I am seeing more and more patients who have been given a diagnosis of Functional Neurological Disorder (FND). It is given to those presenting with neurological symptoms like gait and balance issues, new speech problems, occasional paralysis of limbs, dysautonomia (problems with sympathetic /parasympathetic tone) and other neurological symptoms, which can be debilitating, causing fatigue, anxiety and an inability to concentrate. This is particularly significant for younger sufferers, as it can make school difficult and many are unable to attend.

From a medical point of view these symptoms are considered serious but often patients given this diagnosis have normal MRI findings and a reason for developing these symptoms is unclear.

One area that I focus on is the possibility that neuroinflammation is causing these symptoms, as neuroinflammation is hugely problematic but does not show up on blood tests, MRI or other commercially available scans.

What is neuroinflammation? When people think about the brain and what makes it work, the first thought is usually about neurons, which send electrical signals from the brain to instruct the body to function. There are also a number of specialist immune cells in the brain, which are incredibly important to this process. I would like to focus on one type of specialist immune cell called a microglial cell. These are dendritic cells, meaning they have arms and can move around the brain and their job is to clear debris from neurons and support how they function.  When microglial cells become activated, either by an injury like concussion or after an infection in the upper respiratory tract of the inner ear, they switch from their normal role, and some become inflammatory and others anti-inflammatory.  After this transformation they are unable to switch back to their normal resting state. When these cells become inflammatory they have a negative effect on how neurons work.

The mechanisms of neuroinflammation are influenced by diet, nutrition, lifestyle and combined with specific neurological exercises an important part of recovering from FND.

There are two reasons why diet might be important. The first is to do with energy and the other the triggering of the immune system. The brain needs a steady supply of glucose and an abundance of oxygen – without these it struggles to function well, even when we are in good health. So a steady glucose supply and abundance of oxygen becomes very, very important for those with FND. Neurons require a large amount of energy to function and it gets this from stable blood glucose – what this means in practice is that skipping meals and eating a diet that is high in processed foods and sugars makes blood sugar unstable, making it very hard to recover.

The second reason is to do with immune responses. The immune system throughout the body uses signalling molecules. When you get an infection, these signalling molecules will start to circulate in your system and prime or up-regulate certain responses and, if the microglial cells in your brain are in a primed state, this can switch them into an inflammatory mode and make the symptoms of FND worse. Infections are not the only trigger for the immune system – certain chemicals, airborne toxins and even certain foods can trigger responses in the immune system.

Specific exercises may also help. The human body is an amazing self healing organism.  I am sure many of you have had a broken bone or had stitches after an operation or injury.  If you have broken a bone, part of your recovery will include exercises to get the joint moving properly to help return to full range of motion and function. The same is true of the brain. It is possible to use functional neurology testing to get an idea of which parts of the brain are affected and rehab with focused exercises that support these areas, improving blood flow and strengthening neurons. It is important when working with someone who has FND to get this right, as if you over-stimulate a particular area you can make symptoms worse, so a very measured approach, increasing exercises over time, has the best result.

Eoin Roe is a chiropractor and functional neurology specialist working is Skibbereen. Get in touch through the website www.roehealth.ie or call and leave a message on 028 62081.

So rather than waiting until everyone is exhausted and passing bugs around the house, September is a good time to put a few simple health habits back in place.

One of my favourite autumn health challenges is to see how many different plant foods I can fit into a week. We all know that vegetables and fruit are good for us, but variety matters too. Plant foods provide us with fibre, vitamins, minerals, polyphenols and a huge range of other compounds, while different types of plants also provide food for different members of our gut microbiome.

The often-quoted target is 30 different plant foods a week. But don’t panic – we’re not talking about 30 different vegetables! Beans, lentils, wholegrains, nuts, seeds, herbs and spices all count.

Oats count. Chickpeas count. Walnuts count. Garlic, ginger and parsley count. Berries count. If you’re curious, try writing down every different plant food you eat over the course of a week. You might be surprised at how quickly they add up – or, equally, how easy it is to fall into the same handful of foods every week.

There is fascinating research around plant diversity and the gut microbiome, including work from the American Gut Project which found an association between eating a greater variety of plants and having a more diverse gut microbiome.

30 isn’t a magic number and it certainly isn’t a limit – my goal is to try and exceed it – and some weeks that’s really easy. But it gives me a focus on variety (particularly in terms of vegetables) and that feels like the right thing to be focussing on. 

A few extra vegetables in your soup, some seeds and berries on your breakfast, beans in your dinner and fresh herbs scattered over your meals can make a surprisingly big difference – both to flavour and to your health! 

If you want to add a little extra variety on a week that’s not flowing well, there are some interesting liquid preparations available in your local Health Food Shop 

One new one that has caught my eye is Salus One Essence, from the makers of Floradix. It contains 67 different aqueous extracts of herbs, fruits and vegetables, alongside added vitamins and minerals.

The ingredient list is certainly unusual. Alongside familiar foods such as broccoli, spinach and artichoke, there are ingredients that most of us probably don’t eat very often – including walnut leaf, gentian root, black carrot, lavender flower, rosehip peel and green oat herb.

Obviously, I’m not suggesting that drinking One Essence means you can tick 67 plants off your weekly list and forget about eating vegetables! But I do like the idea of a broad range of plant extracts as an addition to an already varied diet – a nice healthy top-up. 

And there are two other liquids I’ve been reaching for this autumn. Zell Oxygen Plus and Immunocomplex, from Dr Wolz, are liquid nutritional preparations containing combinations of nutrients and plant-based ingredients.

Zell Oxygen Plus is designed as nutritional support, containing vitamins, minerals and other nutrients involved in normal energy metabolism – this is a good one to think of if someone is recuperating and needs a ‘tonic’ to put some pep back into their step. 

Immunocomplex contains a combination of nutrients and plant-based ingredients, including beta glucans, and is aimed at supporting normal immune function – I reach for this one when I’m feeling under the weather and really don’t want to get sick. 

Of course, there’s no magic bullet. The basics still matter most – eating plenty of plants, moving your body, getting outside during daylight, prioritising sleep and making time for the people and things that make you feel well.

Which brings me neatly to another area of health that we’re becoming increasingly interested in: the relationship between what we eat and how we feel.

‘Food, Mood and the Amazing Gut-Brain Connection’ – Marilyn Glenville at Organico 

We are very excited to be hosting a new talk this year with renowned author and nutritionist Marilyn Glenville. Marilyn has been coming to Bantry to give talks on Women’s Health for many years. This year she is coming to give a different talk, one on using your diet to help balance mood and help us all to keep our brains as healthy as possible. 

We’ve always understood that food affects our physical health, but we’re learning more about the fascinating relationship between our diet, our mood, our energy, our concentration, our sleep – and the health of our brains.

At the heart of the talk is the fascinating gut-brain connection. Our gut contains trillions of microorganisms and researchers are discovering more all the time about the relationship between our gut microbiome, our nervous system and our mental wellbeing.

And this isn’t simply a subject for people experiencing mental health difficulties. It’s relevant to all of us. For teenagers, nutrition can be part of supporting energy, concentration and wellbeing during the pressures of school and exams. For busy adults, it can be about maintaining energy and resilience when life feels relentless. And as we get older, supporting memory and brain health becomes increasingly important.

Marilyn will also look at nutrition in relation to ADHD and autism, looking at how food and lifestyle can form part of an overall approach to supporting focus, energy and wellbeing.

She will explore the close connection between the gut and the brain, and how food can influence mood, energy and concentration. She will look at the effects of blood sugar highs and lows, hidden sugars in everyday foods and the key nutrients needed to support brain health. The discussion will also examine the relationship between food, stress, sleep and mood, what we are learning about gut bacteria and mental wellbeing, and the role of nutrition in ADHD and autism. Marilyn will consider why some diets may leave us feeling worse rather than better, while offering simple ways to support focus, energy and emotional wellbeing, as well as maintaining brain health and memory at every age.

There will also be plenty of opportunity to ask Marilyn questions during the evening, including one-to-one questions at the end.

Dr Marilyn Glenville PhD – Nutrition, Mental Health & Wellbeing: The Amazing Connection Between Your Mind, Body, Food and Mood: Monday, October 5, 6.30pm-9pm. Upstairs at Organico, Bantry. Tickets €20

Your ticket also includes €10 redeemable against purchases on the night, tea and coffee during the interval, and the opportunity to ask Marilyn your questions. There will also be 20 per cent off products purchased at the seminar.

Places are limited, so book your ticket through www.organico.ie and come along. We’d love to see you there.

In May this year, I had a really enjoyable time attending the British Association for Counselling and Psychotherapy’s (BACP) 32nd Annual BACP International Research Conference, which was titled ‘Collaboration for a just society – Multidisciplinary research in counselling and mental health’. The conference took place in London and ran across a few days. I was also very grateful to have had the opportunity to present my published research at the conference. To stand on stage and present my work to an audience of peers was very invigorating but also somewhat nerve-wracking, naturally enough. I was presenting my research along with some people who I have been inspired by over the years, so in many ways it felt like I was standing on the shoulders of giants.

The presentation itself was recorded, which I recently had time to watch. I watched it from a position of reflexivity, with the intention of seeing myself through as much of an objective lens as possible. I always find it somewhat unsettling to watch myself but also very helpful. In this case I used a simple and effective framework called The Johari Window to take notes, which provided me the ability to bring different aspects of my experience into my awareness, including things I had not been aware of previously. 

The Johari Window is one of many models for understanding ourselves in relation to our self, others and the world around us. Developed by psychologists Joseph Luft and Harrington Ingham in 1955, it offers a framework for exploring self-awareness, communication and interpersonal relationships. The principles of its use are very relevant to psychotherapy because they invite curiosity about what is known, hidden, misunderstood and yet to be discovered within our experience. As Luft wrote in his book ‘Of Human Interaction’ in 1969, “There are things known to us and known to others, things unknown to us but known to others, things known to us but not to others, and things unknown both to us and to others.” This simple idea reflects the complexity of being human.

The model consists of four quadrants within an overall square. The ‘Open Area’ represents aspects of ourselves that are known both to us and to others. The ‘Hidden Area’ contains experiences, thoughts and feelings that we know but choose not to disclose. The ‘Blind Area’ consists of qualities that others perceive but that remain outside of our own awareness. Finally, the ‘Unknown Area’ represents untapped potential and unconscious processes or experiences that neither we nor others have yet to recognise. Rather than viewing these quadrants as fixed categories, the Johari Window encourages us to see them as fluid. This is very reflective of how we grow and develop over time.

Our understanding of ourselves is shaped through interaction with other people, and equally, our relationships are influenced by what we reveal, conceal, ignore and discover. This idea echoes Carl Rogers’ – an American Psychologist and one of the founders of Humanistic Psychology, assertion, in his 1954 book titled ‘On Becoming A Person’ – that “The curious paradox is that when I accept myself just as I am, then I can change.” Acceptance more often than not creates the conditions for greater openness, both intra-personally, in relation to one’s self, and interpersonally, in relation to others. Within the Johari Window, this can be understood as gradually enlarging the ‘Open Area’ through honest self-reflection and authenticity. 

The ‘Open Area’ is perhaps the space most associated with psychological wellbeing. When people are able to express thoughts, emotions and needs authentically, relationships tend to become characterised by greater transparency and mutual understanding. This does not imply indiscriminate self-disclosure. More-so, it suggests developing the confidence to communicate in ways that feel safe and appropriate. When I was watching the recording of myself, I noticed a striving for authenticity throughout, as I shared my thoughts and emotions and my behaviour aligned with that. It led to a feeling of ease in the moment and this reinforces to me to continue striving for authenticity at all times, even in the nerve-wracking presentation moments! In therapy, the relationship itself often becomes a place where this process can unfold or even be experienced for the first time. A person attending therapy can begin to feel psychologically safe, frequently disclose experiences that have remained hidden for years and, as a result, allow those experiences to be witnessed, understood and integrated.

The Hidden Area refers to the fact that everyone carries parts of themselves that remain private. When I was rewatching my presentation, I noticed that I appeared quite calm, I even received feedback from some people in the audience afterwards that I came across very well. Yet, that didn’t quite match what was happening privately for me at certain moments. I experienced moments of stress and even anxiousness during the presentation and, using this framework, I can see now that was hidden. It was hidden, as it was not relevant to what was happening, but it may have been useful for me to recognise those things in the moment, even privately, as they would have not felt so intense if I did.

Sometimes what we keep in the ‘Hidden Area’ are simply personal preferences or memories, while at other times they reflect shame, fear or experiences of trauma. Many people arrive in therapy having spent years protecting these hidden aspects of themselves, often because disclosure once carried significant emotional or relational risk. These protective strategies are understandable attempts to remain safe. Therapy, therefore, does not seek to eliminate the ‘Hidden Area’, the endeavour can be more about creating sufficient safety for clients to decide whether keeping something hidden continues to serve them.

The ‘Blind Area’ highlights another important dimension of therapeutic work. While watching myself talk and joke on the stage, I realised that I do not see myself clearly at all. I watched myself moving about the stage and translating my research into easy-to-understand concepts linked to what therapists experience in their practices every day. In more simple terms, I don’t give myself enough grace and recognise my strengths…which are hard to ignore when they are on a recording! This was a blind spot, in the ‘Blind Area’, for me, which was useful to see and recognise for myself and my own development and growth. Whereas, when people say these things to me as feedback, I usually don’t fully believe them or give the feedback much weight.

Objective non-judgemental feedback, for lack of a better word, can be an essential mechanism for growth. Within therapy, such feedback is offered with empathy, congruence and unconditional positive regard, reducing the likelihood that it will be experienced as criticism. What emerges between therapist and client may illuminate relational patterns that exist outside the therapy room that can be curiously and gently addressed offering clients the opportunity to reflect upon themselves.

The ‘Unknown Area’ captures the greatest sense of hope within the Johari Window. It acknowledges that every person possesses capacities and possibilities that have yet to emerge. In many cases, for clients coming to therapy, those capabilities may have been buried deeply under life experiences and a bit of excavating can reveal them. When I watched the recording of the conference, I noticed that for the first couple of minutes I was staring at my slides while speaking but I then naturally moved into looking at the audience. I wasn’t aware of this but now I have had time to reflect, I see how that was part of me moving from feeling safe into becoming comfortable in that experience. Useful information for myself moving forward that I would not have known otherwise, and nobody else has ever commented on to date, which will serve me in future. The beauty of The Johari Window, and therapy, is having a chance to look at oneself without judgement and potentially grow into the fullest version of one’s self as result, and what a gift that truly is.

Polycycstic Ovary Syndrome (PCOS) has recently been renamed Polymetabolic Ovarian Syndrome (PMOS). So why the change?

For this article, I will continue to use PCOS, as it’s the name that most of us are familiar with.  PCOS, now PMOS, is not simply an ovarian problem; it is a multi-system metabolic disorder with health implications that goes far beyond the effects on periods and fertility. The change in name was pushed for by health professionals and patient groups in order to highlight and recognise that. The metabolic disturbances that occur in  PCOS have longterm health implications.

PCOS was first described in 1935 by gynaecologists Stein and Leventhal. In 2003 the Rotterdam diagnostic criteria were agreed upon. To diagnose PCOS there needs to be two out of three of the following present:

1) Irregular, infrequent or no periods: This is when a woman’s cycle is less than 21 or more than 35 days or if she has less than eight periods a year.

2) Clinical or biochemical hyperandrogenism: Clinical means that you have physical signs of excess testosterone activity such as bad acne, very oily skin, excess hair growth or hair loss. The hair loss can be diffuse on the scalp or more localised in the male baldness pattern; at the crown or on the forehead hairline. Biochemical means that your blood tests shows a high blood testosterone level. Some women with PCOS have a normal total testosterone blood level  and the issue can be with excessive sensitivity to those normal testosterone levels.

3) Polycystic appearance of the ovary on pelvic scan: This was  defined in 2003 in Rotterdam criteria as a large ovary, more than 10ml in volume or more than 12 follicles or little cysts in the ovary.

This third criterion was amended in 2018 to 20 follicles per ovary when it became clear that many women have the ovarian morphology without the syndrome; in English; 30 per cent of women have 12 or more follicles on pelvic scan but do not have any of the metabolic issues, i.e. have polycystic ovaries but not polycystic ovary syndrome. Even with the amended criterion of 20 follicles, it is recognised that about 20 per cent of women will have 20 or more follicles on a scan but no syndrome.

It is important to clarify at this stage that irregular and infrequent periods is a normal phenomenon during the seven years after our very first period. In addition, in these teen years, symptoms of testosterone activity, such as oily skin and acne are common. It is therefore felt inappropriate to diagnoses PCOS under the age of 20. If a scan under age 20 reveals the ovaries have a polycystic appearance, this should be repeated in the early 20s, as often the appearance of ovaries revert to normal. This is thought to be because it takes seven or more years for the ovarian machinery to settle down into what will be their regular workings.

While your GP can reliably diagnose PCOS, it is vital that other causes of infrequent or no periods are ruled out.

Hyperprolactinaemia occurs when the pituitary gland in the brain develops a benign tumour that secretes excessive amounts of  prolactin, the hormone usually produced when breastfeeding, which switches off periods. Other conditions that can affect periods are thyroid problems, adrenal hyperplasia, – when the adrenal glands that produce cortisol, testosterone and a little oestrogen are not working properly, – as well as more rare conditions such as tumours that secrete testosterone and syndromes of dysfunctional insulin resistance.

So, the baseline investigations should include thyroid and prolactin blood tests, as well as testosterone. Then, confusingly, there can be overlap or an element of PCOS and Hypothalamic dysfunction.

If it’s not completely straightforward, then your GP should refer you to an endocrinologist for an opinion as to whether this is simple PCOS or to determine if anything else is going on.

How does PCOS affect
my health?

Periods and fertility 

What if I only get four periods a year? Not having a period every month means you are not ovulating every month. Infrequent ovulation makes it much more difficult to fall pregnant. 

Endometrial cancer

During a cycle without ovulation the womb lining or endometrium encounters higher levels of oestrogen and lower levels of progesterone, our other female hormone. Net effect is overstimulation of the endometrium causing heavy periods. The serious longer-term effect of that over-stimulation is a two to six times increased risk of developing endometrial cancer.

Polycystic ovary syndrome (PCOS) is associated with dysfunctional metabolic activity across a number of body systems, increasing the risk of several long-term health conditions. Many women with PCOS have a higher body mass index (BMI), which is a key driver of many of these risks. A high BMI increases the likelihood of cardiovascular disease, including heart attacks and strokes later in life, while women with a BMI over 30 are also at greater risk of developing non-alcoholic fatty liver disease. PCOS is closely linked to insulin resistance, meaning women are more likely to develop gestational diabetes during pregnancy and have a significantly increased lifetime risk of type two diabetes. Cholesterol levels are also commonly affected, with lower levels of HDL (‘good’) cholesterol and higher total cholesterol and triglycerides. Hypertension is more prevalent in women with PCOS, further increasing cardiovascular risk. Sleep apnoea is also more common, largely due to a higher BMI, but it is an independent risk factor for heart attacks, compounding the overall risk. In addition to these physical health concerns, women with PCOS have higher rates of psychological conditions, including depression, mood disorders and eating disorders.

The metabolic bits

Women with polycystic ovary syndrome (PCOS) experience dysfunctional metabolic activity across a number of body systems, placing them at increased risk of several long-term health conditions. A high body mass index (BMI), which is common in PCOS, is a major driver of many of these risks. Women with PCOS have a greater likelihood of developing cardiovascular disease, including heart attacks and strokes later in life, while fatty liver disease is also more common, particularly in those with a BMI over 30. Insulin resistance is a key feature of PCOS, increasing the risk of gestational diabetes during pregnancy as well as type two diabetes both during and after pregnancy and throughout later life. Lipid abnormalities are also frequently seen, with lower levels of HDL (‘good’) cholesterol and higher levels of total cholesterol and triglycerides. Hypertension is more prevalent in women with PCOS, further contributing to cardiovascular risk. Sleep apnoea is also more common, largely due to higher BMI, but it independently increases the risk of heart attacks, compounding the overall cardiovascular burden. In addition to these physical health risks, women with PCOS are more likely to experience psychological difficulties, including depression, mood disorders and eating disorders.

So you can see, PCOS involves far more than infrequent periods and trouble getting pregnant. It is a multi-system chronic disease and needs to be recognised and more importantly treated as such: hence the change in nomenclature. 

How useful is the testosteone blood test?

Androgen or testosterone activity is increased in the body but it is not a simple as having a high testosterone level in the blood. When looking at testosterone activity we do blood tests for total testosterone but also for sex hormone binding globulin (SHBG). This is a protein that binds to free testosterone, effectively mopping it up. Women with PCOS can have a normal total testosterone blood level but very low SHBG means that her normal testosterone level will have more effect on her organs. The most obvious place this is seen is on the skin, with oiliness, acne, excess hair growth and hair loss.

PCOS and menopause
transition

When seeing women during menopause transition, it is important to always ask about a history of PCOS. Ovulation can kick back in again, especially after significant weight loss and regular  periods can resume, leading some to assume the PCOS is gone: not true: the metabolic issues persist. These women commonly experience more hyperandrogenism in perimenopause with hair thinning and loss, facial hair, severe acne or oily skin.

These women will be more sensitive to some of the older fashion of progestogens, either in the pill or in a HRT regime, and this needs to guide a doctor’s choice of hormone therapy. 

Treatment

For women trying to conceive, ovarian stimulation is usually successful in inducing ovulation and improving fertility.

Hyperandrogenism, which can cause symptoms such as severe acne, excess facial or body hair, and hair loss, can be managed in several ways.

The combined oral contraceptive pill is often an effective treatment because the oestrogen it contains has anti-testosterone effects and also increases levels of sex hormone-binding globulin (SHBG), which binds to and reduces the amount of active testosterone in the body.

For women who prefer not to take hormonal treatment, metformin, a medication commonly used to treat diabetes, is a safe and effective alternative. In addition to improving insulin resistance, metformin has mild anti-testosterone effects and suppresses luteinising hormone (LH), which can help restore more regular ovulation and menstrual cycles in many women. Other medications with specific anti-testosterone effects, including finasteride and spironolactone, may also be prescribed, particularly for women experiencing hair loss or excess hair growth.

What is most important is that early on, as soon as PCOS is diagnosed, that a women is supported with issues of excess weight because high BMI is the main driver of her increased risk of heart attacks, stroke and lifelong hypertension. Phycological support and counselling may be needed, as prevalence of depression is high. Women with PCOS  should see their GP once a year for blood pressure, BMI and blood tests for lipids and HbA1C to screen for diabetes or pre-diabetes. 

I hope this has been useful and if you have any questions with regard to symptoms you are having or questions about PCOS if you are already diagnosed, please go see your GP.  

Ironically, these are also the years when our fertility is at its highest. Then, when the time finally feels right to start trying for a baby, many couples are surprised to find that conception takes longer than they expected. It can be an emotional and lonely experience, especially when it seems as though everyone else is having children with ease.

There are several factors that can influence fertility, and being aware of them can help you make informed choices while also reminding you to be kind to yourself.

One of the biggest changes we have seen is that many women are choosing to start trying for a family later in life. While 30 is still young, female fertility does gradually decline with age, becoming more noticeable from around 35 years onwards. This doesn’t mean pregnancy isn’t possible but it can sometimes take longer or need assistance.

Our overall health and lifestyle also play an important role. Chronic stress, poor sleep, smoking, excessive alcohol, recreational drugs, environmental toxins, and some long-term health conditions can all contribute to oxidative stress. This occurs when there is an imbalance between free radicals and the body’s natural defences. Oxidative stress can damage both egg and sperm cells, reduce fertilisation rates, and it affects healthy embryo development.

Many women also accept monthly pelvic pain as something they simply have to live with. While period pain is common, it is not normal and ongoing or severe pain every month is not something to ignore. Conditions such as polycystic ovarian syndrome (PCOS) and endometriosis can sometimes go undiagnosed for years because symptoms are dismissed as ‘normal’. Seeking medical advice early can make a real difference.

Other health conditions, including diabetes, hypothyroidism and autoimmune disorders may also affect fertility because they can influence hormone balance and the immune system. Managing these conditions well is an important part of supporting reproductive health.

When pregnancy doesn’t happen as quickly as hoped, many women instinctively place enormous pressure on themselves. However, fertility is not solely a woman’s responsibility. Around a third of unexplained infertility cases involve female factors, another third is impacted by male only factors. With a further third affected by a combination of both male and female factors.

Research has highlighted concerns about declining sperm quality. Lower sperm counts, reduced sperm movement and DNA fragmentation can all affect the chances of conception.

Perhaps the most important advice is this: face the journey together. Open, honest conversations with your partner can ease the emotional burden and encourage both of you to make positive lifestyle changes and seek support when needed. Fertility is a shared journey, and no one should feel they have to carry it alone. Looking after your physical health, prioritising rest, reducing stress where possible, and asking for help early are all positive steps that can support both your wellbeing and your hopes for the future.

by Amanda Roe, a Clinical Hypnotherapist, Acupuncturist, Chinese herbalist, Life and Health coach specialising in Women’s Health. She offers a range of services including acupuncture for fertility, pelvic floor dysfunction, scar’s and pain. She combines this with clinical hypnotherapy to help people suffering with trauma, fears, phobias and eating disorders. For more information or to book a consultation visit www.roehealth.ie or call/text Amanda on: 087 633 1898

by Niamh Cooper, Melissa Byrne & Gillian Hegarty

The weather in July has been nothing short of spectacular, and many of us have lived outside for the last few weeks. Even when the weather decides to take a turn – and it will, eventually, because this is Ireland – this is the season for food you can eat with your fingers. And nothing on any picnic blanket, or kitchen table, will be as spectacularly pink as this beetroot dip. It looks like something a unicorn might eat. And it tastes even better.

If you haven’t tried beetroot yet, zapping it into a dip might be one of the best things you’ve done this summer. You can buy beetroot in a packet, or fresh – and you can eat it, leaves and all! Just a note though: don’t use the pickled beetroot as it won’t work in this recipe!

First, a word about the leaves. When you buy fresh beetroot between June and October, it comes with its beautiful stalks and leaves attached, and they are delicious too. Strip the leaves from the stalks and wash everything. Cut the stalks into roughly 2cm pieces and cook in boiling salted water for two minutes, then add the leaves and cook for one minute more. You can also steam them. Lift out with a slotted spoon and drizzle with olive oil, salt and pepper.

Ingredients

• 250g cooked beetroot

• 50g feta cheese

• 2 tbsp roughly chopped fresh mint

• 2 tbsp olive oil

• 1 tbsp freshly squeezed lemon juice

• Salt and freshly ground pepper

If using fresh beetroot, cut off the stalks, leaving about an inch on the beetroot. Wash gently without damaging the skin, place in a saucepan of cold water, and then ask an adult to help you: Bring to the boil and simmer for 1 to 2 hours, depending on size. The beetroot is cooked when the skin comes off easily and a skewer slides through with no resistance. Remove the skin and stalk, roughly chop, and place in a food processor with all the other ingredients. Blitz until smooth. Taste and adjust the seasoning; you may like more lemon, salt, pepper or mint. The dip looks beautiful, garnished with marigold petals. One warning: beetroot juice stains everything it touches, including you, so wear old clothes. 

A few ways to eat it:

Serve it on bread, with crackers or on toasted pitta; eat with a rainbow of raw vegetables such as carrot sticks, cucumber and peppers; dollop onto a hot baked potato instead of butter; spread inside a wrap; have on a burger instead of ketchup, or whatever way you fancy eating it.

Turn it into a salad. Cut the cooked beetroot into wedges and place in a bowl, season with salt and pepper, add a few rocket leaves and tear in some mint. Mix the oil and lemon juice together and pour over the beetroot. Transfer to a serving bowl and crumble over the feta. Garnish with edible flowers from the garden if you have them, such as violas, marigolds, borage or cornflowers. Broad beans are a lovely addition as well, and they are fantastic right now – if you can get your hands on them.

So there you have it: a dip (or salad!) that is bursting with goodness, looks amazing and is totally delicious. Make a batch, share it with someone, and see if you can convince them it came from a unicorn. 

Did You Know?

• Beetroot has one of the highest amounts of antioxidants of any vegetable? They help protect the cells in your body.

• The amazing colour comes from natural pigments called ‘betalains’, which scientists are researching for their cancer-protective and other effects.

• Beetroot is packed with nitrates, which widen your blood vessels and help oxygen move around your body more efficiently. That is why athletes drink beetroot juice before races. Scientists are also studying whether it may help lower blood pressure, improve breathing and keep our brains healthy.

• The ancient Greeks ate only the leaves. It took hundreds of years before anyone thought of eating the root!

Summertime is the perfect time to pay attention to our feet. For most of the year they are bundled up in socks and shoes and much neglected beyond attending to their need for warmth. But in the summer our feet can come out to play and experience the earth beneath them as nature intended. It’s the time of year when I like to re-introduce my clients to their feet as they emerge from the cooler months. Our feet are the foundation of our body and strong and flexible feet will ensure healthy transfer of force through our body. 

Fascial connections in the body create functional chains from the feet up through the legs and into the pelvis. These connections mean that foot mechanics can influence pelvic alignment and core engagement. The strength of our feet therefore, or lack of, has a direct bearing on our pelvic health and strength, which of course affects our posture and how we hold our body. Our feet are essential in the building and maintenance of a strong core. How are yours holding you up?  Some of the spinal nerve roots that supply the pelvic floor also contribute to the nerves that supply the feet. This shared origin helps explain why lower-body mechanics can influence pelvic function. 

So where do we start to improve the health and strength of our feet? Well first we need to determine where on the foot spectrum our feet rest.

Flat feet: This is where the arches ‘fall’ or lose structure and collapse. The loss of this longitudinal arch causes the feet to roll inwards (pronation), the knees to roll inward and the pelvis to tilt. Without the support of the arch the pelvic floor overcompensates and this overwork leads to chronically weak or tight pelvic floor muscles. Further up the chain it is harder to recruit strength, so we tend to collapse in the upper body and slump. It leaves us feeling tired, as our intrinsic postural muscles are not doing the work they need to.

There is a common association between flat feet and the formation of bunions at the big toe as the foot rolls in excessively when we walk and begins to drift towards the second toe. Also, plantar fasciitis and hammer toes can arise if we neglect our arches.

High arches

At the opposite end of the spectrum feet with high arches can be more rigid and stiff, which makes them inefficient shock absorbers, as the foot doesn’t flatten and spread sufficiently on impact. In this case the legs and hips overcompensate and the pelvic floor grips to hold the force. This can lead to shortening and tightening of the muscles in the back of the hips. And given the body’s compensation pattern here, gripping or ‘locking’ or bracing up the body through joints and muscles can become a common pattern.

While a flat foot rolls inward a high arched foot often rolls outward (supination), this can lead to plantar fasciitis, pain and inflammation on the ball of the foot (metatarsalgia), hammer toes or claw toes. Ankle instability often arises because the feet rolling outward means there is an increased risk of lateral ankle sprains.

Neither end of the spectrum is ideal for your feet and as you can see, both ends can produce the same conditions. A simple thing to check is where is the wear on your footwear…if your shoes are more worn on the outside you roll out on your feet and more likely fall into the high arch camp and if the wear is on the inside of your shoe you roll in on your feet and may have weak or collapsed arches.

What to do

As with all things prevention is better than cure. There is so much we can do to help ourselves feel better and I’m a firm believer in foot strengthening exercises. Thankfully there is a wealth of information available online these days. Orthotics or inbuilt foot supports are often advised to help with foot issues and indeed they can be a life-saver for many who genuinely need them, however in some cases, and with professional advice, it could be possible to see them as interim measure while foot strength is regained. Your podiatrist will doubtless be the best to advise you on this.

As it is summer we should endeavour to be barefoot as much as possible, so we improve the sensory capacity of our feet. How will we ever build healthy feet when our feet are encased in ever-increasing layers of foam and rubber. The cushioned layers of rubbery comfort sold as footwear these days are doing our feet no favours. Not only do they disconnect us from the ground, but their lack of breathability can create a warm, damp environment where bacteria thrive.

There is a rise in the popularity of barefoot shoes, shoes with much thinner soles that allow us to better feel the ground beneath us and thereby build foot strength, however most of us will need to strengthen our feet before purchasing them especially if we’ve grown accustomed to cushioned footwear. And bear in mind, not everyone is a candidate for these types of shoes; people with conditions such as hypermobility, diabetes and neuropathy or acute plantar fasciitis should get professional advice.

Practical tips and exercises

Rolling your foot: This is a fantastic way to increase sense perception in your foot. A tennis ball will work here but if you have a softer ball with a little bit of resistance such as a Franklin ball or something along those lines it is a little better. Gently but firmly press your foot into the ball and do a figure of eight massage for the soles of the feet. Hold it gently down on the arch (quite a tender spot so be aware here) and then lift the big toe towards you, this will give a wonderful stretch to the plantar fascia, the connective tissue on the sole of the foot. A great exercise for those with more rigid feet.

Roll the foot for about one minute and stretch for about one minute. Do take the time to feel the space and sensation you experience after using the ball.

Building your arches: An oldie but a goodie here, the towel stretch. Place a thin towel on the ground and position your toes on the nearest edge to you. Begin to curl your toes and draw the towel in as evenly as you can till you reach the far edge. Once you reach the far edge start to press the towel away with your toes till you have returned to the start. Repeat three times.

Another fun thing to do especially for children with fallen arches is to set a challenge to pick up pencils with your toes, start with picking up one or two and see how many you can pick up before your toes tire.

These are just some basic drills but there are many more out there. I recommend looking up Michelle Edmison’s work on mvmt.101 (on Instagram). She is currently offering a free five-day programme to strengthen your feet. The videos go directly to your email inbox, it’s wonderful to have such a quality resource available for free so avail of the opportunity this summer and get those feet in shape so can they serve you well.

Why does therapy work? How does change actually happen? These are questions I often find myself asking. I am currently undertaking my PhD and I keep coming back to these questions. If I state that I believe in the power of therapy, it could be considered a biased statement certainly. Yet, I am very grateful to have found and experienced a therapist I clicked with who has been so relationally reparative for me over the past seven years. I am grateful, as I have also had the unfortunate experience of therapy, which was not reparative, in fact in one case it was harmful to me. Apart from my own experiences as a client, I also have the honour and privilege to witness my clients doing their own courageous work, which leads to change week in and week out. Despite all of this, I still can’t help but wonder, what is happening when change occurs for someone who has the courage to engage in therapy?

Many clients often enter therapy hoping for relief from distress, greater self-understanding or a different way of relating to themselves, others and the world around them. Despite more than a century of theorising and research, there remains no single explanation for how therapeutic change occurs. As humans, our brains are designed to strive for, and love, single explanations, or silver bullets so to speak. The brain interprets certainty and knowing as safety. However, no matter how much research is conducted or books are written or therapy hours are undertaken, there is no silver bullet. Notice what it is like to even read those words, there is no silver bullet. That can leave us feeling unsettled at best and fearful and anxious at worst!

What has emerged over time as people ask and ask again about change is a recognition that change is a complex process involving the interaction of therapeutic relationships, client autonomy, life circumstances and experiences that unfold both within and outside the therapy room. Historically, different schools of psychotherapy have proposed different mechanisms of change. Within psychoanalysis, for example, change is often understood as occurring through the development of insight into unconscious conflicts and relational patterns. Behavioural approaches, such as Applied Behaviour Analysis, propose that change occurs through learning, reinforcement and behavioural modification. Cognitive approaches, such as Cognitive Behavioural therapy, emphasise the identification and restructuring of maladaptive beliefs and assumptions. Humanistic and person-centred approaches, such as Person Centred Therapy, highlight the importance of empathic understanding, congruence and unconditional positive regard as the conditions through which growth could emerge in a relationship. This is to name only a few as there are hundreds of different types of therapy.

Although these approaches differ in their theoretical explanations, psychotherapy outcome research has increasingly suggested that successful therapies share a number of common factors. The so-called ‘Dodo Bird Verdict’, first articulated by Saul Rosenzweig, an American psychologist and therapist, observed that many different therapeutic approaches produce broadly comparable outcomes. This has been explored extensively since and has pointed research more towards the common factors that work in therapy, as opposed to what therapy works best.

One of the most influential findings from this body of research concerns the importance of the therapeutic relationship. Across modalities, the quality of the alliance between therapist and client consistently emerges as one of the strongest predictors of outcome. Clients who experience their therapist as empathic, collaborative, trustworthy and genuinely engaged tend to experience better outcomes than those who do not. The relationship itself appears to function as more than a context for ‘doing’ therapy, it is often a vehicle of change in its own right.

This relational emphasis has been strongly articulated in psychotherapy research, which increasingly supports a relationally orientated approach to therapy with evidence suggesting that relational processes are central to positive outcomes. Rather than viewing change as the product of techniques alone, it is apparent that change emerges through the quality of engagement between therapist and client and through the extent to which therapy responds to the unique needs, preferences and goals of each individual. Research from Pluralistic Therapy further suggests that therapeutic effectiveness may be enhanced when clients are active participants in shaping the direction of therapy. Put simply, respecting a person’s autonomy and ability to know, and share, what they find useful or not is paramount in therapy.

At the same time, psychotherapy research has consistently demonstrated that factors external to therapy also play a significant role in change. Much of the variance in therapeutic outcomes is attributable to client and extra-therapeutic factors rather than therapeutic techniques alone. Every person who attends therapy brings with them existing strengths, resources, relationships, opportunities, challenges and environments that influence their capacity for change. Yes, therapy sessions undoubtedly matter, as research finds people do better with therapy than without. However, the therapy hour occupies only a small proportion of a person’s life. A client may spend 60 minutes a week in therapy, but the remaining 10,020 minutes, to put this in perspective, are spent navigating relationships, workplaces, families, communities and internal experiences. It is within these contexts that therapeutic insights are tested and integrated.

From this perspective, therapy can be understood more as a space that supports and facilitates change. A client may recognise a longstanding pattern of self-criticism during a therapy session. However, awareness and insightful moments alone rarely transform a person’s whole world. Change begins when that awareness accompanies the person into everyday life. It emerges when they notice the critical voice during the week, pause before accepting it as truth and experiment with responding differently, for example. The therapeutic experience may initiate a new understanding but the process of change develops through repeated experiences outside the therapy room. The work in the therapy room is not isolated, rather, it is part of a whole.

This idea is reflected across several therapeutic traditions. Regardless of approach, many therapies assume that experiences outside of sessions are essential to consolidating and maintaining change. Contemporary process research supports this understanding. Studies examining therapeutic change suggest that clients often describe improvement as an accumulation of experiences over time. These experiences frequently involve applying learning from therapy to everyday situations, engaging differently in relationships, making new choices and reflecting on therapeutic conversations between sessions. Therapeutic gains, so to speak, appear to be strengthened when clients actively integrate what occurs in therapy into their daily lives.

There really is no single pathway to change because different clients benefit from different processes at different times. What has worked for me in my therapy may not work for the next person. Some individuals may change through gaining insight, others through emotional expression, behavioural experimentation, relational experiences or shifts in self-understanding or all of the above and more. In practice, therapeutic change is multifaceted.

Therapy and life outside therapy are therefore not separate domains. They exist in a reciprocal relationship. Each informs the other. Clients bring their lived experiences into therapy and therapy influences how they engage with the those experiences on a day to day basis. Most interestingly, recent research has found that a person’s willingness to change makes up for about 30 percent of therapy ‘working’. This is closely followed by a safe and strong relationship between client and therapist attributed to 15 percent of what works. The approach or type of therapy used makes up for 10 percent of the experience of change. The person of the therapist themselves makes up for seven percent of this and, finally, other and unexplained factors make up the remaining majority of change at 35 percent. Therefore, wondering how does change work in therapy may be something we never get a definitive and final silver bullet answer to. Yet, therapy can provide the conditions in which new possibilities become tangible for any person who wants to show up and experience the fullness of themselves. It is through living those possibilities that change gradually becomes part of a person’s life as result of what happens both inside and outside the therapy room.

For more information on Leo’s services, phone: 085 1300573

email: info@leomuckley.com 

web: www.leomuckley.com 

social media: @leomuckleypsychotherapy.

We think of osteoporosis as a condition that affects the older adult, but it is a condition that is established in youth. Bone mass peaks in your 20s but what builds your bone mass is exercise and loading the bone through heavy weight or resistance. This means that the amount of bone mass you acquire as a child and through young adulthood will determine your risk of acquiring osteoporosis as an older adult even though we actually begin to lose bone mass from about 35 onwards.

Bones are the rigid structures that form the framework of your body, making up the skeleton. And maybe it is our collective association of the skeleton with death that makes us think of bones as inert, dry, dead matter but this association could not be further from the truth.  Bones are dynamic organs composed mostly of collagen and calcium phosphate, which provide strength and flexibility. Bones protect internal organs, support muscles, store essential minerals, and house the marrow, where blood cells are produced.

Bones are constantly renewing themselves through a process called remodelling, where old bone tissue is replaced with new. Bone cells called osteoclasts are our demolition crew which break down and absorb old bone tissue, while osteoblasts are our construction crew, building new bone tissue. This ongoing renewal is crucial for maintaining bone health and strength. Because of their critical role in movement, protection, and overall health, keeping your bones strong is essential – especially when thinking about preventing conditions like osteoporosis.

Osteoporosis is often referred to as a silent disease, as the loss of bone density is painless in the early stages. In fact, the primary way it is diagnosed is through a low radiation scan of the body (DEXA scan) which your doctor may recommend based on your age or risk factors. There are several risk factors to consider.

Women are more likely to develop osteoporosis than men because they have smaller bones than men and women with smaller frames are more at risk than women with larger frames for the same reason. Loss of oestrogen and testosterone in menopause contribute to a loss in bone density with some women experiencing excessive bone loss at this time. In fact, if there are no mitigating familial contra-indications against the use of Hormone Replacement Therapy, this should be something to discuss with your doctor, particularly if you have several risk factors for osteoporosis and are below 50.  

If there is a history of osteoporosis in your family this further increases risk, especially if either parent has experienced a fracture from a trip or fall or less. 

Certain medications and treatments leave one vulnerable to bone tissue loss. S.S.R.I.s commonly prescribed for depression, long term steroid use, some medications used in the treatment of breast cancer, prostate cancer and epilepsy can be risk factors. Conditions such as coeliac disease or Crohn’s and having an overactive thyroid can contribute to loss of bone density. And all patients undergoing radiation or chemotherapy need preventative treatment to protect against bone loss.

The obvious lifestyle apply here: excessive alcohol consumption (more than two drinks a day), smoking and inactivity. Poor dietary choices factor too, whether it is consuming a limited range of nutrients or poor quality foods, which can lead to chronic inflammation, which underlies so many of our health woes these days. Under-eating and over-exercising in younger years can have serious long-term effects on bone density.  

So what can we do?

Far from presenting a negative and hopeless picture there is much we can do, whether we wish to prevent osteoporosis or even reverse it. Diet and exercise are the two most important tools in your toolbox, so let’s look at the specifics.

One third of bone tissue is made of collagen, a flexible tissue that gives bone the ability to bend under pressure without snapping. Calcium is a mineral that hardens bone and gives it rigidity while collagen provides elasticity, bone health requires both. Calcium supplementation is often the first port of call regardless of the degree of bone loss. We can get calcium in our diets from leafy greens such as kale, spinach and bok choy but if you wish to pursue the supplementary route, ensure that your vitamin D source is combined with the mineral K2, which activates a protein that acts as a guide directing the calcium to the bones and not the arteries. In fact, the Rotterdam Study, which tracked nearly 5,000 people over a ten-year period from 1990 to 2000 found a high dietary intake of k2 resulted in a decrease in aortic calcification or hardening of the arteries. K2 can be found in the Japanese dish of Natto (fermented beans) or perhaps more palatably in Kefir, should you wish to obtain it from food.

An important mineral to include here is magnesium. Calcium and magnesium work as a tag team in the bone tissue, while calcium provides the structure and strength, magnesium regulates calcium balance and bone crystal formation. If your magnesium is low, your body can’t use calcium efficiently.

Other foods to consider for calcium are beans and legumes, sesame seeds and in particular tahini, one tblsp of which contains the same amount of calcium as a small glass of milk. According to research published in the #publication Osteoporosis International (2024), consuming 100g of prunes daily has favourable impacts on bone mineral density.

I mentioned above the importance of collagen to keep our bones ‘elastic’. There is recent and ongoing research into hydrolysed collagen peptide supplementation to increase bone mineral density. Research is ongoing but there are positive noises coming from this area; however, we remain at the ‘studies suggest’ stage for the moment. If you do choose to supplement with collagen peptides, note that Vitamin C really matters for the production of collagen in the body so ensuring your collagen supplement incorporates vitamin C and that you continue to consume a variety of fruit and vegetables in your diet is essential.

Bone needs mechanical stress in order to grow. In a recent study in Queensland Australia a group of post-menopausal women with low bone density underwent a supervised training regimen using heavy lifting such as dead lifts, squats and overhead press exercises. This trial, known as the LIFTMOR trial (2018), has been groundbreaking in that it has proven that supervised, heavy resistance and impact training has positive impact on bone density. The trial consisted of 2 x 30 minute sessions weekly. There is a change in thinking when it comes to exercise and osteoporosis. Rather than fearing fragility we can be empowered to build stronger bones safely. Undertaking strength training should always be supervised properly especially if you are a novice and have low bone density but it is encouraging to know that we can rebuild what has been lost by simply safely increasing load. Start gently and progress. First you should learn how to breathe, how to engage your core and hold your posture to maximise your gains and prevent injury. And of course, walk! Walk briskly, walk uphill, take your stairs but put those joints under load.

While this change is outside of our control and will be managed, maybe even embraced in the future, we must allow ourselves to ‘have our moment’ and allow time to genuinely feel uncomfortable feelings. I am not a ‘get on with it’ type of person and very often find it hard to disguise what I’m feeling. The process of anything, as far as I’m concerned, is as, if not more important, than the task. So how something happens is as valuable as the way it actually happens.  The balancing of the process and task is embedded as a principle in community work training and in mindfulness training also. It’s the journey, not the destination that is important.  

But, in this moment, the destination matters too, because we don’t know where the mindfulness groups at Myross Wood will re-locate to. This will take months to figure out but I am relying on patience and trust and will take it one step at a time. And I’m not at all on my own, so many people care, including my weekly drop-in meditation group on Tuesday mornings, people who have been sitting meditating collectively for six years. Everyone offers comfort and potential solutions. My monthly mindfulness peer support for family carers, also in its sixth year, care very much where we will gather in the future.  

This work really matters to me, it supports us through grief, loss and change in our lives, helping us to manage the micro and the macro moments, allowing us to feel real happiness and joy. We are in the process of developing an online communication page and notice board for all carers in West Cork and this is vital work, led by the carers group at Myross Wood.  The empathy and compassion for others in this monthly group is very special to behold. Huge thanks to Cork ETB who have funded this work for a number of years through REACH funding with the welcome addition this year of the Collaboration and Innovation Fund. The work won’t stop, it will need a new venue.

But here now, reflecting over my time at Myross Wood, I have such appreciation for every single person I have encountered along the way.  Whether it was at a weekly mindfulness drop-in session, a themed workshop, staff teambuilding/wellbeing days, last year’s overnight retreat for family carers, or at a fundraising workshop last November to honour Dermot and all the souls. Or perhaps we connected at our monthly mindfulness peer support sessions for family carers, annual reconnect and re-engage programme or outdoor mindfulness in nature sessions.  Thank you every single one of you, from the bottom of a very full heart.

I have an appreciation for the place itself, close to my native Castlehaven, that held us all, surrounded by nature, such a special place connecting us to our very roots. Walking the other day, I had the most magical encounter with a giant hare, who lolloped along the road, stopped and rose up to his/her full height, just looking at me for a couple of minutes before heading off down the path.  I hope so much that the wildlife and nature living there will continue to be supported after CECAS leave.  The many staff and volunteers who supported us over the years deserve a massive mention on this list of gratitude and appreciation. Thank you for the wholesome soup for our carers group and associated events, the homemade cake and most of all the care.

We will deal with what’s happening but it’s ok to pause and take a moment or more, to feel our feelings around the loss of this community space. I will keep people posted in these monthly writings but please keep an eye on my Facebook page for up-to-date information on where we’re heading.  Care by Rachel Holstead feels very apt today.

‘In those moments when you want to care for all the world, / Remember that in you is also the whole of the world. / And you can only begin here – caring for this skin, / These bones, this heart. / Delve deep into caring, and every cell becomes a temple in which to honour the world.’

Mindfulness in June

Our last two drop-in mindfulness sessions at CECAS, Myross Wood, Leap on Tuesday mornings 10-11am, June 16, and 30. €12. Beginners, returners and newcomers are always welcome.

For more information: phone: 087 2700572 or email: susanoreganmindfulness@gmail.com 

f susanoreganmindfulness

www.mindhaven.ie

I’m not a dermatologist but, as a GP with 30 years experience, I have seen one skin condition commonly affecting the face that can be particularly distressing for women: Rosacea can have a significant impact on confidence and quality of life.

What exactly is rosacea?

Many people think that Rosacea is a type of acne, but that is not the case. 

Rosacea is a common female skin condition, mostly affecting the face. It predominantly affects fair-skinned individuals but may appear in any skin type. Rosacea can start at any age from childhood onwards, but most commonly appears in young adults.

While it is more common in women, when affecting men it may be more severe. It is a long-term condition and fluctuates from mild to severe. Rosacea mostly affects the cheeks, forehead, chin, and nose. What is going on in the skin is a mixture of inflammation and increased blood flow caused by rapid vasodilation, in the same way that blushing occurs. Women feel the skin on their face is often sensitive and the affected area can feel very hot or sting.

She finds that pretty much any cream she applies causes redness. As well as the redness there can be elements of thickening of the skin, with small bumps, and pus-filled spots similar to acne. There may also be uncomfortable redness and irritation of the surface of the eyes and eyelids. Some people affected by rosacea may develop eye problems such as painful inflammation involving the front part of the eye (rosacea keratitis) and this may cause blurred vision. If you develop symptoms affecting the eyes, see your GP, as they may need to refer you to see a dermatologist or an optician.

Because this skin condition affects the face, it can be very stressful, result in low self esteem, anxiety, social withdrawal and even depression. 

What does rosacea look like?

Rosacea usually starts with a tendency to blush easily. A red rash on the cheeks can be an early sign. After a while, the central areas of the face become a permanent deeper shade of red, with small, dilated blood vessels, bumps, and pus-filled spots.

Occasionally, there may be some swelling of the facial skin called lymphoedema, especially around the eyes. Occasionally, an overgrowth of the oil-secreting glands on the nose may cause it to become enlarged, bulbous and red called rhinophyma, but this rarely occurs in women. 

What causes rosacea? 

The cause of rosacea is not fully understood. Genetics, immune system problems and environmental factors may all play a part. Factors that trigger rosacea cause the blood vessels in the skin of the face to enlarge (dilate). The theory that rosacea is due to bacteria on the skin or in the gut has not been proven. However, antibiotics have proved helpful to treat rosacea. This is because of their anti-inflammatory effect. Rosacea is not contagious.

Is rosacea hereditary?

Rosacea does seem to run in some families, but there is no clear genetic link.

There are many triggers that may make rosacea worse. These include alcohol, exercise, high and low temperatures, hot drinks, spicy foods, hormone changes and stress. Rosacea patients can be sensitive to the sun. In my work as a menopause doctor, seeing women going through menopause skin changes is a common complaint. If there is pre-existing Rosacea, it often flares up and becomes very difficult to control, triggered by the hormone fluctuations of the menopause transition. Combined with the increased dryness of our skin as we age, the redness and inflammation seen in Rosacea can become really difficult to control over the age of 45. 

How will rosacea be
diagnosed?

Rosacea can be diagnosed by its appearance. Specific tests are not usually required.

Can rosacea be cured? 

No, but long-term treatments can be helpful.

How can rosacea be treated?

There is no magic cream! Resist the urge to buy expensive, lovely smelling and often coloured potions, as many ingredients in our cosmetic creams will aggravate the inflammation of Rosacea.

Use a simple, colour and scent free SPF 30 face cream daily. Avoid gritty exfoliation, as this will definitely flare the inflammation.

There are specific anti-inflammatory creams and oral anti inflammatories can also be helpful. But the redness is also caused by vasodilation or increased blood flow to the skin giving that bright red blush look.  This is harder to manage.

Local treatments: The inflammatory element of rosacea may be controlled with a medication applied to the affected areas. It may take at least eight weeks for the effect to become evident. Some applications work specifically to reduce the redness associated with rosacea.

Oral antibiotics: These are helpful for the inflammatory element of moderate or severe rosacea. The most commonly used antibiotics belong to the tetracycline group and include tetracycline, oxytetracycline, doxycycline, lymecycline and minocycline. Erythromycin is another commonly used antibiotic. The duration of an antibiotic course depends on how your body responds to the treatment. Your doctor may suggest that you use a cream and an oral treatment together.

Other treatments for rosacea may be recommended depending on the severity of symptoms. An eye specialist can help manage severe eye complications associated with rosacea. For patients who develop rhinophyma, a bulbous enlargement of the nose, treatment by a dermatologist or plastic surgeon can help reduce its appearance. Persistent redness and visible dilated blood vessels may be improved with laser therapy performed by a dermatologist. If excessive blushing is a significant concern, medications such as beta-blockers or clonidine may be prescribed. In cases of severe rosacea, a dermatologist may also prescribe isotretinoin tablets to help control symptoms.

What can I do?

Protecting your skin from the sun is an important part of managing rosacea. Before going outdoors, apply a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30 to your face every day. Sunscreen should be reapplied regularly, especially during prolonged outdoor activities, to maintain effective protection.

When cleansing your face, avoid rubbing or scrubbing the skin, as this can aggravate rosacea symptoms. Perfumed soaps should also be avoided because they may irritate sensitive skin. Instead, use a soap substitute, such as an emollient cleanser, which is gentler on the skin. If your skin is dry or sensitive, regular use of a non-perfumed moisturiser can help maintain the skin barrier and reduce irritation.

Many people find that certain lifestyle factors can trigger or worsen their rosacea. Keeping a diary of flare-ups may help identify personal triggers, allowing you to avoid factors that aggravate your symptoms. In some cases, cosmetics can be used effectively to conceal redness, and specialised skin camouflage products may provide additional coverage for excessive facial redness.

Unless specifically recommended by your doctor, it is generally advisable to avoid some acne treatments, as these products can irritate rosacea-prone skin. Similarly, creams or ointments containing corticosteroids should not be used unless prescribed by a dermatologist, as they may worsen rosacea over time.

If your eyes are affected by rosacea, it is important not to ignore the symptoms. Consult your GP, as referral to a dermatologist or ophthalmologist may be necessary for further assessment and treatment. In addition, some medications can increase facial flushing and blushing. Your doctor or dermatologist can review your current medications and make appropriate adjustments if necessary.

For more information go to www.irishskin.ie and www.rosacea.org.

I hope this has been healthful. If you wish to request an article on any particular female health topics please email any
suggestions to the editor for consideration:
mary@westcorkpeople.ie.

The tension a person can experience when bereaved by suicide is very real and can take up much internal space in the body and the mind. The mind can turn repeatedly towards the question of why, while the social world can feel altered and the body may experience all manner of challenges from sore shoulders and back pain to upset stomachs and tightness in the throat. The question of why is not one of curiosity as it quite often carries a sense of responsibility within it. People bereaved by suicide can experience this tiring question of ‘why’ alongside feelings of guilt, blame and anger. It is not unusual for people to replay conversations, to reconsider moments that once seemed ordinary and/or to search for something that might have been missed.

In 1969, Elisabeth Kübler-Ross, a Swiss-American psychiatrist, described grief as a process involving five stages, being denial, anger, bargaining, depression and acceptance, in her outstanding book ‘On Death and Dying’. In bereavement following suicide, these can appear in ways that feel somewhat chaotic and difficult to anticipate. Denial may take the form of a disbelief that the death has happened at all or a sense that it does not fit with what was known of the person who is no longer with us. Anger can emerge towards the person who has died, towards others or towards oneself, often intertwined with love and a resulting confusion. Bargaining may be felt in the repeated returning to moments that now carry new meaning alongside thoughts about what might have been different “if only”. Depression, in this context, speaks to the depth of the loss and the absence that follows, rather than our day -to-day understanding of depression. Acceptance is sometimes described as a form of coming to live with the reality of the death, even when it remains painful and incomplete. These stages are not linear or chronologically arranged. She later clarified that these stages were “never meant to help tuck messy emotions into neat packages” in her book ‘On Grief and Grieving’.

In suicide bereavement, this is particularly important. The processes she described do not unfold in order and, although this may be hard to read, they do not conclude. They move in and out of one another, sometimes within the same day or across days, months, years or lifetimes. I often think of any bereavement or loss as being similar to a knot in a beautiful piece of wood. The knot itself is forever there, tight, messy and not going anywhere. However, the beautiful piece of wood, which features the knot, is a result of growing around the knot over time. With the unique type of grief encountered when bereaved by suicide, it is not that the grief ever ends. It is that, as a person continues to experience their own living, they grow around the grief. It will always be painful; anytime you look at a picture or think about a time in the past, the grief can and often will come back, as if it was yesterday that the loss occurred. The ‘Five Stages of Grief’ framework can offer language for experiences that might otherwise feel disorganised but it does not set a path that must be followed.

What remains central is the relationship with the person who has died and the ongoing work of carrying that relationship in a life that has been altered. What does this mean? Well, if our grief was removed or done away with then it would be a dishonour to the person and the relationship we had with them. To feel the grief fully is to honour that person. To weep and feel physical pain at the thought of who that person was and could have been is a testament to the love held for them. It is unfortunate that due to the human condition we cannot experience that love without the potential to experience the grief of loss in some format.

In 1897, Émile Durkheim described suicide in terms of social forces suggesting that levels of connection and regulation within society are key. His work points towards the importance of belonging and social context, without locating responsibility in any one relationship. Edwin S. Shneidman, in his 1993 book ‘Suicide as Psychache’, wrote that “the common stimulus in suicide is unbearable psychological pain”, which he termed ‘psychache’. This idea can sometimes offer a way of understanding suicide as an attempt to escape suffering rather than as a rejection of others or a wish to die. In 2005, Thomas Joiner proposed that suicide emerges when a person experiences both a sense of not belonging and a belief that they are a burden. This is known as the interpersonal theory of suicide. It also suggests that suicidal behaviour is not simply a wish to die, but something that develops over time through exposure and habituation to pain or fear.

Similarly, in 2011, Rory O’Connor developed the Integrated Motivational Volitional model, which distinguishes between the emergence of suicidal thoughts and the transition to action. Within this model, feelings of defeat and entrapment, also interpreted as feeling powerless or helpless in one’s situation, can give rise to suicidal thinking, while factors such as access to means or impulsivity can influence whether a person acts on those thoughts. Again, these ideas do not explain a single death. They offer a language for thinking about how complex and layered these experiences can be.

Apart from theories that can help in understanding, there is often a felt difference in how this loss is held by others. Suicide bereavement is many times influenced by the social responses that follow. Research consistently identifies stigma as a central feature. This can show up in silence, in avoidance or in use of language as people may not know what to say or sometimes they say nothing at all.

If the person who died by suicide was young then there can be a sense that the life that was unfolding has been interrupted in a way that feels difficult to take in. Developmental expectations are disrupted and an imagined future becomes something else entirely, as the absence is not only of the person as they were but of who they were becoming.

There is also the presence of trauma within this kind of grief. Bereavement after suicide can involve intrusive thoughts, images or bodily responses that are not always associated with other forms of loss. The mind can return to the circumstances of the death in ways that feel involuntary which can make restorative rest difficult. It can make everyday life feel less predictable.

At the same time, it is important not to separate suicide bereavement too sharply from other forms of grief. There is a risk that in emphasising difference, the shared human aspects of mourning are lost. Certainly shame and self-blame can be present. However, grief remains grief and love remains present in the loss. Grief theorists have long tried to describe how people live with loss. Accepting the reality of the loss and processing the pain of grief can be the ultimate challenge and these tasks are not steps that are completed in order. They can be returned to repeatedly, especially when the death carries unanswered questions. Meaning making and honouring the person who died by suicide can be deeply challenging but ultimately supportive in living one’s own life. Talking about this and opening up to loved ones is the best way to go about it. Of course, Psychotherapy and Counselling is also an appropriate place to do this if doing it with loved ones feels too much to start with.

For more information on Leo’s services, 

phone: 085 1300573

email: info@leomuckley.com 

web: www.leomuckley.com 

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