Compass September - November 2016 by PeopleAssetManagement

COMPASS Your Health & Wellbeing Guide

Back to school

September 2016

Blood Cancer awareness month

health tips

Healthy

chicken recipes

Stay fit this autumn without a gym!

easy & tasty

Coping with

Understanding

sleep

disorders sleep apnoea, insomnia, RLS & narcolepsy

money worries Mental health real stories & advice

September October November

Autumn 2016

Contents Autumn Health Tips 3 Understanding Sleep Disorders 5 Coping With Money Worries 7 Back to School Health Tips 9 Mental Health: Real Stories 11 PAM Assist: Employee Assistance Programme

How to Deal With Panic Attacks

Healthy Chicken Recipes 19 Blood Cancer Awareness 23 Donâ&#x20AC;&#x2122;t Fall out of Fitness: Autumn Fitness Help

Raising Low Self-Esteem 29 Improve Your Health at Work 31

is season th y h lt a e h y a st ...Tips to

One thing we can always guarantee in life is change .

Nature reminds us of this by the ever-changing rhythm of the seasons. Autumn is upon us! The temperatures are cooler and the days are shorter. The morning air is brisk, and itâ&#x20AC;&#x2122;s time to start thinking about winter coats, woolly hats, crunchy leaves, mugs of hot chocolate and cosy nights in front of the fire. While you might be disappointed to see the last of the summer salads and barbecues, there are a plethora of yummy foods for you to choose from in autumn. So here are some tips to help you eat healthily, keep your spirits up and live a vibrant, happy life this autumn...

Nature. Some effective natural immuneboosters are: plenty of fresh water, eat plenty of alive (living) raw foods, garlic, lysine, probiotics, vitamins B, C and D, E3 Live, reishi mushroom, zinc, propolis and Manuka honey. Another powerful way to boost your immune system and keep strong is to use the power of gentle exercise. This brings us onto the next tip...

Always buy food in season With the arrival of the new season, now is the time to change your diet! Embrace the yummy foods that autumn offers. Enjoy fresh pumpkins, parsnips, yams, winter squash, sweet potatoes, turnips, apples, pears, figs, elderberries and even cranberries! There are many fresh, seasonal dishes that are sure to become family favourites, to name a few... Creamy pumpkin soup, roasted root vegetables, cranberry chutney, baked sweet potatoes, caramelised pears and crisp apple pies.

Eat your autumn colours Autumn is the season of warm, earthy colours; think deep greens, dark yellows and brilliant oranges. When you eat foods that are rich in these colours, you are absorbing each of their unique health components. Autumn foods are vibrant, colourful and nourishing. One rule of thumb is that the more colourful the fruit, the better it is for your health and your immune system.

Boost your immune system With the changing season, now is the perfect time to boost your immune system. Whenever you feel the need for a boost to your immune system, first look to Mother

Embrace gentle movements In summertime, it’s so lovely to spend time outside. For many, this sunny weather allows them to move their body naturally, using gentle movements such as walking on the beach. But, don’t let cooler temperatures stop you from moving your body! Far too many people stop exercising and spend more time doing sedentary activities indoors. One way you can keep moving during the cooler season is to bring your activity inside: why not purchase an exercise DVD or try some free classes on Youtube. Alternatively, go to the gym, find a dancing class or simply go for a leisurely walk - if the weather allows! Make sure you get yourself organised so that you are well prepared for the coming winter months. By finding an enjoyable way to gently move your body, you will keep yourself fit and healthy. (Just think about how next summer will be even more enjoyable!)

Spend time relaxing at home, wrapped up with a hot water bottle, wearing your favourite pyjamas and enjoying early nights. Watch movies, drink chai tea, or start writing that book you’ve always dreamt about writing.

Up your vitamin D During autumn and winter months our sun exposure is limited, causing large seasonal variation in our vitamin D levels. As well as dampening our immunity, researchers believe that low levels of vitamin D can increase the risk of seasonal affective disorder, or ‘winter blues’. Because the majority of our vitamin D stores are synthesized from sunlight, it’s a good idea to increase your intake of vitamin D-rich foods during the colder months - good sources include oily fish, eggs, milk, butter and fortified cereals. Studies suggested that a walk around midday could be helpful and sitting by a window when indoors is also advised. You may also want to consider a supplement if your diet is lacking in oily fish and eggs, if you don’t spend time outdoors, or have had little sun exposure over the year. Autumn is a nice time to slow down and enjoy some internal reflection. Allow this season to be a chance to nurture yourself by eating fresh seasonal foods and living in alignment with nature. I hope that these tips help you to stay strong and healthy!

Live aligned with the season As the season shifts, give yourself permission to make different choices and changes in your lifestyle. The shorter days and longer nights are the perfect excuse to take the time to really look after yourself. So use this autumn as an ideal time to chill out and relax, giving yourself time for you.

Sleep Disorders

Many of us suffer from sleep deprivation without ever knowing why...

What are sleep disorders & how common are they? Sleep disorders are conditions that prevent a person from getting restful sleep and, as a result, can cause daytime sleepiness and dysfunction. There are approximately eighty different types of sleep disorders. The most prominent sleep disorders are: • • • •

Insomnia Sleep apnoea Restless legs syndrome Narcolepsy

What is insomnia? Insomnia is a sleep disorder in which

people have difficulty falling or staying asleep. People with insomnia have one or more of the following symptoms: • • • • •

Difficulty falling asleep Waking up often during the night and having trouble going back to sleep Waking up too early in the morning Having unrefreshing sleep Having at least one daytime problem such as fatigue; sleepiness; problems with mood, concentration; accidents at work or while driving, etc, due to not sleeping well

Insomnia varies in how long it lasts and how often it occurs. About 50 percent of adults experience occasional bouts of insomnia and 1 in 10 suffers from chronic insomnia. Insomnia can occur by itself or can be associated with medical or psychiatric conditions. Insomnia can be short-term (acute or adjustment insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute or adjustment insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

What is sleep apnoea? Sleep apnoea is a potentially serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnoea stop breathing repeatedly during their sleep. There are two types of sleep apnoea: obstructive and central. Obstructive sleep apnoea (OSA) is the more common of the two. It is caused by a blockage of the airway, usually when the soft tissue in the

back of the throat collapses during sleep. In central sleep apnoea (CSA), the airway is not blocked but the brain fails to tell the body to breathe. This type is called central apnoea because it is related to the function of the central nervous system. Symptoms of OSA may include snoring, daytime sleepiness, fatigue, restlessness during sleep, gasping for air while sleeping and trouble concentrating. Those with CSA may have gasping for air but mostly report recurrent awakenings during night.

What is restless legs syndrome? Restless legs syndrome (RLS) is a sleep disorder that causes an intense, often irresistible urge to move the legs. This sensation is brought on by resting such as lying down in bed, sitting for prolonged periods such as while driving or at a theatre. RLS typically occurs in the evening, making it difficult to fall asleep and stay asleep. It can be associated with problems with daytime sleepiness, irritability and concentration. Often, people with RLS want to walk around and shake their legs to help relieve the uncomfortable sensation.

What is narcolepsy? Narcolepsy is a neurological disorder of sleep regulation that affects the control of sleep and wakefulness. People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime. These sudden sleep attacks may occur during any type of activity at any time of the day. Some patients with narcolepsy experience sudden muscle weakness with laughter or other emotions. Narcolepsy usually begins between the ages of 15 and 25, but it can become apparent at any age. In many cases, narcolepsy is undiagnosed and, therefore, untreated.

How are sleep disorders diagnosed? If you suspect that you may have a sleep disorder, discuss your symptoms with your primary care doctor. He or she can perform a physical exam and help you identify the difficulties you are having with sleep. Keeping a sleep diary for two weeks may be helpful to your doctor. Some illnesses can cause disturbed sleep, so your doctor may order tests to rule out other conditions. If your doctor suspects that you have a sleep disorder, he or she may refer you to a sleep disorder clinic. A sleep specialist will review

your symptoms and may suggest that you undergo a sleep study. A sleep study or polysomnogram (PSG) is a multiple-component test that electronically transmits and records specific physical activities while you sleep. The sleep study can be done at home (Home sleep testing) for select patients. The recordings become data that are analysed by a qualified physician to determine whether or not you have a sleep disorder.

What you can do about it There are a number of things you can try to help yourself get a good night’s sleep if you have a sleep disorder. These include: • •

•

• •

Setting regular times for going to bed and waking up Relaxing before bedtime – try taking a warm bath or listening to calming music Using thick curtains or blinds or an eye mask and earplugs to stop you being woken up by light and noise Avoiding caffeine, nicotine, alcohol, heavy meals and exercise for a few hours before going to bed Not watching TV or using phones, tablets or computers shortly before going to bed Not napping during the day Writing a list of your worries, and any ideas about how to solve them, before going to bed to help you forget about them until the morning

How much sleep do I need? There are no official guidelines about how much sleep you should get each night because everyone is different. On average, a “normal” amount of sleep for an adult is considered to be around seven to nine hours a night. Children and babies may sleep for much longer than this, whereas older adults may sleep less. What’s important is whether you feel you get enough sleep, and whether your sleep is good quality. You’re probably not getting enough goodquality sleep if you constantly feel tired throughout the day and it’s affecting your everyday life.

h t i w g n i p Co

s e i r r o W y e n o M It’s normal to feel worried, anxious or down when times are hard. Job insecurity, redundancy, debt and financial problems can all cause emotional distress. But there are lots of things you can do to help yourself if you’re in a difficult situation. David Richards, professor of mental health services research at the University of Exeter, explains how financial problems can affect your mental wellbeing. He also offers lifestyle tips to help you out of a slump and advice on when to seek medical help.

How financial problems affect mental health When you’ve been made redundant or you’re struggling with debt, feeling low or anxious is a normal response. Losing your job can affect your self-esteem and financial circumstances, which in turn can trigger emotional distress. Fear of redundancy can also lead to worry, which is a very common human emotion. You may be feeling, behaving or thinking in ways that are unfamiliar. But this doesn’t necessarily mean you’re suffering from depression or an anxiety disorder. 7

How can you feel more positive? Professor Richards’ top tips for coping with feeling low and anxious are: “Be more active, face your fears and don’t drink too much alcohol.” P Being more active means not withdrawing from life. Keep seeing your friends, keep your CV up-to-date, don’t ignore the bills – try to keep paying them. If you have more time because you’re not at work, take up some form of exercise, as it can improve your mood if you’re feeling low. P Facing your fears means not avoiding things you find difficult. For example, if it looks like you’re going into debt, get advice on how to prioritise your debts. When people feel anxious, they sometimes avoid talking to others or can lose their confidence about driving or travelling. If this starts to happen, facing up to these situations will generally make them easier. P For some people, alcohol can become a problem. You may drink more than usual as a way of dealing with, or hiding, your emotions or just to fill time. But alcohol won’t help you deal with your problems and could add to your stress.

Why routine is important If you don’t have to go to work in the morning, you can get into a poor sleep routine, lying in bed until late or watching TV all day. Get up at your normal time and stick to your routine. If you lose your routine, it can also affect your eating. You may stop cooking meals, start eating snacks instead of having proper meals, or miss breakfast because you’re still in bed.

When should you get medical help? Most people who experience emotional distress will pick themselves up after a few days or weeks and then feel able to tackle challenges, such as finding a new job and organising bill payments. However, for a small number of people, the feelings of anxiety and low mood don’t go away, and these feelings interfere with the way they live their life. If you’re still feeling worried, anxious or low after a few weeks, see your GP. You may find that talking to a professional therapist could help. Your GP can advise you on talking therapy services in your area.

Seek help immediately if... If you start feeling like you really can’t cope and life is becoming very difficult or isn’t worth living, make sure you get help straight away. These are dangerous signals that shouldn’t be ignored and mean you need to talk to someone. As previously stated, either see your GP or contact helplines such as Samaritans (08457 90 90 90) for free, confidential, nonjudgemental emotional support. If you’ve had depression or anxiety before, even if it wasn’t formally diagnosed, seek help immediately. You’re more likely to have an episode of depression if you’ve had one before.

5 Tips to Help You Cope When You’re in Debt

1. Focus on the here and now

3. Face your demons

Whether it’s debt management or an IVA, getting out of debt can be a long process and it’s important to take it one step at a time. Spending all your time thinking about the future and what might happen can lead to your stress levels creeping up. It’s scientifically proven that living in the moment will make you happier. It’s equally essential to not get too bogged down with the past. It’s better to accept what’s happened and focus on taking steps to improve your life right now.

We all have times when we want to bury our head in the sand. If problems seem too much to deal with it’s incredibly tempting to try to put them out of our mind000000000000000000000000000 and forget them. Only we never really forget things when we try to put them out of our mind – they just hang over us like a cloud and make us feel worse. This can be true when the problem relates to money, as feelings of fear and shame make it even harder to hold our hands up and ask for help.

2. Stay positive Think about all the things that you love about your life. Getting out of debt often means having to do without some of the material things that we often convince ourselves we need. If you take stock of your situation it’s certain that there’ll be things in your life that are more important than money. They’re what’s important. Keeping a positive mental attitude will make everything easier to manage. Being positive doesn’t mean painting on a fake smile and struggling on.

4. Stick to a budget Creating a budget is one of the first steps towards taking control of your finances and getting back on track. Budgeting helps you to see where your money is going, so it’s easier to make sure that you’ve covered all of the things you need to pay. A budget is also great in helping you spot areas where you can make savings. As most of your household bills and debt payments are made monthly, we suggest that you make all the figures in your budget calendar, monthly.

5. Get support We know that being in debt can be an isolating experience. For some reason we all feel a bit strange talking about money to our friends and family and it can lead to feeling quite lonely. If you can overcome this awkwardness and confide in a trusted friend or family member then you’re bound to feel less alone. If you’re worried about your finances or need support and feel you can’t talk to friends or family, or just want expert advice, please see the numbers and services listed here.

Useful Numbers & Services Citizens Advice Bureau

www.citizensadvice.org.uk The Citizens Advice Bureau is a good place to get information about benefits, how to deal with debt, what you’re entitled to if you’re made redundant, and who to speak to if you end up losing your home.

GOV.UK

www.gov.uk The GOV.UK website has sections on: • • •

Redundancy & dismissals Benefits Managing debt

Finding a new job The Jobseekers section on GOV.UK provides lots of advice for people looking for work, including tips on how to write a CV, planning your job hunt, and applying for jobs online.

Coping with debt Citizens Advice Bureau also has lots of information on sorting out debt on its website in the section on Help with debt. The charity Mind also has a section on its website (www.mind.org.uk) about money under mental health, which includes advice on how to manage debt. Other useful organisations include: • Money Advice Service 0300 500 5000 • National Debtline 0808 808 4000 • StepChange Debt Charity 0800 138 1111 Remember! These helplines & services are FREE to use. 8

s p i T h t l a H e a re n t s ! p r o f

After a long summer break, it’s time for the kids to head back to school and focus on classes, sports and other after-school activities. But as you get adjusted to the first month of school, it’s a good idea to take a couple of precautionary measures to set them up for a safe, healthy year. Here are some back-to-school health tips to consider...

Set bedtimes It’s essential for kids (and adults!) to get a healthy amount of sleep each night to stay focused throughout the day. Although sleep requirements vary somewhat among individuals, most adults need about eight hours of sleep each night, and children and adolescents typically need more than eight hours. To get your kids ready to wake up earlier for school, consider making their bedtimes a little earlier each night for a week or two before school starts. Sticking to a routine is important too, so don’t let weekends become late-night free-for-alls.

Teach good hygiene habits With so many people around, germs are bound to be lurking in classrooms. To help your kids avoid getting sick (and prevent them from bringing germs home), it’s important to show them how to protect themselves. Teach them to wash their hands after using the toilet and before going to lunch or eating a snack. It may also be smart to provide your children with on-the-go hand sanitiser to use when washing their hands isn’t convenient. You should also instruct them not to share food or drinks with other kids.

Stock up on healthy foods It might be easy to pack your kids’ lunches with premade snacks, but a healthy diet is of the utmost importance, and junk foods don’t fit into the equation. Make it easier for yourself by stocking up on healthy foods like fruits, vegetables, whole-grain bread and lean protein like turkey. Take a few minutes during the weekend to cut up fruits and vegetables and prepare

things like tuna salad or hard-boiled eggs for convenience in the mornings, and buy plenty of containers for nutritious dinner leftovers. Consider getting a small ice pack and an insulated lunch bag to allow more variety. Also remember to limit liquid calories as the easiest place to start by cutting out sugary beverages. Sugary drinks are simply empty calories, devoid of nutrients. Try also limiting fruit juice or diluting juice such as orange or apple juice with water to reduce the sweetness and the calories. Try also helping your kids substitute sugary drinks for a glass of fatfree milk.

Manage stress As with any new or potentially unsettling situation — like starting school for the first time or entering a new class or new school — allow kids time to adjust. Remind them that everyone feels a little stressed or nervous about the first day of school and that it will all become an everyday routine in no time. Emphasise the positive things about going back to school, such as hanging out with old friends, meeting new classmates, buying cool school supplies, getting involved in sports and other activities. It is completely normal for the back-toschool season to be stressful for kids and parents alike, but too much stress can lead to a variety of health issues, like insomnia and sluggish immune systems. Help manage stress by talking to your children about anything that’s bothering them, and take care not to overload anyone’s schedule, including your own. School work and after-school activities are important, but it’s also essential to take time to relax, play and spend time as a family.

Nutritious breakfasts While there has been debates about the merits of eating breakfast for weight loss, it is agreed that kids should not skip breakfast. Breakfast is a perfect opportunity to help your kids get a healthy dose of nutrients such as fibre, calcium, and protein.

Great options include: whole grain cereal (with at least 3 grams of fibre) and low-fat or fat-free milk, low-fat Greek yogurt and fruit, or scrambled eggs and a slice whole wheat toast. And, whenever possible, try to eat breakfast as a family.

Testing eyes & ears You can’t expect a child to learn if they’re having trouble seeing the blackboard or hearing the teacher. So have your paediatrician screen for vision and hearing problems during your child’s back-to-school check-up. Remember you can’t assume your child has 20/20 vision just because they never complain about not being able to see; children with vision issues may not realise the world isn’t blurry to everybody else. If your child often has headaches, tilts their head to one side to read school work, or holds objects unusually close or far away to view them, it could be a sign they have a vision problem.

Stay safe When a child starts school, it’s often the first time they’re out from under your watchful eye for any length of time. So it’s important to review basic safety rules. If your child will be walking to school, go over the route together ahead of time to check out possible hazards, such as busy streets. Don’t let a young child walk to school alone, and don’t expect a slightly older brother or sister to provide adequate safety supervision. In carpools, seat belts should be a given, but remember to check out other drivers’ safety standards well ahead of time. For safe bus trips, tell your child to stay seated quietly while the bus is in motion. If you can’t take your child to the bus stop, arrange for an adult or responsible child to get him on and off the bus safely. It is also vital to discuss the issues of strangers and their associated danger. It’s important not to worry your children unduly but unfortunately in this day and age, where children can be more vulnerable when they are out and about, our kids do need to be aware of potential threats to their safety. Finally - take a breath! With all this preparation, your kids will be in great shape. If you’re relaxed and calm, they’ll head off to school feeling excited and ready to get to work.

Looking after your

Mental Health s e i r o t s l Rea

“It’s okay to ask for help” Steven, a police officer who has experienced depression and suicidal feelings, talks about his experience and why more men need to know it’s okay to talk... I lay in bed, wide awake, sleep nothing more than a hope. Then it struck me: I have no interest in enduring another day of this. For the first time, I plotted a way to take my own life. Unfortunately, my first thoughts of suicide were not my last and had it not been for timely intervention in the previous months, I may well not be here today. How did I find myself at this point? How did I get that far along? Primarily, by not telling anybody that I was on the way there.

A staggering 78% of suicides in the UK are by men. Yet not enough people are talking about it. I had been experiencing anxiety and depression. I was having therapy, trying my best to confront issues I’d never dealt with. But my true feelings were still left behind, confined within my own four walls. I wasn’t sharing them with my friends or family. I was a closed book. Was it because of my upbringing? Was it my job? Whatever it was, I was a man who did his best to avoid showing ‘weakness’. Weakness was dangerous. Weakness could get you hurt. I believed that showing my emotions was the biggest weakness. So I bottled them up, pushed them aside and left them to be dealt with another day. Eventually the time came that I ran out of bottles. My emotions ran free, overwhelming me, drowning me from within. There are too many men out there who were just like me unwilling or simply too afraid to show they’re struggling. Men do 11

not want the stigma of terms like ‘mental illness’ or ‘depression’ hanging over their head. Men are ‘strong’; men ‘keep it together’. But figures show a staggering 78% of suicides in the UK are by men. Suicide is also the leading cause of death for men my age. In England and Wales, 24% of all deaths of men aged 20 - 34 are suicides. Otherwise healthy men, are being cut down in their prime. Yet not enough people are talking about it. If you listen to a ‘typical’ conversation of a group of men, you might hear discussion about general health or illness; flu and stomach bugs, or even sporting injuries… yet you probably won’t hear talk of mental health.

Opening up when we’re struggling can be the hardest thing, but if we have problems, we need to share them. So how do we begin to address this problem, this epidemic? Firstly, we need to talk about it. Opening up when we’re struggling can be the hardest thing, but if we have problems, we need to share them. If we know somebody going through a tough time, we ask them how they’re feeling. And if they tell us they’re depressed or anxious, we don’t baulk at the subject, we confront it. I know from my own experience just how difficult that can be - but it’s time to step up guys. Let me appeal to the logical, ‘man’ side of your brain. Imagine if you are helping someone carry something. And they are loading you up, adding more things for you to carry until you realise you can’t hold any more. You’ve reached the limit of your strength and any second now you are going to drop everything. Would you say that you need to share the load? You would. So why should your mental health be any different? Why should you allow yourself to be loaded up until you break? I know it might sound easy. I know it’s certainly not. But through my experience and therapy I have learnt I should open up to people

about how I’m feeling, instead of bottling up my thoughts and feelings and allowing them to fester. If I’m anxious, I should tell somebody. I’ve also learned: • • • • •

There are lots of people who are experiencing – or have experienced – what I’m going through The people who truly care about you will move heaven and earth to help you There is help available, I just needed to know where to find it Opening up about my problems, encourages others to Having setbacks is normal. There will be bumps along the way

The next step is to raise the message within the public consciousness. We can do that by breaking down the stigma attached to suicide and mental health to make it easier for people to open up about their problems. We can do that by supporting charities like Mind, and Time to Change and by fundraising or sharing blogs like this. We also help support and expand the services offered to those who are suffering. The more help available, the more people can be helped. I say all of this from a position of experience, because the best thing that I did for myself was to open up. Only when I shared my emotions, did I begin to feel the load lighten and in turn spied a light at the end of the tunnel. Now, I realise that it was the strongest thing I ever did.

s” es n li n lo e m ca er ov I “How Joanna talks about how she overcame loneliness by getting in touch with a local mental health service... “I have a mental illness”. These words can often make you feel isolated and alone, especially if the person you tell doesn’t react with the kindness and compassion you deserve. Loneliness can be crippling and make everyday tasks feel much harder. I myself have depression, anxiety and borderline personality disorder. All of which have led to me feeling lonely at different times in my life. This loneliness is caused by many different things; from the attitudes of others to the crippling self-doubt they cause me. For me, being lonely has been one of the hardest things about my diagnoses that I have had to deal with. From when I was at school I have always felt some form of loneliness depending on the circumstances at the time. Sometimes it was because of how hard I found it to make friends when I felt so different. Sometimes my depression told me I needed to withdraw.

Feeling lonely isn’t just about having no-one around you; I have felt lonely when surrounded by a group of people.

When I had to open up at work over my mental illness and subsequently lost my job, loneliness threatened to overtake me. I had a few friends outside of work but most that I socialised with regularly were work colleagues. The first time I realised the relationships had changed was when I couldn’t attend the Christmas dinner. I felt isolated. No-one knew what to say to me anymore and I was cut off from a major part of my social network. I was stuck at home with little to say to anyone. The few friends I had I suddenly felt incredibly disconnected from. They didn’t understand what was going on in my head as I couldn’t explain it myself. I felt trapped with my thoughts. This made the loneliness increase. What helped me to feel less alone was finding people who understood or were going through similar things. This came in the form of a local peer support charity who ran a recovery course.

Attending the recovery course was a major turning point for me. Turning up on the first day I felt nervous about what awaited me, especially with my difficulty making friends in the past. By lunchtime, however I realised that the people on the course weren’t judging me, nor did I have to try and explain to them what was going on in my head.

Feeling lonely is more about feeling detached from those around you. Mental illness can cause this detachment. People, when they hear the phrase “I have a mental illness”, can picture all sorts of scenarios that cause them to back away.

They understood. It didn’t matter if I sat quietly and just listened. Over the weeks of the course I made friends that I keep in contact with every week. So while mental illness can be isolating and lonely, there are people out there who understand. Finding others who had similar problems made me feel less alone.

Another reason for feeling lonely, despite being surrounded by people, is the role stigma plays. It can be difficult to be open about what is happening inside your head. Even if you can explain it, quite often it feels easier to hide what is really going on. This makes the detachment from others greater and increases how lonely you feel.

Peer support was the key to helping me on the way to recovering and feeling less stigmatised. It made the loneliness less intense and easier to deal with. Although I do still face times where I feel lonely I now have a support network of friends who I can turn to who make me realise I am not alone. 12

“Being diagnosed with bipolar” Lee talks about being diagnosed with bipolar disorder... A lot can happen in a year. This time last year I was looking forward to celebrating my 40th birthday, fully aware that I had some inner turmoil but as yet it didn’t have a name. I suffered with bouts of feeling incredibly low; a despairing sort of low that I could neither explain, nor have the ability to think myself out of. At its worst I couldn’t even summon the energy to get out of bed, but just lie there in an inconsolable grief of introversion.

The toughest step of any problem is confronting it. At other times I had a head full of ideas, I was buzzing with life and a feeling of invincibility, I felt people should listen to what I was saying and I would get easily irritated and frustrated if they didn’t. It had been obvious for some time that my mental state was fragile, I had trouble sleeping, I was at times irrational and becoming increasingly paranoid and skittish with my behaviour. Without me realising it at the time, this was also having a devastating effect on my family life. My mood swings could cast a shadow over the whole house and test family life and relationships. The toughest step of any problem is confronting it. And after a long period of procrastination I eventually saw a doctor, who in turn referred me to a consultant psychiatrist. It was at this point the word ‘bipolar’ was first used.

people felt similar to me, and with the help of medication it could be managed. I started medication last April to stabilise my bipolar and the impact it has had is very positive, it is not an illness that can be overcome but I am now getting towards some sense of normality. Medication, alongside knowledge and a strong base of family and friends means that I am enjoying life again. I am still the same person inside and with the help of medication I can now manage the extremes. It’s not always easy, I still have difficult spells from time-to-time, but as my forty-first birthday fast approaches, I am looking forward with a renewed sense of purpose. I made the decision early on that I would be honest about my illness; I wanted to talk openly to family and friends about my bipolar and how I feel. The response I’ve had has been nothing but supportive, and I also find talking about it really helps.

I don’t want bipolar to define me, but it is a part of me that’s always been there. I am still the same person inside and with the help of medication I can now manage the extremes, which is helping me live a more balanced and productive life. So, why am I writing this and why should you care? Two reasons:

I made the decision early on that I would be honest about my illness.

1. Its cathartic and sometimes easier to write it down than to say it 2. Mental health issues will effect 1 in 4 people this year and the more open people are the less stigma their will be.

Bipolar, I’d heard of it but wasn’t familiar with it. Bipolar is a mood disorder that manifests itself with bouts of mania and depression. With this diagnosis, I had a strong feeling of things starting to make sense and almost straight away I felt like a weight had been lifted off.

Mental health issues are difficult to talk about, public figures such as Stephen Fry, Alistair Campbell and Ruby Wax have all talked publicly about their problems and it shouldn’t stop there. If public figures can share their experiences it lessens the stigma, if the general public can talk openly about it, eventually there will be no stigma.

I’d been suffering with bipolar quietly for years without knowing it and suddenly it had a name. It gave me some comfort that other 13

A lot can happen in a year.

Mental Health Across the lifespan

We all have mental health, and stressful or transitional points in our lives can affect our wellbeing if we donâ&#x20AC;&#x2122;t look after ourselves and receive the right support.

New parents

Children

50% of women with perinatal mental health problems are not identified or treated, costing the UK economy ÂŁ8.1 billion. Postnatal depression in fathers has been associated with emotional and behavioural problems in their child.

10% of children and young people (aged 5-16 years) have a clinically diagnosable mental health problem, yet 70% of children and adolescents who experience mental health problems have not had the appropriate interventions at a sufficiently early age.

From 15 years onwards

At work

In 2013, 6,233 suicides were recorded in the UK for people aged 15 and older. Of these, 78% were male and 22% were female.

In the UK, 70 million days are lost from work each year due to mental ill health, making it the leading cause of sickness absence.

Later life

The 5 key factors that affect the mental health and wellbeing of older people are: Discrimination, lack of participation in meaningful activities, poor relationships, poor physical health and poverty.

The importance of an

Employee Assistance Programme With ever-increasing pressures at work and home, there are times when we all need some extra support to balance the demands of everyday life. That's why PAM Assist provides a free and confidential, Employee Assistance Programme, on a nationwide basis. Staffed by experienced and professional advisors, we are there to answer your calls 24 hours a day, 7 days a week, 365 days a year. Through PAM Assist, employees will have access to clinical and professional expertise, giving them a chance to talk about all kinds of work and personal issues that are affecting them. These might include; debt advice, relationships, managing money, stress management, health advice, work issues, domestic abuse, drug/alcohol addiction, family care or bereavement. In order to effectively support and manage such issues, PAM Assist provides a tailor-made service for both managers and their colleagues. Our counselling and support team provide advice, triage and counselling, acting as a proactive intervention to support everyone. Assistance can be accessed in many ways, including our comprehensive online information portal, our 24 hour telephone helpline, UK-wide face-to-face counselling and cognitive behavioural therapy, telephone counselling and secure online video counselling. â&#x20AC;&#x2039;We aim to offer employees all the tools, information and support they need to make positive changes to improve their current situation.

So now let's look at what services the programme includes and why implementing an employee assistance programme so important...

What Services are Included? Since employees are often the most

significant asset of any business it is important to ensure that they are well taken care of. Our comprehensive EAP services can help your employees be prepared for life's ups and downs. The service includes: P Free and confidential advice P Free telephone number P Available 24 hours a day, 7 days a week, 365 days a year P Information and support for all issues P All calls handled sensitively and professionally P Online portal for wellbeing topics, with videos tackling issues such as stress management & health advice P Dedicated Account Manager P Telephone and Face to Face Counselling P BACP accredited counsellors P Up to 6 structured telephone counselling sessions Advice-line Our telephone advice line is available 24 hours per day 365 days a year. The advice line is resourced by experienced, non judgemental BACP accredited counsellors, who will provide your employees with complete peace of mind, providing advice, triage and counselling services. Key features include: P Confidential access via free-phone number P Access for staff 24 hours per day, every day of the year P Incident support line P All calls are answered within fifteen seconds or three rings P All calls answered directly by a professional counsellor P Access to counselling immediately Online Portal Many of our advice resources can be found on our online portal, to accompany our 24-hour telephone helpline. A password and username will be set up for employees to gain access whenever they require. All the information is downloadable and can be printed at the ease of a button. The online portal offers: P Stress management tool P Downloadable health leaflets P Monthly features and news articles Fitness portal P Health advice and information sheet P Emotional support and wellbeing videos

Therapy Services Upon contacting the helpline our colleagues triage the enquiry to determine the correct support pathway for the individual. Calls usually falling into one of four categories: • Advice required • Referral for specialist consultation, e.g. legal, financial or medical appointments arranged • Therapy required e.g. personal centred counselling or cognitive behavioural therapy • Method of delivery required e.g. faceto-face, telephonic or secure video conferencing • Emergency assistance required, e.g. suicide risk Depending upon which category the call falls into, PAM Assist provides counselling and Cognitive Behavioural Therapy on a rage of delivery bases. A method will be decided that best suits your needs. These methods of therapy delivery include: P Telephone P E-Clinic P Self Referral P Management Referral

Confidentiality Confidentiality is the foundation of the service. PAM Assist is bound by professional standards regarding confidentiality and the disclosure of individual's details who have contacted them. We ensure the confidentiality of all our callers, only asking for non-personal and non-specific data, for Management Information purposes (e.g. broad area of work, age group and gender). We ask for the caller’s first name to make the experience less formal. We may also ask the caller for a contact detail e.g. phone number if our specialist services or our advice line need to phone them back.

The Benefits... EAP services are introduced by employers to assist in the identification and resolution of employee concerns. These can be personal matters or workrelated issues and, in some instances, can affect performance in the workplace. It is an invaluable resource, offering employees confidential expert advice and support 24 hours a day, seven days a week. Our comprehensive EAP service can help your employees be prepared for life’s ups and downs, and can also help: P Raise morale and productivity for a more focused workforce by providing a valued benefit P Reduce absenteeism and staff turnover P Demonstrate a commitment towards meeting legal requirements and duty of care towards your employees P You’ll be perceived as an employer of choice through the promotion of a caring work environment P Monitor trends in the workplace P High value employee benefit For more information about the PAM Assist service or for any other enquiries please contact 01925 227000 and we will be happy to help. 16

How to deal with

Panic Attacks... A panic attack is a sudden surge of overwhelming anxiety and fear. Your heart pounds and you can’t breathe, you may even feel like you’re dying or going crazy. Left untreated, panic attacks can lead to panic disorder and other problems, they may even cause you to withdraw from normal activities. But panic attacks can be cured and the sooner you seek help, the better. With treatment, you can reduce or eliminate the symptoms of panic and regain control of your life.

Understanding panic attacks In many cases, panic attacks strike out of the blue, without any warning. Often, there is no clear reason for the attack. They may even occur when you’re relaxed or asleep. A panic attack may be a one-time occurrence, but many people experience repeat episodes. Recurrent panic attacks are often triggered by a specific situation, such as crossing a bridge or speaking in public—especially if that situation has caused a panic attack before. Usually, the panic-inducing situation is one in which you feel endangered and unable to escape. You may experience one or more panic attacks, yet be otherwise perfectly happy and healthy. Or your panic attacks may occur as part of another disorder, such as panic disorder, social phobia, or depression. Regardless of the cause, panic attacks are treatable. There are many effective treatments and coping strategies you can use to deal with the symptoms. 17

Signs & symptoms

How to handle a panic attack

Panic attacks often strike when you’re away from home, but they can happen anywhere and at any time. You may have one while you’re in a store shopping, walking down the street, driving in your car, or sitting on the couch at home. The signs and symptoms of a panic attack develop abruptly and usually reach their peak within 10 minutes. Most panic attacks end within 20 to 30 minutes, and they rarely last more than an hour. A full-blown panic attack includes a combination of the following signs and symptoms: P Shortness of breath P Heart palpitations P Chest pain/discomfort P Trembling/shaking P Choking feeling P Feeling unreal/detached P Sweating, nausea/upset stomach P Feeling dizzy/faint P Numbness/tingling sensations P Hot or cold flashes P Fear of dying or going crazy

Professor Paul Salkovskis, Professor of Clinical Psychology and Applied Science at the University of Bath, says it’s important not to let your fear of panic attacks control you. “Panic attacks always pass and the symptoms are not a sign of anything harmful happening,” he says. “Tell yourself that the symptoms you’re experiencing are caused by anxiety.” He says don’t look for distractions. “Ride out the attack. Try to keep doing things. If possible, don’t leave the situation until the anxiety has subsided.” “Confront your fear. If you don’t run away from it, you’re giving yourself a chance to discover that nothing’s going to happen.” As the anxiety begins to pass, focus on your surroundings and continue to do what you were doing before. “If you’re having a short, sudden panic attack, it can be helpful to have someone with you, reassuring you that it will pass and the symptoms are nothing to worry about,” says Professor Salkovskis.

Breathing exercise

Is it panic disorder?

Sarah’s story

If you’re breathing quickly during a panic attack, doing a breathing exercise can ease your other symptoms. Try this: • Breathe in as slowly, deeply and gently as you can, through your nose. • Breathe out slowly, deeply and gently through your mouth. • Some people find it helpful to count steadily from one to five on each in- breath and each out-breath. • Close your eyes and focus on your breathing.

If you feel constantly stressed and anxious, particularly about when your next panic attack may be, you may have panic disorder. People with panic disorder may avoid situations that might cause a panic attack. They may also fear and avoid public spaces (agoraphobia). “There’s no quick fix, but if your attacks are happening time after time, seek medical help,” says Professor Salkovskis.

You should start to feel better in a few minutes, though you may feel a little tired afterwards.

As with many mental health conditions, the exact cause of panic disorder isn’t fully understood. However, it’s thought the condition is probably linked to a combination of physical and psychological factors. It’s important to be aware that some physical conditions and disorders can have similar symptoms to those of anxiety. For example:

I remember my first panic attack very well. I was going through a difficult breakup and had just landed at Heathrow. I was walking along and suddenly the lights seemed very bright and it seemed like there were an awful lot of people. I felt tiny and vulnerable, like any one of those people could harm me if they wanted to. My knees turned to jelly immediately and I collapsed sobbing on the side of the corridor. I was hyperventilating and I thought I was dying. It came out of nowhere and I had never experienced anything like it before. From that time onward I began to worry constantly about every small detail of life, from the moment I left the house. I’d be waiting at the bus stop having internal conversations with myself about what position I was in the queue and what would happen if I couldn’t get on the bus – I’d be late and lose my job and be totally screwed. All of that stuff happened first thing in the morning, every morning, and continued for every small detail you can imagine throughout the day, so I stopped going out except for work. What works for me is to accept that I am having a panic attack, to notice and acknowledge the way I feel without judging it to be bad, to breathe the way my body seems to want to breathe for any given breath, and to think about what triggers in the environment might have contributed to the way that I feel in the moment. I now accept panic as part of my own normal range of reactions to certain things, and for me that has been the key to living a more normal life. When I think back to even my childhood I was always a worrier and experienced a lot of anxiety. So, while I still feel panicked sometimes, I don’t beat myself up about it, which is what previously made things worse.

Ways to prevent panic attacks “You need to try to work out what particular stress you might be under that could make your symptoms worse,” says Professor Salkovskis. “It’s important not to restrict your movements and daily activities.” •

•

• • •

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Doing breathing exercises every day will help to prevent panic attacks and relieve them when they are happening. Regular exercise, especially aerobic exercise, will help you to manage stress levels, release tension, improve your mood and boost confidence. Eat regular meals to stabilise your blood sugar levels. Avoid caffeine, alcohol and smoking – these can make panic attacks worse. Panic support groups like 'No Panic' have useful advice about how you can effectively manage your attacks. Knowing that other people are experiencing the same feelings can be reassuring. Cognitive behavioural therapy (CBT) can identify and change the negative thought patterns that are feeding your panic attacks.

What causes panic disorder?

• • • • •

• • •

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Mitral valve prolapse Postural orthostatic tachycardic syndrome (POTS) Anaemia Paroxysmal atrial tachycardia – episodes of rapid and regular heartbeats. Thyrotoxicosis – where large amounts of thyroid hormones are released into the bloodstream, causing rapid heartbeat, sweating, tremor and anxiety. Poorly controlled diabetes Adrenal tumours – growths that develop on the adrenal glands Carcinoid syndrome – a set of symptoms caused by some carcinoid tumours that can develop in the cells of the endocrine system (glands that produce and secrete hormones). Zollinger-Ellison syndrome – causes overproduction of insulin and low blood sugar (hypoglycaemia).

Healthy Chicken Recipes Packed with protein and hugely versatile, chicken is the staple ingredient in many of our favourite dishes...

Chicken, crème fraîche & tarragon pasta The perfect midweek dinner, this easy chicken pasta recipe can be prepared in just 15 minutes. If you don’t have crème fraîche, use a little cream or plain yogurt – just add it at the last minute so it doesn’t curdle. 2 tbsp olive oil 300g (10oz) chicken breast, cut into bite-sized pieces 3 garlic cloves, crushed 300ml (1/2 pint) half fat crème fraîche 1 tsp dried tarragon 500g (1lb) penne pasta 1 lemon, juiced

In a large frying pan, heat the oil and add in the chicken pieces. Cook over a medium heat for about 3 minutes, stirring a few times. Add the garlic, crème fraîche and tarragon and lower the heat. Season well with salt and pepper and let the sauce bubble for as long as it takes to cook the pasta (about 8 minutes). Meanwhile, cook the pasta in salted water according to pack instructions. Once ready to serve, add a squeeze of lemon juice (to taste) into the pasta sauce. Drain the pasta and add it to the sauce with a tiny bit of its cooking water to loosen the sauce a bit.

Sticky chicken with winter veg quinoa Give your midweek meals a lift with this scrumptious sticky chicken recipe. Packed with winter veg and served with wholesome quinoa, it’s full of flavour and can be prepared in under an hour. 250g (8oz) quinoa 1 head cauliflower, cut into florets 2 large parsnips, each cut lengthways into 8 175g (6oz) butternut squash, peeled and cubed 175g (6oz) sweet potato, peeled and cubed 12 thyme sprigs Pinch of chilli flakes 1 lemon, zested 4 tbsp olive oil 2 tbsp runny honey 4 chicken breasts 1 x 31g pack flat-leaf parsley, chopped

Preheat the oven to gas 6, 200°C, fan 180°C. Cook the quinoa following the pack instructions. Meanwhile, put the vegetables in a roasting tin. Mix the thyme, chilli, lemon zest, olive oil and some seasoning in a bowl, add two thirds to the veg and toss to coat. Roast for 25-30 minutes, turning occasionally. Meanwhile, squeeze half the lemon into the remaining dressing, add the honey and mix well. Add the chicken and toss to coat. Heat a griddle or frying pan over a high heat. Add the chicken and cook for 2-3 minutes on each side, until golden brown. Remove and place on the roasting veg for the final 10 minutes of cooking time. Take the chicken out and set aside. Combine the quinoa and roasted veg in a bowl. Toss with the parsley and the remaining lemon juice. Serve with the chicken.

Healthy chicken korma Now you can enjoy this traditional Indian dish, guilt-free! With a few clever ingredient swaps this creamy chicken korma is just as delicious but healthy! 4 small chicken breasts, skinless and boneless (approx. 600g) 40g (1 1/2oz) 0% fat natural yoghurt 1 tsp light olive oil 2 medium onions, finely chopped 3 garlic cloves, finely chopped 2.5cm (1in) piece root ginger, peeled and grated 3 tbsp Korma curry paste 3 tbsp double cream 2 tsp soft brown sugar 2 tbsp chopped coriander Rice, to serve Lime wedges, to serve

Cut the chicken breasts into bite-sized pieces, season well. Place in a small bowl and pour over the yogurt. Cover with cling-film and leave to marinate in the fridge for 30 minutes or overnight, to tenderize. Meanwhile, heat the oil in a large non-stick saucepan over a medium heat. Add the onions, garlic and ginger and cook, stirring frequently, for 5 minutes. Add 2 tablespoons water, cover with a lid and cook for another 10 minutes or until softened and starting to brown. Add the curry paste and cook for another 2-3 minutes. Add 400ml (14fl oz) water and bring to the boil. Turn down the heat and simmer, uncovered, for 10-12 minutes or until the liquid has reduced by half. Remove the pan from the heat. Using a stick blender, blend until completely smooth. Add the marinated chicken pieces, stir in the cream and sugar and cook for another 10 minutes or until the chicken is tender and cooked through, stirring all the while. Season to taste. Serve scattered with a little chopped coriander, a small portion of rice and lime wedges to squeeze over. Freezing and defrosting guidelines: Once the curry is cooked, chill completely, tip into a freezerproof container and freeze for up to 1 month. Defrost fully before heating to piping hot and serving

Coriander & lime chicken with chickpea salad This zesty new spin on a chicken salad is surprisinglysimple and healthy, yet flavour-packed and satisfying. Enjoy as a quick meal for two thatâ&#x20AC;&#x2122;s sure to impress. 2 chicken breasts 2 tsp coriander seeds (or ground coriander) 1 tbsp olive oil 1 lime, zested and juiced 1 red onion, finely sliced 1 x 400g tin chickpeas 150g (5oz) roasted red peppers, drained and sliced 2 tbsp extra-virgin olive oil Handful flat-leaf parsley, chopped Small handful coriander, chopped

Put the chicken breasts between 2 sheets of cling-film and bash with a rolling pin to flatten slightly. Lightly crush the coriander seeds (if using) and rub into the chicken with the olive oil and lime zest. Season and set aside for 10 minutes to marinate. Heat a griddle pan over a high heat and cook the chicken for 2-3 minutes on each side, until golden and cooked through with no pink meat showing. Set aside to rest for 5-10 minutes. Meanwhile, combine the onion, lime juice and a pinch of salt in a bowl. Leave to stand for 10 minutes, or until the onion has softened a little and the juice has turned pink. Tip the tin of chickpeas and its water into a small pan. Cook over a medium heat, until warmed through; drain well. Add the chickpeas, peppers, extra-virgin oil and herbs to the bowl with the onion; toss to combine. Slice the chicken and serve with the chickpea salad.

September is

Blood Cancer Awareness Month

Leukaemia CARE is a national blood cancer support charity and are dedicated to ensuring that anyone affected by blood cancer receives the right information, advice and support. September is Blood Cancer Awareness Month, and they are using it as an opportunity to raise awareness of the different blood cancers, symptoms and treatment.

What is blood cancer? There are three main groups of blood cancer: leukaemia, lymphoma and myeloma. Blood cancer is an umbrella term for cancers that affect the blood, bone marrow and lymphatic system. Unfortunately, blood cancer affects a large number of people. Every 20 minutes, someone in the UK is told they have a blood cancer. That’s 70 people a day, 25,000 people a year. There are three main groups of blood cancer: leukaemia, lymphoma and myeloma. Some types are more common than others: • Non-Hodgkin lymphoma is the sixth most common cancer in the UK • Leukaemia is the eleventh most common cancer in the UK • Other types of blood cancer – such as myeloma – are less common. 23

Leukaemia

Symptoms of leukaemia

Leukaemia affects your white blood cells. These are an important, infection-fighting part of your immune system, made in your bone marrow. If you have leukaemia, you produce an abnormal number of immature white blood cells which ‘clog up’ your bone marrow and stop it making other blood cells, vital for a balanced immune system and healthy blood. Acute leukaemia comes on suddenly, progresses quickly and needs to be treated urgently. Chronic leukaemia develops more slowly, over months or years.

Leukemia symptoms vary, depending on the type of leukemia. However, common leukemia signs and symptoms include: • Fever or chills • Persistent fatigue, weakness • Frequent or severe infections • Losing weight without trying • Swollen lymph nodes • Easy bleeding or bruising • Tiny red spots in your skin (petechiae) • Bone pain or tenderness

There are four main types of leukaemia: • Acute myeloid leukaemia (AML). It affects around 2,600 adults a year in the UK. It’s most common in people over 65, but people of any age can get it. • Acute lymphoblastic leukaemia (ALL). This is the most common type of leukaemia in children. ALL affects around 650 people a year in the UK. About half the cases are in adults and half in children. • Chronic myeloid leukaemia (CML). Is quite a rare condition: only about 700 people every year are affected. • Chronic lymphocytic leukaemia (CLL). Doctors diagnose just over 3,200 people with CLL a year in the UK. It’s much more common if you’re over 60 and is very rare in people under 40.

When to seek medical advice Make an appointment with your doctor if you have any persistent signs or symptoms that worry you. You may overlook early symptoms because they may resemble symptoms of the flu and other common illnesses, so be aware.

Lymphoma Lymphoma is a type of blood cancer that affects your lymphatic system, an important part of your immune system which helps protect the body from infection and disease. If you have lymphoma it means you make too many lymphocytes, a type of white blood cell. Your lymphocytes also live longer than they should. This overload compromises your immune system. Lymphoma can develop in many parts of your body, including your lymph nodes, bone marrow, blood, spleen and other organs. The two main types of lymphoma are: • Non-Hodgkin lymphoma (NHL). Most lymphomas are NHL – it’s the sixth most common cancer in the UK. Each year, around 12,000 people are diagnosed with it in the UK. It’s more common in older people – 1 in 6 people diagnosed are over 65. • Hodgkin lymphoma (used to be called Hodgkin disease). This is less common, and makes up less than 1% of all cancers in the UK. Around 1,800 people a year are diagnosed with Hodgkin lymphoma. Hodgkin lymphoma can develop at any age, but it’s most common in young adults and in older men and women.

Symptoms of lymphoma The most common symptom of both types of lymphoma is a usually painless swelling in a lymph node, usually in the neck, armpit or groin. Lymph nodes, also known as lymph glands, are pea-sized lumps of tissue found throughout the body. They contain white blood cells that fight against infection. The swelling is caused by a certain type of white blood cell, known as lymphocytes, collecting in the lymph node. However, it's highly unlikely you have non-Hodgkin lymphoma if you have swollen lymph nodes, as these glands often swell as a response to infection. Some people also have other more general symptoms. These can include: • Night sweats • Unintentional weight loss • A high temperature (fever) • A persistent cough or breathlessness • Persistent itching skin all over the body A few people with lymphoma have abnormal cells in their bone marrow when they're diagnosed. This may lead to: • Persistent tiredness or fatigue • Increased risk of infections • Excessive bleeding eg. nosebleeds, heavy periods or blood under the skin

When to seek medical advice

Symptoms of myeloma

See your GP if you have any of the above symptoms, particularly if you have persistently swollen glands with no other signs of infection. While the symptoms are unlikely to be caused by lymphoma, it is best to get them checked out.

Early in the disease, symptoms may be subtle. Some people are diagnosed after a routine blood test, before any symptoms are noticed. Other people are diagnosed with myeloma after being admitted to hospital with more severe symptoms. These symptoms include: • Unexplained and eventually constant pain, especially in the spine, ribs, pelvis, head, arm, or leg • Constant fatigue or weakness • Frequent infections • Unexplained weight loss • Spontaneous bleeding or easy bruising • Unexplained vision problems • Shortness of breath • Unexplained nausea or persistent vomiting • Problems thinking or concentrating • Foamy urine • Unprovoked fractures in the spine or elsewhere in the skeleton or rapid loss of height • Unexplained chronic numbness or tingling in the fingers or toes

Myeloma Myeloma (also called multiple myeloma) is a blood cancer of the plasma cells. Plasma cells are found in bone marrow and produce antibodies to help fight infection. In myeloma, unusually large numbers of abnormal plasma cells gather in your bone marrow and stop it producing an important part of your immune system. In the UK, just under 4,800 people are diagnosed with myeloma each year. The risk of myeloma increases as you get older – about 4 out of 10 (40%) of cases are in people aged over 75.

Myelodysplastic syndromes (MDS) The myelodysplastic syndromes (MDS) are a group of blood disorders where a person’s bone marrow is not producing the correct amount and quality of blood cells. Red, white and platelet cells can be affected. These problems lead to people with MDS feeling very tired, weak and bleeding or bruising more easily. There are different levels of severity of MDS; it’s not a type of leukaemia but can sometimes lead to acute myeloid leukaemia. MDS is rare – about 4 in every 100,000 people get MDS. It mainly affects older people, and is more common in people over 70 years old. If you have low or intermediate risk MDS you may not need treatment straightaway, but regular blood transfusions and medication can help. People with more severe MDS can have chemotherapy and a small number of people may need a stem cell transplant.

When to seek medical advice Any of the above symtpoms warrant a visit to a health-care professional or any other persistent signs that concern you. Although it is unlikely to be myeloma, it is best to get it checked out to be sure and also for peace of mind.

An True Treatments for blood cancer When it comes to deciding on the best treatment, it all depends what type of blood cancer you have, how advanced and aggressive it is and your general health. Your doctor will suggest the most effective course of treatment for you. Common treatments are chemotherapy, radiotherapy and, in some cases, a stem cell or bone marrow transplant.

What is chemotherapy? Chemotherapy involves taking drugs that destroy cancer cells, hopefully putting it into remission or significantly slowing down the progression of the disease. There are many types of chemotherapy drugs and they work in different ways. Sometimes doctors will prescribe a single drug, but often they’ll recommend combining two or more because they often work better together. Chemotherapy can be used on its own, but it’s often combined with other treatments like radiotherapy. Chemotherapy is designed to attack cells that are growing and multiplying. That’s because cancer cells grow and multiply faster than healthy cells. Some healthy cells can be caught in the crossfire, as they can also be growing and dividing quickly. This can cause side effects such as nausea, tiredness and hair loss. If you’re getting ready for a stem cell, bone marrow or cord blood transplant, you’ll also need chemotherapy to suppress your immune system and stop it attacking your donor’s new ‘foreign’ cells. This is called conditioning therapy. 25

What is radiotherapy? Radiotherapy works by using highenergy X-rays to kill cancer cells. For it to be effective, doctors need to give the right amount of radiation, targeted at the right area of the body. That’s why you get radiotherapy in specialist centres where doctors, physicists and radiographers work together. They normally use a machine called a ‘linear accelerator’ for the treatment. Radiotherapy can treat some types of leukaemia and lymphoma. Doctors can also use it to prepare a patient for a stem cell, bone marrow or cord blood transplant as part of the conditioning therapy. A low dose of radiation will lower someone’s immune system, so they’re less likely to reject donor cells. The type of radiotherapy you might have before a stem cell transplant is called total body irradiation or TBI and this means it affects the whole body. Radiotherapy can also damage normal cells, which can cause side effects. These vary for each person; some experiencing mild symptoms such as tiredness while for others it can be more debilitating. These side effects will normally have passed within a few weeks of the treatment finishing. When radiotherapy finishes, most of your body's healthy cells will continue to grow normally again. But radiotherapy can have long-term side effects. Please visit www.leukaemiacare.org.uk for more information, advice and support regarding blood cancer.

Inspirational Story... Chris Lewis was diagnosed with lymphoma back in 2007. Since then, he has used his diagnosis to publicly speak about his experiences, set up his own cancer support website and start his own charity. Back in 2007 when I was 51, I was thinking about retiring early. Life had been kind to me and I was enjoying a successful career. My wife had retired but I still wanted to achieve more. We agreed that I would work for another five years, then call it a day. It was an extremely demanding life both physically and mentally, but I didnâ&#x20AC;&#x2122;t feel ready to retire just yet. However, my choices were removed when I was diagnosed with Stage 4 mantle cell lymphoma, a few months later. We were absolutely stunned, as up to that point I had never even been an inpatient in hospital, so to be diagnosed with incurable cancer was a real-life nightmare. On diagnosis, things moved quickly. Initial scans then six courses of R-CHOP chemotherapy. I was told that to give me a chance of extending my life, I would need a stem cell transplant from an unrelated donor. The search was on and after several anxious months I was in remission and a donor was found. A young man aged 22 from London, via Anthony Nolan. We had to move fast and I was admitted to hospital just before Christmas to start my transplant procedure. I found this a very tough process not just physically, but mentally too. Spending six weeks in an isolation unit can be a sobering time. There was no WiFi in those days either! The aggressive chemotherapy was tough, but so was thinking what the future may have in store. Would I survive the treatment, or be able to return to work? How would we pay the bills if the worst happened? The transplant was successful and I was able to return home. So frail that I could barely climb the stairs or shower on my own but

over time things improved, and despite numerous infections and trips to hospital, things settled down. However, my health had become unreliable and I was unable to continue my career, which was a massive blow, both financially and economically. It felt like my independence had been taken away and I was relying on my family and friends for help, taking me for treatment and helping me with jobs at home. My doctors were happy they had kept me in remission but my new enemy was graft versus host disease (GvHD) - my body rejecting my transplant. Which to this day continues to be very troublesome, having had serious issues with my skin, tendons, lungs and liver. Generally these issues can be controlled with anti-rejection drugs, but the consequences of that is my immune system is compromised leaving me open to minor infections and viruses giving me big problems. Unfortunately all these complications mean that I will never be far away from my next blood test, and my medical team and I have become close friends after eight years of regular treatment. But incredibly I am still alive despite all the predictions and statistics from back in 2007.

My life has changed tremendously. I now have very different values. My boys have forged their careers, and I have two beautiful grandchildren and time to spend with them. I am grateful that the treatment I have received has allowed me to see these things. This experience filled me with a desire to give something back to the incredible people that have supported me over the years, so now I do public presentations about my experiences and run my own website, to allow both professionals and patients to share their views and experiences. It is now read in every country in the world. My determination to use my experiences positively for others has had a real impact on my own life, and although cancer has taken a lot from me, it has given me some incredible moments of my own. Life is exciting again, for the right reasons, and it is now difficult to remember my life before cancer. I would like to finish this piece with one very valuable tip; learn to be patient as everything in healthcare takes time. If you would like to see more of Chris' work you will find the site at www.chris-cancercommunity.com

t u O ll a F t ’ n o D of F i t n e s s

10 of the worst autumn health habits. . . I know it’s sad that summer has come to an end. However, that doesn’t give you permission to wallow in a food and hibernation coma until the first buds of spring arrive. The following ten bad habits are particularly tempting and damaging to your health come autumn… 1. Overeating Because obesity puts you at prime risk for heart disease, eating bear-sized portions when the air starts to chill and the leaves start to change colour is not a wise move for your waistline or your heart. In fact, oversize portions of the high-calorie carbohydrates we crave come fall—think white bread, refined pastas, and sugary drinks—will only make you put on weight. 2. Becoming a Couch Potato If you sit for at least 8 hours a day at work then make it a habit to come home and sit for another 6 or more hours until you go to bed, you’re not getting much activity in your

life. In fact, all of the sitting actually increases your risk of weight gain, heart attack, and stroke. So get up and get out! Get your blood and muscles pumping for at least 30-minutes each day. 3. Avoiding Fruits and Vegetables I know that once the ground frosts over it’s difficult to stick to that fresh plant-based meal you consumed in summer. However, loading up on fruits and vegetables vs. refined sugar is quite easy in the colder months to if you’re willing to buy local and buy frozen fruits and vegetables with no added sugar when you can’t get fresh. 4. Hibernating Inside If you veto going outside come autumn, you’ll be in sorry shape come winter. Why? We all need sunshine (or rather vitamin D) to help balance our mood and combat depression. Plus, getting outside for some fresh air helps reduce stress, autmun

allergies and even lowers blood pressure. So if you don’t like to be outside after dark, take a stroll on your lunch hour or go for a run before work. 5. Drinking Excessively When the weather gets chilly we tend to look for more reasons to celebrate indoors. And with Halloween parties, Bonfire Night and more on the go, alcohol tends to play a big role is social events. But remember, keeping your drinking to a minimum will keep your weight, blood pressure, and heart rate balanced, so don’t overdo it! 6. Withdrawing from Social Activities Sure, some days we just want to go home from work and bury ourselves in our duvets, avoiding all social contact. However, the best way to ward off the autumn blues is by getting out with friends or family, for at least a couple nights in the week. This way you’ll boast your mood, social connections, and health at the same time.

7. Too Much Comfort Food

9. Not Taking Advantage of a Flu Shot

In autumn it’s easy to stay as stuffed as a Christmas turkey. We naturally put on a few pounds to prepare for winter, but that’s no excuse to fill yourself with fatty, sugary food and gain a bunch of “winter” weight.

Many of us are lucky enough to get a free annual flu shot as part of our health plan.

Break the empty carbohydrate cravings by sticking to complex carbs—like brown rice, whole grain breads and cereals, and whole wheat pastas come fall.

Many workplaces offer free flu shots to protect their staff from falling ill due to a chronic virus during months when immunities tend to plummet. Protect yourself and your loved ones from falling ill. 10. Becoming SAD

While the thought of getting up early to job in the chilly morning air might make you apt to crawl back into your warm bed.

If you tend to get a bit blue during autumn and winter, you might suffer from Seasonal Affective Disorder (or SAD), a depression disorder that stems from a lack of sunlight (or vitamin D).

An autumn exercise routine will keep you motivated, energized and trim during the colder months. Try a fun activity, like hot yoga or Zumba class to warm you up.

Be proactive against the blues by getting outside in natural daylight as much as possible, or purchase a light box, a tool that mimics natural daylight indoors.

8. Not Exercising

Fun ways to get fit - wi tho ut a gy m ! Create Your Own Bootcamp

Take a Hike

Practice Yoga at Home

Bootcamp-style workouts are a lot of fun. Who doesn’t love a challenge? You can create your own by doing strength and cardio exercises at home or outside at a park, all you need is a good pair of trainers!

Hiking is a great way to get your heart pumping while enjoying some fresh air in the great outdoors.

One of the best things about yoga is that you need only your body and a mat to get stuck in.

Grab some friends, lace up your trainers, and get your hike on! The scenery and the feeling of accomplishment after your hike is arguably better for you than an afternoon at the gym.

There are tons of online yoga workouts that demonstrate the poses, so you can try pretty much any kind of yoga without leaving the comfort of your own home.

Try this circuit: jumping jacks, lunges, high knees, push-ups, triceps dips (off a bench or curb), and sit-ups. Do each exercise for 60 to 90 seconds; rest in between exercises as needed. Repeat the whole thing two or three times. Join a Team Sometimes dragging yourself to the gym can be, well, a drag. How about signing up for an adult sports league? Sports quite literally make a game out of working out, so you’ll get your heart rate up, burn calories, and have a good time doing it. If you already missed the chance to sign up for a team, offer to be a reserve. When the season gets going and schedules get busy, teams often need extra players, so you’ll be the first person they call. Take a Walking Tour of Your Area Walking is an easy way to stay in shape because it requires only a pair of supportive shoes and it’s something you can do pretty much anywhere. A fun way to spice up your workout is by signing up for a walking tour of your city or nearby historic area. You can learn something new while fitting in a workout!

Try a Track Workout Running burns more calories than almost any other cardio activity, but it can be boring on a treadmill or along the same old neighbourhood route. A great way to keep your running workouts exciting is heading to a nearby track. Changing up your speed challenges your body so you burn more calories—and it keeps the workout interesting. Turn Housework into a Workout Tackling your jobs and burning calories at the same time? Talk about killing two birds with one stone! The key to turning your cleaning activities into a workout is focusing on the ones that have the highest calorie burn, like scrubbing the tub or vacuuming. To get yourself in the right mindset, throw on your trainers and put on some upbeat music. If you want a real challenge, do some push-ups or squats every time a new song starts to play.

Raising low self-esteem Nothing is more important than how you feel and think about yourself.

You may think of self-esteem as your inner voice – the voice that tells you whether you are good enough to do or achieve something. Self-esteem is about how we value ourselves, our perceptions and beliefs in who we are and what we are capable of. Our self-esteem can be misaligned with other people's perception of who we are. Interestingly enough, self-esteem has little to do with actual talent or ability. It’s quite possible for someone who is good at something to have poor self-esteem, while someone who struggles at a particular topic might have good self-esteem. In the first case, the person might think “I have to give a speech tomorrow and I’m dreading it. I know I’m no good,” even though they are experienced and successful. The other person may be determined to give a good speech and focuses on feeling more confident about the result, even though they display less talent than the first person. It is easy to see how a lack of self-esteem can influence how a person behaves, not to mention what they achieve in their lives.

Why do people experience low self-esteem? There are ways to boost your self-esteem, even if you feel as if you are struggling. There are many reasons why someone might have low self-esteem. A feeling of failure can stem from a poor decision or a series of experiences in life that lead to the person feeling down on themselves. 29

For example let’s say that you don’t have confidence in your own abilities and you don’t feel strong enough to resist falling in with the wrong crowd. In this situation you may feel powerless to refuse the offer of drugs when they are presented to you. Thus you take them so you can fit in and feel part of a group, hoping this will increase your self-esteem and confidence. The effects of the drugs may make you feel more confident for a short time, but this is an external force – it does not come from within you. If you become addicted to drugs, any self-esteem you do have will eventually crumble. You will feel depressed at having succumbed to them and you may feel hopeless at the odds of beating the

addiction. It sends you into a spiral that can be hard to escape from.

Watch your internal dialogue However, there are solutions. As you may have guessed, positive internal dialogue is a big part of improving your self-esteem. Instead of saying things like ‘I’m not good enough’ or ‘I’m a failure’ you can start to turn things around by saying ‘I can beat this’ and ‘I can become more confident by viewing myself in a more positive way.’ To begin with, you will catch yourself falling back into old negative habits, but with regular effort you will start to feel more positive and build your self-esteem as well.

Help yourself and seek help from others Self-esteem varies from situation to situation, from day to day and hour to hour. Some people feel relaxed and positive with friends and colleagues, but uneasy and shy with strangers. Others may feel totally in command of themselves at work but struggle socially (or vice versa). Everybody is different. Some people are naturally positive and optimistic, maintaining equilibrium when faced with constant difficulties, while others are less so. Some people are good at appearing to be positive and optimistic on the outside while they struggle with low self-esteem and feelings of self-doubt on the inside. You cannot achieve everything in a day, but you can start taking steps to enhance the way you feel. If you are addicted to drugs or you have problems with overeating or drinking too much, take steps to get help. Focus on changing your daily routine as well, so you become healthier and more positive too. Exercising for half an hour a day is recommended by the World Health Organisation, but it is also enough to improve your general mood. Watching what you eat and trying to maintain a healthy well-balanced diet will also help your body and mind function well and could also help to lift your spirits. Adequate good-quality sleep will also help to ensure that your body and mind function optimally. A common symptom of low self-esteem is the feeling that you cannot perform well in public. Gaining confidence to function in public with ease depends largely on previous personal experiences. Preparation is important - knowing your information and what you want to say. The key is to face up to your anxieties and not to walk away from them. Blocking out or refusing to think about fears allows fears to take over and damage your self-esteem. Even the seemingly most confident people may feel insecure deep down. To feel nervous is not necessarily a bad thing. Actors, singers and those who work in the media can be all but paralysed with nerves before a performance, but as soon as the moment of action comes their control and technique takes over. It can be the same for everyone if properly prepared. One trick is not to let nerves show, to appear confident however you feel inside, to learn to channel the nervous energy positively. Once you are in control, the fear will subside and your self-esteem will improve.

Quick tips to improve self-esteem P Gain Control of Yourself Do not be critical of yourself to others. Whilst it can be useful to confide your concerns to someone you trust, telling the world is something else. Be kind to yourself. Make a list of your good qualities and believe them, believe in yourself. P Don't Be A Complainer Everyone has problems, so why should yours be greater than others? By being negative you can isolate yourself from others and cut yourself off from solutions to problems. P Learn to Relax Allow time for yourself each day. This may only be a few minutes, but it is important to be quiet and to unwind. P Boost Your Own Morale Allow yourself a treat from time to time, especially if you have overcome a hurdle in personal presentation, particularly after your first formal talk or after a successful meeting. It does not have to be expensive a cup of coffee at a pleasant place, or some other treat. P Congratulate Yourself Maybe on a job/task well done and perhaps tell a friend. Do not always be the one to give out praise, you need some too. Justified praise is a good boost to morale. P Learn to Channel Nerves Positively When you are nervous, adrenalin is pumped through the body and you feel more keyed up and alert. This extra energy can be used to good effect; enabling you to communicate with greater enthusiasm and intensity.

P Learn to be Assertive Stand up for what you believe in and do not be pressured by others. See our section on Assertiveness for lots more information about becoming more assertive.

Improvements will come in small steps It is difficult to go from poor self-esteem to positive self-esteem overnight. Instead you will find you make small improvements over a period of time. Try and stay in touch with how you feel during the day. Do you feel good about yourself? Why is that? If you feel low and you sense negative thoughts running through your mind, ask yourself why this is the case. Half the battle to conquering poor selfesteem is to identify when and why you feel a certain way. If you find exercise is a big mood booster you can build more of it into your day. If you find you feel low if you are on your own, you can make plans to get out and about more often. 30

Improve Your Health at Work Avoid those snacks, take a walk during lunch, clean that keyboard and you're on your way to a healthier workday. Eight hours in a chair in front of a computer, five days a week can take a toll on your body. From drinking enough water and eating healthy lunches to preventing eyestrain, here are some tips that will help you stay healthy and in shape at work. 1. The snacks that your co-workers so nicely place on their desk can add a few hundred calories to your daily diet if you're not careful, and they can leave you with unwanted pounds if you help yourself day after day. If it's out of sight, it's out of mind, so if you know someone has a treat dish on their desk, walk around his or her desk so you don't feel the temptation. In most offices, people are trying to lose weight, so go in with people and get fruit bowls instead of sweet treats and see if you can get people to replace their unhealthy snacks with something healthier. 2. Drinking an adequate amount of water - eight to 10 glasses every day - can help keep you hydrated. Many foods are also good sources of water; fruits like oranges, grapefruit, grapes, watermelon, and apples can help keep you healthy and hydrated. The 3 o'clock lull that many people feel at work can be due to dehydration, so drink lots of water. Try taking a 500ml bottle of water to work and try to finish it by lunch, and then fill it up again and finish that by 3 p.m. By 5 p.m., finish a third bottle. 3. One of the most important things you can do during the day to stay healthy and in shape is to exercise. Walking during lunch is a great idea as not only are you burning calories, but you're de-stressing and refreshing yourself.

Try and find a walking partner whom you can depend on for a daily walk - someone who will drag you out even if you claim you're too busy. If you really can't get out during lunch, park further away than you normally do so you have a short walk to work in the morning and evening, or make it a habit to take the stairs instead of the lift. 4. Eating a healthy lunch is an important part of a balanced diet. But eating reasonable portions is an important part of your health. Eat a healthy lunch at work, but also practice portion control so you aren't consuming too many calories and then sitting in a chair all afternoon. Many times, it's not that you are eating unhealthy food, it's that you are eating too much. 5. Eyestrain is another problem that can be encountered in front of a computer. It can cause headaches, difficulty focusing, and increased sensitivity to light. To prevent eyestrain, the distance to the screen from your eyes should be about an arms length away. You should also be able to comfortably read what's on your screen at that distance, without having to squint. If you can't read your screen from an arm's length away, simply increase the font size on your computer. 6. A healthy tip that all of us want to hear is that holidays are an important part of staying healthy at work. It's very beneficial to get away for a long holiday that will help you recharge your 'batteries. A trip away or even time spent at home will help reduce stress and get your mind off work, especially if you're having a difficult or challenging time.

Stop the Unhealthy Snack Attack! 10 Fresh Ideas For Work Fresh fruit: Put sliced fruits together in a salad or simply wash and pack your favourite whole fruits. Vegetables: Bring a tub of sliced vegetable sticks and a small side of hummus to offer your body some protein. Healthy bars: Look for bars that are relatively low in sugar and high in fibre and protein. Single servings of trail mix: Pre-package small bags of trail mix or dried fruit and nuts. Pre-portioned cheese: String cheese is a good idea for dairy-lovers, rich in protein and calcium. Wholegrain crackers: A much better idea than snacking on a bag of fried chips. Add a side of hummus as an extra treat. Peanut butter: Smear a single servings on your apple or crackers all week long. Yoghurt: Protein-rich yoghurt can feel like a treat with fresh fruit or a light drizzle of honey Popcorn: Don't fall victim to the buttery, salty bags, air-pop your own at home. Cereal: Opt for a fibre-rich wholegrain cereal. Instant porridge packets are another great snack.

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