“I still get nauseous the day before and have weeks of incredible anxiety” – Joaquin Phoenix, on his role as the Joker

Everyone is familiar with what anxiety feels like. It’s the physical and mental uneasiness you feel just before an exam, a date, an interview or a speech. It can manifest in different ways for different people; for some it’s a short-lived fight-or-flight response but for others it has become a part of daily life, floating in the background. What this means is that anxiety is healthy, and sometimes beneficial, but when it lingers and limits us it can be an unwanted anchor that is as damaging as any physically-impairing condition [1]. 

Not only can it cause psychological stress, but it can also reveal itself in physical signs [2]:

• Headache
• Nausea
• Sweating
• Increased heart rate or palpitations
• Shortness of breath
• Tremor 

It’s no surprise, then, that anxiety and fear are closely related: both are emotions and a response to a real or perceived imminent threat. However, fear is generally described as a response to a short-term threat and specific to a trigger that you would rationally consider to be hostile (take the classic example of a lion chasing the nomadic hunter). On the other hand, anxiety is this reaction but stretched out – it can be a response to a vague threat in the future that may or may not happen, and the thought of escaping that threat can be as vague as the threat itself [3]. 

What are some causes of anxiety?

Aside from some obvious psychological causes, there are 2 you should consider:

Diet

• Coffee – A common culprit people find is caffeine – it doesn’t just keep you awake. It can also put your alertness into overdrive causing undue stress [4]
• Skipping meals, not drinking enough water or not eating fruits/vegetables – can cause your body to stress about the next meal and that dip in blood sugar or electrolytes can be the first domino in a chain of reactions

Vitamin or mineral deficiency

Vitamin B6 and Iron deficiency – this is surprisingly common. It’s especially common in pre-menopausal women, pregnant women or those who bleed more often (e.g. haemophilia). These two nutrients play an important role in regulating the production of neurotransmitters in your brain, such as serotonin, which is more commonly associated with low mood. These vitamins are also involved in the production of red blood cells so a deficiency will lead to anaemia, which can present in a very similar way to anxiety [5].

Folic acid – like some of the B vitamins, folic acid is involved in the promotion of neurotransmitter release and can lead to mood disorders and anxiety. A significant number of people have mutations in their MTHFR gene, a gene commonly screened in genetic tests for mental health, that leads to abnormal metabolism of folic acid [6]. In this subset of people, a therapeutic option is the supplementation of L-methylfolate. 

SUMMARY:

Anxiety and fear are closely related in that they are both emotions and a response to a threat. However, anxiety can sometimes take over your life and there are some simple ways to fix that. One such example is through a blood test to screen for deficiencies. 

For more information and advice please book  a consultation with one of our GPs today: www.gogodoc.com

References:

[1] https://oxfordmedicine.com/view/10.1093/9780195173642.001.0001/med-9780195173642-chapter-10 

[2] https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/symptoms/ 

[3] https://www.psychologytoday.com/us/blog/science-choice/201812/anxiety-vs-fear 

[4] https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/causes/ 

[5] https://www.mindbodygreen.com/0-11727/are-vitamins-triggering-your-anxiety.html 

[6] https://medlineplus.gov/genetics/gene/mthfr/ 

What is the prostate gland and what does it do?

The prostate gland is part of the male reproductive system and is anatomically located immediately below the bladder and in front of the rectum (see diagram below). A typical adult prostate is around the shape and size of a walnut and surrounds the urethra, which is the tube that runs through the penis and provides a route for urine and semen to leave the body.

The prostate gland is responsible for producing a fluid that nourishes, lubricates and protects the sperm cells found in the semen. The prostate gland’s activity is regulated primarily by a male hormone known as testosterone which is produced in the testes.  

What happens to the prostate as I get older?

As you get older, the cells in the prostate multiply, causing the prostate to enlarge. The most common cause of prostate enlargement is referred to as benign prostatic hyperplasia (BPH). The exact cause of BPH is unknown, but is thought to be due to a hormonal imbalance that men experience as they age.

Furthermore, BPH is not uncommon. According to information from the National Institute for Health and Clinical Excellence (NICE), 40% of men over 50 years old and 90% of men over 80 have BPH.

What are the symptoms of an enlarged prostate?

As the prostate enlarges, it begins to gradually compress the urethra and restrict urine flow from the bladder, which leads to a set of symptoms referred to as lower urinary tract symptoms or LUTS for short. The symptoms are briefly described below. 

• Frequency: The need to urinate an abnormally large number of times per day (usually urinating once every hour or two hours). 
• Urgency: A sudden and overwhelming urge to urinate. You may find yourself having to rush to the toilet immediately. 
• Nocturia: Waking up one or more times to urinate during the night.  
• Weak/slow urine stream: You may notice your urine stream is not as powerful as before.  
• Intermittency: An intermittent urine stream. You may notice that your urine stream starts and stops. 
• Straining: You may feel the need to strain during urination to start or maintain a good urine flow.
• Emptying incompletely: After passing urine, you may have the sensation that there is still more urine to dispel. 
• Terminal dribbling: You may experience or discover that urine leaks after you have finished urinating. This may present as stains in your underwear. 

A useful mnemonic to remember the above symptoms is FUN WISE(t).

It is important to note that not all men with prostate enlargement will have symptoms. It is possible to have all, some or none of the above symptoms. If you do experience symptoms, it is crucial to think about how these are affecting your life.

Where can I get more information about the prostate?

You can access more in-depth information about the prostate and associated conditions by visiting the following websites:

– NHS: https://www.nhs.uk/conditions/prostate-problems/

– Prostate Cancer UK: https://prostatecanceruk.org/prostate-information

If you would like to discuss your concerns or find out more about the prostate including further medical tests and investigations, please do not hesitate to book an appointment with one of our Gogodoc GPs here

Diagram reference: 

Nerd, A., 2014. 32 Label Male Reproductive System Quiz. [online] Labels Database 2020. Available at: <https://otrasteel.blogspot.com/2014/04/32-label-male-reproductive-system-quiz.html> [Accessed 16 February 2021].

A (non-exhaustive) list of strategies:

“Anxiety is the dizziness of freedom” – Soren Kierkegaard

1. Controlled diaphragmatic breathing 

As we discussed above, anxiety can show itself through physical symptoms and a major aspect of that is shortness of breath. It’s very common when someone becomes anxious for changes to occur in their breathing. They can begin to gulp air, thinking that they are going to suffocate, or can begin to breathe really quickly. This has the effect of making them feel dizzy and therefore more anxious. This is called over-breathing, or hyperventilation [1]. The first step in combating this is knowing that it happens. Next, knowing when it happens, you should mindfully slow down your breathing and use your stomach to do the work… imagine your abdomen as the pump and focus on pushing it. Take longer to breathe out than breathing in – say, breathe in for 4 seconds and breathe out for 5. A way to think about it is following a rectangle:

2. Exercise

Exercise is branded as the ‘wonder pill’, being the treatment for a wide range of ailments and rightly so! Not only can exercise reverse the potential physical complications of anxiety caused by a lack of physical activity, it can also help to alleviate anxiety. This makes sense when you think about it – it distracts your mind from external worries when all it is concerned about is keeping your heart pumping blood to your muscles and brain. Research shows aerobic exercise is especially helpful. A simple bike ride, dance class, or even a brisk walk can be a powerful tool for those suffering from chronic anxiety [2]. Why is this the case? It turns out physical activity physically changes your brain by increasing the availability of important anti-anxiety neurochemicals, including serotonin, gamma aminobutyric acid (GABA), brain-derived neurotrophic factor (BDNF), and endocannabinoids [3]. 

Exercise also works to calm the part of the brain intimately involved with fear, called the amygdala, by activating the ‘rational’ and more newly evolved area of the brain called the prefrontal cortex [4].

3. Use your five senses 

What are the five senses? These are the senses of smell, hearing, seeing, tasting and feeling. Using the five senses is a commonly used technique to trick the brain into a restful state [5] – away from the heightened sense of the surroundings and rushing thoughts. The “5-4-3-2-1” grounding method incorporates this and is simple [6]:

• 5 things you can SEE: Your hands, the sky, a plant on your colleague’s desk
• 4 things you can physically FEEL: Your feet on the ground, a ball, your friend’s hand
• 3 things you can HEAR: The wind blowing, children’s laughter, your breath
• 2 things you can SMELL: Fresh-cut grass, coffee, soap
• 1 thing you can TASTE: A mint, gum, the fresh air

It works the same way mindfulness does, so if you’re looking for a similarly effective but easier to follow method then you might find this useful.

SUMMARY

Anxiety is like fear, but it’s harder to understand and control when you’re not aware of how it works and some easy ways to calm it down. There are plenty of ways to address anxiety and the list above is not exhaustive by any means. 

It’s important to know that you’re not alone – 1 in 4 people will experience a mental health problem of some kind each year in England and 1 in 6 people report experiencing a common mental health problem (like anxiety and depression) in any given week in England [7]

Ultimately, the best treatment is therapy from a healthcare professional in this field. If you feel like your anxiety is out of control and believe you need a referral to a therapist or psychiatrist, the easiest way to do this is to contact one of our GPs who can guide you to the best person for the job. 

To seek more help and advice please book an anxiety appointment with one of our GPs today.

References:

[1] https://web.ntw.nhs.uk/selfhelp/leaflets/Anxiety.pdf

[2] https://www.health.harvard.edu/blog/can-exercise-help-treat-anxiety-2019102418096 

[3] https://pubmed.ncbi.nlm.nih.gov/28319590/

[4] https://www.jneurosci.org/content/33/18/7770 

[5] https://onlinelibrary.wiley.com/doi/abs/10.1111/nicc.12198 

[6] https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/5-4-3-2-1-countdown-to-make-anxiety-blast-off 

[7] https://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/

FEELING TIRED ALL THE TIME?

Tiredness can be defined as a lack of energy, feeling weak, or being too tired to participate in family, work, or leisure activities.(1)

We all experience tiredness or fatigue from time to time, whether it’s from a long workday, a day full of chores or a day spent running after screaming toddlers. However, sometimes we may find ourselves feeling unusually tired for periods of time with no discernible cause. We may consequently struggle to concentrate on day-to-day activities, have a low mood and feel rather sleepy.

If you are experiencing unexplained tiredness, know that you are not alone. Feeling tired/run down is one of the top three reasons for seeing a GP, and around 80 to 85% of the time, the cause will become apparent to your GP by the end of the consultation.(2,3)

While tiredness is a common symptom of several medical conditions and some serious diseases, most of the time, the cause is easy to identify and manage. This article will briefly review some of the leading causes of tiredness, covering lifestyle, physical and psychological factors.

LIFESTYLE

POOR SLEEP. Adults should be aiming to get at least 6 to 9 hours of sleep a day. Inadequate sleep will not only make you tired but can affect your ability to eat well and exercise, which can further perpetuate tiredness.

ALCOHOL. A high alcohol intake can upset sleep. Current guidelines recommended that adults adhere to no more than 14 units of alcohol a week.

CAFFEINE. While caffeine (commonly found in tea, coffee and energy drinks) can increase energy in the short term, a high caffeine intake can affect sleep and make you agitated as well as tired. You can try slowly decreasing the intake of caffeinated fluids or trying decaffeinated drinks.

Other lifestyle causes include skipping meals, a sedentary lifestyle and night shifts.

PHYSICAL

ANAEMIA. Anaemia is a condition where your body lacks enough healthy red blood cells to carry oxygen to your body’s tissue, making you feel tired and weak. Your GP can check for anaemia with a routine blood test.

UNDERACTIVE THYROID (HYPOTHYROIDISM). An underactive thyroid is when thyroid hormone production is deficient in the body, which can cause you to feel tired, gain weight and feel depressed. Your GP may prescribe daily hormone tablets if you have an underactive thyroid. 

SLEEP APNOEA. The most common type is obstructive sleep apnoea which is when your breathing stops and starts while you sleep. Sleep apnoea may cause you to wake up several times during the night which severely impacts your sleep quality.

As tiredness is a non-specific symptom, there is a never-ending list of medical conditions resulting in tiredness. These include endocrine and metabolic causes such as pregnancy and diabetes; heart and lung conditions such as asthma and coronary heart disease and side effects of everyday medications such as antihypertensives.

To find out more about medical causes please speak to one of our GPs or visit our website www.gogodoc.com

PSYCHOLOGICAL

STRESS. Long-term or chronic stress can affect us both physically and mentally. There are various strategies to help you deal with stress, including physical exercise, time-management techniques, and talking to family members, friends, or healthcare professionals.

DEPRESSION. Feeling depressed can lower your energy and reduce your sleep quality, making you feel tired. By speaking to your GP, you can discuss treatment options, including medication or talking therapies. To find more about depression and book an appointment visit our page: https://gogodoc.com/depression-gp-appointment/

ANXIETY. A common type of anxiety known as generalised anxiety disorder (GAD) is where you experience constant and uncontrollable anxiety, affecting your day-to-day activities. Find out more about anxiety here https://gogodoc.com/anxiety-gp-appointment/

SUMMARY

There is no straightforward method to distinguish between normal and abnormal tiredness, and at times there may be multiple factors that contribute to feeling tired or fatigued. If you are experiencing an unusual amount of tiredness, please do not hesitate to contact one of our GPs. They will be more than happy to discuss your situation and provide guidance.

References

1. Nicholson K, Stewart M, Thind A. Examining the symptom of fatigue in primary care: a comparative study using electronic medical records. JOURNAL OF INNOVATION IN HEALTH INFORMATICS [Internet]. 2015;22(1). Available from: http://dx.doi.org/10.14236/jhi.v22i1.91
2. McAteer A, Elliott AM, Hannaford PC. Ascertaining the size of the symptom iceberg in a UK-wide community-based survey. British Journal of General Practice [Internet]. 2011 Jan [cited 2021 Feb 8];61(582). Available from: https://pubmed.ncbi.nlm.nih.gov/21401979/
3. Tired All The Time (TATT) – General Practice Notebook [Internet]. 2018 [cited 2021 Feb 8]. Available from: https://gpnotebook.com/simplepage.cfm?ID=x20190411125959960611