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CFS/ME: Are you sleeping too much?

CFS/ME: Are you sleeping too much

Difficulty with sleep is common for people with CFS/ME. Some people find they are sleeping too much, while others find they are not sleeping enough. If you experience problems with sleep there are several things you can do to help yourself.

There is no such thing as an ideal amount of sleep. For example, some people need 10 hours, while others only need five. An average night’s sleep is around eight hours. When the amount of sleep someone is getting is causing an increase in fatigue that is when it becomes a problem.

When people first have CFS/ME they often over sleep. People who have had CFS/ME for a longer period of time often go from over sleeping to not being able to sleep enough, despite high fatigue levels. Continue reading CFS/ME: Are you sleeping too much?

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Trick and Treat: How healthy eating is making us ill

Trick and treat: how healthy eating is making us ill

Every year the amount of money the Chancellor gives to the UK’s National Health Service goes up and so do our taxes to provide for it. And every year we hear more and more complaints about falling levels of service, lengthening waiting times for treatment, and worsening levels of hospital-borne diseases. With the billions of pounds we pump into the NHS each year, have you ever wondered why we don’t get a better service? The reason seems to be because we do pump billions of pounds into the NHS every year. Continue reading Trick and Treat: How healthy eating is making us ill

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Books on Prescription: Reading Well for Long Term Conditions

We are delighted to announce that Fighting Fatigue and Irritable Bowel Syndrome: Navigating Your Way to Recovery have been placed on the Reading Well scheme for long term conditions.

If the pen is mightier than the sword, perhaps the book is mightier than the drug.

These stirring words from Professor Martin Marshall at the 2017 Reading Well launch really summed up the miraculous effect that books have on us.

Bibliotherapy –  the use of books and reading to facilitate management of and recovery from illness – is not a new concept, but it has found increased recognition in recent years thanks in part to the Reading Well scheme. Continue reading Books on Prescription: Reading Well for Long Term Conditions

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Natural Health Worldwide: Changing healthcare for good

Natural Health Worldwide: Changing healthcare for good

The author of Prevent & Cure Diabetes announces the launch of an innovative patient-centred portal – Natural Health Worldwide

The connectivity of the internet has given opportunities for ‘disruption’ of traditional business models in many fields with which we are now familiar – taxis, room rental, publishing, information retrieval, to name but a few. Now there is an opportunity also to rethink health care – how we access diagnosis, treatment and expert advice.

Natural Health Worldwide (NHW) is a new website that launched on 1 June, this year. It is a portal which connects patients from all round the World with NHW health practitioners. These practitioners, also from all round the World, can be Medical Doctors, other qualified Health Professionals or Experienced Patients. Each practitioner has an individual webpage where they can describe their qualifications, their experience and what they specialise in. Patients can search the site by type of practitioner and or illness/problem.

Appointments are booked through the website and can be conducted by Skype, FaceTime, ‘phone or email. This makes the process very convenient and also caters to a forgotten patient population – the housebound and bedridden. After each appointment, patients rate their practitioners on ‘Knowledge’, ‘Value for Money’ and ‘Approachability’, as well as having the opportunity to leave more discursive comments. The rating system means that practitioners build reputations and this will help inform subsequent patients as to who may be the best practitioner for them.

Patients can also access lab tests via the site and there is also an extensive phlebotomists’ listing in the UK (to begin with) if blood samples are needed, again making the process quick, easy and accessible to all.

NHW has a philosophy of providing healthcare that is as ‘natural’ as possible, with many of the practitioners using diet, supplementation and other non-prescription drug approaches. However, this does not exclude the use of prescription drugs, where appropriate. Initially the focus of the site is on conditions such as ME/CFS, Adrenal and Thyroid problems, Lyme Disease etc. However, NHW expects to widen its coverage as the site grows.

Dr Sarah Myhill, my co-author and author of Sustainable Medicine and Diagnosis and Treatment of CFS/ME (second edition) is the website founder and has funded its development – this website is her gift to patients. Dr Myhill stands to gain nothing from NHW, having divested herself of all financial interests.

The motivation for this project can be seen from two perspectives. First, over the years, Dr Myhill has had to turn away thousands of patients and wanted to develop a portal that would provide an excellent and accessible service for these often neglected and ignored people. NHW does just that, bringing practitioners to those patients in an easy one-stop shop.

Secondly, NHW is part of a wider agenda, which has the aim of empowering patients to take control of their own health-care. So much of modern medicine can be driven by vested financial interests and in the process, the patient is almost completely forgotten. Dr Myhill had the vision of swinging the pendulum back in favour of the patient and away from those vested interests.

To achieve this empowerment, three key areas were identified:

  1. The knowledge to work out why you have symptoms and disease – Dr Myhill has undertaken an extensive book-writing exercise, with 3 books published already and 2 more on the way this year*
  2. Direct access to relevant medical tests – this is achieved via the NHW website
  3. Direct access to knowledgeable Health Practitioners who can further advise and guide patients, together with access to safe and effective remedies – this is achieved via the NHW website

The hope is that NHW will contribute to the future of healthcare being more patient-centred, with access to health practitioners, lab tests, and the necessary knowledge, all putting patients back in control and giving them the choices that they both need and deserve.

This post was written by Craig Robinson. Craig first met Sarah in 2001, as a patient for the treatment of his CFS, and since then they have developed a professional working relationship, where he helps with the maintenance of www.drmyhill.co.uk, the moderating of Dr Myhill’s Facebook groups and other ad hoc projects, as well as with the editing and writing of her books.

 

Interested patients – please register at – https://naturalhealthworldwide.com/patient_sign_up.php All patients who register in June or July will be entered into a free mystery prize draw.

Interested practitioners – please register at – https://naturalhealthworldwide.com/practitioner_sign_up.php

Other media and general enquiries – please email office@naturalhealthworldwide.com

 

*Dr Myhill has published:

Due out this year are

  • The Paleo Ketogenic Diet – getting the best of both worlds – [co-authored with Craig Robinson]
  • Life is an Arms Race – fighting infections – [co-authored with Craig Robinson]
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Dignity in Care

My mission to promote better care begins

Not all care services and nursing homes have a training budget or, if they do, it may be very limited. In an attempt to raise standards in older people’s services I offered some free training on ‘Dignity in Care’ and ‘Care Quality Commission Essential Standards on Quality and Safety requirements’. Both courses were snapped up quickly by some services. I wish I could have offered more.

Every morning waking up was as painful as the previous mornings had been, especially when I searched my brain to see what I was doing that day. I cried. I felt raw, still suffering after the loss of Mum and Aunty Ann.

That day I was delivering a training session on Dignity in Care to staff who supported older people. I had a large group of 20. Usually I teach up to 14, but I guessed that as it was a free course, the manager had put in as many as she could.

The staff came from a variety of cultures and were very knowledgeable. They shared their knowledge on which cultures liked different foods and liked to be washed/bathed differently and those who needed support to have prayer time.

I was pleasantly surprised when two staff members shared their stories on how and why they had had to report staff who had abused some individuals they were supposed to be supporting. They kept the details confidential and did not give any names of the individuals who had been abused or staff involved, but it was clear that some staff had been suspended on full pay whilst investigations had taken place.

I had the utmost respect for these two people for reporting their concerns. It couldn’t have been easy with the individuals concerned being part of their team, but they had done it for the welfare of the people they were looking after. These two staff members wanted and needed to talk about it and I gave them the opportunity in the break times to do this on a one-to-one basis with me. Before they started talking I told them that I was bound by confidentiality but also duty of care and would have to report anything I had concerns about. Confidentiality has to be breached if a vulnerable person is at risk of abuse or harm.

Back in the training session, the staff members were very much aware of their ‘duty of care’. They understood that all professionals have a duty of care to the people they support and that they needed to ensure that the individuals they supported did not suffer any unreasonable harm or loss. Some, however, found the issue of choice difficult to work with and understand. Many people, whether they have a learning disability, or are older, or have dementia, may need support to make informed choices, and this includes informed choices about risks. People receiving care must be supported and, with the aid of a risk assessment, enabled to fulfil their dreams, needs and wishes.

On my ‘Dignity in Care’ course I wouldn’t usually cover manual handling and hoisting, but since my late mother’s ‘accident’ with the hoist, I had been asking questions about hoisting at every opportunity I got. I asked about the law, the Health and Safety Act 1974 and, in particular, the Manual Handling Operations Regulations 1992. These are regulations that staff need to adhere to. Each individual requiring manual handling should be risk assessed and it will be stated on the risk assessment and in the individual’s care plan how s/he is to be moved, what equipment should be used and how many staff should be involved in the manoeuvre.

All was going well until I asked this question: ‘Do you always use two staff if it says two staff?’ Many said ‘Yes’, but one staff member said, ‘No, not always.’

I could feel anger brewing up inside and I wasn’t sure if it was because of her biased attitude or because of what had happened to Mum. (Probably both!) I pointed out the dangers, but she responded, ‘I’ve done it loads of times and no one’s been hurt.’ I finished this subject by reiterating what they should do and informed the Manager during the tea break that this member of staff needed to understand what was meant by safe practice and why it mattered.

This blog is taken from Suzan Collins’ moving personal story of fighting for justice in elderly care, Beyond My Control.

If this story has affected you or you want to share your stories of dignity in care tweet us and join the #carersweek conversation.

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Diagnosis of diabetes and its precursor, metabolic syndrome

Before getting to the testing stage we can get some very useful clues from a combination of the clinical picture together with commonly done routine tests. However, if you eat what is generally considered a ‘normal, healthy, balanced diet’ (ho! ho!) based on the intellectually risible food pyramid, then it is likely that you have carbohydrate addiction and are on the way to metabolic syndrome and diabetes.

In order of priority and ease, the diagnosis can be made from:

  • The contents of the supermarket trolley
  • Diet
  • Snacking
  • Tendency to go for other addictions
  • Obesity
  • The clinical picture

The contents of the supermarket trolley

  • Bread, biscuits, cake, pasta, cereals, sugar, waffles, bagels, dough nuts and other such
  • Fruit juice, pop, alcohol, “energy” drinks and general junk drinks
  • Fruit basket with tropical sweet fruits such as pineapple, melon, bananas, grapes. Apples and pears
  • Sweet dried fruits – sultanas, raisins, dates
  • Snack foods – cereal bars, ‘energy bars’
  • Sweets, toffees, fudges
  • Honey, fructose, syrups
  • Jams, marmalades, choc spreads
  • Artificial sweeteners
  • Ice creams and puddings, like cheesecakes and trifles
  • Low cocoa-percentage chocolate
  • Crisps, corn snacks, popcorn…you get the idea – we call it junk food!

Such a supermarket trolley is very indicative of a diagnosis of carbohydrate addiction, metabolic syndrome and/or diabetes.

“Indeed, I have just returned from a trip to the supermarket. The man in front was placing his purchases at the check-out. I felt myself sighing as the packets of chocolate biscuits, crisps, white bread and sweet drinks piled up. But what moved me to an intense desire to shout out were the final three items – paracetamol, ibuprofen and a box of antacids. He was poisoning himself with the carbs, then symptom-suppressing with the drugs. Addiction has blinded him to the obvious.”

Diet

Breakfast gives the game away. This is because no food has been consumed overnight and with carbohydrate addiction, blood sugar levels are low in the morning. The need for a carbohydrate-based breakfast indicates metabolic syndrome – typically with consumption of fruit, fruit juice, sweetened tea or coffee, cereals, toast, bread or croissants. ‘Oh, but surely porridge and muesli are OK?’ so many cry. Often they are not OK – the only way to really find out is to measure blood sugar levels.

“Even now my daughters can hear me groaning when the adverts on the telly for breakfast cereals come on. I really cannot stop myself. The Telegraph recently reported that, ‘Children’s breakfast cereals can contain as much as three teaspoons of sugar – the equivalent of two and a half chocolate biscuits,’ and so there are also ‘hidden’ dangers.”

Snacking

The need for a carbohydrate snack or sweet drink is often triggered by falling blood sugar. Many people comment that when they go on holiday and treat themselves to a fry-up for breakfast, they no longer feel hungry before lunch. Snacking is a disaster – it feeds the fermenting mouth and gut, prevents the glycogen sponges squeezing dry, spikes insulin and prevents fat burning.

Carbohydrates with every meal

The symptom of ‘not being satisfied’ with meat and vegetables is particularly indicative of carbohydrate addiction, with the need for a sweet pudding to ‘hit the spot’.

Tendency to go for other addictions

Also highly indicative of carbohydrate addiction is the tendency to have other addictions … such as alcohol, smoking, coffee, chocolate, prescription drugs (yes – many of these are addictive), and ‘legal’ and illegal highs.

Obesity

Obesity is not the cause of metabolic syndrome and diabetes, but may be a symptom of both. Many people with type 2 diabetes have metabolic syndrome and normal weight and vice versa – obese people may have no signs of metabolic syndrome. It is the constant sugar spikes in the portal vein, the effect of which eventually spills over into the systemic (whole body) circulation, when the liver is overwhelmed, this characterises metabolic syndrome and diabetes. We cannot measure these spikes because the portal vein is buried deep in the abdomen and links the gut to the liver. Interestingly, it is the fatty liver which is highly correlated with metabolic syndrome and diabetes – not the fatty rest of the body. Fat in the liver can be measured with MRI scans, but this is an expensive test not routinely available.

The ability to gain and lose weight is an essential survival ploy for all mammals. Think of the hibernating female brown bear who has to survive months of intense cold, pregnancy and breast feeding with no food intake. She achieves this on autumn fat together with the ability to switch into fat burning. She remains completely healthy throughout.

Share your story for Diabetes Week by using the hashtag #knowdiabetes.

This blog was originally published in Prevent and Cure Diabetes: Delicious diets, not dangerous drugs by Dr Sarah Myhill and Craig Robinson.

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Understanding a brain with dementia

How the brain works, a very logical and straightforward article produced by Alzheimer’s Australia, gives a clear and basic introduction to the brain dysfunction involved in dementia and always helps me to picture what is going on inside of the head of someone affected by this disease. The article explains that the brain can be thought of as a factory and that the factory runs at peak efficiency when all the parts are working.

At the front of this factory (the frontal lobes) are the directors. They make plans for the factory and decide on who is going to do what and when. As things get underway they get feedback or other information as to how well things are going and they make judgements on what looks good and what does not look so good. Then they make further decisions, to change that or to keep this, and show their appreciation and annoyance. Planning, organising, judging, decision-making and appreciation therefore take place at the front of the brain.

In the middle of the factory (the parietal association cortex) are the managers. Each manager runs his/her own department. The left side is the talking side: there is a speech department that moves the throat, tongue and lip muscles, a language department that is responsible for finding the words you want and knowing the words’ meaning, a music department, and various other departments. The right side is the picture side, with a motor department that helps you find your way around a building, knows where you are when you are driving a car, puts your arm through the sleeve of your coat, and so on.

The directors pass their plans on to the managers, and the managers make sure the directors’ plans are carried out. In order to do this, directors and managers communicate freely with one another, sending messages back and forth.

At the bottom of the factory (the limbic region, amygdala and basal ganglia) are the workers. They do not know what the directors’ plans are, but they know their job and they do that same job day in, day out. They take care of things like appetite control, the need for water, staying alert and awake or going to sleep, as well as basic emotions, such as turning on tears, making the face red and increasing the pulse rate.

When brain damage occurs, basically someone gets sacked. It can be the director, a manager or a worker, depending on where the damage takes place. Someone can also go on temporary leave of absence – for example, when there is a temporary swelling or loss of blood supply in the brain that is reversed in a short time.

The result of any injury, whether permanent or temporary, is that the efficiency of the factory is reduced. Messages are sent but are not picked up. Directors get annoyed. The managers get tired and the emotional workers get overwrought. Confusion reigns.

Understanding who has been fired and who is still on the job can help in interpreting the behaviour of people living with dementia.

This blog is taken from The Dementia Whisperer: Scenes from the frontline of caring by Agnes B Juhasz.

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Taking charge of anxiety with an invisible illness

Mental health and coping with anxiety affects everyone, and if you are suffering from an invisible illness it can be even more difficult. It’s #mentalhealthweek so here are some tools for looking after your emotional and mental health when dealing with chronic illness, whether it be IBD, IBS, CFS, ME or other fatigue/auto-immune conditions.

How can we deal with anxiety and invisible illness?

Since many patients feel stress can trigger their symptoms, it is vital to try to get a handle on anxiety. It has been suggested that support for this should be part of Inflammatory Bowel Disease (IBD) patients’ care plans, yet currently only 12 per cent of IBD clinics offer this. Therefore, it is clearly an area where more medical services need to be directed. As I discussed in Chapter 1, initial consultations after being diagnosed can lead to the patient being overwhelmed with information and having a variety of leaflets thrust into their hands about the disease they can only take in later. But where’s the leaflet that tells us how to cope with the associated emotions? The leaflet that gives us ways of not breaking down, and staying strong? The leaflet that offers support groups and websites?

Hopefully the studies I have cited have highlighted the growing link between mental health and IBD. Of course, if you feel you are struggling with anxiety and depression it is vital you speak to your GP urgently. If you have done this and are looking for some self-help suggestions to deal with times of worry and help manage your anxiety, then the guidance below from Sally Baker – a therapist who works specifically with the mind-body connection – may be beneficial. (It is important to be aware at the same time that these tips offer general guidance which cannot replace the individual advice of a medical professional and if you are feeling any new symptoms of anxiety and depression, then it is very important to see your GP.)

Advice from Sally

When Sally works with clients living with chronic ill-health she recognises how having little or no confidence in how one will physically feel from day to day encourages self-doubt and frustration. As you are probably aware, feeling negative about yourself can create a vicious circle of frustration, disappointment and anger. One of the first therapeutic approaches she suggests to break this cycle of negative self-thinking is to encourage patients to gain an enhanced level of self-awareness to highlight the impact those uncomfortable emotions have on them.

She has found one of the most beneficial ways of discovering if a person is prone to negative thoughts about themselves is to explore the kind of things their inner voice says to them. If on reading this your response is, ‘What inner voice? – I don’t have one!’ then that is your inner voice.

Your inner voice runs an almost continuous internal dialogue commenting on everything you do and often makes judgements on how well you do it too. Happening as it does just below conscious awareness, one’s inner voice goes unchecked, and unchallenged, for most of the time.

For many people, especially those living with chronic illness, their inner voice is rarely a source of uplifting encouragement. It is more likely to give an unremitting flow of self-criticism, and negative self-judgements (everything from ‘I hate my body’ to ‘What am I doing wrong?’). Taking the time to become aware of how your inner voice speaks to you can accurately demonstrate to you your own level of self-judgement and self-condemnation. Tuning in, and clearly hearing your inner voice, is the crucial first step to silencing the draining and dispiriting stream of negativity that can hinder moving forward and making positive changes. Sally suggests spending a little quiet time – just a few moments – every day for about a week tuning in to your inner voice, and simply listening and noting down the negative statements. A therapy tool she then uses to resolve those negative, limiting beliefs is called Emotional Freedom Technique (EFT or ‘Tapping’). EFT is an energy therapy that has proved highly effective for revealing true feelings, in this case prompted by one’s negative self-talk.

Once you have a greater awareness of your own negative self-talk you can then apply another of her core therapy tools – called Percussive Suggestion Technique (PSTEC) – to turn-down, or dispel, the emotions attached to the negative beliefs you have about yourself. Turning off negative self-talk is the beginning of a powerful journey which can transform a former inner-critic into your greatest advocate – someone cheering for you instead of undermining you.

This blog is taken from Managing IBD: A balanced guide to inflammatory bowel disease by Jenna Farmer, available as ebook and paperback. For more from Jenna you can follow her blog A Balanced Belly, and for more emotional therapy techniques from Sally Baker check out her book Seven Simple Steps to Stop Emotional Eating.

If you found these tools helpful help us raise awareness of mental health by sharing for #mentalhealthweek

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10 Ways to Colour Your Pregnancy Journey with Love

Midwife Bridget Sheeran has just released her first adult colouring book for pregnant mums. To help you get the most out of the book we’ve put together these ten top tips for using the book on your pregnancy journey.

  1. Notice and enjoy the touch of the book in activity! The good quality paper, colourful & unique hard cover design. Press the double page images flat in the centre of the page – no need to worry about felt pens seeping through; coffee spills on the cover; children pulling and tearing the cover or pictures of real life birth of other women’s shapes, colour, babies and sizes!
  2. Bridget has made it easy to just go ahead and start. The introduction invites you to consider the book as a handy companion with all the best intentions of a midwife there to put into your bag and to take it anywhere with you on your pregnancy journey.
  3. Look at the posed essential questions at the end of the introduction, and with the wishes of an experienced midwife – go ahead, take the time it takes and find your own answers for this birth. If your ‘brain feels tired’ be inspired by the index at the back explaining each image and take what you need from that, not forgetting to add you own ideas.
  4. Genuine, good intentions from Bridget’s best wishes are there for you from woman to woman, to discover and keep. Turn the pages and indulge with the child-like qualities of learning new things – with colours and fun! This can seriously change your way of engaging with the ‘usual’ approach to childbirth and learning, and bring new skills such as ‘letting go’ and ‘jumping straight in’ – like the beginnings of birth, and positively stepping into the unknown.
  5. Interacting with the images and the positive messages about birth and you, will lead you to discoveries of yourself plus whom is connecting with you right now – today – to help you, as others have been helped before. Busy lives can prevent us from ‘taking stock’ of who we need around us and who we have nearby…use the book to consider what Mother Nature shows us to do, such as to listen within, appreciate who cares and connect with both.
  6. Some days are ‘sloppy-jo’ days for resting and yet there will come a day when you feel great and ready to get up and MOVE – the colouring in of Dancing Mamas the evening before contemplating an exercise class or a walk locally can motivate you take that step, knowing there are friends and fun to be had in this healthy pursuit.
  7. Using the small actions of colouring in – literally at your fingertips, you use what’s called right-brain activity. This benefits you, because not only does it bring a sense of calm to your day, but also it is what Nature herself has prescribed for you – in preparation, as your baby grows and for taking care of yourself while pregnant and for afterwards, mothering the baby.
  8. In your own time, before or during antenatal classes, this book can help you consider your questions through the prompting of Bridget’s words and images. It may make you think differently about what perhaps you can do for yourself in preparation, to use your body well and to get your baby down (and out) however you give birth. You can discover how well designed your body actually is – or find out through specific birth classes what skills you need eg flexibility of your joints or pain coping practices.
  9. Pass on what you notice about yourself and Birth to other children, using this book – have fun conversations about the colouring, nature’s way and your growing family.
  10. Focus on your physical and emotional needs now, and this will help you after the birth, because you will have already found what works for you or what is needed. Your resources do include the people nearest you, and the birth workers (midwives & doulas) to help your birth recovery and for you to become the woman you want to be after the birth.

Buy Preparing for Birth: colouring your pregnancy journey by Bridget Sheeran, and let us know your favourite ways to stay mindful and calm during pregnancy on twitter.

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A gentle introduction to IBS for IBS Awareness Month

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is an invisible, fluctuating disease and as such it is often difficult for family members, friends, colleagues, health service professionals, welfare insurance administrators and others who encounter people with the disease to understand the suffering of the individual.

People with IBS are often faced with troublesome and sometimes severe physical symptoms that in different ways obstruct or challenge their everyday life. The disease is by its nature potentially shameful. In our modern western society some of our most fundamental bodily functions, like flatulence and defecation, are considered to be private and nothing you would want others to know about. Hence, for many persons with IBS, sharing their illness experience does not come easily.

Among healthcare professionals, knowledge about IBS is quite often insufficient and it is regarded as a low-priority disease. Sometimes IBS patients find that their troubles are dismissed or belittled, for example, in healthcare encounters or by family members. Not being taken seriously – at home or by healthcare professionals – can be a devastating experience which affects self-image. For some people getting the diagnosis is affirming, providing a legitimate passport to the healthcare system. For others, however, being diagnosed means nothing but being a ‘closed-case’, and they feel left with insufficient information, advice and support. They find they have more questions than answers. In the jungle of potential self-management suggestions (available through various websites, blogs and chat forums) about what to eat, when to sleep or how to behave if you get urgent bowel movements and start to panic on the bus, it is easy to get confused. Being on your own, having to figure out how to live the rest of your life with an illness that won’t go away, and a disease for which there is no treatment or clear and certain ‘rules’ to follow but learning to know one’s own body and what works best, is not an easy task.

Literature about IBS has until now tended to be either too medically orientated, complex and difficult for lay people to understand, or to be like a pamphlet, too brief to be useful. Irritable Bowel Syndrome is therefore a very much welcomed contribution for all laypersons – people with IBS, family members, colleagues, neighbours and others who for some reason need to learn more about the disease, what life with IBS is about and what help is out there. The book offers a thorough explanation of the mechanisms and (as far as there is scientific evidence) likely causes of IBS, and of available pharmacological and non-pharmacological treatment options. It also portrays life with the illness from the perspective of those who live with the disease, and linked to this, a variety of self-care strategies are described. The book can of course be read as a whole, but it also forms a very useful reference book for certain aspects or topics of particular interest to the reader. I am certain that anyone who is interested in knowing more, or has specific questions, about IBS will find useful information and answers to their questions.

Cecilia Håkanson RN, PhD is a researcher and senior lecturer at the Palliative Research Centre and the Department of Health Care Sciences at Ersta Sköndal Bräcke University College, Stockholm, Sweden. She is also an affiliated researcher at Karolinska Institutet, Department of Neurobiology, Care Science and Society, in Stockholm, Sweden.

This extract is taken from Irritable Bowel Syndrome: Navigating your way to recovery By Dr Megan Arroll and Professor Christine Dancey