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Difficult Conversations about End of Life

Author of upcoming book ‘Dodging Dementia: Understanding MCI and other risk factors: Second edition of The Essential Guide to Avoiding Dementia’ Mary Jordan has written the following blog which provides insightful support on the difficult conversations surrounding end of life. Her newest book will be available on Hammersmith Health Books and other online vendors in September!

A diagnosis of dementia is an opportunity to come face to face with our own mortality – and that of those we love. It may not be an opportunity everyone wants to embrace but in some ways this diagnosis gives us all a chance to accept our mortality and, if desired, to plan for how we would like our own end of life to be. Carers have told me that although they found the subject difficult to face, they have often been strengthened by the experience of considering their own end and have achieved some measure of peace from doing so.

Understanding the end-of-life wishes of someone with dementia

Establishing end-of-life wishes can be a very important part of caring. Even if discussing these matters after diagnosis is difficult, carers can at least be sure that they are doing an important and loving thing. It can be very difficult for people with dementia to make their wishes known. An important factor in dementia is the loss of the ability to foresee or understand the consequences of one’s actions or even to think clearly about the future. People with dementia have a tendency to exist ‘in the now’ and may find it very difficult to engage in discussion about a theoretical future. This means that effort to establish feelings about the end of life may have to be inferred.

It is important not to transfer our own feelings onto the person we are caring for. Just because we may feel that we would ‘rather be dead than demented’, this may not be how a person with dementia feels. We should listen to the way someone talks rather than trying to use direct questions. People with dementia may use expressions such as: ‘It’s awful’ or ‘There is nothing left’ or ‘I’m angry’ when asked how they are and this can be indicative. Others will answer ‘I’m fine’ or ‘I feel Ok’ or ‘Very well’ to the same question.

Reality vs. our preferences – the value of making a plan

Unfortunately, the final days of life often come in an unexpected manner. We would all like to imagine a final peaceful ‘drawing to a close’ of life, perhaps surrounded by loved ones, well cared for and pain free. The actualities can be quite different. Perhaps a fall or an infection is followed by an emergency admission to hospital and a fast deterioration. Sometimes residential care homes are so worried about possible accusations of neglect or mismanagement that residents at the end of their life are admitted to hospital instead of being cared for in the surroundings they are used to. There may not be time to consider wishes and advanced plans in these circumstances but remember that where these have been discussed and recorded it is more likely that they will be adhered to. Hospitals are generally bad places to die (they are designed to care for and cure) and privacy and peace and calm are rarely obtained there. Nevertheless, my experience is that families who have discussed end of life and who have planned and considered ahead often feel more comfortable about events leading up to death even if things have not turned out the way they planned.

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Spreading the word about Carers

The following blog is by Sara Challice, award-winning author of ‘Who Cares? – How to care for yourself whilst caring for a loved one.’

Have you heard of Health and Wellbeing boards? No, I hadn’t either, until I was asked to be on one a few years ago to represent carers within my borough of Richmond.

There are 153 Health and Wellbeing boards across the country, and their purpose is to establish collaborative decision making, planning and commissioning across councils and the NHS, informed by the views of patients, people who use services and other partners.

At present, I believe I am the only one on one of these boards, but we need a Carer Representative on every board – to ensure carers are represented across the UK, and are considered and supported within the various upcoming papers and proposals. Because if there is a paper on residents living with long-term health conditions, you can guarantee there will be a carer behind the scenes supporting them – but carers can often still be overlooked.

Please do get in touch with your local council and ask your Health and Wellbeing board if they have a Carer Representative.

Supporting Working Carers

Did you know 600 working carers quit every day due to the insufficient support? And inadequate support for working carers costs UK businesses £8.2bn every year.

But there is a better way.

Businesses Virgin Media O2 and Sainsburys recognise carers in their workplace need support, and I give online sessions supporting staff caring for loved ones. Often given during lunchtime hours, these invaluable sessions allow space for carers to learn self care tips, insight and psychology to help them become more resilient and regain balance, whilst juggling work with caring. These sessions can also include their line manager, so there is a learned experience for all, creating a supportive collaboration within the workplace, allowing for better communication.

Sharing Learned Experiences

Have you heard of Caregivers Burnout, the Helper’s High or Compassion Fatigue?

This invaluable insight, and much more, is shared in my sessions to support those caring for loved ones. Whilst engaging carers, I share stories and tips to help improve their health and wellbeing, and each session focusses on a particular topic, helping them gain clarity on all that is happening to and around them, whilst they take back control and find ways to enjoy their lives again – guilt free.

Of recent, carers have been asking for a session on, ‘Preparing for life after caring,’ because often, we just never know when our caring role may suddenly come to an end.

What can carers expect, and what steps can they put in place now to safeguard their own needs for when this big life event occurs? In this particular session, I share my own experience during my transitions once my caring role had come to an end, and I share insight and strategies to help carers with their transition, creating resilience whilst boosting their own health & wellbeing.

“I so could have done with this information. It would have made life so much easier!” – says Sara

Finally, Sara is giving a keynote speech in London for Carers First, a charity supporting carers over a number of counties. In sharing insight and knowledge, the event brings together trustees, staff and volunteers to collaborate, celebrate and plan for the future.

“Sara has delivered many online sessions for Carers UK, and we were delighted when she ran a series of Wisdom to Empower sessions for us, which were some of our highest attended online meet ups of the year.  The sessions were highly valued by the carers, providing them with vital support during one of the most challenging times of their lives. Sara shared lots of tips and insight to help them gain the clarity to make positive changes in their lives and maintain wellbeing – not only for themselves, but for those they care for.” – Michael Shann, Head of Membership and Volunteering, Carers UK

Read the first chapter of ‘Who Cares?’ for free here and to get in touch with Sara to learn more about her engaging sessions for carers, please email, or to learn more of her expert information, advice and support, transforming the lives of carers, go to

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The Damaging Effects of Chronic Stress

chronic stress

The following is an extract from ‘The Plant-Based Dietitian’s Guide to Fertility’ by Lisa Simon RD and looks at the effects stress can have on fertility. The book will be available for purchase on Hammersmith Health Books and other online vendors this month. 

I cannot emphasise enough how significant an effect chronic stress can have on your health. I would go so far as to say that it is at a level playing field with nutrition and, if it isn’t addressed, quite simply you will not improve your health.

Your body’s response to stress is instant and starts in your brain. It begins a series of interactions between the hypothalamus, pituitary and adrenal glands. This results in the release of adrenaline and cortisol, two of the ‘stress hormones’, from the adrenal glands. Once the stress has passed, your cortisol and adrenaline levels reduce back down. This step is really important as the communication between the glands in your brain and the adrenal glands above your kidneys also influences the production of sex hormones. If the stress doesn’t pass, the stress response doesn’t stop and this results in disruptions to your reproductive hormones. It is because of this that chronic stress may lead to poorer sperm quality and infertility in both men and women.

The effects of chronic stress on fertility

So, the effects of chronic stress on general health but also on fertility can be significant, and sometimes it feels like a bit of a vicious circle. Struggling to conceive is stressful, going through fertility treatment is stressful, and worrying about the effects of stress is stressful! Add that to general life stressors like work, relationships, social pressures, financial strains etc, and you can see how present stress is daily, even if you are not always aware of it. This is when the effects of such stress can start to become apparent in your state of health and affect your fertility, and this is why it is so important for both your mental and physical wellbeing to have in place some great stress management techniques. In terms of fertility treatment, data show that men report feeling stressed providing sperm samples on the day of egg retrieval, and this may negatively affect overall semen quality, with effects on sperm concentration and motility. However, it is difficult to say whether stress results in reduced semen quality, or whether it is a consequence of decreased semen quality.

Being diagnosed with infertility, frequent medical appointment, and failed IVF treatment are all very stressful events. It isn’t just the stress itself though that can affect sperm quality; how you respond to stress may also play a part. Responding by being assertive or confrontational may negatively affect fertility by increasing adrenaline production which then results in the blood vessels in the testicles tightening. This reduces testosterone production and the making of new sperm, so for men, stress management techniques are just as important as for women.

As stress causes an increase in cortisol and subsequent suppression of sex hormones, this can lead to a decreased sex drive and can also lead to undesired weight gain. Whereas acute stress is more likely to result in a reduced appetite, chronic stress is more likely to decrease behavioural control and increases impulsive behaviour. An estimated 35-40% of those experiencing stress increase their food intake. The types of food likely to be chosen are foods high in sugar and/or fat, with low-energy, high-nutrient foods, particularly fruit and vegetables, decreasing. This may then lead to overeating, which in turn can lead to weight gain and potentially increase feelings of anxiety and depression. Conversely, some experiencing chronic stress may decrease their food intake, leading to weight loss, with potential adverse effects on their mood, energy, concen­tration and, for women, their menstrual cycle.

Managing Chronic Stress

Managing stress is the third pillar of lifestyle medicine and essential to improving your chances of conceiving a healthy baby. In terms of techniques for doing so, everyone is different, and what might work for one person may not necessarily work for the next. For example, I’ve had patients telling me that meditation is their idea of ‘hell’, but then when I explore further, I find their concept of meditation is sitting on a yoga mat, cross legged, with both hands raised, fingers touching, while gently humming. This stereotypical image does not reflect the broad spectrum of meditation and is very different to most people’s practice.

Note from the author: In my new book, The Plant-Based Dietitian’s Guide to Fertility, I recommend the following from which you can pick and mix what is right for YOU. Please do see the book for the full information:

  • Guided meditation
  • Controlled breathing
  • Positive visualisation
  • Laughter therapy (yes! You heard right)

My experience of managing stress after embryo transfer

I can’t say that I didn’t worry at all during the two week wait after embryo transfer as I think some degree of anxiety is inevitable when you are pinning so much on something working, but every time I felt as though my anxiety was starting to get too high, I would apply some or all of the stress management techniques I describe in the book to bring it down.

Another thing I would highly recommend, if it is possible for you after embryo transfer, is to book those two weeks off work, or at least the first week. You want to remain as calm and stress-free as possible during that time, not having to deal with the commute if you are not working from home; work stress is something that you just don’t need. Also, finding something to occupy your mind is crucial so you don’t spend long periods trying to second-guess whether you are pregnant. That can be really counterproductive, and please, STEP AWAY FROM GOOGLE! It can be so tempting to search the internet for ‘signs I am pregnant’ or ‘what does implantation feel like?’ but this can raise stress levels and mean that you are obsessing over the slightest little sensation. Try and spend those two weeks doing lovely things with either your friends or your partner. Go out for relaxing meals, watch a film in the cinema, organise a pamper evening, do some crafting – anything that helps you to relax and distracts you from negative thoughts.

And remember, if none of these techniques are for you, there are many other forms of stress management that can be equally as effective. These can be going for a lovely walk, or a gentle run outdoors in nature, curling up with a cuppa and your favourite book, or having a lovely warm (not hot) bubble bath. As long as you take some time out, away from your phone and other screens, and just focus on being present, you will feel much better for it.

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Tips for Sleeping Well from The Fatigue Book


The following is an extract from ‘The Fatigue Book’ by Lydia Rolley and looks at the importance of sleeping well in managing the effects of Chronic Fatigue Syndrome.

It would seem to make logical sense that, if you suffer from fatigue, at least you would beable to have a good night’s sleep, right? Well, as you have no doubt discovered by now, the fatigue does not play by the normal rules of life, and what your body is craving from a good night’s sleep is sadly often denied.

As humans, we spend approximately a third of our lives sleeping. That is quite a lot of time. Sleep is essential for our mental and physical wellbeing. Sleep contributes to the proper functioning of our body’s systems. Lack of sleep, therefore, has negative health consequences.

I have worked with many chronic fatigue sufferers who, although they sleep a lot, struggle to sleep well. From my experience, people either tend to over-think sleep issues, which can lead to increased anxiety about getting to sleep, or not to think enough about these issues,
which can lead to disordered sleep habits. Chronic fatigue sufferers who have sleep difficulties usually wake feeling unrefreshed. Some may not be waking until late morning or even into the afternoon. Often it is hard to get out of bed, as the body feels weighed down and heavy. The heavy feeling and sleepiness can continue throughout the day. Some people report feeling more alert for a few hours later on, often in the early evening. Almost a small window of hope, but this can be followed by difficulty switching off at night and not being able to get to sleep.

Changing your sleep pattern does not happen by chance. It does take a lot of patience, being intentional and very consistent. Concentrating on your sleep and developing healthy sleep hygiene habits together make the biggest difference to your overall health and ability to function and cope well. I have seen countless people transform their sleep habits and have witnessed the benefits. The change started when they chose to try something different.

Sleep difficulties can be complex and multi-faceted, but most can be solved. Ignoring sleep issues, and hoping they will go away, does not work. Trying to sleep for a few extra hours to fill the gap only tends to prolong the problems rather than solve them. When sleep is disordered, our bodies need to be retrained to know when it is time to sleep and when it is time to wake up.

What I have learnt over the years is that, even though some of these tips seem obvious, they almost need to be exaggerated, repeated and magnified in order to have an effect. Please keep that in mind as you start to put into practice the following tips, which will give you some useful starting points.

I have full confidence that you will benefit from healthier sleep habits.

Tip 21: Separate Day and Night Clearly


This is probably not your present reality and that is okay for now, but please keep this fact clearly in your mind as a goal for your future sleep pattern. The boundaries between day and night can get very blurred with disordered sleep. The more disordered your sleep becomes, the more unrefreshing will be your experience. Reintroducing clear boundaries will prevent further deconditioning.

This is the direction we are heading towards to regain a healthier sleep routine. For now, just be aware of your current day and night sleep routine by drawing a line on the chart below where you think your sleep pattern currently is.


In the weeks and months ahead, be aware of how your current line gradually changes position and consider what has contributed to that shift. If you are sleeping excessively in the daytime and want to start changing that habit, see Tip 23.

Keep a Reflective Sleep Diary

The reason for keeping a sleep diary is to understand your current sleep situation and give greater clarity to what may need to change. This sleep diary is more of a reflective diary rather than a scientific measurement of your sleep cycles (such as on a sleep app). A reflective diary can be more useful in empowering you to make some changes.

In your reflective sleep diary (see Appendix 2, page 276) consider the following questions:

  • What was I doing an hour before bedtime?
  • How was I feeling in the evening?
  • What time did I get into bed?
  • How long did it take me to fall asleep? Why? Any reasons?
  • Did I wake in the night? How often? Why? Any reasons?
  • What time did I wake up?
  • What time did I get up?
  • How did I feel?
  • How would I rate my night’s sleep out of 10? (10 being excellent.)

I would recommend only doing this for a week or two, no more than that. That is enough time to recognise any patterns of sleep and highlight any particular areas that need concentrating on.

Every few days, respond to the following statement:



Tip 23: Set an Alarm

This tip is not always popular but it is of the utmost importance. When you are exhausted and perhaps have no particular reason to get up, it may seem sensible to rest for longer, but this is counterproductive. Staying longer in bed does not help poor quality sleep. Sufferers frequently report feeling worse for going back to sleep. Seeking balance and retraining your body to learn a sleep-wake cycle goes hand-in-hand with managing your activities, pacing and rest.


I recommend that you try the following method to create an ordered sleep-wake cycle:

  • Decide what time you would like to wake and get up, for example 8.00 am.
  • Use a simple alarm clock with a silent tick.
  • Place the clock somewhere that requires you to move to switch it off.
  • Check your reflective sleep diary and set the alarm for the average weekly time you currently wake and get up – for example, it maybe 11.30am.
  • Set your alarm at this time for a week, so that you get used to waking up with the alarm.
  • Avoid going back to sleep – open the curtains, turn the light on, sit on the edge of the bed, put your pillows on the floor, etc.
  • The following week, set your alarm for 30 minutes earlier.
  • The following week, set your alarm for another 30 minutes earlier.
  • Do this consistently for a few weeks, until you are waking and getting up at your preferred time.

If the 30-minute chunks are not successful, try 15-minute chunks of time.

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Keyboard Hands

The following was written by the author of ‘One Step Ahead of Osteoarthritis’, Frances Ive.

Attention all keyboard users. One day you could  get stiff, painful and knobbly fingers and thumbs, because of osteoarthritis, and one of the contributing factors is overuse of keyboards. No time is too soon to do regular (daily) exercises for the hands, to try to prevent building up problems for the future. Doctors have now been advised by NICE to recommend exercise to everyone when they get a diagnosis of osteoarthritis.

It’s true we use our hands too much and throughout history, those people who reached old age, would have had gnarly fingers, inflammation and pain.  In the 21st Century we are building up even more problems with kids using keyboards from a young age and throughout their lives. Originally, typists bashed their fingers down on to the keys of manual typewriters, but now computer keyboards, phones and tablets are used so much at work and at home, adding even more pressure to our hands.  And, when we use keyboards we put strain on our shoulders and arms as well and the tension radiates downwards to the hands. This results in pain and inflammation and sometimes immobility and inflexibility.

The pressure put on fingers by repetitive typing and key entry is astounding.  Someone typing at 40 words per minute (wpm) uses 12,000 keys per hour and 65,000 keys during an 8 hour day, putting up to 25 tons (25,000 kg) of force each day on their hands. Add to that, using fingers and thumbs to send texts on a phone all the time!   

Trying hand exercises may help to keep your fingers fit as you age. Stretching out the fingers, shaking our hands, squeezing a spongy ball or touching fingers to thumb are all good for keeping hands/fingers flexible and avoiding pain.

You can get osteoarthritis from 40, it is often hereditary, but also results from overuse of joints and the wearing down of cartilage (the protective surface at the end of our bones). Over 8 million people in the UK have osteoarthritis, of whom the majority are women.

Read more in One Step Ahead of Osteoarthritis, by Frances Ive

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Endometriosis Awareness Month


The following blog is by Lisa Simon RD, author of upcoming book ‘The Plant-Based Dieticians Guide to Fertility’ which will be available on the Hammersmith Health Books website and other online vendors from 27th April 2023.

I don’t think anyone who has not experienced endometriosis can truly understand just how debilitating a condition it can be. I say this because I was diagnosed in 2010 and it is one of the reasons I decided to write my book, ‘The Plant Based Dietitian’s Guide to Fertility: From pre-conception to healthy delivery’, and to dedicate a chapter to endometriosis, a condition that can reduce fertility for many individuals. I feel passionately about helping as many women and men as possible to optimise their fertility and to help those women who are now in the same position I was and who are experiencing debilitating symptoms on a monthly basis. Nutrition is a key area that can help improve our situation. Unfortunately there is so much nutrition misinformation out there which often causes confusion and even harm, so my aim was always to write a book that could be relied upon to provide only information that is backed up by a referenced evidence-base. This evidence increasingly supports a whole food, plant-based diet and I give guidance on how to get started, including some stand-by recipes that I hope you will find helpful.

How many women are affected by endometriosis?

Around 1.5 million women are living with endometriosis in the UK and around 176 million worldwide. However, it can take on average eight years to be diagnosed, meaning that many women live with chronic pain and fatigue for a long time before they are given a formal diagnosis.

What is endometriosis?

Endometriosis is a chronic, inflammatory, oestrogen-dependent condition that arises where cells similar to those that line a woman’s uterus are found elsewhere in the body. Most commonly they are found in the pelvic cavity, but they may also grow in the intestine, bladder, liver, kidneys and nasal cavity, on caesarean scars, and even in rare cases in the lungs and brain. These cells respond to each menstrual cycle and bleed, but unlike those in the womb which are shed as a woman’s monthly period, they have nowhere to go and so become inflamed. This results in pain and the formation of scar tissue which can then lead to pelvic pain, bowel and bladder symptoms, painful and/or heavy periods, painful intercourse and infertility.

The risk of misdiagnosis

The reason that it can take so long to get a diagnosis is that many of the symptoms of endometriosis are very similar to another chronic condition, irritable bowel syndrome (IBS). This means that women are often sent to see a gastroenterologist and subjected to a number of investigations before being given a diagnosis of IBS along with advice on how to manage this condition. This may or may not result in some symptom relief because often IBS and endometriosis can co-exist. However, this is then often seen as the end of the road rather than a referral also being made, or initially being made, to gynaecology, meaning that if endometriosis is present it is not detected.

What can you do to ensure you receive the correct diagnosis?

I would always advise you take a pain and symptom diary and a written list of all your day time and nocturnal symptoms with you to your initial GP appointment. This ensures that you are giving as much information as possible so that the chance of you being referred to the correct specialist is increased. So for at least a week before your appointment write down when you experience pain, where it is in your menstrual cycle, and how you would rate it on a scale of 0-10 (where 0 is no pain and 10 is the most pain you could ever experience). If symptoms get worse in line with your menstrual cycle, this should ring alarm bells for your doctor.

How did endometriosis affect me?

I first experienced the pain of endometriosis shortly before my 30th birthday when I was studying to be a dietitian. I was walking to a lecture when suddenly I was immobilised by excruciating pain on the left side of my abdomen; it literally took my breath away and it was terrifying because I had no idea what it was. The only thing I could do was to wait for it to be manageable enough for me to drive myself home. This recurred often  over the next few months and I began to notice the pain was roughly at the same time each month, although I did sometimes experience pain outside of these times. I couldn’t tell if it was around the time of my period because I was experiencing a pretty much absent cycle but I had suspicions it was gynaecological rather than IBS pain (I had been diagnosed with IBS in my late teens).

I saw my GP who referred me to gynaecology but the waiting list was long and all I could do was put up with chronic pain which significantly impacted my life. I missed several weeks in total of university, and missed out on spending time with friends and family because the pain was such that all I could do was lie curled up in a ball on the sofa with a hot water bottle in a desperate attempt to reduce it. Perhaps this sounds familiar to you?

Eventually I could not cope with it any longer and saw a gynaecologist privately with a subsequent laparoscopy, a surgical procedure where a camera is inserted through a cut by the belly button and if endometriosis is seen it is removed. I ended up having two of these operations because the cells grew back a few years after the initial surgery. I experienced post-surgical complications after the second surgery which resulted in a longer hospital stay.

I also experienced secondary infertility. When my husband and I started trying for a baby I assumed I would fall pregnant pretty quickly as I already have a seven year old son at that time. However, after failing to conceive for two years and given our ages (I was 36 and he was 41) we decided to go down the IVF route. All the routine tests were performed and we were diagnosed with unexplained infertility. However, I knew that endometriosis was likely playing a part.

Everything changed for me when I adopted a whole food, plant-based diet and really looked at other areas of my life where I could make positive changes.  I am happy to say that these days I do not experience pain during my monthly periods (which have now returned) and I attribute much of that to my revised dietary pattern and lifestyle. There is a growing evidence-base supporting the benefits of adopting a plant-based diet and also for the role of exercise in helping to manage conditions that involve inflammatory processes, like endometriosis.

I am thankful that our IVF treatment was successful and I am now the mother of two lovely children. My experience with infertility and IVF treatment, and the physical and emotional impact means that I fully understand what each of my patients goes through and I feel empathy with each and every one.

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What walking can do for people with cancer


The following was written by the author of ‘Get Your Oomph Back’, Carolyn Garritt.

‘Walk all over cancer’ is an annual month-long fundraising initiative by Cancer Research UK in which the charity challenges participants to walk 10,000 steps every day through March and to raise sponsorship and awareness of issues relating to cancer as they go. There’s information about the initiative, and how you could support it here.

Walking can be a fantastic way to improve our overall fitness and sense of wellbeing, as well as an important part of charity fundraising. What many people don’t realise though, is that walking (and physical activity in general) can also be a powerful part of treatment and recovery for those of us who have had a cancer diagnosis.

Exercise and cancer

Historically when people were undergoing cancer treatment they were advised that ‘rest is best’. It was assumed that physical activity might make patients too tired, particularly as they underwent radio and chemotherapies, which are known to cause fatigue, along with a whole host of other side effects. 

Steadily over the past twenty years or so this caution has been disproved and what has emerged is a powerful body of evidence that shows that exercising, right from the day cancer is diagnosed then through treatment and afterwards, can help cancer patients in many ways and for the rest of our lives.

Being active after a cancer diagnosis (regardless of activity levels beforehand) has been shown to reduce our risk of the cancer coming back. Some clinical studies have shown that risk of recurrence could be lowered by as much as 40%. Yep – four zero. This is significant, so much so that some studies now recommend that exercise should be considered part of the cancer treatment itself.

As well as reducing the risk of (primary) cancer coming back, exercise can help to slow down the development of secondary cancers. It can help alleviate many of the myriad side effects from cancer treatments and can offer some pain relief and mental and emotional support for those towards the end of life.

Increasingly cancer patients are aware of the benefits of physical activity but are often unsure how to start. I wrote my book ‘Get Your Oomph Back’ to explain just how they might, based on my work as a cancer exercise specialist and on my own experience of breast cancer.

Start with walking

For many, myself included, it starts with walking. It’s such a fundamental, functional activity, and it’s accessible and free. Walking can help our heart and lungs to recover their fitness and capacity after a period of illness or inactivity. Walking is a weight bearing activity, so it can help us to protect our bone density – which is often reduced by cancer treatments.

Walking, especially in nature, can help to calm the mind and blow away cobwebs that build up during the weeks and months of treatment. The book contains some suggestions about how we can make going for a walk more mindful, which may help us to feel a little less anxious. 

Walking uses the muscles in our buttocks and legs, which are very often weakened by a period of inactivity. As a result of their cancer treatment, many people lose muscle mass from their limbs, and at the same time they gain fat around the torso. Walking can help offset both.

Now, cancer treatment itself is rarely a walk in the park. As a trainer I often recommend people try to walk a mile a day, if they can, but some people find that their treatment, particularly chemotherapy, can be so arduous that walking becomes very difficult. I have worked with several people for whom walking to the end of their street was a challenge. It’s important that everyone feels they can start from whatever point they need to and build up their activity levels gently.

Meet Sarah

Sarah was diagnosed with stage 4 ovarian cancer in her early fifties and is one of my personal training clients. Her initial cancer treatment was tough going. Immediately after diagnosis she developed blood clots, a complication caused by the cancer, that left her without the breath or energy to move very much at all. At some points early in her chemo, she could not walk to the post box at the end of her street – in fact I remember her showing me a photo of the day she jubilantly made it there and back.

Because her cancer was stage 4, she will probably be on some form of cancer treatment for the rest of her life. She has an impressive attitude towards exercise and how she is caring for herself, that I think we can all learn from – I certainly have. She knows that she may well have to have more drugs, more chemo and she knows how tough they can be. So she is determined, to use her words, ‘to be match fit’ when that time comes. Although it hasn’t been easy, she is currently fitter than she  remembers ever being even though she’s still dealing with significant side effects from the treatment she’s had so far.

From walking just the length of her street, Sarah has steadily built up and a few months ago she walked her first parkrun. She’s currently about halfway to her first parkrun ‘milestone’ – recognition of progress once she has completed 50 of the weekly 5km events. And she’s getting faster. She has gone from post box to parkrun to PB and doesn’t appear to be stopping any time soon. 

Sarah is currently undertaking a challenge to walk a total of 100kms during March, as a fundraiser for an ovarian cancer charity. More info here:

How walking can be even better – add poles

Nordic walking (walking with poles that you use for momentum) is an incredibly useful form of exercise for everyone and has particular benefits for people who’ve had a cancer diagnosis. I teach Nordic walking at two of London’s Maggie’s Centres and it is as likeable as it is effective. Adding the poles means that we use the muscles in our top half as well as bottom, and Nordic walking has been shown to help us build strength and range of motion in our arms and shoulders – helpful after breast cancer. 

Walking with poles burns more calories than without and so it’s useful for those trying to lose weight or body fat. It works the muscles around the torso in a way that’s gentle and doesn’t bend the back or squash the bladder – which is good for those who have back problems or cancer in the bones, and after prostate cancer and/or pelvic surgery and radiotherapy. The poles can help people whose balance has been affected, and the poles can reassure those with peripheral neuropathy in the feet, a common side effect of chemo.

But over and above, Nordic walking is an enjoyable form of walking. It is often done in groups and surrounded by nature. At Maggie’s it provides an open space for people to talk – about their cancer but also about everything else – whilst exercising. Juliet is one of my regulars who walks with me on Hampstead Heath. She refers to our Nordic walks as her ‘Monday medicine’.

There’s a step-by-step guide to Nordic walking technique in my book.

Parkwalk – habit forming

Parkrun is a global movement in which volunteers host timed 5km events in designated parks on Saturday mornings. They decidedly are not a race, and participation is welcomed across the ages and across abilities. You don’t have to run them – plenty of people walk. I tend to do a bit of both.

Parkrun events are friendly and non-competitive. Last year this intention was reinforced with the introduction of ‘parkwalk’, a campaign that provides encouragement and support to anyone who is walking and ensures that everyone feels part of the parkrun community.

This community building can really help anyone to make walking become a habit. Saturday becomes ‘parkrun day’. I highly recommend them to anyone who’s trying to walk more. They are usually at 9am on Saturdays and by 10 o’clock, you feel fabulous. More information here: 

Take part now

By taking part in Walk All Over Cancer, people are helping to raise funds and awareness that might ultimately benefit Sarah, Juliet and me to live and thrive as people with a cancer diagnosis, through future cancer research. 

The impact is bigger than that though. By promoting walking as a form of exercise, cancer charities and organisations like parkrun are helping people to walk more and to gain the often unrealised benefits of this utterly simple, natural form of movement. 

Happy walking, folks.

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Celebrating International Women’s Day

This blog post was written by Hammersmith Health Books founder, Georgina Bentliff.

In honour of this day that internationally celebrates women’s achievements, we would like to make a special mention of these brilliant authors. All write, based on great expertise in their chosen field, to improve the health of others and are dedicated to achieving a healthier future for women and for all.

international womens dayDr Sarah Myhill, MB BS

Dr Myhill qualified in medicine (with Honours) from Middlesex Hospital Medical School in 1981 and has since focused tirelessly on identifying and treating the underlying causes of health problems, especially diseases of civilisation’ with which we are beset in the west. She has worked in the NHS and independent practice and for 17 years was the Honorary Secretary of the British Society for Ecological Medicine, which focuses on the causes of disease and treating through diet, supplements and avoiding toxic stress. She has recently deregistered from the UK’s General Medical Council and is not registered as a Naturopathic Physician with the Association of Naturopathic Practitioners. She has particular expertise in treating CFS/ME. Visit her website at


international womens day

Beverley Jarvis

Beverley has been teaching and writing about cooking since she qualified as a home economist and cookery teacher in the late 1960s. Her guiding principles have developed through many years of working as a home economist, including a stint as head of home economics for the Nestle company, and through writing about food and teaching cookery. She has presented a series on microwave cookery for the BBC and appeared on Food and Drink plus morning TV shows. She has previously published 23 cookbooks under the name Beverley Piper, starting out with Microwave Cooking for Health, published by Penguin.



international womens day

Dr Shireen Kassam, MB BS, FRCPath, PhD, DipIBLM

Dr Kassam is a Consultant Haematologist and Honorary Senior Lecturer at King’s College Hospital, London, with a specialist interest in the treatment of patients with lymphoma (cancer of the lymphatic system). She is also passionate about promoting plant-based nutrition for the prevention and reversal of chronic diseases and for maintaining optimal health after treatment for cancer. In 2018 she founded Plant-Based Health Professionals UK, a community interest company whose mission is to provide evidence-based education and advocacy on plant-based nutrition. In 2019 she became certified as a Lifestyle Medicine Physician by the International Board of Lifestyle Medicine.


international womens dayDr Zahra Kassam MB BS, FRCPC, MSc, DipABLM

Dr Kassam is a Radiation Oncologist at the Stronach Regional Cancer Centre in Ontario, Canada and an Assistant Professor in the Department of Radiation Oncology at the University of Toronto. Her areas of clinical practice are gastrointestinal and breast cancers and she has published peer-reviewed papers on these malignancies as well as in education and mentorship. She is a certified Lifestyle Medicine Physician with the American Board of Lifestyle Medicine and has completed the eCornell certification in plant-based nutrition and the Plant-Based Nutrition course at the University of Winchester. In 2019 she co-founded Plant-Based Canada, a not-for-profit organisation with the goal of education the public and health professionals on the evidence-based benefits of plant-based whole food nutrition for individual and planetary health.


Carolyn Garritt, MSc

Carolyn Garritt is a cancer rehabilitation personal trainer and Exercise Lead for the West London Maggie’s Cancer Support Centre. She has been working in this relatively new field for more than eight years and is a qualified personal trainer and instructor in running, boxing, sports conditioning, chair-based exercise and Nordic walking. She has trained hundreds of people recovering from or living with cancer. She also has personal experience of cancer – she helped both her parents become more active after their cancer diagnoses and in 2020, while she was writing this book, was diagnosed with breast cancer herself. Visit her website here.



Dr Heather Herington, BsC (Biol), NMD, DHANP

Dr Heather Herington is board certified in Classical Homeopathy and trained as a primary care physician. She has specialised in women’s health and mental health (including PTS) for over thirty years. She is passionate about encouraging people to realise the extraordinary potential everyone has to heal naturally with the right knowledge and motivation. Her two-pronged approach focuses on restoring biochemical balance with diet, lifestyle measures, homeopathy and botanicals and enabling survivors to tell and/or reshape their story. Visit her website here.


international women's day


Lydia Rolley

Lydia Rolley is a recently retired NHS Occupational Therapist and Family Therapist/Systemic Psychotherapist, with more than 15 years of experience in fatigue management. Her latest release is a practical, attractively illustrated guide to managing chronic fatigue in order to enable recovery at a pace that works for the individual. Each chapter includes a range of tips from which to choose plus food for thought, pause and mind, body and soul. Essential text is highlighted so that the severely fatigued can focus purely on that in the early stages of recovery.

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A Love Letter to the Books That Help Us


Dear ‘Who Cares?’ by Sara Challice,

For those caring for loved ones, you are an inspiring guide filled with personal stories and heartfelt advice, teaching people how to look after themselves as well as their loved ones so they can stay healthy and happy whilst caring.

Thank you for your empathetic approach to helping carers safeguard their own health and wellbeing.


Hammersmith Health Books


Dear ‘Eat Well to Age Well’ by Beverley Jarvis,

Inspiring your super-ager peers to eat well with over 75 delicious recipes, your tips and tricks to make cooking less physically demanding for empty-nesters and those who have recently retired are a wonderful addition to any kitchen.

Thank you for providing delicious and easy recipes that make sure cooking a lovely meal doesn’t become a chore.


Hammersmith Health Books


Dear ‘Could it be Insulin Resistance?’ by Hanna Purdy,

You are an insightful and practical guide using an evidence-based approach to explain what insulin resistance means, the causes and what to do about it.

Thank you for sharing your personal experiences along with a variety of ketogenic recipes to help combat the effects of Insulin Resistance.


Hammersmith Health Books


Dear ‘Emotional Logic’ by Dr Trevor Griffiths and Dr Marian Langsford,

You are a refreshing and liberating medical view of the useful purposes of our unpleasant emotions, using true stories and case studies to teach us how to move life on with healthy adjustments.

Thank you for sharing your knowledge on how to harness emotions into inner strength.


Hammersmith Health Books


For 20% off these books, simply use code: LOVELETTER23 at checkout.

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A True Story of Transformation

The following is an extract from ‘Who Cares?’ by Sara Challice and the true story demonstrates that just the smallest of changes can create the biggest of differences, making life much easier to bear.

Christine’s story

Christine wakes early, climbs out of her single bed and heads downstairs. She is in her mid 30s, petite, pretty, with shoulder-length blonde hair and this weekend she is back at her parents’ house in Holland [..]

She hears the click of the kitchen door open behind her, and as she turns, she sees her father pushing her mother in a wheelchair, into the kitchen. Her father is in his mid 70s, tall and wiry with short white hair and a short white beard. He has dark bags under his eyes and the corners of his lips are turned downwards. […] As he wheels his wife to the kitchen table, Christine can see the years of caring have taken their toll on him. He has been caring for her mother for over 20 years, ever since she was diagnosed with multiple sclerosis.

Her mother, in her late 60s, has short brown hair, and sits quietly in her wheelchair and half smiles at Christine.

‘Right, let’s get your medication and breakfast,’ her father states irritably.

Christine stands to watch in silence as her father prepares her mother’s breakfast. Once it is ready, he brings a bowl of porridge to the table, sits down and starts to spoon-feed her mother in silence.

Christine notices how roughly her father feeds her mother. It is very matter-of-fact, another job to be done. He feeds her out of obligation, nothing more.

Once he has finished, he grabs his shoes from the corner of the kitchen, laces them up and finds his jacket hanging in the hallway. Without a word, he opens the kitchen door and leaves the house […]

She turns and comes to sit with her mother, holding her hand.

They smile at one another, but she sees a pained expression on her mother’s face. Life is not good and it hasn’t been for a long time.

Christine sits and chats with her mother, telling her of all her news from back in London, where she now lives and works.


Around lunchtime, her father reappears after his bike ride.

Whilst her mother rests in another room, Christine decides to have a chat with her father, as she is worried for both of them.

‘How are things, Papa?’ she enquires.

Her father lets out a huge sigh as he sits looking at his hands in his lap with a furrowed brow. ‘You know I love your mother very much, but I feel so drained. I am at the end of my tether. I feel I am purely existing for your mother, and when she is gone, I will be gone.’

These words upset Christine. She will be heading home the following morning, leaving her father caring for her declining mother. She worries things are likely to get worse.

Later that week, Christine is at a networking evening in London where a few speakers get up to tell their stories to help others. The topic of the night is ‘Making the world a better place’.

Christine watches as I tell my story from the stage of caring for Neal and how I made his world a better place. As I finish and step down, Christine comes running towards me.

‘I loved your talk, Sara. I would really like your advice.

‘Could we meet up later this week?’ I smile at Christine and we exchange contact details to meet.

The following Wednesday morning, Christine sits holding her coffee cup and starts to tell me about her father caring for her mother for many years. She describes how her mother is now very disabled and hoisted in and out of bed. Christine relays to me all that her father has said, including that he feels he is purely existing to care for another […] She also tells me about her mother’s head hanging onto her chest but not wanting help to support it. She then shakes her head despairingly, ‘But what can I do, Sara? My parents live in another country and I am working here in London, rarely able to see them.’

I gaze back at Christine, concerned. ‘I can understand how your father feels. He’s been caring for a very long time. It can get the best of us. I know. I’ve been there.’

‘From the sound of it, there are a few things going on here. This scenario is cyclical.

Apparently 80% of communication is non-verbal. As your father feeds your mother abruptly, she will certainly notice that he is helping her because he has to, not because he wants to. He’s feeding and taking care of her purely out of obligation.

The trouble is, your mother will undoubtedly be noticing this, which will make her feel even more of a burden. In turn, your father will sense this, and on top of his frustration at having to care, he may be feeling pangs of guilt, which she may then be picking up too. All these negative emotions will be circling around, not making for a good atmosphere for either of them.’

Christine has pulled a notepad from her handbag, quickly scribbling down my observations. I continue, ‘Your mother clearly feels she is a burden but she still deserves quality of life. She must love your coming to visit, and at the very least, she deserves to be able to see you when you are able to catch up together. I think it’s time to ensure the headrest is added to her wheelchair, so she doesn’t hurt her neck.’

‘Could you ask him [her father] to make an agreement with himself? When he awakes the next morning, can he agree to do everything with love, not just for his wife, but also for himself? Not just in feeding and taking care of her, and not just in every mall chore he does that day, but in everything he does for himself?’

‘Then, when he goes to bed that night, to ask himself, does he feel any better?’

Christine looks up at me smiling and puts down her pen. We finish our cuppas and say our goodbyes.

Although I don’t hear from Christine over the next six weeks, I then see her again at another networking group and we happen to meet in the doorway before we both head in. Christine greets me with a huge smile and gives me a hug, ‘Sara, thank you so much! Everything has changed.’

‘I shared your advice with my father and he took it on board. Then, when I was back visiting them this last weekend, I watched him taking care of Mum. He was completely different. He was very caring and lovingly fed her. Afterwards he actually asked mum if it was okay for him to go for a bike ride. She nodded and said, “Yes, of course”. He then headed off for a few hours.’

‘Not only that, but the atmosphere in the house has lifted.

They have noticed this shift, and are now looking at new ways to improve their lives. For example, previously Dad would physically pick up Mum to transfer her into the car – dangerous for both of them. But now they order a wheelchair taxi to save his back and keep Mum safe!

I suggested to Mum that the headrest be added to the wheelchair at all times, but she wants to keep exercising her neck, so instead, she is hoisted back into bed a few times a day to give her a rest.

And finally, before this change, I was calling them every day, worried sick, but now I know they are alright, I call them just once a week for a catch up. I can now get on with my life, here in London.’

I give Christine another big hug after hearing her wonderful news and we head into the event together.

In her parents making just a few simple changes to their daily routine, not only had it improved the quality of life for them, but for their daughter as well, causing a ripple effect.