3 ways to stay merry this Christmas – don’t let the silly season be a sad one!

December 24th, 2015

 

‘Tis the season to be jolly so they say. Not for everyone. For some people feelings of separation and loneliness can be magnified as they watch others laughing and having fun. Feelings of anxiety about the coming year and all that it might hold come to the fore. Depression caused by past events, relationship traumas or biochemical imbalance is made worse by the darkness (in the Northern hemisphere anyway.)

One man’s heaven can be another man’s hell. If Christmas and New Year are looking like an inferno to you then there are some things that you can do to help you move through it with as little damage as possible.

  1. Look after your body; I have listed the hardest one to do first, but your body (and subsequently your mind) will feel so much better if you can try not to give it too much of the bad stuff and more of the good stuff. You know what I mean. We know that drugs, alcohol, sugar, lack of sleep, over eating and no exercise are all going to take their toll on how you feel and how you feel about yourself. Yet I just described Xmas to a tee. This year if you know you are susceptible to feeling low at this time, try and pace yourself. Even just having the awareness can help. Have a glass of water before you pour another wine. Have a slightly smaller serving of pudding (and only one serve). Just be mindful of how you are treating yourself. If you go in with an attitude of self care then you will probably make a few changes quite easily. Others – not so much – but at least it will be a start.
  2. Look after your mind; Spend time each day focusing on the breath. Breathing exercise and meditations will calm and steady the mind. I know I harp on about it but that’s because it works. If you feel like everything is beginning to bubble up and become too much then find a spot to sit and begin to make each breath longer than the last. Soon you will be doing long, slow, deep breaths. The slower the breath, the slower the mind. This also activates your parasympathetic nervous system and will slow your heart rate and lower your blood pressure and promote a feeling of peace and calm. And what’s more you can do it anytime, anywhere, if needs be.
  3. Look after your spirit; be really kind to others. If you go out of your way to do random acts of kindness then you will feel good about yourself. Not much more to say about that one really.

I for one am finding that the approach of my 3rd Xmas morning with only my beautiful dog around feels a little bit heavy in the heart. I will get calls from the family back in London (40 hours of travel away from me) and I miss them terribly. But I have armoured myself against any more disastrous feelings. I swapped my days off (not enough for the long journey home) with a colleague so he can spend time with his family. That makes me feel a bit better. I’m grateful that I have a job where I can be kind to people I have never met before and make them feel better. That makes me feel even better. I have done a random act of kindness for today to someone who is exceptionally rude and obnoxious as a rule. This has the bonus value of making you feel even better than a random act of kindness to a nice person. I won’t be drinking alcohol because I’m on call so there will be no hangover to deal with. The eating and sleeping part will depend on how much work we get but I will no doubt have enough time to make my way through the kilos of seafood in my fridge and the gluten and sugar free diet can bugger off until the new year. But hey! I know I’m going to be smiling so that’s ok.

Last but not least – however down you might feel remember that there is always someone worse off than yourself. There are always things to be grateful for. Start counting the blessings this Xmas has bestowed upon you , be it a roof over your head, a dog to cuddle, food in the fridge, the love of friends and family, be they far or near.

And if all that fails then you need to get my book (click here) and begin to change your life for the better.

A very merry Christmas to everyone. Big, big love,

A powerful, legal, mood altering substance, used by millions that could be seriously affecting your health and your mental health

November 15th, 2015

Why are amphetamines, cocaine, heroin and other mood altering substances illegal? The main argument given by governments is that they are bad for the health and wellbeing of the people who used them.

These drugs are ingested into the body but have no nutritional value. They cause “highs” that the user enjoys, followed by “lows” which include depression, fatigue and insomnia amongst others. This leads to the need to take more which leads to addiction and a decline in health and mental health. This in turn can lead to hospitalisation and eventually death – thereby costing the country a lot of money at the same time.

My personal stance is that these substances should be made legal and regulated and that the enormous amount of tax raised could be used for helping people get off the drugs they are addicted to. People that would come forward a lot more readily due to less stigma and consequences of doing so. But that is another blog!

What I want to know is – if drugs are illegal due to massive health ramifications then why is sugar still legal?

Cane sugar has the nutritional benefit of sucking on glass (nutrition data). It gives the user “highs” and “lows” and leaves the user wanting more and becoming addicted. It can lead to obesity and Type 2 Diabetes Mellitus which leads to a whole myriad of co-morbidities such as peripheral vascular disease, renal failure and other nasties.

Diabetes is the 8th cause of death in the world and approximately 90% of those are Type 2. Other drug related deaths don’t even feature in the top 12. Except of course, smoking and alcohol related deaths which are linked to the top 5 – Ischaemic heart disease, stroke, COPD, lower respiratory infections and trachea, bronchus, lung cancers. Cigarettes and alcohol are legal.

So there seems to be a massive inconsistency as to the reasoning behind making some substances legal and some illegal. As I have said, I think it is a more progressive idea to legalise everything, encourage open discussion, public awareness and public rehab programs. This is working with smoking with the numbers of smokers gradually declining. It largely comes back to education. Education about the substances and of course education about yourself and what makes you take them in the first place.

So here’s the education part:

Sugar kills. Slowly. Painfully.

You could end up with feet like this;

ischemic_disease

Or be hooked up to a dialysis machine like this;

dialysis

I will be forever thankful to my Grandfather who, when I was 12 years old put a two pence piece (an old, dirty copper coin) into a glass of coke. He took it out in a few minutes and it was as shiny as new. He said “If it does that to this coin, imagine what it will do to your insides and your teeth.”

I haven’t drunk coke since.

Although it is sugary drinks and energy drinks leading the way in sugar intake, it is in so much processed foods; juice, yogurt,sauces, dips, condiments.

Education about yourself:

Self study – does sugar affect your mood? too much refined sugar can use up valuable B vitamins which help us to deal with stress effectively. There are numerous papers on sugar and its relation to mental health in the British Journal of Psychiatry

If you need help breaking the sweet stuff addiction then I can highly recommend Sarah Wilson’s words of wisdom. Her book “I Quit Sugar” helped me a lot.

And of course you must support yourself in all areas of your life in order to overcome the demons in the mind that make us need props like sugar to lean on. We have to look after our Self physically, mentally and spiritually. You must learn how to control the mind and the emotions rather then let them control you. My new book “This Giraffe can Laugh” covers ways that you can do just that.

It will be available shortly as an ebook and as paperback on this website. I’ll keep you posted.

It’s time. Take back the control.

 

Spanners and Lemons; how to deal with the less than ideal.

September 27th, 2015

Why is it that just when you think you have everything organised in your life and you fell like everything is going according to plan, someone or something throws a large spanner in the works?images

Any why is it that as soon as one spanner has been thrown in, some other plonker comes along and throws in a few rocks just for good measure?

Well I don’t know why the good runs don’t last all that long. They just don’t. The fact is that shit happens, regularly. The more useful question to ask is “How do I cope when shit happens?”

I had an awesome run of things recently. I passed all my exams and fully qualified as a paramedic. I held the first proof copies of my book in my hand. I was staying with friends and loving the great company and funny conversations. I finished my tattoo and generally felt invincible!

Then I got back home to the outback of NSW from being in Sydney for 5 weeks and things aren’t as perfect all of a sudden. A few people are being less than friendly or professional for some unknown reason, a company is reneging on a deal to do with my book – after I’ve paid them, a neck and shoulder injury is resurfacing once again and I”m feeling a little bit lonesome now I’ve left all my besties 9 hours away.

SO- how to deal with it?

  • I remind myself that all of these things are neither good nor bad. They are just sequences of events, stuff simply happening around me or to me. What determines an event as good or bad is my reaction to it, my thoughts about the matter.
  • All the other times in my life where something “bad” has happened have ended up being times of learning, progress and strengthening.
  • I therefore choose to think of these events not as “bad” but as “interesting” and “exciting”. I don’t know what the outcome will be but I know I will somehow be better off eventually.
  • I take it step by step, day by day. You can only do what you can do. Right here, right now I am ok. Nothing lasts forever, the stuff we view as “good” or the stuff we view as “bad”. It all ends up as stories in the end.
  • I choose to view everything as challenges, not as problems. Life throws new obstacles at you to test out the skills you have gathered from past life experiences. I have the tools I need.
  • And finally I make sure I keep meditating even though my mind is a million places at once and I make sure I do activities that work directly to raise the spirits – painting, walking across the opal fields and most important of all – cuddling the hell out of my dog!

lemons

3 simple things to remember to reach deep states of meditation

September 20th, 2015

“I can’t meditate, I have too many thoughts and emotions to be able to still my mind. “

“Meditation is frustrating.”ascension

“I have tried meditating but it gave me a panic attack.”

When I suggest meditation as a part of a program to wellness and mental health, I am quite often faced with replies such as these. The very thought of sitting with all of the thoughts that race around the screen of your mind is just too much for people to bear. So how do we move beyond this? How is it possible to get into the deeper states of meditation when all you get is tsunamis of thoughts washing away any hope of basking peacefully in the light of enlightenment?

The following are key points to remember when beginning the daunting journey into your self:

  1. Tsunami to storm – calming the seas of thought. Do not try and stop thoughts from arising. Minds think thoughts, that’s what they do, about 50,000 per day apparently (although who on earth sat all day and counted them?). If you put up resistance to thinking you will just end up thinking very frustrated thoughts. What we can do is to notice the thoughts and redirect the thoughts. Gently. Without judgement or chastisement. We can help ourselves to do this by slowing the breath right down at the beginning of meditation. The slower the breath is, the slower your thoughts will flow. If your thoughts have slowed down you will not only have more of a chance of recognising them but the tiny space between them has a chance to grow. Take the time at the beginning of your meditation to make each breath a little longer than the last until you are breathing as slowly as possible while being comfortable. Fill your lungs completely to aid this task.
  2. Your anchor – keeping you steady. The thing that keeps your mind steady is the focus of the meditation. This is usually either the breath or a mantra. With the breath you focus on following the sensations of the breath within the body – all the way in and all the way out. A mantra is a word repeated over and over, usually to the rhythm of the breath. The task is to focus on either of these things and when your mind drifts off (as it inevitably will) you bring it back to its anchor again. It gives you the point of reference you need in order to be able to know that you have drifted. The essential thing to remember here is not to be critical of yourself. When you realise that your mind has drifted off just notice where it went and bring it back again. You wouldn’t get angry with a boat for drifting along a current. When you notice that it has you simply pull on the chain until you are back at your chosen location.
  3. Diving into the deep calm waters. If you have ever been diving or snorkelling then you will have noticed that although the surface of the sea is choppy and wavy, below the surface is calm. Sounds are muted down there and you feel weightless. It is this way in meditation when you can eventually sink below the choppy surface of the thoughts to experience your self, your awareness, your consciousness. Essentially this starts out as a shift in awareness. The moment that you realise that your mind has drifted off you have become aware. This awareness is a shift of perspective – you have moved from being within your thoughts to being an observer of your thoughts. This observing awareness is your self. It is your self beyond your mind and beyond your body. It is full of peace. As your meditation practice becomes stronger and regular you give your self that chance to be more present. You will notice thoughts arising but it will be like looking up at the surface of the water from below. You can tell there is activity but it isn’t really affecting your stillness down below. You will also soon be able to notice the place that the thoughts arise from and dissolve back into. At times you will be able to dive even deeper into this space between the thoughts.

And the point of all this? Thoughts breed emotions. Emotions have physical feelings and often very real consequences. Meditation teaches us to be aware of what is going on within us and shows us that we are more than these thoughts and emotions. We have the ability to step back and choose which thoughts to act upon and which thoughts to let go. Meditation is not just for when you are sitting still. Meditation enables you to take awareness into your day. It enables you to take back the control.

I hope this helps you sail the stormy seas a little more effectively. Enjoy the journey.

Is someone you love suffering with depression? 10 things to look out for.

September 13th, 2015

Life is full of stresses and hardships and it is perfectly normal and ok to feel sad, angry or nervous about things once in a while. Sometimes we feel negative emotions like these for no reason at all. But being depressed is different. There can be no abating of these feelings, no relief from severe negative emotions. If you or someone you know is experiencing these feelings for more than 2 weeks at a time and it is affecting daily living then it is possible that it might be a case of clinical depression and not just a “hard time” or a “bad mood”.psychiatry

If you are concerned about someone that you think might be suffering from depression then there are 10 areas of life that are usually affected that you can ask about or be on the look out for:

  1. Sleep; they might have trouble getting to sleep or staying asleep, awaking in the night and being unable to get back to sleep. They might be sleeping far too much.
  2. Energy; they might feel lethargic and weak.
  3. Mood; could be described as flat, irritable, frustrated, sad, overwhelmed, disinterested. It might change dramatically without good reason.
  4. Motivation; they might have a loss of interest in things that once they were passionate about or enjoyed. Find it hard to get excited about anything.
  5. Concentration; they may be distracted easily, unable to read. Have to re-read things over.
  6. Memory; might be poor, unable to remember events or placement of things. This can be very distressing.
  7. Self-esteem; they will probably be a harsh self-critic with a low opinion of themselves.
  8. Socialisation; they will be unlikely to want to go out, wanting to stay in and withdrawing from others.
  9. Appetite; might change, either a loss of appetite or eating a lot more than usual. Weight changes might be evident too.
  10. Libido; they might have a diminishing sex-drive.

To make things worse, these symptoms breed more stress for the person and it is not uncommon then to see patterns of chronic pain and illness as the body’s natural systems are under too much pressure to respond effectively. The neurotransmitters needed to deal with stress, relaxation, sleep and mood are no longer firing effectively and the illness feeds itself.

Quite often people will turn to drugs and/or alcohol because they get temporary relief from all the thoughts, feelings and emotions that by now seem totally out of control. Unfortunately this just makes things worse as the after effects magnify all the original problems and the body is even more depleted of its coping mechanisms. Because drugs and alcohol do provide temporary relief, the person is likely to take more and so a vicious cycle of addiction can begin.

So before you judge someone for drinking too much or taking illicit substances, consider that it might be the only answer they have found to their problems. Before you tell your child, parent or friend to “cheer up” or “pull yourself together”, consider that they might not have the physiological reserves to do so. These people need compassion and care and help.

If this is you or someone you know then take the first step and contact someone on these lists. Help is available and you are not alone:

Help lines and websites in Australia

Help lines and websites in UK

Conversations with Dog – Part 2

September 6th, 2015

Due to yet another injury I have been off work for a few weeks. All good, it’s nothing serious and I should be back in the saddle next week hopefully. My time has been spent studying for upcoming exams, communicating backwards and forwards with the publishers and hanging out with my amazing dog who is labrador x kelpie.

IMG_0745She is slender, blonde, intelligent and full of love. A lot like her human mother really.

In an attempt at challenging her and keeping her clever little head entertained I have taught her numerous commands. She has the usual “sit”, “stay”, “wait”, “come here” (this one seems to be rather subjective to her mood) – but she also has “hi-five”, “kiss” and “kangaroo”. We also have 3 or 4 different games we play. She has determined the rules (these can also be subjective to mood).

But this is nothing compared to what she has taught me.

Metta lives in the present moment. She doesn’t hold on to past problems or worry about what will happen in the future. She is only concerned with right now. How do I know this? It does not matter if I have been away for 5 minutes or 5 weeks, when I return she bears no grudge. She is always super excited to see me. When we have disagreements, (there is always a bone involved in our disputes – bones of contention, one might say) she doesn’t sulk for hours or bring it up at a later date. She just gets on with the very important business of enjoying the moment.

This means that she is also very mindful. She can be hurtling around the garden (which is a hotbed of cacti of all shapes and sizes) trying to catch the ball and she will never crash into anything. She stops, millimetres away from inch long spikes, teasing them with her precision.

I throw soft toys around the house for her to catch and wrestle and I am safe in the knowledge that she will neither run into furniture nor knock anything over whilst thrashing the poor stuffed giraffe around ferociously. Her spacial awareness constantly amazes me. Anything that has been knocked over has been due to my lousy throwing skills.

I know that I am not this aware of my body. I knock elbows (fracture them if I’m honest), stub toes, cut fingers… and I have been practicing mindfulness for years. And I am constantly bringing my thoughts back from the future. “How is this going to work out?”, “What if this is to happen?”. Knowing full well that…

Worrying is like paying on a debt that might never come due (Will Rogers)

…and yet still patiently having to train my mind on a daily basis to do my bidding.

If only training the mind was as quick as training a dog.

 

A funny, intelligent, successful woman who speaks publicly about her mental health issues. And no, I’m not talking about me for a change – it’s Ruby Wax.

August 24th, 2015

As with other incredibly successful comedians, it is hard to believe that someone so funny and seemingly so confident could possibly have any mental health problems. Ruby Wax has joined other brilliant and funny minds such as Spike Milligan, Robbie Williams, Stephen Fry and Russell Brand on the list of comics who have some seriously unfunny moments.

I first discovered that Ruby had suffered severe depression when I stumbled across her Ted Talk, What’s so funny about mental illness? http://www.ted.com/talks/ruby_wax_what_s_so_funny_about_mental_illness

Ruby studied Mindfulness based Cognitive Therapy at Oxford University and has been awarded an OBE for her services to Mental Health. I am currently reading her brilliant book Sane New World – Taming the Mind and I can highly recommend it for anyone who wants to know how mindfulness meditation can help you recover from depression. Ruby manages to make both mindfulness and neuroscience funny – there must truly be a link between genius and insanity!

Mindfulness meditation (and other types of meditation and breathing exercises) were a large part of my road to recovery and in this book you can get a glimpse into the science of what happens in the brain when you take up meditation. It is a must for anyone who has suffered depression at any time, for anyone interested in meditation, for all the meditation skeptics…actually, for anyone who has a brain.

http://www.rubywax.net/sane-new-world.html

 

Water is a rubbish drink – wine is heaps better.

August 16th, 2015

I can already here cries of outrage in the distance! Water is a zyshrubbish drink? She think’s she’s into wellness? What is she on about?

Well it is. As drinks go it is the most rubbish of them all. It has no taste, no smell, no colour…boring!

Which is why I am always in a constant battle with myself to try and drink more water. I know all the reasons as to why I should be drinking about a litre and a half to two litres a day, but it appears that my taste buds do not respond to reason.

 I know, for example, that a state of dehydration can lead to medical issues surrounding kidney function, blood pressure, palpitations, confusion and lethargy. You think that would be enough into scaring a person to drink more H2O. But no.

 There are even studies that show dehydration can have an impact on our mood and lead to depression and anxiety. http://psychcentral.com/news/2012/02/20/dehydration-influences-mood-cognition/35037.html

 If this is the case then water has a serious design flaw. If it was made to taste like a nice, crisp, Marlborough Sauvignon Blanc for example then I for one, would ensure that I stayed hydrated with great ease. As it is I spend far too much brain power trying to think of ways to fool myself into drinking water.

 So far I have come up with these ways to drink water :

  1. Herbal teas. Unfortunately they cannot contain caffeine as too much caffeine acts as a diuretic and you wee out all that water you spent so much energy trying to consume.
  2. I don’t eat sugar as a rule (evil, evil addictive drug – but that’s another story) so I can’t do cordial. Instead I squeeze lemons and limes into the water. This has the added bonus of being extra good for you because of the wonderful properties of these citrus fruits. As a lover of hot drinks I get extra excited if it is a mug of hot lemon water. Woo hoo.
  3. Decaf coffee. Organic and fresh for the plunger but yes, decaffeinated. Partly because of the diuretic affects and partly because by this point I will have already had 3 proper coffees and I am worried that I not only will start weeing out all my hydration efforts but that I will be lying in bed at 3 am envious of the soft, little snores coming from my dog.
  4. Carbonated water. As I am not drinking alcohol at the moment (I know, my story gets sadder) this is what I drink at restaurants. Special because its fizzy. Really special with a squeeze of lemon in it. Double woo hoo.
  5. Coconut water. It has sugars but only a part of the sugar is fructose (evil evil etc. etc.) and it is full of electrolytes to really assist with the hydrating bit. Finally something that tastes great – only problem is that you shouldn’t drink 2 litres a day of the stuff.
  6. Other than that I make deals with myself; “Once you have drunk 2 glasses of lemon water you can have your second mug of coffee.” That sort of thing.

 As you can probably tell by now, this isn’t so much an advice blog as a HELP! blog. So if you are one of those annoying people who drink 2 litres of water a day no problem – perhaps you would be good enough to post a comment as to how you do it so that us-who-prefer-wine might benefit. Many thanks.

WTF is meditation anyway?

August 13th, 2015

When people tell me they suffer with depression or anxiety (which they do a lot), I will always suggest that they begin to meditate. Immediately I am met with replies of “I can’t do that – my mind is far too busy” or “I couldn’t possibly stop thinking for ages. My mind doesn’t work like that”. Or they will just murmur in a way that suggests they might be into it if they knew what the hell it was.

Saying that you can’t meditate because your mind is far too busy is like saying you can’t do arm strengthening exercises because your Breathearms are far too weak.

It is why we do the practice! And it’s called a practice because we have to practice it – no one is any good at it without the practice.

Meditation has many purposes and there are many types but essentially the main aims of meditation are:

  • To become aware of what the mind is doing – what it sneaks off to think when you aren’t watching.
  • To improve your power of concentration – to regain the control of your mind.
  • To instil a feeling of peace from a) the physical effects of breathing longer, slower, deeper breaths and b) from knowing that you are not your mind, that you are the being that uses your mind.

What is the practice? Well it can be done in a range of ways but most commonly it is practicing to follow your breath all the way in and all the way out and when your mind wanders off to think about what you are going to have for dinner you simply bring it back to the breath. Sounds boring? It is. But so (in my opinion) are arm exercises – yet if we want to ensure that our arms are strong enough that we can use them to our advantage so that they are not going to be flaccid masses hanging off our torso, unable to help us when there are heavy obstacles in our way, we need to do daily exercises.

It’s cruel but that’s the way it is.

So if your mind has a nasty habit of running down negative pathways and tells you that you are not good enough, that you can’t cope, that everything is going to turn out badly… you have to spend the time training it to go down the pathways you want it to go down. And the first step in doing this is meditation.

 

This link will take you to a free, guided meditation I have recorded. It is only about 10 minutes long. If you don’t think you have time to spend 10 minutes a day regaining control over your mind… you need to do it twice.

 

Conversations with Dog

August 5th, 2015

pawprintsAbout 2 years ago I encountered some enormous changes and massive challenges in my life. I separated from my husband of 10 years and I was posted to a small outback town, 10 hours drive from where I had lived since moving to Australia, at about the same time. I suddenly found myself very alone.

I had always been used to having people all around me. Our house was always full of friends and relatives and I was lucky enough to know many wonderful people in the area. But in the outback of New South Wales I knew no one. The position came with its own challenges and I found out that the people that were supposed to be helping me were  less than supportive. The town’s population was about 600 but only about 350 of then lived in town with the rest scattered out on properties. Being on call meant that it was very hard to get to know people and I found myself spending a lot more time than I was used to completely alone.

Conversation was not a problem. If I wanted to talk to people of course all I had to do was pick up the phone. I developed a bit of a social media addiction because I could feel like I was a part of all the action of my friends lives, even from my far away land. And I had the incessant chatter of my own mind to listen to every time I wasn’t practicing to slow it, calm it and stop it with breathing and meditation practices.

Amongst all the issues I was facing, what I realised was that a large part of being alone was the fact that there was no physical contact. I was no longer in a relationship and I was no longer getting the hugs and kisses from friends as we said our hellos and goodbyes. I was getting the occasional handshake at most. There was no sense of friendly energy, of another being sharing my space and being part of my journey.

Once I acknowledged this I opened up to a totally new and exciting adventure that had the potential to solve this aloneness. I considered becoming guardian to a dog.

Having spent over 20 years looking after other people; children, adults with physical or developmental disabilities, and more recently emergency care patients, I steered away from having children or animals so that my home life can be spent looking after myself and staying on top of all the things I need to in order to be mentally and physically well. This is very time consuming for some of us!

But once I had opened up to the idea of having a dog in my life – a dog came into my life! A local police officer’s dog had had a litter of pups and it only took me about 10 seconds to fall in love with a beautiful little white one.

Metta puppy

 

Since that moment I have never felt as lonely as before. My little Metta Bonetta Schnuffalupagus Velvet Head (or Metta for short) is the best companion a person could wish for. I can’t believe I was 36 before I learned about the love of Dog. She is loyal, unconditionally loving, playful, protective and snuggly. What more do you want from a best friend? Studies have shown that cuddling dogs has the same benefits as cuddling humans by increasing the “love-hormone” oxytocin (see the link below)

 http://www.dailymail.co.uk/sciencetech/article-2999387/The-cuddle-hormone-shows-dog-really-DOES-love-you.html

And it turns out, as an added bonus, that she is also great to have conversations with too – we very rarely disagree about anything.

So if you live alone or have feelings of being alone then consider letting a god into your life, sorry (easy mistake), a dog into your life.

metta&mebeach