When we talk about stress, we talk about the physical and environment and social and mental.
Stressors can be chronic pain, infections, extreme cold, extreme heat, dehydration, poor diet, smoking, alcohol, too little exercise, too much exercise, too happy, too upset, too much work, too little work, too much responsibility or only thinking about yourself. You get the idea.
It’s too easy to blame emotions. These upsets affect the limbic system and contribute to chronic diseases and mental illness.
Chronic Exertional Compartment Syndrome CECS this can cause pain in your legs, or your arms, or even your abdomen when you exert yourself. Overexercising can cause swelling in limbs and then pressure on arteries. This can then slows the flow of blood and the muscles become painful.
Change can be very difficult. Here are some random tips.
It’s a dangerous place when you start to see people and yourself for who you are. Protect yourself. Don’t go chasing windmills. Choose only the battles you know you can win. Step away from the rest. Be comfortable with saying no! Step back from situations – think of yourself as a journalist – how would I report the situation Notice your body – where are you feeling the tension When people are being negative = do the 5 grounding technique Practice using the body to calm the mind
Be curious – not judgmental – about yourself and others. You may come across as a little standoffish when you are backing off, but you are protecting yourself.
When you use your voice, and this is perhaps new to you, criticizing other people, you may come off to others as rude because they are used to you being a people pleaser and not rocking the boat.
Balance – PEOPLE PLEASERS have a very difficult life. Now is the time to put yourself first
Where should I spend my energy – Do I want to spend my energy worrying about what others think of me?
Emotions too intense to tolerate? Usually you have been triggered.
When the reaction is overboard or out of proportion to the situation, perhaps you have been triggered.
Thank you, Marilyn, for pointing out a very important condition missing in my website. This website is a community project. Please comment if you see anything missing or something you don’t agree with. The comments don’t appear, but I will answer them in the blog. I can’t always do this in a timely manner, as I am still working as a physician, but I will do my best.
Polymyalgia rheumatica is an inflammatory disorder causing muscle and joint aches and stiffness across the neck, both shoulders and pelvis. It develops gradually over a few weeks to months and often will come with fever, loss of appetite and fatigue.
The exact cause is unknown, but likely due to genetic markers, or infection, or both.
Those affected will be over the age of 50, usually over 70 and more often female and of European descent. The episodes are longer than 2 weeks and cause morning stiffness for more than 45 minutes. These symptoms are usually better later in the day, compared to osteoarthritis which can become worse towards evening.
Muscle weakness can occur because of pain. The pain is worse with movement and can radiate through the fascia of the arms and legs and into bursa (these are protective cushions around the joints.) The hands and feet can also hurt.
Before the diagnosis is made, a good history and investigations need to be performed. Infection, malignancy, and giant cell arteritis, (temporal arteritis causing severe headache, scalp tenderness, later visual loss, stroke, even death) need to be excluded.
Apart from an examination for tenderness and other causes, bloods will need to be drawn: A Full or Complete Blood Count; C reactive protein – which is usually moderately raised, Liver function tests and electrolyte and creatinine testing as cortisone is used in the treatment of PMR.
Additional testing includes:
TSH for fatigue, Rheumatoid Factor and, if positive, anti CCP (anticyclic citrullinated peptides) which are raised in rheumatoid arthritis. CK for muscle disease like polymyositis, and ANA (antinuclear antibodies) for autoimmune disease.
A rheumatologist can be invaluable in excluding disease like RA.
Corticosteroids are powerful anti-inflammatory drugs, more powerful than Non-Steroidal Anti-inflammatories (NSAIDs) but they do carry the risk of more serious long term side-effects, like skin changes, bruising, mood changes, osteoporosis, aggravation of diabetes, hypertension, cataracts, glaucoma, fluid retention and heart failure, and increased risk of infection. A basal bone density test – an X-ray to assess fragility of bones – is important.
Usually 15mg for three weeks, then slowly tapering as tolerated, usually 10% every couple of weeks. Reducing the dose must take place over a long period of time with slow reductions over many weeks.
Vitamin D is vital – a supplement always in winter in cold climates with little sun, and more so with cortisone. Bisphosphonates and other osteoporosis meds can be considered if indicated. Gastric side effects can be decreased using proton-pump inhibitors.
Managing PMR requires medical and self care. The self care is important. Any load – physical or emotional – that overloads the body can increase inflammation. Gentle exercise and stretching, mindfulness, (look for Palouse mindfulness further down the page), restorative breathing, all help towards moving towards healing.
Physical stress and emotional stress is the biggest reason for inflammation in the body. Inflammation in your bladder (cystitis) in your stomach (gastritis) in your brain (brain fog and dementia) in your heart (SCADs heart attacks). The limbic system doesn’t differentiate (see the difference) between physical and emotional stress.
For example, the ten years before menopause, hormonal fluctuations cause physical stress. SCADS Spontaneous Coronary Artery Dissection – where the walls of the arteries in your heart split – the cause of 30% of heart attacks in women under the age of 50 – all due to added physical stress load on the body.
Last week, I had a patient present with urticaria – her whole body was covered with raised red freakishly itchy patches. She couldn’t cope. The medications, even Prednisone, was not working. (Prednisone is a very strong anti-inflammatory drug).
We went through all the possible reasons, but I didn’t mention anxiety. (My patients are fed up with my talking about anxiety anxiety anxiety). She brought it up. She’d had a disturbing experience before the rash appeared. She commented on my site (comments are hidden) how the rash improved almost immediately with the program below. I reminded her to look at the rash and imagine if this was what was happening on her skin, imagine what is happening inside the body.
Stress doesn’t only affect the body. It also affects the mind. Causing anxiety, depression, inattention, brain fog, . . . the list goes on.
We all have stress. Anxiety is when the stress load is too much and the body is overwhelmed.
A healthy self image is very important to enjoy a good quality of life. We place far too much emphasis on how we look. Enjoy the body you have. Don’t chase the Kate Middleton and Mylie Cyrus looks. Look to role models that suit your body.
However, if you are obese, it can compromise your health. Living well and nourishing your body is important. But not always easy. Don’t believe it’s only about what you eat.
I’ve always been chubby, not really – since the age of about ten really, but I am happy with my body. It serves me very well. I am also lucky, because I should have been obese. I use food for comfort. To celebrate. When I’m bored. Any emotion that makes me feel uncomfortable has me thinking – fooooood. Especially carbs that are easy to digest because that is what my freaked out brain desires. Chocolate . . .
Luckily for me, my stress response is a Fight (not so lucky for others) response. My limbic system gears up to run, to fight, and my hormones set my metabolism on fire. So I remain overweight, but not obese. Phew!
For those of you who are obese, more than likely, you have a freeze response to stress. Your metabolism is a super saver. It shuts down to hoard calories (kilojoules), storing energy as if you are about to enter the ice age. Or more likely now, global meltdown. Oops now I’ve stressed you out more. Feel those calories bloating up your body.
What to do? Of course, eating healthily is essential. The Mediterranean diet or a combination of Keto and Mediterranean can be found on Diet and Lifestyle. Of course, consult your healthcare provider first. And another obvious ingredient would burning calories – Exercise. But what to do if you don’t have the motivation (because of freeze response)?
I discuss these issues not to help you lose weight, so much as to help you find a path of balance in your life. To find balance, we have to take care of hidden stress or poor self-image problems. What we feel about ourselves and our bodies can be a reflection of hidden issues.
Notice – Notice do I fidget a lot – fidgeting or not being able to sit still is like the steam whistling when the water is boiling in a kettle. It is your body’s way to tell you that your are uncomfortable.
I believe we have 3 brains. The thinking part of the brain – Cortex. That’s the part that tells you nothing is wrong. I’m fine. Leave it alone.
The limbic system is the part damaged in trauma. That damage causes inflammation, over-reactions to food, or toxins. Around menopause time inflammation can cause heart attacks – even strokes. Or high blood pressure or diabetes.
The third part of the brain is the celiac plexus in your gut. You can get colitis, irritable bowel syndrome, constipation, diarrhoea, bloating, abdominal pain.
Each of us has a body part or parts that respond differently to stress. I used to be a snot factory, my sinuses poring out disgusting green secretions. Others have fibromyalgia or other problems. Stress switches on the genes that causes these diseases. The more stress, the more likely the disease acts up.
Write down everything you can think about that’s worrying you before you go to sleep. Scribble. It doesn’t matter what it reads like. Just write. Then slam the book closed and pack it in the drawer. Done!
Practice your breath – in for the count of 4, hold for 2, out for 6 to 8, hold for 2 and repeat. focus only on your breath. When the mind moves, gently bring it back to your breath.
If you still can’t sleep, focus on not worrying about whether you are going to fall asleep or not. Remember that if you relax and breathe, it is the same as sleeping. Not really. But you can fool your brain.
One trick I read from Medium article, Choose a work, like any word with at least 5 letters, say Scapegoat – then start with the first letter and think of as many words as you can starting with the letter S, then move do C, then A, and so on. I find this works very well. It tricks the brain. An overactive brain needs exercise and this has helped me fall asleep.
If we have trauma or lots of stress (like chronic pain or illness – remember the physical stress is the same as emotional stress on your Limbic system) where was I, okay, when we wake up after a night of stress, our cortisol levels are high.
High cortisol causes – Fatigue, Weight gain, easy bruising, swelling, especially the legs, mood swings, mental fog, muscle weakness, potassium to go down, it lowers your bodies ability to fight infection.
Where does the cortisone come from? Stress causes a rise in Adrenaline – which is the hormone meant to protect us from dying – like say you are lying on the street bleeding out – your body reacts by pushing out Adrenaline to raise your blood pressure and pulse. It also causes release of anti-diuretic hormone – ADH – from the Limbic system. This is all to keep your blood volume up.
The body reacts to ANY stress as if you are bleeding out. Or as if you need to get ready to fight or flee. So now if the Adrenaline is up for more than 3 days, Cortisone starts to go up. Cortisone is from your adrenal glands.
Your body needs to feel safe. Many of us don’t feel safe. Especially today. No money. The plague is causing havoc. There is lack social contact. There is distrust in the medical system. In every system. We’re all a little fed up.
What can we control? Only ourselves. Start with little baby steps. Ways to Calm down. If you can’t do everything you want to, give yourself a break. Be curious. What is stopping me from doing the work to get better? The last thing you need is judgement. Be kind to yourself and others.