Tuesday, March 1, 2011

Take Care

I saw a woman yesterday who has a familiar story. She told me about her busy full-time job, her family obligations, her health concerns and all the pressures in her life. We discussed her symptoms, which included poor concentration, tension in the neck and shoulders, irritability and difficulty sleeping. I gently explained that all of her symptoms are classically related to stress.

The human body is programmed to respond to stressful situations in a way that allowed us to survive in ancient times: we recognize a threat and our body gears up for fight or flight. Of course, millions of years ago, we were fighting or fleeing from wild animals. That's rarely the kind of stress we face today. But, our bodies cannot differentiate the threat of attack by tiger or a deadline at work. The physiologic response is the same in either case. A lot of people feel they are under constant pressure, so their sympathetic nervous system (that of the fight or flight response) is always firing. The body is flooded with stress hormones like epinephrine and cortisol which help us to move fast and escape danger, at the expense of mental concentration, rest and digestion. We end up burnt out, finally exhausted physically, but with the mind still racing ahead, worrying about the next day.

So what is the remedy to daily pressure when we can't escape the stresses? We have to work and take care of family, after all. However, too often the priorities are out of sync with our own best health. My patient listed all of her obligations, and said she had no time to get help for herself. She was doing everything for everyone else, including things that could be delegated, and choosing to put herself in last place. I talked to her about reducing the stress response with proven remedies, such as talk therapy, yoga, meditation and massage. I could see her getting anxious trying to insert even one of these things into her schedule. After some problem solving, she was able to come up with a few things she could delegate, or allow to go undone for a day so she could find an hour here and there. She agreed to start meeting with a therapist right away. That's always a good outcome, because I know she'll feel better just having taken the step to put herself first for a change. All too often, though, I will see a patient like this for a follow-up and find out they haven't called the therapist or scheduled the massage or attended the weekly yoga class. And they aren't feeling better.

Why is it so easy to put ourselves behind every other obligation in life? I know from experience, if I'm not healthy and relaxed, everything else I undertake suffers. I bet you've noticed the same thing in your own life. I often say goodbye to people in conversation or email with the words Take Care. We throw this phrase around in casual conversation, and I often say it without thinking what I really mean. Today I recognize when I tell you to take care, I mean put yourself first, thinking of your own physical and emotional needs. So take care, please, and notice the difference you feel in your day.

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