AUDIOBOOK: MANAGING FATIGUE AFTER A STEM CELL TRANSPLANT
Narrated by actor Andrew Hayden-Smith, our audiobook explains how fatigue is an expected side effect of stem cell transplant and includes practical tips and advice on how to deal with it.
This is the audiobook version of our popular booklet 'Managing Fatigue After a Stem Cell Transplant'. All our Anthony Nolan booklets are available free from www.anthonynolan.org/booklets
Full transcript (auto-generated)
0
00:00:01.360 --> 00:00:02.160
introduction
1
00:00:02.560 --> 00:00:08.211
Hello and welcome to Anthony Nolan managing fatigue after a stem cell transplant audio guide it's been produced with
2
00:00:08.260 --> 00:00:12.060
guidance and advice from healthcare professionals and are remarkable patients.
3
00:00:12.340 --> 00:00:14.140
You'll be in the same situation as you.
4
00:00:15.240 --> 00:00:21.540
This guide will help you understand your post-transplant and provide handy tips and advice that make it more manageable.
5
00:00:22.520 --> 00:00:28.139
This audiobook will explain what 40 guys some of the most common reasons why develops and how can affect both your
6
00:00:28.189 --> 00:00:29.520
physical and mental health.
7
00:00:30.380 --> 00:00:34.480
We also talked about how we can manage your energy levels including exercising regular.
8
00:00:34.680 --> 00:00:37.380
Sleeping well and getting support from your friends and family.
9
00:00:38.000 --> 00:00:43.400
The topic has been giving it an audio track so you can easily access the information is relevant to you when you need.
10
00:00:44.060 --> 00:00:51.016
We highlight some of the information resources that you might find relevant these guys are free to order from my website
11
00:00:51.074 --> 00:00:52.060
anthonynolan.org.
12
00:00:53.920 --> 00:00:59.790
If you need to ask us any questions or would like more advice. You can get in touch with the Anthony Nolan patient
13
00:00:59.842 --> 00:01:02.520
services team at patient info at anthonynolan.org or
14
00:01:04.560 --> 00:01:05.660
all three or 3
15
00:01:08.620 --> 00:01:09.320
attractive
16
00:01:09.520 --> 00:01:10.420
What is fatigue?
17
00:01:11.420 --> 00:01:14.620
feeling tired after work
18
00:01:15.180 --> 00:01:20.380
When you find difficult to concentrate and have no energy even after lots of rest and a good night's sleep.
19
00:01:21.040 --> 00:01:24.840
Take a Mick if you're both physically and mentally drained leaving you with very little motivation.
20
00:01:25.180 --> 00:01:27.980
It can be hard to concentrate even on simple things.
21
00:01:28.420 --> 00:01:31.420
There isn't a standard set of Rules that decides if you have fatigue or not.
22
00:01:31.680 --> 00:01:33.280
Everybody's recovery is different.
23
00:01:33.420 --> 00:01:35.120
And it will affect them in different ways.
24
00:01:35.740 --> 00:01:39.140
This is why it's important to keep your medical team well informed about how you feel.
25
00:01:39.860 --> 00:01:40.560
if you regularly
26
00:01:41.000 --> 00:01:42.900
Feel tired especially when you wake up.
27
00:01:45.640 --> 00:01:47.440
Have trouble sleeping during the night.
28
00:01:47.940 --> 00:01:49.140
I feel depressed.
29
00:01:49.720 --> 00:01:51.220
It could be a sign of fatigue.
30
00:01:51.780 --> 00:01:54.480
You might be felt like you had very little energy before you're transferred.
31
00:01:54.960 --> 00:01:59.860
The combination of your blood cancer a blood disorder and how was treated could have left you feeling constantly tired.
32
00:02:00.680 --> 00:02:06.680
He can develop at any time after transplant the most patients starting to feel fatigue during pre transplant conditioning.
33
00:02:07.520 --> 00:02:10.420
Usually happens when your blood counts are still no but as they say.
34
00:02:10.760 --> 00:02:12.260
energy levels will rise to
35
00:02:12.740 --> 00:02:17.740
You might also notice it when you go home and find you not able to do your normal day-to-day activities as he wants to.
36
00:02:18.760 --> 00:02:22.760
Play some people are short term effects of treatment that gets better over a few months.
37
00:02:23.460 --> 00:02:25.660
What am I coming over about 6 months to a year?
38
00:02:26.320 --> 00:02:28.620
How old is Mike recover many years after they transfer?
39
00:02:29.000 --> 00:02:30.500
women never completely gone
40
00:02:31.180 --> 00:02:35.380
This could mean that you need to make some permanent changes to your lifestyle, so it's easy to come to terms.
41
00:02:36.440 --> 00:02:39.040
stem cell transplant in 2014
42
00:02:39.860 --> 00:02:46.210
I think on balance, I will possibly always suffer from fatigue, but it's a very small but not insignificant face to pay to
43
00:02:46.262 --> 00:02:47.460
be back. Enjoy my life.
44
00:02:48.260 --> 00:02:53.904
It may be times in your recovery 140 is unavoidable, but it's still possible to manage your situation and make the best of
45
00:02:53.951 --> 00:02:54.460
the energy.
46
00:02:55.160 --> 00:02:58.060
This can be done through a combination of medication and practical tips.
47
00:02:58.340 --> 00:03:00.040
disgusting tracks 3 and 4
48
00:03:03.560 --> 00:03:05.360
What causes fatigue in what help?
49
00:03:05.960 --> 00:03:09.060
There are many possible causes of fatigue related to your transplant.
50
00:03:09.380 --> 00:03:11.580
your general health and wellbeing also facts
51
00:03:12.220 --> 00:03:17.520
Consent for older patients and those who had a lower level of fitness before they transplant.
52
00:03:18.580 --> 00:03:23.080
Your type of blood cancer or blood disorder and other health concerns could also affect fatigue.
53
00:03:24.060 --> 00:03:27.460
In this track we look at the main causes of transplant related fatigue.
54
00:03:27.720 --> 00:03:28.720
starting with the most
55
00:03:29.580 --> 00:03:31.780
We also suggest ways to make it easier to manage.
56
00:03:32.160 --> 00:03:34.560
You may not experience all of them during the recovery.
57
00:03:35.540 --> 00:03:36.340
conditioning
58
00:03:37.440 --> 00:03:43.405
For your stem cell transplant unit had a course of treatment known as conditioning therapy consisting of chemotherapy and
59
00:03:43.455 --> 00:03:44.540
possibly radiotherapy.
60
00:03:44.980 --> 00:03:48.380
Prepare your body for transplant by removing the cells of your immune system.
61
00:03:48.760 --> 00:03:51.160
Including those caused in your blood cancer a blood disorder.
62
00:03:52.020 --> 00:03:56.420
Is creating enough space in your bumper off your donors sells to rent Grafton stop making new cells?
63
00:04:00.440 --> 00:04:06.669
My fatigue setting on about day 5 of my week of conditioning with chemo I Began to feel like a different person. It wasn't
64
00:04:06.720 --> 00:04:10.040
so much tiredness. It felt like my energy has been taken from me.
65
00:04:10.640 --> 00:04:11.540
conditioning therapy
66
00:04:13.460 --> 00:04:15.860
Andy Steele while your new immune system develop
67
00:04:16.380 --> 00:04:22.101
During this time you have less red blood cells that normally transport oxygen around your body which is needed to release
68
00:04:22.148 --> 00:04:22.480
energy.
69
00:04:23.300 --> 00:04:28.300
Unfortunately conditioning therapy is essential pre-transplant step so it's difficult to avoid.
70
00:04:29.660 --> 00:04:32.460
This is why it's one of the main causes of fatigue after transplant.
71
00:04:33.180 --> 00:04:37.080
It often improves after a few weeks or months for some patients it can last long.
72
00:04:38.020 --> 00:04:43.681
Improving your general fitness prior to transplant has been shown to reduce the impact 40 can have post-transplant but
73
00:04:43.729 --> 00:04:46.320
unfortunately this isn't always possible for everyone.
74
00:04:47.140 --> 00:04:47.940
eating and drinking
75
00:04:48.640 --> 00:04:51.640
Whilst get back to your normal diet after your transplant.
76
00:04:52.260 --> 00:04:56.660
During the first few months to a year.
77
00:04:57.300 --> 00:04:59.900
Setting food my taste different to how they did before.
78
00:05:00.260 --> 00:05:01.860
Might not like the food.
79
00:05:03.140 --> 00:05:06.340
Chemotherapy damage the cells in the mucosal lining of your mouth.
80
00:05:06.640 --> 00:05:10.740
Swinton breakdown which can cause painful ulcers to form inside your mouth and throat
81
00:05:11.580 --> 00:05:17.780
Courses may also form further down your digestive tract causing discomfort and making it difficult to eat certain foods.
82
00:05:18.420 --> 00:05:22.320
It's normally occurs about a week after treatment and should clear up in a week or two.
83
00:05:23.520 --> 00:05:29.416
Who did the body only feel sauce to eating certain food becomes difficult it could leave you feeling tired and low on
84
00:05:29.467 --> 00:05:29.820
energy.
85
00:05:30.400 --> 00:05:35.400
The body needs plenty of fluids and various vitamins and minerals to release the energy stored in food effective.
86
00:05:36.240 --> 00:05:38.840
stem cell transplant in 2014
87
00:05:39.420 --> 00:05:44.020
I find myself unable to eat much food had a metallic taste and I didn't enjoy an alcoholic.
88
00:05:44.580 --> 00:05:48.380
What's the name of my music presents a month later things gradually return to normal?
89
00:05:48.960 --> 00:05:52.060
Here are some handy suggestions to help with your diet during recovery.
90
00:05:52.800 --> 00:05:57.600
3 full-size meals a day can feel daunting so try eating smaller portions more often.
91
00:05:58.280 --> 00:06:02.980
During early recovery focus on food you want to eat then what you think is the healthiest?
92
00:06:03.900 --> 00:06:06.800
It's more important to get the energy needed anything else at this.
93
00:06:08.020 --> 00:06:09.520
soft foods like soup
94
00:06:09.600 --> 00:06:12.700
Mashed potato in ice cream easy to swallow if you have a sore mouth.
95
00:06:13.360 --> 00:06:15.760
Your hospital may also give you nutritional drinks.
96
00:06:16.760 --> 00:06:20.760
ice lollies or ice pops can help relieve a sore mouth and answer your fluid intake
97
00:06:21.880 --> 00:06:23.880
Try the drink of the 2 L of liquid.
98
00:06:24.620 --> 00:06:26.420
They should be non caffeinated.
99
00:06:26.940 --> 00:06:30.440
You can have with tea, or coffee alongside water juice or cold.
100
00:06:31.140 --> 00:06:34.140
You might find it easier to water regularly throughout the whole day.
101
00:06:35.140 --> 00:06:38.840
Please talk to your hospital dietitian.
102
00:06:40.680 --> 00:06:42.380
They will answer any questions you might have.
103
00:06:43.280 --> 00:06:44.180
sickness and diarrhoea
104
00:06:45.240 --> 00:06:49.540
It's common to feel sick and be sick after your transplant because of your treatment medication.
105
00:06:49.620 --> 00:06:53.220
possible infection or graft-versus-host disease for gvhd
106
00:06:54.160 --> 00:06:57.060
Nausea normally only lasts a week or two for most people.
107
00:06:57.840 --> 00:06:59.640
For the same reasons you may also experience.
108
00:07:01.300 --> 00:07:06.500
Sickness and diarrhoea can make it difficult to get the energy need from your food which could lead to weight loss.
109
00:07:06.920 --> 00:07:10.120
Play discomfort cause and also affect your sleep and mental well-being.
110
00:07:10.700 --> 00:07:14.300
Your medical team can give you antiemetic medication that stops you feeling sick.
111
00:07:14.760 --> 00:07:15.960
anti diarrhoea medication
112
00:07:16.240 --> 00:07:17.840
Depending on how you feel.
113
00:07:18.520 --> 00:07:22.020
Identify the foods that make your symptoms worse and remove them from your diet.
114
00:07:22.920 --> 00:07:23.920
replace lost fluids
115
00:07:25.800 --> 00:07:32.611
Isotonic drink so sachets of oral rehydration salts replace lost salt and sugar known as electrolyte that your cells need
116
00:07:32.668 --> 00:07:33.400
to stay here.
117
00:07:35.420 --> 00:07:38.920
if you have a low number of functioning red blood cells in your body is known as an
118
00:07:39.920 --> 00:07:45.504
Almost all stem cell transplant patients will have anaemia at some point in their recovery and it's most likely to happen
119
00:07:45.550 --> 00:07:45.920
earlier.
120
00:07:46.380 --> 00:07:50.580
This is because many blood cancer and blood disorders stop your body making blood cells.
121
00:07:51.300 --> 00:07:55.400
Conditioning therapy had pre-transplant will also reduce the number of blood cells.
122
00:07:56.200 --> 00:07:59.800
oxygen from the lungs to all of the cells in the body
123
00:08:02.140 --> 00:08:06.840
Red blood cells carry oxygen on a protein called hemoglobin and if you don't have enough of it.
124
00:08:06.960 --> 00:08:09.060
feeling tired or short of breath
125
00:08:10.000 --> 00:08:15.600
Anaemia can be caused by other factors including low vitamin B12 or folic acid levels.
126
00:08:16.660 --> 00:08:21.924
Anaemia treatment will vary depending on what's causing it. So please check with your medical team before taking anything
127
00:08:21.968 --> 00:08:22.360
yourself.
128
00:08:23.100 --> 00:08:27.900
They will check your hemoglobin level regularly monitor your other symptoms to decide the best treatment.
129
00:08:28.260 --> 00:08:30.460
You may be given a combination of treatments in.
130
00:08:30.900 --> 00:08:32.400
vitamin supplement tablets
131
00:08:32.840 --> 00:08:36.140
hormone injections known as you approach or keep
132
00:08:36.520 --> 00:08:38.920
Which stimulate your body to make more red blood cells?
133
00:08:39.860 --> 00:08:40.960
a blood transfusion
134
00:08:42.220 --> 00:08:43.520
graft versus host disease
135
00:08:43.940 --> 00:08:45.040
4GB HD
136
00:08:45.760 --> 00:08:50.260
After your transplant there are still small differences between your donor stem cells and your own self.
137
00:08:50.780 --> 00:08:55.180
This means your new Moon System 8 home of the cells in your body because it's season is different.
138
00:08:55.920 --> 00:08:59.920
Some gvhd can be a good thing because it shows your new immune system is active.
0
00:00:00.000 --> 00:00:02.300
Can attack any remaining overturning disease?
1
00:00:02.880 --> 00:00:06.480
However too much gvhd can cause side effects including fatigue.
2
00:00:07.080 --> 00:00:12.580
gvhd could potentially happen anywhere on your body but often affects the skin digestive tract and
3
00:00:13.480 --> 00:00:19.530
If you have gvhd in part of your digestive tract I can make eating and drinking different but can also cause sickness and
4
00:00:19.580 --> 00:00:20.080
diarrhoea.
5
00:00:20.420 --> 00:00:22.220
Which will all affect your energy levels.
6
00:00:22.920 --> 00:00:29.120
Coping with gvhd can be a painful and stressful process and discomfort could affect your sleep and mental health.
7
00:00:30.140 --> 00:00:33.940
the best medication for you
8
00:00:34.480 --> 00:00:37.980
Generally gvhd is treated using steroids and immune suppression.
9
00:00:38.400 --> 00:00:43.600
other treatments such as anti sickness or diarrhoea drugs will help relieve the symptoms gvhd cause
10
00:00:44.300 --> 00:00:49.900
More information on gvhd is available in essential guide to gvhd booklet website.
11
00:00:53.640 --> 00:00:54.240
problems
12
00:00:55.040 --> 00:00:58.340
Recovering from your stem cell transplant will be both physically and emotionally.
13
00:00:59.660 --> 00:01:04.360
Play may be times when you find it difficult to a combination of feeling unwell stress and anxiety.
14
00:01:05.060 --> 00:01:07.260
It's common to have problems sleeping while you in hospital.
15
00:01:07.860 --> 00:01:14.044
Play might be noisy or two on the ward or your medical team mini to wake you to check your blood pressure and temperature
16
00:01:14.095 --> 00:01:14.760
in the night.
17
00:01:15.240 --> 00:01:19.740
You can also be difficult to get used to a new environment and routine when you return home after treatment.
18
00:01:20.360 --> 00:01:25.960
You should get better over the first year but some people still struggle to get a good night sleep for longer.
19
00:01:26.820 --> 00:01:30.120
The quality of your sleep is as important as the amount of sleep you have.
20
00:01:30.580 --> 00:01:36.080
Having long naps during the day can disrupt your sleep works and make it more difficult to fall asleep at night.
21
00:01:36.700 --> 00:01:41.807
If your medications make you drowsy and you fall asleep during the day this will also affect your quality of sleep
22
00:01:41.852 --> 00:01:42.300
overnight.
23
00:01:43.100 --> 00:01:46.800
So you can listen to some general tips on improving your quality of sleep?
24
00:01:47.340 --> 00:01:50.740
But you may also benefit from the treatment including a type of cancer.
25
00:01:51.060 --> 00:01:52.860
call Cognitive Behavioral Therapy
26
00:01:54.360 --> 00:01:57.360
Information about counselling can be found in a booklet on mental health.
27
00:01:57.620 --> 00:02:00.020
Go on our website anthonynolan.org.
28
00:02:01.460 --> 00:02:05.260
If you're struggling with sleep your medical team of female sleeping medication.
29
00:02:06.220 --> 00:02:08.820
Sarah had a stem cell transplant in 2014.
30
00:02:09.360 --> 00:02:16.215
I thought exhausted all the time. You don't expect to find it hard to stay upright while you're waiting for the kettle to
31
00:02:16.271 --> 00:02:23.126
boil when I got home. I found that I couldn't get up the stairs. It was a shock but I didn't give up I said I push myself
32
00:02:23.183 --> 00:02:24.260
one step at a time.
33
00:02:25.000 --> 00:02:28.500
Your post-transplant energy levels may also be affected by hormonal changes.
34
00:02:29.220 --> 00:02:33.920
Depending on your situation your stem cell transplant could lower the levels of certain hormones in your body.
35
00:02:34.400 --> 00:02:36.400
this includes thyroid hormones
36
00:02:36.580 --> 00:02:39.480
vitamin D and sex hormones oestrogen and testosterone
37
00:02:40.480 --> 00:02:44.380
Hormone replacement therapy HRT if you need it.
38
00:02:45.020 --> 00:02:48.520
It's likely that you will need a lot of different medications during your recovery.
39
00:02:48.700 --> 00:02:50.900
the control side effects and reduce discomfort
40
00:02:51.620 --> 00:02:55.020
You shouldn't have to put up with pain because it will have a negative effect on your mood.
41
00:02:55.120 --> 00:02:56.320
activity levels and
42
00:02:57.220 --> 00:03:02.620
Some medication can make you feel drowsy and the effect could be greater when they taken in combination with others.
43
00:03:03.460 --> 00:03:07.760
If you have any concerns about the issues raised in this track please talk to your medical team.
44
00:03:08.020 --> 00:03:11.820
You'll be able to alter the medication and make your symptoms more manageable.
45
00:03:16.660 --> 00:03:17.360
track 4
46
00:03:17.560 --> 00:03:18.760
How can I manage fatigue?
47
00:03:19.480 --> 00:03:25.530
Maybe times new recovery 140 is unavoidable, but it still possible to take control of your situation and make the best of
48
00:03:25.580 --> 00:03:26.380
the energy have.
49
00:03:26.880 --> 00:03:31.963
In this track we look at how we can manage your energy levels more effectively and have your physical activity and quality
50
00:03:32.005 --> 00:03:33.380
of sleep can affect your fatigue.
51
00:03:34.200 --> 00:03:35.600
managing your energy levels
52
00:03:36.080 --> 00:03:39.480
Many patients find the energy levels go through highs and lows during the day.
53
00:03:39.800 --> 00:03:43.300
It's very easy to overdo it when you get up in the morning and feel full of energy.
54
00:03:43.640 --> 00:03:45.040
I need to need a nap in the afternoon.
55
00:03:45.980 --> 00:03:50.380
If you get into the Habit of listening to your body and know how you react to certain activities.
56
00:03:50.680 --> 00:03:52.080
It will be easier to manage.
57
00:03:53.040 --> 00:03:58.566
Ask your GP or medical team to refer you to an occupational therapist you can help you plan your daily activities and
58
00:03:58.614 --> 00:04:00.740
maximize your energy levels and rest periods.
59
00:04:01.440 --> 00:04:05.940
You may find that incorporating some of the following suggestions in your daily routine will be beneficial.
60
00:04:06.940 --> 00:04:08.840
Write a list of the things you wanted to eat.
61
00:04:09.420 --> 00:04:12.120
Next to you prioritise the things you either really enjoyed.
62
00:04:12.560 --> 00:04:13.460
Are you really need?
63
00:04:14.040 --> 00:04:18.340
Take a very frustrating to think that you wasted your energy and had to miss out on something important.
64
00:04:18.840 --> 00:04:20.440
Even if you're having a really bad day.
65
00:04:20.680 --> 00:04:22.180
Try to do at least one thing.
66
00:04:22.580 --> 00:04:26.680
It can be difficult but it's leaving something will make you feel more positive and lift your mood.
67
00:04:27.280 --> 00:04:31.880
Break down your tasks into smaller more manageable goals and make sure you get some rest in between.
68
00:04:32.440 --> 00:04:36.240
Top up your energy levels regularly and reduce the risk of becoming exhausted.
69
00:04:37.100 --> 00:04:40.000
Please yourself with activities of spread out evenly through the day.
70
00:04:40.360 --> 00:04:43.860
Try to avoid routines why your energy levels constantly rise and fall.
71
00:04:44.240 --> 00:04:47.540
They will help make the most of the energy you have and stop you doing too much.
72
00:04:48.260 --> 00:04:50.060
Decide when it's best to stop and rest.
73
00:04:52.960 --> 00:04:54.960
ENT nurse coordinator
74
00:04:55.580 --> 00:05:00.480
Everybody is different and there is no right or wrong for how much energy you should or shouldn't have.
75
00:05:01.200 --> 00:05:05.200
Listen to your body do the things that you want to do if you feel able to.
76
00:05:05.620 --> 00:05:07.820
If you feel like your body needs to rest.
77
00:05:07.960 --> 00:05:09.160
inset Andres
78
00:05:10.020 --> 00:05:11.720
Try keeping a diary for a week.
79
00:05:11.980 --> 00:05:14.880
Newtown when you sleep rest and the activities you're doing
80
00:05:15.160 --> 00:05:18.560
Also jot down, how tired you feel and the times you feel your best.
81
00:05:19.120 --> 00:05:24.220
We've included in the printed version of this you can photocopy and use yourself.
82
00:05:24.860 --> 00:05:30.307
If you set yourself achievable goals that can also be expanded over time it will help you feel in control of your recovery
83
00:05:30.352 --> 00:05:31.960
and give you a sense of progression.
84
00:05:32.360 --> 00:05:34.660
Walk around your house.
85
00:05:35.000 --> 00:05:36.400
Send to the end of your street.
86
00:05:37.840 --> 00:05:40.340
You might set yourself a length of time you want to walk through.
87
00:05:41.240 --> 00:05:46.040
Anthony Nolan my transplant tracker app allows you to set these goals and monitor your progress.
88
00:05:46.900 --> 00:05:49.800
Can be downloaded for free from the Apple and Google Play store.
89
00:05:50.520 --> 00:05:52.620
Emma has received two stem cell transplant.
90
00:05:53.380 --> 00:06:00.180
My dad suggested. I write a diary not of how tired I was each day and when but of my mini achievements that day.
91
00:06:00.940 --> 00:06:06.640
It might be really silly things but as the weeks progress. They became more substantial and I could see a way out.
92
00:06:07.600 --> 00:06:09.100
exercising and keeping active
93
00:06:09.860 --> 00:06:15.660
Exercise may feel like the last thing you want to do but it can help reduce fatigue and improve your physical strength.
94
00:06:16.180 --> 00:06:20.580
You finding your fitness endurance and muscle strength will have reduced during your treatment.
95
00:06:21.240 --> 00:06:26.140
Keeping active and slowly building up towards structured exercise will be an important part of your cover.
96
00:06:26.980 --> 00:06:30.380
Getting plenty of exercise and fresh air releases hormones called endorphins.
97
00:06:31.160 --> 00:06:36.160
Play artist Feelgood singles in your body the lift your mood and reduce feelings of stress and anxiety.
98
00:06:36.840 --> 00:06:42.233
Play can be difficult to know when it's safe to start being more active after your transplant, but if your medical team
99
00:06:42.278 --> 00:06:46.040
agrees, you should be able to try a few very simple exercises in your hospital bag.
100
00:06:46.860 --> 00:06:51.960
If your hospital has a physiotherapist will give you some suitable exercises and stretches the time.
101
00:06:52.480 --> 00:06:57.855
How's your recovery continues your physio work with you increase your physical activity and progress your exercise
102
00:06:57.902 --> 00:06:58.280
program.
103
00:06:59.500 --> 00:07:02.200
focus on maintaining functional movement to begin with
104
00:07:04.260 --> 00:07:04.960
building up
105
00:07:05.620 --> 00:07:09.920
you're probably find a more manageable to break down activities into small chunks with some rest and
106
00:07:10.780 --> 00:07:16.280
If you're really struggling with fatigue or having a particularly bad day physical activity may seem daunting.
107
00:07:16.960 --> 00:07:19.460
Sometimes even light activity can be a real challenge.
108
00:07:19.920 --> 00:07:21.820
important to still do something
109
00:07:22.240 --> 00:07:23.440
And it could help you feel better.
110
00:07:24.100 --> 00:07:25.900
It might be simple as moving regular.
111
00:07:26.020 --> 00:07:32.020
Aiming to break up long periods of sitting or lying down by getting out of bed having a wash and moving around indoors.
112
00:07:32.820 --> 00:07:35.120
Aisling had hair transplant in 2012
113
00:07:35.400 --> 00:07:38.000
After my transplant I was very very weak.
114
00:07:38.480 --> 00:07:45.183
I think that the stairs without being really out of breath is part of my recovery or receiving some Physiotherapy and
115
00:07:45.241 --> 00:07:49.080
those daily exercises help me get some movement back in my routine.
116
00:07:50.020 --> 00:07:54.020
physical activity can do exercises as part of a home or gym Pro
117
00:07:54.460 --> 00:07:58.260
Play organised Sport or simply doing tasks around the house or garden.
118
00:07:58.840 --> 00:08:01.640
You don't have to join a gym or exercise class if you don't want to.
119
00:08:02.180 --> 00:08:04.880
It's best to build physical activity into your everyday routine.
120
00:08:05.580 --> 00:08:08.680
It's often easier to stick to something you enjoy it doesn't need much effort.
121
00:08:09.940 --> 00:08:14.240
How's recovery progress is your exercise program should cover for key areas?
122
00:08:14.700 --> 00:08:17.800
Aerobic which is anything that increases your heart and breathing?
123
00:08:18.520 --> 00:08:22.220
You could try walking or jogging cycling dancing or a team sport.
124
00:08:23.160 --> 00:08:26.060
Resistance involves lifting objects to strengthen your muscles.
125
00:08:26.700 --> 00:08:30.500
This could be simply carrying the ohaus to lifting weight in the gym.
126
00:08:30.980 --> 00:08:33.380
make sure you start gently and build up Roger
127
00:08:34.500 --> 00:08:37.500
Your balance can be improved by practicing activities like.
128
00:08:38.660 --> 00:08:43.160
Even basic activities like standing on one leg will strengthen your muscles and improve your balance.
129
00:08:44.240 --> 00:08:48.340
Your flexibility improved by stretching your muscles and moving your joints.
130
00:08:48.740 --> 00:08:51.540
This will make and paint.
131
00:08:52.220 --> 00:08:55.720
Yoga tai chi pilates will improve your general flexibility.
132
00:08:56.920 --> 00:08:59.820
the NHS recommend adults do at least 150
0
00:00:00.020 --> 00:00:04.720
physical activity 75 minutes of vigorous physical activity each week
1
00:00:05.280 --> 00:00:09.480
strengthening activities that work most of the body should also be done on 2 Days to Die
2
00:00:10.000 --> 00:00:13.000
It's also to reduce extended periods of sitting.
3
00:00:13.960 --> 00:00:18.260
As a guide to moderate level activity include things like brisk walking or cycling.
4
00:00:18.560 --> 00:00:19.460
We can still talk.
5
00:00:19.720 --> 00:00:24.420
But you can't sing the words to a song where is vigorous exercise makes you breathe hard and fast.
6
00:00:24.980 --> 00:00:29.080
If you're working at this level you will be able to see more than a few words without pausing for breath.
7
00:00:29.940 --> 00:00:30.740
these guidelines
8
00:00:34.500 --> 00:00:37.600
You should be a long-term goal that you build up to gradually over time.
9
00:00:38.460 --> 00:00:41.160
Alex had a stem cell transplant in 2016.
10
00:00:41.620 --> 00:00:46.820
One thing that changed so much for me with a park runs. It was a breath of fresh air for me it gives me motivation.
11
00:00:47.600 --> 00:00:52.200
A lot of real people doing it so I really recommend it when your strength is back a bit.
12
00:00:52.280 --> 00:00:53.780
Is there all over the country?
13
00:00:54.700 --> 00:01:00.400
Your medical team GP might be able to help you access local exercise classes for free and reduced cost.
14
00:01:01.020 --> 00:01:06.320
Also refer to a physiotherapist prescribe 3 sessions with a personal trainer at your local.
15
00:01:06.860 --> 00:01:10.860
Some programs for people who have had cancer or other long-term conditions.
16
00:01:11.360 --> 00:01:15.760
Have a look at what's available through your local Hospice and support centres such as Maggie centres.
17
00:01:16.960 --> 00:01:18.660
When is it not safe to exercise?
18
00:01:19.480 --> 00:01:23.480
If you're recovering well, it's safe to do light or moderate exercise.
19
00:01:23.880 --> 00:01:27.580
There could be times especially in your early recovery when your blood counts are very low.
20
00:01:28.000 --> 00:01:31.200
It's probably best to focus on moving regularly during this time.
21
00:01:31.320 --> 00:01:34.320
physiotherapist or another member of your medical team
22
00:01:34.580 --> 00:01:37.780
Will be able to give you specific advice about exercise.
23
00:01:39.000 --> 00:01:44.289
Exercise should be avoided if you start to feel unwell in any way as it could be a sign that you have picked up an
24
00:01:44.336 --> 00:01:44.800
infection.
25
00:01:45.160 --> 00:01:47.360
If you have a temperature persistent headache.
26
00:01:47.600 --> 00:01:48.600
aches and pains
27
00:01:48.840 --> 00:01:52.240
Feel sick or start to feel sick or feel dizzy and faint.
28
00:01:52.400 --> 00:01:54.700
Is reported to your medical team straight away?
29
00:01:55.920 --> 00:01:57.020
Getting a good night's sleep.
30
00:01:57.840 --> 00:02:02.540
Improving the quality and give you more energy and help you recover.
31
00:02:03.200 --> 00:02:06.200
variety of reasons
32
00:02:07.020 --> 00:02:12.873
If you can record your sleep patterns using a wearable fitness tracking device or make a note of the hours you sleep you
33
00:02:12.922 --> 00:02:15.020
can look back on when these problems occur.
34
00:02:20.280 --> 00:02:22.280
Our bodies have a natural clock building.
35
00:02:22.600 --> 00:02:28.200
Normally it allows us to wake up feeling refreshed and sleepy at the end of the day.
36
00:02:28.720 --> 00:02:30.020
Is sleep wake cycle?
37
00:02:30.300 --> 00:02:32.600
Is also called our circadian rhythm?
38
00:02:33.040 --> 00:02:37.940
When two Become disrupted general well-being and ability to fall asleep at night?
39
00:02:38.920 --> 00:02:45.395
Night-time important for your overall well-being and your general recovery so limiting your daytime that is really
40
00:02:45.452 --> 00:02:46.020
important.
41
00:02:46.600 --> 00:02:51.200
Extra sleep during the day will make you feel better because it doesn't affect what's causing your fatigue.
42
00:02:53.480 --> 00:02:55.180
Sorry for late morning early afternoon.
43
00:02:55.660 --> 00:02:58.960
And limited to 45 minutes to avoid night-time disruption.
44
00:02:59.860 --> 00:03:02.460
Jimmy had his stem cell transplant in 2014.
45
00:03:02.940 --> 00:03:10.142
As much as you will need to sleep a lot monster asleep your mind off things whilst you're awake keep your mind occupied by
46
00:03:10.201 --> 00:03:12.740
DVDs laptops games or puzzles it does help.
47
00:03:13.760 --> 00:03:15.460
Struggling to get a good night's sleep.
48
00:03:15.680 --> 00:03:17.580
You might find the following suggestions help.
49
00:03:18.220 --> 00:03:20.320
Use earplugs and blackout blinds.
50
00:03:23.140 --> 00:03:26.440
alcohol caffeine and nicotine for 4 hours before sleep
51
00:03:27.300 --> 00:03:30.900
Don't use devices with an electronic screen before bed.
52
00:03:31.480 --> 00:03:34.180
Anything that's worrying you before going to sleep.
53
00:03:35.040 --> 00:03:38.040
Start a relaxing pre sleep with him such as reading a book.
54
00:03:39.020 --> 00:03:43.120
Stick to a regular sleeping pattern your body's natural sleep cycle will be more settled.
55
00:03:43.840 --> 00:03:46.140
Create a calm dark and cool sleeping environment.
56
00:03:47.160 --> 00:03:49.360
Only go to bed if you feel truly tired.
57
00:03:49.540 --> 00:03:53.140
If he doesn't come try something relaxing like reading or listening to me.
58
00:03:54.300 --> 00:03:57.900
Mindfulness Meditation can also help improve sleep and reduce fatigue.
59
00:03:58.440 --> 00:04:02.740
Play how to focus your thoughts on the present so that your mind that the more stressful.
60
00:04:03.700 --> 00:04:07.500
You can find out more on the website or download the headspace app.
61
00:04:08.640 --> 00:04:09.540
asking for help
62
00:04:10.280 --> 00:04:13.780
Even simple day-to-day tasks can be difficult for someone with fatigue.
63
00:04:14.000 --> 00:04:17.400
We're having a strong support network around you will help relieve the bird.
64
00:04:18.080 --> 00:04:20.980
Relatives and close friends might be able to help around the house.
65
00:04:26.760 --> 00:04:30.960
Play me also be able to help with childcare from time to time so that you can get some rest.
66
00:04:31.380 --> 00:04:35.480
This will give you more time and energy to focus on getting better and enjoying the things you like.
67
00:04:36.400 --> 00:04:41.564
Other tasks such as your weekly shopping can be done online and delivered to your door. So you don't have to worry about
68
00:04:41.607 --> 00:04:43.200
finding a trolley at the supermarket.
69
00:04:43.880 --> 00:04:48.180
If you can afford it paying for a cleaner will also free up your time to focus on your recovery.
70
00:04:49.500 --> 00:04:51.400
He was received to stem cell transplant.
71
00:04:52.080 --> 00:04:54.180
Having my family around was a great support.
72
00:04:54.580 --> 00:05:00.870
My mum and dad put the effort into the boring stuff for me. They were cooking clean so I had the energy to go for a little
73
00:05:00.922 --> 00:05:04.480
walk or see my friends. I wasn't waiting my energy on the doll stuff.
74
00:05:04.660 --> 00:05:06.660
I got more satisfaction from the
75
00:05:07.700 --> 00:05:13.000
You can also access a range of places including social services government benefits and charity.
76
00:05:13.340 --> 00:05:15.540
Nobody expects you to do everything on your own.
77
00:05:16.040 --> 00:05:21.040
Many people will be happy to offer support, but you also need to have the confidence to ask for it when you need it.
78
00:05:21.660 --> 00:05:24.960
Your hospitals welfare officer will be able to help me find the support you need.
79
00:05:27.740 --> 00:05:28.240
track
80
00:05:28.760 --> 00:05:30.360
fatigue and your mental health
81
00:05:30.940 --> 00:05:33.740
Some patients trying to focus on just the physical side effects.
82
00:05:34.020 --> 00:05:36.620
the mental aspect
83
00:05:37.260 --> 00:05:40.660
Your mental health is closely linked to your energy levels post transplant.
84
00:05:40.980 --> 00:05:43.880
Can affect both how you're feeling and your mental agility?
85
00:05:44.980 --> 00:05:48.980
It can be tricky to work out. What came first your fatigue or feeling low.
86
00:05:49.460 --> 00:05:53.760
Play can be exhausting and mentally draining to be anxious and worried about your future all the time.
87
00:05:54.460 --> 00:05:55.260
similarly
88
00:05:55.380 --> 00:05:59.880
If you're too tired to do the things you want it can leave you feeling down and even depressed.
89
00:06:00.620 --> 00:06:04.720
In this track will look at how 40 can affect your emotions memory and concentration.
90
00:06:05.620 --> 00:06:08.720
We also talked about possible coping strategies that you may find useful.
91
00:06:09.880 --> 00:06:14.720
Hopefully, you'll find it easy to relax and get a good night's sleep by addressing your feelings and finding a better way
92
00:06:14.760 --> 00:06:15.880
to cope with your situation.
93
00:06:16.760 --> 00:06:17.960
This isn't always easy.
94
00:06:18.400 --> 00:06:20.300
Highlighted some of the healthcare profession.
95
00:06:22.460 --> 00:06:26.560
Finally at the end of this track we have outlined some breathing exercises you can try for yourself.
96
00:06:27.160 --> 00:06:32.960
They can be used alongside mindfulness Meditation based techniques to help calm your mood and help you relax.
97
00:06:34.000 --> 00:06:38.700
During your recovery that could be times when you find certain mental tasks more difficult than he wants to.
98
00:06:39.160 --> 00:06:45.060
Difficulty remembering appointments recalling the names of people objects and concentrating and gender.
99
00:06:45.880 --> 00:06:48.680
These problems are known as cancer related cognitive changes.
100
00:06:48.900 --> 00:06:50.100
crcc
101
00:06:50.660 --> 00:06:53.360
So we recall and process information.
102
00:06:53.940 --> 00:06:55.940
We often go hand in hand with fatigue.
103
00:06:56.240 --> 00:07:00.740
How many patients find the experience more crcc when their fatigue is also bad?
104
00:07:01.600 --> 00:07:03.200
Research into crcc.
105
00:07:04.020 --> 00:07:08.320
Despite some promising early results there are no established treatments for yet.
106
00:07:08.720 --> 00:07:12.220
However, there are many tips you can use to manage your situation include.
107
00:07:12.500 --> 00:07:16.500
Making list of the things you need to do more important thing is it will be 9 to 4?
108
00:07:16.920 --> 00:07:21.220
This could be your phone and post it notes in easy to see places.
109
00:07:21.840 --> 00:07:26.740
Always keep important things such as your phone and keys in the same place of their easy to find.
110
00:07:27.340 --> 00:07:31.040
Find a quiet place with few distractions to help you concentrate on a task.
111
00:07:31.880 --> 00:07:34.680
Turning off the TV or radio will also help you concentrate.
112
00:07:35.580 --> 00:07:38.880
Try doing a heart attack to the start of the day when you feel less tired.
113
00:07:39.880 --> 00:07:43.880
Getting into the same daily routine will make things more familiar and easy to remember.
114
00:07:44.640 --> 00:07:48.440
crosswords jigsaws and other puzzles exercise your mind and make it stronger
115
00:07:49.460 --> 00:07:51.460
Anthony Nolan's lead nurse
116
00:07:51.860 --> 00:07:56.360
There is a connection with mental agility in physical fatigue that we see in patients.
117
00:07:56.940 --> 00:08:00.640
Is really important to acknowledge and should be discussed with the same emphasis?
118
00:08:01.440 --> 00:08:02.340
your emotions
119
00:08:03.120 --> 00:08:05.620
There's no right or wrong way to feel during your recovery.
120
00:08:06.080 --> 00:08:11.480
I'll probably be times when you're worried x when you're scared and times when you want to cry, but that's ok.
121
00:08:12.040 --> 00:08:15.440
Sometimes it's reassuring to hear that what you're feeling is completely normal.
122
00:08:16.220 --> 00:08:21.951
Take a very easy to get lost in a circle of negative thoughts during your recovery especially if you're tired or have one
123
00:08:21.998 --> 00:08:23.420
or two setbacks along the way.
124
00:08:23.820 --> 00:08:28.220
Try to also remember the positive X and when you felt in control.
125
00:08:28.860 --> 00:08:33.260
They will give you a sense of progress that delete a thought of hope and positivity for the future.
126
00:08:33.860 --> 00:08:36.560
Sarah had a stem cell transplant in 2016.
127
00:08:36.900 --> 00:08:40.100
Mental health is often overlooked when going to a stencil transfer.
128
00:08:40.280 --> 00:08:45.180
Mental health problems can occur when you least expect it many years down the line.
129
00:08:45.840 --> 00:08:46.940
Find yourself.
130
00:08:47.200 --> 00:08:49.500
Take a break and know when to seek support.
131
00:08:50.300 --> 00:08:55.900
It's impossible to see what will work best for you and some things may work better than others at different times.
0
00:00:00.960 --> 00:00:03.660
You might find useful during your recovery.
1
00:00:03.880 --> 00:00:05.680
Here are a few ideas to get you started.
2
00:00:06.420 --> 00:00:08.120
What you're going through isn't easy.
3
00:00:08.240 --> 00:00:10.340
enjoy the little things in life that will lift your
4
00:00:11.040 --> 00:00:16.240
Slice of cake when it empties go out for a nice always wanted to do.
5
00:00:16.600 --> 00:00:17.500
whatever takes your fancy
6
00:00:18.300 --> 00:00:21.300
Many patients also use their favourite comedy stand up.
7
00:00:23.360 --> 00:00:28.060
You might be familiar with the idea and mindfulness Meditation relaxation techniques.
8
00:00:28.680 --> 00:00:33.880
Activities like tai chi and yoga also combined gentle movements with elements of meditation.
9
00:00:34.240 --> 00:00:38.240
These activities can help you become more aware of your feelings and focus your thoughts on this.
10
00:00:39.080 --> 00:00:42.080
Even simply taking a deep breath and really calm your nerves.
11
00:00:42.940 --> 00:00:47.040
When we experience difficult times in our lives it can be easier to talk to someone we don't know.
12
00:00:47.520 --> 00:00:52.220
Counselling or talking help you come to terms with your feelings and change your behaviour.
13
00:00:52.460 --> 00:00:54.660
in control of your emotions
14
00:00:55.500 --> 00:00:58.500
GP will be a cancer.
15
00:00:58.820 --> 00:01:02.920
If your situation allows you can pay to see someone private.
16
00:01:03.900 --> 00:01:06.600
Alex had his stem cell transplant in 2016.
17
00:01:07.100 --> 00:01:11.200
It was a child to talk to people sometimes and I knew full well I wasn't great company.
18
00:01:11.380 --> 00:01:17.080
I look back now and think how easy is it to reply to a text message, but it was tiring to even think about it.
19
00:01:17.440 --> 00:01:18.940
That's how bad the fatigue was.
20
00:01:19.600 --> 00:01:20.800
If you need some extra help.
21
00:01:20.980 --> 00:01:26.525
Charities like Macmillan and Maggie's phone the purpose-built Cancer centres with the aim of Supporting patients and their
22
00:01:26.570 --> 00:01:26.980
families.
23
00:01:27.300 --> 00:01:31.100
They provide a calm and tranquil place for cancer patients to focus on their recovery.
24
00:01:31.480 --> 00:01:35.680
health professionals who can help with my topics including
25
00:01:36.160 --> 00:01:37.960
And emotional support.
26
00:01:38.440 --> 00:01:42.140
We also provide recreational classes professional talks and support.
27
00:01:43.000 --> 00:01:48.869
Show me Anthony Nolan patients and families forum you can read and talk about a wide range of topics related to stem cell
28
00:01:48.917 --> 00:01:49.500
transplants.
29
00:01:49.780 --> 00:01:52.780
Take your time and was involved in the discussion as you like.
30
00:01:53.560 --> 00:01:58.960
Some people in reading about the experiences of other people without feeling the need to contribute themselves.
31
00:01:59.760 --> 00:02:03.460
More information is available on our website anthonynolan.org.
32
00:02:04.440 --> 00:02:07.440
Your mental health and stem cell transplant.
33
00:02:08.980 --> 00:02:11.680
Crispin had his stem cell transplant in 2013.
34
00:02:12.260 --> 00:02:17.438
I did some counselling with the Maggie centre. I really benefited from sitting down and talking to someone who was not
35
00:02:17.482 --> 00:02:18.360
personally involved.
36
00:02:18.840 --> 00:02:22.040
Underestimated the value of that kind of therapeutic chatting.
37
00:02:22.200 --> 00:02:24.800
Sometimes you just need to take a step away from yourself.
38
00:02:25.640 --> 00:02:30.340
You will now lead you through a simple set of mindfulness breathing exercises that you can practice on your own.
39
00:02:31.160 --> 00:02:36.972
Mindfulness is a meditation based approach that helps you stay calm and focus on the present rather than worry about the
40
00:02:37.020 --> 00:02:37.360
future.
41
00:02:37.840 --> 00:02:42.340
Focusing on your breath can be a good way of clearing your mind of other thoughts and concerns.
42
00:02:43.040 --> 00:02:45.640
Start by finding a relaxing and comfortable position.
43
00:02:45.900 --> 00:02:48.900
You can stand if you want, but it might be better to sit or lie down.
44
00:02:49.680 --> 00:02:53.080
Play some background music while you practice your brain.
45
00:02:54.100 --> 00:02:55.100
Now close your eyes.
46
00:03:01.160 --> 00:03:02.960
And then story exhale through your mouth.
47
00:03:04.240 --> 00:03:05.240
Repeat this a few times.
48
00:03:06.440 --> 00:03:07.540
Continue to breathe.
49
00:03:08.200 --> 00:03:09.500
How your body feels?
50
00:03:10.220 --> 00:03:12.020
focus on your lungs filling and
51
00:03:12.420 --> 00:03:14.520
And the Rhythmic rising and falling of your choice.
52
00:03:15.420 --> 00:03:16.920
10 minutes
53
00:03:18.120 --> 00:03:23.020
Hopefully the short exercise that you can practice every day will leave you feeling calmer and more relaxed.
54
00:03:23.840 --> 00:03:28.440
5-minutes exercise for yourself
55
00:03:28.900 --> 00:03:34.000
Information on breathing exercises and other mindfulness techniques is available on mindful.org.
56
00:03:36.840 --> 00:03:38.840
living with fatigue
57
00:03:39.420 --> 00:03:43.920
Many patients underestimate how much in effect 40 can have on their lights at their transport.
58
00:03:44.540 --> 00:03:48.340
One of the biggest challenges you might face is explaining 42 friends and family.
59
00:03:48.860 --> 00:03:54.690
They might think that because you've had a transplant you know but I can get on with life as normal when in reality you're
60
00:03:54.738 --> 00:03:55.360
still record.
61
00:03:56.200 --> 00:03:58.500
There will be times when you need help from those closest.
62
00:03:59.080 --> 00:04:04.580
Simply be helping with daily tasks like shopping and housework, but you also need their emotional support.
63
00:04:05.120 --> 00:04:08.320
It may be times when you're feeling down and don't really want to be social.
64
00:04:08.920 --> 00:04:13.120
It can't be difficult to tell you. I'm still sure that you appreciate the help they can.
65
00:04:13.680 --> 00:04:18.280
how to show them the printed version of this audio guide to understand what you're dealing with
66
00:04:19.600 --> 00:04:22.300
Rachel received to stem cell transplant for aml.
67
00:04:22.940 --> 00:04:27.040
I'll get up at 8 in the morning and by 10:30. I'll be snoozing on the sofa.
68
00:04:27.380 --> 00:04:28.480
Even ask yourself.
69
00:04:28.700 --> 00:04:33.600
Am I making this my really this tired because I've never felt anything like this before.
70
00:04:34.400 --> 00:04:38.500
Depending on your situation, you might have to work while still managing your foot.
71
00:04:39.000 --> 00:04:40.400
This can be a challenging time.
72
00:04:40.660 --> 00:04:45.160
They should be able to plan in place to help.
73
00:04:45.600 --> 00:04:47.700
Many patients have a phased return to work.
74
00:04:48.040 --> 00:04:50.840
Where are their responsibilities or time spending?
75
00:04:52.220 --> 00:04:55.620
You can find more information on the patients and employees.
76
00:04:59.860 --> 00:05:01.460
extra information and support
77
00:05:02.140 --> 00:05:07.766
The patient services team Anthony Nolan provide information and support to anyone who is having or recovering from a stem
78
00:05:07.812 --> 00:05:09.440
cell transplant and their families.
79
00:05:09.860 --> 00:05:13.460
You can talk to a member of our team of anything by calling all three off.
80
00:05:13.780 --> 00:05:14.680
303
81
00:05:16.140 --> 00:05:19.140
Email patient info at anthonynolan.org.
82
00:05:19.940 --> 00:05:25.661
You can find support and advice from other stem cell transplant patients and their families by joining our patient and
83
00:05:25.709 --> 00:05:26.340
family store.
84
00:05:26.820 --> 00:05:27.720
You can sign up.
85
00:05:30.200 --> 00:05:34.000
You can also follow our patients and families Facebook page to receive news and updates.
86
00:05:35.120 --> 00:05:41.547
You can also download or order our free information booklets and find links to other organisations who offer support at
87
00:05:41.601 --> 00:05:42.520
anthonynolan.org.
Information published: 24/10/19
Next review due: 24/10/22