Beautiful distraction

One of the best coping strategies is good, healthy distraction. Sitting in a movie theatre, reading a good book, watching a TV series. Playing computer games. These things take our minds off any lingering fears we have after treatment and can keep us going during treatment.

I tell myself that these are always things I can enjoy even if my condition deteriorates and I can’t go out so much. They’re insurance for the future as well as enjoyment in the present.

I always find the holiday season difficult as someone alone, someone with eating difficulties. The very word BBQ causes me physical pain. How can people eat all that tough food? Socialising is hard. I also have nagging fears about the condition of my mouth. You have to wait until after the season to see about these things if a crisis occurs such as breaking a tooth off at the gum as I did just before Christmas.

So … I have had quite a good season despite that. I’ve read three good books (we’ve had a lot of cloudy weather) , watched three good movies and played an addictive phone game. The first six items were good healthy distractions, the last item has often made me feel guilty because it encourages an unhealthy addiction. Oh, Wordscapes.

First up the three movies (used to always call them films). I’m fascinated by American politics so “Vice” a film about G W Bush’s VP, Dick Cheney, was enticing although I am a real film snob and usually prefer little indie films or foreign films or art films. Turns out it was really good, a bit draggy in the middle but innovative, witty, had some empathy for this very conservative and ruthless politician but was basically a satire. Throughout the film his heart attacks accumulated into a sort of metaphor for the heartlessness of this sort of politics and fly-fishing for his ability to manipulate naive people and reel them in as he did with G W Bush (according to the movie). His wife was portrayed as a Lady Macbeth type of figure egging him on to more and more ruthless political goals. At one stage they even talked in made up Shakespearean.

Would they give up politics when they discovered their daughter was gay and yet Republican politics demanded that they be anti gay marriage? Some false end credits (best part of film) suggested yes … but of course they didn’t. Cheney was the power behind the throne and his wife was the power behind him.

To sum up, the film cleverly made a dry as dust topic very interesting and showed how Cheney’s politics lead the way to the present situation in the US.

Then I saw Mary Poppins by mistake and it was goooood. I’m very suspicious of false cheer and forced positive thinking but this film was a delight. My favourite scene was the brilliantly choreographed London lamp-lighters’ dance. Anything with Lin-Manuel Miranda in it is worth looking at.

Third up was Bohemian Rhapsody. I didn’t follow Queen in my youth but of course all the songs are well known and catchy and the film gave me a glimpse into the life behind those famous songs. After it was over I googled, watched the Live Aid concert on You Tube and learnt a lot more about Mercury. I don’t think the film captured his essence but it was well made and very poignant. Why do geniuses have to be so tortured? Also, what were we thinking all those centuries in denying gay people their identity? I was pleased to read that in his latter years he had a lot more friends than the biopic showed. Left the cinema feeling sad.

My favourite scene was the one where the record executive refused to back Bohemian Rhapsody or BoRap as one of the band members said fast forwarding to modern slang.

Books. The easiest read was Nine Perfect Strangers by Liane Moriarty set in or near Sydney. Just a great chick lit read. Beautiful example of the genre.

Normal People by Sally Rooney. Sweetest love story I’ve read for ages. Written by a young writer in her 20s and captures relationships so well.

Bridge of Clay. Another Aussie book. A really worthwhile tale of building a bridge to heal family dysfunction – goes deep and is worth the annoying narrative style that makes it hard to get through the first part. Captures emotions so very well. A male book which is a change after Nine Perfect Strangers.

TV series: Gran Hotel. What can I say? Beautiful soap with a patina of merit because it’s Spanish! Fantastico!

b

In a flap

When I realised I’d have to have a hemi-glossectomy (half my tongue removed) I was relieved to hear that the missing bit of tongue could be replaced by a flap of tissue from my arm. Phew! There wouldn’t be a gaping hole and the remaining part of my tongue could push the flap around to enable me to talk.

This flap surgery is well known to vast numbers of head and neck cancer patients but the rest of the world knows little about it and even GPs seem confused. Twice I’ve been to different GPs on duty after a big surgery and they have  said, “I don’t know what I’m looking at.”

This article, a patient’s record,  is about the “free flap”, tissue taken from elsewhere in the body to fill a defect in the head and neck. What I didn’t know in those early days is that the flap of tissue (because it is big) has to have a blood supply. A “pedicle” (a long attachment) of vein and artery is removed from the graft site with the other tissue.

Many head and neckers have had tongue cancer and will be familiar with the tongue surgery to remove the tumour, the removal of a square hunk of tissue from the inside wrist plus a long string of blood vessels. They will have the raw wound from this graft site covered with a thin peeling of skin from the front of the thigh – the donor site.

This is big complex surgery and takes a team, including a head and neck surgeon and a plastic or reconstructive surgeon. It can take 8 hours or so on the operating table and the patient will probably need a temporary tracheostomy so they can breathe while the tongue settles down again.

There will probably be a neck dissection to remove lymph nodes along the side of the neck from below the ear to below the chin. The blood vessels from the forearm flap are joined to blood vessels via this cut in the neck. (I’m getting to the limit of my understanding here.)

However, if it goes well, it can give the patient an acceptable quality of life. There’ll be some change in speech sound but the speech should still be clear. The scars will never go away but after a year they are acceptable. You have a wide pink patch on your inner wrist with a long thin scar where the blood vessels were harvested. There’ll be a large square white wrinkly patch on your thigh where the skin to cover the wrist was taken.

Patients sometimes get a sort of  “turkey neck” from the neck dissection where the scarred side of the neck of an older person is firm and the looser skin on the good side spills out annoyingly on the other side of the scar.

These side effects were bearable for me and I have never felt any discomfort from my flap. My speech has a slightly unpleasant nasal quality. I suppose it sounds as if I have something in my mouth – which I have! A doctor called it “hot potato” speech. But is has never impeded me too much. After my first flap surgery I went back to part-time teaching but have to admit it was hard.

Some people don’t get used to their flap so easily. The flap is too bulky and has to be surgically “debulked”. One man said his flap felt like a wet flannel in his mouth. Some people go from a kiwi accent to a formal British one, I have heard. Personally, I’d rather have a posh accent than hot potato speech.

It’s hard to clean your mouth after a flap. Hard to get to back teeth because there can be scarring and tenderness where the flap is joined to the native tongue. A Waterpik or syringe might be needed to squirt water into the mouth and flush out the larger particles of food.

In my case, an unfortunate development was that my flap forced the native tongue into a gap in my teeth on the good side of my mouth. This part of the tongue turned into a small round red lump with the papillae worn off. Not a good look but out of sight out of mind.  At least I don’t have hair on my flap which is not unheard of, especially for men.

The first six months to a year is difficult. It can take a long time for the most superficial wound, on the thigh, to heal. The wrist wound looks red and raw for months until it fades into the innocuous pink. I wore a tennis wrist band for a long time. The tongue flap itself can heal well and even develop some of the  the appearance and texture of the rest of the oral mucosa or lining of the mouth – that pink, slimy, mucousy look. But generally it remains whiter than a tongue and can be very white and wrinkled like a hand held in water for a long time. After all, it is skin.

During the time in hospital, the healing can be hard. The wrist looks like raw meat and can get infected and full of fluid. I remember a nurse pressing on my wrist and the fluid squirting up to the ceiling like a putrid fountain. Laughter from the crowd!

The flap in the mouth has to have a good blood supply so right from the start it is checked with a Doppler device that checks its “pulse”. I vaguely remember waking up in IC and someone saying, “That is a viable flap”. Good, I thought. I remember later that it was not healing well in parts, had some “necrotic” (dead) tissue and had to be debrided with what looked like a drill. I have since found that debriding means cutting the wound in a criss cross pattern so that the body wants to heal it fast. It worked. Some people have to have their flaps redone. Rarely.

I had a second flap taken from my right wrist after a recurrence in 2014. It went over my inner cheek (buccal mucosa) and gum/jaw. Although I was four years older and in my late 60s, the whole process went a lot better. Maybe because the transfer of tissue was more superficial than for the reconstruction of a tongue. But now I have two pink wrist scars and on each thigh a square of wrinkly white skin.

Trouble with the tongue flap is that problems can only be dealt with by ENT doctors or staff in the surgical ward. GPs and dentists usually have no experience of these flaps so you need to have a clear line of communication with your team. You need to know who to ring if you have problems with the flap, such as it rubbing against a tooth.

Fortunately, there are taste buds throughout the mouth so a person with a tongue flap can still taste.

Terms

Microvascular surgery: Surgery on very small blood vessels such as those only 3 to 5 millimeters in diameter. Microvascular surgery is done through an operating-room microscope using specialized instruments and tiny needles with ultra fine sutures.

Pedicle: a small stalk-like structure connecting an organ or other part to the human or animal body, part of a graft, especially a skin graft, left temporarily attached to its original site.

Papillae: the tiny lumps on the surface of a normal tongue

Here are some notes from medical sites on the net

Microvascular techniques have allowed surgeons to readily transfer tissue from one region of the body to another. In the ideal situation, one must replace tissue lost with tissue that has similar characteristics. In the head and neck, tumor extirpation may result in loss of the thin mucosal covering of the oral cavity, pharynx, or larynx.

The radial forearm free flap is ideal for reconstruction of defects of the oral tongue.

The radial forearm free flap is a versatile flap that includes the volar forearm skin and the underlying soft tissues and fascia containing the radial artery as the perforator. It was first introduced by Yang Guofan in China in 1978. Since then, it has been commonly used as a donor flap for reconstructing the intraoral lining and resurfacing facial and neck defects.  It has been used in various sites, particularly for tissue defects remaining after a wide excision of head and neck malignancies. The radial forearm free flap has many advantages, including thin and pliable characteristics, a relatively hairless nature, and a long pedicle with a large external diameter, making it very useful .

https://synapse.koreamed.org/DOIx.php?id=10.5999/aps.2015.42.6.769&vmode=PUBREADER

Here are some articles about survivors who have successfully lived through this hand to mouth procedure.

http://www.dailymail.co.uk/health/article-40937/Surgeons-rebuilt-tongue–arm.html

http://newswise.com/articles/unique-surgery-creates-fully-usable-tongue

A Waikato wonder

The range of bush covered hills behind Ngaruawahia have always looked dark and brooding to me. That is until I walked up them and saw the wonders they contain. Kauri! Some of the most southern in the country and a surprisingly sub-tropical forest full of nikau and rimu as well as the stands of kauri.

This is the Hakirimata range, 10k north of Hamilton and just over the river from Ngaruawahia’s main drag. There’s a well designed network of tracks, carparks at each end, toilets and a tramping track right along the top of the ridge.

This is from the DOC pamphlet about the tracks.

My foray to the Hakirimata Range was just to do the Kauri Loop Track which is just to the north of this map. It was hard enough because to get a view you have to walk from river level to the top of the range but the summit track in the middle of the map is the hardest. There are a few lower level wanders you can do though. I have some pictures of the southern end where the main entrance is complete with carved portal.

Entrance to the southern entrance

The Kauri Loop track is steep – steps – but really good. You can see one giant kauri and a stand of rickers and some other quite big specimens.

Son and granddaughter try to show the width of this tree. Don’t do it justice. It really is an impressive tree.

From the Kauri Loop Track, you can walk up to a lookout with good views of the Waikato River. Didn’t know there were so many real lakes and coal min lakes around Huntly. Once again, Huntly looks miserable when you drive through on Highway 1 but when it is see from above with the river running through it, it takes on a new life.

On a gloomy day the view from the lookout was still spectacular. That is Huntly in the centre.

How photography helped me

After my big tongue op in 2009, I needed months to heal and get my speech back to some sort of normal so I stayed off work and took a photography course online. It was far too hard for me. I don’t have the technical understanding to get to grips with the manual functions of a DSLR (digital single lens reflex) camera and I just wanted to take pretty landscape pictures. I completed the course with a pass grade  and ever since then have enjoyed the five or six basic skills I took away from it. I’m going to share them with you because going out with camera or phone, taking pics of our world and sharing them is therapeutic.

Here are five skills in brief – for landscapes:

1.Edit. Every phone or computer will have basic editing software. Straighten the horizon! Crop. More later.

2. Hold the camera down low.

3. Obey the rule of thirds which means dividing the screen in 3 vertically and horizontally and placing the object of interest in the intersection of these lines.

4. Frame the object for a special effect with a tree for example.

5. Use the vanishing point sometimes – a road disappearing into the distance. Very emotive. 

Rule of thirds

Why edit? Digital photos often need sharpening. Do “Auto Enhance” or use the sharpen/clarify function. Be subtle. Crop and straighten if need be. A little crop will often bring the subject into better focus. Takes seconds/minutes.

Why a low angle? Makes the pic look more dramatic and adds some foreground like the grass on the foreshore of a beach – leads eye in and frames the pic.

Why the rule of thirds? It’s a art concept where an object not placed in the middle of a pic but to one side is more pleasing to the eye. The horizon in top third or bottom third looks better for example.

Framing? Things look more striking through a natural frame – but only sometimes.

Vanishing point. Eye is drawn into the picture and the point itself is filled with mystery, the unknown. Always makes an impact. Avenues of trees are good. 

Vanishing point

More stuff. The best pictures tell a story. I can’t do that yet. I’m a bit too impatient to wait for objects to be in place to make the pic more than a calendar shot but that would be another point for improvement. There’s also the idea of lines or objects leading the eye into the picture – a log of driftwood on the beach for example. Some of the ideas I’ve stated are cliches but good ones like the lonely tree representing the loneliness of the universe – or again shooting past the driftwood to add some feeling to a beach pic. 

Yep, taking some pics, editing them and then sharing them is a thing I enjoy and feel I can still do even if my health doesn’t persist. Sharing is so easy in today’s world and part of me wants to advocate for the conservation of New Zealand’s natural environment.

Good for the soul. 

And here is a website taking it up a level. Very easy to read. 
https://www.makeuseof.com/tag/5-photography-tips-for-beginners/

Not so magnificent obsessions

I vaguely remember the film Magnificent Obsession, 1954. I would have been 8 so why do I remember it? The title is floating in my memories but I’m writing about little obsessions now – little interests that keep you going. I’m thinking about people who have been limited by their head and neck like me or far worse. I can barely eat in a socially acceptable way, can’t bite or chew, I have an uncomfortable dental plate and mouth-guard and I’m pretty badly scarred.  But you know what keeps me going apart from friends and family? It’s my obsessive personalty.

That sounds like a bad thing and sometimes it has been for me (my obsession with the current world political situation for example) but the little positive obsessions have been really helpful and have brought me joy. There was the decade long obsession with Shakespeare that got me through my latter teaching years. When I had two classes doing Shakespeare in the same term, my imagination and intellect (such as it is) would be aglow. I read a book called “Shakespeare’s Imagery” and wanted to go to Stratford on Avon where a lot of the similes and metaphors he used got their origin. 

Another obsession was with alpacas after seeing a couple of beauties at  a Rotorua agricultural day about 10 years ago. That obsession has faded too but has given me an online identity on some sites. 

I’m obsessed with pohutukawa trees at the moment. Actually, I have been for a long time. I used to have a massive one outside my window during my childhood and those big old trees are wonderlands, covered in crimson flowers at Christmas. 

Secret weapon for moments of fear

When I started this latest head and neck cancer chapter, I was really scared. The cancer had come back which meant more difficult surgery followed by radiotherapy. It meant loss of teeth and later dental decay. It meant endoscopes and drills, needles,  extractions and biopsies and torches shone in my mouth. What horrible news were they going to give me next? How would I keep calm in the face of pain?

At the time, 2014, I was just beginning to live by myself as my husband had gone into care, so I had to find a way to cope with those little moments of fear and panic, let alone the wider fear of death and dying. Somehow I hit upon the idea of memorising an alphabetical list of things and chanting it to myself.

It sounds very strange but I learnt a list of Kiwi icons off by heart. We New Zealanders have gone to town with “kiwiana” in the last couple of decades. Long having struggled to define our identity as an independent,  bicultural country, we have iconised things like our native birds and trees, aspects of Maori culture and brands from the early days.

I had bought a poster from an Orewa tourist shop with a list of such items and put it on the toilet wall. After learning them by heart I had a calming device for every contingency.

Here are the first six items on the list:

  • Aroha = Maori word for love
  • Beehive = our house of parliament
  • Crown Lynn = an iconic crockery firm from the 50s
  • Downunder = slang term for Australasia
  • Eel = we have lots of them
  • Fantail = one of our cutest native birds

The first few were easy to remember but I used to forget some and had to think hard to retrieve the memory. What was U again? (It was “ute”.) This distracted me from the pain and panic. The list was particularly useful when the mask came down during radiotherapy and and the tongue depressor made my jaw ache unbearably.

One thing that made the list more memorable was that it was a pictorial list so each item had a stylised picture associated with it.

I still use it today if I’m having an examination and have to stop my heart beating like crazy. It works and I found out only recently that distraction techniques like this are commonly recommended by health psychologists.

Wish I’d looked after my teeth

So grateful for upper plate.

One of my first memories is of having five teeth out when I was five years old. Might have been because Mum used to put honey on our dummies. I remember coming out into the waiting room and being given a colouring book and pencils. When I opened my mouth to speak, blood poured out.

Here I am 67 years later still irked by my bad teeth. It’s not Mum’s fault but a combination of factors. Both parents had had all their teeth removed in their teens and were probably not great role models for tooth cleaning and avoiding sweet foods. We didn’t have fluoride in the water and there was no such thing as floss, interdental brushes and tooth mousses … Dental nurses had clinics in each school and cheerfully drilled and filled kids’ teeth with a sense of fatalism you wouldn’t see today.

I had multiple fillings each time I went to the dentist in Milford until I was 16 and free dental care ended. No one told me this was a sign that I needed to look after my teeth better. It was free! Having fillings was normal.

I remember the pain. The injections never worked properly in those days. When involuntary tears poured down my cheeks once, I was reprimanded by both the dentist and the assistant. “Oh Maureen! You have to be brave.” My greatest joy was when the dentist hung his drill up for the last time at the end of the session. There was a sort of motion that signaled to me that the agony was at last over.

University and no money to pay for a dentist. Started work and needed a tooth out. Stabilized teeth during 30s and 40s but then more decay again as I grew older. By the time I hit my 60s, I had lost a fair few teeth and had a number of root fillings. 67 and I had a marginal mandibulectomy of my left lower jaw and radiotherapy. Front teeth were broken in surgery. Trismus or limited mouth opening. Very hard to clean my teeth – gums and teeth in poor condition. However, I concentrated on getting through the treatment and getting over it. Getting dentures to fill the front gap. I did try to clean my teeth well, but let’s face it, I should have tried harder.

What am I left with now? A pretty appalling situation. A nice upper denture,  partial metal, gives me an okay smile and you can’t really see my lower teeth which are gradually breaking up. The lower two front teeth are stuck together like two tall trees swaying in the wind roped to each other or two close-knit tombstones. The others are stumps or half teeth. There’s nothing on the left side to hold a denture properly because of the flap over the gum. Strangely I’ve got some strong molars at the back but they are causing me to bite my tongue and cheek because of changes to the architecture of my mouth after a couple of big reconstructive surgeries.

I’m trucking on okay though. As long as I can keep the bottom teeth for a little bit longer my lower lip, palsied on the left by a cut nerve, won’t get sucked in too much more. I mean, I’ll cross that bridge when I come to it. Can’t have the lower teeth removed unnecessarily anyway because of the threat of osteoradionecrosis.

A lot of this sad story is because of the oral cancer and treatment but I do believe I could have lessened the damage if I had looked after my teeth more religiously. That’s what I’d advise other head and neck cancer patients to do. Don’t do a half pie job. You need to go above and beyond to look after your teeth after radiotherapy.

I’m very comfortable sitting here at my computer and I don’t want to get up but heck, I think I’d better go and … clean my teeth.

All new Weiti Bay walk

Real estate company’s photo of the development

I tend to take East Coast Road from Silverdale to Browns Bay to see my family rather than the motorway.  Since moving here in 2012, I’ve noticed a new road being formed to the left towards Okura. Eventually I discovered that it was the route into a new subdivision behind the previously unspoilt Karepiro Bay which is well known for the historic Dacre Cottage and its distinctive red barn.

View of Weiti or Karepiro Bay from southern end

Last week we christened the road, got as far as a security gate and were directed to a small car park up the road where a new graveled path winds its way to the beach. The present subdivision consists of huge houses and lifestyle blocks but apparently two villages of about 200 houses each will be built by the car park. It’s all scrappy, hilly country so far, some paddocks, stands of pines but by the car park a nice area of native bush and gum trees. The path would have taken us about 15 minutes. The rewarewa were in glorious bee-filled flower.

This is what we saw when we got to the beach (had to take shoes off and wade across stream). Godwits! They looked much more interesting in real life. Elegant but soft and quite delicate although not as delicate as the fussy little dotterels who ran in ones or twos in front of us as we walked along. I don’t blame them for being skittish, of course, because they were nesting on the beach and they’re mighty endangered. All the nesting sites on the top of the sand were roped off but they didn’t know that, did they? No pictures of them because they are so well camouflaged and my skills and patience are not good enough for a good shot.

Godwits

A walk along the beach taking care not to disturb the dotterels, godwits, oystercatchers and terns doesn’t take long and at the end of the beach you can walk out onto some rocks for a better view of the area.

Grannies on rocks

The track to Okura is closed at the moment but after carefully picking our way back along the beach we climbed the track at the other end which goes over the headland to Stillwater. There and back, just to the top and along a bit to enjoy the spectacular puriri and nikau forest. Here is one of the giant, gnarled old puriri.

Classic puriri

I didn’t time the walk but it is a good one for bush, beach and bird lovers.

And just to make this more of a visual record of the walk, here is a video Photo Gallery made for me without my asking.

A 90 minute walk with variety

A walk with long tail but no backtracking.

This Orewa/Eaves Bush/Hatfield’s Beach walk is a classic for walking groups on Hibiscus Coast but this post celebrates the fact that it is exactly 90 minutes if you walk from McDonald’s, halfway down Orewa Beach. You can walk to Eaves Bush on the footpath and come back along the beach so no retracing of steps is needed.

Eaves Bush off Old North Road is a real gem. A local group looks after it and stands of quite mature kauri as well as young rickers line lots of the paths. There is no kauri dieback but I wouldn’t be surprised if it was closed any time soon – to protect the trees – so it’s now time to enjoy this loveliness. There is some delightful undergrowth with many quite rare native plants.

You go in a bit of a loop through the bush and then up to Hillcrest road where a steep walkway takes you down to the old Hatfield’s subdivision which look 60s ish – maybe 70s/80s in parts. Remember when PM Rob Muldoon was interviewed here every Christmas? He had a bach nearby. Anyway, it is a modest suburb with mature trees and gardens. Then it’s down another walkway to a little creek that winds to the other end of the beach. Then over the main road to beach itself.

Hatfield’s beach is great! It’s on a busy road and it’s a boaties’ beach but it’s usually quiet and there’s no housing, just grass and trees and wetland in this particular bay. It’s almost unspoilt with a bit of an estuary on one end and cliffs and rocks leading to Orewa on other, the south end, where a short walk takes you to some steps up the cliff. Great views from these steps and then a walk through a luxuriant, luxurious suburb to the main road again, Hibiscus Coast Highway. You don’t have to walk on the road though because there’s a path through some pines and then beside the road to the Orewa Beach lookout.

Fabulous views from roadside. Orewa and beyond. Sea galore. From the lookout even better. There is a short bit down to the bridge near Old North Road again and then you can walk through the Arundel Reserve to the beach and join the people and their dogs walking along it back to McDonald’s. A good 90 minute walk for average walkers on a Sunday morning.

A small flat white at the McCafe is only $2.50 so it’s a cheap date.

It’s the little things?

 

The minutiae of life or little things you notice. Life’s trivia or just things like a gerbera in flower or a rose bud. A gadget in the cellphone shop. God, if I hadn’t had an eye for these things in the last ten years or so of head and neck cancer issues, I would have been lost.

It ties in with the fashionable concept of mindfulness too. I was between appointments and feeling restless. Went for a walk ten minutes up the road to patchy patch of pine forest and native bush. I heard a shining cuckoo, a tui and saw a fantail and wax eye.  The aural and visual senses. Little things that calmed me down.

Past the patch of untidy bush was a view of the horizon with one of my favourite sights – all the distant craggy islands and peninsulas written clearly against the sky. You can count clear days like that on the fingers of one hand every couple of months. There was Little Barrier, Great Barrier and Coromandel all blue and mysterious behind the nearer, lower, greener islands.

Then a walk down what was an ugly new subdivision sloping down to Whangaparaoa Road. Now softened with banks of flax and flowering manuka. One particular bank had such a swathe of soft white manuka flowers that it hit my eye with joy. I wondered if anyone else ever noticed things like this. It’s much more of a little thing than the spectacular ocean view.

The Sunday Star Times had a great feature in its recent Sunday mag. “Don’t worry, be happy.” What were the little things people recommended to put you in a good mood? Say thank you, said one journalist. When you’ve been through a tough time write down the things that you are grateful for. Sounds cheesy she said, but it worked for her. Say no to things you don’t want to do said someone else. Rescue a dog, go outside and my particular favourite: clean something meticulously. The other night I cleaned in and around the kitchen sink and polished the stainless steel. Sometimes just one shelf in the fridge or one drawer will do it.

Do a little thing and do it perfectly.