HOW DO PHYSICIANS TEST YOUR KIDNEY FUNCTION?

Jun 6, 2018 | Healthy Tips

HOW DO PHYSICIANS TEST YOUR KIDNEY FUNCTION?

By Veeraish Chauhan, MD

A common misconception that people often have is equating urine output to kidney function. Hence, the assumption is that if you are “making urine,” your kidneys are working just fine. However, nothing is further from the truth, and assessing the function of your kidneys requires lab testing and sometimes radiological imaging.

Most people know that getting a stress test is a way to test your heart’s function.

But how do you test your kidney function? You might have heard doctors mention words like “creatinine” or “GFR” when checking how good or bad your kidneys are doing. Although there are a lot of methods by which the kidneys’ performance can be measured, I will explain the ones that are used most often in a clinical setting.

Broadly speaking, you could check kidney function through either:

(1) Blood tests

(2) Urine tests

(3) Radiological imaging

Blood Tests

This is the most common and usually the most reliable method. Doctors will often order tests that could be variously worded like “basic metabolic panel (BMP),” “chem 7,” “renal function panel,” “GFR,” etc. Essentially, what they are measuring is the levels of electrolytes and two other chemicals called blood urea nitrogen (BUN) and creatinine.

BUN measures the amount of nitrogen present in your blood in the form of urea, hence the name BUN! In other words, what we are measuring is the urea level in the blood.

Urea, as you might know, is a nitrogen-containing compound present in the urine of mammals and often used as a fertilizer. Before you conclude that there is fertilizer flowing in your blood, let me make emphasize that industrial grade urea that is used in fertilizers is manufactured artificially. In fact, urea was the first “organic“ (that is, found in nature in living organisms) compound that was artificially synthesized in a laboratory when German scientist Friedrich Wohler synthesized ammonium cyanate in 1828.

BUN: An Imperfect Test

So why do we measure the urea level in the blood? That is because the blood urea level, (or BUN!) depends on the balance between processes that increase its blood level vs. the processes that decrease its blood level. Factors that increase the level of urea in the blood include dietary protein intake, the ability of your liver to synthesize urea, and the rate of normal cell breakdown (medically referred to as “catabolism”) that also leads to urea production. Finally, the process that decreases the urea level in the blood is your kidney’s ability to excrete urea in the urine.

Assuming that the factors that increase urea level stay constant on a day to day basis, you could argue that the urea level in the blood would be most dependent on your kidneys’ functioning. Hence, kidney disease could be detected by an increase in the blood level of urea, or BUN. However, please bear in mind that this is a simplistic explanation, and the BUN levels, as you might have guessed, could be influenced by diet, catabolism, and the liver function.

Creatinine Is a Better Alternative

You thus don’t need to be a medical professional to realize that BUN is but an utterly imperfect test of kidneys’ function, subject to the vagaries of a multitude of other non-renal factors.

So let’s talk about the other chemical I mentioned above: creatinine.

The word “creatinine” comes from the Greek word for flesh, and it is a product of muscle breakdown. Since your muscle mass does not change on a daily basis, the rate of creatinine production is also fairly constant. As creatinine level in the blood builds up (from muscle breakdown), the kidneys do a great job of filtering it out of your system. (A very small, and usually insignificant (unlike urea!) amount of creatinine is reabsorbed by the kidneys, which could technically influence its blood level, but for simplicity, let’s disregard that for now).

Hence, assuming a steady muscle mass, the level of creatinine in the blood should only be influenced by the kidney’s ability to filter it out. Therefore, increase in blood level of creatinine usually implies worse kidney function.

The blood’s creatinine level is hence a useful piece of data that can help physicians estimate the rate at which kidneys filter blood using validated formulas and equations (that we obviously don’t need to worry about here). That rate is referred to as Glomerular Filtration Rate or GFR; a term you might hear physicians throw around a lot when talking about your kidney function. For most average sized people, a normal GFR would lie between 60 to 120 ml/min.

Normal Is Normal for Normal People!

GFR estimation is based on a formula that was designed for average sized normal people. Since the calculation depends on the blood creatinine level, which in turn depends on the muscle mass, it may not be applicable in people in extremes of age (kids, people over 70 yrs), or muscle mass (people with muscle wasting, liver failure, etc). In other words, a creatinine level of 1.2 (considered “normal” as per most lab ranges) might be ok for a muscular person like Arnold Schwarzenegger but could reflect significant kidney disease in a 90-year-old woman. Just like the BUN level, a medical professional should be able to tell when to consider creatinine and GFR levels really abnormal.

Urine Tests

Testing the urine to look for protein or blood, and its chemical composition may help in indicating the presence of kidney disease. Protein or blood should usually not be detectable in urine and are non-specific markers of kidney disease. A physician should determine whether further specific workup and/or a referral to a nephrologist is warranted.

Radiological Imaging

These techniques entail taking pictures of the kidneys using different methods like ultrasound, CT scan, or MRI. This can help in determining the shape and size of the kidneys. The kidneys are smooth bean-shaped organsapproximately 8-14 cm (3-5.5 inches) in size (depending on the person’s size). Most chronic kidney diseases, with some exceptions, tend to distort the kidneys’ architecture and this can be picked up easily on imaging. One might also be ablfe to pick specific causes of kidney disease/dysfunction like stones, obstructions, hydronephrosis, polycystic kidney disease, etc.

Source:

Hall JE, Guyton AC. (2011). Guyton and Hall textbook of medical physiology. Philadelphia, PA: Saunders Elsevier.

5 COMMON CAUSES OF CHRONIC KIDNEY DISEASE: WHO SHOULD GET TESTED FOR KIDNEY DISEASE?

Jun 6, 2018 | Healthy Tips

WHEN TO SEE A KIDNEY DOCTOR

Jun 6, 2018 | Healthy Tips

WHEN TO SEE A KIDNEY DOCTOR

What is a Nephrologist and When Should You See One?

By Veeraish Chauhan, MD.

Nephrologists are physicians who specialize in the diagnosis and treatment of kidney disease. What conditions are treated by a kidney doctor, and when is a referral to one of these specialists needed?

Kidney Disease Overview

If you haven’t heard about nephrology (the study of kidney disease) before, it’s not surprising. Chronic kidney disease (CKD) is often referred to as the “silent killer,” as many people have mild symptoms or no symptoms at all when they are diagnosed.

There are many different terms which can be used to describe kidney disease which can add to the confusion. As noted above, Nephrologists are doctors who treat kidney disease, with the Greek term “nephros” meaning kidneys. You may also hear the term renal disease used to describe kidney problems. The term renal comes from the Latin root “renes” which also means kidneys.

What types of medical conditions may affect your kidneys, what are some of the common symptoms, and when you should be referred to a nephrologist? Studies suggest that delaying a visit to a nephrologist can increase your risk of complications or even death, so this is an important question.

Conditions Treated by Kidney Doctors (Nephrologists)

Kidney doctors care for people who a number of different types of kidney disease including:

Acute kidney injury: Acute kidney disease refers to the rapid onset of kidney disease often related to conditions such as shock (reduced blood perfusion of the kidneys), dehydration, or kidney problems related to surgery

Chronic renal failure: Chronic kidney disease can be caused by a number of different conditions (see below)

Kidney stones: There are different types of kidney stones which may or may not cause symptoms

Kidney infections (pyelonephritis): The term “urinary tract infection” refers to a spectrum of conditions ranging from bacteria in the urine, to symptomatic bladder infections, to infection of the kidneys (pyelonephritis)

There is a wide range of medical problems that can affect the kidneys in different ways. Some of the more common conditions which can cause kidney failure include:

Diabetes (diabetic nephropathy): Diabetes is the leading cause of kidney failure in the United States

Kidney disease related to high blood pressure and heart disease (cardiorenal syndrome)

Obesity

Chronic kidney infections

Kidney stones which cause obstruction

Congenital (from birth) kidney problems such as horseshoe kidney

Glomerulonephritis: Glomerulonephritis is an inflammation of the kidneys which can be caused by a number of different processes, including the bacteria which causes strep throat.

Kidney disease related to lupus (lupus nephritis)

Polycystic kidney disease: Cystic kidney disease is hereditary, though the severity of the disease, as well as age of onset, can vary

Autoimmune diseases such as IgA nephropathy

Kidney failure secondary to liver disease (hepatorenal syndrome)

Chronic kidney disease is described by 5 stages based on the severity of the disease. Grade 1 kidney failure refers to a mild disease, whereas grade 5 renal failure usually indicates that dialysis or a kidney transplant will be needed.

In addition to managing kidney problems (trying to correct the condition or prevent it from worsening), kidney doctors manage the symptoms often associated with kidney diseases, such as electrolyte disturbances (especially problems with potassium levels) and high blood pressure.

Symptoms of Kidney Disease

In order to understand the more common symptoms of kidney disease, it’s helpful to review the structure and function of the kidneys. Your kidneys are located on your flanks, near your spine. Injuries to your back or side below your diaphragm may cause injuries to your kidneys.

Your kidneys perform several important functions. These include filtering your blood to remove toxins, maintaining the proper levels of electrolytes (such as sodium and potassium) to ensure proper functioning of your cells, and maintaining fluid balance in your body.

If you become dehydrated, your kidneys initially work to restore the fluid status to your body, but kidney injuries may occur with prolonged or severe dehydration. If your kidneys are not functioning properly, the level of sodium and potassium in your body may be affected. Electrolyte problems with kidney disease can be serious, Since the right amount of potassium is necessary for proper functioning of your heart, kidney problems may result in abnormal heart rhythms.

Abnormal blood pressure, whether high or low can result in kidney damage. Kidney damage, in turn, can cause problems with regulating your blood pressure.

The kidneys are also responsible for making a hormone involved in the production of red blood cells. For this reason, kidney disease can result in anaemia, a lower red blood cell count.

Some people have urinary problems, such as difficulty urinating. Occasionally people also have flank pain, due to the location of the kidneys. Kidney stones may herald themselves with severe pain which has been likened to childbirth but can be present without pain as well.

Nonspecific or vague symptoms are common, and a reason why you should see your doctor even if you can’t precisely identify your symptoms. These may include fatigue, insomnia, or a metallic taste in your mouth.

Early on with kidney disease, and sometimes even with advanced kidney disease, people may have few symptoms. In fact, the most common symptom of kidney disease is no symptoms at all!

Diagnosing Kidney Disease

There are several different types of tests which can be done to screen for and follow kidney problems. These include blood tests (such as BUN (blood urea nitrogen), Cr (creatinine), and GFR (glomerular filtration rate)), urine tests (especially looking for proteinuria), and imaging tests such as CT, MRI, and IVP.

The Best Time to See a Nephrologist

The time it’s best to see a nephrologist can certainly vary depending on your particular conditions. That said, you should ideally be seen by a nephrologist once your creatinine is high enough to be called CKD Stage 4. That would mean a GFR of less than 30.

Importance of Being Referred to a Nephrologist

I am not emphasizing the importance of a referral to a nephrologist because I am one. In fact, multiple medical studies have clearly proved that patients who are referred late to nephrologists are more likely to die, or progress to dialysis!

Risk Factors for Kidney Disease

Since kidney disease can become serious before symptoms are present, it’s important to have a high index of suspicion and be aware of conditions which predispose you to kidney disease. People who are at greater risk of developing renal failure include those with:

Diabetes

Long-standing high blood pressure

Heart diseases such as coronary artery disease, or congestive heart failure

Other vascular diseases such as cerebrovascular disease (strokes) and peripheral vascular disease (such as aortic aneurysms)

A family history of kidney disease

Prolonged use of non-steroidal anti-inflammatory drugs (NSAIDS) such as Advil (ibuprofen) and Celebrex

Treatments

The treatments for kidney disease vary widely based on the particular cause. When kidney function is severely reduced a person may need dialysis for kidney failure or a kidney transplant.

Being Your Own Advocate with Your Kidneys

When it comes to kidney disease, recovery usually does not happen once your GFR has chronically declined to the advanced stages. Hence, the emphasis really needs to be on prevention. The next time you see your physician make sure to discuss the results of your GFR and ask if you should be seen by a specialist.

Bottom Line on When to See a Kidney Doctor

The best time to see a kidney doctor will vary based on your kidney function, the particular renal condition you have, and other risk factors. It appears that a referral to see a nephrologist should be considered for an elevated Cr (stage 4) or a GFR less than 30, but some people should see a kidney doctor much sooner. Since timely consultation with a nephrologist is correlated with survival, it’s best to err on the side of seeing one of these doctors earlier rather than later.

Sources:

Kim, D., Kim, M, Kim, H. et al. Early Referral to a Nephrologist Improved Patient Survival: Prospective Cohort Study for End-Stage Renal Disease in Korea. PLoS One. 2013. 8(1):e55323.

Smart, N., Dieberg, G., Ladhani, M., and T. Titus. Early Referral to Specialist Nephrology Services for Preventing Progression to End-Stage Kidney Disease. Cochrane Database for Systematic Reviews. 2014. (6):CD007333.

Smart, N., and T. Titus. Outcomes of Early versus Late Nephrology Referral in Chronic Kidney Disease: A Systematic Review. American Journal of Medicine. 2011. 124(11):1073-80.e2.

THE SMARTEST WEIGHT LOSS TIPS FOR WOMEN OVER 40

May 5, 2018 | Healthy Tips

By Malia Frey | Reviewed by Richard N. Fogoros, MD

Losing weight is hard for everyone. But weight loss tips for women over 40 need to take into account the unique hormonal changes, lifestyle adjustments, and exercise considerations that we deal with when we hit that special age.

If you’re over 40, weight loss is still possible. But you need to plan ahead, exercise smarter and eat a good diet full of key nutrients that will keep your body young and strong. Use these diet tips, meal plans and fitness routines to get and keep the body you deserve.

See Your Doctor

When you’re over 40, weight loss may play a big role in your overall well-being and your ability to age well. When you go in for your annual check-up or before you start a diet, talk to your healthcare provider. Find out if weight loss might improve your health. You may be able to decrease your risk for disease or even stop taking certain medications if you lose weight. And having that important information may help you to stay motivated when weight loss becomes challenging

Prevent Menopausal Weight Gain

Are menopausal changes affecting your weight? Many women struggle with weight loss before, during, and sometimes even long after menopause. Weight gain at this time may be related to changes in your hormones. But this is also a time when many women make changes to their daily routines that may affect their weight. For example, after the kids leave home some women are not as busy during the day with non-exercise physical activities like carrying groceries, lifting laundry baskets and other household chores. Evaluate your lifestyle to make sure that a change in your daily habits isn’t affecting your weight.

Reboot Your Confidence

Who says sex appeal fades as you age? Many women say that their 40s are the sexiest decade. Often, women experience renewed confidence, professional success and a more sultry sense of self during this decade. So why not use it to your advantage? If you’re trying to reshape your body or lose weight in your 40s, a renewed sense of confidence and sex appeal will help you reach your goals. You might think that you’ll feel better about your body after the diet, but the truth is that if you feel better about yourself before you diet, you’ll be better equipped to manage the lifestyle changes necessary for weight loss.

Set Goals for Over-40 Weight Loss

Your 40s are not the time to try fad diets for quick weight loss. You’re smarter than that. You need a plan for long-term health, well-being, weight loss and weight maintenance. To do that, set SMART goals. SMART goals are used by motivational coaches to help anyone become more successful. If you want your weight loss plan to work, you’ll set one too. It takes just 30 minutes or less to set up and it provides a roadmap for your entire weight loss journey.

Increase Your Energy

Your sleep habits, you’re eating habits, and your work habits may lead to poor sleep. It’s very hard to slim down when you’re not resting properly. To lose weight over 40, you should increase your energy using natural, healthy methods. First, make small changes to improve your sleep at night. Then during the day, steer clear of high-calorie coffee drinks and other beverages that cause weight gain and use diet-friendly methods to boost your energy instead.

Build a Balanced Workout Program

In your 20s and 30s, you may have been able to lose weight with a walking program or simply by staying more active during the day. But in your 40s, losing weight takes smarter planning. You need three types of exercise to slim down, tone up and stay healthy. Make sure you incorporate cardiovascular exercise, strength training and stretching into your weekly program. Each type of exercise provides unique weight loss benefits.

Change Your Diet

There is no single diet plan that works for everyone. But a diet plan for your 40s should be one that you can use to reach your weight loss goals and then modify and stick to for life. Evaluate your current eating style, think about your past diet history and choose a diet that fits your needs.  Evaluate commercial diet plans or create your own eating plan at home. 

SYMPTOMS OF A URINARY TRACT INFECTION

May 5, 2018 | Healthy Tips

Signs Can Vary In Women, Men, Children, And The Elderly

By Jerry Kennard | Reviewed by Richard N. Fogoros, MD

Anyone who has ever had a urinary tract infection (UTI) knows full well how frustrating and uncomfortable they can be. Even a mild case can cause pain when urinating, an increased urge to urinate, and blood or pus in the urine. If the infection moves from the bladder to the kidneys, the condition can get worse, triggering severe back pain, nausea, vomiting, and, in rare cases, kidney damage.

And, it’s not just adults who can be affected. Newborns and children can also get UTIs, and those occurring in the elderly can sometimes be life-threatening. By knowing the signs and symptoms of a UTI, you can seek treatment and avoid many of complications of this all-too-common infection.

Frequent Symptoms

The symptoms of a urinary tract infection are largely defined by their location in the urinary system. Broadly speaking, there are two types of UTI:

A lower urinary tract infection is one that occurs in the bladder or urethra (the tube through which urine exits the body). It is commonly referred to as a bladder infection.

An upper urinary tract infection involves the kidneys and ureters (the duct through which urine passes from the kidneys to the bladder). An infection of the kidneys is also referred to as pyelonephritis.

Lower Urinary Tract (Bladder Infection)

A lower urinary tract infection typically occurs when bacteria enter the urethra and cause an infection in the bladder.

When symptoms appear, they often start with a dull ache or discomfort in the pelvis or urethra. Usually, within hours, the UTI will manifest with characteristic symptoms, including:

Pain or burning during urination (dysuria)

An increased urge to urinate (urinary urgency)

The need to get up at night to urinate (nocturia)

Inability to hold your urine (urinary incontinence)

Passing frequent, small amounts of urine

Foul-smelling urine

Cloudy urine caused by pus (pyuria)

Bloody urine (hematuria)

Pus discharge from the urethra

Lower abdominal discomfort

Pelvic pain in women

Low-grade fever

Fatigue

Upper Urinary Tract (Pyelonephritis)

A bladder infection that has migrated to the kidneys is usually considered serious and in need of urgent medical care. Pyelonephritis can cause systemic (all-body) symptoms that are not only more overt but frequently debilitating.

Signs of pyelonephritis may include:

A high fever (over 100.4 degrees)

Body chills

Rigors (shivering and sweating accompanied by a rise in temperature)

Nausea or vomiting

Flank pain (pain that’s usually deep and high in the back or sides, though it can be present in the upper abdomen)

Special Populations

Babies, young children, and the elderly are also commonly affected by UTIs and often in vastly different ways. The main challenge in the very young and very old is that the classic signs are frequently either missing or misattributed to other causes.

With new-borns especially, the only clues you may have are a persistent fussiness or crying accompanied by odd-smelling urine and the refusal to eat.

This is why it is important to always to discuss your baby’s bowel and urinary habits at every doctor visit, however mild or incidental the changes may seem.

In contrast, the signs of a UTIs in toddlers and younger children will be more characteristic and may include dysuria, urinary urgency, daytime incontinence (enuresis), or the rubbing or grabbing of the genitals.

A UTI in the elderly will usually not have any of the traditional symptoms seen in other adults. These may include urinary incontinence and mental confusion (caused by the bacterial penetration of the blood-brain barrier). If your loved one is older, the main clues to watch out for are sudden changes in behavior and bladder control, especially if accompanied by lower abdominal pain or strong-smelling urine.

Complications

UTI complications often occur as result of an untreated or undertreated infection. The risk is also high in people with an underlying kidney disorder, diabetes, or diseases that cause immune impairment (such as HIV).

Complications of a urinary tract infection include:

Recurrent UTIs occurring at least twice in six months or four times in a year, most commonly in women

Urethral narrowing (stricture) in men with recurrent infections

Increased risk of preterm birth and low birth weight in pregnancy

Permanent kidney damage

Sepsis (a potentially life-threatening, whole-body inflammatory response caused by a severe infection)

In Children

Because a urinary tract infection in new-borns will often have few, if any, of the classic signs of a UTI, a child may only become symptomatic when sepsis (also referred to as urosepsis) develops. Sepsis is always considered a medical emergency.

Go to an emergency room or call 911 if your baby develops some or all of the following symptoms:

Yellowing of the eyes and skin (jaundice)

High Fever

Decreased tone (floppiness)

Vomiting

Cloudy or bloody urine

Irregular breathing

Pale pallor or even a bluish skin tone (cyanosis)

A bulging of the soft spot on the back of the head triggered by the development of meningitis

In the Elderly

Since UTIs are frequently missed in the elderly, the infection may only become apparent when urosepsis starts to affect the brain and other vital organs.

Symptoms include of this dangerous complication include:

An abnormally rapid heart rate (tachycardia)

High fever or hypothermia (body temperatures below 95 degrees)

Difficulty breathing or shortness of breath (dyspnea)

Profuse sweating

Sudden extreme anxiety

Severe back, abdominal, or pelvic pain

Dementia-like symptoms triggered by the development of brain inflammation (encephalitis)

If left untreated, sepsis can lead to septic shock, organ failure, and death.

When to See a Doctor

While milder UTIs will often go away on their own without treatment, you shouldn’t avoid seeing a doctor if the symptoms persist for more than a couple of days.

With that being said, if you develop signs of a kidney infection, including flank pain, nausea, or vomiting, you need to see a doctor immediately.

If you are pregnant, you should never take a chance with UTIs, especially if you have diabetes, HIV, or have had previous infections. Even mild symptoms should be looked at, treated, and monitored to ensure that the infection is fully cleared.

Without exception, any symptoms of suggestive of sepsis should be treated as a medical emergency. This is especially true in babies or the elderly.

Sources:

Heppner, H.; Yapan, F.; and Wiedermann, A. “Urosepsis in Geriatric Patients.” Aktuelle Urol. 2016;47(1):54-9. DOI: 10.1055/s-0041-106184.

Robinson, J.; Findlay, J.; Lang, M. et al. “Urinary tract infections in infants and children: Diagnosis and management.” Paediatr Child Health. 2014; 19(6):315-19.

Schwartz, B. (2014) “Urinary Tract Infections.” In: Levinson, W. eds. Review of Medical Microbiology and Immunology, 13e. New York, NY: McGraw-Hill Education.

Solomon, C. “Urinary Tract Infections in Older Men.” N Engl J Med. 2016; 374:562-571. DOI: 10.1056/NEJMcp1503950.

10 STRESS BUSTERS

May 5, 2018 | Healthy Tips

10 STRESS BUSTERS

If you’re stressed, whether by your job or by something more personal, the first step to feeling better is to identify the cause.

The most unhelpful thing you can do is turn to something unhealthy to help you cope, such as smoking or drinking.

“In life, there’s always a solution to a problem,” says Professor Cary Cooper, an occupational health expert at the University of Lancaster. “Not taking control of the situation and doing nothing will only make your problems worse.”

He says the keys to good stress management are building emotional strength, being in control of your situation, having a good social network and adopting a positive outlook.

What you can do to address stress

These are Professor Cooper’s top 10 stress-busting suggestions:

Be active

Exercise won’t make your stress disappear, but it will reduce some of the emotional intensity that you’re feeling, clearing your thoughts and letting you to deal with your problems more calmly.

For more advice, read how being active helps mental wellbeing.

Get started with exercise.

Take control

There’s a solution to any problem. “If you remain passive, thinking, ‘I can’t do anything about my problem’, your stress will get worse,” says Professor Cooper. “That feeling of loss of control is one of the main causes of stress and lack of wellbeing.”

The act of taking control is in itself empowering, and it’s a crucial part of finding a solution that satisfies you and not someone else.

Read tips on how to manage your time.

Connect with people

A good support network of colleagues, friends and family can ease your work troubles and help you see things in a different way.

“If you don’t connect with people, you won’t have support to turn to when you need help,” says Professor Cooper.

The activities we do with friends help us relax. We often have a good laugh with them, which is an excellent stress reliever.

“Talking things through with a friend will also help you find solutions to your problems,” says Professor Cooper.

Read about some other ways relationships help our wellbeing.

Have some ‘me time’

Here in the UK, we work the longest hours in Europe, meaning we often don’t spend enough time doing things we really enjoy.

“We all need to take some time for socialising, relaxation or exercise,” says Professor Cooper.

He recommends setting aside a couple of nights a week for some quality “me time” away from work. “By earmarking those two days, it means you won’t be tempted to work overtime,” he says.

Challenge yourself

Setting yourself goals and challenges, whether at work or outside, such as learning a new language or a new sport, helps to build confidence. This will help you deal with stress.

“By continuing to learn, you become more emotionally resilient as a person,” says Professor Cooper. “It arms you with knowledge and makes you want to do things rather than be passive, such as watching TV all the time.”

Avoid unhealthy habits

Don’t rely on alcohol, smoking, and caffeine as your ways of coping. “Men more than women are likely to do this. We call this avoidance behaviour,” says Professor Cooper. “Women are better at seeking support from their social circle.”

Over the long term, these crutches won’t solve your problems. They’ll just create new ones. “It’s like putting your head in the sand,” says Professor Cooper. “It might provide temporary relief, but it won’t make the problems disappear. You need to tackle the cause of your stress.”

Help other people

Professor Cooper says evidence shows that people who help others, through activities such as volunteering or community work, become more resilient.

“Helping people who are often in situations worse than yours will help you put your problems into perspective,” says Professor Cooper. “The more you give, the more resilient and happy you feel.”

If you don’t have time to volunteer, try to do someone a favour every day. It can be something as small as helping someone to cross the road or going on a coffee run for colleagues.

See more on giving for mental wellbeing.

Work smarter, not harder

Working smarter means prioritising your work, concentrating on the tasks that will make a real difference.

“Leave the least important tasks to last,” says Cooper. “Accept that your in-tray will always be full. Don’t expect it to be empty at the end of the day.”

Read some tips on how to manage your time better.

Try to be positive

Look for the positives in life, and things for which you’re grateful. “People don’t always appreciate what they have,” says Professor Cooper. “Try to be glass half full instead of glass half empty,” he says.

Try writing down three things that went well, or for which you’re grateful, at the end of every day.

Listen to an audio guide on beating unhelpful thinking.

Accept the things you can’t change

Changing a difficult situation isn’t always possible. Try to concentrate on the things you do have control over.

“If your company is going under and is making redundancies, for example, there’s nothing you can do about it,” says Professor Cooper.

“In a situation like that, you need to focus on the things that you can control, such as looking for a new job.”