Coping with Stress - Dr.Kumaresh Krishnamoorthy Column

and relationships with others.

How stress can affect your mind	How stress can make you feel
Memory problems. Difficulty making decisions. Inability to concentrate Seeing only the negative Repetitive or racing thoughts. Poor judgment.	Moody and hypersensitive. Restlessness and anxiety. Depression. Anger and irritability Sense of being overwhelmed. Lack of confidence

How stress can affect your body	How stress can affect your behavior
Headaches. Digestive problems. Muscle tension and pain Sleep disturbances Fatigue. Chest pain. High blood pressure. Weight gain or loss Asthma or shortness of breath. Skin problems.	Eating more or less. Sleeping too much or too little. Neglecting your responsibilities. Increasing alcohol and drug use. Nervous habits (e.g. nail biting, pacing). Teeth grinding or jaw clenching. Overdoing activities such as shopping. Losing your temper. Overreacting to unexpected problems.

Keep in mind that the signs and symptoms of stress can be caused by other problems, so it's important that you consult a doctor to evaluate physical symptoms.

Can stress hurt my health?

The stress response of the body is meant to protect and support us. When faced with a threat, the body's defenses kick into high gear. Our heart rate and blood flow to the large muscles increase, the blood vessels under the skin constrict to prevent blood loss in case of injury, the pupils dilate so we can see better, and our blood sugar ramps up, giving us an energy boost. In the modern world, most stressors are psychological, rather than physical. Unfortunately, our bodies don't make this distinction. The problem with the stress response is that the more it is activated, the harder it is to shut off. Instead of leveling off once the crisis has passed, the stress hormones, heart rate, and blood pressure remain elevated. Extended or repeated activation of the stress response takes a heavy toll on the body. The physical wear and tear it causes includes damage to the cardiovascular system and immune system suppression. Stress compromises the ability to fight off disease and infection, makes it difficult to conceive a baby, and stunts growth in children. In an attempt to cope with stress, some people drink too much alcohol, abuse drugs, blame others (e.g. spouse or parent), and may become physically violent, most often with family members.

Health Problems Linked to Stress:

Heart attack Hypertension Stroke Diabetes Depression Obesity Eating disorders

Substance abuse Ulcers Irritable bowel syndrome Memory loss Insomnia Thyroid problems Infertility

How can I change my lifestyle habits to manage stress better?

• Get enough sleep.
• Connect with others and share your feelings.
• Exercise regularlyNothing beats aerobic exercise to dissipate the excess energy. Physical activity plays a key role in reducing and preventing the effects of stress.
• Eat a balanced, nutritious diet.Take time to eat breakfast in the morning, it will help keep you going throughout the day.
• Reduce caffeine and sugar.You'll feel more relaxed, less jittery or nervous, and you'll sleep better.
• Don't self-medicate with alcohol or drugs. These lessen stress only temporary. Don't mask the issue at hand; deal with it head on and with a clear mind.
• Do something for yourself everyday.Too much work is actually inefficient and can lead to burnout. Recognize when you are most stressed and allow yourself some reasonable breaks. Most importantly do things that make you happy.

How can I handle stress better?

• Have realistic expectations:Know your limits. Whether personally or professionally, be realistic about how much you can do. Set limits for yourself and learn to say "no" to more work and commitments.
• Reframe problems:See problems as opportunities. As a result of positive thinking, you will be able to handle whatever is causing your stress. Refute negative thoughts and try to see the glass as half full. Your thoughts can become like a pair of dark glasses, allowing little light or joy into your life.
• Maintain your sense of humor:This includes the ability to laugh at yourself. The act of laughing helps your body fight stress in a number of ways.
• Express your feelings instead of bottling them up:In order to live a less stressful life, learn to calm your emotions.
• Don't try to control events or other people:Many circumstances in life are beyond your control, particularly the behavior of others. Consider that we live in an imperfect world. Learn to accept what is, for now, until the time comes when perhaps you can change things.
• Ask yourself "Is this my problem?"If it isn't, leave it alone. If it is, can you resolve it now? Once the problem is settled, leave it alone. Don't agonize over the decision, and try to accept situations you cannot change.

How can I meet the challenges of stressful situations?

• Avoid Procrastination:One of the greatest sources of stress is over-commitment or poor time management. If procrastination causes stress in your life, learn to stop putting things off. Make a weekly schedule and fill it with lots of time for leisure as well as work.
• Give priority to the most important tasks and do those first:If a particularly unpleasant task faces you, tackle it early in the day and get it over with. You will experience less anxiety the rest of the day as a result. Most importantly, do not overwork yourself. Resist the temptation to schedule things back-to-back. All too often, we underestimate how long things will take.
• Delegate tasks and break up big projects:People who haven't learned to delegate often feel needlessly stressed. Delegating isn't a matter of dictating to others; it's asking others to assist you by doing tasks they can handle. Break big projects into smaller, more manageable tasks so you don't feel overwhelmed and nothing gets done as a result.
• Make Decisions:Before going to bed, think about your problem and the various choices you could make. Think about each choice clearly in your mind. Tell yourself you're going to make the decision while you sleep. You may not name the solution the next morning but if you keep trying, you will eventually awaken with your mind made up.

What are some common techniques for stress relief?

Stress relief technique	Description
Breathing	Stress often causes our breathing to be shallow, which nearly always causes more stress because it puts less oxygen in the bloodstream and increases muscle tension. The next time you feel uptight, try taking a minute to slow down and breathe deeply. Breathe in through your nose and out through your mouth.
Progressive Muscle Relaxation (PMR)	Relaxation exercises help reduce anxiety and stress. First, you cause tension in certain muscle groups and then you totally relax them. As the muscles relax, so does your entire body, as well as your overstressed mind
Meditation	Quiet the mind to relax the mind, body and spirit. Take a moment to close your eyes and imagine a place where you feel relaxed and comfortable.
Practice Yoga	Yoga allows you to build up a natural response to stress and bring the relaxed state more into your daily life.

When is professional help needed?

There's a fine line between feeling stressed out while still being able to function effectively and the debilitating, even paralyzing phenomenon we think of as burnout. The difference is between handling your stress on your own, and being unable to figure out what to do because the pressures of life have become so overwhelming. It's time to seek professional help if you:

• Feel that stress is affecting your health.
• Feel that it will never end.
• Feel so desperate that you think about quitting your job, running away, taking a drug overdose or injuring yourself.
• Feel depressed, sad, tearful or that life is not worth living.
• Lose your appetite and find it difficult to sleep.
• Are managing your stress level by eating, sleeping, drinking alcoholic beverages, smoking or using drugs.
• Have worries, feeling and thoughts that are difficult to talk about.
• Hear voices telling you what to do.

Tips for Dealing with Stress

Stress is a normal reaction to events that threaten us. Such threats can come from accidents, financial troubles and problems on the job or with family. The way we deal with these pressures has a lot to do with our mental, emotional and physical health.
The following are suggestions to get you started on managing the stress in your life:

• Look at your lifestyle and see what can be changed -- in your work situation, your family situation, or your schedule.
• Use relaxation techniques - yoga, meditation or deep breathing
• Exercise - Physical activity is one of the most effective stress remedies around!
• Time management - Do essential tasks and prioritize the others. Consider those who may be affected by your decisions, such as family and friends. Use a check list so you will receive satisfaction as you check off each job as it is done
• Watch your diet - Alcohol, caffeine, sugar, fats and tobacco all put a strain on your body's ability to cope with stress. A diet with a balance of fruits, vegetables, whole grains and foods high in protein but low in fat will help create optimum health.
• Get enough rest and sleep
• Talk with others - Talk with friends or family members about what is bothering you
• Help others - Volunteer work can be an effective and satisfying stress reducer
• Get away for awhile - Read a book, watch a movie, play a game, listen to music or go on vacation. Leave yourself some time that's just for you
• Work off your anger - Get physically active or start a project
• Give in occasionally - Avoid quarrels whenever possible
• Tackle one thing at a time - Don't try to do too much at once.
• Don't try to be perfect
• Ease up on criticism of others
• Don't be too competitive
• Make the first move to be friendly
• Care for a pet - Petting an animal can help reduce stress and lower blood pressure

CONTACT:
Dr.Kumaresh Krishnamoorthy, M.S (ENT)
Head and Neck Surgery Fellowship (Buffalo, USA)
Neurotology & Skull Base Surgery Fellowship (Cincinnati, USA)
Senior Consultant in ENT - Head and Neck Surgeon and Skull Base Surgeon
Apollo Hospitals, 154/11, Bannerghatta Road, BANGALORE 560 076, INDIA