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Incontinence and Bowel Management for Women, Men and Children.
Women’s Health Physiotherapist Brisbane, Australia.
Pelvic Floor Dysfunction Treatment.

On the Geneva Express to Venice

Panaroma from Chateaux de Tourbillon showing the nearby Basilique de Valere both situated at Sion, Switzerland

We departed Chamonix early in the morning to catch the Mont Blanc Express to Sion. The reason we planned to stay in Sion is because this fantastic direct train from Geneva to Venice stops in Sion for a pick up. And this little stopover turned out to be an unexpectedly fantastic 24 hours. We arrived at 10 am and Sion did look a little industrial and dour, but we dropped our bags and wandered into the ‘old’ part of town and there was a street market going on – by 11am everyone was drinking wine, there was a fabulous flamenco guitarist playing, little kids were dancing and I was won over instantly.

   

Sion Friday morning markets  A fabulous flamenco guitarist

The music must have triggered the need to have a Spritzer at 11.30am especially as everyone else seemed to deem it was ok to have a drink before lunch. There is an easy-to-follow numbered tourist walk through Sion – it has two quite impressive castles and some very, very ancient history. Sion is one of the most important pre-historic sites in Europe. The oldest trace of human settlement comes from 6200 BC during the late Mesolithic age. (1) I doubt I would say to people – Sion HAS to be on your must visit list, but if you are like us and it is a pick-up point for the direct train to Venice, then definitely do it. (Friday would be the best day – with that street market and all).

The train network is spectacular in Europe- I wish we had something similar in Australia. It’s so nice to sit back and watch the country side speed by while writing a blog. Departing at 9.15am we arrived at Venice at 3 pm. Unfortunately it was raining, but it has always been very hot, sunny and dry in Venice, so it makes for a nice change.

The Art Biennale happens every 2 years, alternating with the Architecture Biennale. As Bob is an architect, we have only ever attended the Architecture Biennale (for professional CPD reasons). What drew me to Venice this trip was the fabulous sculpture by Lorenzo Quinn called Support – his inspiration being the prediction that Venice will be lost to the Adriatic Sea in under 100 years due to rising sea levels caused by climate change. The hands symbolise the support needed to hold up the magnificent buildings that have existed for thousands of years.

      

The reason we came to Venice! Bellisimo Lorenzo

When government coffers are dwindling and budgets are tight, often the first funding that gets mooted to be slashed are those funding the arts, but when a sculpture can be so ‘visible’ and generate such conversation with just its ‘visibleness’ (I made that word up) then no amount of Senate Committee estimates and research can match that. Arts funding is essential to fight for, just as climate and environmental research is. This terrifying article shows us the future and it isn’t all rosy unless by rosy you mean the colour of our skin when we step out of the house without sunscreen to put the clothes on the line. I have a friend who is right into the science of Climate Change and I asked him to fact check the article I have linked and he has said – yes you better believe it.

Venice didn’t disappoint – we had another beautiful dinner at Vinaria – their food is so special and different to the usual enormous menus of spaghetti, pizza and seafood that Venetian restaurants often have. But at the same time as being delicious and different they are quite reasonably priced.

  

Anchovy stuffed dumplings  Pasta with Artichokes and zucchini flowers    Outside Vinaria

The next day we did a fast cruise through the Art Biennale (held between 13 May – 26 November 2017, Central International Exhibition, 57th Venice Biennale 2017, Arsenale and Central Pavilion, Giardini. Curator: Christine Macel.) It was raining quite heavily so we decided to buy a one day transport pass so we could hop on and off the vaporettos rather than walking the quite long distances to the Giardini – our first stop at the exhibition. The transport is fantastically expensive in Venice – a vaporetto is 7.5 euro each regardless if you go one stop or up the Grand Canal to all stops. You can get on and off as many times as you like within the one hour – after that it’s another 7.5 euro. So we decided 22.50 for the day pass (24 hrs) was better value because of the heavy rain and the big puddles!

                

Some pieces from the Art Biennale

The next day we headed to the train station – a short walk from our accommodation Hotel Marin– and after quite a few visits to Venice being close to the train station is a very easy location to base yourself. Dragging your luggage long distances over the cobblestones and bridges of Venice is no fun. So it was back to work for me – our train trip to Florence meant the start of the ICS (International Continence Society) Conference and signalled I had to get my brain out of holiday mode and into conference mode and I wasn’t sure it was going to be that easy…..holidays are such fun.

Hotel Marin 10 minute walk from the train station (very small rooms but reasonably priced and clean)

Farewell Venezia  and hello to Firenze.

(1) Sourced https://en.wikipedia.org/wiki/Sion,_Switzerland 13/9/17

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Chamonix and World Physiotherapy Day 8th September 2017

September 8th each year is World Physiotherapy Day, so what’s the most important piece of advice I can give you on World Physiotherapy Day?

Start moving and keep moving.

After a week in Chamonix, I have seen what it takes to improve balance as we age; how to obtain the best homuncular refreshment there possibly is and how to stave off the effects of arthritis and obesity. And it all revolves around getting out in the fresh air and hiking.

  

This area is so beautiful and supercharged with visual splendour. It is so easy to want to start moving and keep moving. It is also so easy to use public transport to get around. The car certainly has a lot to answer for with turning us lazy. After scrambling over rocky paths, my ankle proprioceptors have been turned inside out and are buzzing with their new-found energy. Whilst Meg Lowry’s App ClockIt to help with balance and coordination is fabulous, I do think it could become redundant, if we went made a point of going for regular bush walks on very uneven surfaces every weekend.

We have many bushy areas in our local suburbs – even just going to Mt Cootha and clambering over some rocks, up an incline will refresh your balance every week. Taking the kids to the bush is a great way to introduce them to hiking early. Over here in Chamonix, there were many families with young kids in tow with their hiking boots on enjoying the fresh air and the mountain scenery. Of course it was pleasantly cool, and that is one thing that really makes hiking in Australia – well in Brisbane at least much harder. When it can reach 30C in winter in Brisbane, it is hard to hike in the summer months.

But enough of this World Physio Day message- back to my travel memories – because if I don’t write it down, in just a flash I may forget it.

After having spent a frenetic weekend getting the most out of our time with Jimmy and Sophie and our mountain passes, we decided to have a formal rest day on Monday, which meant a late start and a leisurely walk around town. As I said in the previous blog, the festivities of the Ultra Trail Marathon, were still apparent and the town was full of tourists (not in a Venice way) who were very happy and enjoying the fun and frivolity. One of the traditions of Chamonix must be a waiter and waitress race, where they walk briskly along a (quite a long) set course carrying a tray with 2 bottles filled with water and 2 drinks. The winner is not just the first person across the line, but the one with the least spillage. Careful measuring of the fluids left in the bottles and glasses were recorded and then the winner was decided. The crowd cheered and the music gave the town a wonderful buzz.

     

The famous waiter race of Chamonix The official starting car 

    

The houses, restaurants and streets were adorned with flowers

On Tuesday, with brilliant sunshine, we headed off with our mountain pass to the Plan Praz and the Telepherique du Brevent (2523 metres) and sat for a hot chocolate at surely one of the most scenic cafe decks ever. There was extensive glacier education there on the extent of change of the glaciers over time.

Hot chocolate at surely one of the most spectacular cafes ever

We then caught the bus to Argentiere (No2) to the peak Aguile de Grande Montets. We headed to the Telepherique to Les Grandes Montets at 3295 mtrs. The air was thinner there ,just like at Du Midi, but I took it slower and it didn’t seem to bother me as much. I thoroughly recommend this lookout as it is much less busy than Du Midi and again in the extreme category for spectacular beauty. We had a picnic lunch and watched some mountaineering training on the mountain slopes.

The training school for mountaineering

We then caught the bus back to town to a station called Le Praz and caught the Telepherique De La Flegere to Stage one and then further to the top in an open chair lift <insert horror emoji here> to Col L’Index (abbreviated to Index). I sat frozen (with fear not the cold) as we travelled up an enormous distance over a very rocky mountain and I did not move a muscle which made it difficult to get off the moving chairlift. All my family will tell you I am not great with heights and to have achieved this was a milestone. Unfortunately, we were too late this day to finish the walk to the intended destination (Lac Blanc) but instead just walked down from the top back to the Telepherique. We then caught the Number 1 bus (or 2 as well will take you to Chamonix) back to town.

The walk down from the top to the Telepherique

Wednesday was a late start as I was feeling stiff from all the downhill walking from the day before. We bought another 2 day pass and caught the  Telepherique at Du Midi to the mid-station called Plan de L’Aiguille and with the intention of walking to Montenvers and seeing the Ice Cave which was shrouded in cloud on our first day. The cloud cover when we set off was very thick and unfortunately we headed up, instead of down and spent an hour walking and arrived back at the beginning again. But in the process we saw this very pretty small lake.

Detour to Lac Bleu actually went up instead of down as there was a really heavy fog.

This was quite a difficult walk, with narrow paths and lots of rocky ridges. I did manage to put one of my hiking sticks on the edge of a path and into thin air and toppled over the edge, ageing Bob by a decade at the same time. Fortunately there were lots of bushes to cling onto, but I did concentrate even harder after that little slip.

We saw quite a few Marmots on this trip.

    

And there were many cairns – stacked stones along all the trails

We eventually made it to Montenvers- Mer de Glace – the beautiful glacier and mountain area where the Ice Cave is located and which was in total white-out the other day. The misty cloud had cleared by the time we reached it today and it was truly spectacular. I have also made a mental note to add a stay at the Grand Hotel du Montenvers, which has just been recently renovated, to my bucket list. Yes I will be returning to Chamonix!

    

 

 The Montenvers Glacier

Today, Thursday, was the last day of hiking before we head off to Italy. Sadly the day was very, very misty with no view of anything much. We caught Telepherique De La Flegere again and for a second time got on the open ski lift L’Index. I was this time more frozen with cold than fear. We walked for 2 hours to get to Lac Blanc – what was described as a stroll in the park was quite a difficult walk, but I imagine it was truly worth it in full sunshine. We waited and waited hoping the mist would lift, in the process warming up with a delicious hot vegetable soup on a terrace watching a mist float over the lake.

  

Lac Blanc very misty sadly 

There was some wispy gaps in the cloud which allowed some special photos to remember this very beautiful lake. The walk down to the Telepherique was spectacular and interesting, until right at the end where it took a nasty uphill turn. I have worked out I am excellent on the flat and downhill but less so on the ‘ups’ but the thought of missing the last gondola down and having to walk it down got me through to the finish.

Chamonix is one of my favourite places and I am quite sure we will have another visit one year. I thoroughly recommend it to you as a place to hike in summer and I am sure if you are a skier, it would be special for winter pursuits.

To all my Physiotherapy Colleagues – Happy World Physio Day

(And to all my family, patients, staff and friends my foot has been magnificent – allowing me to hike between 15000 -20000 steps each day!)

Networking with Elaine Miller and Mont Blanc #mustdo #bucketlist

Elaine Miller (otherwise known as Gusset Grippers) is a Women’s Health Physio and wonderful comedienne from Edinburgh. She has just completed a sold out stint at the Edinburgh Fringe doing an evidenced-based show on the pelvic floor! You have read about her many times on my blog. I met Elaine years ago on Facebook and we have become firm virtual friends. We met IRL (in real life) a couple of years ago at The Women’s Health Summit and as I was coming to London on my way to Florence for ICS 2017, we arranged to meet in York as it is approximately half way between London and Edinburgh.

We had a delicious spread at Mannions in York – worth the trip alone for the morning tea. 

It was so good to be able to brainstorm some ideas with Elaine and chat about her future gigs – many of which are in Australia later this year. Using comedy to bring continence and sexual dysfunction out of the cupboard is such a brilliant idea and Elaine does it with such aplomb! Saying pish in Scottish is far less awkward too. York is a gorgeous city – very historic and lots of fabulous pubs and cafes to eat at.

   

Friday saw an early start and an Uber to Heathrow to fly onward to Europe. We flew into Geneva and hired a car driving to Annecy in a very quick time. Annecy is a beautiful French town with a definite old and new section. We stayed in the old section and it was easy to wander around for hours, stopping occasionally for a pizza and Aperol spritzer.

      

The next day we headed with great excitement to Chamonix and Mont Blanc. This has been something I have wanted to do since our wonderful walks around the Swiss and Italian Alps in previous trips and some very good friends had stumbled across Chamonix accidentally and reported its beauty to us.

The first day was rainy and chilly as we headed up to Montenvers and the Mer De Glace – via a little red train to 1913 metres to see this famous glacier.

    

The panoramic view of the mountains was obscured unfortunately by cloud and rain, but we were able to still descend to the Ice Cave and witness for ourselves, as we climbed down the 448 steps, the terrible effect of global warming on the depth of the glacier. It’s quite staggering how much it has receded, particularly in the last 2 years, between 2015 and 2017.

     

448 steps down and up to the Ice Cave

     

At the entrance to the Ice cave and Bob and Jimmy at ‘The Bar’ inside the Ice Cave

 

This dog accompanies one of the workers and spends the day at the glacier every day

The most frequently visited app on my phone around holiday time is the weather app and the completely clear yellow sun with no clouds showing on the app for Chamonix was the best news there could be. It was to be Sophie and Jimmy’s last day in Chamonix and to see the tip of Aguille Du Midi revealing itself above the mountain in front of our hotel was very exciting. I’ll let the photos do the talking, but this should be a must on any bucket list you create.

     

I would recommend staying a week in Chamonix. The town is exciting and very pretty and just sitting in any cafe and looking in any direction and there’s a stunning view to behold. There are so many walks to do – I would definitely recommend getting at least a 3 day pass to get onto all the gondolas to the different areas – this includes the Du Midi but you’ll pay an extra 29 euro to take the Panoramic Mont Blanc Gondola to Helbronner which travels across to Italy. It takes 30 minutes each way and allow time to spend there checking out the different view to the Italian Alps.

    

To get the most out of the day we grabbed some quick lunch and then headed off to the Mont Blanc Tramway – it was the final day this was open so we were very lucky with the timing (we had no idea this would close for the season so early). It was very crowded and as time was short (and I was suffering with a touch of altitude something) we decided to jump back in the return trip and then set off hiking from the train station at the top of the mountain down to Les Houches. It was such a beautiful walk and a great way to finish Sophie and Jimmy’s stay with us.

 

  

The busy Mont Blanc Tramway and the mountainside wildflowers and panoramic vistas on our hike

We were a trifle worried when we chose these dates for Mont Blanc because the famous Ultra Trail Marathon is on at this time. But if anything I think it makes it more exciting to be here with the UTMB on (but accommodation is difficult to get at the last minute).

Time for bed but there is more to come with the beautiful Chamonix…..

The Seven Sisters #alert #thisisatravelblog #formymemory

 

The Seven Sisters a highlight of our Brighton excursion

We’ve had a hectic couple of days- testing out my foot well and truly. I do look a little ‘lame’ by the end of each day but the pain is forgotten as the Spritzer kicks in.

Bob:Upper photo Circa 1976 & lower photo 2017  

Yesterday we ventured back in time to visit the iconic Sutherland Ave- we replicated the photo Bob took 41 yrs ago and then moved onto his old stamping ground The Warrington. It is a very nice, typical English pub and you couldn’t wipe the smile off Bob’s face, especially as he downed his warm bitters, bangers and mash and the Scotch egg that completed the trip down memory lane.

The Warrington

 

We then moved onto Abbey Road- dicing with death to reproduce the Beatles walk across the zebra crossing. It must be very amusing (or quite annoying) for the residents watching the parade of tourists every day.

  

The iconic Abbey Road crossing        

     

 We didn’t really research the photo before         

Up to Little Venice and then to Hyde Park where they were in full throttle at Speakers Corner. I did ponder grabbing a low ladder and sprouting on about the virtues of pelvic floor exercises and the value of using the correct defaecation dynamics.  All the speakers were very intense and looked a little fanatical – mostly in the name of their favoured religion, but it made for interesting theatre.

It was a glorious day for Hyde Park- if not a little hot – but the temperature allowed for an ice-cream to be consumed, so we sat on the grass and watched the passing boats on The Serpentine (the large lake in the middle of Hyde Park). We then walked a short distance to Knightsbridge and the iconic Harrods. There must be an invisible vapour that is pumped across the doorstep of Harrods that entices you to go mad with purchases. I went to Harrods back in 1984 and swore I would never go again – and I never did use the special hair rollers (?!?!) that I purchased there 33 years ago. But as I said, you get in there and say “What the hell let’s buy some mementos of our visit here for presents back home”.

   

Harrods -it is a truly spectacular building                      

Lorenzo Quinn collection at Harrods

We are especially going to Venice to see Lorenzo Quinn’s sculpture depicting global warming so it was a lovely surprise to see this showing of his sculptures at Harrods.

 

The weather was a full page 3 spread

The next day we ventured south on the train (on the hottest Bank holiday London has seen) to check out Brighton…..with a couple of million others. (I will be writing a separate blog on the toilets in England. I will be writing to the Director General of British Rail in fact, but I will keep this a positive travel log of the last few days of London, rather than taking you through the highs and lows of my train trip to Brighton). It was hot, the beach is very pebbly and it was very choked with people, so we made a quick decision to catch the bus on to find The Seven Sisters. I can thoroughly recommend this trip. If you want to do this, catch the 13X bus from Brighton and get off at Seaford and find the start of the walk to the Seven Sisters. If you do it this way, when you get to the top of the hill, you will walk towards the Seven Sisters facing a most glorious view. It’s a lovely grassy walk, quite a lot of it next to a golf course. Take a picnic lunch and sit up on the cliff facing the Seven Sisters and just soak up the panorama.

 

Then once you reach the Seven Sisters Tourist Office you can catch the bus back to Seaford and pick up the train to Brighton, or alternatively, get off the train at Lewes and change to a London train that takes you to Victoria Station. I have certainly found the transport system here fantastic. As I said previously, get your Oyster card (and keep it topped up), download City Mapper London onto your smart phone and it’s so easy. You really can’t have a car in London and why would you when the trains, tube and double-decker buses are so good.

The 29th August dawned another brilliant day – some food shopping happened to get ready to throw a surprise birthday dinner for Soph – the surprise was well and truly a surprise and it was so nice to meet some of Sophie and Jimmy’s friends. Mothers need to visualise where kids are living, who is who and what they do when living thousands of miles away- and meeting their friends has been very nice. Living in London and walking the streets and using the tube has been good too- it makes it appear less scary when you see it in action.

Today I got punished for complaining about the hot weather – just like that, it dropped from 29C, sunny and muggy to 14C cold and wet. But it didn’t really matter as we had planned some birthday festivities for Soph’s 29th birthday. We headed to a beautiful restaurant, The Duck and Waffle, up the top of the Heron Building (110 Bishopsgate, London EC2N 4AY) for lunch. You are zipped up to the 40th floor in a glass lift and the view is truly spectacular. Their signature dish is obviously the duck and waffle with mustard maple syrup, but we had quite a few tasting plates which were very different and delicious.We then headed off to see The Lion King at the Lyceum Theatre in 21 Wellington Street
London WC2E 7RQ. It was a magnificent production and the hundreds of kids that were there were so well-behaved and thoroughly enjoyed the show. A delightful show for the kids when they’re a bit older.

As Jimmy would say ‘A sneaky chocolate fondant to finish at the Duck and Waffle

Tomorrow is a networking day with one of my Women’s Health colleagues from Edinburgh, Elaine Miller. We are meeting in York and will be talking up a storm about continence promotion and I look forward to our collaboration and exchange of ideas.

Until next time.

 

 

Hats off to Australia Post and British Post (actually known as Royal Mail)

On April 22nd, I suddenly remembered it was Jimmy’s birthday in early July. So I diligently packed 2 giant packets of Tim Tams, a large bottle of vegemite and some strapping tape for their sporting activities into a small box, popped into Australia Post and $44 later it was on it was on its way to London, via the slow boat to China. You see I thought $44 was enough postage- I had 10 weeks until Jimmy’s birthday- even if I didn’t pay the extra $30 for the faster version of sea mail!

Proof that I sent the parcel on 22nd April, 2017

As the date in July grew closer I decided to let on I’d done this wonderful thing of planning 10 weeks ahead of Jimmy’s birthday and started asking Soph- did any parcel arrive? And each week the answer was the same…….Nope, no Mum, no parcel. So the birthday came and went and because I was lousy and tight and didn’t pay $77 to post some (of the most delicious ) biscuits and a bottle of black spread, there was no pressie. Days grew to weeks and weeks grew to months and I gave up on that parcel ever arriving. I could picture some posties sitting in the corner of the distribution centre with chocolate and vegemite oozing out of each corner of their mouth.

Fast forward to 25th August and we land in London make our way on the very fast train to Paddington from Heathrow (15 pounds each off peak, 25 pounds return) – thanks Michelle Lyons for the tip-off – and then cabbed it to our accommodation (20 pounds Paddington to Islington) – and I can now tick off ‘Catching a London cab’ from the bucket list. We were too lousy to do that in 1984.

Our London accommodation has a gorgeous garden but 3 fights of stairs and I am sure by the end of the week I’ll be trained up for those Alps in France. There’s nothing like getting to your bedroom on the top floor and remembering you needed a glass of water from the kitchen (on the bottom floor). The 19thCentury men and women of England must have also had very small feet because the stairs here are half the width of our stairs at home -tremendous concentration needed not to slide down them in the unladylike fashion.

We had showers and then Soph arrived at our house and momentarily had the life squeezed out of her. We then headed off to check out her London digs and as we all walked in through the gate what should be popped in the letterbox but a parcel delivery card. Yes the parcel had indeed arrived – four months to the day from when it was posted.

Yes that says delivered 25th August, 2017

Just think I could have brought that parcel all the way to London in my luggage and it would have arrived a day earlier! Needless to say I DID bring 6 packets of Tim Tams, a jar of vegemite and some strapping tape to replace the ‘lost’ parcel. They are now set up for the rest of their stay here. Apologies to all the posties of the world who I had falsely accused. Let’s hope the plebiscite mail does better than my parcel for Jimmy and Sophie.

We have had a busy time exploring London – their public transport system is so well set up for travelling massive distances in a very efficient manner. When you come to London you must acquire an Oyster card – it’s the way you get on and off the Tube and any transport quickly and easily. Load it up with plenty of pounds and off you go. Just remember to swipe as you enter the tube and as you leave.

We went to the Borough markets and bought some amazing French cheeses and ate my first Gumbo – a delicious spicy concoction and then went to Greenwich and lazed in an elevated park with some glorious views of London. Last night, we ate at Ottolenghi, one of the most iconic and dynamic restaurants in the country inspired by Yotham Ottolenghi – who has written some beautiful cookbooks which we have at home. The food is in tasting plate size, is very fresh and beautiful. Thanks to my kids for a gorgeous birthday present.

    

Today has dawned yet again like a hot steamy Brisbane day – so the winter woollies I brought for London will stay unpacked for another day. We are off to Maida Vale to recreate the iconic photo, then to see Jimmy living his dream working at the Budgy Smuggler (iconic swimmers made in Australia) pop-up in Shoreditch and then later some delicious Japanese for dinner.

As usual there is a theme on holidays and it revolves around food.

 

 

London here we come!

Bob circa 1976, Sophie circa 2017 Sutherland Ave, London

We had to go and see for ourselves, this amazing quirk of fate!

41 years ago my husband and practice manager extraordinaire, Bob stayed in the Vienna Hotel in Sutherland Avenue for a month when ‘doing’ London as an architecture student. He had a ball there – I don’t ask any questions – but needless to say he has fond memories for the Vienna Hotel. When our daughter headed over to the UK in February this year to ‘do’ London, she went to stay with a friend for the first two weeks and amazingly the friend was staying in Sutherland Avenue. I mean what are the chances in a city the size of London?

So she arrives, heads to her friend’s house, she chats to Bob – tells him the street number and boom IT”S THE SAME ADDRESS EXACTLY! Of course it’s no longer The Vienna Hotel – it is now refurbished into townhouses but her friend is actually living in the same building that Bob stayed in 41 years before.

That is an amazing quirk of fate and Bob will soon be planted in that photo above, right outside his old stamping ground The Vienna Hotel.

Heading off overseas is always exciting, but this trip will be a great opportunity to network with Women’s Health colleagues from around the world, when we gather at the International Continence Society (ICS) Conference in Florence… yes Florence. ICS certainly know how to pull a crowd.

Some of the physios are Aussies, but many will be physiotherapists who I have become very friendly with through our various professional Facebook groups; some I have been lucky enough to meet IRL (in real life) when they have presented in Australia such as Michelle Lyons, a wonderful Irish Physio who travels the world teaching. Others I will be meeting for the first time face-to-face. Who would have thought such a thing was possible? The internet is a wonderful thing.

I am also very excited to meet up again with Elaine Miller, comedienne extraordinaire, who is making a huge effort after her giant appearance at The Edinburgh Fringe to collide with me in York. I have a pressie for her, from the fabulous Fiona Rogers of Pelvic Floor Exercise which could be the draw card, but I am so grateful she is making the effort to catch up. Elaine calls herself a recovered incontinent and through comedy gives evidence-based information to her audiences while cracking them up with her glorious humour. Elaine has done so much to bring incontinence out of the cupboard and it’s always nice to talk to people who make me laugh.

So at last it is just one more sleep (yes there will needless to say be no sleep on the plane) until I get to hug my daughter. It’s been painful to sit thousands of miles away watching TV footage that is hard to watch. I want to helicopter around her (and Jimmy) for a short while to build up my mummy stocks – yes Jimmy there are hugs to be passed on from Deb too!

See you again when I’ve landed in Nick’s homeland.

 

A Treatise on my PF(#)

Old age ain’t for sissies: Bette Davis

This is one of my mother’s favourite sayings. I just thought I’d be a little older than 61 before it became my catch cry!  And before everyone flicks over to the next story on Facebook or Twitter to avoid the gross thought of a blog on my own (PF) pelvic floor- this article is on the other PF, the other disruptor in my life, which has reared its ugly head again, seven years after I first encountered it.

In 2009, when holidaying at Noosa, we walked furiously up and down Noosa beach – in those days barefoot, pounding away trying to keep fit and soaking up the vista of the rolling waves and picture perfect scenery. It wasn’t the happiest of holidays as my father was very ill and I was driving up and down to Brisbane to see him in hospital. Each day as I kept walking there was a peculiar, unpleasant tenderness under my right heel. It was weirdly sorer after I had rested and then when tried to weight bear as I got up from the lounge or the beach, I had a nasty limp which quickly passed and I wondered what the hell was wrong – I am after all a PF (vagina-centric pelvic floor) physio.

We returned to Brisbane after the two-week holiday and then visited my increasingly unwell father daily at the Wesley, walking up and down the steep hills around the hospital in a rather pretty pair of crystal adorned sandals, with a rock hard leather sole. During this time I could barely weight bear on my right foot – the pain was intensive and unrelenting, but there were much bigger and ultimately sadder events unfolding. Dad passed away at the end of January, so there was immense grief and of course plenty of stress and anxiety. Over the course of the next few months, as we sorted Dad’s affairs, my foot got worse and worse – and eventually the diagnosis was made – I had Plantar Fasciitis, one of the most common causes of heel pain.

It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). Plantar fasciitis commonly causes stabbing pain, that usually occurs with your first steps in the morning. As you get up and move more, the pain normally decreases, but it might return after long periods of standing or after rising from sitting. (1)

It was and still is amazing, how many women (and men) suffer with my affliction. It became a talking point with me and my patients, swapping stories, remedies, stretches, brands of shoes, inner soles, orthotics, spikey Massuse shoes – they all had their own success and many failure stories. At first I was wearing joggers to work; then I started to frequent orthopaedic shoe shops to try on shoes I thought I was going to be wearing in my 90’s not my 50’s; next came the moon boot; and then had a stint on crutches. It was quite depressing to even get up and get a drink of water because when you have plantar fasciitis, the worst pain is after you have been resting off it.

About two weeks after the diagnosis in 2010, I contemplated a steroid injection, but then came the horror stories of failed injections, of the excruciating pain of the injection and of feet made worse. So I decided against it and endured a foot hell for about 9 months until a radiologist friend at a party asked me why I was walking with such a limp? When he heard, he sort of ordered me to attend his rooms pronto, for an ultrasound-guided cortisone injection. So I did that on the next available appointment and I walked in on crutches and walked out carrying them under my arm!

There was the odd day of soreness but really after 9 months of excruciating pain – it just vaporised. The next time I felt it twinge/burn/talk to me was 12 months later at my first ‘Explain Pain’ course and Dave Butler called Plantar Fasciitis a chronic pain condition. My sore right heel, which had not been sore for about a year started to burn – I wanted him to shut up, I wanted to run out of the room, I was in a momentary world of fear, and cortisol and adrenaline were rushing through my body. A classic reaction which taught me in a second about the brain and its primitive approach to chronic pain.

As a result of this experience with plantar fasciitis, I had changed my behaviours with shoe-buying for a number of years – never anything with hard leather inner soles, not too flat and I was always having to test them for days/ weeks on carpet before I was game to wear them out in the real world. I found a great pair of joggers and then bought 3 pairs of the same shoe and have worn them all out with kilometres of pain-free walking for all these years………until March 2017.

On this particular weekend, I had spent a weekend walking barefoot around the house on our wooden floors, something I never usually did since my first painful heel experience and then really ‘strode it out’ on a couple of walks around the neighbourhood in a frantic attempt to ‘get fit urgently’ to hike Mont Blanc this year in September.

Walking trails Mont Blanc – the goal.

Suddenly there it was again – intense heel pain- this time in my left heel. I was shocked. And then I started to panic. ‘This is not good’ my deep primitive brain started saying out loud. My brain flashed back to the last time this happened, when I was incapacitated for 9 months, when I wore very ugly shoes and I couldn’t walk as my form of exercise.

Since that realisation that plantar fasciitis was back in the frame, I have frantically embarked on the roundabout of ALL of the plantar fasciitis treatments to get rid of my pain. You can click on this great systematic review of evidence for all the treatments for PF (plantar fasciitis) and since my  heel pain has started, our PF (pelvic floor) physiotherapy practice has become PF (plantar fasciitis) obsessed and we are having staff meetings and inservices to brainstorm my foot.

I have been furiously icing, stretching, massaging, strengthening the intrinsic muscles, relaxing all the muscles, strapping, taking anti-inflammatories, taking 10mg Endep, doing neurodynamic stretches and applying chronic pain science principles to my foot pain – and that was by the end of the first week. I have even tried prednisone for a week (did nothing but give my already hearty appetite a boost) and have even contemplated a short burst of oral HRT (hormone replacement therapy -as one of the theories mooted is that as women age and become menopausal, their tendons thin, as does the heel fat pad, and hence more pressure and strain on the plantar fascia). But I decided against that.

What I do have now is an impressive array of joggers that I have bought in the attempt to find a shoe that allows me to walk and not think every second- yes, there’s my left heel, oh damn now there’s my right heel – a classic example of too much talk coming from my feet, through the dorsal root ganglion of the spinal cord and shooting up to the representation of my feet on the sensory brain map. Hopefully one day I will be able to wear my joggers and STOP thinking about my feet.

 

Spikey balls

Strassburg foot sock (This stacked up pretty well in the evidence)

I was living the nightmare of my pain patients – I was anxious; catastrophising; panicking; trying multiple treatments all at once; and watching my dream of hiking hundreds of kilometres around Mont Blanc disintegrate into pieces.

Not too long into the process, I decided to head straight to the ultrasound-guided cortisone injection, after all, that saved the day 7 years ago. Dr Steve, who did my first miraculous injection was away on holidays (damn him) when I made the appointment, but I couldn’t wait the 3 weeks for him to come back, so headed in for my jab. Sadly, it didn’t work and if you read the articles, unfortunately that is the case, not all steroid injections work.

After 8 weeks of pain, I decided to consult a specially designated Heel Pain Clinic. $720 and 25 minutes later the impressions of my feet for special plantar fasciitis orthotics were on their way to Sydney to be manufactured and they were going to save the day…. in 4 weeks time. These are designed to tilt my calcaneus (heel bone) laterally, to relieve the pressure on the plantar fascia. They arrived by Express post a week later and were popped into my shoes to await a miracle cure.

Day after day I woke up thinking “IS it better? IS there a change?”

I think the change from the orthotics was minuscule and after giving them a go for 5 solid weeks, it was time for a last-ditch effort – another steroid injection. Dr Steve was available and while his conversation with me just prior to the injection – ‘that I was the first and last person that had ever had such a fantastic, miraculous, complete cure in 2011’ – did completely depress and terrify me at the same time- I went for it and again it appears to have worked.

I say appears because I am nervous. It’s the same as when you become superstitious about telling your mother that your baby is sleeping through the night- you don’t want to jinx it. (Science just doesn’t match superstition).

(Another apparently useful (but expensive) treatment for PF is high energy extracorporeal shock wave therapy (HESWT). The results of the meta-analysis provide strong evidence that HESWT was effective in the treatment of recalcitrant plantar fasciitis when compared with placebo. We recommend HESWT as a remedial measure after failure of traditional conservative treatment and ahead of surgical intervention.)

So to Dr Steve – I tentatively say an enormous thank you again. The test will come when I head off on holidays very soon – walk the walk to the plane and traipse the streets of London and climb the trails of Mont Blanc.

And to all those out there who suffer with this very underrated affliction, I hope you gain something from reading the evidence and knowing that I feel your pain and have enormous sympathy for you- for something that reminds you every second step you take – of this awful pain.

I’m coming for you Mont Blanc!

L’Aiguille du Midi (3842m)

(I doubt I’ll be brave enough to do this though!)

 

 

 

Time Out

Sue timing out at Sunshine Beach

Time Out sounds like something I read in a book 25 odd years ago when a child, (who may not have been mine), tried to flush our cat down the toilet. It is supposed to be a circuit breaker, to stop the child from continuing down a path of destruction or bad behaviour such as screaming, punching their brother or …………………flushing a cat down the toilet.

But the Time Out that I am writing about is the type that refreshes the soul, clears the head and helps to press the re-set button. Getting away for a weekend or even a night has a remarkable effect on clearing out the cobwebs and if you somehow combine it with the ocean, then that really has a profound cleansing effect. So when thinking about what this week’s Nugget would be for our Pain Relaxation class (these Mondays come around remarkably quickly!), I decided to write about the value of scheduling some ‘time outs’ during the year, because we have snuck away to Sunshine for our own ‘time out’ escape this last weekend.

Work life balance is important when dealing with life’s stresses. If you don’t acknowledge the need for a break, for a change from routine and for different scenery, then you can feel overwhelmed with life’s round-a-about. When you relax, you give yourself permission to let go of worries for a while. Relaxing gives your mind and body time to recover from the stresses of everyday life.

Relaxation tips

Fit things into your day that help you unwind. For everyone it is different. Some ideas can include:

  • listening to music
  • going for a walk
  • coffee with friends
  • yoga
  • reading
  • watching TV

Find something that you enjoy and make a conscious effort to do that relaxing thing every day. In a busy work day, even 10 minutes of downtime can help you manage stress better. It can also help to have a place where you go to relax. This can be your bedroom, bathroom (maybe take a bath?), the garden, the verandah or a local coffee shop, a park or even the library– somewhere where you feel comfortable and secure.

Take a minute to breathe and regain control

We all take breathing for granted because it is something that happens without us being conscious of it. However, if you take a couple of minutes to concentrate on how you breathe, it helps to lower your heart rate and decreases any anxiety. When we are relaxed we take slower breaths which in turn helps us to feel calmer.

Breathing techniques

We have done lots on breath awareness, but revisiting our breathing techniques is the certain way to be able to ‘turn it on’ when it’s most needed. Just like we learn any new skill such as shooting goals, if you play netball or basketball, better breathing techniques can be learned.

Practise the tips, below, so that when life is hectic you can stop, take a moment and breathe. Breathing better will help your mind and body regain control of the situation.

  • Sit in a comfortable and supportive chair and place one hand on your chest and the other hand on your abdomen.
  • Breathe as you would normally but notice where your breath is coming from in your body.
  • Then concentrate on taking a belly breath and notice how your abdomen rises as you breathe in and falls as you breathe out.
  • Now bring your palms very lightly together and notice the warmth in your hands under your fingertips and palms. Take a moment to observe the intensity of that warmth.
  • Noticing is important, as it is a mindfulness activity which directly influences your heart rate and decreases your cortisol and adrenaline release. 

Bigger Time Outs

Bob at Sunshine National Park

These can include a morning hike through the nearest nature reserve (for us Brissie people Mt Cootha is close and a great short hike); a day trip to the nearest scenic outlook (Tamborine, Springbrook, Sunshine National Park) or stay a night or two and breathe in some sea air and just sit on the beach and listen to the peaceful rhythm of the ocean. Sometimes unexpected things happen on a Time Outs such as whale watching from the verandah of your accommodation.

Just breaking the routine and taking some time to chill reinvigorates and refreshes and most importantly gives you new memories to savour when you are at work.

My advice? Plan a time out soon!

This blog was written using the resource: http://www.yourmentalhealth.ie/mind-yourself/good-mental-health/feel-well/time-out/

Anger Management

There have been a number of incidents over the last couple of months that have led to me writing this blog on Anger Management. Anger is an emotion that comes up regularly in conversations I have with patients- they may be angry with their partners, their work colleagues, their health professionals – and it’s such a negative emotion which can sap an already depleted nervous system of any positivity. As a Women’s Health colleague pointed out- anger can also be a positive emotion when injustices occur and changes must be made to set things right. But why I am raising this issue and posting some anger management strategies is to assist those people where their anger is a negative in their life and they would like to address it with themselves or with someone in close proximity to them.

Social media is full of angry people. The apparent anonymity gives rise to a belligerence in replies that would probably never happen if people were conversing face to face. Facebook rants, Twitter tirades (most unbecoming of a US President methinks) and blog trolling are regular occurrences. Media ‘personalities’ – often white 50 something males – are very angry people and they can be responsible for some of the mob mentality that arises from talk-back radio, whipping up outrage and crushing moderate intelligent thought and conversation on topics.

One of the more public ones recently happened here in Australia, when the Qantas CEO Alan Joyce was giving a speech and a ‘gentleman’ walked up on stage and proceeded to smash a cream pie in his face.

Now to be honest Alan Joyce was never one of my favourite people because over the years he has made what seemed to be like some harsh decisions  about Qantas and staffing and maintenance of their planes which I felt I had an opinion on (based on what, I have no idea) but over recent times I have admired his public position on gay marriage and equal rights in this area, and he has been brave enough to vocalise it despite of his position as a CEO of a major company. Now this is apparently what riled the offender. He got so angry and indignant that he felt he had the right to go right up on stage while Joyce was presenting and push a cream pie in his face. I saw the news the next day and the offender was contrite and apologetic, but I did hear it wasn’t enough and Alan Joyce is going to press assault charges.

Every night on the news, there are also many instances of road rage – where someone upsets the other with a change of lanes or by driving at the speed limit (instead of over it) and next thing, a completely-over-the-top reaction – sometimes aggressively, violent response, with someone being hurt. Similarly horrific, there are regular instances of domestic violence, where wives and children most predominately suffer as a result of uncontrolled anger. So I decided to do some reading on anger management strategies and write a blog on it.

The information in this blog is taken directly from ‘Change Your Thinking’ by Sarah Edelman PhD (2006) without too much summarising because it is so good and it was important to not reduce the message on this increasingly necessary topic- this is a great book with topics including managing depression, overcoming frustration and anxiety strategies. I highly recommend it to you either if you are a patient or a clinician.

Anger is an emotion that we experience when we perceive that something is bad or unfair. In most situations anger is directed at other people or organizations, governments systems or even ourselves. Anger is often accompanied by the perception of threat where part of us feels unsafe.

Anger affects the way we behave. When we feel angry we may lose our patience or act on impulse. We may become aggressive and say things we later regret. Anger drains energy and interferes with our happiness and to have good relationships. Angry people may argue, attack, abuse, hit, blame or withdraw. This behaviour creates more problems than it solves. It can lead to physical violence, destruction of property or abuse of alcohol and drugs. Uncontrolled anger can lose your friends, break up your marriage, cause problems at work and cause you to become a social outcast.

An occasional burst of anger is not always a problem but it must be proportionate to the situation. However, long term, intense or frequent episodes can be a detriment to all aspects of our lives including the ability to feel good and to enjoy good relationships. Long term or frequent anger increases stress to organs of the body and increases blood pressure – thus increasing the risk of hypertension and heart disease.

Researchers have found that anger/ aggressive behaviour can be influenced by brain chemistry or defects within the brain. Negative childhood experiences may also affect the anger response.

Some people rarely express anger. This may be because they are well adjusted and have flexible expectations. On the other hand, lack of expression of anger may carry with it suppressed anger. This may manifest in passive-aggressive behaviour. They may be full of negative comments or subtly undermine others.

There is a belief that ‘letting out your anger’ is better than holding it in. If we are experiencing a brief episode of anger then physical activity – hitting a punching bag, gardening or going for a run – is a good way of release. Evidence shows that people often feel angrier after an explosive response – not less. More importantly, yelling is often hurtful to people we care about. We may feel guilty and remorseful afterwards.

STRATEGIES FOR MANAGING ANGER

Extingush the Fuse – Preventing an Angry Explosion

Although it may not always be possible to avoid getting angry, we can learn strategies to keep our anger in check and prevent it escalating: –

  • Learn the internal signals of anger arousal. You may become hot, flushed, your heart may start pounding, your hands may tremble or your jaw may clench. These are your clues to take control. Then use the ‘Stop – Breathe – Leave’ technique: –

Stop

Say the word ‘stop’ in your mind and visualise a stop sign or flashing rail crossing lights. This will short-circuit your automatic response and allow you to choose to respond differently. Go on to…

Breathe

Take in a few deep breaths to lower your anger arousal and distract yourself from the perceived injustice. Then…

Leave

Physically remove yourself from the situation. Leave the room or go for a walk. During the most testing period, this will keep you out of harm’s way or causing harm to others.

  • Once you have removed yourself from the situation, this will give you the opportunity to reflect. Ask yourself, ‘What is my goal here?’ Is it to get on with people? To have happy children? Avoid unnecessary stress? Enjoy the evening? Look after my health? Whatever the circumstance, focus on what really matters and recognize that getting angry stops you from achieving what really matters.

Reduce Your Physical Arousal

When we can reduce our level of anger arousal, our anger also receded. Here are some techniques: –

  • Exercise

Physical exercise allows us to use up reserves of energy that anger draws upon. Although our level of anger can rise during the actual exercise, it drops substantially afterwards and helps to relax. Vigorous exercise also releases endorphins which increase our sense of well-being. The exercise does not have to be pumping iron or punching a bag, equally effective is vigorous housework or digging the garden.

  • Diaphragmatic Breathing

I use belly breathing every day with my patients and myself for that matter. Belly breathing is calming and allows the brain to think more clearly and allows for easier processing of information. Place your hand over you tummy and as you breathe in feel your tummy rise up under your hand and then as you breathe out, your belly drops away.

Breathing gif to work with

  • Deep Relaxation

This is a physical state in which all our major muscles are extremely relaxed. As it is difficult to practice deep relaxation while we are angry, this technique is not suitable during an acute stage of anger. Use the methods above in the first instance. Practice deep relaxation as a maintenance tool which, when practised daily, reduces our potential towards becoming angry in the first place.

Dealing with Sustained Anger

Unlike explosive anger which is usually over in a few minutes, more sustained anger which does not fade quickly or after a night’s sleep, requires a long-term approach. Here are some strategies: –

  • Problem Solve

Whenever we perceive an injustice has occurred, it is sensible to think about actions we can take to redress it. Sometimes there is nothing we can do about it and we must accept the situation. At other times, we can resolve it through problem-solving. Even if we may not successful, it helps to know we tried our best and there is nothing more we can do about it.

When you find yourself feeling angry about a situation, ask yourself ‘What is the best action I can take to resolve this problem?’ You might be able to present a reasonable case to fight a traffic ticket. You might need to assert yourself to a builder who has left shoddy workmanship. You might discuss with your partner or housemate that you are unhappy that you are doing all the housework and ask they do their fair share. In many cases, taking some constructive action enables the problem to be solved.

  • Sometimes It Is Better to Let It Go

Sometimes we find ourselves in situations that are plainly unfair and there is nothing we can do to change them. Or we may recognize that our chances of achieving a fair solution is small and the cost of pursuing it is likely to be high. When we weight the chance of success against the cost of failure, it makes perfectly good sense to let it go. It may be best to practice acceptance. The acceptance affirmation below can be helpful in these situations: –

ACCEPTANCE

NOT HOW IT

Was

– Might have been

– Should have been.

NOT HOW

I wanted it to be

– Hoped it would be

– Planned it would be.

I ACCEPT THAT THIS IS HOW IT IS.

Now get on with my life in a positive way.

  • Give Yourself Some Stewing Time

At the outset of your anger resulting from a significant injustice, give yourself permission to stew for a while. Perhaps do some exercise, talk about it or even write a letter. As long as you don’t say or do things you’ll later regret, it is OK to experience the anger for that significant injustice for a few hours or days.

  • Talk About It (Ventilation)

The very process of talking about something that we feel angry or upset about can help us feel better. Sometimes all we need is to be heard and validated by a sympathetic, caring listener. Psychologists call this process ‘ventilation’. While talking to a third party can be helpful, sometimes speaking directly to the person we feel angry about is best by releasing accumulated anger and resentment and thus to feel better. It is not best to do this during an acute stage of anger when the risk of hostile confrontation is high.

  • Write a Letter

Sometime it is difficult to directly speak with the person who makes us angry either because the issue is too upsetting or we do not trust ourselves to remain calm. In this case, it might be better to express our thoughts on paper. This process gives us time to express ourselves coherently. While sending the letter helps the other person understand our position, sometimes just the process of writing helps us rationally evaluate the problem to the point where the letter might not need to be sent.

  • Thought Stopping

Thought stopping can be helpful in dealing with recurring ruminations that just won’t go away. Before you begin the process of stopping the unwanted thoughts, you need to prepare a pleasant fantasy that you will use to replace them. This pleasant fantasy might be memories of a good holiday, hugging a grandchild, a moment of past success, a beautiful place, a sexual fantasy, an inspiring person, an activity or hobby. To practise thought stopping, you need to catch yourself in the process of rumination and immediately shout out ‘Stop!’ either aloud or in your mind. Then turn your mind to that pleasant fantasy and focus on it for 30 to 60 seconds. If the unwanted thoughts return repeat as necessary. To be effective, thought stopping needs to be practised consistently for as long as the ruminations continue. At first this will happen many times per day but with practice, the unwanted thoughts will reduce and eventually disappear.

Choose to Let Go of Your Anger

Anger comes from the perception that important rules are being violated. When we feel angry, we tend to blame other people or external events. The truth is other people do not actually make us angry, they merely provide the stimulus. We make ourselves angry through our belief that things should not be this way.

Like all emotions, anger is generated by cognitions. Other people’s actions can anger us but whether or not we get mad depends on how we perceive what is happening in our world. Events that enrage some people, do not phase others.

Anger is different to most other unpleasant emotions in one important way – we instinctively want to hold onto it. If we have sustained anger, we need to ask, ‘do I want to hold on to this anger?’ Choosing to let go of anger may feel like we are letting a culprit off too lightly. Our sense of indignation can be a major obstacle to moving on. We have to ask ourselves – ‘who is suffering?’ Sustained anger can be painful and self-defeating. Anger does not hurt the other person – it hurts us. Even if we are able to make the other person uncomfortable by snubbing or bitching about them, chances are we are still suffering. Anger might be likened to drinking poison and hoping the other person will die. Why would we do it to ourselves?

  • The Cost / Benefit Analysis

Wanting to stay angry is one of the biggest obstacles to letting go of it. If we are not convinced we want to let go of the anger, do a cost / benefit analysis of maintaining the rage. Put pen to paper and under the headings of ‘Costs’ and ‘Benefits’ write down your thoughts. A benefit might be, ‘It feels right’ or ‘It gives me something to talk about with friends’.

Costs might be ‘It distracts me from thinking about more important things’, ‘I get churned up in the stomach’, ‘It stops me from getting a good night’s sleep’, ‘It makes me hard to live with’, ‘It is such a waste of time and energy’. After weighing up the costs and the benefits, this process might help us commit to whatever is necessary to let go of the anger.

  • Goal Directed Thinking

Anger can be self-defeating because it prevents us from getting the things we really want. These might include maintain a good relationship with our partner, being respected by our colleagues enjoying a night out or simply feeling happy and relaxed. It is not in our interests to feel this way.

  • Remember the vital question, ‘Does thinking this way help me to feel good or to achieve my goals?’

Identify and Challenge Anger Producing Cognitions

Anger is rooted in negative thinking. It is fuelled by being preoccupied with what has gone wrong or with assumptions about the bad intentions of others. One way to combat this negative syndrome is to maintain a constructive outlook about yourself and others.

Once we are motivated to work on letting go of our anger, we are ready to take the next step – to identify and challenge the patterns of thinking that makes us feel that way: –

  • The Shoulds

Of all the thinking patterns that contribute to human unhappiness, it is the ‘shoulds’ that are the most pervasive and unhelpful. ‘Shoulds’ play a major role in feelings of anger, resentment and bitterness. They reflect our expectations of how people ought to behave. Beliefs like ‘My husband should be able to communicate better’‘My friends should be more supportive’; ‘The trains should run on time’; ‘Pet owners should not allow their pets to make a mess of my garden’; The neighbours should keep their music down’ can cause us to feel angry if we hold them as absolute truths rather than preferences. This is because the world does not conform to our rules. Rigid expectations make us anger prone.

This is not to say that we should have no expectations of others or that we should accept unreasonable behaviour without challenging it. At times it is important to take an stand and do what we can to right the wrong.

However, it is important to be flexible and accept that in the real world, people will not always think the way we think.

  • The ‘Just World Fallacy’

A common expectation of an anger prone person is that of justice and fair play. The problem is that this expectation does not match what happens in the real world. Injustices exist in every society, every family and every work place. Perhaps we should be taught from kindy that many things in life are simply not fair and often there is nothing we can do about it.

Again, if there is something we can do to resolve an injustice, it is important to try. However sometimes there is nothing we can do about it. We can get angry or we can accept that we live in an imperfect world and focus on the things that are within our control.

  • Black and White Thinking

Anger often arises from black and white thinking. This is the tendency to see situations as either good or bad, right or wrong. It is the inability to see shades of grey that makes us prone to anger.

  • Injustice May Be Subjective

It is important to appreciate that although we may be strongly attached to our point of view, it is quite possible that it is not completely correct or definitive. Justice is often subjective. What is perceived as fair by one person, is not necessarily fair to another.

  • Blaming

Blaming goes hand in hand with anger and resentment. Some people spend all their lives blaming others for their own unhappiness. It fuels our anger and makes it hard to let it go. The blaming habit is strongly tied to our ‘shoulds’ – underlying assumption is that people who break our rules are bad.

As we can rarely punish others or control their behaviour so labelling them as idiots or creeps and demanding they should not be the way they are is a waste of our energy and it only makes us bitter.

We may still take action to resolve a perceived injustice but importantly we need to remember that we live in an imperfect world full of imperfect human beings.

When we can truly accept this we make life easier for ourselves.

  • Personalizing

Whenever someone acts unfairly, rudely or aggressively towards us, we might take offence because we perceive their behaviour as a personal attack. At times people will act in ways we do not like. But we don’t have to take it personally. It is not always about us. Consider, ‘Could this have happened to anyone in this situation?

  • Empathy

‘Forgiveness is not an occasional act. It is a permanent attitude.’ M. L. King Jr.

It is easy to feel anger towards people who say or do things we do not like. It is harder to understand them – their thoughts, their motives, their insecurities and their pain. Our anger often disappears when we can see the situation from the other person’s viewpoint.

Anger can turn to compassion. We can develop empathy towards almost any person when we can see their vulnerabilities and how things are for them. We are all trying to live on this planet using the resources we have developed over our lives. Resources are our: – cognitions, problem solving skills, social support, innate sense of security, self-worth and our ability to communicate and get on with other people. These resources are determined by two factors: – our life experiences; and our biology which includes reactivity to stress, intelligence, energy levels, physical strength, memory and our body’s chemicals that determine our psychological predispositions.

Some people are dealt a great hand both biologically and in their life experiences. As a result, they are well equipped to deal with life’s challenges. Others have been dealt a very meagre hand. For them life is a struggle. Their behaviours that appear to be unreasonable, selfish, stupid, neurotic often reflect the person’s limited resources with which to respond to life’s challenges. Understanding how it is for other people and why they behave the way they do does not mean we must like their behaviour. We may loathe it. However, it releases us from blaming and labelling them and enables us to stop taking it personally.

‘The reason to forgive is for your own sake. For our own health. Because beyond that point needed for healing, if we hold on to our anger, we stop growing and our souls begin to shrivel.’ M. S. Peck 

  • Behavioural Disputing

Behavioural disputing can be one of the most powerful techniques for letting go of anger or resentment towards someone.

The process is to go against our feelings and to treat perceived adversary in a friendly and reasonable manner – as we would treat a friend – through direct pleasant communication, friendly email or even a card. Changing our behaviour towards this person changes the dynamics between us and thus the way we feel. In most cases, they will respond in kind. We will feel more comfortable in their presence and they in ours. Most people respond positively to a peace offering but if this does not happen, we have lost nothing and we can enjoy the moral high ground, knowing we have behaved in a decent way.

  • Coping Statements

Coping statements are useful as reminders of our processes to quell anger when it resurfaces. Some examples are:-

  • Everyone behaves according to their own values and rules
  • People don’t have to do what I think is right
  • The world is not fair
  • If it’s beyond my control, let it go
  • Stay goal-focused-remember the big picture
  • Keep your cool and you’re in control
  • He/she is not perfect, and neither am I
  • People are just people. They are neither good nor bad.
  • Justice is in the eye of the beholder.

 

  • Communication

Good communication skills are our most valuable tool for solving problems, redressing injustices and getting on with people. Communicating with others when we feel angry can help us in two ways. Firstly, when we tell someone that they have done (or are currently doing) something that is a problem to us they may choose to change their behaviour. Secondly, the very process of communicating can sometimes make us feel better. Telling someone that we feel angry or upset over something that has happened can allow us to release a lot of anger. This is particularly the case if we speak directly to the person we feel angry with. If we can communicate in a calm, non-threatening manner, people sometimes validate what we say. This means that they express understanding for how we feel or acknowledge that we have the right to feel the way we do. Occasionally, they may even acknowledge that they did the wrong thing or apologize for their behaviour. Granted, this does not always happen, but in situations where it does, it is like salve to our wound. We can forgive and recover from almost any transgression when people are willing to acknowledge they were wrong or say that they are sorry.

Although it is usually appropriate to speak to the person who is directly involved, sometimes we may need to approach a third party who has the power to intervene. This is particularly the case when our initial approach gets us nowhere. So for instance, you might end up speaking to the school principal about the unsatisfactory behaviour of one of your child’s teachers or to the bank manager about the lack of service at your branch or to the foreman about the poor attitude of some of your fellow tradesmen.

Sometimes we may need to communicate in writing. This is usually necessary when we wish to make a formal complaint. We might also communicate in writing if there needs to be a record of our complaint or when we find face-to-face communication too difficult. Taking time to compose our thoughts on paper often results in clearer and more constructive messages. Whatever the circumstances, our case is strengthened with calm, rational communication, whether spoken or written. We are far more likely to get a favourable response when we are perceived as reasonable and conciliatory, as opposed to hostile, accusing or unreasonable.

Of course, even excellent communication skills do not guarantee that we will always get our needs met. Unfortunately, no system of communication in the world can ensure that other people will always do what we want; but constructive communication increases the likelihood of resolving problems and it helps us to keep people on side, enjoying healthy relationships that are based on mutual respect. Given that communication is such an invaluable resource, it is surprising how often we shy away from using it (‘It won’t work … what’s the use?’). Often it is because we feel uncomfortable bringing up an issue that involves a perceived injustice. The situation is already upsetting to us, and the possibility of an unpleasant confrontation may be extremely anxiety-provoking. It might seem easier to rationalize that talking about it will not work anyway. However, it’s important to keep in mind that communication does not necessarily result in conflict. Good communication involves sound judgement, negotiation and diplomacy, and very often leads to a reduction in tension and improved relationships.

IN SUMMARY

  • Anger is created by the perception that something is unfair, and is usually accompanied by feelings of threat or vulnerability. While it can sometimes motivate us to behave assertively or to solve a problem, anger has many negative consequences.
  • Acute, explosive anger is potentially harmful because it generates destructive behaviours and alienates other less intense but more sustained anger is also self-defeating because it drains our energy, impairs our relationships, makes us unhappy and can adversely affect our health. Different strategies are appropriate for dealing with the different types of anger.
  • Unlike other upsetting emotions, people often want to remain angry because they believe it is justified. However, anger hurts us more than the other. An important first step in releasing anger is to recognise the cost of holding onto it, and to make a decision to let it go.
  • Several cognitive strategies can help to release anger, including a cost/benefit analysis, goal-directed thinking, thought monitoring and disputing, empathy and coping statements. Accepting that injustice is unavoidable at times, and that ‘justice’ is sometimes subjective, can also help to release anger.
  • Behavioural strategies that are useful in the management of anger include problem solving and arousal reduction techniques, such as physical exercise and deep………… In addition, behavioural disputing choosing to behave in a friendly manner towards someone we resent-can be a powerful strategy for releasing anger. Utilizing effective communication can also resolve anger by lowering interpersonal tension.

A fantastic summary of anger management. Every chapter in Sarah Edelman’s book is thorough and most importantly manageable and practical for patients to implement.

World Continence Week: Incontinence is no Laughing Matter

It’s that time of the year again when the world celebrates World Continence Awareness Week. ‘Celebrates’ may sound like an unusual word to use when talking about issues such as urinary and faecal  incontinence, but it is important to confidently and loudly give a shout out about the conservative strategies to treat or manage the scourge of incontinence.

Incontinence makes people lose their confidence; it makes them anxious; it causes embarrassment; it makes you feel alone.

Well how lonely can you be when the figures are so staggering? One in three women leak urine; one in five have some faecal incontinence. That means if you have fifteen friends, five of them could leak urine and three of them might have faecal incontinence. In 2010, when the De Loitte Access Economics Report ‘The economic impact of incontinence in Australia’  (1) (which explores the current prevalence and economic impact of incontinence in Australia, and provides an outline of the future projected growth of this burden) was completed, it showed that 4.8 million Australians were currently living with incontinence and this prevalence of urinary, faecal and mixed incontinence is estimated to increase to over 6.4 million Australians by 2030.

You are not alone – it’s just that we as a community still have issues disclosing it. 

65% of women and 30% of men sitting in a GP waiting room report some type of urinary incontinence, yet only 31% of these people report having sought help from a health professional (2)

Why is that? Why as a community do we not encourage people to intervene early and seek conservative help from a Pelvic Health Physiotherapist to fix this problem?

Why don’t GPs say :’Hi Mrs So-and-So, did you know it’s World Continence Awareness Week? Do you have any issues you’d like to raise with me? I reckon Mrs So-and-So would be relieved that the ice had been broken and she could spill her guts about the fact she has stopped exercising because she floods; that she’s spending as much on pads as her daughter is spending on nappies for her grandchild; that she is constantly stressing about potential odour and that she has stopped going on outings with Probus because she’s worried if there will be enough toilet stops.

These are significant quality of life issues that can even turn women into agoraphobes. They make women change their career paths. They make women depressed.

We know education is a cornerstone of treating urinary incontinence and someone who does in fact succeed in making incontinence a laughing matter is Elaine Miller, a Women’s Health Physio and comedienne from Edinburgh, Scotland.

Elaine Miller doing her stuff

Elaine uses jokes and a comedy routine to impart facts and figures about incontinence. She has been a regular participant at The Edinburgh Fringe, at conferences and on talk shows. People listen when satire and humour is used to pass on information. I find it especially works well with memes – I could write a whole paragraph on something, but the words on a picture (which is all a meme is) are far more effective at driving home a point than a whole lots of words.

Humour also breaks down barriers. It makes things not seem so catastrophic. It shows us that we are all vulnerable – from the woman who works on the factory floor, to the CEO of a major company. Elaine is doing an amazing job at all these things because she is not only very funny, but her routine is evidence-based – which is what we should all demand from our health care professionals. If she could travel the country…even the world, spinning her yarns, women everywhere would come out of the woodwork and charge into their nearest (evidence-based) health practitioner and start making the quite simple changes that would significantly help and even cure their urinary incontinence.

Over the course of World Continence Awareness Week I will be posting advice and hints that will change your life. Make sure you keep following. What you do now you know, makes old age much more tolerable.

(1)  https://www.continence.org.au/pages/deloitte-report.html The Economic Impact of Incontinence in Australia, 2010                                                 (2) (Byles & Chiarelli, 2003: Help seeking for urinary incontinence: a survey of those attending GP waiting rooms, Australian and New Zealand Continence Journal).

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