Daily Pills and Shame

At six, I rode my first bike. My ever-so-slightly younger brother was already gliding the pavement without his training-wheels and I was the one left behind. motivated by shame, I vowed to catch-up and allowed my dad to teach me. I learned quick when he let go at the top of a local hill that had just been tar-and-chipped. The immanent fear of danger was a quick and efficient teacher.

At seventeen, I drove my first car. My girlfriend had started college and my friends had figured out I didn't like to pay for gas. Their was no way I was going to get caught riding the bus as a high-school upperclassman. A weeks worth of trips on the same bus as the freshman and having to get up an hour earlier to do it proved to be the breaking point for my reluctance to get a part time job and begin paying for car insurance. Again, shame drove me to take the next step in my life. 
 
As a nurse working on a hospital's chronic heart floor, I see the effects of shame. Older women who are afraid to admit they can no longer cook for themselves and end up sending their sodium and sugar levels through the roof with microwave dinners. Older men who refused to use a walker or a cane until they fell down the stairs and broke their pelvis. No one wants to admit that they may be suffering from the worst parts of getting older, dependance and physical decline. 

Today, the doctor told me what I had already known. My blood pressure is getting too high. Most of the patient's I take care of would be happy to have my numbers, but I know that the sixty-five year old I take care of during the day probably had borderline numbers like me when he was my age. What kept them from taking care of their systolic business in the 1980's? Aside from lack of information, I'm guessing it was shame. Ignorance may be bliss, but the next best thing is a good show for the rest of them. Right? 

I've seen the ravages of heart disease and high blood-pressure. I've seen proud men drown in their own fluids, their lungs filled up past the first lobe. I've seen women stroke out with a systolic pressure above 240, despite headaches, multiple visits to the ER with chest pain, and difficulty breathing. When I have time, I ask them when they started getting mild symptoms, when they noticed it (and started ignoring it); it's almost always in their 30's and early 40's. They started killing themselves in their 30's!

So, at thirty-four, I've taken my first blood pressure pill and hope the small monthly investment pays bigger dividends thirty years from now despite the shame and the admittance of the inevitable, my body isn't perfect and neither am I. They always say it's the first step. Next step, the right foods and exercise... I'm not there yet. 

Chronic Stress: How to Cope in a Down Economy (Part 1)

The following is the first part in a series on how small businesses can reduce chronic stress in the workplace.

They may lurk in a back office hazed in a ring of smoke sitting next to a cold cup of caffeine. They may be hunched over a calculator and a keyboard crunching numbers, or they may be out at the counter making sure that everything gets done “just right.” Often, they coexist with the equally anxious hired hand in charge of keeping daily operations going and the lights on. Either way, with slim pickings for profit margins and given the generally-negative economic atmosphere, is it any surprise that many small business owners and executives exhibit signs of chronic stress? With that said, what are the signs and possible symptoms of chronic stress and what is its overall impact on the viability and longevity of small businesses in the area and the health and well being of the owners and staff? Once identified, aside from buying a fishing boat and moving to the bahamas, what can be done about it?

This three part article will be an interesting read. It may even take you down memory lane and serve up a few “aha” moments that will better your life and hopefully your health. After all, a happier staff is a more productive staff and “if the boss ain't happy, ain't no one happy.” Your health and the health of your staff is the bottom line.

The disclaimer

Many people read articles like this one, see the list of symptoms, and feel the affliction known to University Clinics around the world as “Medical Student’s Disease” or at doctor’s offices as “cyberchodndria.” In that, armed with the new knowledge of possible symptoms, you begin to see them everywhere. Rest assured and take a deep breath, this article is meant to educate, not diagnose. It’s meant to help you ask questions of yourself, start conversations at work, and then take those questions to your primary care provider.

Am I covered? Wait... if you’re having chest pain signs or other signs of a heart attack, call 911 or go to the emergency room.  So, with that in mind and the lawyers off of speed dial, let’s move on.

Warning! Science Content.

In order to understand abnormal reactions to stress we must first understand our body’s normal reaction to it, which begins with a brief history lesson and some basic physiology.

Only in the last few hundred years, has mankind been able to worry more about what new iPhone app to download than about running away from large predators while looking for food. If you want an excellent primer on the subject, watch the new animated movie “The Croods” with your family. In it, the patriarch of the cave-family uses the motto “Never not be afraid.” His only job is to keep his family alive. He is big and strong and only has to react to threats. No “ideas” necessary.

Physiologically and chemically, not much has changed since the stone-age. In order to outrun the saber-tooth tiger at your heels or fight the bear at your front door, two chemicals do most of the heavy lifting and it starts in your brain.

Think of the amygdala as the alarm bell in your brain. Tucked away in the back of the medial temporal lobes of the brain, this almond sized piece of the basal ganglia is responsible for receiving perceived threat information from the frontal cortex and signaling the adrenal glands (housed atop the kidneys) to begin production of a host of hormones. Just the sight or sound of a perceived threat sets off an unconscious signaling process. Most people identify this as “getting tense” or feeling agitated, but they seldom know why.  

Enter the hormone adrenaline. If the amygdala gets the engine primed, adrenaline revs it through the gears like a Japanese drift racer. It constricts peripheral blood vessels, which decreases the possibility of limb hemorrhaging. Core blood pressure goes up, to fight possible hemorrhaging, and it takes the brakes off your SA node to increase your heart rate to pump needed fuel to running legs. If you’re not already on the run, you’ll feel your heart race, beads of sweat gather on your arms, and you’ll get a headache from too much light entering your dilated pupils.

While adrenaline recruits massive amounts of muscle fiber for fast action, the corticosteroid Cortisol feeds them by elevating the amount of glucose in your blood. It also stalls your immune system and its inflammatory response to protect muscle cells during extreme use. If you haven't been eaten or mortally wounded, the system is designed to save you and then reset itself and return the body to normal. You, however, at the cash register or on the couch after a hard days work will feel completely drained, possibly lethargic, and have no motivation to get into the sunlight you crave.  

Granted, Wolves and Vikings are negligible threats in most of Ohio, but the system still serves its purpose. Cars get pulled off of kids by superhuman moms. Trauma victims make it to the Emergency Room alive and first responders function at top gear, but what happens when the intermittent stresses of wolves, vikings, and overturned cars are replaced by the unending stress of bills and payroll? What happens if the system doesn’t reset itself?

We'll get into this next week and focus on the negative effects of chronic stress over a period of time and begin to delve into practical (and free) ways to begin to identify and combat those effects in your everyday life. In the meantime, check out the references below for more in-depth reading on the subject as your time permits.

References:

Lemonick , M. (2003, October 06). How to heal a hypochondriac. Time, Retrieved from http://www.time.com/time/magazine/article/0,9171,1005818-2,00.html

U.S. Census Bureau. (2007). Retrieved from U.S. Census Bureau website: http://www.census.gov/econ/smallbus.html

Mayo Staff. (2010, September 11). Stress: Constant stress puts your health at risk.. Retrieved from http://www.mayoclinic.com/health/stress/SR00001

McEwen, B. S., & Mirsky, A. E. (2007). Physiology and neurobiology of stress and adaptation: Central role of the brain. Retrieved from http://physrev.physiology.org/content/87/3/873.full

My Oldest.

She's picked up a wicked "you have to know something obscure to know what I'm laughing at" sense of humor. Half the fun is watching her watching whoever it is that she's talking to. Her eyes kinda twinkle and you can see the smile on the corner of her mouth begin to twitch as the other person mulls over the obscure thought connection puzzle she's laid in front of them. She lets it go if they don't get it, but her voice dances when they do; they're in the club. They've figured out the secret handshake and cared enough to play along. I've taught her well.

Her inhibitions leave when she's on the dance floor. She owns it. She knows it.  She talks to it. Barefoot, she caresses the wooden floor, whispering with each pirouette. With her toes, she digs in and shouts a chassé, knowing the air accepts her, loves her, and the floor regains her when she's done.

The floor is the foundation of all her muscle, all her moves. It never leaves, never fails, always accepts her efforts to leave and pushes back, with equal force, to help her gain new heights in what she loves. Just enough resistance to make her strong, a trust earned since she was three. I hope I've done the same.

She notices everything, physical and emotional. Windshield wipers that go faster than ours. The movie that showed an obscure shot of the Central Park Zoo trying to pass it off as somewhere else. Seeing others bullied afflicts her physically with pain and hardens her to action. My own inner facial flinch when she does something I don't approve of makes her crumble when I leave the room. She knows me so well it scares me.

She's so much like me that it scares me. Not that I'm afraid she'll do something stupid, she will. Not that she won't be brilliant, she is. No, her burden will be an internal one, a constant struggle between introversion and the excitement of the crowd, the shy subtlety of "will you join my club" and the pure joy of performance. Her power is her weakness; her joy is high and her sorrow black, but tomorrow is always sunny. I think she'll navigate it well. 

I Smell a Panic and it's Covered in Aspartame

Every few years some sort of death food or medicine rears its ugly head on the internet and circulates like wild-fire. Apparently, aspartame is back on the paranoia circuit again.

Remember, anything can be a poison. Of course it's not the best thing for you and has unintended consequences if you guzzle it by the gallon in a frothing frenzy to not eat (all natural) sugar. It might also show up in the blood stream of dead people who had multiple health issues that forced them to use a sugar-substitute; diabetes probably being the common co-morbidity. Others may have been indulging in an unknown variety of "all-natural" health elixirs that don't mix well with much, including aspartame.

If you have ever taken a course in statistics or research you will (or should) learn the phrase "correlation does not mean causation." One of the top examples is the correlation between ice-cream sales and drownings, one of the highest ever studied. As one increases, so does the other. The key is in understanding that they are related, not in causation, but in relation. The relation being the heat of summer time that causes people to eat ice cream and swim. One does not cause the other, but they very often keep close company.

One story that was circulated regarding aspartame included the story of John Cook who "began drinking six to eight diet drinks every day. His symptoms started out as memory loss and frequent headaches." It goes in to great detail describing horrific symptoms that led to his untimely demise. Which begs the question: Was Mr Cook given the standard test for Phenylketonuria (PKU) at birth?

Strikingly, Mr Cook's symptoms correlate with PKU and the substance phenylalanine is often found together with aspartame in sugar-free diet drinks. Was he too old to be tested at birth or was he denied the test by well intentioned parents for fear of a government conspiracy covering up horrendous deaths? We will never know because the story is just vague enough to sound true, but uses a wonderfully generic name that is hard to track.  

Although a bit more money from the government or the FDA might help their bottom line, Doctors, Pharmacists, and Nurses are not part of the conspiracy. They might alert someone as to the over consumption of any food-additive or a potential interaction between medicines or over-the-counter (OTC) herbals.

The current postings smell of the same pseudo-science and panic inducing rubbish that fuels the anti-immunization campaigns, which harm more people than they help.  A web search gives nothing but uncited cut-and-paste news stories that fail to mention where they can from or an original author that has written anything else in the health field. The only "support" for the story is a self-publicized conspiracy theory.

If you or your child need sugar substitutes to make a medical condition bearable, than use them in moderation, but don't throw them away and cause yourself harm by ignoring your medical condition.

If you feel over-burdened to spread medical news, make sure it is a cited article and not cut-and-paste. For everything else, find a medical professional you trust and can talk to before you jump on a band wagon. Even Dr Oz is wrong occasionally, so get a second opinion if you want, but the internet can be a dangerous place to take at its word.