stressed-executive

Today I did a minor surgery on an interesting fellow.  While I was dissecting a benign but bothersome mass, called a fibrolipoma off his skull, we had an interesting chat.  I had noticed that he had been bleeding quite a bit during his surgery.  He mentioned to me that he had stopped his anticoagulants as instructed a few days before his surgery.

Why was this fellow on anticoagulants?  He was a “young” early forty-something, muscular and in phenomenal physical condition.  He was happily married with young kids and made more money than he could spend.

He had been on anticoagulants for the past couple of years every since nearly dying from a heart attack.  He had thought that he had been doing everything right.  He was a busy, involved Husband and Father, an avid recreational hockey player and he also played in a soccer league – all while functioning as the president of a medium sized oil company.

stock-footage-executive-having-on-call-duty-at-home

So when he as sitting down in the chair one evening, going over stock reports and working his way through the unending pile of work – he dismissed the initial dull ache in his chest as just one more pulled muscle of a litany of them that he had experienced over the years.

So he took a tums….and he thought the pain went away a little.

Until it returned a little later.  He took another tums and when this didn’t help, he thought he’d just turn in to get some sleep.  He had never slept very much.  At best, with all the demands of his family, work and interests – he had averaged about 3-5 hours of sleep per night for as long as he could remember.  This habit of his started with the early years of University, studying and working to keep up in Engineering at University….then in continued during his early years of working as a young Engineer, trying to climb the corporate ladder.

Finally, as President of a larger and successful company he was accustomed to the constant workload and seemingly unending demands.  His solution to fulfilling the requirements of being a Family Man and also playing in his soccer and hockey leagues was simple – just cut out the sleep!  That trick worked just fine for him all these years and he had no reason to believe that he could not keep this going.

So when he started to feel nauseated, he blamed the lunch he had earlier in the day at the place on the corner by his office building.  He went up to bed and made a mental note to book a massage to address that pain in his left arm that probably resulted from hockey last night.

heart2battack

By the time he got to the top of the stairs, he intended to get into bed beside his wife who had been asleep already for hours.

She awoke suddenly with the loud thump that felt like something large fell in her room.  She got up to call to her husband downstairs to see what had happened – and tripped over his body on the floor beside the bed.  In a panic, she turned the light on and would never forget the sight of her pale husband on the floor, unconscious and with a bluish tinge to her lips.  Her panicked thoughts turned immediately to her daughters and the anguish she would have explaining to them something she could not even imagine.

Still unsure whether or not she was having a nightmare, she called 911 and started CPR.

cpr

 

Days later, her husband woke up in the hospital, drowsy, sore, nauseated and unsure where he was.  All he knew is that he had to get to the office…….it took him a while to realize what really happened to him – it wasn’t “just a heart attack”.  It was but one deadly manifestation of chronic stress.

This fellow was lucky.  He survived his heart attack, and it took him some time to work through the old “disbelief – denial – bargaining – acceptance – introspection” cycle.  So as he lay on my surgical table talking to me about his experience, he admitted that it took him some time to accept that “living the dream” nearly cost him his life.

He quit his job and took a lesser position at a smaller but stable company.  He resolved to changing his lifestyle to become much more aware of stress and the negative effects of chronic sleep deprivation.  He had always been a good Husband and Father – but he realized that a dead Husband and Father is not a good one.

He adjusted the way he saw and interacted with the world and he was thankful that he was healthy enough to be able to live with a heart that continued to work despite having sustained about 15% permanent damage.

And he learned a new and healthy respect for stress.

Stress-1

So what, exactly is stress?  Stress is a state of prolonged emotional tension from internal or external stressors, which may cause various physical manifestations that can accumulate to threaten your health and well being.

 

“People are disturbed not by a thing, but by their perception of a thing.” 

(Suffering occurs from trying to control what is uncontrollable)

Epictetus (Greek Philosopher AD 55-135)

 

Stress can and does lead to bad health and you have to protect yourself against it.  It is also unnatural to experience prolonged stress.  We probably evolved the ability to feel stress in order to survive dangerous situations.  For example, in the “caveman” days, stress probably functioned to increase blood pressure, heart rate, body temperature and blood sugar in order to help us survive dangerous but temporary situations like trauma, exposure and hunger.  Those early humans that had the ability to “get through” these sorts of tough situations ended up surviving more often than those that didn’t.

Technology has largely removed stressors like exposure to the elements and starvation from the lives of human beings lucky enough to live in the “first world” – and so we are now attuned to respond to other “stressors” like financial, interpersonal and work-related stress.  We also now often live in cities that contain millions of people that live close to each other.  As a result, personalities, interests and personal styles can clash – leading to social stress.

Even young kids are at risk.  Parents tell kids to “study”, “do well in school”, “get along with your peers”, etc., etc.  Kids are waking up early in the morning well before dawn to go to hockey or swimming, etc. practice; they spend hours in school on desks under cold, flat fluorescent lights – often listening to teachers say “blah, blah, blah” for hours on end.  They listen to their parents fight at night, they are subjected to bullying, insecurity and competitiveness in school and in their social lives with personalities that clash more often than they get along.  Our kids increasingly do meaningless homework to “artificially” learn about abstract concepts years before their brains are even wired to be able to grasp abstract concepts.  But our increasingly redundant “British industrialist-modeled” education system decrees that they spend hours per day sitting in a desk and at home to complete tasks with little meaning most of the time.

Stressedkid

Kids compete to get into schools, onto teams, into social groups, for jobs, colleges, clubs, friends and increasingly for parental attention and affection.  The venues for this sort of competition is also becoming a 24/7/365 stressor for kids as facebook, tumbler, twitter, instragram, youtube and snapchat infiltrate and influence their lives.

Our kids are often chronically sleep deprived, and they learn to compete and to “be the best” from a very early age to the point that they often grow up not knowing what it is like to feel secure, well rested, and “stress free”.  Kids are increasingly at risk of turning into adults with the same lack of insight into stress.

Stress has become our new normal, and is the worst of the legacies that we are leaving to the next generation.

Signs of stress may not be recognized by people experiencing chronic stress.  These signs are (borrowed from http://www.law.suffolk.edu/offices/stuservices/asp/warning.cfm):

Physical Signs of Stress:

  • Tension, or migraine, headaches
  • Upset stomach, problems retaining food
  • Change in appetite
  • Tightness in chest, back, shoulders
  • Aching jaw, tight forehead
  • Shortness of breath, dizziness
  • Excessive sweating
  • Sweaty palms
  • Tingling sensation in fingers toes
  • Nervous tension all over; heart palpitations
  • Diarrhea or constipation
  • Constant low grade fever
  • Cold, or sore throat
  • Rashes, hives, skin irritation
  • Increased blood pressur
  • Always tired
  • Menstrual problems, missed menstrual periods

Emotional Signs of stress:

  • Less interest in hobbies, familiar fun activities
  • Upset by the unexpected
  • Sudden shifts in mood
  • Frequent and/or recurring nightmares
  • Vague feelings or uneasiness, restlessness
  • Feelings of being swamped, overwhelmed
  • Feelings of anger, resentment
  • Intolerance, irritability with others
  • More easily frustrated
  • Increased fear of failure
  • Feelings of inadequacy, powerlessness, hopelessness
  • Changed interest in sex, either more or less
  • Apathy, general dissatisfaction
  • Desire to cry
  • Reduced confidence
  • Fear that everyone except you is doing fine
  • Worry that you are asking for too much help or too much time from others

Behavioural Signs of Stress:

  • Change in eating habits
  • Eating more less
  • Sleep problems
  • Too much, too little
  • Difficulty talking to, holding, loved ones
  • Isolating self from others
  • Staying at home or staying at work
  • Complaining more
  • Increased use of alcohol, drugs, coffee, tobacco
  • Change in general activity level
  • Change in sexual activity, either more or less
  • Pacing
  • Increased nervous habit, such as nail biting or hair twisting
  • Loss of temper: yelling, throwing, and kicking
  • Increased recklessness, risk-taking
  • Bossiness or inflexibility with others
  • Grinding teeth
  • Stuttering
  • Sudden outbursts of crying
  • Laughing, or anger

Intellectual Signs of Stress

  • Having difficulty remembering recent information or details of recent situations
  • Less able to make decisions
  • Difficulty concentrating
  • Attention span shortens
  • Feeling confused, especially with familiar tasks
  • Repetitive thoughts
  • Continually thinking particular thoughts
  • Misunderstanding what others tell you
  • Increasingly poor judgment
  • Thoughts of escaping, running away
  • Racing thoughts
  • Unable to slow down thought process
  • Loss of objectivity

 

What is the best “Defence” against stress?  How do you “Cure” stress?

First – be aware of stress.  Look at your life objectively, and determine if you may be stressed.  Know that stress REQUIRES YOUR PARTICIPATION.  Somehow, you must be aware that your stress is affecting you WITH YOUR PERMISSION.

Second – Respect stress.  Don’t slough off the fact that you are stressed and don’t just assume that “it’ll get better soon”.  Stress never gets better unless you take action.

Third – Recruit your resources.  Ask your friends and family for insight and help with recognizing and dealing with your stress.  If you have nobody – get somebody, even if you have to walk unannounced into a church.  That’s the nice things about churches.  The clergy that run them, at the end of the day, are there for anybody and everybody.

Fourth – Deal with it.  That also means deal with yourself.  Remember number one up above: stress needs your permission to stress you.  All problems can be either solved or accepted.  You may be not able to solve an unsolvable problem – but you can ALWAYS deal with it.  Have the talk that you need to have, get help for the problem you have.  Don’t stay in the “stress rutt” – motor yourself out of it.  Quit that job or make a plan to change it.  You have to be brave enough to make your decision – or get help to do it.  There is always a solution and there is always somebody.  Very few people live on an “island unto themselves” – and while there are challenges in living with millions of neighbours – there are also clear benefits.  Each of us is surrounded by hundreds or thousands and even millions of good people.  Get to know some good ones, it isn’t hard.

Fifth – Recognize the patterns of stress in your life and how it tends to “sneak in”.  Develop strategies for a “gut check” on a regular basis to see if you have allowed that monster back into your life again.  In fact – schedule the “stress gut check” on your calendar every month.  Give yourself time to reflect on your life and sources of stress.  Often, you can eliminate sources of stress – but just as often, you can choose to feel differently about a source of stress that you can’t control.  This takes practice and gets easier with experience.

One Strategy to deal with Stress

circles

One useful strategy that I often describe to patients is to view the world and your concerns about it into two or three concentric circles, with you at the centre.  The outermost circle is your circle of concern – everything you care about, but can’t do anything about.  Within this is the circle of influence – everything you care about that you can possible influence.  The closest circle to you is your circle of control – everything that is directly under your control.  Controlling your stress is a simple matter to choose to be unconcerned about anything outside of your circle of influence.  With EVERY issue that you face – you should place it in the correct circle.  Sometimes it takes a bit of effort to figure out whether or not you can affect or control a certain concern in your life – and therefore which circle your concern belongs in.  Simply organizing all of the concerns in your life this way is a great approach to dealing with your stress monster.

 

 

 

 

 

 

The REAL culprit behind many illnesses…..STRESS!

Dr. John Fernandes

B.Sc., M.Sc., M.D., LMCC, CCFP, FCPC Clinical Lecturer, University of Calgary I am a Physician with over a decade of experience in my own Private Clinic as well as a full admitting Physician to a Tertiary Care Hospital in Calgary. Married with two daughters that both want to be Physicians as well. Hobbies include skiing, golf, mountain biking and Karate.

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