Dear Stress, Let's Break Up

The Merriam-Webster dictionary defines stress as a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation.  Most of us, particularly my fellow healthcare professionals, have an intimate knowledge of stress and do not need a formal definition.  Some level of stress has been our constant companion as we have acquired both formal and practical life education over the years.  Now that we have moved past school and training into the world of careers and parenthood, the sources of stress have changed but the level remains constant if not increased.  Since the reality of life stressors is not going away any time soon, the important thing is to learn techniques to deal with stress effectively.

Stress is not always a bad thing.  The body’s reaction to acute stress leads to what we know as the flight or fight response.  In the short term, this makes us more alert and prepared to take on necessary survival functions.  The type of stress that causes problems is chronic stress.  The same chemicals that allow one to be ready for oncoming danger in a crisis situation can cause a breakdown in the body’s maintenance activities when present for too long. 

Many times the effects of chronic stress are so insidious they are not recognized immediately.  Most of us are so perpetually wound up we do not realize this is not a healthy state of being until some medical professional indicates we have a hypertensive disorder.  The physical manifestations of stress can include headache, chest pain, fatigue, musculoskeletal pain, and dysfunction of the gastrointestinal tract.  The psychosocial ramifications can be sleep disturbance, anxiety, depression, irritability, rage, disordered eating, isolation behavior, lack of focus and substance abuse.  The best way to counter these effects is to identify sources of stress and develop methods to manage it.

The National Institute of Mental Health (NIMH) website suggests the following tips for coping with stress:

o   Note what you have accomplished at the end of the day rather than what you have been unable to do

o   Set priorities for what must get done now and what can wait

o   Recognize signs of your body’s response to stress

o   Stay in touch with supportive people (family, friends, community groups, religious organizations)

o   Avoid dwelling on problems

o   Look into stress coping programs

o   Have regularly scheduled healthy and relaxing activities

o   Exercise regularly

o   Get proper health care for existing or new health problems

o   Seek help from a qualified mental health professional if you feel overwhelmed and unable to cope without using drugs or alcohol

             

Managing stress is important part of being well.  Finding balance in life helps modify stress.  Work/life balance is a popular 21^st century phrase.  However, it implies there are only two aspects of being that need to be considered to achieve wellness.  It conjures the image of a scale where work has to be balanced with everything else on the other side.  True life balance involves putting work, kids, partners, finances, emotional health, physical health, and spirituality all in their proper places.  I think of it more like a hanging mobile where some items have to occupy a higher location or a larger space in order for everything to keep spinning.  Figuring out for ourselves where everything goes on that mobile is the first step in stress management and overall wellness.

No More Tired Than Usual

Last week I had the privilege of being in Kampala, Uganda with the non-profit organization World Children’s Initiative (WCI).  WCI was working with the pediatric cardiology staff of the Uganda Heart Institute to enable them to be self-sufficient in their treatment of congenital heart disease.  I was there in a non-clinical capacity but it was still very rewarding work.  One thing I realized about being out of my normal routine on the other side of the world was the test it put on my health behaviors.  One of the main habits being compromised was adequate sleep.

I know many people have lives where control over how much sleep they get is not completely their own.  A lot of parents of children under 5 years of age (and many times even older) have not experienced more than 6 hours of consecutive rest in years.  Also, on-call physicians cannot dictate the number of times during the night a nurse or patient may awaken them for issues of varying importance.  We are all extremely busy with work and family and it is hard to fit everything into the day.  Despite that being the case, we need to prioritize getting enough rest when it is possible.

Data shows most adults should get 7 to 9 hours of sleep every night.  However, it seems a lot of Americans do not abide by those recommendations.  The 2009 Behavioral Risk Factor Surveillance System (BRFSS) showed that 35.3% of adults get less than 7 hours of sleep during a typical 24 hour period.  I know that I have prided myself in the past for my ability to “function” on little to no sleep.  That is definitely a beneficial skill if necessary.  The problem is sometimes we just get in the habit of not sleeping, so we don’t even when we can.

As I think about my own life I recognize that one large contributor to inadequate sleep over the years has been poor time management.  Despite every intention of getting to bed at a decent time it doesn’t quite work out.  Here are some things to consider about managing time and getting enough rest.

Make a schedule of things that need to be done during the day.  Instead of just making a list, I ascribe a particular amount of time to complete each task.  One thing it has made me realize is some activities take way longer to complete than I would have thought.  This is how it gets to be 10 pm before you know it and you still have 5 things to do before you go to bed.  Giving one’s self a time limit also curbs the dillydallying to which we all fall prey at times.

Become an enemy of live television programming.  TV is quite a time suck.  God has given us DVR to help deal with our hectic lives.  Saving up shows and watching them when you have free time just makes sense.  Never getting around to watching the shows stored up on the recorder is just more evidence the hours you would have spent in prime time would have been a waste.  Sports are among the few televised events whose enjoyment is improved by watching live.  Pretty much everything else can be recorded.

If there is an opportunity, sleep when you are sleepy.  This is one of the most important things I learned when I was working as an ob/gyn.  You might feel lame going to bed early but your body will thank you.  When given the choice of staying awake to inefficiently complete a non-urgent project or getting rest in order to be productive for the next day, pick sleep.  Life is filled with instances when all you want to do is sleep and that is not a viable option.  If you actually have a choice, do yourself a favor and take a nap.   

Recognize that being sleepy all the time is not okay.  Normalizing chronic fatigue makes it easy for people to ignore it as a problem.  Living with a perpetual sleep deficit distorts the perception of tiredness.  The 2009 BRFSS also reported 37.9% of adults fell asleep unintentionally during the day at least once in the previous month.  Most of those individuals probably did not think they were overly tired because they felt that way every day.  No matter how well you think you are coping without sleep, it is impossible for me to express how much better you will feel when adequately rested.

Sleep isn’t the most obvious component of healthy living but it does contribute to overall well-being.  In order to function at a decent level, humans need to be well-rested.  You are better able to tolerate the irritations of life without participating in negative habits when you are not sleep-deprived.  Similarly, you are better energized to exercise and to prepare healthy meals when you are well-rested.  Even if your life legitimately makes it impossible to get more than 7 hours of sleep per night, try to get as much rest as you can.  For those who have sleep issues or want to learn more about sleep and health let me direct you to the CDC page on sleep, http://www.cdc.gov/sleep/.  Have a restful week.

  

I’M REALLY NOT A VEGETARIAN

A common misconception about me is that I am a vegetarian.  The funny thing is I am quite a carnivore.  I do well when I travel internationally because I don’t really discriminate against any type of meat.  I have always said if it is seasoned up right I’ll try almost anything.  The confusion for most people comes from the fact I really like vegetables also.  So many people have seen me consuming grilled brussel sprouts and quinoa veggie salad they think I have beef with beef.  I will admit I made a decision a few years ago to limit my intake of animal fats in order to decrease my risk for coronary heart disease, stroke, diabetes, obesity and certain types of cancer.  Since I like a challenge, I started this endeavor by spending a month being a vegetarian.  It just so happened it was Vegetarian Awareness Month at the time so that may be where the confusion began. 

For me, it really was not that difficult to use black beans, eggs and quinoa as my main sources of protein.  My daily diet did not have to change that much.  I learned how to prepare tasty, satisfying vegetarian and even vegan meals.  At the end of my trial run as a vegetarian I determined I still wanted to eat hamburgers and Buffalo wings, but I could live without them.  Although I have allowed meat back into my meals, I still try to center my diet around foods grown from the earth. 

Many of us could benefit from cutting back meat in our diets to decrease consumption of saturated fats.  This does not have to be a radical event where you throw out all the bacon in your house.  Thankfully, if you are not already suffering from hypertension, diabetes or the like drastic measures are not yet necessary.  Also, you likely will be more successful with a change your diet if you make it gradually and of your own volition.  That tends to feel more autonomous than because someone else told you to do it so you don’t die.  With that in mind, you may want to try these ways to bump up the fruits, vegetables and grains in your diet.

Start having one meat-free day per week.  You can test out vegetarian dishes and see what you find tasty and filling.  If you are starving without meat you may need to add more protein to the mix.  Black beans and quinoa are my go-to sources of meat-free protein.  For the sake of full disclosure, let me confess I am not a tofu fan.  As an omnivore, when I want a burger I don’t want soy.  However, some people like the idea of meat substitutes that behave kind of like real meat such as tofu, tempeh, and seitan.  Figure out what works for you.  If nothing else, you’ll learn you can enjoy a meal without meat. 

Eat actual vegetables on the days you don’t eat meat.  My friend uses the term “pasta-tarian” for people who don’t eat meat, but never actually consume vegetables.  One of the benefits of decreasing meat consumption is it allows more space in your diet for vegetables.  This is negated when your meatless day is spent eating grilled cheese sandwiches and spaghetti.  Every once in awhile it is good to ingest something that came off a stalk.  There are so many systems in your body that will thank you.

Don’t deep fry the nutrition out of your vegetables.  Living in the South for eight years taught me anything can be battered and fried.  In all honesty, many of those items are delicious.  However, for maximum health benefits, you actually want to taste the food you are eating.  I once heard a dietitian say you want to avoid food that is shiny.  If there is so much batter, sauce or oil on your vegetables as to make the taste unrecognizable, you may have cooked the healthy right out of it. 

Try cold water fish as your meat.  Salmon, tuna, mackerel, sardines and herring are great sources of omega-three fatty acids.  Omega-3s are the “healthy” fats that help prevent heart disease and high blood pressure.  Regardless of what some pescatarians would have you believe, this is still eating meat.  However, the effects on cholesterol are quite the opposite of that of a ribeye steak.  Of course, nothing is a panacea so you have to make sure you consume these fish in moderation due to potential mercury exposure. 

Limit the size of your meat portions.  When you do incorporate terrestrial meats into your meals, make sure the size is no larger than the palm of your hand.  Fred Flintstone should not be our patron saint of portion size.  Most American food portions are too large.  By decreasing your meat portions, you’ll have more coveted plate space for those healthy whole grains and vegetables.

Those who know me well know I am a stickler for semantics.  Maybe that is why, even though most of my meals are plant-based, I refuse to call myself some version of a vegetarian.  I am simply an omnivore who chooses vegetables more often than meat.  For the sake of your health, you may want to do the same.

Getting Your Mind RIght

This first month of the year is often full of people, myself included, sharing their thoughts on how to be more physically well by modifying physical activity and nutrition.  As January wraps up I’d like to dig deeper into a dimension of wellness that gets neglected a lot, emotional health.  Many people think not being in the midst of an emotional breakdown equates to emotional wellness.  Similarly, others believe taking prescription medications or seeing a mental health professional means their emotional wellness is covered.  The problem with both these ways of thinking is it can make you a passive participant in your own emotional well-being.  As any cardiologist can tell you, taking the meds and seeing a specialist will only take you so far if you don’t engage in activities on your own that support those therapies.  Floating through life overlooking your emotional health until a crisis occurs is also not the best strategy.  As with physical health, there needs to be some prevention and maintenance to ensure emotional wellness.  Below are a few simple steps to start taking care of your emotional health.

Determine what brings you joy in life.  This is about identifying what you enjoy and being OK with it.  Be honest.  Do you like to sit at home and read a book while drinking a cup of hot tea?  Do you like to travel internationally and party with the locals until the early morning hours?   Is there is nothing in the world that warms your heart more than hearing your children laugh?  Once you stake a claim to what brings you joy, figure out how to make that a more frequent part of your life experience.  This may mean shifting priorities in terms of time management and finances, but the benefits in terms of your emotional well-being will be worth it.

Don’t get caught up in other people’s vortex of negativity.   While we like to focus on the power of positive thinking, it is important to remember the corollary.  There is power in negativity.  It is nice to believe your positivity can overcome the negative attitude of others.  In reality, that is only true when the negative person is willing to meet you half-way.  Trying to bring sunshine into the lives of those who are determined to remain bummed out can be a futile effort.  Let me be clear.  There is a difference between the occasional therapeutic vent and a constant doom and gloom perspective.  Some people are perpetually negative and even mean-spirited.  Spending time in that environment is not without repercussions on your emotional health.  A negative perspective has the ability to bring down even the most Pollyanna among us.  Particularly when you are trying to get your own mind right, it is beneficial to scale back the self-pitying folks in your world.  Don’t be dragged into their downward spiral.  

Stop doing the things you hate doing.  There are dreaded items on everyone’s to-do list.  Sometimes the best thing to remove the dread is to relocate the items to someone else’s list.  The most important part of any to-do list is that the activities get done, not who completes them.  Taking into account cost and feasibility, some tasks need to be outsourced.   It could be as small as buying the birthday cupcakes from bakery instead of making them or as large as having someone cater Thanksgiving dinner.  Some things are still being done by you simply because it has become expected.  It may be time to modify the expectations of the people in your life.  Admit you were wrong in thinking how much fun it would be to tend the lawn when you bought the house.   Hire someone else to do it.  While many solutions involve a fee, in the end you may come out ahead from the perspective of time better spent on other activities.   You may also avoid the financial burdens associated with the coping mechanisms you currently employ to deal with the stress of yet another thing to accomplish.  For the benefit of your emotional well-being it may be worth the investment. 

Don’t always be available.  This comes down to valuing your own time.  Other people respect your time when you teach them it is to be respected.  Some of us fall into the trap of saying yes just because we can’t think of a “good” reason to say no.  It can be an honor to be asked to participate in a project or to attend a function.  However, “no” can still be an appropriate response.  Once you have established yourself as the safety valve, other people learn to wait you out when a task arises.  Whether it is agreeing to chair a committee at your child’s school or to pick up extra call as a physician, don’t feel like it always has to be your duty.  You may end up harboring bitterness towards others simply because they choose to exercise the same right of refusal you have.  Just because there is a space in your schedule does not mean it has to be filled with other people’s priorities.  Time is precious and using it wisely is a key to emotional health.

Be grateful.  How well we deal with most situations in life is a matter of perspective.  Approaching life with an attitude of gratitude helps us to handle its difficulties as well as its blessings.  Recently, I heard a sermon about gratitude which brought up two important points I’d like to share.  First, comparison deactivates the desire to appreciate.  It is very easy to be unappreciative of good things in your life if you are constantly measuring them against what others have.  Second, gratitude begins where entitlement ends.  Thinking something is owed to you tends to make it feel less worthy of thanks.  One way to maintain a grateful spirit is to regularly count your blessings.  Whether it is every day, every week, or even just once a month, writing down at least one thing for which you are grateful automatically puts you in a better head space.  Also, knowing you are going to put it in writing causes you to be more conscious of things for which to be grateful.  Try it and see if there is an effect on your emotional well-being.

Initially, some of these tips may seem like a license to be selfish.  However, consider how you would feel if the same advice was being given to someone you love instead of to yourself.  Remember the first step in emotional health is loving yourself as much as anyone else. 

Wellness for Beginners

As we start 2014, I would like to give a brief primer on how to approach life with a mindset of wellness.  Everyone wants to do big things when a new year begins.  However, most big results are the culmination of doing the proper little things.  Achieving optimal health and wellness is a great example of that.  Health was defined by the World Health Organization in 1947 as "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".  Halbert Dunn (aka the Father of Wellness) said that wellness should cultivate a "zest for living" by incorporating the following five dimensions - emotional, social, intellectual, spiritual and physical.  Below are some simple ways to keep on the path of wellness in all its dimensions.  Here’s to a zesty new year!

NUTRITION

• Eat more fruits and vegetables (at least 5 per day).
• Eat the rainbow of whole foods.
• Drink more water (baseline about 3 liters for men and 2.2 liters for women).
• Don't skip meals.
• Stop drinking sugary drinks.
• Limit alcohol consumption.
• Limit eating food prepared outside the home.
• Don’t use your kids as an excuse to stock your pantry like a candy store.
• Remember dessert can be a piece of fruit.
• Don't be afraid of carbs, just make sure you pick the healthy ones.

PHYSICAL ACTIVITY

• Walk 30 minutes at least 5 days per week.
• Add resistance training to your exercise regimen.
• Stretch.
• Spend less time sitting during the day.
• Use the stairs more.

INTELLECTUAL

• Read a book or a long magazine article that has nothing to do with work.
• Do crossword puzzles or sudoku.
• Play cards or board games with your friends and family.  Strategy flexes your brain.
• Always put forth your best effort at work.  Even if your job is mindless, it may be a stepping stone to something more intellectually stimulating.

SOCIAL

• Don’t let other people define fun for you.
• Make a date with your significant other at least once a month.
• Talk to your kids about something other than chores and school.
• Have family game/movie night.
• Communicate with your best friends regularly.  Receiving a random note written with real-deal paper and pen is always a pleasant surprise. 

EMOTIONAL

• Remember it is OK to say no just because you don't want to do it.
• Do something just because you enjoy it.  Not everything has to be tied to some greater societal good.
• Have at least one person to whom you can vent honestly, but don’t abuse the privilege.
• Don't be afraid to ask for help or a break.
• Use your vacation days.
• Find someone who fills your tank when everyone else has drained it.
• Tell the people you love that you love them, often.

SPIRITUAL

• Figure out what you personally believe and how it affects your life.  Blindly accepting what your mama, grandmama, or clergy tells you is simple, but it tends not to sustain you in times of personal crisis.
• Determine what brings you peace and take time to reflect on it every day.
• Be kind. 

Finding My Essence of Strength

In September 2010 I made the decision to leave my job as an obstetrician-gynecologist to pursue my own personal wellness.  At the time I did not have a clear picture of what wellness was for me but I was confident the current situation was not it.  Six years in private practice, after four years each in medical school and residency training, had left me emotionally and physically drained.  It was a classic case of burnout.  After some down time for rest and rejuvenation, I realized I wanted to return to work in a capacity where I was still able to help other people.  The groups that always touched my heart the most were those struggling with excess weight and my fellow burnt out physicians.  Unsure how I could help the latter, I knew I could address the former by working as a personal trainer. 

Exercise had been a significant source of enjoyment and stress relief for me throughout my life.  I loved helping clients experience the same as they also reached their fitness goals.  However, as I became more successful as a personal trainer, I found myself reverting back to the old feelings of constant exhaustion.  It made no sense to me because theoretically I had a much less stressful job now.  The fact was I managed to bring the same maladaptive life skills to personal training that I had as a full-time ob/gyn.  Despite spending my entire adult life figuring out how to rid my world of illness, I had never learned how to maintain my own wellness.  Once I acknowledged I am best able to help others when I do what I need for myself, I made a special effort to focus on all aspects of life that contribute to my well-being.  Putting systems in place to ensure I keep my true purpose in mind and consistently make decisions in line with that purpose helped me find the peace I had been seeking since I stopped practicing medicine. 

At the same time I was acquiring satisfaction in my life, I was conversing with several of my physician friends who were expressing extreme dissatisfaction with their situations.  That is when it became clear to me how I can be of service to not only doctors, but all people in healing professions.   As a group, healers are particularly prone to putting the needs and desires of others ahead of themselves to the detriment of their own well-being.  Physicians are just the tip of the iceberg when it comes to healers who are unwell.  The qualities of those who dedicate a significant amount of time and effort to keeping others healthy or returning them back to good health make them susceptible to self-neglect.  They often develop behavioral patterns to get through the rigors of their daily responsibilities which leave only enough reserve to care for others and not themselves.  As one who has seen the issue from both sides, I feel it is my mission as a wellness coach to help healers recognize their ability to improve their situations and to start making the life changes necessary to be well.