Wednesday, 15 January 2020

Trauma Focused CBT: Session Six

(Trigger Warning: Mentions of Abortion, Miscarriage, and Stillbirth)

I went into session six feeling quite positive, after seeing a friend the day before. I'm finding making plans with friends gives me something to look forward to, and distracts me from things. I'm trying to talk about abortion more with close friends too (and actually use the term "abortion" rather than "termination", in order to face my fear of using that term).

My last piece of homework for CBT was to list my 10 most to least feared situations related to my trauma. For me, these include saying the word "abortion" out loud, looking at a pregnancy scan, conversations/television storylines about other people's abortions, miscarriages, or stillbirths, conversations about my traumatic abortion (especially details), and hearing an anti-choice person's opinion of abortion. The latter one is my most feared as it challenges a very personal decision and puts the blame of my trauma on me.

I have recently managed to say "abortion" out loud and pregnancy scans don't make me feel as down now. I can't totally explain why certain things trigger me, but some make more sense than others I suppose.

I decided to focus more on the positive side of things in this latest session, as I wanted to remind myself what I'd actually achieved and I wanted to see for myself if I had progressed. I'm definitely taking baby steps, but there is a definite improvement in how I react to certain things. My therapist was so pleased to hear this, which made me worry that she would make this the last session (I'm so used to mental health professionals cutting off support at the slightest hint of progress) but thankfully she does want to see me again and hasn't even mentioned bringing these sessions to an end.

My homework for the next session is to go through 2 or 3 of the "feared situations" and try to face them. We discussed which ones I could manage, and which I would struggle too much with. We decided that I would watch a storyline about baby loss or abortion, look at a pregnancy scan, and try to talk more about my abortion. So far I've managed to do these without too much panic. I'm finding it so helpful to have learnt skills to help cope with the feelings I have when exposed to these situations. If I'm properly triggered by something, it's very hard to use the skills (Safe Place, Breathing Exercises, Grounding etc) but if I can "nip it in the bud" so to say, then I can avoid or minimise the triggered feelings.

So overall I'm finding I am very slowly progressing, but I do still need at least a few more sessions of therapy. I'm being realistic too. My therapist and I agree that I'll never be totally desensitised to talk of/memories of my abortion, but I will be able to get to a point where I can still function with these things on my mind. Maybe I can even lessen/stop the flashbacks I get.

My next session is on Monday, and I will try not to leave it so long before I blog about it.

Resources:

What Does It Mean to be Triggered? https://www.verywellmind.com/what-does-it-mean-to-be-triggered-4175432

Amy's Mystery Illness- Trauma Focused CBT: Sessions 3-5 https://www.amysmysteryillness.co.uk/2019/12/trauma-focused-cbt-sessions-3-5.html

Symptoms of PTSD https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd/symptoms-of-ptsd/#b


Monday, 30 December 2019

Trauma Focused CBT: Sessions 3-5

(Trigger Warning: Multiple mentions of Abortion)

I'm sorry for my lack of posts recently. A lot has happened generally; including in my personal life. I've been feeling very down and anxious, as well as angry, upset, and irritable. It's made concentrating on blogging pretty much impossible. I think I'm starting to come round now, and at least try to keep up to date with my blogging.

I have had about 5 sessions of Trauma Focused CBT now, and although I don't feel like there's been much/any progress yet, I do feel positive that this is the right type of therapy for me and I will find things easier to cope with in time. I'm not sure how many sessions of this type of CBT I'm allowed, but I'm hoping there are at least a few more!

The sessions have been difficult, but productive. I have had times where I could talk in detail about the abortion, and times where I want to talk about anything but. For the times I am getting triggered/overwhelmed however, there are tools I have obtained to deal with it. I will explain some below:

Grounding: This is very useful for when I dissociate. A type of grounding I use, involves the 5 senses. When I find myself dissociating, I have to try and find/describe something I can see, smell, hear, touch, or taste. This reminds me that I am physically here right now, in the present time. When dissociating, I can often feel like I am not real, my body is not in the physical world, I'm not in the present time even. Grounding helps me to remind and reassure myself that this is not true. I am here, the past is in the past, the trauma I have been through is not happening now etc. I won't lie, it's not easy and it does take time, but most of the time this technique works.

Safe Place: This visualisation technique is used for when I am overwhelmed and panicky after talking about my trauma. A safe place is somewhere in my mind that can be anywhere; fictional or real. Personally, I like to visualise a sandy secluded beach in a warm climate. I can visualise this on my own, or my therapist can guide me to focus on certain things about it (e.g. the sight of the waves, the smell of the sea, the feel of sand between my toes etc). Performing a gesture such as clenching an object or my fist can help bring me to this place too. I clench my fist and imagine I am grasping a handful of warm, soft sand. Like grounding, this is difficult and takes time to focus on, but it can give me a short break from thinking about my trauma. This also slows down my breathing, heartbeat, racing thoughts etc.

Mindfulness: I find having a guided meditation video/audio recording, or having my therapist guide me, helps with this. I can use this when I'm feeling overwhelmed and panicky, or even when dissociating. It brings me back to the present time and helps me to focus my attention on things happening, stimulating my senses etc in the here and now. During mindfulness meditation I may be asked to focus on how my chair feels against my legs or back. I may also be asked to focus and describe the sounds in the room. If I have any thoughts about the traumatic abortion, instead of fighting them, I need to accept they are there, but try to shift my focus back to the present and remind myself that the trauma is not happening anymore.

I have been working through my PTSD booklet as well, and have got up to the part where I list feared situations, from most feared to least feared. For me, feared situations involve conversations about my abortion, someone else's abortion, using the word itself, stories about baby loss, and pregnancy scans. I may go into this in detail in the next CBT based blog post. The point of this task is to slowly expose myself to each of these situations. As you can see in this post, I am trying my best to use the word "abortion" instead of "termination", because this is the scary word for me. To me, it sounds more harsh, although I couldn't really explain why. It's not healthy to avoid using a word however (unless the word is a slur of course!) so I need to train myself to feel less scared about this.

My next session is coming up in about a week's time, and we will be focusing on the specific fears I have. This will be a difficult session, so I may need a few days to process things before I blog. In the meantime, I hope everyone's Christmas went well and the New Year brings good things.

Sunday, 10 November 2019

Trauma Focused CBT: Session Two

(TRIGGER WARNING: Descriptions of termination and discussion related to it)

My homework from session one was to go through the PTSD self help book and answer some of the questions. These involved check boxes for feelings, thoughts, behaviours etc that I could relate to. I found I'd ticked almost all of these! I didn't know I could relate to this diagnosis so much, but there you go. I'm hoping that, even if I don't necessarily get more support from this (because my local mental health team literally doesn't offer more than Trauma Focused CBT for PTSD) I will at least find it personally helpful as a way to put a name to the struggles I have.

I got up to a certain point in the booklet, but found it very hard to answer one of the questions in particular. This one asked me to describe the nightmares and flashbacks I have, in as much detail as I can manage. I gave some basic, vague answer, but found myself getting panicky, the more I thought about my termination and the nightmares and flashbacks I have about it.

In session two, my therapist went through my answers to some of the questions in the booklet. She asked me to embellish, and give examples of some of the times I have engaged in the behaviours I ticked, feelings, and thoughts I related to. A type of behaviour I engaged in was to react to pretty normal events in a tense and jumpy way. For example, when waiting for therapy, I was very anxious due to how busy the waiting area was. My therapist came to get me, and I jumped when she called my name. Another example I can think of is a bit of a silly one. Every single time the toaster goes off, I jump! It doesn't matter if I was expecting it to go off at that particular time or not. My body acts as if something scary has happened. Of course I get teased for this, but if you've ever jumped at something, you'll know how much it can shake you up, even if just for a few seconds.

We also went through some of the thoughts I had, and questions I asked myself constantly, in relation to the traumatic termination I had. I had made the decision so quickly, I still doubt whether it was something I ever wanted to do. I of course ruminate over them and weigh up pros and cons. I wish I could say for certain whether it was the "right" thing to do or not (for me I mean, I strongly believe anyone can have a termination if that is the right thing for them). If I had continued with the pregnancy and kept my child, I would've struggled but I think I would've been a good mother. I've always wanted to be a mother too, so I hope so so much that this wasn't my only chance.

I guess, because I don't think it would be the end of the world to keep my child, it makes me wonder whether I made the right decision. On the other hand, I was just learning to become an independent adult, living in my own place, having further education etc. It would've been very hard to do that whilst heavily pregnant. Halls would hardly be an ideal place for a baby either. But again, there would be things that could be done. See, I'm forever second guessing myself and not being sure of what would've been the right thing to do for me.

The termination itself was horrible. I won't go through the graphic, physical things. I feel sick and panicky even thinking about what I went through. This is something I will eventually have to go through with my therapist, but thankfully she is not rushing me. Even in session two, I was going through my thoughts about it, hypotheticals etc, and I was dissociating, struggling to speak etc.

This took up most of the session. We went through a couple of worksheets as I described various behaviours, thoughts etc. One was about the "Fight or Flight" response. The worksheet displayed a diagram of a body, with organs shown. Each part of the body was labelled and each function, to do with the fight or flight response, explained. For example, the mouth getting dryer when anxious, and the heart beating faster. These things happen due to the body's primal instincts. We are "supposed" to get anxious when faced with a dangerous situation. The mouth gets dryer because digestion is not needed at that time, and energy is diverted towards the muscles in order to get them ready to run or face the danger. The heart also beats faster in order to pump more blood to the muscles to help them work more efficiently. Other functions include shallower breathing, adrenaline being released, and muscles tensing etc. Unfortunately this can happen even when the situation isn't dangerous. When we have an anxiety disorder for example, we perceive things as dangerous even if they are not, or are very unlikely to be.

The next worksheet talked about unhelpful thinking habits. There are different types of thoughts that can be unhelpful to our mental health. These include the "mental filter". This is when we only notice certain comments, thoughts, events etc. These are usually negative ones, so we exaggerate the negatives as being absolutely awful and incessant.

Another unhelpful thinking habit could be saying/thinking we "should" or "must" do/think or not do/think something. This puts an unrealistic expectation and pressure on ourselves. A particular "should" I have is that I "should" earn my rests. As you may know, I have physical health conditions including Fibromyalgia and Hypermobility. These cause lots of pain and exhaustion. I feel like I "should" be productive every day though, no matter how ill I feel. So because of that, I "should" be productive before I am allowed to rest, otherwise I'm doing nothing but resting (in my eyes).

There are many other "unhelpful thinking habits" that I can relate to, but it would take all day to describe them, and this blog post is long enough! Onto the last topic of this session:

Lastly, we spoke briefly about having a "safe place". This is a visualisation of a nice place, where I feel safe and happy. Somewhere I can go to in my head when things are getting too intense or negative. As I am facing some traumatic things in these therapy sessions, I will need to have time to have a breather and "escape" to somewhere calm. My homework for the next session is to think of a safe place in my head; a sandy beach for example.

I am starting to think of that safe place, which I will describe in my next blog post.

Saturday, 19 October 2019

Trauma Focused CBT: Session One

(Trigger Warning: PTSD, abortion, self harm, and suicide mentions)

Last Thursday, I had my first session of Trauma Focused CBT. I was nervous and reluctant to go, leading up to this appointment. I was worried that I would be made to talk about things before I was ready. I didn't want to be in floods of tears in a public place, and I didn't want to be badly triggered either.

The therapist I saw, was the same one I saw for general CBT a while back. She is a compassionate, yet matter of fact therapist, which I find is a good balance for me. I don't like people to sugar coat things. I'd rather be told straight out if something needs to be said. Of course, I need the compassion too, especially when talking through some very difficult events.

At the start of the session, I was asked to fill in the usual PHQ etc forms (for Depression, Generalised Anxiety, Phobias etc) as well as a risk assessment for suicide/self harm. I gave similar answers to that of the questionnaires I filled in during my phone assessment. I think it will be very difficult to find a way to improve my scores on these; especially as I am on a low dose of Citalopram now and it's not doing a lot yet.

After this, my therapist asked me to give a brief description of my (main) trauma. This was about my termination 10 years ago. I told her some things, but she realised when I was getting distressed, and didn't push for me to carry on.

She then explained the difference between general CBT and Trauma Focused CBT. That is, that with general CBT, cognitions (thoughts) are challenged. This does not happen with trauma focused. Thoughts themselves are not challenged, but different perceptions are considered. So, in a way, ideas around the traumatic event are broadened, and other perspectives are allowed in.

My therapist then showed me the theory of CBT by drawing on a piece of paper. She wrote "Thoughts" "Emotions" "Behaviours" and "Physical Symptoms" round in a circle shape, with arrows to show how one leads to the other. We went through the main thoughts I had around my termination (she also asked me why I preferred to use the word "termination" rather than "abortion". I told her that "termination" seemed like a softer, more distant term, even though I knew they meant the same thing. She said one aim she wanted me to work towards was to be able to say "abortion" comfortably).

The thoughts, or themes, I felt around my termination were "guilt" "regret" and "loneliness". The emotions I had were low mood, and feeling like this was my only chance to have children (I can't remember what else I wrote). The behaviours included avoiding conversations, and becoming triggered when exposed to conversations, television storylines etc based around termination. She asked me what happens when I am triggered. I told her it was one of two things really. I could become inconsolable; in floods of tears, and panicky, as if I couldn't cope with life. On the other hand, I could dissociate.

She wanted me to explain what happened when I dissociate. I said I felt spaced out, as if I was having an out of body experience. I may go very quiet, and will freeze, as if I can't do anything. I will also stare at walls. It could take hours before I can ground myself. The ways I ground myself include grabbing something near me (a pen, for example) in order to remind myself that I am in my body and I do exist. I could also focus on what I can see, smell, or taste. So it's all based on focusing on what stimulates my senses. It's not easy, but it works eventually.

As for "physical symptoms" I explained that I found it very hard to separate the ones I had due to my mental health problems, and the ones I had due to my physical conditions (i.e. Fibromyalgia and Hypermobility Syndrome/Hypermobile Ehlers Danlos Syndrome). After thinking about it for a while, I found that I felt exhausted, achier, tensed up (especially from clenching my jaw throughout the day) and dizzier.

She also said that we would go through my trauma in little chunks, at my own pace. Sometimes I might want to talk about it all at once, sometimes I might only manage some brief detail. She explained also that some of the topics we will go through include grounding skills, and establishing a "safe place". She asked me if I'd come across the term "safe place" before, and if I knew what it was. I said I'd used the term before and I suppose my safe place would be my home.

My therapist explained that it was a vision/memory of a place that makes me feel calm and safe (a sandy beach for example). I would use this safe place to escape to, in my mind. I would think about what I could see, smell, hear, feel etc and I may do a gesture (such as clenching my fist) to bring me to that place in my mind. I suppose clenching my fist could indicate wanting to hold some sand in my hand, and feel the soft grains running through my fingers.

We talked through what my aims were for therapy. I said that I felt I hadn't processed my trauma properly, and I needed guidance in order to do this. I would also like to be able to talk through my trauma with more balanced emotions. I wanted to not be so triggered, and I would like to ground myself more easily if I dissociate.

Finally, we did a screening questionnaire. These were 22 questions that my therapist would read out to me, and I would answer "not at all", "a bit", "moderately", "quite a bit" and "extremely" depending on how severely I related to the statement. I found that my answers were mainly "quite a bit" and "extremely". To meet the criteria for PTSD, I had to get a score of about 33. It turned out that my score was 65, so showed that I had very significant PTSD. So there's another diagnosis to add to the list!

Although I wish I didn't have so many diagnoses, I am glad that my problems are validated and I have a name to put to them. For about a year, I suspected I had PTSD, but I wasn't sure if I quite fit the criteria. At least now I know that I do, and I hope that Trauma Focused CBT will at least lessen some of my struggles.

After my appointment, I felt very overwhelmed and in my own head. I'm only just starting to come out of this, but I still feel rather overwhelmed. Things from my past are coming to the forefront now, and I'm finding them very hard to face. I know that I need to face these things if I ever want to move on though.

Resources

Treatments for PTSD: https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd/treatments-for-ptsd/#.Xarjl-hKiM8

PHQ-9 Depression Test Questionnaire: https://patient.info/doctor/patient-health-questionnaire-phq-9

Dissociation and dissociative disorders: https://www.mind.org.uk/information-support/types-of-mental-health-problems/dissociation-and-dissociative-disorders/#.XarkROhKiM8

Grounding exercises: https://www.livingwell.org.au/well-being/mental-health/grounding-exercises/

Finding a Safe Place is Important for PTSD Recovery: https://www.healthyplace.com/blogs/traumaptsdblog/2015/11/finding-a-safe-place-is-important-for-ptsd-recovery

Online PTSD questionnaire: https://www.dynamicyou.org/mental-health-questionnaires/online-post-traumatic-stress-disorder-ptsd-questionnaire/

Tuesday, 8 October 2019

Let's make sure "Every Mind Matters", by funding our Mental Health Services!

It's "Time to Talk", "Ask Twice", "Be in your mate's corner", and currently "Every Mind Matters". These buzz-phrases are easy to remember, and uplifting I suppose, but how helpful can they be for mental illness?

A lot of these mental health awareness campaigns aim to get people reaching out, talking about their mental health; whether they have a diagnosable mental illness, or their mental health isn't as good as it could be (mental health and mental illness are two different things, but that particular thing is for another blog post). They also aim to get people reaching in and checking if their loved ones are really OK.


I took part in the "Every Mind Matters" Mind Plan quiz today (you can take it yourself here ) and was given these 5 pieces of advice:


  1. Relax your muscles and mind - I was given a video to watch, in order to help me with this.
  1. Move more every day - "Why not try getting off the bus or train a stop earlier, or taking the stairs more often?"
  1. Make time to do something you enjoy - It suggested going to the cinema, or listening to music.
  1. Make time to chat - The emphasis was on chatting over the phone or in person
  1. Take time to reflect - This piece of advice wanted me to focus on the good things about my day.

None of these are necessarily bad pieces of advice, but they are extremely simplistic considering the answers I gave. I have severe Clinical Depression, severe Generalised Anxiety Disorder, as well as Obsessive Compulsive Disorder, Borderline Personality Disorder, and possibly Post Traumatic Stress Disorder (not officially diagnosed, mainly because specific treatment isn't available with my local mental health team). My answers included statements that I was often extremely stressed, anxious, low, and struggling to sleep well. This barely touches on the big messy knot that is my (extremely poor) mental health, but even taking this miniscule fraction of it, I'd expect to be getting better advice than moving more, thinking positive, and chatting to a mate.

It's great that there's more awareness of mental health problems, and that people are being encouraged to talk to each other (whether that's reaching out or reaching in) but the appropriate services need to be there when people ask for help.


Just as medication, advice, and possibly seeing specialists is usually what happens when diagnosing and treating physical health problems, so should it be considered when diagnosing and treating mental health problems. Specifically, we need more choice of psychotherapy, better crisis services, more psych beds. We need less of a wait for therapy full stop. Community Mental Health Teams (for people with more serious/complex mental illness) need sorting out too. Too many people fall through the ever widening gaps because their needs are not able to be met.


Do you know how disheartening, even dangerous it can be when you finally muster up the courage to ring for help (whether that be IAPT, CMHT, GP etc) and be told there's either a wait, you need to ring someone else, or even that the help isn't available? I've become suicidal after being knocked back by mental health services. They are supposed to help you get better, not make you worse! Mental Health services in areas such as mine are woefully underfunded, and those with complex/serious mental health problems are given barely any therapy, if any.


If #everymindmatters
then make sure our minds are looked after, by properly funding our NHS mental health services!


Resources

Your Mind Plan - Every Mind Matters:  https://www.nhs.uk/oneyou/every-mind-matters/your-mind-plan-quiz/?WT.tsrc=Search&WT.mc_id=Brand&gclid=CjwKCAjw5_DsBRBPEiwAIEDRW4JL3hTok4A793ZCwPbRexXE7BNfGIC9cGn5PX9mK5eSI4-dp-4P8xoCKkgQAvD_BwE


Improving Access to Psychological Therapies: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/iapt

What is a Community Mental Health Team?: https://www.rethink.org/advice-and-information/living-with-mental-illness/treatment-and-support/community-mental-health-team-cmht/


Wednesday, 18 September 2019

Getting the ball rolling: Primary Care

I finally feel like I'm just about ready to start Trauma Focused CBT. This is offered through my local Primary Care Mental Health team, and I can self refer for assessment. Last week, I rang up to give my details and was offered a telephone assessment last Thursday. They originally wanted to give me an appointment for last Wednesday, but after discussion amongst themselves, they decided I needed to speak to someone more senior because of my complex needs.

The telephone assessment went really well, and I managed to remember everything I needed to say (prompted by my notes as well, of course). The first part of the assessment was the more "objective" part; where we went through my answers to the PHQ9 and GAD7 questionnaires, as well as questions on specific phobias, functioning, employment, and recent appointments. My scores for the PHQ and GAD questionnaires were quite high; indicating my levels of Depression and Generalised Anxiety are quite severe. I knew this beforehand, and the complex issues that form part of my mental health problems just exacerbate those levels too. It's like my brain is constantly battling itself!

I was asked how I had been feeling recently (awful to be honest), how my family life was (ok, but a lot of stress about various things), my aims for therapy (to be able to talk about my termination with others, and help people who have been through similar experiences) and why I decided to contact the service this time (I was fed up of how easily triggered I got, and I want help to change this).

The telephone assessment was only supposed to take about 30 minutes. It ended up taking an hour, 10 minutes! Thankfully, I was given time to explain everything, and I certainly wasn't rushed! I do hope this helps them to get an idea of my needs and aims though.

The day after the assessment, I received a phone call to say they'd accepted me for CBT (I'm hoping they mean Trauma Focused, but we'll see).

I seem to have a lot of ideas for blog posts, and not enough energy to get them past a very rough draft stage! I can't promise my next post will be about my mental health, but you should hear from me, for updates on that subject, soon.


Friday, 13 September 2019

Another ENT follow up, and a Chronic Vestibular Migraines diagnosis

Today, I had my second follow up with the ENT department. I saw the consultant himself this time, and he was a very pleasant man. He introduced himself and asked me to take a seat, before asking me how I'd been. I told him that things were pretty much the same as before. My balance hadn't improved, despite the physio exercises, and the dizziness and flashing lights/floaters were pretty much the same too.

He told me the results of my Vestibular tests were relatively normal, so he didn't think it was my ears that were affecting my balance etc. He said it was more of a "central" problem.


I found he took me seriously and was sympathetic to my struggles with my physical symptoms. I also told him my physio had told me to speak to the doctor about Vestibular Migraines. The consultant wholeheartedly agreed with him and gave me the formal diagnosis of Chronic Vestibular Migraines

I've included a link which explains what Vestibular Migraines actually are, but these are the symptoms I experience:


  • Dizziness: This tends to be all the time, but I do get acute bouts of dizziness where I feel as if I am going to fall over or faint
  • Balance Problems: Again, I feel like I'm going to fall over. It is the primary reason why I use a walking stick, and is a problem I've had for years. 
  • Flashing lights: This does what it says on the tin. They are flashing lights in my field of vision. They can be incredibly distracting and I cannot concentrate when there are lots at a time.
  • "Floaters": These are little shapes (wiggly lines is a typical one) in my field of vision. They float around then disappear
  • Sensitivity to light/sound: I don't always get this, but I have noticed it happen a lot recently.
  • Some nausea: This tends to come on with the acute bouts of dizziness
  • Migraine headaches: I do still get classic migraines (with the headache) now and again. As I've experienced classic migraines in the past, the ENT consultant says I am more susceptible to Vestibular ones now
Vestibular migraines don't typically occur with the classic type headache/s. The primary symptom tends to be dizziness, so it is not usual that someone would think they are having a migraine at the time.

After I'd explained my symptoms and the consultant had given me the diagnosis, he wanted to know what medication I take. I listed off the medication that I could remember, and he told me that some of the medication (namely the Tramadol) could be exacerbating the dizziness, as it works as a sedative. 

The next thing he suggested was to start by finding my triggers and exclude certain foods to see if they affect the migraine symptoms. He also wants to see me in about 3 or 4 months time


Overall, I'm very pleased with how the appointment went and how I was treated. Most things were discussed and at least I'm still under the care of ENT.

Do you suffer from Vestibular Migraines? Please comment below with what helps/makes them worse.


Resources

Vestibular Function Tests: https://www.stgeorges.nhs.uk/service/general-medicine/audiology/vestibular-balance-and-dizziness-service/vestibular-function-tests/

Vestibular Migraines: https://www.webmd.com/migraines-headaches/vestibular-migraines#1

Floaters and flashes in the eyes: https://www.nhs.uk/conditions/floaters-and-flashes-in-the-eyes/