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health, pain

Understanding Pain

felicitybooty

There are many different types of pain, different reasons for starting, it has different affects as to what we can and can’t do, and there is a myriad of different combinations of what makes it better or worse. So how can we possible understand what pain means? In this blog we are going to delve deeper into what pain means, and therefore what it is that we can do in response.

From my experience of seeing thousands of people in pain, I understand that the first thing we all want to do when we get pain, is for it to stop! It’s uncomfortable, it stops us doing things, we can’t think straight, so of course, the quicker it goes the better. But who ever we are, whatever age we are, young, old, fit, healthy, health challenged etc we will all feel pain. It is a universal human experience. Pain is are bodies way of giving us information about an area(s) that needs our attention. Focusing our attention in on understanding our unique pain, gives us the tools to help ourselves. Ignoring it, only leads to our body needing to ‘shout’ a little louder for you to hear next time. So let’s delve a little deeper into what it is our bodies’ are trying to tell us.

To take the next step, we need to really feel all the sensations going on in body. Allowing ourselves this time, space and safety to ‘let go’, so that whatever is going on, we can say to ourselves ‘I’m ok, this is happening, so I need to feel it, I’m safe to feel it’. Just taking this first step to listen to your body, can open up the possibility for healing and change. When we can feel, then we can start getting some clarity.

Our Inquiry

What kind of sensation is this? (hot, cold, throbbing, fizzy, tight, sharp, dull, achy, weak, heavy, unbalanced, not me) If we have clarity on what character of sensation it is, then we know more about it, and when it changes.

Where is it coming from and going to? Where does it start and finish? Sometimes when we have a sensation for a long time it can feel like our whole body is involved, so its good to map out areas of different types of sensation. As with all these questions, when we take on the role of the observer, we can give ourselves perspective rather than being overwhelmed with sensations. It is from this stance that we are able to help ourselves more affectively.

What makes it better and worse? This really gives us tools to help ourselves, and can empower us to make decisions that put our welfare first. E.g. standing or sitting for too long aggravates, so in my day I need to change my position regularly. Or: lifting really hurts, so I’m going to ask for help with lifting, or making sure I have allowed myself more time to do something/ change how I cuddle my child-sitting rather than lifting them up on my hip ( our children have more understanding than we give them credit for). Or – sitting on the sofa is bad, so I’m going to put an upright chair in the lounge while I heal etc. Or cold really helps, so I keep some frozen peas ready for when I need them.

The last question is – What thoughts and emotions do I have about this? Are your thoughts going into overdrive – because I have this pain I will no longer be able to do…. because I have this pain, it will never go. Because I have this pain it means I’m useless/ I’ve fail, not a good enough parent/spouse/employee. All these thoughts, and there are a plethora of examples, add another layer for your body to cope with. A pressure or a deadline, or an ultimatum – ‘there is not much point in looking after myself because I’m useless’ or maybe you are convinced that you are doing all the ‘right things’ to help yourself, yet your body still hurts because actually they aren’t the right things for you, at this time, with this type of pain. Which brings us nicely back to where we started, and checking in with what is actually going on, what you feel, where is it, what makes it better and worse and what thoughts have I attached to this sensation?

I’m hoping by now you are beginning to understand that what we experience in our body is unique to us. There is no one size fits all, and by being open to understanding your own unique pain, it opens us up to understanding what our body is asking us to do and not do, without our heads getting in the way. We have the tools, we can make sure we have the motivation – to get better, and now you have the framework to start trying it out.

Our experience of pain or discomfort, could then be the opportunity to connect with yourself better, not a reason to disconnect. Let me know how you get on and what insights you gain from allowing yourself to feel and understand your pain.

health

Understanding Osteopathy: The Body’s Self-Healing Power

felicitybooty

Osteopathy’s whole foundation relies on one amazing thing about the body: it’s self healing capacity. The body will always try to heal itself e.g. wounds, tears and strains. There will always be blood and inflammation rushing to the area to heal those tissues. Osteopathy has this phenomenon at its core. The body heals itself and if its not healing, then why not?

Our bodies do an amazing job of maintaining an equilibrium and this is what we call health. Our eating, sleeping, breathing, toileting, moving, laughing, crying and more, are all wonderful expressions of health. To appraise someone osteopathically is to look at all these uniquely individual expressions of health. To understand what is working and what needs support. Osteopaths are great at listening to understand what’s going on for each patient, but they are also amazing at listening with their hands. Osteopaths build up an encyclopaedia of textures and sensations that they feel with their hands, coupled with their knowledge of anatomy and physiology, it is a bit like having hands for x-ray machines.

Osteopathy is never just about looking at a sore part, whether it’s a sore back or neck or knee or a sore tummy in a baby, as that is only a part of the picture. Our body works as a whole, so when a part hurts, osteopaths look at how each person is functioning as a whole. So we ask ‘Why is it happening? and ‘Why is it not resolving itself? But we also ask ‘Who are you?’ ‘ Where is the health?’ ‘What needs to change for you to be able to heal this more effectively?’

Sometimes the change that is needed is just about re-establishing movement and balance within the body. But often it is about re-establishing movement and balance within the body AND within that persons life. To experience health, our lives need joy, movement, variety, purpose, creativity, love, sovereignty and belonging. Without these fundamental elements of human existence, we hamper our body’s ability to flourish. Exercise is helpful in rehabilitation, but joyful movement with something you love, well that is a game changer. That gives you a skill to support your health for life.

Questions to ask yourself

What movement do you enjoy? This can be anything – walking, swimming, yoga, dancing (in the kitchen or out) singing, table tennis etc How do you feel?

Where is the creativity in your day? This is not only creative arts, it might be creating meals for your family, creating spreadsheets? creating schedules etc It’s whatever gives you a creative buzz.

What brings you joy?

health, menopause

Menopause

felicitybooty

By Seema Bhandri

Following on from Felicity’s post on the perimenopause she asked me to share my own experience of the perimenopause and how it affected me, what I discovered when I researched it and what helped and worked for me, as well as resources I used or have found along the way. 

My Story

I went into an early menopause in my early 40’s and only realised when I stopped a hormonal contraceptive pill. I’d had no periods on the pill, which was a normal occurrence on that type of pill, and they never returned, and it was all a bit of a shock when a blood test (FSH) showed I was post menopausal. On reflection my periods had been dwindling in my late 30’s with occasional gaps of 2months here and there. As Felicity eloquently put it you have either stress hormones or oestrogen hormones, and at that time in my life I was busy starting a new career as a GP, and working and adapting was a stressful time. In hindsight I do feel stress played a role in my perimenopause journey. 

On writing this I notice a couple of things, firstly, I talk of ‘my’ periods. I see how we relate to our menstrual cycle is very personal. How bothered we are by them, how much we take notice of them, how much we like them or dislike them. The same is true in my clinical experience of the menopause. Everyone is different in how they are with the changes and that can change over time too. 

Secondly the shock I felt. I hadn’t anticipated the arrival of the menopause so swiftly. Looking into it I found that 5% of women in the UK experience an early menopause (see below). An early menopause is defined as it occurring between the ages of 40 and 45. Premature ovarian insufficiency (POI) is a menopause that occurs before 40 years old. This is much less common. The shock is and was for me like a grief. At that time and even now I don’t feel we really are that open about that aspect of it. 

All that said the symptoms that really triggered me to find out what was going on was not the lack of periods (I had thought the lack was just related to the pill working it’s way out of my system) but forgetting names of people, word finding difficulties and quite overwhelming anxiety. I was also seeing an acupuncturist for sleeplessness. But I hadn’t pieced all together! This is not an unusual feature…. the symptoms being a bewildering array that often we don’t connect together! Thankfully there is much more information out there in the public domain following celebrity publicity (eg Davina McCall) and good sources of information exist now like https://www.balance-menopause.com. 

After the penny dropped I found acupuncture helpful for the hot flushes that were keeping me awake! And within 3 sessions things were improving. And that was partly because acupuncture brought back my periods briefly. And worked well to control my symptoms for several months. 

I remember a friend telling me about a book called Natural solutions to menopause by Marilyn Grenville because at that time there wasn’t as much information available online. I used the book to direct me to herbs especially sage tincture initially then I did seek help with a medical herbalist. I tried yoga breathes that were like a dog panting (sitali pranayama) for the hot flashes! I used magnesium for the night cramps and reduce the anxiety/help sleep. I did try over the counter herbal mixtures and they didn’t work as well as a concoction that was directed at my symptoms. 

I did some training in functional medicine in 2017 and in the process of doing a gut reset diet I went sugar free and found all my peri menopausal joint pain went and my sleep improved considerably allowing for more tolerance of the remaining hot flushing/night sweats symptoms. 

Over time I recognised the more active and stress free I was the symptoms were hardly noticeable. An example was a sabbatical I took where I walked  4-8hours each day. And spent a lot of time outdoors, away from work in the NHS the symptoms were unsurprisingly absent! 

I met patients in the NHS managing the symptoms so differently, as I realised what was affecting me I got more interested how patients were managing the thing that I too was trying to get my head around. I met patients who knew, for example, if they did 3 classes of aerobics a week they coped well. Some changed their diet too to great benefit.

Fortunately more and more has been written/spoken about the perimenopause and menopause, and GPs are better equipped (https://thebms.org.uk/education/rcog-bms-menopause-advanced-training-skills-module/  ) to answer questions, sometimes, and maybe more workplaces/society are aware of the profound changes that can occur.

I noticed a big change when the pandemic came along, my symptoms significantly deteriorated and all the usual places I would have gone weren’t available so I briefly for a time went on to HRT from the doctor. Somehow it helped but never really felt like it was what my body wanted….I used to forget to take it and find myself not using it regularly. 

As time passed the symptoms have come and gone. I’ve found the strategies that worked for me: changing my diet, managing stress, and most importantly being active, have been the most helpful and loops back to Felicity’s blogpost. I feel it was an opportunity to know my body better, and it was a real reckoning of the toll stress takes. And was part of the unfolding impetus to change careers. 

One other book I read was Passage to Power by Leslie Kenton. It was about the menopause being a time for women  to come into their own sense of themselves. And around the same time I listened to a radio 4 programme about the whale menopause (https://www.bbc.co.uk/programmes/b07mxv62) which was curious and consolidating somehow. 

As much as learning strategies to cope, the menopause changed my perspective of what it was to live with a sense of wellness and integrity of purpose. 

Reference

Early and premature menopause
https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/early-and-premature-menopause/#:~:text=Menopause%20before%20the%20age%20of,before%20the%20age%20of%2045.

Other Resources 

Home

https://www.daisynetwork.org for women affected by Premature ovarian Insufficiency 

Home
Menopause Wellness Hub

https://www.menopausematters.co.uk

https://www.womens-health-concern.org/help-and-advice/menopause-wellness-hub/

health

Peri-menopause, Diet and Exercise

felicitybooty

I have had some request for more help and information on managing the peri menopausal stage, and my research has been really interesting. Menopause is being discussed much more which is really helpful for men and women to get a greater understanding. But what I found really interesting is how different a women’s body reacts to food and exercise compared to a man’s, and that most of the research is based on male physiology. So the research doesn’t take into account how a women’s body physiology changes as her hormone levels start to change in their 40’and 50’s.

Did you know, for example, that a women’s cholesterol is higher in the first half of her cycle compared to the second half?

And that as you get older your insulin resistance increases as a women?

Let me just explain what insulin resistance is. Insulin is what opens a cell membrane so that glucose can get into the cell to fuel it. All cells need glucose, but if it can’t get in easily, then the glucose stays in your blood stream. This is called insulin resistance, and its the high blood glucose levels that cause lots of problems such as inflammation, diabetes and heart disease. So what does this mean for women in their 40’s and 50’s?

It means that the diet and exercise that worked for them in their 20’3 and 30’s no longer has the same effect, and that the body starts to store the glucose as fat, usually around the tummy and organs! So you could still be going to the gym, and eating your healthy diet but you are putting on weight.

My next really interesting find is that; a women’s body needs different types of exercise and food depending on where she is in her cycle! This is a revelation to me, because on those days in your cycle when you are tired and you just want to eat carbohydrate, you body is actually telling you to slow down, reduce your stress and fuel your body.

Which brings me to my next revelation. You either have stress hormones or sex hormones, not both. This is simply put, but if you are working all hours and not getting enough sleep, not eating the right foods, or working out too much then that acts as a stressor on your body and it produces stress hormones rather than sex hormones. So for women at a peri menopausal stage when oestrogen and progesterone levels are starting to drop, it really knocks those levels down further. Leading to irregular or heavy periods, brain fog, fatigue, hot flushes etc.

However there are stages in a women’s menstrual cycle when they can cope with some stress and exercise better and it can actually improve your oestrogen production. This is at the beginning of the cycle, not long after you have started your period. And this is because oestrogen thrives on strenuous exercise. This is because the hormone needs to be moved around the body, otherwise it can sit, usually in your breast area leading to breast tenderness. This stage lasts until ovulation in the middle of your cycle and then for a few days after. But the week leading up to your period is when progesterone needs to be rising. Progesterone needs reduced stressors and regular good sources of carbohydrate. So this is the time to relax, and take pressure off yourself. Then your period will start on time and reduce the spotting just before.

In the middle of a women’s cycle there is a peak of testosterone. This helps you build muscle so its a good time to use weights in your exercise. Using weights at this point of your cycle will produce much bigger results than if you lifted heavy weight at other stages in your cycle. Muscle mass as you age is important because it increases insulin receptors reducing that insulin resistance affects on the heart and other organs and also improves strength and flexibility reducing pain from arthritis and osteoporosis.

So instead of having a weekly or daily routine for exercise, as women, we need to have a monthly cycle so that some weeks we can really push ourselves to get out of breath, and other weeks to lift more weights and then really slow down at the end of our cycle. This means we are augmenting our hormones rather than fighting them.

There is so much I could on with, as I haven’t started on fasting yet and how that affects our hormones, but I think I will have to put that in my next blog. To find out more all this information this is the work of Dr Mindy Pelz. She has written ‘Fast Like a Girl’ and ‘ The Menopause reset’ which are really helpful books to read. You can also listen to Dr Ragan Chatterjee’s interview of her, on his podcast ‘Feel Better, Live More’

I would be interested to hear your experience of diet and exercise and your hormones. So please get in touch @felicitybooty

children, health, pain, parents, Pregnancy

Our Bodies and Trauma, Shock & Accidents

felicitybooty

Trauma is commonly associated with catastrophic events or long term abuse. These events will surely leave someone vulnerable to trauma, but everyday occurrence like a fall, a medical procedure or a bump in a car might also cause a trauma response that leads to long term symptoms and loss of resilience. This is because trauma is not the event. It’s the way the body’s nervous system perceives, processes and assimilates the event.

If the body perceives an event as threating, a fear, flight, fight response is initiated. This mobilises the body to get away from a threat by pumping large quantities of adrenaline throughout the body. We are all familiar with this sensation of a racing heart and shaking, and in our children they cry, scream, shake, flush red or go pale etc. This burst of energy is not something that can be rationalised in the moment, but if ignored or controlled rather than released, then the process won’t complete, and that energy will stay ‘stuck’.

Then there is the ‘freezing’ response to trauma or fear. This again is when the body is overwhelmed with fear, but instead of mobilising to run, the body stops, collapses, the mind dissociates, because it can’t process what is going on. We can see this in the wild when animals ‘play dead’, to try to evade being eaten. In humans we see it when we have been exposed to a traumatic event but they act like nothing is wrong. Or when someone is very quiet after an accident and they just aren’t quite here.

I describe these two states, because 1) There is a lot you can do to help the people around you, so they can complete the cycle of trauma, rather than it staying in the body, especially children 2) As an osteo, health often means helping patients resolve their body responses to trauma. For example, Mothers, fathers and babies that have been through a shocking birth or their entrance into the world did not go to plan, meaning that the start of being a family is very different than they expected. I see children that are exhibiting hyperactive type symptoms, but actually allowing their bodies the release a fight, flight response means they can regulate better. And children who can not tolerate sound and changes in their lives because they have an overwhelmed nervous systems that has ‘frozen’.

First Aid for Accidents and Fall

This is taken from a book call Trauma-proofing your kids by Peter Levine and is a great read for any parent. Making yourself familiar with how shock and trauma is processed will enable you to help when the time is needed. This ensures a completion of the physiological cycle, rather than it getting stuck.

  • Attend to your responses first. Take time to notice your own level of fear or concern. Take some good full breaths, and as you exhale slowly, sense the feelings in your own body until you are settled enough to respond calmly. An overly emotional or dismissive adult may either frighten the child or shut down their fear response so it cant be released.
  • Keep your child still and quiet. Because your child’s body is surging with adrenaline this maybe difficult. Use a firm confident voice with a ring of authority that conveys a loving manner, that you are in charge of protecting them. Keep your child warm with a jumper or blanket and dont let them move on their own.
  • Encourage plenty of time for safety and rest. This is particularly true if your child shows signs of shock (glazed eyes, pale skin, rapid or shallow breathing, disorientation, overly emotional or overly flat expression or acting like nothing has happened) Do not allow them to jump up and return to play. Help your child know what to do by modelling a relaxed, quiet, and still demeanour. You might say something like “After a fall, its important to sit (lie) still and wait for the shock to wear off”
  • Hold your child. Avoid clutching tightly, as well as excessive patting or rocking, as it may interfere with natural bodily responses. In older children its suggested that you place a hand on their back or upper arm near the shoulder. A warm ‘healing hand’ can help your child feel grounded as your calmness is directly communicated through touch.
  • As the shock wears off, guide your child’s attention to his sensations. The language of recovery is the language of the instinctual brain-which is the language of sensation, of time and of patience. Just as touch is important so is your tone. Softly ask you child how they feel ‘in their body’. Repeat his answer as a question – “You feel okay in your body?” and wait for a response or nod. Be more specific with the next question ” how do you feel in your tummy (head, arm, leg etc)?” If he mentions a distinct sensation, gently ask about its location, size, shape “colour” or “weight”. Don’t worry about what these sensations mean; the important thing is that your child is able to notice and share them. keep guiding your child stay in the present moment with questions such as “how does the rock (sharpness, stingy, ‘owie’ feel now?”
  • Allow one or two minutes silence between questions. This may be the hardest bit for parents, but its the most important part for your child. This allows any physiological cycle that maybe moving through your child’s system to release the excess energy and move towards completion. Ques that the cycle has finished include a deep. relaxed spontaneous breath, the cessation of crying or trembling, a stretch a yawn, colour coming back into the face, a smile, an orientation to surroundings or making eye contact. Wait to see if another cycle begins or whether it’s time to stop. keep in mind there is a lot happening in your childs nervous system that maybe invisible to you.
  • Do not stir up a discussion about the accident or fall during initial first aid. It’s best not to ask questions to alleviate your own anxiety or curiosity. The reason for this is that the ‘story’ can disrupt the rest period needed for the discharge of excess energy that was aroused. Telling about it can wind kids up. After the release happens, your child may wish to tell as tory about it or draw a picture. Refrain from shaming statements such as “I told you that you would get hurt playing on those stairs”
  • Continue to validate your child’s physical responses. Resist the temptation to stop your childs tears or trembling. But keep contact with them, reminding them that what ever has happened its over and they will soon be okay. In order to return to equilibrium your child’s discharge needs to continue until it stops on its own. Your job is to use a calm voice and reassuring hand to let your child know “It’s good to let the scary stuff shake right out of you”. The key is to avoid interrupting or distracting your child, or holding her too tight or moving too far away.

Uncategorized

COVID update January 2022

felicitybooty

10th January 2022

High infection rates mean caution is required to keep the practice open. I have reviewed my infection control policy and feel that the level of PPE, cleaning and ventilation of the room should still remain the same.

If you have any symptoms please call to rearrange your appointment. If you have had close contact with someone with COVID, please either cancel your appointment for 10 days or I will need a negative PCR followed by negative lateral flows on the subsequent days since the PCR.

Uncategorized

Covid Procedures

felicitybooty

COVID-19 clinic policy and procedures.  Infection risk assessment and mitigation

This document provides a written record of the heightened infection control measures that this clinic has put into place to ensure the safety of all staff and patients during COVID-19.

This risk assessment and mitigation record has been undertaken in conjunction with review of the iO’s guidance ‘Infection control and PPE’ and ‘Adapting practice guide’.  In this document you will find the following:

Table 1: This is an overview of the measures we have taken that will form your clinic policy for operating during COVID-19 and available to all staff and patients.

  • Table 2: Areas assessed for risk and mitigating action taken. This records in detail the areas of potential risk we have identified and record of the mitigating actions we have taken and when.
    • Table 2a – Protection for staff and patient before and when in clinic
    • Table 2b – Heightened hygiene measures
  • Table 3: PPE policy for staff in your practice
  • Table 4: Details of how I have communicated to patients our policies

We have assessed our practice for risks outlined and put in additional processes as detailed below  

Undertaken a risk assessmentAs of 11th May 2020, I have undertaken a risk assessment of my practice. All patients will be triaged over the telephone to assess for symptoms of COVID 19 in the patient, in the patient’s family, or whether they have been in contact with someone with suspected/confirmed COVID 19 in the last 14 days. Screen for extremely clinically vulnerable patients, or a member of the patient’s family is considered clinically vulnerable.    
Heightened cleaning regimesAll Hard surfaces will be cleaned before and after each patient, including chairs, door handles, plinth, pillows, card machine etc. Treatment times staggered to give time to clean the room between appointments. Aeriation of the room: leaving the window open during and after treatments.  
Increased protection measuresAll linen has been removed from the treatment room. Practitioner will have bare arms up to the elbow and will wash hands and arms with soap and water for at least 20 seconds or use hand sanitiser gel. Practitioner to wear mask, gloves, and either plastic apron or change clothes between each patient. New pedal bins for deposing of waste between patients All toys and books removed from treatment room and waiting areas. Each patient will be offered 70% alcohol hand gel before and after treatments. The practitioner will open and close all doors for the patient.  
Put in place distancing measuresPatients will be able to wait in their cars until the practitioner calls to say the room is ready for them. No other people will be in the hallway before or after treatments. The patient will come alone, and only bring what they need for the appointment. Patients asked to arrive close to their appointment times as to minimise contact with other patients Treatment times staggered so patients don’t come into contact with each other.  
Providing remote/ telehealth consultationsTelephone consultations and advice available
(Document last updated: 3/11/2020)  
Table 2a. Protection of staff and patients before they visit, and when in the clinic. We have assessed the following areas of risk in our practice and put in place the following precautions to
 Description of riskMitigating actionWhen introduced
Pre-screening for risk before public/patients visit the clinic  Patients coming to the practice that have COVID 19 symptoms   Patients in vulnerable category that need a treatment and therefore putting themselves at risk.   Patients coming to the clinic and not being aware of the risk of coming.   Patients coming to the clinic and putting other members of their household at risk or other people they are shielding. •  Triaging patients over the telephone in the first instance to see if advice can alleviate symptoms.  Case history can be taken over the telephone to consider whether a face to face consultation is needed.
• If face to face consultation is needed the screening for symptoms of COVID 19
• Screening for clinical vulnerable patients. Clinically vulnerable people are those who are:
I .aged 70 or older (regardless of medical conditions)
II. under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab each year on medical grounds):
III. chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
IV.    chronic heart disease, such as heart failure
V.           chronic kidney disease VI.          chronic liver disease, such as hepatitis
VII.         chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), or cerebral palsy
VIII.        diabetes
IX.          a weakened immune system as the result of certain conditions, treatments like chemotherapy, or medicines such as steroid tablets X.            being seriously overweight (a body mass index (BMI) of 40 or above)
XI.          pregnant women
•             Screening for additional respiratory symptoms or conditions e.g. asthma, hayfever etc
•             Screen to see if other members of the family have symptoms of COVID 19 or are in a high-risk category i.e. shielding. •             Have they been in contact with someone with suspected/confirmed COVID 19 in last 14 days.
•             Communicate the risk of face to face consultation – document that the patient has been informed and that they are not experiencing symptoms. •             Communicate process on arrival in clinic: patient needs to stay in their car until called, they will be given hand sanitising gel on arrival.  Practitioner will open and close doors. NB: All triage pre-screening information will be documented in the patient notes.		11th May 2020
Protecting members of staff PPE to be worn by practitioner for treatments, detailed below in table 311th May
Confirmed cases of COVID 19 amongst staff or patients?A patient who has visited the clinic experiences symptoms of COVID 19 after their appointmentShould a patient advise me that they have symptoms of COVID-19 after visiting the clinic in line with government guidance. 11th May
Travel to and from the clinic  Patients need to use public transport to the clinic Patient need a chaperoneThis is a low risk for my clinic as most people can walk or come by car. If possible the chaperone will be asked to wait in their car, if they come by public transport then they can wait in the hallway or outside if the weather is nice.11th May
Entering and exiting the building Reception and common areasPatients will not be able to social distance if they meet in the hallway between appointments.               Patients will have to touch more surfaces if they must go into the bathroom to wash their hands before and after treatments  Patients will wait in their car until asked to come in.   Patients will be asked to arrive close to their appointment time so that they are not kept waiting long.                 Patients will be given alcohol gel before and after treatment at the entrance door 11th May11th May
Social/physical distancing measures in placePatients may still meet outsideAppointment times will be staggered to allow for one person to leave before another arrives3rd April 2020
Face to face consultations (in-clinic room)Minimise close contact during face to face consultationsIncrease distance initially in treatment room. All treatment techniques are gentle and do not increase droplet production. Practitioner will look away from patient if its not necessary to look at them e.g. when not talking.11th May
Table 2b Hygiene measures We have assessed the following areas of risk in our practice and put in place the following heightened hygiene measures
 Description of riskMitigating actionWhen introduced
Increased sanitisation and cleaning  Areas that are difficult to clean between patients.
Touch points are potential areas of cross contamination		Clinic decluttered, all linen, toys and books removed.  Pillows and plinth covered in plastic. All hard surfaces wiped clean after each patient including door handles and chairs. Practitioner to open and close doors for patient11th May
    Aeration of rooms  Droplets in the air from the patient contaminating room    Leave windows open during and after treatment.    11th May
Staff hand hygiene measures Cross contamination to patient and from patient.Practitioner will wash hands and arms for at least 20 seconds before putting on gloves for treatment and again after.3rd April 2020
Table 3. Personal Protective Equipment: Detail here your policy for use and disposal of PPE
Clinicians will wear the following PPE  Single-use nitrile gloves and plastic aprons with each patient
Fluid-resistant surgical masks (or higher grade)  
When will PPE be replaced  When potentially contaminated, damaged, damp, or difficult to breathe through. At the end of a session (4 hours), or sooner if needed to be removed
Patients will be asked to wear the following PPEPatients will be asked to wear face coverings as per government advice to wear face coverings in places where social distancing is difficult.
PPE disposalNew foot pedal bin for treatment room to dispose of PPE and paper on plinth. Double-plastic bagged and left for 72 hours before removal, keeping away from other household/garden waste, and then this can be placed in your normal waste for collection by your local authority. Cloths and cleaning wipes also bagged and disposed of with PPE
Table 4. Communicating with patients: Detail here how you will advise patients of measures that we have taken to ensure their safety and the policies that have been put in place in our clinic
Publishing your updated clinic policyAvailable on website  
Information on how you have adapted practice to mitigate riskAvailable on Website
Pre-appointment screening calls24 hours/morning before a scheduled appointment, practitioner will either call, text or email to confirm that they are well, their household is well and they have not been exposed to the virus    
Information for patients displayed in the clinic Notices displayed for hand washing, hand rubbing with gel. Notices informing patients that they cant be treated if they have symptoms of COVID 19
Other patient communicationsVideo on facebook page
Pregnancy

Antenatal workshop, Body Awareness using Breath and Movement

felicitybooty

My work with pregnant women and babies, has really open my eyes to the whole process of conception to birth and beyond.  The women and children that thrive within this process, seem to be the ones that feel empowered and connected to what’s happening.  I don’t mean studying and reading books and magazine about pregnancy and self-help books for bringing up your child, I think these only highlight how different and complex every pregnancy, birth, and child is.  I mean being aware of what is actually happening, what feelings this pregnancy is bring up and being kind and accepting of those sensations and emotions.  It can be the most challenging thing you have ever done, so being open and flexible to what might happen, enables women to feel empowered and take time to make choices and decisions that have to be made during pregnancy and birth. Doing what right for them, not what everyone else may be doing.

One of the tools that I teach many of my patients, not just the pregnant ones, is breathing.  I know, I know, we are all breathing all of the time and we don’t give it a second thought. But the way we breathe reflects the emotions that we are experiencing.  For example when we are calm, and safe, we tend to use our diaphragm to breathe.  This is a big muscle in between our rib cage and abdomen.  When we are using it we can see and feel our abdomen expand with each inhalation and flatten when we breathe out.  When we are exerting ourselves, with exercise, or stress we tend to use our ribs and shoulders more to draw our breath in, so the movement is felt in our chest.  This sort of breathing tells our body to be ready for action.  This can be exhausting on the body if it turns into a long-term breathing pattern.

If we flip this around, if we are feeling stressed, and are breathing up into our chest and shoulders, and we stop and spend a few moments concentrating on breathing into out abdomen, then it tells the body to slow down, lowers your heart rate, massages your gut, and tells your body you are safe and in no danger.  This allows the feelings of stress, whether it is being over whelmed, out of control, panicked to subside.

We are programmed to give birth in a safe place.  If our body/mind starts  experiencing fear then the birthing process will slow down.  By using deep diaphragmatic breaths during labour, it calms the central nervous system, and encourages the softening and opening in the pelvis.

In order to help more women during their pregnancy and birth, I have started an exploratory workshop, where women can come and give themselves some dedicated time to experience how breathing can help and how a birthing ball can aid that.

I am definitely not a midwife, and the body awareness skills I am teaching, are an addition to the support your Antenatal sessions are providing.

Next workshop Thursday 23rd Feb at Edington village hall, then fortnightly after that. 6.30pm-7.30pm.

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