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Singing the blues

I had an interesting conversation this week about mental illness and it resulted in a debate on whether people suffered more from anxiety today because of the world we live in or because we have opened a Pandora’s box on mental illness. 

One not uncommon text I received said ” Depression is the pits, I swear. Today I only got out of bed because I did not have a choice. I am sitting here and my heart is aching and I’m weepy but if you asked me why I am not sure I could explain. Just that I am feeling the weight of the world on my shoulders and damn, my shoulders are definitely not made for this. I wish I could go home, pop a couple of sleeping tablets and try again tomorrow when everything does not look so grey.”

The early years of this century have witnessed a worldwide epidemic of poor mental health and related illnesses. But while depression is the condition most will associate with mental health issues, and the leading cause of disability worldwide, it is not the number one mental health concern people face. That unwanted accolade goes to anxiety.

And it is not a new disorder.  You will have been living under a rock if you haven’t heard about it and, statistically, one in 5 reading this will be a sufferer. Over 40 million adults in the U.S. have it – that’s about 20% % of the entire population. The amount of people that I know who suffer from it in my circle of friends, family members and community make me think it’s higher but then I’m no meta-analyst. Just this week talk of anxiety has dominated a discussion with a co-worker, colleague, friend and a coachee (and we are only 4 days in, as I write this).

By dominated I mean it was the main discussion point in our interaction. The world economic forum describes it as “rampaging through society like a non-contagious cognitive plague, forming a low-level hum that hides in the corners of our collective minds”. Others may describe it less whimsically as an ever-present, uninvited guest living rent-free inside our head.

So that we are on the same page let me unpack what I am talking about. Mental illnesses are abnormalities of the mind that result in persistent behaviour patterns that can seriously affect your day-to-day function and life. Anxiety disorders, including generalised anxiety, social anxiety, panic disorders and phobias, can be experiences at varying levels of severity ranging from low-level to chronically debilitating. They all have one thing in common: persistent excessive fear or worry in situations that are not necessarily threatening.

Anxiety on a continuum at the lighter end of the scale is the feeling you get just before a job interview or an exam.  It’s completely normal and not what I am referring to because these people are getting through the day. I’m referring to when anxiety jumps the line, so to speak.  There is a point where it gets in the way and makes people more uncomfortable, wanting to stay at home rather than deal with the big unknown because their heart is racing and it feels like they are crawling out of their own skin, they feel sick and everything is scary – this is what is called clinically significantly anxiety.

Highly common is social anxiety which comes about from fear of being judged or criticised in social situations, I started suffering from this out of the blue a few years ago which made it almost impossible to make a presentation as my heart raced and my mouth would be so dry that it was too difficult to deliver the message effectively – never mind the personal toll feeling like that took. People often think that social anxiety is unique to our time, exacerbated by social media like Facebook and Linked In. 

One recent coaching client told me he came off social media a few years ago because it made him so anxious – but it sounds remarkably like the anxiety people experienced 400 years ago. In the 17th century, Robert Burton  wrote this description in The Anatomy of Melancholy (1621) referring to a patient “He dare not come into company for fear he should be misused, disgraced, overshoot himself in gestures or speeches, or be sick; he thinks every man observeth him.” The language may be different, but the sentiment will resonate with anyone who has ever experienced social anxiety –  the feeling of being watched and judged and its accompanying sense of low worth and desire to shun that judgemental society.

At work we have seen significant changes to our approach to mental health. In Botswana we are seeing a surge of organisations calling for employee assistance programmes (LEA, BOMRA, FNB, in the last few months alone) to help employees cope better. While before such programmes were designed to address issues of retrenchments and layoffs and occasional counselling for stress, organisations are appreciating that with 20% of the workforce susceptible (higher than the amount of people who get flu) – and the effects of on productivity absenteeism and health costs, it cannot be ignored.

None of this of course answers the imponderables referred to above – is our society more anxiety-ridden than in the past or is the subject simply more open and openly-discussed?  Certainly, even in my own lifetime, there has been a significant shift from the ‘’put on a brave face’ attitude to a more open atmosphere which encourages acknowledging ones inner fears.

But it is not hard to imagine how this could easily tip over into some sort of mass mental hysteria.  In all instances, whilst it’s easy to see a broken leg – it’ll have a cast on! –or a bacterial or vital infection – there’ll be a raised temperature and other external symptoms – mental illness is invisible yet in its more severe manifestations it is equally as debilitating.

The positive news is that these days help is out there, from counselling and therapy to controlling medications or a combination of both.  I am also reminded of the old joke notices that were commonly hung in workplaces which read ‘You don’t have to be mad to work here but it helps!’.  On a serious note any psychologist or psychiatrist will tell you there is no such state as ‘normal’ – all that is required is to reach a place where you can function and feel safe.  That’s the new normal.

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Appendicitis: Recognising the Signs

29th March 2022

Many a times I get clients casually walking into my room and requesting to be checked for “appendix”.  Few questions down the line, it is clear they are unaware of where the appendix is or what to expect when one does have it (appendicitis). Jokingly (or maybe not) I would tell them they would possibly not be having appendicitis and laughing as hard as they are doing. On the other hand, I would be impressed that at least they know and acknowledge that appendicitis is a serious thing that they should be worried about.

So, what is Appendicitis?

Appendicitis is an inflammation of the appendix; a thin, finger-like pouch attached to the large intestine on the lower right side of the abdomen. Often the inflammation can be as a result of blockage either by the faecal matter, a foreign body, infection, trauma or a tumour. Appendicitis is generally acute, with symptoms coming on over the course of a day and becoming severe rapidly. Chronic appendicitis can also occur, though rarely. In chronic cases, symptoms are less severe and can last for days, weeks, or even months. 

Acute appendicitis is a medical emergency that almost always ends up in the operating theatre. Though the appendix is locally referred to as “lela la sukiri”, no one knows its exact role and it definitely does not have anything to do with sugar metabolism. Appendicitis can strike at any age, but it is mostly common from the teen years to the 30s.

Signs to look out for

If you have any of the following symptoms, go and see a Doctor immediately! Timely diagnosis and treatment are vital in acute appendicitis;

Sudden pain that starts around the navel and shifts to the lower right abdomen within hours

The pain becomes constant and increases in severity (or comes back despite painkillers)

The pain worsens on coughing, sneezing, laughing, walking or deep breaths

Loss of appetite

Nausea and vomiting

Fever

Constipation or diarrhoea

Abdominal bloating/fullness

Diagnosis

The doctor often asks questions regarding the symptoms and the patient’s medical history. This will be followed up by a physical examination in which the Doctor presses on the abdomen to check for any tenderness, and the location of the pain. With acute appendicitis, pressing on and letting go of the right lower abdomen usually elicits an excruciatingly unbearable pain. Several tests may be ordered to determine especially the severity of the illness and to rule out other causes of abdominal pain. The tests may conditions include: blood tests, a pregnancy test, urinalysis, abdominal  “How do ultrasound scans work?” ultrasound (scan), CT scan or MRI Scan.

Treatment

The gold standard treatment of acute appendicitis is surgical removal of the appendix known as appendectomy. Luckily, a person can live just fine without an appendix! Surgical options include laparoscopy or open surgery and the type will be decided on by the Surgeon after assessing the patient’s condition. Painkillers and antibiotics are also given intravenously usually before, during and after the surgery.

Complications

Appendicitis can cause serious complications such as;

Appendicular mass/abscessIf the appendix is inflamed or bursts, one may develop a pocket of pus around it known as an abscess. In most cases, the abscess will be treated with antibiotics and drained first by placing a tube through one’s abdominal wall into the abscess. The tube may be left in place for a few hours or days while the infection is clearing up but ultimately one would still have surgery to remove the appendix.

Peritonitis – without treatment, the appendix can rupture/burst. The risk of this rises 48–72 hours after symptoms start. A ruptured appendix spreads the infection throughout the abdomen (peritonitis). This is life threatening and requires immediate surgery to remove the appendix and clean the abdominal cavity.

Death – The complications of appendicitis (and appendectomy) can be life threatening, only if the diagnosis has been missed and no proper treatment has been given on time. This is rare though with the evolved medical care.

If you need further advice or treatment please call 4924730, email  HYPERLINK “mailto:info@themedicscentre.co.bw” info@themedicscentre.co.bw or visit www.themedisccentre.co.bw

Antoinette Boima, MBBS, BMedSci, PgDip HIV/AIDS, Cert Aesth Med is the Managing Director of The Medics Centre in Palapye.

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A degree of common sense

7th February 2022

Here’s a news item from last month you may have missed. In December 2021 the University of Staffordshire announced it would be offered a degree course in pantomime! Yes, that’s right, a degree in popular festive entertainment, the Christmas panto.

We used to have one here, put on by the Capitol Players, though it seems to have fallen away in recent times, but the spectacle is still alive and well in the UK, both in local ad-dram (amateur dramatic ) societies and on the London stage and most of the major cities, these latter productions usually featuring at least one big-draw name from the world of show business with ticket prices commensurate with the star’s salary.

In case you’re unfamiliar with the pantomime format, it consists of a raucous mixture of songs and comedy all based around a well-known fairy or folk tale. Aladdin and His Magic Lamp, Cinderella, Jack & The Beanstalk & Dick Whittington are perennial favourites but any well-known tall tale goes. There is no set script, unlike a play, and storyline is just a peg to hang a coat of contemporary, often bawdy, gags on, in what should be a rollicking production of cross dressing – there has to be at least one pantomime dame, played by a man and always a figure of fun, and a Principal Boy, ostensibly the male lead, yet played by an attractive young woman.

As an art form it can trace its roots back to 16th century Italy and the Commedia Del’Arte which used a mélange of music, dance, acrobatics along with a cast of comic stock characters so it has a long and proud theatrical tradition but you have to wonder, does that really qualify it as a suitable subject for a university? Further, what use might any degree be that can be acquired in a single year? And last but not least, how much standing does any degree have which comes from a jumped-up polytechnic, granted university status along with many of its ilk back in 1992, for reasons best known to the government of the time? Even more worrying are the stated aims of the course.

Staffordshire University claims it is a world first and the masters course is aimed at people working inside as well as outside the industry. Students on the course, due to start in September 2022, will get practical training in the art form as well as research the discipline.

“We want to see how far we can take this,” Associate Professor of Acting and Directing Robert Marsden said. The role of pantomime in the 21st Century was also going to be examined, he said, “particularly post Me Too and Black Lives Matter”. Questions including “how do we address the gender issues, how do we tell the story of Aladdin in 2021, how do we get that balance of male/female roles?” will be asked, Prof Marsden added.

Eek! Sounds like Prof. Marsden wants to rob it of both its history and its comedic aspects – well, good luck with that! Of course that isn’t the only bizarre, obscure and frankly time and money-wasting degree course available. Staying with the performing arts there’s Contemporary Circus and Physical Performance at Bath Spa University. Sounds like fun but why on earth would a circus performer need a university degree?

Or how about a Surf Science and Technology degree at Cornwall College (part of the University of Plymouth). Where the one thing you don’t learn is….how to surf!

Then there is a  degree in Floral Design at University Centre Myerscough. No, I hadn’t heard of it either – turns out it’s a college of further education in Preston, a town that in my experience fits the old joke of ‘I went there once…..It was closed’ to a ‘T’!

Another handy (pun intended) art is that of Hand Embroidery BA (Hons), offered at the University for the Creative Arts. Or you could waste away sorry, while away, your time on a course in Animal Behaviour and Psychology. This degree at the University of Chester teaches you about the way animals think and feel. Cockroaches have personalities according to the subject specs– you couldn’t make it up.

Happily all these educational institutes may have to look to their laurels and try to justify their very existence in the near future. In plans announced this week, universities could face fines of up to £500,000 (P750m), be stripped of their right to take student loans or effectively shut down if they cannot get 60 per cent of students into a professional job under a crackdown on ‘Mickey Mouse’ courses. Further, at least 80 per cent of students should not drop out after the first year, and 75 per cent should graduate.

The rules, published by the Office for Students (OfS), aim to eliminate ‘low-quality’ courses by setting new standards & requiring courses to improve their rating in the TEF, the official universities ratings system. Universities not meeting the new standards will not be able to charge full annual fees of £9,250. Unconventional courses that could fall victim to the new rules could include the University of Sunderland’s BA in Fashion Journalism, where students learn essential’ skills such as catwalk reporting and the history of Chanel.  They have only a 40 per cent chance of entering highly skilled work 15 months after leaving.

At University College Birmingham, BSC Bakery and Patisserie Technology students – who learn how to ‘make artisan bread’ – have a 15 per cent chance of a professional job within 15 months. Universities minister Michelle Donelan welcomed the move, saying ‘When students go to university, they do so in the pursuit of a life-changing education, one which helps pave their path towards a highly skilled career. Any university that fails to match this ambition must be held to account.’

OfS found that at 25 universities, fewer than half of students find professional work within 15 months.  Business and management courses at the University of Bedfordshire (14.8 per cent) were among the least likely to lead to graduate-level jobs.  Asked to comment, the University of Sunderland said it always looked ‘to find ways to improve outcomes’; University College Birmingham said data on graduates and definition of ‘professional work’ was limited. I’ll bet it is! As the saying goes, ’what the eye doesn’t see, the heart doesn’t grieve over’. What a pantomime!

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Why regular health checks are important!

7th February 2022

With the world still reeling from the negative impact of the Coronavirus disease-19 (COVID-19), and the latest Omicron variant (which is responsible for the ongoing global forth wave) on everyone’s lips, we should not forget and neglect other aspects of our health.

While anyone can get infected with corona virus and become seriously ill or die at any age, studies continue to show that people aged 60 years and above, and those with underlying medical conditions like hypertension, heart and lung problems, diabetes, obesity, cancers, or mental illness are at a higher risk of developing serious illness or dying from covid-19.

It is a good habit to visit a doctor regularly, even if you feel healthy. Regular health checks can help identify any early signs of health issues or assess your risk of future illness hence prompting one to take charge and maintain a healthy lifestyle. Heart disease, diabetes, some cancers and other non-communicable diseases (even communicable) can often be picked up in their early stages, when chances for effective treatment are high.

During a health check, your doctor will take a thorough history from you regarding your medical history, your family’s history of disease, your social life and habits, including your diet, physical activity, alcohol use, smoking and drug intake. S/he will examine you including measuring your weight, blood pressure, feeling your body organs and listening to your heart and lungs amongst the rest. Depending on the assessment, your doctor will notify you how often you need to have a health check. If you have a high risk of a particular health condition, your doctor may recommend more frequent health checks from an early age.

Diet – a healthy diet improves one’s general health and wellbeing. It is recommended that we have at least two serves of fruit and five serves of vegetables daily. Physical activity – regular physical activity has significant health benefits on one’s body, mind & soul. It contributes to preventing and managing non-communicable diseases such as cardiovascular diseases, cancers and diabetes, reduce symptoms of depression and anxiety, enhances thinking, learning, and judgment skills and improves overall well-being. According to the world health organisation (WHO), people who are insufficiently active have a 20% to 30% increased risk of death compared to people who are sufficiently active. Aim for 30 minutes to an hour of moderate physical activity at least four days in a week. Examples of moderate physical activity include brisk walking, gentle swimming and social tennis.

Weight – maintaining a healthy weight range helps in preventing long-term complications like cardiovascular disease, diabetes and arthritis. It is also vital for one’s mental wellbeing and keeping up with normal activities of daily living. Ask your doctor to check your body mass index (BMI) and waist circumference annually. If you are at a higher risk, you should have your weight checked more frequently and a stern management plan in place.

Alcohol – as per WHO reports, alcohol consumption contributes to 3 million deaths each year globally as well as to the disabilities and poor health of millions of people. Healthy drinking entails taking no more than two standard drinks per drinking day with at least two alcohol-free days in a week.

Smoking –Nicotine contained in tobacco is highly addictive and tobacco use is a major risk factor for cardiovascular and respiratory diseases, many different types of cancer, and many other debilitating health conditions. Every year, at least a whopping 8 million people succumb from tobacco use worldwide. Tobacco can also be deadly for non-smokers through second-hand smoke exposure. It is not ‘fashionable’ if it is going to cost you and your loved ones lives! If you are currently smoking, talk to your doctor and get help in quitting as soon as possible to reduce the harm.

Blood pressure: Hypertension is a serious medical condition and can increase the risk of heart, brain, kidney and other diseases. It is a major cause of premature death worldwide, with upwards of 1 in 4 men and 1 in 5 women – over a billion people – having the condition. Have your blood pressure checked annually if it is normal, you are aged under 40 and there is no family history of hypertension. You might need to have it checked more frequently if you are over 40, your blood pressure is on the high side, or you have a personal or family history of high blood pressure, stroke or heart attack. Your doctor will be there to guide you.

Dental care – eating a low-sugar diet and cleaning and flossing the teeth regularly can reduce one’s risk of tooth decay, gum disease and tooth loss. Visit a dentist every six months for a dental examination and professional cleaning, or more frequently as per your dentist’s advice.
Blood tests – annual to five-yearly blood tests may be done to further assess or confirm risk of disease. These may include blood sugar levels, cholesterol levels, kidney function, liver function, tumour markers, among other things. They may be done frequently if there is already an existing medical condition.

Cancer screening – various screening techniques can be done to detect different cancers in their early or pre-cancer stages. These include; skin inspections for any suspicious moles/spots, two-yearly mammograms for those at risk of developing breast cancer, Pap smear or the new Cervical Screening Test (CST) every five years, stool tests and colonoscopy (every five years) for those at most risk of bowel cancer, prostate cancer screening for those at risk (over 45 years of age, family history of cancers etc.). Discuss appropriate tests with your doctor.

Vaccinations – You should discuss with your doctor about the necessary routine immunisation, in particular; the Covid-19 vaccines, an annual flu shot, a five-yearly pneumococcal vaccine if you have never had one or you are immunocompromised and any other boosters that you might need.

If you need further advice or treatment please call 4924730, email HYPERLINK “mailto:info@themedicscentre.co.bw” info@themedicscentre.co.bw or visit www.themedisccentre.co.bw

Antoinette Boima, MBBS, BMedSci, PgDip HIV/AIDS, Cert Aesth Med is the Managing Director of The Medics Centre in Palapye.

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