(Combination case study/feature/self-help article with toolkit added) Nosisipho Samuels’ baby was four months old when she returned to her work as a designer at a publishing company. She had been coping wel enough with the changes to her family life: the disrupted sleep, the added financial pressures, the lack of time for herself and for spending with her partner. Then her mother, who cared for the baby, became ill and was hospitalised for several days. Nosisipho knew she was taking strain, but thought she was managing until unexpected deadline pressures at work increased and she made a grave error of judgment that cost her company a lot of money and caused her great distress. This is the kind of thing that happens when life’s difficulties outnumber our resources for coping. It’s called stress. Unmanaged employee stress leads to problems like absenteeism, an increase in grievances and litigation, errors of action, interpersonal conflict, violence and a loss of intellectual capital in the work place. But for most people, it is the personal cost that is highest. Unchecked stress can become an engine that fuels itself and can lead to debilitating depression and anxiety disorders. Nosisipho’s happy years with her company helped smooth over the potential y devastating consequences of her stress-related mistake. The mistake itself was to be the warning signal she needed to change some things in her busy life. After feeling weepy for a week after the incident, she went to see her doctor who advised her to take some time off work to see to her domestic problems. This was not difficult to arrange with her boss, who had already suggested she take some leave, which she’d refused because she didn’t want to appear to be running away from her mistake. The two weeks she spent at home meant she could look after her mother and the baby, and gave her a chance to assess what she needed to change to avoid a future melt-down. She organised for her husband’s unemployed cousin to come and stay with the family for a few months to help out. When she returned to work she was feeling not just more rested and in control, but as though she’d learnt a hard lesson about looking after herself. Nosisipho’s stress arrived in one heap and caused a pile-up. Psychologists Thomas Holmes and Richard Rahe examined the medical histories of over 5000 people to find out whether stressful events might cause il ness. From their studies a stress scale was devised. The most stressful events are the death of a spouse, divorce, illness and gaining a new family member. However, it is not just huge life events that cause stress. Constant time pressure, moving, taking out a loan, a change in sleeping and eating patterns, having to take out a bond – even holidays – all contribute to a build-up of stress levels. Not al pressure is bad. Some stress is needed for people to perform at their peak, to keep them motivated and enthused. Pressure only becomes a problem when it starts to outstrip our ability to cope with it: when there’s too much, it goes on for too long, or it arrives too suddenly. How to know when the load is getting too heavy There are many symptoms of stress and some of them are so subtle, it might take a while to become aware of them. The symptoms can be classed into four major categories. These can range from irritating to debilitating. At the beginning, however, we tend to ignore them or treat them superficially, so that we can “get on with things”. Be aware, however, that any of these things, especially if they recur or increase in intensity, could be symptoms of stress: • Headaches • Indigestion • Diarrhoea • Picking up weight • Losing weight • Getting colds or infections often – or things like dandruff or cold sores • Skin irritations • Neck and shoulder pain Stress changes the way we act. You or someone close to you may have noticed: • Changes to your sleep patterns, particularly insomnia or waking in the early hours • Being less careful about your appearance • Withdrawal from your usual social contact Stress creates new feelings and thoughts too: • Feelings of helplessness and uselessness • Listlessness and feeling unmotivated • Inability to concentrate or make straightforward decisions Don’t wait for stress to wipe you out. Be alert to its signals and adapt your life. STRESS TOOLKIT
Once you have acknowledged that you are suffering under too much pressure it is up to you make some changes. • Take stock of changes in your circumstances, behaviour and feelings. Write down your challenges. Tackle each thing methodically if you can. • Tell someone. Your family, employees, col eagues and boss need to know that you are taking strain. They can’t help relieve the stress if they don’t know that you’re doing too much. Don’t wait for someone to notice. Tell people. • Tel ing people means facing up to what’s going on. It also means that you don’t isolate yourself during difficult times. People like to help and no-one will think you’re weak for admitting that you are struggling to cope. • Manage your time. Work out what the most important things are to do, what you can give someone else to do, and what reasonable deadlines are. • Pace yourself. Try and take a few minutes away from your desk or work environment. A walk at lunch time is very good for your head and your body. • It is okay to say “I can’t do this right now. I have too much on my plate already.” Learning to say “no” is a way to protect your boundaries and your health. Because stress has a direct effect on your immune system, your health is more vulnerable during times of stress and you are more likely to become ill. There are several ways you can try and keep yourself physical y up to the chal enges of stress. • Exercise is the single most important element in maintaining health and you don’t need to be an exercise junkie to reap the benefits of exercise. Thirty minutes of walking every day – or even every other day - may not seem like much, but it makes a measurable difference to your health. • Watch what you eat. Try to make sure that you eat something fil ing for breakfast. A packet of crisps and a fizzy drink at 10am – when you realise you haven’t eaten anything yet – are not good for you. Keep fruit, nuts or biltong in your desk drawer or bag and nibble on them al day. • Keep drinking water. Try to get out of the coffee and tea habit. Water wil keep you sufficiently hydrated so that you don’t also suffer from headaches and fatigue. • Try to reduce the amount of alcohol you drink. You might feel like a few beers or glasses of wine after work help you to relax, but they’re more harmful than helpful in the long run, particularly bad if you have sleep difficulties. • Try to go to bed at the same time every night, and relax with a book or a magazine (not the television or the iPad) in bed. Regular, deep sleep is vital for the body to recharge its batteries.

Source: http://www.icas.co.za/docs/default-document-library/article-on-stress---copy.pdf?sfvrsn=0

Vance albaugh - curriculum vitae

Vance L. Albaugh, MD, PhD Phone: (717) 629-1233, Email: vance.albaugh@vanderbilt.edu, Fax: (615) 322-0689 EDUCATION Surgical Residency Training Vanderbilt University Medical Center; Nashville, Tennessee Medical/Graduate Pennsylvania State University College of Medicine; Hershey, Pennsylvania USMLE Step 1: 243 (99), July 2007 USMLE Step 2 CK: 255 (99), August 2010 USMLE Step


Isotretinoin SCP contains the active ingredient isotretinoin Consumer Medicine Information What is in this leaflet 6. you have very high fat levels Ask your doctor if you have any (cholesterol, triglycerides) in questions about why Isotretinoin your blood SCP has been prescribed for you. 7. you have hypervitaminosis A It does not take the place of tal

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