Life is an adventure, sometimes wrought with stress. Once we learn how to manage it, we can begin to enjoy the life we have.
When my editor called me a week ago to say she was interested in co-authoring an article with me, I had a variety of reactions. My editor is nothing like the one encountered by Andrea Sachs in "The Devil Wore Prada." Miranda Priestly was, as we euphemistically would say, the queen bitch editor from hell. Every time Miranda shrieked, Andrea had palpitations, rapid breathing, and fear for her life. She was experiencing the typical "fight or flight" response that has saved the human race from extinction. Working with my editor, Dr. Lori Trost, is a true cerebral experience. She is a compassionate, understanding, brilliant woman who is unlike the editor in the aforementioned fictional book. That being said, I did have a minor spike in my stress level, as there was a deadline involved.
Stress is a major component of all our lives. From our first acceptance to dental school, the coursework to complete the program, board examinations, decisions on residency or postgraduate studies or leaping into private practice (with further decisions on associateship or launching into the greater unknown of opening up a private practice), we have been under various levels of stress throughout our careers. Not to mention all the stresses involved in getting accepted to dental school; dating; marriage; children and ensuing parental issues; divorce; business fluctuations; patient difficulties; hormonal changes; and the inevitable role-changing status of becoming empty nesters, parental caregivers, or maintaining a solitary lifestyle. Women tend to have multiple roles with conflicting demands, and are often stressed trying to handle the pressures of work, family, home, and personal needs. With all these roles, we are "on call" 24/7, leaving precious little time for ourselves.
Let's go back a few years (for some of us, more years than others) to our basic physiology class. What is stress? How is it manifested? What does the body do to respond to stress, and how do we counteract these seemingly uncontrollable neurological reactions?
The hypothalamus is the brain control center for homeostasis and, therefore, all stress-related events. During a stress episode, signals are sent to the hypothalamus from all over the body, and involuntarily, we react. The occurrence triggers the "fight or flight" survival response, mediated by the autonomic nervous system, the hypothalamus, and the endocrine system. Stress may be either physical (illness, injury, trauma, infection) or psychological. Regardless of whether the causative agent is actual or perceived, the body's reaction is still the same.
Cortisol, which is released from the adrenal glands and synthesized from cholesterol, has been called the stress hormone. There is an elaborate feedback loop for this system of stress in the body. The pituitary gland releases ACTH (adrenocorticotropic hormone), which allows the increased cortisol production and secretion from the adrenal glands. The hypothalamus secretes CRH (corticotrophin-releasing hormone), which signals the pituitary gland to release ACTH. Following a stressor event, both hormones are released, causing the immediate rise in cortisol. When an adequate amount of cortisol is then produced, there is a negative feedback loop involving the pituitary and hypothalamus to decrease the output of ACTH and CRH respectively. In normal functioning, cortisol is responsible for maintenance of blood pressure, vascular tone, gluconeogenesis, and bone metabolism.
The level of cortisol shifts with the circadian rhythm of the body. The highest level occurs in the morning between 6 and 8 a.m., and the lowest is at midnight, or during sleep. Cortisol levels may be slightly higher after meals. Medications may alter cortisol levels, without the stressor events. Spironolactone (a diuretic) and estrogen hormone therapy will elevate cortisol levels, while phenytonin and androgen therapy may lower levels. Women in their last trimester of pregnancy will also have an elevated level of cortisol present in their blood. Other nonstress causes of increased cortisol include excessive caffeine consumption, highly trained athletes, depression, panic disorder, and alcohol abuse. Patients who exhibit depression may have increased cortisol levels which may actually impede central fat loss during weight loss.
Cushing's syndrome, which occurs due to a hypersecretion of ACTH, will produce increased cortisol, while Addison's disease will exhibit the opposite effect. Increased cortisol will increase fat storage, as seen in Cushing's disease; foster insulin resistance; increase blood sugar and pancreatic production of insulin; and cause memory and cognition impairment and possible immune response shifts.
Stress may be classified as either acute (immediate, short-term) or chronic. Acute stress is the true "fight or flight response," brought on by a release of catecholamine, which elicits a rapid pulse; increased respiration, blood pressure, and blood glucose levels; peripheral constriction of blood vessels; muscle tension; pupil dilation; and digestive cessation. All of these reactions will help the body flee any imminent dangers. This is great during a bank robbery or possible explosion, but what about normal, everyday life stresses? The body will react the same way, maybe not to as high a level of release, but it will react.
Chronic stress leads to health issues. It occurs when our bodies are pounded daily by "little things" that pile on top of each other and become bigger. The effect of chronic stress is cumulative. We do not see immediate results, but long-term effects may be devastating. How we handle these chronic assaults to our hormonal system is the key to enhancing our life and productivity.
The effects of stress are demonstrated in a variety of ways. Emotion has been shown to affect body functions, such as heart rate, breathing, pupil dilation, and sleep patterns. Additionally, stress can affect bodily systems without having an offending physical presence. Take anxiety, for instance. According to the Miriam-Webster dictionary, anxiety is "an abnormal and overwhelming sense of apprehension and fear often marked by physiological signs (such as sweating, tension, and increased pulse), by doubt concerning the reality and nature of the threat, and by self-doubt about one's capacity to cope with it." Anxiety occurs because of fear or tension without any definitive cause, but will elicit a response in the autonomic nervous system to release epinephrine to elicit the symptoms discussed in the definition. This definitive correlation between the mind and body may affect our health. We need to put a more positive spin on this relationship. We will discuss the methods and techniques in just a bit.
Stress manifests itself in two ways: psychological and physical. The feeling of nervousness, anxiety, depression, sadness, irritability, moodiness, frustration, and forgetfulness may be stress manifesting itself. Insomnia, agonizing over decisions, and constantly thinking negative thoughts may also indicate out-of-control stress levels. Physically, stress may appear as back pain, muscle tension, headaches (migraine or otherwise), tachycardia, angina, tinnitus, loss of appetite, fatigue, and the ever-popular bruxism (See Table 1).
Since stresses can be related to home, work, or social settings, occasionally we have the means to change the causative agents. For the most part, issues that cause us stress are out of our control. After 9/11, we all experienced some form of grief, anxiety, anger, or other emotion that was brought on by the repeated visualization of those horrific hours in Manhattan. Whether you lived two blocks from the Towers or on the other side of the country, we all felt some emotions. Those emotions caused us stress, and we relived that stress through repeated television and newspaper broadcasts of the events. Post-traumatic stress disorder can occur in individuals who have experienced true military combat or any form of overwhelming trauma. In the days and weeks following 9/11, we all experienced our own form of this type of stress, which was, again, out of our control — not just the event but the rebroadcast of the scene.
So what's a woman to do? How do we reduce or control stress? What options do we have that are easy and economical, both in the time spent and the amount of available "me" slices that we can budget to make our lives more livable? We all have heard about the effects of a positive mental attitude. Research has shown that positive attitudes lead to a lower risk of early death, fewer work-related problems due to emotional or physical well-being, less physical pain, increased energy, and a feeling of peace, calmness, and serenity. No, I am not suggesting we all go off to meditate in the mountains or do yoga on a daily basis. Everyone does not have the same solution to beating stress. And where would we Midwesterners find the mountains you ladies have out in Arizona? That in itself may be a stress-inducing event! (See Table 2)
To counteract our stress, we first have to accept that we cannot change everything. Sometimes, we can't even change part of anything. As Andrea Sachs learned, we are not able to control someone else's temper tantrum, outrageous demands, hideous social graces, or unrestrained verbiage. We have to accept this as reality. As dentists, we are driven to be perfectionists. We want everything in our world to be "just so." In reality, we know — even with the best technology, the best hands, the best lab, the best of everything — we have that one patient who, for one reason or another, will not allow total perfection. Again, this is something we cannot change in our professional lives.
We must attempt to gain control of our life situation. Between the carpools, the cleaners, the 12 patients, the business manager who just gave two weeks' notice, deciding what to do for dinner, arranging who will be at skating/swimming/hockey/piano lessons and at what times ... WAIT! I get dizzy thinking about all this. We need to realize that we are spinning out of control. We need to find our control again. There is a distinct need to learn the word "no" again. As a parent, you rue the day when your child first learns to utter that one syllable. Now, we should reinstall it in our lives. We can't be all to everyone. We can't do all for everyone.
We need to do what we can and take time for ourselves. Aside from throwing away the day planner and PalmPilot® (which my life would truly be total chaos without), we must try to schedule some "me" time into our daily lives. Yes, daily. Not a weekly event or once-a-year vacation from life, but a daily time to decompress.
Decompress? What is that? Taking leisure time for ourselves as a reward. I am not saying to spend six hours soaking in the tub, eating bon-bons, watching romantic comedies on the plasma TV installed in the bathroom. Who has six hours to do nothing? We would look like a prune after six hours anyway, and that would cause all sorts of new stresses. What we do need to learn is not to combine too many activities. Do you ever look at your calendar and wonder, what was I thinking when I scheduled this insane day? Multitasking has become a way of life. We must find time to unitask. Slow down and focus on one thing. This will keep us balanced, as opposed to flying all over the charts trying to do all and be all.
There are 24 hours in a day. Do you know your best time? I am a morning person. I amaze my friends with the amount of "things" I can accomplish between 7 and 10 a.m. Yes, sometimes I am stressed, but I do believe in my afternoon naps, when time permits. If you perform better in the morning, schedule most of your demanding tasks during the time you are at your highest energy level.
We don't reward ourselves enough. I am not talking about Godiva chocolates or hot fudge sundaes. True rewards are not always dietary. We can have pleasure without food. Going for a massage or facial, taking time to read a book, calling a friend you haven't heard from in ages, listening to music, or enjoying seasonal delights in your own city — all of these are easy rewards that can be brief minivacations for your soul yet render vast benefits to decreasing stress levels. Real vacations work wonders too. When we take time away to relax and rejuvenate, we will return with a newfound positive attitude.
Exercise and diet are key to staying stress-free. A good exercise program will increase endorphin levels, while also increasing cardiovascular and musculoskeletal health. Brisk walking for 30 minutes a day, five to seven days a week, has been shown to reduce the risk of heart attacks and strokes in women. Take the stairs, play tennis, swim, join a gym. Set aside more "me" time. A healthy, balanced diet, including age-appropriate multivitamin and mineral supplements, will help keep your body in good working order. Yo-yo dieting has been shown to have reverse effects on weight loss. Maintaining a healthy lifestyle serves as a huge component in eliminating stress.
Getting to bed earlier may seem like a daunting task, but research has proven that getting those seven to eight hours of sleep does do a body good. How do we get that elusive good night's sleep? Turning off the television before you go to bed is one really great idea. Watching the news, hearing about all the people who got shot, children abducted, terrorists capturing more soldiers — none of this lends itself to a restful night's sleep. You still have visions of those television "pictures" swimming around in your brain as you try to get to sleep. Watching your favorite sports team may not bode well for sleeping either. If they win, you are excited. If they lose, you are upset. Either way, you are not going to fall into a restful sleep. Try to develop nighttime routines that evoke sleepiness, such as watching talk shows or Food TV (my personal favorite). Reading is always good, as long as the story isn't about a mass murderer intent on finding all of the female dentists in your city. The better you sleep, the more rested you will be and the less stress you will start the day with.
Finally, remember to breathe. It sounds elemental, but if we are trying to de-stress our lives, it is critical. Just as we tell our patients when we are using that sharp, pointy needle to anesthetize them, we, too, must remember to take time to breathe.
Not all stresses are evil. We may not be motivated without a certain level of stress. Some stress allows athletes to overachieve and break personal or standing records. Look at me. I finished my article in record time. I made my editor happy, which, in turn, decreased her stress level. It is all about the way you handle the stress in your life.
One final thought: Ask yourself what you do for fun and when the last time was you actually had fun. This should be a major component in every woman's day, a major factor in every woman's life. Fun, enjoyment, and personal pleasure — three ingredients to a life wrought with clear and unclear stresses — will give us the ammunition to have our own personal force field to keep stress at bay and truly enjoy the life we have. Life is an adventure every day. Remember the song, "Don't Worry, Be Happy"? Once we learn to accept what we cannot change, we will enjoy a higher quality, stressless e-ticket ride.
Resources
- www.stressbusting.co.uk
- www.merck.com/ "Mind-Body Interactions" by Merck Manual. Accessed July 8, 2004
- www.nmha.org "Fact sheet: Coping with Everyday Problems" by the National Mental Health Association. Accessed July 8, 2004
- http://www.cdc.gov/niosh/stresswk.html "Stress at Work" by the National Institute for Occupational Safety and Health. Accessed July 8, 2004
- http://www.achenet.org/women/stress/ "Headaches, Stress and Moods" by American Council for Headache Education. Accessed July 8, 2004
- www.americanheart.org "How Can I Manage Stress?" "Stress Leaves Blood Vessels Tightly Wound," "Stress and Heart Disease," "Stress Induced Blood Vessel Spike Leads to Increased Stroke Risk," "Pets Can Tame High Blood Pressure" by the American Heart Association. Accessed July 8, 2004
- www.mayoclinic.com "Managing Workplace Stress: Plan your approach" (2003) by Mayo Clinic. Accessed June 25, 2004
- www.mayoclinic.com "What's your Outlook? The benefits of positive thinking" (2002) by Mayo Clinic. Accessed June 25, 2004
- www.amwa-doc.org "How Stress Affects your Body" (1995) by American Medical Women's Association. Accessed June 25, 2004
- www.medem.com "Controlling Stress: How to Manage Life in a Busy World" (1996) by the American Medical Association. Accessed July 8, 2004
Sheri B. Doniger, DDS
Dr. Doniger has been in private practice of family and preventive dentistry for 20 years. She is currently focusing on women's health and well-being issues. She can be contacted at (847) 677-1101 or donigerdental@ aol.com.
