Twenty-four years after moving to New Zealand, I am very fortunate to still have many friends and relatives in England and still be able to go back and see them. A consecutive Britrail pass provides the freedom to travel around the country on any train at any time, to visit people and places that played an important part in my earlier life and to take some pictures to remember them by.
My mother was brought up in Ramsgate and Margate, and during my own childhood we often visited these and other seaside towns in Kent.
Broadstairs in the sunshineFolkestone harbour on a dull day
My own childhood was spent in Gravesend. Returning there recently I found the town so changed that I hardly recognised it, and didn’t take any photos other than one of the house where I grew up.
Our old family home on The Overcliff
Besides the outings to the seaside we often visited other parts of Kent.
North Kent marshes – where I set one of my novelsCutty Sark – now in Greenwich but was lying on the Greenhithe shore during my childhood
My teenage years were spent in Yorkshire. I don’t often go back there now, but I took this picture during a delightful stay with an old school friend who lives in Wharfedale.
A stream near Leathley
Oxford, where I attended medical school and spent most of my subsequent career, still feels like home. The city centre has deteriorated but walking by the river is lovely as ever.
River Thames in Grandpont Nature Park
And a favourite place full of memories – the College of Healing course, the Elgar museum, the walks on the hills – is Great Malvern.
The Malvern Hills – I think this one is called the SugarloafWalking on the Malvern Hills
A highlight of my time in London was a lunch party for 24 of the friends who have given me hospitality over the years.
One of three tables set for lunch
As we all get older, and the state of the world gets more precarious, I know I may not see some of these people and places again. But I hope there will be more visits to England still to come.
Although medical topics are more openly discussed nowadays, some diagnoses seem more socially acceptable than others. People are quite happy to talk loudly in cafes about their heart attacks and hip replacements, but not about conditions likely to evoke fear, disgust, disapproval – or disbelief, in cases of “invisible” illnesses that are not clearly defined or understood.
When I have been injured in falls caused by my own recklessness while playing with exuberant dogs or running on slippery rocks, other people have always been helpful and sympathetic. Such a contrast to the negative reactions I have sometimes received in relation to migraine, and I know that my experience is not unique. People who have never had an attack themselves may assume migraine to be “just a headache”, or “all in the mind”, a trivial indisposition being exaggerated to gain sympathy or avoid unwanted obligations, and brought on through the sufferer’s own fault.
Research over recent years has identified some of the genes which predispose to migraine, and some of the physiological changes that take place during attacks, and migraine is now classed as a neurological disease. But its validity is not always recognised because it is a complex condition that can present in a wide variety of ways and follow a variable course, and there is no diagnostic test. Other conditions which have a consistent symptom pattern accompanied by specific abnormalities of biochemistry, pathology or Xray, are more likely to be taken seriously.
Someone in the throes of a severe attack, prostrated by pain and vomiting, is clearly very unwell. But in between attacks they may look and feel quite healthy, so that observers cannot believe there is anything wrong with them, and do not understand why they may be trying to control their condition by lifestyle measures. For example, while it would be accepted that someone with diabetes needs to follow certain rules about diet, a migraineur wanting to avoid “trigger foods” when out for a meal risks being considered rude and fussy.
Some of the stigma around migraine may be blamed on lingering sexist attitudes within the medical profession. Historically, certain doctors labelled their female migraine patients as neurotic, hypochondriacal and frigid, while describing their male ones as responsible, ambitious high achievers. Psychoanalysts have claimed, usually without any evidence, that the attacks represent sexual conflicts or the outburst of suppressed emotions such as anger or disgust. Such theories are less fashionable now that the biological basis of migraine is established, but have not entirely disappeared.
Lastly, though I am reluctant to admit it, I believe that migraineurs themselves can play a part in perpetuating stigma. My husband has told me that my personality appears to change during attacks, and not in a good way. If this is true for me and others, maybe we unknowingly give off “vibes” that confuse and alienate people. A projection of the guilt or shame we ourselves may be feeling at these times? If we were better able to retain our self-respect, and not try to hide the attacks nor apologise for them, we might get fewer hurtful responses.
Migraine and Me: A Doctor’s Experience of Understanding and Coping with Migraine by Jennifer Barraclough is available in e-book or print versions from Amazon and other online retailers.
Since buying my first iPhone I have taken thousands of photos, which have been stored rather haphazardly in various locations on my computer, some identified only by their numbers. I recently resolved to declutter and reorganise my digital files, prior to updating my devices. Labelling all the photos and allocating them to folders has proved a massive task, made harder because of my somewhat obsessional nature. How to classify them? Some belong in more than one category – animals, husband, family, friends, holidays, me with different hairstyles. Which to keep? I don’t like deleting any, apart from a few duplicates and photos of people I no longer recognise.
The project – still not quite finished – has sometimes felt overwhelming. For a while I was rushing to get it done, and wishing I hadn’t started it at all. But it seemed too late to give up, so I resolved to take a more thoughtful approach and appreciate all the images for the happy or sad memories they evoked.
Doing this has been a poignant reminder of the transience of life. Many of the people and animals in the photos have now died. The appearance of myself and my husband has changed over the years, and not for the better. I may never want to look back at these files again myself, and I have no close family so nobody else will want to keep them after my death. Anyway, they might all have been wiped out by some technical disaster by then. I was reminded of the Tibetan Buddhist monks who create beautiful mandalas made of coloured sands, and then deliberately destroy them.
Only read on if you like cats. I usually include some photos in my posts, but couldn’t decide which to choose from among so many, so I decided just to feature the cats who have lived with us since we moved to New Zealand. Excluding all the foster kittens, there have been seven long term residents, two of whom – Magic and Leo – are still alive. It was quick and easy to find their photos, which made me think that the project has been worthwhile after all.
CinderellaFloella (daughter of Cinderella)FelixDaisyHomerMagicLeo
This is not an “anti-drug” post – I fully accept that prescribed medication is the mainstay of migraine prevention. Certain beta-blockers, antidepressants and anticonvulsants are long established for reducing the frequency and severity of attacks, and the newer CGRP inhibitors have even better results. But none of these drugs work for everyone, and all of them can have unwanted side effects. I took propranolol for many years with some benefit, but then its effect seemed to wear off. I then decided to look more closely at what lifestyle factors triggered my attacks, and to explore some complementary therapies that seemed more “natural” and gave me more choice and control over managing my health. Many of the non-drug options for migraine prevention are supported by evidence from clinical trials as well as by anecdotal reports, but the orthodox medical approach tends to focus on drug treatments alone. My new book Migraine and Me: A Doctor’s Experience of Understanding and Coping with Migraine aims to give a more holistic overview. Here is a brief summary of some of the preventive methods it describes. They do not offer a cure for migraine but, whether used alongside drugs or instead of them, they can help. Most of them are relevant to other chronic medical conditions too.
Being instructed to eat better food, get more sleep, take more exercise, stop smoking, drink less, and reduce stress can be irritating – but these deceptively simple “healthy living” guidelines can make a real difference. There are special considerations for migraineurs such as not going too long between meals, and identifying triggers in the diet and environment.
Dietary supplements which have been found effective include magnesium, B vitamins and Coenzyme Q. The herb feverfew, illustrated, is available in capsule form but the most natural way to take it is by chewing its leaves, as described in one of the case histories in my book.
Relaxation techniques can help by activating the parasympathetic “rest and digest” branch of the nervous system, as opposed to the sympathetic “fight or flight” branch which tends to be overactive in migraineurs. Relaxation is a component of many other therapies such as biofeedback and massage.
Psychological therapies may be regarded with suspicion because they are thought to imply that migraine is “all in the mind” rather than being a neurological disease with a genetic basis. I am certainly wary of psychoanalytical theories that cite repressed anger or sexual conflicts as being the cause. But more practical approaches such as cognitive behavioural therapy (CBT) can alleviate the mental distress and social difficulties that make it harder to cope with attacks and may well be exacerbating them.
Creative activity through art, music or writing is a way of processing emotions around migraine. If the results are made public, they can contribute to understanding of the condition. Some works by historical figures such as Richard Wagner and Vincent van Gogh are thought to have been inspired by the migraine experience.
These and other approaches are covered in more detail in Migraine and Me: A Doctor’s Experience of Understanding and Coping with Migraine, available in both print and e-book versions from your local Amazon site and other online retailers. Please forward this post to anyone in your circle who may be interested.
Watching Joe Biden’s determination to cling on to power despite his obvious physical and mental decline has made me think again about a question that keeps arising as I get older: Is it better to stop doing things while the going is good, or to carry on till it is clear you are not coping?
I am a few years younger than Biden. I feel fit and well, in fact better than before since my sleep pattern has improved and I have grown out of the migraines that plagued my earlier life. And yet, looking back over the last few years I realise what a lot of my former activities I have given up. This has sometimes been because of external factors outside my control, such as family illnesses and transport difficulties and lockdown effects, but also reflects the gradual loss of energy and confidence that comes with aging.
Not all the changes are bad. My life is quieter, and more locally based. I still enjoy driving but no longer fancy long trips, which must reduce my environmental footprint. I have resigned from my previous choir over in Auckland city, but joined another which is nearer and requires less time commitment. I don’t do sessions at the animal rescue centre any more, but help to look after two dogs as well as my own two cats. I closed my Bach flower client practice some time ago, but still make up remedies for friends. Instead of the film society in the city, I go to the local cinema or watch DVDs at home. I have joined a book group, dance and TRX exercise classes in the village where I live, and made a few new friends there. I still love writing and would hate to give that up, yet I don’t write as fluently as I used to, nor do I have so many new ideas. I don’t want to be like well-known authors such as Agatha Christie and PD James, whose later novels were so inferior to their early ones. Perhaps my latest book Migraine and Me will be my last.
There may come a time when someone wanting to continue as an active and productive member of society becomes a nuisance, an embarrassment or worse. But this is not inevitable. Older people can have much to contribute due to their long experience of life, and it is a mistake to underestimate them on grounds of age. The English environmentalist and chimpanzee expert Jane Goodall recently undertook a lecture tour around the world at the age of 90, and I’m told that her presentation in Auckland was inspiring.
Along with a big crowd of other British expats wearing red white and blue, I attended a joyful and nostalgic version of the Last Night of the Proms performed with orchestra and choir in the Bruce Mason theatre on Auckland’s North Shore.
The programme began with God Save the King and finished with Rule Britannia, Land of Hope and Glory and Jerusalem, with many other traditional items in between. New Zealand content included the national anthem, a Maori song called A Te Tarakihi, and a film of the Spitfire flying at the Warbirds air show. The soprano soloist wore a series of splendid gowns, one resembling a giant Union Jack. I used to think I hated bagpipes, but the wonderful performance of Highland Cathedral by a pipe band was a highlight of the show.
Towards the end, the hall filled with balloons and streamers as the wildly enthusiastic audience sang along and waved our flags. We all had a good time, and perhaps some of us were left wondering whether the UK or NZ feels more like home.
I’m pleased to announce that Migraine and Me: A doctor’s experience of understanding and coping with migraine is now available as an ebook from Amazon Kindle and various other online retailers as listed on this link, with a print version planned to follow soon.
My migraines began in my teenage years and continued until later life. In this short book I’ve combined personal stories from myself and other contributors with information from published research. Writing both as a (retired) doctor and as a (recovered) migraine patient, I’ve aimed to balance the medical aspects with the psychological, social and even spiritual ones. The book describes how lifestyle measures and complementary therapies, as well as prescribed drugs, can help to prevent attacks. It covers some sensitive topics such as the concept of a ‘migraine personality’ and the reasons for stigma, and ends on a positive note with sections about creativity and ‘silver linings’.
To quote from the blurb: “Migraine and Me offers empathy, practical insights, and hope for anyone affected by this complex neurological condition, once described in a drug advertisement as hell on earth.”
If there is anyone in your circle who is affected by migraine and might be interested, please share this post with them. Here again is the link to the book.
My new ebook Migraine and Me is nearly finished but I’ve left the final draft aside for a while, so I can check it through with fresh eyes before publication.
Meanwhile I’ve been continuing my project of “Going wide with D2D”. The aims are to bring some of my earlier books to a wider readership, and to update my basic skills in formatting text and using self-publishing technology.So Wellbeing for Writers and Beautiful Vibrations are now available not only from Amazon Kindle (kdp) as before, but also from many other ebook retailers as shown on this link http://books2read.com/jenniferbarraclough.
“A short practical guide about how to enjoy the journey to becoming a (self)published author, and how to cope with challenges such as lack of time for writing, lack of inspiration, negative criticism, and aversion to marketing. Jennifer’s experience as an author of both fiction and non-fiction books, combined with many years of working with clients in various therapeutic settings, has given her a wide personal understanding of the psychology of writing. This little book includes many practical tips for making the process run smoothly, and enhancing mental and physical wellbeing.”
“Anxiety, sadness, anger and loss of hope are common responses to serious or chronic illness. Symptoms of the condition itself, side-effects of treatment, concerns about diagnosis and prognosis, restriction of activity, and changes in relationships take their toll on both body and mind. Ideally, negative feelings will soon be replaced by a more positive adjustment, but sometimes they are severe or prolonged. Bach flowers are not a cure for physical disease but help to relieve the emotional distress often associated with it. Dr Edward Bach described them as having ‘beautiful vibrations’ capable of promoting positive mental states such as hope, courage and calm. This practical guide, illustrated by case histories and flower photos, explains how to select and use the remedies as part of a holistic approach to healing. Despite all its unpleasant aspects, the experience of illness can have a silver lining and the flower remedies help to bring this out.”
In 2015 my husband Brian had major cardiac surgery. I wrote some posts describing his operation and gradual recovery on this blog – here are the links to Part 1, Part 2 and Part 3. Now it’s time for another episode. Writing about these experiences is my way of processing them, and maybe reading about them will be helpful for other patients and their partners who are going through something similar.
The operation was successful, and Brian remained fit and active both physically and mentally for the next eight years. Then he became slightly less well, with a more irregular heartbeat, and more shortness of breath when climbing up the 68 steps on the hill behind our house. These changes happened slowly and neither of us took too much notice – after all, it would seem normal to be slowing down at the age of 90. But after seeing the results of Brian’s routine followup echocardiogram, his cardiologist was concerned and arranged a series of further investigations.
These included a Transoesophageal Echocardiogram, CT Coronary Angiography, and Coronary Angiogram. Performed at weekly or fortnightly intervals, with blood tests in between to check Brian’s renal function, each of these tests involved spending a long morning at our local North Shore Hospital. They were not without risk, because they required sedation and/or arterial injection of contrast media, but Brian tolerated them well. He was understandably anxious during this period and I gave him a course of Bach flower remedies, Mimulus and White Chestnut, which seemed to help. When all the tests were complete we saw the cardiologist again. He said that the porcine aortic valve inserted in 2015 was broken and that Brian needed another operation “soon” – otherwise his prognosis would be very poor.
Brian said that he didn’t feel ill, so was rather reluctant to have another operation at his age, even though it would be a far less invasive procedure than the open heart surgery he had before. But he did agree, and on the following Monday I got a call from Auckland City Hospital asking us to come straight in that afternoon. Brian was given a single room, and hooked up to an ECG monitor. I tried to concentrate on reading while he had various tests, was visited by the anaesthetist and cardiologist, and was shaved all over in preparation for his TAVI at 7.30 a.m. next day. I went home in the evening and fed the cats.
TAVI stands for Transcatheter Aortic Valve Implantation. The procedure, which takes about two hours, is carried out under light anaesthesia. It involves making an incision in the groin to access the femoral artery, through which the new valve (formed from either porcine or bovine tissue) is delivered to the heart on the end of a catheter. Another incision is made in the radial artery, near the wrist, for the injection of contrast media to allow the procedure to be monitored by x-ray. There is a large team of clinicians involved: two interventional cardiologists, a specialist nurse, other nurses, cardiac physiologists, and radiographers.
It seemed pointless for me to go back to the hospital until Brian was out of the operating theatre, so I stayed at home and occupied myself by changing the bedlinen. In the middle of the morning a doctor rang to tell me that the operation had been completed successfully. I had not realised quite how stressed I was feeling until, on hearing this news, I burst into tears. When I returned to his room about noon I found Brian conscious and lucid though looking rather strange, with most of his body covered in a red dye, and wound dressings on his arms and legs.
Having had another echocardiogram to check that his new valve was working well, Brian was discharged the evening after his operation. A few days later he was feeling reasonably well, still needing to rest much of the time but able to go out for short walks. Full recovery is likely to take a month or two. It is wonderful to see what modern medical technology can achieve, and hopefully Brian’s TAVI will be followed by another long period of good health.
Update: I was going to publish this post last week but then Brian had a serious setback due to bleeding from the bowel. Apparently this can happen after a TAVI for various reasons. He required emergency admission to hospital and was very unwell for several days, but improved after a series of blood transfusions, and is now happy to be back home. He needs to rebuild his strength, and will be having further outpatient investigations to see whether there is a correctable cause for the bleeding.
The Bach flower remedies are not intended to treat migraine or any other medical disorder directly, but to correct any imbalances of mood or personality which may be associated, whether as cause or effect. They are among the many “complementary” modalities which can aid in the management of this complex condition.
The system was developed in England by Dr Edward Bach almost a hundred years ago. Through intuition, he identified a series of wild flowers corresponding to the emotional states of people and animals. This may sound unscientific and bizarre, but the therapy continues to be widely used around the world, and a number of clinical trials have testified to its effectiveness: I am one of the practitioners contributing to a new database of published studies which can be found at https://www.cambridge-bach.co.uk/bach-science-studies-database/ . The remedies, prepared in liquid form and taken by mouth, carry the energetic signature of the source plant. They are safe and free from side effects, having no chemical content apart from the low concentration of brandy used as preservative. An individualised mixture, containing up to six of the 38 remedies, is chosen for each client.
Because the therapy is prescribed for the person not the disease, there is no standard formula for migraine. Theoretical examples of flowers to address the emotional burden of the condition include Mimulus for fear of more attacks, Elm for feeling overwhelmed by responsibilities, Gentian for being discouraged about the lack of improvement, Red Chestnut for worries about how the attacks are affecting others. Treatment needs to be continued for several weeks to have a lasting effect but can be short-term for acute situations and Rescue Remedy, a combination of five flowers available as spray, can have a calming effect in the early stages of a migraine attack.
Whether or not a “typical migraine personality” exists, any long-term traits of personality which are making life more stressful could be contributing to attacks. Philip Chancellor’s book Illustrated Handbook of the Bach Flower Remedies, published in 1971, reads as somewhat old-fashioned but contains many interesting case histories from the records of Dr Bach’s clinic in the Oxfordshire village of Brightwell-cum-Sotwell. It describes five women with migraine, all of whom improved on remedies chosen according to their personality type. These included Chestnut Bud for being slow to learn from experience and repeating the same mistakes in life; Oak for working to the point of exhaustion due to a strong sense of duty; Scleranthus for an inability to make decisions; Vervain for being unable to relax due to over-enthusiasm; Wild Rose and Centaury for a woman passively resigned to being dominated by her husband and having no life of her own.
Two of my own books are relevant to this topic. Beautiful Vibrations: Living through medical illness with Bach flower remedies and Migraine and Me: A doctor’s experience of understanding and coping with migraine. Both are available in print or e-book formats through major online retailers.
Jennifer Barraclough 