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Is My Baby Drinking Enough Milk?

Is my baby drinking enough milk?

Milk supply myths debunked!

Nicole Parakrama | BSc Hons Molecular Cell Biology, UCL (UK) | 17th April 2021 | <5 minute read

“Aney why is he crying so much?”…

…“Hungry-da?”…..

Mothers of infants might find this line of questioning familiar!

In our culture, we tend to cajole and bribe our children into eating more, with the goal of making them as chubby as possible. However, when we don’t allow our children to regulate their hunger for themselves, this can lead to unhealthy eating patterns (see this study here) with repercussions all the way into adulthood (some other great longitudinal studies here and here). We do our children a great disservice when we don’t take into account their varying body structures, feeding patterns, and metabolisms when considering when and how often we feed them.

“Aney why is he crying so much?”…

…“Hungry-da?”…..

Mothers of infants might find this line of questioning familiar!

In our culture, we tend to cajole and bribe our children into eating more, with the goal of making them as chubby as possible. 

 This same culture can extend to breastfeeding as well, with negative repercussions as a result! A study conducted by Rodrigo et al among 249 mothers at the Colombo North Teaching Hospital, found that “a family member telling mothers that their milk supply was low had

However, when we don’t allow our children to regulate their hunger for themselves, this can lead to unhealthy eating patterns (see this study here) with repercussions all the way into adulthood (some other great longitudinal studies here and here). We do our children a great disservice when we don’t take into account their varying body structures, feeding patterns, and metabolisms when considering when and how often we feed them. This same culture can extend to breastfeeding as well, with negative repercussions as a result! A study conducted by Rodrigo et al among 249 mothers at the Colombo North Teaching Hospital, found that “a family member telling mothers that their milk supply was low had the most

the most significant impact on Perceived Inadequacy of Milk (PIM)”.  In other words, we can give undue weight to the opinion, however well-intentioned, of someone who is (to put it simply) not the mother of our baby. 

It is not surprising, then, that one of the most Googled questions on breastfeeding is – “How can I tell if my baby is drinking enough milk?”  This is an understandable concern, as we simply cannot see how much milk our baby is taking in at the breast, so we have to guess!  Rest-assured, our babies are very clever at making their needs known – and they will usually drink as much milk as they need.  In turn, our breast tissue will respond over time and produce a supply of milk to match their demands. There ARE instances where concerns are warranted, and supply is low for medical reasons, but this is very often not the case.

significant impact on Perceived Inadequacy of Milk (PIM)”. In other words, we can give undue weight to the opinion, however well-intentioned, of someone who is (to put it simply) not the mother of our baby. 

It is not surprising, then, that one of the most Googled questions on breastfeeding is – “How can I tell if my baby is drinking enough milk?” 

This is an understandable concern, as we simply cannot see how much milk our baby is taking in at the breast, so we have to guess!  Rest-assured, our babies are very clever at making their needs known – and they will usually drink as much milk as they need.  In turn, our breast tissue will respond over time and produce a supply of milk to match their demands. There ARE instances where concerns are warranted, and supply is low for medical reasons, but this is very often not the case. 

A longitudinal study by Nielsen et al studied the milk intake of 50 healthy, exclusively breastfed babies over 6 months, and found the milk intake and fulfilment of energy values to be in excess of literature values.

Unfortunately, it is this fear of having a low supply which can become a roadblock in our breastfeeding journeys, far more often than it being an actual medical issue.

At a very high level, the rule of thumb is – if your baby comes off the breast looking relaxed, and if the number of heavy, wet diapers in 24 hours is more than or equal to the number of days old (for newborns up to one week), and 5-6 thereafter, your baby is very likely getting adequate milk (check out this comprehensive presentation by the Sri Lanka College of Pediatricians, particularly slides 41-46).

There are 9 common occurrences that may worry mothers, but which are not necessarily an indication of inadequate milk supply:

1. My baby wants to nurse very frequently

Breast milk is actually digested very efficiently (usually within 1.5-2 hours) and frequent feeding is common as a result.  Some babies are also more ‘sucky’ than others or require more skin contact.

2. My baby suddenly nurses more frequently, or for longer durations

This may be a growth spurt, which usually lasts a few days to a week. Since milk production is supply & demand-based, allowing your baby to feed extra will result in your breasts producing more milk to catch up.

3. My baby suddenly nurses less frequently, or for shorter durations

With age, as your baby gets more efficient at extracting milk, and the size of their little tummy increases, this will happen and is not an indicator of low supply.

4. My baby guzzles down a bottle of milk after nursing

Many babies will take a bottle of milk even after a full breastfeed, due to their suckling reflex, and then fall asleep due to exhaustion rather than satiation.

5. My breasts don’t leak milk, or only leak a little, or have stopped leaking

Leaky breasts have nothing to do with your milk supply adequacy. Leaking often stops once your milk supply has adjusted to your baby’s needs, and/or as the feeds become more predictable.

6. My breasts seem softer, or don’t get engorged anymore

Again this often happens once your milk supply has adjusted to your baby’s needs, and/or as the feeds become more predictable.

7. I don’t feel a let down sensation

Some women may never experience a let down sensation (tingling, pins & needles or a feeling of warmth), or find that it reduces over time. This is not connected to a reduction in supply.

8. I get very little milk when i pump

There are many reasons why this could be… pumping technique, pump type, flange size etc. At the best of times, your baby’s suck will always be more efficient at draining your breasts than the pump can mimic.  Pump output should not be used as a reliable indicator of production.

Hopefully you will find some reassurance if you are in this boat of questioning your supply.  However, if you have already found it in yours or your baby’s best interest to give formula, there is no guilt or shame in that. Breastmilk, while optimal, is not the only way to feed your baby. There are many circumstances where combination feeding (formula + breast milk) or only formula is necessary, and your child will be none the worse for it.  A well-fed baby combined with a happy mother really is the best end result.

How I became ‘The Milk Coach’

When my first child was born, I was quite unprepared for what lay ahead.  Particularly when it came to breastfeeding – I was naïvely expectant that I could just place him onto my chest, and let nature take its course.  What a surprise I was in for!  Cracked nipples from sub-optimal positioning, and my milk taking its own time to come in, led to terrible pain.  This pain became excruciating when my son developed oral thrush which travelled through to my milk ducts.  Fortunately, thanks to a lot of research and some wise mum friends, I was able to power through those awful first few months.  Most crucially, I was able to advocate for myself with health professionals (and I’m thankful for the ones who listened to me when I did!).

This birthed a passion to peer-to-peer counsel, share with and advocate for my fellow Sri Lankan mums, to support them to achieve their breastfeeding goals. To this end I am working to add to a science background (in Molecular Cell Biology) with an accreditation by La Leche League International (LLLI). 

Join the conversation, follow @themilkcoach on Instagram or Facebook.

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Confused over AstraZeneca news? We break it down in one minute!

AstraZeneca, long regarded as the problem child of the COVID vaccines, is plagued again by negative news. So what’s happened? What does it mean for you?

Short read:

The overall risk of blood clots is ca. 4 for every 1,000,000 people. The benefits of AstraZeneca vaccine outweighs the risks posed by COVID19 and the vaccine itself for over 40s. Anyone who didn’t suffer from clots should receive their second vaccine when offered.

However, as the risks posed by COVID19 to under 30s are lower, alternate vaccines are more prudent for use in this population. This is not out of safety concerns but utmost caution.

Want more details? We break it down into bite sized pieces below:

What’s happened?

In early March 2021, a slew of European countries paused administering the AstraZeneca vaccines after some reports of blood clots began to appear.

As per protocol, all severe adverse effects have to be investigated by the relevant medical authorities. When investigating, authorities look for signs of causation – did A cause B? Or did A and B happen to occur at the same time?

Most often, they do this by analysing the rates of occurrence of the event in the general population (or in the specific demographic) and then compare that to the rate of occurrence in the corresponding vaccinated population.

Here’s a simplified fictional example of what that means:

In the general population, say 1% of people over 50 suffer from heart attacks in a one month time period. In the vaccinated population, if this rate is the same or lower, then the event is deemed to not be caused by the vaccine. But if this rate is higher in the vaccinated population, then further investigations or ending of the vaccine trials or drives are required.

What did the investigations show?

On March 19th, EU & British regulators stated that the benefits of the AstraZeneca vaccine in preventing COVID19 outweighs any risks posed by it. They investigated ca. 30 cases of clots out of the 20,000,000 people who had received the vaccine in the EU & UK.

Following this, Germany, Italy and a number of other countries recommenced their vaccine drives with prudent processes in place.

So what’s the latest news about?

On April 7th, The UK’s major medical body, the MHRA held a press conference in collaboration with the EU’s major medical body, the EMA to discuss their findings.

There was confirmation that blood clots have been identified as a “potential side effect” in “an extremely small number of people” (emphasis added).

For example, in the 40-49 age group, 0.5 harms can be caused for every 100,000 people. This compares to 51.5 ICU entries with COVID19 in the same age group for every 100,000 people.

Most importantly, the benefits of AstraZeneca vaccine was found to far outweigh the risks for the majority of people.

What are the key things to remember about this event?

  1. The vaccine is still safe to administer to the vast majority of people over the age of 30. If you’ve had the first dose and haven’t had the below symptoms, you should take the second dose.
  2. If you have a known blood disorder, speak to your doctor before going for vaccination. 
  3. Anyone who has the below symptoms four days after vaccination should seek prompt medical advice.
  4. Symptoms to look out for include: 
    • new onset of a severe or persistent headache
    • Blurred vision
    • Shortness of breath
    • Chest pain
    • Leg swelling
    • Persistent abdominal pain
    • Unusual skin bruising or pinpoint spots beyond injection site

No medicine or vaccine is without risk. But knowing the destruction caused by COVID19 (even to those that present with no symptoms), it is always a matter of weighing the benefits against the risks. Agencies continue to monitor safety and will continue to act expeditiously when necessary. 

Concerned about clots or any of the above symptoms? Speak to an on demand GP on oDoc within 3 minutes.

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  1. “MHRA issues new advice concluding a possible link between COVID19 vaccine Astrazeneca and extremely rare unlikely to occur blood clots”, MRHA website, April 2021
  2. Under 30s won’t be given Astrazeneca vaccine over “extremely rare” risk of blood clots, ITV, April 2021

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PCOS – breaking the stereotype

There is so much noise around women’s health. Specifically, PCOS and most of it seems to be scientifically incorrect. PCOS is one of the most common endocrine disorders in women, affecting one in four women of reproductive age, which is 25% of the entire female population, so it is only fair to bust the myths around it. Before we debunk the misconceptions, here’s a little about PCOS.

A little about PCOS

Polycystic Ovary Syndrome or PCOS is an endocrine disorder that affects the way a woman’s ovary works. Women who suffer from PCOS either have an irregular period, excess production of male hormone or polycystic ovaries (where there are multiple cysts on the ovary). The excess androgen and cysyts in the ovaries prevent ovaries from releasing eggs every month. However, the exact cause of PCOS is still unknown.

Let’s go on and bust the myths around it because separating myth from fact can help you live a healthier life with PCOS. 

Myth #1: Having polycystic ovary syndrome means you have cysts in your ovaries

This is untrue. The name of the disorder is very misleading. If you have PCOS, it doesn’t mean you have cysts in your ovaries and having cysts in your ovaries doesn’t mean you have PCOS.

To be diagnosed with PCOS, you need to have at least 2 of the following symptoms:

Let’s go on and bust the myths around it because separating myth from fact can help you live a healthier life with PCOS. 

Myth #1: Having polycystic ovary syndrome means you have cysts in your ovaries

This is untrue. The name of the disorder is very misleading. If you have PCOS, it doesn’t mean you have cysts in your ovaries and having cysts in your ovaries doesn’t mean you have PCOS.

To be diagnosed with PCOS, you need to have at least 2 of the following symptoms:

Let’s go on and bust the myths around it because separating myth from fact can help you live a healthier life with PCOS. 

Myth #1: Having polycystic ovary syndrome means you have cysts in your ovaries

This is untrue. The name of the disorder is very misleading. If you have PCOS, it doesn’t mean you have cysts in your ovaries and having cysts in your ovaries doesn’t mean you have PCOS.

To be diagnosed with PCOS, you need to have at least 2 of the following symptoms:

Excess androgen – elevated male hormones levels may result in physical signs, such as excess facial and body hair (hirsutism) and occasionally, severe acne and male-pattern baldness.

Irregular periods – this is when you have less than nine periods a year with more than 35 days in between your periods. 

Multiple cysts in your ovaries – your ovaries can be enlarged with tiny follicles that trap the eggs, preventing them from being released every month, causing the ovaries not to function properly. 

So, having just cysts in your ovaries doesn’t necessarily mean you have PCOS. 

If you have any of the above symptoms and would like to get professional advice, you can consult a gynaecologist from the comfort of your home via oDoc.

Myth #2: You can’t get pregnant if you have PCOS

INCORRECT! YOU CAN GET PREGNANT EVEN IF YOU HAVE PCOS. 

PCOS is a common cause of  infertility due to the irregular release of eggs from the ovaries and the hormonal imbalance which interferes with fertilisation, BUT this isn’t the case for everyone. You can still get pregnant both naturally and after fertility treatment. Many medications can stimulate ovulation which is the leading cause of infertility. Women with PCOS who want to start a family can try different fertility treatments. Have a sit down with your gynaecologist to understand your body and treatment options better.

Myth #2: You can’t get pregnant if you have PCOS

INCORRECT! YOU CAN GET PREGNANT EVEN IF YOU HAVE PCOS.

PCOS is a common cause of  infertility due to the irregular release of eggs from the ovaries and the hormonal imbalance which interferes with fertilisation, 

BUT this isn’t the case for everyone. You can still get pregnant both naturally and after fertility treatment. Many medications can stimulate ovulation which is the leading cause of infertility. Women with PCOS who want to start a family can try different fertility treatments. Have a sit down with your gynaecologist to understand your body and treatment options better.

Myth #2: You can’t get pregnant if you have PCOS

INCORRECT! YOU CAN GET PREGNANT EVEN IF YOU HAVE PCOS. 

PCOS is a common cause of  infertility due to the irregular release of eggs from the ovaries and the hormonal imbalance which interferes with fertilisation, BUT this isn’t the case for everyone. You can still get pregnant both naturally and after fertility treatment. Many medications can stimulate ovulation which is the leading cause of infertility. Women with PCOS who want to start a family can try different fertility treatments. Have a sit down with your gynaecologist to understand your body and treatment options better.

Myth #3: You can only get PCOS if you are obese or overweight

Again, nope. This is not true. PCOS is more common in overweight women than lean women, and obesity can worsen the symptoms, but it can affect women of any body type and size.

One of the causes of PCOS is excess insulin in your body. This happens due to your cells forming a resistance to insulin which causes your blood sugar level to increase, and your body might produce more insulin to tackle it. Excess insulin causes more androgen to be produced, which causes difficulty with ovulation. 

The body’s inability to use insulin properly can lead to weight gain. That’s why getting into the habit of eating healthy and exercising regularly is recommended as part of most women’s treatment plan.

Myth #3: You can only get PCOS if you are obese or overweight

Again, nope. This is not true. PCOS is more common in overweight women than lean women, and obesity can worsen the symptoms, but it can affect women of any body type and size.

One of the causes of PCOS is excess insulin in your body. This happens due to your cells forming a resistance to insulin which causes your blood sugar level to increase, and your body might produce more insulin to tackle it. Excess insulin causes more androgen to be produced, which causes difficulty with ovulation. 

The body’s inability to use insulin properly can lead to weight gain. That’s why getting into the habit of eating healthy and exercising regularly is recommended as part of most women’s treatment plan.

Myth #3: You can only get PCOS if you are obese or overweight

Again, nope. This is not true. PCOS is more common in overweight women than lean women, and obesity can worsen the symptoms, but it can affect women of any body type and size.

One of the causes of PCOS is excess insulin in your body. This happens due to your cells forming a resistance to insulin which causes your blood sugar level to increase, and your body might produce more insulin to tackle it. Excess insulin causes more androgen to be produced, which causes difficulty with ovulation. 

The body’s inability to use insulin properly can lead to weight gain. That’s why getting into the habit of eating healthy and exercising regularly is recommended as part of most women’s treatment plan.

Myth 4: Losing weight is how you get rid of PCOS

Unfortunately, there is no cure for PCOS, so losing weight will not make PCOS go away, but it can help manage many of the symptoms. It is said that 10% reduction in body weight can reduce clinical symtoms by 80-90%. Losing weight will help with balancing the hormones. Lifestyle changes, such as healthy eating and regular exercise, improve the way your body uses insulin and, therefore, regulates your hormone levels better, thus helping your symptoms.

Myth 4: Losing weight is how you get rid of PCOS

Unfortunately, there is no cure for PCOS, so losing weight will not make PCOS go away, but it can help manage many of the symptoms. It is said that 10% reduction in body weight can reduce clinical symtoms by 80-90%. Losing weight will help with balancing the hormones. 

Lifestyle changes, such as healthy eating and regular exercise, improve the way your body uses insulin and, therefore, regulates your hormone levels better, thus helping your symptoms.

Myth 4: Losing weight is how you get rid of PCOS

Unfortunately, there is no cure for PCOS, so losing weight will not make PCOS go away, but it can help manage many of the symptoms. It is said that 10% reduction in body weight can reduce clinical symtoms by 80-90%. Losing weight will help with balancing the hormones. Lifestyle changes, such as healthy eating and regular exercise, improve the way your body uses insulin and, therefore, regulates your hormone levels better, thus helping your symptoms.

Myth 5: Women with PCOS do not need to use contraception

If you are not planning on getting pregnant, then you should always use contraception during sex. As mentioned above, ovulation is irregular when you have PCOS, so you never know when the egg will be released. So if you want to avoid unplanned pregnancies, always use a form of contraception.

Myth 5: Women with PCOS do not need to use contraception

If you are not planning on getting pregnant, then you should always use contraception during sex. As mentioned above, ovulation is irregular when you have PCOS, so you never know when the egg will be released. So if you want to avoid unplanned pregnancies, always use a form of contraception.

Myth 5: Women with PCOS do not need to use contraception

If you are not planning on getting pregnant, then you should always use contraception during sex. As mentioned above, ovulation is irregular when you have PCOS, so you never know when the egg will be released. So if you want to avoid unplanned pregnancies, always use a form of contraception.

Myth 6: Irregular periods = PCOS

No! Having PCOS may mean that you might have irregular periods but there are various other factors which can lead to irregular periods such as stress, extreme dieting and other endocrine disorders. Regular periods range between 3-7 days and occur every 21-35 days. Anything longer than this can be considered irregular. If you are experiencing irregular periods, speak to a doctor to get more information.

Myth 6: Irregular periods = PCOS

No! Having PCOS may mean that you might have irregular periods but there are various other factors which can lead to irregular periods such as stress, extreme dieting and other endocrine disorders. Regular periods range between 3-7 days and occur every 21-35 days. Anything longer than this can be considered irregular. If you are experiencing irregular periods, speak to a doctor to get more information.

Myth 6: Irregular periods = PCOS

No! Having PCOS may mean that you might have irregular periods but there are various other factors which can lead to irregular periods such as stress, extreme dieting and other endocrine disorders. Regular periods range between 3-7 days and occur every 21-35 days. Anything longer than this can be considered irregular. If you are experiencing irregular periods, speak to a doctor to get more information.

These are just a few of the misconceptions about PCOS. If you want more information or are experiencing any of the symptoms mentioned in this blog, please seek medical advice from an SLMC registered gynaecologist or GP via oDoc. Do not self-diagnose or self-treat PCOS. 

Checked by Dr. Haroon Thowfeek and Dr. Mohamed Rishard

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Taking charge of your Mental Health

Taking charge of your Mental Health

The transcribed version of the video is available below.

Shevangi: Hi, good evening everyone. I’m Shevangi from the oDoc team and thank you so much for joining us today. Today, We’ll be talking about something very important in this day and age. It’s mental health and its importance. Have you ever felt overwhelmed with your daily tasks? Have you ever wanted to just drop off and just get away? Ever wondered what it takes to get over this and just carry on? These are thoughts that many of us have felt I think. So we at oDoc believe that this is a very, very important topic that one should not shy away from, but instead, we should talk about it out loud. So here to advise us on how best to overcome these thoughts that I mentioned before and move towards a much healthier mental wellbeing is Dr. Suhashini Ranatunga. Let me first start by giving a brief introduction about the specialist Dr. Suhashini.  She’s a consultant psychiatrist at the national hospital, Sri Lanka and as well as a lecturer in psychiatry at the faculty of medicine, University of Colombo. She is also an MBBS, MD, and MRC holder specializing in psychiatry. Thank you so much, doctor, for taking the time out of your busy schedule to be with us today to discuss what I think is something very, very important for everyone today. So it’s a pleasure to have you on board. So welcome. 

Dr. Suhashini: Thank you for having me and Thank you for choosing this topic to talk about today.

Shevangi : Okay, thank you, doctor. So without any further ado, I would like to just dive straight into the questions, but before that, to all our viewers who are watching, if you also have some questions, please do send us your questions by the comment section below and our team will send the questions over to me. And I will ask that the doctor at the end of the session. So the first question, Dr. Suhashini is, many of us are aware that good mental health stands for having a stable and positive outlook on life and its challenges, but is that all? what exactly is the correct definition or what exactly is mental health and how important is it to adopt good mental health habits? 

Dr. Suhashini: Okay. I think part of the definition you have described in your question. If I  have to define what mental health is, it is a state of wellbeing in which a person, a human being is able to realize his or her abilities and can cope with the normal stresses of life.

Not all of us will ever have a happily ever after. There will be challenges. There will be stresses, but a person with good mental health is able to face these challenges that he or she faces, and also a person with good mental health can work productively, can work fruitfully, and is able to contribute to society. So that is what mental health is all about. But we also talk about what positive mental health is. So positive mental health is not just the absence of a mental health disorder. It is not merely the absence of disease. It is something similar you might be able to grasp it this way, where we might not have any physical problems, any physical ailments, but you people say that you are very unfit. So you can’t take a walk, you can’t go on a hike because they feel physically unfit. So positive mental health is something similar to that where you might not be suffering from a mental health disorder, but so that you’re not suffering from a mental health disorder, but you also need to appreciate what positivity or positive mental health is all about. So that is having positive characteristics in your life with regards to health. And that is having a feeling of purpose. A sense of contentment, your ability to maintain fulfilling relationships, loving, fulfilling relationships, and your flexibility to learn new skills, to adapt to a new environment, to adapt to a new job, to adapt to a new family, and also to able to enjoy life, the ability to live life to the fullest.

So that is basically what positive mental health is all about.

Shevangi: Great. thank you doctor for clarifying that. Just jumping onto the second question, which is also related to what you were saying. What are the common mental health disorders in Sri Lanka and how do we recognize them in ourselves or even others or our loved ones?

Dr. Suhashini: Okay. That’s a very broad area. From my experience or research coming out in Sri Lanka, the commonest mental health disorder would be what we call depression. We see a wide variety of anxiety disorders. To you, it might mean stress disorders, stress-related disorders. And now with the aging community, we also see disorders related to cognition or dementia, which we talk about. We also see psychotic disorders, substance use disorders are becoming very common in Sri Lanka now. These are the spectrum of disorders, but something I would like to highlight or talk about is depression is very common in Sri Lanka and all over the world. If I am to give one message, that is basically that it is a treatable mental health disorder. Part of your question was basically how do we recognize these mental health disorders, with regards to any form of mental health disorders, not just depression, but even anxiety or even substance use disorders or even dementia. The basic concept or the whole mark feature of any mental health disorder is a drop in your functioning.

If you were somebody who was, you know, able to cope with work, cope with what was going on at home, cope with other stresses that you have, that stress is going on in your life. And suddenly you feel that your, your ability to cope or your ability to handle things are affected. And you’re not able to perform well as before. then that could indicate that something is going wrong.

With regards to depression, not only depression but all mental health disorders. There are lots of good websites that are available online which people can go online and look up and educate themselves about. That’s something I would like to do direct but if we have time, I’m more than happy to discuss the common mental health disorders and their common features.

Shevangi: You were talking about certain symptoms that you see within the common disorders. Let’s say ,does someone have to show these symptoms in order for them to seek help, or go speak to a mental health professional or someone who hasn’t face these symptoms Can they go and speak to them?

Dr. Suhashini:  As psychiatrists, we see in Sri Lanka, we are not willing to talk about mental health problems or talk about our emotions. Basically having a mental health issue is considered a sign of weakness. Having a mental health problem is considered a weakness of personality. This is a huge misconception in our society. Sometimes some people would say that it is even the fault of the patient. Mistakenly people believe that if we are in a bad mood or if something is going wrong, we should be able to snap out of it. Because of all these misconceptions, people are extremely unwilling to come to a psychiatrist, to seek mental health, to go and see a mental health professional. And also patients themselves, don’t like to accept that they have a mental health disorder, because that would be a direct attack on themselves saying that I’m a weak person or I don’t have the courage to face up to these difficulties.

I think most importantly, I guess you can do it. The media can do it to improve mental health literacy in our country to make people understand that just like your heart can get affected, your stomach can get affected. So can the brain, and there can be problems occurring in the brain and these problems need professional help. And there are now good treatment options available with regards to mental health disorders. If patients do present there is very good help available to them.

Shevangi: Great. So if someone who hasn’t seen any of these symptoms can go seek help, right?  There’s no set time when they should, or they shouldn’t?

Dr. Suhashini: Well, earlier the better. It’s also important that family members realize that there is a person who might benefit from a professional consult. Sometimes patients are brought to us, and a lot of bad things have happened to them. They have attempted suicide. they have used other methods like drowning out their pain like going into alcohol, taking drugs. Relationships have become strained as a result of the mental illness.  Sometimes family members bring patients to us and even if the patient is not willing to come and see a professional. So I guess it’s everybody’s responsibility, it’s a collective responsibility. And if we do see patients with these behavioral patterns, these emotional disorders, then my advice is to get help as early as possible.

Shevangi: Great. Doctor, we got a question that’s coming from one of the viewers.  So can I ask you that?

Dr. Suhashini: Yes, go ahead.

Shevangi: Quite a long question. So I’m going to read the whole thing. it’s from Chandika. say ” hi, one month ago, I broke up with my girlfriend,  about a four months relationship and it’s just like a rebound. She had a lot of problems. Now. She’s not talking with me. All communication has been completely cut off. At the moment, it feels like I’m lost and I can’t concentrate on my work. I can’t get over with this breakup. What should I do?  Can I please have your advice?”

Dr. Suhashini: Okay. So this is quite a common scenario we actually encounter. Number one, a breakup is basically a loss event. So a person is extremely attached to somebody and suddenly when this person is no longer in this person’s life, then we consider that as a loss event to a person and feeling anxious, feeling lonely, feeling that they have no purpose anymore, feeling that they’re useless. all this can actually have a huge impact on the self-esteem of a person, as well as on different aspects of the patient’s life. So the first important message is to feel lonely, to feel anxious is normal. We all experience these emotions and especially when somebody dear to us leaves us we all experience these emotions. The golden rule is with time, it does get better. But what am I supposed to do during that time?  These might be things you can try out: Distraction works for a lot of people, talking to somebody works for a lot of people, connecting with your friends, your family spending quality time with them will have a huge impact on your mood. Starting a new routine or starting a new hobby might temporarily distract you. Things, which you should not be doing, are turning to alcohol. Some people say that I can forget her when I smoke weed or drink alcohol. So these will lead to long-term problems and they are not even temporary measures because you will feel worse the following day. My advice is basically to give it time, and spend quality time with other people, start something new, a new project, or whatever, and stay away from the negative things that can have any negative impact on your mental health. If these thoughts like feeling anxious, unable to sleep, feeling very low, inability to work, um, problems at the workplace. If this continues for months and months and if they’re becoming worse. Then that might be an indication that you’re going in for depression. And then it might be time for you to see somebody, a professional. 

Shevangi: Great. Thank you for that doctor. That was really helpful, very elaborate. one more question, within our generation today, work stress or being stressed in general is something a lot of us face. Everyone talks about it. Like it’s, it’s normal for us, right? . Being stressed.

So could you give us a few tips that we can follow to reduce the stress or handle it better? 

Dr. Suhashini: Yeah, that’s an interesting question. So there are people who are prone to stress, we call them anxious individuals where their predisposition is to become stressed or to get stressed for the slightest thing. Feeling anxious is a normal human emotion. But if this goes on long-term that is when it starts having negative consequences on one’s physical health as well as your mental health. What is most important is that we have a balance of work, recreation, or time to wind down. For different people, there are different ways in which they find relaxation. for some people it might be listening to music, spending some time with friends, family, for some people it might be meditation. for some people, it might be just going out for a walk. So it is an individualized thing and each person needs to find out what their anti-stress button is. If you’re feeling stressed, then you need to kind of probably spend more time attending to those kinds of activities. In the meantime, I mean, these are general things. It’s important for you to realize what are the things that stress me out. If it is exams, then you need to do something about it. So generally we feel stressed at exams because we are worried about how our performance will be or that we feel under-prepared. Then if it is that you need to start preparing early. If it is something like viva or facing an interview, then you need to have interview prep and start practicing for that early on. The hallmark feature is that the more you expose yourself to something that causes anxiety, the less anxious you will become with time. So if you are somebody who becomes very anxious at interviews, Then before the actual interview day, you need to, you know, expose yourself, face mock interviews as much as possible. the more you face them on the day of the interview, the anxiety will be less because the brain has gone through something similar to that before. If you’re somebody who becomes very anxious because you can’t keep deadlines, then that is somebody who needs to manage their time better. If you’re somebody who gets very stressed because of problems with relationships, then you need to handle your relationships better. There are different types of therapies now which are taught or which are done for people with anger management, for people with assertiveness issues, people with interpersonal relationships. So maybe attending one of those courses might be helpful.

Shevangi: Great. doctor, I have another question which leads on from one of the answers you gave me previously, you said depression was one of the most common disorders that you see in our generation in Sri Lanka. So if it’s so common, are there any tips or things you would like to tell a family member or someone who is taking care of a loved one who’s going through depression? Is there something you can say you should not say anything like that?

Dr. Suhashini: Okay.something you can say is if a doctor has prescribed medication for depression, the most important thing is that you make sure that that family member takes the medicine. The chances of you recovering if you do take the medication as prescribed is about 60 to 70%. So basically encourage the family member to take the medication. Lots of negative things with regards to mental health or things that can worsen depression: taking alcohol, Drugs ,negative relationships, negative people in your life, critical people. if there’s domestic violence at home or any form of physical, sexual, emotional abuse, those kinds of things can  maintain depression. These are the myths with regards to depression: in our society, we are extremely scared to ask about suicide. evidence has shown that if you ask about suicide, if you asked a depressed person, are you feeling suicidal? And that person says, yes, then you need to basically act on it and take that very seriously. The myth is people used to wonder if I ask about suicide from him. Am I putting thoughts? Am I putting ideas into his head? So that doesn’t happen. If you ask about suicide, you’re actually saving a life. If this person says yes, then it, then this person needs immediate professional help. If this patient says, no, don’t worry. You’re not putting an idea into his head. Saying you know, he might go and commit suicide. So the danger of depressionis suicide that is one of the dangers. So basically providing this patient, making sure that this patient takes medicine, staying away from negative things and making sure this person visits their regular mental health professional are things the family can help with. 

Shevangi: Great. Thank you doctor. The other question I have is also related to something you said earlier. You said that mental health is not something we speak about in Sri Lanka. It’s still a very taboo topic. If you look at the Western world, there’s so much noise around it and everyone’s doing something they can. So what can we as individuals do more or do better to spread awareness on mental health and how important it is to speak about it?

Dr. Suhashini: Yeah. So I think what you’re doing right now is doing a lot you know, talking about mental health. It shouldn’t be a taboo topic, at home with your family members, in school. It shouldn’t be something that, you know, we speak behind closed doors. Depression is so common. I mean, one in five people is affected by depression. The amount of patients that present to mental health services is less than 20%. So what can we do? So talking about it might help. The media can play a huge role. If it is a school teacher or a principal of a school, they can have awareness days or sessions to talk about mental health.

In our own homes, as parents, we can encourage our children to express themselves, talk about their emotions. We get very worried, even as parents, when our children start crying and then the moment they start crying to try to distract them and try to sush them down. So take these as opportunities, even when negative things occur in a family, take them as opportunities to talk about negative emotions with your child. I guess these are the things we can do. And also to express empathy to people suffering from mental illness, the moment a person is diagnosed with cancer or a heart attack, we rush to go and see them. And, you know, we are all out to help them. But if we know that a person is suffering from a mental illness, then we prefer to kind of step back because we are not sure how to handle this, what might we can do about it? Depressed people are some of the loneliest people in the world and a depressed person will, actually a symptom of depression is withdrawing themselves from society, withdrawing, drawing themselves from their friends circle and staying inside closed doors, inside their room, thinking about all the negative things. So, I guess if you have a friend or a family member who you think is depressed, offering to go and spend time with them, listening to them, taking them out for a walk or a coffee or lunch might actually do a lot for that person’s mental health.

Shevangi: Definitely. Great. Thank you, doctor. So we have come down to the last two questions which have been sent to us from our viewers. one before the last is how can you build resilience? How can we rebuild resilience mentally as we come out of what 2020 has been?.

Dr. Suhashini: Okay. So earlier I spoke about positive mental health. Positive mental health does not mean that you never go through bad times or experience emotional problems. We all go through disappointments. The last year has been full of disappointments for all of us at different levels. We have had loss and we have had change. so these are all part of normal life, normal. they’re all human experiences we all experience throughout a lifespan. These experiences will cause sadness, they will cause anxiety, and stress. But just as a physically healthy person is able to bounce back from an illness or an injury, people with strong mental health are also able to bounce back from adversity, trauma, disappointments, and stress. So, this is what we call resilience. What I discussed earlier, things to build resilience are basically to cultivate positive mental health, doing all the positive things, and staying away from all the negative things that impact your life.

Shevangi: Great. Thank you, doctor. So we’re onto our last question. It was sent anonymously to us via DMs. So this person has said, lately, I’m having a lot of stress in my family life. I think it’s affecting my mental health, like, I’m always forgetting, not being able to focus on anything for a long time. Can’t have pleasure from anything that I used to enjoy before. And it’s even hard to do my job lately. So many mistakes in my work. What can you say about this? 

Dr. Suhashini: Well, okay. So what he or she has described is classic anxiety, classic stress where you’re not able to concentrate, you’re making a lot of mistakes at your workplace, you’re having problems with your relationships. something which I can recommend is what we call problem-solving therapy where we talk about what are the main issues? What are the main negative things that are happening in your life right now? What are the things you can do about it? What are the positive things you can do about it? So let’s say if he says that, I’m in a financial crisis right now, I’m going through a lot of financial hardships. Okay. So then you can say, what can I do to improve my circumstances at the moment? and then we asked him to make a pros and cons list. And then, try and think of what is the best decision I can take or what is the best next step and then acting on it?  So it’s a form of therapy where we focus on the problem. Try to look for the solutions or come up with different solutions, picking the correct solution, picking the correct way to go forward, and then acting on it. That helps. Also, if you’re going through anxiety, like we discussed earlier, think of things that have reduced your anxiety earlier. it might be talking to a friend, talking to your spouse. maybe taking some time off work, spending some time outdoors, things like that. And spending some time with regards to that. Also if you’re taking alcohol, drugs, then probably staying away from that. If anxiety levels are very high, you’re finding it extremely difficult to fall asleep at night. And if it’s having a huge impact on your life, then there’s also medication that can be prescribed on a short-term basis until you get through this difficult period.

Shevangi: Great. Thank you so much for answering all our questions, doctor. it’s been amazing. We’ve come to the end of our webinar today. You’ve clarified a lot of my doubts and everyone else who has sent us questions. So thank you so much. As you said, it’s a very important topic that everyone should be talking about. And we at oDoc completely believe that, and we will continue to voice out about mental health and spread awareness wherever or whenever we can. So thank you so much for taking time off to answer all our questions. It was a very informative session. If any of you who are watching would like to get advice from Dr. Suhashini in a  more private setting, you could always consult her through oDoc and clarify any doubts you may have from the safety and privacy of your homes. With that, I would like to conclude this discussion. Thank you so much doctor once again, it’s been a pleasure.

Dr. Suhashini:  Thank you. Thanks for having me and thanks for talking about positive mental health. 

Shevangi: Definitely. thank you so much, doctor. Hopefully, we’ll have another session soon to spread more awareness.

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5 Ways to Best Take Care of Your Brain

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