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How and why I came to write ‘Yoga for Cancer’

book

Blog written by Vicky Fox, author of ‘Yoga for Cancer’

Where it all began

I trained as a yoga teacher in 2008 and felt so lucky to be doing something that not only I enjoyed but I felt huge benefit in. I was always fascinated by the therapeutic application of yoga and how yoga could support people and in 2013 Laura Kupperman came over from Colorado to teach her “Yoga For Survivors” training which focused on how to support people diagnosed with cancer.

I had started studying with her when one of my best friends was involved in a tragic accident which meant that whilst learning how to adapt practices for side effects of surgery and treatment for cancer I also learnt how to hold space, be present with pain and not to be able to fix it. I think this was a huge learning for me just being fully present with someone with all that they were experiencing and with no judgement but just to be. This made my first few classes of yoga for cancer less frightening, remembering that these were just wonderful people coming into the room to have some space where they were nurtured and protected, practice yoga and maybe start to get connected to their bodies again.

What inspired me to write the book

The yoga classes gave them chance to switch from being a patient to being a co-crafter of their well-being and I started to meet the most fabulous people who shared with me what they were going through and I learnt to adapt so that everyone could participate in every bit of the class no matter what they were bringing with them on that particular day.

I volunteered to teach at Paul’s Cancer Support Centre which was a fantastic charity offering support for people living with cancer. The room I taught the yoga in was a shared space room that was used for other activities and it was not uncommon to go into the room, move furniture around and pick up the odd crisp that had escaped under a table. I loved teaching there but I also wanted to give my students the chance to experience what I felt when I went to triyoga, my local studio for a class. A dedicated space just for yoga with all the props you could possibly need and not a crisp in sight.

At the same time one of my friends worked for a company that had a charitable trust and they were thinking of sponsoring me to teach a free class for people impacted by cancer. As a result I approached Jonathan Sattin the owner of triyoga with this idea. We were negotiating room rates when I found out that the trust had voted for a different charity and so I had to contact Jonathan to tell him that I couldn’t teach the class as I didn’t have the funds for the room. He immediately responded that I could have the room for free and I agreed to teach the class for free and there we had it, the free class of yoga for anyone living with cancer started in April 2014. The “free” aspect was really crucial to both myself and Jonathan. It can be expensive being diagnosed with cancer. You might need child care, you might not be able to work, you might need to take taxi’s or have overnight stays in hotels. All this costs money and I wanted the classes to be as inclusive as they possibly could and being able to make them free meant we could do that.

 

 

 

How and when the book started to take shape

When we went into lockdown in March 2020 it was imperative that I got these classes online as soon as I could because I knew that community was a hugely important part of the class and suddenly we were all being told to stay at home and I knew this would be so challenging for some of my students. Triyoga immediately put a class on their online platform, on a Sunday, which quickly grew and I taught more classes from my home. If you knew anyone who was considered “vulnerable” during the first wave of covid you will know why the support of a community was so incredibly valuable. Some students were told if they caught covid they would not be able to be treated for cancer and other students had trials they were on cancelled as a result of covid. This online community became hugely important because students were unable to see physiotherapists or to get advice on certain side effects and so they started being discussed more widely in class.

The more I taught online the more I got to know my students, the more they asked for yoga poses that might help with a side effect. I wonder if it was that people felt more able to open up in this online format or whether it was just that they didn’t have as much choice. Students that only came once a week to class now were showing up to every class and I realised that what everyone needed support with was not cancer but the side effects of treatment for cancer.

I started creating little, short videos which I either put on Instagram or on my website with some ideas on poses that might help with cording, lymphoedema, scar tissue, peripheral neuropathy and other side effects that people needed support with. I had already started writing a book on yoga for cancer but teaching online helped me find more focus for the book and the idea of A-Z of side effects for treatment for cancer started to take more shape.

What I am most grateful for

I could not have done this book without the sharing and honesty of my students who have emailed me, spoken to me, opened up to me about what they are experiencing and asking what might help. They have trusted me and I am hugely grateful to them for this. My students really need all the credit for this book because it wouldn’t have happened if it wasn’t for them.

Anybody who is fortunate to work in a job where you contribute and others benefit will know how much purpose this gives you in life. I am so lucky to be able to do what I do and meet the most amazing people that I meet. By being forced into online teaching (which is now in a hybrid format of live studio and livestream) it enabled me to reach out to more people and where I had been unable to teach people that lived on the other side of London to me, I was now able to teach people anywhere in the UK or even abroad.

What I hope to achieve with my book

I hope this book will be an extension of these classes and empower anyone impacted by cancer that although you can’t control life you are able to control your response.

Remember, you can read the first chapter for free!

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What does Get Your Oomph Back include?

Blog post written by Carolyn Garritt, author of ‘Get Your Oomph Back – A Guide to Exercise after a Cancer Diagnosis’,  now officially launched.

 

There are many tools described in the book. Often the best starting point is simply to walk – outdoors if possible. Walking mindfully and seeking out nature (in an urban environment as well as the countryside) can feel really soothing and, as long as the walk is brisk, it can help to restore physical fitness as well as a sense of wellbeing.

If you’re not able to stay on your feet for long, then marching in a chair, and chair-based exercises in general, can elevate the heart rate more than many people imagine. You can get properly out of puff at home if that’s what you need to do, for now. There’s a chair-based cardio routine in the book.

In the book I also talk about Nordic walking – using poles – which I boldly describe as ‘perfect exercise’. It is very clever – it elevates the heart rate, gives the lungs space to work, improves the posture, protects the joints, strengthens the bones, supports the balance (pain and numbness in your feet is a common side effect of chemo). It helps reduce the risk of, and manage, a condition called lymphoedema, helps rebuild upper body strength and uses 95% of your body’s muscles.

And yet – perhaps most importantly – it feels really nice. The poles propel you along, so walking can feel more manageable. The fact that it’s outdoors, in nature, it’s low-cost and highly sociable, just seals the deal. Possibly my most used and useful type of activity.

Strength training

In the book there’s a lot of information about strength training – often overlooked, and definitely one aspect of exercise that folks are unsure about. Strength training – using weights, resistance bands or our own bodyweight – can help us to feel less tired after cancer treatment. Most people feel they lose some strength while they’re on the injury bench, and if we’re out of action for a while we can lose muscle mass.

Building (or rebuilding) stronger muscles is known to reduce our risks of cancer returning. It can also make everyday activities seem more manageable. Many of the people I’ve worked with (regardless of their age) have found that they can’t climb stairs as easily as they could before. There’s some specific information in the book about how to tackle stairs.

Do what you enjoy

One important theme throughout the book is that we should, I believe, do what we love when it comes to exercise. If you don’t love any type of exercise at all, there are some suggestions about how you might find acceptable, even likeable forms of activity. In my mind, nothing is out of the question – I’ve trained people to play croquet and to tackle ultra-marathons. And pretty much anything in between.

There’s definitely scope to get into, or return to, team sports, such as football, rugby and/or basketball, after a cancer diagnosis, and there are now organisations that run group-based activities specifically for people with a cancer diagnosis, such as the wonderful Active Ostomates.

Parkrun

In the book I also talk about parkrun which is, in my view, community, grassroots exercise at its very finest.

Running (slowly) is without doubt the exercise I love most. There’s a ‘couch to 5k’ running or walking programme that incorporates a monthly trip to parkrun.

Boxing

Boxing features too because it is a superb stress-buster. It helps sharpen our hand-eye coordination, which can be a bit foggy after treatment, and if done properly it works the whole body. (You don’t have to spar or hit actual people – I’m talking about using pads, mitts or a punchbag.) You do have to really think on your feet and stay light on your toes, yet it can be for anyone. My oldest trainee boxer is 84.

Combining boxing with using a skipping rope is one way to push ourselves and strengthen our hearts, lungs and bones as we go.

Yoga

Yoga, particularly restorative yoga, is another tool described. It’s important for people to find ways to relax (not easy, I know) and also to stay flexible as this can help deal with some of the aches and pains associated with taking cancer drugs.

Making time

Too much? I know that the idea of exercising can feel overwhelming. Fair enough. If you know you’re short of time or energy (or enthusiasm), then the book contains several cunning ways to incorporate movement into your daily routines. It can be as simple as getting off the bus a stop early and then walking, or taking the stairs rather than the lift. These actions can all add up to a more active day.

How am I doing?

And so, 18 months down the line, how am I doing? I know I’m not as fit as I was before, but I’m working on it and I’m doing my own strength training rather relying on what I do for a job to keep me strong. I’m less anxious about the cancer coming back, for sure. The drug I’m going to take for 5-10 years (tamoxifen) does make me tired and achy but I’m figuring out ways to minimise that.

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How I Successfully Reversed My Type 2 Diabetes and Hypertension

Blog post written by Dr Eugene Kongnyuy, author of ‘No Pills, No Needles’.

 

Ten years ago, I was diagnosed with both type 2 diabetes and high blood pressure (hypertension). My GP prescribed Metformin for my diabetes and Ramipril for my hypertension. I was shocked and devastated because as a physician I had always thought that these two conditions were incurable. The diagnosis was like a death sentence to me because I knew its implications. Nonetheless I asked myself: ‘If diabetes and hypertension are caused by unhealthy lifestyle, shouldn’t it possible to reverse them if one switches to a healthy one?’ I decided that I would self-experiment through trial and error. I didn’t follow any complicated research rules. I was the patient and the researcher. My aim was to find out what could successfully reverse my diabetes and hypertension so that I could stop taking medicines.

Intuitively, I followed three simple steps: I ‘try’ something, I ‘track’ my blood sugar and blood pressure, and I ‘tell’ whether or not it works. Over five years, I tried out over 70 different things involving different diets and lifestyle changes.

 

Reversing my diabetes

After 29 unsuccessful trials (over two years), the 30th trial successful reversed my diabetes (but not my hypertension). The trial consisted of stopping eating lunch, which made me lose 10 kg. The first week was difficult because lunch was more than a meal to me – it was an opportunity to socialise and have informal discussions with my colleagues. Missing lunch meant missing the fun and merrymaking with friends. However, with strong willpower, I managed not to eat at lunchtime. I joined my friends during lunch but drank water instead of eating. In three months, I then lost those 10 kg of weight and my BMI (Body Mass Index) dropped from 26.1 to 22.8. My blood sugar went down to levels I had never seen before. I stopped taking Metformin and the diabetes was gone. A series of laboratory tests with my GP confirmed that the diabetes had been reversed.

It was in fact the weight loss that reversed my diabetes – missing lunch simply helped me to lose weight. A recent study, published in the Lancet and involving 685,616 adults, revealed a BMI of 23 or higher significantly increased the risk of diabetes (see reference 1 below). The findings of this study are consistent with my personal experience – weight loss is the centre-piece of diabetes reversal.

 

Reversing my hypertension

After reversing my diabetes, I continued with self-experiments with the hope of finding a cure for hypertension. After five years of self-experimenting (70 trials in total), none of the things I tried proved able to reverse my hypertension and I felt disappointed. Then one day I was challenged by my sister-in-law, Charlotte, who was (and still is) running for 150 minutes a day to lose and maintain her weight. I went out for morning exercise with her. That day, I realised I needed to do more.

Over a month, I gradually increased my daily exercise from zero to 1 hour per day. That was a turning point in my life because I hated exercise and I still believe no one hates exercise as much as I did then. Six months after starting 1 hour per day of regular exercise, I took my blood pressure (BP) and it was very low. I stopped the BP medicine and my hypertension was gone. One hour of regular, moderate- to high-intensity exercise per day may be what you need to reverse your own high BP. Moderate to vigorous exercise, especially of a type that makes you sweat, is the centrepiece for the prevention or reversal of high blood pressure.

 

Reverse lifestyle diseases with lifestyle changes

Diabetes and hypertension are lifestyle diseases and can be reversed by adopting the appropriate lifestyle. It’s not easy to change our lifestyle. Some of the things that worked for me include strong willpower, support from family and friends, and making exercise fun – I play music (a motivational fitness song) when exercising. With behaviour change, ‘start small, think  long-term’.

There are other benefits to weight loss and exercise, apart from reversing diabetes and hypertension. I’m physically stronger and regular exercise boosts my self-esteem, makes me concentrate, sleep and feel better. It helps me to combat stress and I feel better mentally.

Over the years, I have kept with 1 hour of exercise per day while tracking my BP and blood sugar, and I have learned a lot more. I have also continued practising my ‘no lunch’ strategy. My blood sugar and BP have remained within  the normal ranges. I have continued to learn from personal experience. Initially I wasn’t thinking of sharing this experience. It was the arrival of the Covid-19 pandemic, which showed a higher mortality rate amongst people with diabetes, that pushed me to decide to share my experience. If it worked for me, it can work for many, and the methods I used to explore my own health can be applied by anyone to find out what works for them. You will find all my lessons in my book ‘No Pills, No Needles – how to reverse diabetes and hypertension by finding out what works for you’.

 

References

  1. Teufel F, Seiglie JA, Geldsetzer P, Theilmann M, Marcus ME, Ebert C, et al. (2021). Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults. Lancet 2021; 398(10296): 238-248.
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How to Get Your Oomph Back by Carolyn Garritt

Blog post written by Carolyn Garritt, author of ‘Get Your Oomph back – A Guide to Exercise after a Cancer Diagnosis’, launching on 25th November. Available for pre-sale now. 

At the start of the pandemic, I was working as a personal trainer specialising in exercise for people with cancer, a job I had adored for more than seven years. I was fit, and mostly worked outdoors, one-to-one or with groups. As the realities of coronavirus became clear I knew I wouldn’t be working much, but I imagined I’d use the time to update my website, do the bookkeeping, and finish that book (about exercise and cancer) that I’d been writing for, well, ages.

And then, three weeks into lockdown, I found a breast lump. Quite by accident, after I had been shadow boxing, holding weights, with a couple of clients online. I thought I had just inflamed one of my pectoral muscles.

I was wrong.

 

The diagnosis

Going through a cancer diagnosis felt odd, almost dreamlike. Doing it at a time of global crisis just made the whole thing even more surreal, and it felt incredibly strange to be facing decisions as a cancer patient after years of working with them. It was suddenly happening to me too.

I was very lucky as I already had a network of support through my work. I was also fortunate because I knew a great deal about the side effects that I might encounter, and I knew what I could do to promote my own recovery.

 

Why exercise is so important

Research has shown – convincingly – that being active after a cancer diagnosis is really, really helpful in aiding rehabilitation and in improving our outlook for the future. In fact, exercising after cancer can help reduce the risk of it coming back by between 30% and 40%. That’s huge, and it has often been said that if exercise was a pill, it would be prescribed to every patient. For those living with secondary or advanced cancer, exercise can help to slow down the cancer’s progression, again, just as drugs can.

More immediately though, exercise can help us to feel better. Clinical studies have shown that exercise can help combat most of the commonly experienced side effects of cancer treatment:

Fatigue – Anxiety and depression – Hot flushes and night sweats – Weight loss / weight gain – Pain and joint stiffness – Bone thinning – Lymphoedema

 

Exercise to improve treatment side effects

Cancer treatment can be completely debilitating, and the side effects often drag on for months. Research shows that 95% of people find that they experience fatigue. For those living with cancer, life can become cyclical, as you go through endless treatment cycles and experience the associated ups and downs.

There’s also the anxiety – will it come back? Did the treatment really work? Will my next scan be okay?

 

Why my new book?

The reason I started to write my book was because I found in my work that increasingly people knew, or had been advised, to try to be more active after a cancer diagnosis, but they were often unsure what to do. What would work, what was safest, and when, during their cancer ‘journey’, could they start? Get Your Oomph Back aims to answer these questions and more.

There is a solid and growing body of evidence to show that exercising can help alleviate some of the anxiety, tiredness, pain and body changes that frequently accompany cancer treatment. In many ways it made writing the book very easy as I could find loads of really helpful, robust knowledge to call upon.

 

I’m really pleased to say that my book is being published in November. I still haven’t caught up with the bookkeeping!

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The Bowel Cancer Recovery Toolkit published in Chinese – a first for Hammersmith Health Books

Blog post written by Sarah Russell, author of The Bowel Cancer Recovery Toolkit.

Over a decade has passed since I had my own stoma surgery. And if someone had told me that 10 years later I would have a book translated into Chinese and I would be training ostomy nurses in China on Zoom, I would never have believed them.

Life really does take an incredible path sometimes. Here’s the timeline of how I went from ‘patient’ to ‘global expert’…

11 years ago

I went through abdominal surgery to remove my bowel and have a stoma formed, after suffering a life-threatening bowel perforation. I would need to use a colostomy bag fo

r the rest of my life. In most cases stoma surgery is life saving and life changing, and that was certainly true for me. I underwent 5 major operations over 18 months and it would be fair to say it was a difficult time. I had 2 young children and was a competitive athlete at the time. The surgeries floored me and I remember wondering if I would ever be able to go cycling or running ever again.

Lying frail in my hospital bed I asked about exercise, abdominal rehabilitation and whether I could run and do sports again now I had a stoma. My questions went unanswered. Nobody seemed to know what to do.

9 years ago

I managed to rehabilitate myself, get fit, retrain my abdominal muscles and return to running, cycling and the life I loved. To date I’ve completed 37 marathons and have just run a 50 mile ultra-marathon in the UK.

But in doing so realised there was a huge gap in patient support, nurse/surgeon education and knowledge about rehabilitation and exercise after stoma surgery. Despite my best efforts this hasn’t changed much, and we are still very much scratching the surface.

 

6 years ago

I started working with ConvaTec as their global exercise specialist and through our research in the UK, found that people who had their stoma due to cancer were reluctant to return to exercise and had very low levels of physical activity. I then trained in cancer rehabilitation to add to my MSc in sport/exercise science and 20 years of fitness rehabilitation qualifications.

 

4 years ago

I was working with a colorectal cancer patient (who was a keen runner and triathlete) and wanted to find an inspiring book for her to read about returning to exercise. I looked and couldn’t find one. So thought ‘Oh I’ll write a book then. That won’t be too hard’.

I contacted Hammersmith Health Books who took it on without a moments hesitation and then patiently waited whilst I wrote and re-wrote the book. It turned out writing a book is quite hard.

 

2 years ago (in 2019)

The Bowel Cancer Recovery Toolkit was finally published.

Let me tell you, if you’ve never published a book, it’s a terrifying process. Waiting for the first reviews on Amazon is utterly nerve wracking.

I hoped that people would find it comforting, useful and helpful. Which thankfully they have. Not only that but nurses and doctors have given it rave reviews and recommend it to their patients. That’s all I wanted and it makes me really happy to be able to help others. Read the reviews here.

During this time I continued to work with ConvaTec as a consultant and we developed an innovative nurse training course and the me+recovery training programme for patients.

For the first time patients could access professional advice on rehabilitation after stoma surgery and nurses could attend an RCN accredited (the only one of it’s kind in the world) course to teach them about abdominal exercises and safe activity for their patients. To date we’ve trained 350 UK nurses and many more around the world.

 

And so now today..

My book has just been translated and published in Chinese (a first for Hammersmith Health Books). I honestly find this mind blowing, but probably unsurprising. As it’s clearly something that’s desperately needed.

Each year there are around 380,000 people diagnosed with colorectal cancer in China (with a population of 1.3 billion) and cases are rising quickly in people under the age of 30.  It’s not a dissimilar picture in the UK, with around 45,000 cases each year and a sharp increase in younger people being diagnosed.

Even since publication of my book, the role of exercise in bowel cancer is becoming more and more important. Evidence is building to show that physical activity has a huge part to play in both prevention of cancer in the first place, but also in the role of recurrence. We now know that being physically active could reduce the risk of developing cancer (and it recurring) by around 30%.

If there was a pill that could offer the same thing, everyone would have it prescribed as a miracle treatment.

The exact mechanism as to why exercise is so effective isn’t yet fully understood, but it’s thought the anti-inflammatory effects of exercise combined with faster transit time through the bowel are the key physiological factors.

Having worked with thousands of patients, healthcare professionals and nurses over the last 6-8 years, I’m now hugely passionate about exercise and movement at all stages of bowel cancer prevention and diagnosis:

  • As part of a healthy lifestyle to reduce the risk of developing bowel cancer
  • As ‘pre-hab’ – getting fit for surgery
  • As rehab – after surgery – aiding recovery and reducing risk of parastomal/incisional hernia
  • As part of a healthy lifestyle AFTER a diagnosis of bowel cancer – improving mental wellbeing, confidence, physical strength and lowering risk of recurrence
  • For people with terminal bowel cancer, potentially prolonging life and helping with symptom control

All of this is covered in the book, along with advice on diet after surgery and specific abdominal exercises after stoma surgery.

Of course each person will interpret the advice and information differently, exactly as they should. But the ethos of the book is for each individual to focus on their own recovery and develop the confidence to exercise safely in their ‘post cancer body’ regardless of wherever they live in the world and wherever they are on their cancer recovery journey.

 

And finally…

The most recent part of this story (and it’s certainly not over yet) is the most incredible and ambitious project put together by ConvaTec to deliver the me+recovery training programme to a global audience.

In August 2021, we delivered online training (via Zoom) for stoma nurses in China, Japan, New Zealand, Australia, Singapore, Malaysia and South Africa – all at the same time.

It comprised 4 x 3 hour sessions to a group of 60 nurses with simultaneous translation into Chinese and Japanese. With me sat at home in my little studio in East Sussex. And due to the time differences, some of the nurses were up in the middle of the night. That’s commitment.

It was incredible. The cultural differences and the clinical approaches were fascinating and so very different. But the outcome was that every single nurse involved wanted to do better for their patients. They wanted to learn how to help them rebuild their confidence, return to exercise and know how to do safe abdominal exercises after their surgery.

I didn’t think it could work.  But it did. I’ve never experienced anything like it and it was an honour to be part of it.

In the book I write ‘My goal in writing this book is to try and help people, and to support, educate and encourage, and to start to change understanding and practice’.

And thanks to both ConvaTec and Hammersmith Health Books, that’s starting to become a reality.

Little by little we can start to change clinical practice around the world, give people better advice and enable people who receive a bowel cancer diagnosis to recover with confidence and live their best life.

 

For more information about me+recovery from ConvaTec Your home of stoma care advice, support and lifestyle tips. (convatec.co.uk)

For more information about my private practice www.sarah-russell.co.uk and my clinical Pilates www.theostomystudio.co.uk

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Raising awareness of Polycystic Ovarian Syndrome (PCOS) for PCOS Awareness Month

Blog post written by Rohini Bajekal, co-author of upcoming release ‘Living PCOS Free’, launching in February 2022.

This September is PCOS Awareness Month. Despite PCOS being the most common endocrine condition to affect women of reproductive age and those AFAB (assigned female at birth), with at least 1 in 10 affected, most people have never heard of it. Depending on how hard one looks for the condition, up to 3 in 4 of those with PCOS remain undiagnosed.

PCOS is the number one cause of anovulatory infertility and those with the condition are at greater risk of a number of long-term conditions, including type 2 diabetes, gestational diabetes, cardiovascular disease, metabolic syndrome and endometrial cancer.

PCOS is a chronic condition so, while there is no “cure”, making positive lifestyle changes can go a long way in managing PCOS and its symptoms, including insulin resistance, both in the short-term and longer term. Lifestyle modifications can tackle the underlying insulin resistance. All national and international guidelines recommend lifestyle and behavioural changes as the first line of management for PCOS, even before medications.

Knowledge is power and education is key. Raising awareness of what to look out for allows those with PCOS to access early help, support and advice. This may be through campaigns such as PCOS awareness month, workshops and education in schools or even by opening up the conversation between friends, family and colleagues.

Living PCOS Free is a practical guide which shows readers how to manage PCOS using proven lifestyle approaches alongside conventional medicine. Dr Nitu Bajekal, AKA ‘The Plant Based Gynae,’ dispels misinformation and tackles irregular periods, infertility, acne, weight gain and more.

For the diagnosis of Polycystic Ovarian Syndrome, any two out of three of the criteria below have to be met (Rotterdam criteria, 2003).

  • Ovulatory dysfunction (oligo- or anovulation: not producing eggs on a regular basis)
  • Clinical symptoms or biochemical (lab) evidence of androgen excess: (Increased levels of androgens including testosterone)
  • Polycystic ovarian appearance in one or both ovaries on pelvic ultrasound scan (specific features such as number of follicles, volume of ovary)

There are some common symptoms of PCOS, but it is important to mention that not everyone with the condition will have all the symptoms and vice versa (these symptoms may have other causes) so it is important to get a proper diagnosis:

  • Infrequent periods or missed periods are the most common sign of PCOS (oligomenorrhoea/amenorrhoea). NB: Pain is not a feature of PCOS. Painful and/or heavy periods or painful sex may be signs of endometriosis, fibroids and/or adenomyosis, all of which can affect fertility. Missed or infrequent periods could be a result of other conditions such as hypothalamic amenorrhoea resulting from calorie restriction (disordered eating, for example, or over-exercising).
  • Excess facial/body hair (hirsutism)
  • Acne (often adult and/or cystic)
  • Scalp hair loss (alopecia)
  • Unwanted weight gain
  • Insulin resistance
  • Fertility problems

There are several less well-known symptoms including:

  • Eating disorders, especially binge eating disorders without purging, unlike bulimia. (This may be missed, especially in those from different ethnic groups or those with excess weight. Referral to a therapist, dietitian specialising in medical nutrition therapy or another specialist, such as an endocrinologist or dermatologist, may be needed.)
  • Excessive daytime sleepiness
  • Breathing problems (sleep apnoea, snoring)
  • Acanthosis nigricans (darkened skin: behind the neck, underarms, groin).
  • Psychological issues such as depression and anxiety, which must be addressed.

 

Lifestyle matters and nutrition is the cornerstone

A plant-predominant dietary pattern

Given the commonality of PCOS among those with type 2 diabetes, and the higher risk of other serious health conditions, people with PCOS should be advised to focus on predominantly whole plant foods, including whole grains, beans, fruit, vegetables, nuts and seeds, herbs and spices. These foods are full of fibre and micronutrients that are nourishing and absorbed slowly, helping to normalise blood sugars. We know this works very well in people with type 2 diabetes and metabolic syndrome. Living PCOS Free is packed with tasty and nutritious plant-based recipes with gluten-free and oil-free options.

Exercise

Regular movement in a form that you enjoy is key. Aerobic exercise and resistance training, including high intensity interval training (HIIT) are all recommended to help improve insulin sensitivity in women with PCOS. Aim for 300 minutes of exercise per week (approximately one hour a day) and try to exercise outdoors in natural light.

Sleep

Ensure a regular sleep routine with seven to nine hours of restorative sleep.

Stress management and reduction

Consider exercise, meditation, mindfulness, community work, psychotherapy or yoga to help manage stress and lower cortisol levels which make insulin resistance worse.

Positive social connections

Build or join a community, whether online or offline; ensure you have a support network or a friend you can trust and confide in. Loneliness is a source of chronic stress and is associated with an increased risk of heart disease, high blood pressure and type 2 diabetes.

Avoid or limit risky substances

Eliminate risky substances such as drugs and tobacco and limit alcohol (people with PCOS are at higher risk of non-alcoholic fatty liver disease), which has no health benefits.

Living PCOS Free features an easy-to-follow 21-day plan by Nutritionist Rohini Bajekal, illuminating case histories and plant-based recipes.

https://nitubajekal.com/pcos/

https://nitubajekal.com/pcos-nutrition/

 

Dr Nitu Bajekal MD FRCOG Dip IBLM

Consultant Obstetrician and Gynaecologist

Lifestyle Medicine Physician

 

Rohini Bajekal Nutritionist and Lifestyle Medicine Professional

 

About the authors

Dr Nitu Bajekal, MD is a Senior NHS Consultant Obstetrician and Gynaecologist in the UK with over 35 years of clinical experience in women’s health. Her special interests include Lifestyle Medicine, PCOS, endometriosis, period problems, menopause, precancer, complex vulval problems and medical education. She is a keyhole surgeon with experience in laparoscopic procedures, including robotics.

Rohini Bajekal MA Oxon, MSc Nutrition, Dip IBLM, is a Nutritionist and Board-Certified Lifestyle Medicine Professional based in London. Rohini is passionate about PCOS and has personal experience of living with this condition.

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Mental Health Awareness Week Blog Special

Blog post written by Dr Trevor Griffiths and Dr Marian Langsford, authors of Emotional Logic. Available for pre-order now, launches 27th May.

The authors of Emotional Logic: Harnessing your emotions into inner strength have been married for nearly forty years. Marian still practices medicine under her maiden name of Langsford. They both now teach internationally the Emotional Logic method of preventing stress-related mental and physical illnesses, which Trevor developed while in medical practice. The best compliment they have received, they say, was from a medical student in Bulawayo, Zimbabwe, who stood up after a training session and said, “I have learnt today that it is really cool to be old, and married, and still together, ‘cos you get to travel the world and inspire people like us!” We don’t look very old; we received that as the honour it was intended to convey in that culture.

Learning to activate your inbuilt Emotional Logic helps to build more responsive relationships in any new situations you face. And it can be learnt at any age. An active schools programme in the UK has a wide range of age-appropriate materials, such that a five-year-old boy took an emotion leaf from a ‘Talking Together Tree’ they had made in the classroom, and took it to the teacher saying, “I would like to tell the class why I am feeling angry about something.” Imagine the difference that ability to talk sensibly about emotions rather than only act them out, or regulate them, might have.

In Chapter 1, Trevor comments on Marian’s story about a misunderstanding with a friend who had offered to help tidy her garden one autumn. She had told how understanding the emotional logic of her many loss reactions that followed helped to avoid a break-up. Here is an extract from Trevor:

As the eldest daughter in a Devon farming family, Marian grew up on a mixed dairy and horticulture farm overlooking rolling hills, surrounded by buckets of early flowers that needed bunching each evening for market the next day. They were not rich. She loved it. She has a wisdom from nature that I had missed, having been brought up in the London suburbs. For example, she once said, “Gardening isn’t all about pulling up weeds. You have to plant something in the earth in its place, and care for it.” A comment like that can leave me fixed into a garden chair for ages while I watch her getting her hands covered in earth and planting. Something simple like this can lead me to a lot of thinking, which I consider is my core skill.

So, what do I think about? I think a lot about human nature. I think things like, ‘Seemingly small things that break out on the surface of people’s lives can have deeper roots than we realise at first.’ It took me a few decades to realise that it did me a lot of good to listen to Marian. I think many men discover the same at some point in their married lives…

Emotional Logic was born out of years of experience in general medical practice, and out of a disrupted family background that Trevor experienced as traumatising. With a depth of emotional memories to draw upon, Emotional Logic harnesses the language of emotions into the inner strength needed to come through times of trouble stronger and healthier. Post-traumatic growth is encouraged as a way forward from post-traumatic stress. As a senior Community Psychiatric Nurse who uses Emotional Logic in her work said, “Emotional Logic heals the broken heart behind mental illness.”

Once learnt, people can share their new trauma-responsive conversational skills in their daily encounters with others. This prevents isolation following hurts. It reduces the risk of illness by building greater resilience and a realistic hope for recovery into relationships. Even if setbacks and disappointments occur, knowing how to activate one’s inbuilt Emotional Logic provides a world of constructive options to talk about. And where is there better to talk and to explore new ways forward than in nature, where the seeds of something beautiful in life can take root and grow.

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Corneal Grafts and Vaccinations

Blog post written by Nat Hawes, author of the Nature Cures series of books.

Nat Hawes shares important information for anyone having the COVID-19 vaccine who has had a corneal graft. There is a risk of graft rejection if ameliorating action is not taken. This means you can have the vaccine but must take special care of your eyes at the same time.

Corneal grafts are also referred to as corneal transplants or keratoplasty. They are used to correct problems caused by medical conditions or injury e.g. from infection.

Nat tells us:

‘Anybody who has had a corneal graft should be aware of the possible risk of rejection of the transplanted cornea following vaccination because vaccinations enhance the immune system. They should contact their eye consultant to be prescribed steroid eye drops to administer four times a day, or they may be advised to increase steroid drops if they are already using them. They will also need to have their eyes checked two weeks after they have had the vaccine. This is appropriate for both the influenza and the COVID-19 vaccines.

‘Although, as yet, there have been no confirmed cases of rejection due to the COVID-19 vaccine, there has been some documented from flu vaccinations.[1] It is still early days though and most people have only had the one dose of the COVID-19 vaccination so far in the UK. Rejection can take place up to 2 months after the influenza vaccination and is potentially reversible.[1]

‘Corneal rejection is caused by CD8 and CD4 T cells (defensive white blood cells) fighting to eradicate the foreign body (transplanted cornea) from the body and it is these very same T cells which are boosted by the COVID-19 vaccines so it is a distinct possibility that corneal rejection might occur.[2]

‘This may be much more of a risk after the second dose of the vaccine so it is important that corneal graft patients are made aware of this so that they can take the appropriate steroid drops to counteract it, and have their eyes checked. They should still go ahead with having the vaccine, but cautiously.’

 

  1. Wertheim MS, Keel M, et al. Corneal transplant rejection following influenza vaccination. Br J Ophthalmol 2006; 90(7): 925-926. doi: 
  2. Pluddemann A, Aronson JK. What is the role of T cells in COVID-19 infection? Why immunity is about more than antibodies. The Centre for Evidence-Based Medicine. 19 October 2020. 

 

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Coping with osteoarthritis during Covid-19

Blog post written by Frances Ive, author of One Step Ahead of Osteoarthritis

 

The Covid-19 pandemic is the number one health issue everywhere, but despite that we still have to manage osteoarthritis. According to a recent article in the British Medical Journal, Covid impacts on osteoarthritis in a couple of ways:[1]

  • There is more likelihood of being hospitalised when suffering from the virus if you already have osteoarthritis.
  • OA sufferers are likely to have additional pain in the joints when they contract Covid.

A key recommendation in the BMJ article is that physical activity is extremely important, regardless of age. Although this would seem to be difficult during a severe outbreak of the virus, it is feasible if the symptoms are mild. Also, all activity keeps us healthy and more able to fight illness.

I emphasise the importance of exercise in One Step Ahead of Osteoarthritis, in order to keep us active and mobile and enjoying a good quality of life. A glowing statement from Professor Sir Sam Everington, GP in Tower Hamlets, Chair of NHS Tower Hamlets Clinical Commissioning Group, and a board member of NHS Clinical Commissioners, who wrote in his foreword for my book: ‘This book should be prescribed on the NHS by all doctors. It can’t be, but if you have osteoarthritis or want to live a happier and healthier life, buying this book is the best investment you could ever make.’

Professor Sir Sam’s involvement in the social-prescribing initiative increasingly being adopted by GPs (pre-Covid) would account for his enthusiasm. The main message in One Step Ahead of Osteoarthritis is taking responsibility for your own health through:

  • exercise
  • weight management
  • healthy eating
  • supplements
  • complementary therapies
  • practical tips (shoes, keeping warm, bathing, etc.)

Even in lockdown we can walk locally and there’s no limit to how long you can stay out. If you are used to doing yoga, Pilates or other classes, there is a wealth of sessions being provided online either free of charge or for a nominal sum under £10. For those people who find exercise very hard due to chronic arthritis or other conditions, Chair Yoga provides a good alternative and that too is available online.

Finally, try not to overeat when confined at home and stick to the Mediterranean diet with plenty of fruit and vegetables. Recognised by doctors as the best diet for all conditions, it can also help us to keep our weight down, an important factor for reducing pressure on weight-bearing joints. Both Vitamin C and Vitamin D are essential for supporting the immune system, helping all conditions and giving us a fighting chance against Covid.

 

[1] https://ard.bmj.com/content/80/2/151

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Reporting Harm – The Development of New Vaccines

The development of new drugs, and especially new vaccines, is very much in the public eye at the moment. This development is hugely costly not least because most potential products have to be rejected during development as not sufficiently safe and/or effective – this means the successful products have to carry the costs of all the failures as well as their own. It also means that once a product has made it through to official approval and general use there is inevitably huge reluctance to find fault with it as long-term problems emerge – very few drugs and vaccines are withdrawn at this stage. This makes it particularly important that any one of us who experiences a problem with a drug or vaccine reports it so the side-effect/bad reaction/failure can become part of official statistics about the product.

The phases of drug development are…

  1. Discovery and development when bio-scientists look for likely candidates based on knowledge of human biology
  2. Preclinical (lab-based) research
  3. Clinical research (what we think of as ‘drug trials’ where efficacy, dosage, safety etc are assessed)
  4. Official review and approval for specific uses by the relevant national authority (e.g. FDA in the US; MHRA in the UK; HPRA in Ireland)
  5. Post-marketing surveillance and monitoring (‘pharmacovigilance’)

Those of us outside the industry can contribute to drug and vaccine safety and efficacy by taking part in clinical trials, if the opportunity arises, if we have a particular health problem or are prepared to act as healthy ‘control’ patients. However, ALL of us who receive any medication or vaccination can contribute to ongoing monitoring by reporting any negative effect. In the UK this is done via the Yellow Card system (there is a great article about the Yellow Card system on the website of Independent Living here). In the US, the FDA monitors adverse events that may occur related to receiving a vaccine through its Vaccine Adverse Event Reporting System.

How many times have you, or someone you know, grumbled that a flu jab has given you a fever and a day or more off work? Or an asthma attack? Or that an antibiotic has had strange side effects, such as loss of hearing? Or that a statin has left you constantly weak and exhausted? But have you recorded the problem so that anybody who could take this into account knows? Just as we should exercise our right to vote, we need to exercise our right to speak out about the ill effects of health products – and the Yellow Card system applies not just to drugs and vaccines but medical devices (e.g. implants) and equipment (e.g. hearing aids which are often overly complicated for those to whom they are sold) too. With the roll-out of a number of brand new vaccines developed at unprecedented speed we must not be complacent or keep problems to ourselves – it is time to exercise our pharmaco-vigilance!