptian naval fleet to battle. She can be best be summarised by one her most famous quotes “I will not be triumphed over”.  All things considered, what’s not to love about her.   

So on the day when we celebrate women and take time to reflect on the challenges we have yet to overcome, how will you #BeBoldForChange?

-Alex