My Night As An Insomniac

January 24, 2016 Dr Preeya Alexander

I totally 100% completely and utterly understand sleep troubles.

I’ve had those nights where I slept 30 minutes maximum.

My mind ran a million miles an hour with thoughts:

“Why can’t I fall asleep?”
“What’s the time now?”
“Should I check the clock or ignore it?”
“How many hours of potential sleep left?”
“Should I get up?”
“Should I read?”
“Will I survive tomorrow?”

I literally lost my mind.

I heard the birds start singing at 530 in the morning.

I heard my husband’s not so gentle snore ALL night.

I moved the pillow one thousand times and none of the positions I tried were comfortable.

I PANICKED! I now understand the term cold sweat because I had one!

I have so much empathy for people who have trouble sleeping, for the anxious souls who can’t switch their brains off. When a patient comes into my room and breaks down saying “I haven’t slept properly for ages” – I feel like hugging them and saying “Oh my gosh I know the feeling! You feel like you’re going crazy!” – and sometimes I do just that and I see the patient’s immediate relief!

Sleep hygiene is a massive area in medicine now – and after my recent horrendous night practiced VERY HARD what I preach to my patients. I wound down, I stopped watching TV in the hour before bed and I stopped all caffeine after midday. I started my hour before bed with a warm shower and had a milo – yep adults can drink it too – before I headed upstairs to bed.

Trust me – if you develop a routine – if you do it much the same every night and train your body to expect sleep then sleep quality does improve.

It’s all about preparation. Avoid things that wake your brain up (TV, computer, iPAD) in the hour before bed and if you’re in bed for 30 minutes tossing and turning – get out!!! Go into a chair and read for a bit – don’t just lie there!

Try progressive muscle relaxation – where you squeeze your feet first then relax, then your calves, then your thighs, keep going up each muscle group until you get to the face. Try soothing background noise from an app like sounds of rain or the forest. Try focusing just on your breath in and out – counting a slow 1, 2 for the breath in then the breath out. Try anything that works for you… but whatever you do – DON’T PANIC!

The Lies of a Pregnant Lady

January 20, 2016 Dr Preeya Alexander

The first trimester is tricky (for so many reasons) but I found trying to act like I wasn’t pregnant and not being able to share it really tough! Having survived it (whilst lying through my teeth) I thought I should share my top 5 lies for trying to survive the first trimester without drinking. There will be pressure to “just have a drink” and don’t mind those sneaky glares and whispers of “is she pregnant?.” To avoid that I manipulated my medical knowledge to make the excuses fool proof and now you can use them too!

“I’m on Metronidazole for a tooth infection”

This baby (excuse the pun!) was my ‘go to’ and worked on groups of doctors at social events who bought the story hook, line and sinker. Metronidazole is an antibiotic that is often used in severe dental infections – you can’t drink on it for 2 reasons: firstly you get very sick and vomit and secondly it can cause major liver issues. So it’s the perfect reason as to why you can’t even TOUCH alcohol.

Hot tip – you need to pretend your tooth is a little bit sore! I forgot to do this and it makes you look a little stupid!! So pick a tooth and don’t forget to feign the pain now and then – and ideally don’t order a chewy well done steak for dinner (again – a double mistake I made: you don’t eat steak with a sore tooth and secondly, who has their steak well done other than a pregnant woman?).

“My GP said my liver tests were a bit off and to avoid alcohol”

This is not uncommon. Fatty liver is a major problem with alcohol use, obesity and poor diet. So it’s not uncommon for me to tell my patients to lay off the booze and change their lifestyle so we can recheck the liver. You can easily use this – strict no alcohol until your next liver test which might be 4 or 8 weeks (whichever suits to get you to the ‘safe’ telling period!).

“I’m doing dry [insert whatever month it is]”

Stick to your guns. People will try and guilt you into drinking – but just be firm – you are trying to do a health kick. You can only use a reason for so long – so you need to be creative and mix it up – I used this one once I was near the time when I could tell people just to buy some extra time.

Glass swap

Get your partner or friend (who is in the know) to subtly swap wine glasses with you at social functions. Hold something and pretend to take sips and then subtly pass it to your accomplice who can finish the drink. Trust me – once the non-sober people are lubricated on a dance floor you can stop faking – they just won’t notice anymore!

“I’m pregnant you annoying idiot!”

If you’re just getting pestered and there’s no way around it (trust me, there are some moments when you just can’t avoid it) perhaps you need to tell some close people. It depends on how comfortable you feel with that plan and the people – but always an option!!

Good luck ladies!!! May you lie through your teeth and survive the first trimester – P.S good luck hiding the vomiting if you’re lucky enough to have it! More tips on nausea management in early pregnancy to come soon!

Also – I hear you asking – “what’s with the photo and how does this relate to the post at all?” – well I found once I was over the first trimester (the nausea, the lies and the anxiety of miscarriage) I was ecstatic – reflected in this photo – so there you go!

Read This Before You Give Advice to a New Mother

November 16, 2015November 16, 2015 Dr Preeya Alexander

Posted by a newly pregnant woman (me) whilst on holidays- hence the photo!!

Recently a patient of mine, who was a new mother, came into my rooms and broke down after being approached in a cafe by a stranger whilst bottle feeding her child. An elderly woman, probably well-meaning, came up and asked her if she had issues breast feeding and ‘ oh what a pity it was that the baby was on the bottle already.’

Cue the look of shock/horror on my face, which I quickly had to hide because I didn’t want the patient to know I was utterly flabbergasted by this other woman’s highly intrusive comment into her life.

Wow – where’s the boundary? When you see a woman with a child you have NO idea about her story. You don’t know if the child was conceived accidentally on a holiday or if time and thousands of dollars were saved, borrowed and hidden away to pay for the medical bills to conceive him or her. You don’t know if the mother’s birth was so easy she sneezed and it was done, or so traumatic she needed too many stitches and the obstetrician lost count. So how can we, as a complete stranger, pass judgement or give advice?

The truth is when we look at a mother and baby we know nothing about their story.

To the woman breast feeding in the park – go for it – good on you! The immune benefits to your child are fabulous. But by the same token if you are bottle feeding (out of preference, because you had supply issues, because your nipples were scratched and looked like a war zone, because you had to go back to work at 3 months to support your family and breast feeding wasn’t feasible) – good on you too, you are feeding your baby and doing a bloody amazing job.

Both women are trying their best. Both women are feeding their children. And both women are nailing motherhood.

Let us stop the judgement and celebrate mother’s for all the amazing things they are doing and trying to do. And if you have a comment or piece of advice PLEASE (oh pretty pretty please) ask if this under slept, exhausted women who has a child requiring her attention for its every single need wants to hear it.

What Makes Us Exercise?

September 27, 2015September 27, 2015 Dr Preeya Alexander

Social media is flooded with people who love to share their love of exercise, pictures of their own abs and their ability to run long distances with fluorescent shoes and matching tights. I always feel overwhelmed – gees I don’t have a six pack to flaunt and I don’t have a this elusive ‘thigh gap’ all the fitness gurus rage about.

But does this mean I am not fit? Does this mean that I am not healthy? And most importantly does this mean I don’t exercise enough?

I’m sure at some point you have felt inferior to someone who talks about how healthy and exercise driven they are. I have.

The truth is – you don’t need to be stick thin and an exercise junkie to be healthy. And certainly the Australian National Heart Foundation Guidelines are happy with adults achieving 150 to 300 minutes of exercise per week so why isn’t that enough?

We need to stop seeing exercise as a burden. We need to stop trying to compete with our own brains and its major goals its puts on us (e.g. ‘I want to be able to run 15 kilometres in the next 6 weeks’).

We exercise to maintain a healthy weight and prevent obesity. We exercise to reduce our risk of having a heart attack or a stroke. We exercise because evidence has shown it is good for mental health and is beneficial in conditions like Depression. It’s also helpful in fibromyalgia (a disorder where people suffer from diffuse muscle pain and fatigue). We exercise for OURSEVLES.

I don’t see it as a burden anymore. When I walk my dogs with my husband it’s about us all being healthy and getting some activity into our day. When I have a quick 30 minute kick boxing session on the verandah before dinner its because I need to build up my minutes of exercise for the week and because it will make me feel better about my day.

I think about banking my exercise – I need to make it to 300 minutes (as per the National Heart Foundation guidelines) by Sunday so every minute I do gets banked towards it. THAT is MY motivator.

I’ve stopped trying to measure up to the unrealistic expectations of fitness in the media– I don’t need a six pack to know I am healthy. I don’t need to be a size 6 to know that I am doing enough.

Its not for anyone else – its for you.

Build exercise into your life in whatever capacity suits you- whether its walking the dogs, swimming, pilates, cycling…. And make sure you are doing it for you – and for the right reasons – the six pack might be the unexpected outcome of your exercise endeavors but it is by far the least important – it’s the benefits to your health that count!

You Can Make Friends with Salad

September 27, 2015October 7, 2015 Dr Preeya Alexander

Ahhh the 2 fruit and 5 serves of vegetables a day – it causes so much discussion – “how could I possibly fit this in my day” and “why do I need so much?”

I’ve asked the same questions but the truth is – it makes a difference and as a Doctor I harp on about this every single day to my patients. Eating more fruit and vegetables helps to maintain a healthy weight and prevent obesity. It also protects against chronic diseases like cardiovascular disease and can help the prevention of diabetes. When I tell a patient “look if you bump up the fruit and veggies you can lower your risk of diabetes, heart attack, stroke and bowel cancer” – I anticipate excitement “oh yes, tell me how I can change my life please!!” but I am so often met with resistance “its so hard” or “I don’t have the time.”

The numbers sound big – 2 and 5 but really they are achievable I promise.

A serve of fruit is equivalent to an apple or banana or a cup of canned fruit. A serve of vegetables is equal to 1 cup of raw veggies or half a cup of cooked green veggies like spinach or broccoli. Canned and frozen fruits and veggies count (thank goodness).

So how do I do it? I whip up a soup most weeks for lunches and easy on the run dinners – canned tomatoes, fresh tomatoes, carrots and celery whipped together – easily my 3 serves of vegetables at lunch time. Tuna salad for lunch with 2 handfuls of baby spinach and a medium tomato and a tuna can chucked in at work – and done – another 3 serves of vegetables easily. A tub of no sugar added fruit as a snack or fruit and yogurt and I easily fit in the 2 serves of fruit.

The point I’m making is its possible – when your packing the lunch box (for you or your kids) chuck in a piece of fruit or do a massive soup batch on your free night of the week and let that fill you with you veggie intake. Don’t forget lentils and legumes are vegetables too – whip up a hommus or chuck in some beans when you next do a meat dish…

The way I do it is to plan ahead and to put all the veggie requirements into a meal and THEN think about the other stuff like the piece of baked chicken or cous cous on the side. Let the veggies be your first thought – not the steak! It’s a mind set change – but its one that we as a country have been very poor at doing!

The benefits are amazing and when you think of all the benefits I mentioned before- 2 and 5 doesn’t seem like much at all!

Can Exercise Adapt To You?

September 21, 2015September 21, 2015 Dr Preeya Alexander

I’ve never been able to go for a run. I’ve tried. But I don’t really get it. I find myself over analyzing the process thinking – “oh my goodness – how long could I possibly do this for?” “Why do my knees hurt already?” “What am I meant to be thinking about at this point to keep going, am I meant to think at all?”

My husband on the other hand loves a run –so do most of my friends. I’ve always wondered – am I the weird lady who doesn’t like running? But judging from my patients’ experiences – I am not alone!

I’ve finally accepted that its OK I cant and don’t like running! I’ve stopped trying to put the square piece in the circle hole – it aint gonna fit!

Put me on a pilates reformer and I can do hundreds like the best of them. Put me on a bike in a spin class or my beloved red bike fondly named “Clancy” and I’m happy to cycle for hours.

I often find patients telling me they have trouble with exercise because their joints hurt when they run or that they don’t like gyms. I’ve negotiated with morbidly obese patients what exercise they can do – yes, you can go for a gentle stroll and if you feel confident to hop into bathers or a big t-shirt then hydrotherapy is fantastic for exercise and your joints. The truth is we can ALL find some sort of exercise that suits us and we just need to the adapt the exercise to our joints/lifestyle/preference.

If you have sore joints or tight iliotibilal bands (like ME!) try cycling, swimming or pilates. If you don’t like gyms try cycling, walking or hiking. If you don’t like exercising alone because you can’t get motivated go for class fitness like a spin class or join an outdoor exercise group for their program.

Find something that suits. Trust me, you don’t need to learn the hard way like me – with sore knees and a real bitterness towards running and my poor husband after he tried to make me give it a go!!

Find something that works for you. I promise you there is SOME sort of exercise that fits for you!

The Sadness of Social Media

September 27, 2015September 27, 2015 Dr Preeya Alexander

I can’t tell you how sick I am of seeing patients, friends and even celebrities bullied on social media.

Why is it that when we are talking to someone face to face we don’t comment on their weight, how big their teeth or how annoying their pictures on their social media are. And yet when we can leave a comment or press a button to show our distaste we gain a new sense of courage – we feel we can kick the person over the letters of the keyboard. Facebook introducing a ‘dislike’ button for posts makes me incredibly sad – so we are now promoting negative feedback? What happened to “if you have nothing nice to say, say nothing at all?”

When a young person comes into my room with stress or mental health issues – more often than not social media has some role to play. The vulnerable young soul in front of me feels inferior, bullied, worthless. I wish I could say this was rare – but I see this far too often, and it makes me a scary combination of sad and angry.

More needs to be done. It’s not just kids its adults too. Adults are quick to leave a comment on Instagram “gross” or “you look fat in that” – have these people EVER thought of the implications of their nasty damaging comments?

I don’t have children yet but from my experiences as a GP I am bloody scared of social media in my future child’s life. What age do you let them have access? How do you police it? How do you check they are not being bullied? And even worse how do you check THEY are not the bully?

Yes social media can be great – but in the wrong hands it can be devastatingly destructive.

Chewing the Fat

September 27, 2015 Dr Preeya Alexander

Cholesterol- should you get it checked? Why do we care?

Every day I deal with patients who have high cholesterol and I feel like most of the time I am trying to convince patients to be worried about it – I’m worried as your doctor so why aren’t you?

People think because its common in Australia, that’s its OK – “Ohhh well my dad and grandpa have high cholesterol… it was always going to happen to me.” That may be – yes, high cholesterol can be genetic -BUT there are lots of things you can do to manage your cholesterol other than taking tablets.

Diet is the main area you need to focus on and here are stop key tips to help – pick a few you can do – because any will help your cholesterol.

Avoid fried foods and saturated fats (like butters and creams). Try to eat reduced fat cheese, milk and yoghurt.
Be careful with your take aways – avoid fried foods – try and opt for a fresh sandwich, sushis or salads. Treats like pizza, fish and chips are sometimes foods – which means NOT every day.
Aim for 2-3 fish or vegetarian meals a week – reducing the amount of meat can help to lower cholesterol.
Plant sterol enriched products (there are margarine brands which are labeled) can lower the cholesterol by up to 10 to 15%. If you are using butter, stop and use this instead because it may help!
Aim for the 5 and 2 vegetable and fruit serves respectively daily – don’t forget there is good evidence behind this and it will most definitely help your cholesterol.
Medication can be an option and lower certain cholesterol parameters by half – but only certain people qualify for this on the PBS in Australia and we try to make people change their lifestyle given this can make a big change before we start prescribing tablets.

High cholesterol increases risk of stroke and heart attacks – 2 big killers in Australia. So if you think having high cholesterol is “normal” – you are mistaken – it’s a killer and there are lots of things you can do to bring the numbers down.

Take a look at your diet – and tell me – can you afford to cut the fat somewhere?

Stressing about Stress

September 27, 2015October 7, 2015 Dr Preeya Alexander

Sometimes I wonder if I stress because I think I should be stressed. You have an upcoming exam or presentation and you know you should be stressed so you work yourself into a frenzy thinking “well Im meant to be stressed, I feel stressed, oh my goodness I’m stressed” – and just like that you are freaking out! Some degree of stress can be helpful and some people find this drives them – but there can be a point when it’s no longer helpful.

So what can we do to manage stress? How do we keep the mind calm and manage that rising fiery pit of stress and anxiety in our stomach?

The truth is I can’t give you a concrete answer because we are all different but I can share some tips that I share with my patients a lot of the time:

Regular physical activity is key – I do harp on about this a lot but the truth is regular physical activity can do a lot to manage stress. Yes, its great for your cardiac health but its also great for the mind. So despite feeling like the stress levels are climbing and you don’t have time for exercise – you always do and it will help!
Yoga/meditation – anything that gives your body and mind some down time.
Avoid caffeine and alcohol – there can be a tendency to use these types of substances to ‘self medicate ‘ but it can worsen stress – and if you feel stress levels climbing then I tend to avoid both of these.
Write lists and sort out the things that are stressing you – stressed because you have an exam coming up and you feel under prepared – start building in more study. Stressed because you feel like you cant balance the kids, work and life – write down things you could do to get some help- do you need to call on more family or friend support? Avoiding what is stressing you doesn’t make it go away – acknowledge it and start finding ways to deal with it!
Sleep – make time to let your body relax – sleep abates stress.
Accept some level of stress – remember when the cave man was chased by a lion he was most certainly stressed and ran super fast and thats what saved him. Stress is helpful so harness some of it – but don’t let it get the better of you!

So theres some of my tips – see if some of them work for you! If you’re feeling stressed just reading this then I’m sorry! But maybe its time to start managing those stress levels… Good luck!

The Sun – Friend or Enemy?

September 24, 2015September 27, 2015 Dr Preeya Alexander

Its hard to get the right balance of sun – too much and you are at risk of skin cancer – too little and you risk Vitamin D deficiency. Most of my patient’s struggle with the balance, and if I’m honest I do too!

Being deficient in Vitamin D is a problem – it can be a factor in osteoporosis and now we know it can also lead to muscle fatigue – so when you exercise you feel tired much more quickly. We don’t routinely test blood Vitamin D in Australia anymore because it’s not cost effective – so don’t go asking to get your Vitamin D checked unless you’re willing to pay for the test! Pregnant ladies, people with osteoporosis and dark skinned people (brown bears like myself because we don’t absorb vitamin D very well) are high risk and will usually be tested – but for everyone else its about trying to boost your levels WITHOUT copping a skin cancer.

The guidelines suggest 20 minutes of sunlight in summer and 40 minutes in winter (good luck with winter sun!). This means having SOME skin exposed to the sun – preferably arms and legs so you absorb the Vitamin D. Going for a short walk with some skin exposed is ideal – get your vitamin dose and do something physical – win win!!!

BUT what you don’t want to do is rub yourself in baby oil and lie in the sun baking – that’s when skin cancer starts creeping in. And when I see 20 year olds with melanoma my heart cries – this is something COMPLETELY preventable!! I don’t think I will ever understand lying in a solarium or on the beach with no sun cream when there are people in their 30s with melanoma that has spread throughout the body likely to be the cause of their death.

I love the sun! There’s something special about sitting with the sun on your back with a book/glass of wine/lunch/friends. It’s just about achieving some sort of balance!