Why You Get Sick After A Stressful Time Ends

You’ve just put in a long, busy week at work.  Two projects were due, one of your most trusted employees was out sick, and your boss was in a foul mood all week because she was feeling pressure from the C-suite…  Finally you achieve Friday!  You get home, peel off your work clothes, relax for the evening and go to bed.  Then Saturday morning you wake up with a fever, sore throat, swollen glands and a cough.  What the heck?!

Why does this happen?  Wouldn’t you think you’d get sick WHILE you were under so much stress?  There actually is a good reason why you get sick AFTER a stressful time ends, not during the stressful time.

To explain this, we have to look at how the body reacts to stress.  Stress increases the fight-or-flight hormones by activating what’s called the sympathetic nervous system.  You know the feeling you get when you narrowly avoid a car accident?  Nervous, shaky, heart racing?  That’s due to adrenaline.

High adrenaline levels over more than a few minutes will make the adrenal glands increase the amount of cortisol and other stress hormones they are making.  Cortisol raises blood sugar and helps mobilize metabolic resources for dealing with stress.

However, these hormones are not meant to be high for days on end.  At some point the stress drops and the cortisol and other hormone levels drop again.  The drop in hormones can trigger migraines (something my son and I know from personal experience) and also can weaken the immune system.

When you’re under stress levels of IgA decrease dramatically.  IgA is the antibody involved in the immune system of the nose, throat and GI tract.  Unfortunately germs are always there, whether you’re under stress or not.  While your systems are revved up the immune system can keep the invaders off the walls, but after the stress releases and the hormone levels drop (and antibody levels are low) you are more prone to get sick.

So how can you reduce the likelihood that you will fall prey to a cold, flu or migraine after a period of stress?  The key is in managing the stress well DURING the stressful period so that the “let-down effect” isn’t so dramatic.

Make sure you’re getting plenty of sleep.  Sleep deprivation increases stress levels and suppresses the immune system.  Exercise also reduces stress hormone levels and improves sleep.  Make sure you’re choosing an exercise you enjoy too, forcing yourself to do something you hate is NOT going to reduce your stress!

Reach out to family and friends.  Social isolation and feeling you’re “going it alone” increase perceptions of stress.

Practicing active relaxation techniques like meditation and yoga are very powerful ways to keep adrenaline and cortisol levels manageable.

Remember, you can’t keep stress away.  Being a grownup (or a teenager or a kid, LOL!) means demands are going to be placed on us that we will have to deal with effectively.  The key is in managing how we deal with the stress.  Avoiding big swings in our body’s stress hormone levels is key to staying healthy.

QUESTION: Do you tend to get sick WHILE you’re under stress or AFTER the stress lets up?

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When Vertigo Sets You Spinning

Imagine you’re going about your business as usual.  You finish a long day and go to bed, but in the middle of night you roll over and wake up suddenly feeling like you’ve been strapped into the Whirling Teacups ride at the amusement park!

I’ve seen two patients this week with acute vertigo.  Vertigo can be a minor annoyance or a sign of a very serious problem.

Vertigo is actually a symptom, not a medical illness in and of itself.  It is defined as the illusion of movement.  This means you feel like you’re moving but you’re actually not.

Everyone has had vertigo.  When you were a kid and spun around in a circle over and over to make yourself dizzy, then fell down on your back to watch the sky whirl around.  That was vertigo.

Vertigo is a problem with the inner ear.  There are delicate fluid-filled tubes called semicircular canals that sense the movement of the head.  When the fluid can’t shift the way it should, or the ear can’t sense the movement properly, the brain gets mixed signals.

Credit wikis.lib.ncsu.edu

Credit wikis.lib.ncsu.edu

Have you ever been seasick or carsick or airsick?  Motion sickness is a problem when the brain gets signals from the eyes and ears that don’t match.  If the ears say you’re moving and the eyes say you’re not (like turbulence in an airplane or trying to read in the car) the brain can’t make the signals match.  Nausea and dizziness are what happens.

You can get vertigo as part of a viral respiratory infection if the virus infects the inner ear.  Swelling will keep the fluid from moving properly and may keep the inner ear from sensing movement properly.  This is called labyrinthitis.

You can also get vertigo if a little bit of debris blocks fluid from moving properly in the canals.  This is called benign positional vertigo and happens with movement and stops when you’re not moving.

There are a few times when vertigo can signal a serious problem.  Vertigo in combination with hearing loss can be a sign of a problem called Meniere’s disease which happens when there’s too much fluid in the inner ear.  The unusual combination of vertigo and hearing loss in just one ear can be a sign of a benign tumor on the acoustic nerve.

Very rarely, vertigo can be a sign of a stroke if it affects the part of the brain related to balance.  This is of course more likely in those who are at risk for strokes.

What can we do to help vertigo?  Well most cases of vertigo are just annoying, not scary or dangerous.  So most of the time we focus on keeping the patient reasonably comfortable while the body heals the problem on its own.  Antihistamines like diphenhydramine and cetirizine are helpful, as are over-the-counter motion sickness medicines like Bonine and Dramamine.

If simple measures don’t work, sometimes steroids are useful to decrease swelling and inflammation in the inner ear.  Other treatments are used based on the cause.

If you develop dizziness and a feeling like you’re moving or spinning or off-balance, please see the doctor right away.  Most of the time it’s just an aggravating, temporary problem that feels better with some simple treatments.  However if it keeps up or you’re very uncomfortable or there are signs of a serious cause, more tests may be needed.

QUESTION: Have you ever had vertigo? How was it treated?

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Syrup of Ipecac

Guess what?  A patient’s grandmother taught me this week that something I learned in residency is completely obsolete.  AWESOME!

When I was a resident I was taught to advise parents to have syrup of ipecac in the medicine cabinet in case their child swallows a poison.  I was taught to tell parents never to USE it unless told to do so by Poison Control, and to have the Poison Control phone number posted by the phone and easy to find.

What is syrup of ipecac?  It is a liquid medicine that reliably makes people vomit.  The point of having it ready in the house is that if you need it, that’s not when you want to be heading to the pharmacy to buy it.  If you need it, you need to use it NOW.

My patient’s grandmother listened carefully to my advice and then headed to the pharmacy to buy syrup of ipecac.  Guess what she found?  It’s not on the market anymore.  Not produced anymore.  Hasn’t been available for years.

What?!  Well I’m nothing if not willing to admit I might be wrong.  However, before changing the advice I give parents I wanted to look and see what the rationale was behind the change, and find out what I AM supposed to tell parents to do in case their child swallows a poison.

There are 3 main reasons why the use of syrup of ipecac is no longer recommended.  First of all it is not very effective.  It is pretty reliable at causing vomiting, but it generally does not completely empty the stomach.  If your child has swallowed a poison you want to get rid of ALL of it, right?

Second, it could cause more damage if used improperly.  There are poisons that do as much or more damage coming up than they did going down in the first place.  I would always tell parents NEVER to use syrup of ipecac without specific instructions from Poison Control, but I can see how a panicky parent might just reach for ANY remedy without making that all-important phone call.

Third, syrup of ipecac has the potential to be abused.  Patients with bulimia are known to use it to make themselves vomit.  Repeated abuse of ipecac can cause heart problems and trouble with the salts in the bloodstream.  Also, there is a terrible (but thankfully rare) mental illness called Munchausen syndrome where people deliberately cause themselves to be ill.  Some people are seeking attention or malingering.  In a truly horrible variant of this called Munchausen syndrome by proxy, parents or other caregivers cause illness in those under their care.  Ipecac was one substance frequently used to cause illness in these cases.  Taking it off the market takes it out of the hands of those who would choose to use it to hurt themselves or someone else.

So what should parents do in case of an accidental poisoning at home?  Please remember that the most important aspect of treating poisoning is not letting it happen in the first place.  Keep all cleaning products, household chemicals and medications locked up and secure.  Even vitamins should be kept out of children’s reach.

If your child gets into something and swallows a substance, and you’re not sure if it might be poisonous, the first thing to do is to call the National Poison Control number at 1-800-222-1222.  The experts will help figure out what your next step should be.

I just called and double-checked the number is still right (and it is).  I also have my own Poison Control story.  My oldest child got into his father’s underarm deodorant when he was a toddler and took a couple of bites.  (Why he didn’t stop after one bite is a mystery, that stuff CAN’T taste good!)  The Poison Control guy was so nice and supportive.  I suppose they get a lot of calls from moms who feel like they’ve lost their chance at Mother of the Year, right?

After looking up the active ingredient and making sure it wasn’t toxic, he laughed with me gently and reassured me that they get lots of those calls and mine certainly wasn’t the first child to develop a taste for deodorant.

What do you do if you have a 13-year-old bottle of syrup of ipecac sitting in your medicine cabinet?  Give that bottle the honorable burial it deserves, in the trash can.

Thank you Connie for letting me know what the pharmacist told you when you went looking for syrup of ipecac at the drugstore.  You’ve given me a great chance to improve my practice and give my patients the most up-to-date information.

They told me in medical school that 50% of what they were going to teach us was wrong.  It’s up to us to keep reading, keep researching and keep learning to figure out which 50% it is!

QUESTION:  Do you (or did you) have syrup of ipecac in your house?

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Low Back Pain

You bend over to pick something up off the floor and suddenly feel a sharp pain in the low back.

You have a piece of furniture that REALLY belongs in the other corner of the room but you’re home alone.  It’s not that big, right?  I can move it myself.

You get home from work after 8 hours on your feet and think “I have to do something about my back.  I can’t handle another shift like that, the pain is too much.”

Do you have low back pain?  If so, you’re not alone.  Low back pain is one of the most common problems family doctors see.  From weekend warriors overdoing it at the gym, to sports injuries, to shoveling snow and pulling weeds and moving furniture, there are many ways to injure your back.

The most common cause of low back pain is a musculoskeletal injury.  For instance, you slip on the ice and land on your back.  You also might lift something heavy or twist while carrying a baby. (That’s how I herniated a disc in my back, bent over and twisted while putting my son in his crib.)

If you have low back pain, what do you do?  Well, of course the first thing to do is to see the doctor, especially if your pain is more than a simple “I overdid it” that goes away in a few days.  The doctor will ask questions about your pain, examine you, and may order tests and prescribe medicine to help you feel better.

When I see a patient with musculoskeletal back pain the first thing I do is to send them to physical therapy.  Most cases of low back pain are caused by two things: mechanical imbalance in the spine, and weak core support.  The therapists will help figure out what the patient is doing that might be making back pain worse (like bending and lifting improperly), teach strengthening exercises to address core weakness, and add treatments to relieve pain like traction, electrostim or ultrasound.

As I discussed in a previous post, chiropractic therapy is very helpful for low back pain as well.  Often manual therapy like massage and osteopathic or chiropractic adjustment can improve or relieve back pain very quickly.

If physical therapy and manual therapy don’t relieve symptoms in a few weeks we may discuss imaging like an Xray or MRI.  More serious problems may be present that need specialist care like injections or even surgery.

What are some of the danger signs that suggest low back pain is an urgent problem?  If you are having trouble emptying your bladder or controlling the bowels you need to see the doctor right away.  So-called “saddle anesthesia” which is numbness in the area between the legs (the part of you that would touch a horse’s saddle) may indicate damage to the spinal cord and should be checked out immediately.  Also, if you have a personal history of cancer then back pain could be a sign of a recurrence and should be reported to your doctor right away.

There are a few supplements that are helpful with musculoskeletal back pain.  Magnesium helps to relax muscles and can decrease pain from spasm.  Fish oil is helpful for painful conditions of all sorts, but you have to take a lot of it, as I wrote in a previous post.  Turmeric has anti-inflammatory properties.  (This is not an all-inclusive list, of course.)

Millions of people suffer with back pain every year.  Luckily most of the time it goes away without too much muss or fuss, with some simple strengthening exercises and pain-relieving medicines.  Most patients also benefit from some education on how to take good care of their back so the pain doesn’t come back.

Low back pain doesn’t have to take over your life!  It takes some time, work and patience, but straightening out the problems with your back is so worth the effort!

QUESTION: Do you have low back pain?  What have you found that helps?

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Is Soy Healthy To Eat?

I seem to have this conversation a lot, especially with patients and with other health professionals.  We know that incorporating more plant foods and reducing or eliminating meat and dairy is effective for decreasing the risk of heart disease.  One of the best plant sources of protein is soy.  Is soy healthy to eat?

In a recent conversation with a personal trainer, I mentioned that I recommend soy supplements for those looking for weight loss.  You would have thought I was recommending arsenic!  In short order, he rattled off a number of concepts that I had heard before and knew were either myths or highly exaggerated.

Many of my patients use soy for weight loss.  You, Dear Reader, may be one of them 🙂  Just in case your family, friends, or (God forbid) health care professionals tell you soy is dangerous or unhealthy, I want to give you some scientific evidence to use as ammunition.  This of course is not an exhaustive list and new research is coming out all the time, so if you hear about a new study about soy and health, please let me know!

Soy has estrogen and increases breast cancer risk

This one has been pretty definitively disproven.  I reviewed a lot of research about this one recently.  In fact, soy food intake DECREASES breast cancer risk and prolongs survival in women who already have breast cancer.

Soy has estrogen and causes menstrual problems and infertility

Soy isoflavones are plant compounds that bind to estrogen receptors in human cells.  The theory is that since they bind to estrogen receptors they will behave like estrogen in the cells.

Estrogen is a powerful regulator of female fertility and the menstrual cycle.  There is some evidence that a diet high in soy foods can make menstrual periods a little farther apart but there is no evidence that it will interfere with female fertility.  I did find one study that suggested that male sperm count is lower in men who eat a lot of soy, but whether that will interfere with fertility is unclear.

Soy has estrogen and will make men grow “man boobs”

I had to laugh out loud at this one.  I personally have never seen this happen in male patients eating soy foods.  “Man boobs,” or gynecomastia, is growth of the male breast tissue in response to estrogen.  This happens to men who are obese because fat tissue has aromatase, an enzyme that changes a man’s testosterone and other male hormones into estrogens.

I went to the literature and found a study.  Soy doesn’t make men grow breasts.  ‘Nuff said.  If you are a man who is obese and feel you have too much breast tissue, the best option is to work on losing weight.  Soy can help with weight loss and will NOT cause your breast tissue to grow.

Soy has estrogen and will interfere with babies’ growth and development

This has been discussed and debated for years.  Obviously, human breast milk is the best, most perfect food for human infants.  However, if breastfeeding is not possible then soy formula is an option many families choose, especially if the baby seems not to tolerate cow’s-milk formula.

There was a concern that the isoflavones in soy might interfere with babies’ growth and development.  However, studies have shown that babies who are fed soy formula have no difference in growth and development compared to babies who are fed cow’s-milk formula.

Soy causes thyroid problems

This one is interesting.  There actually IS some evidence that the soy isoflavones interfere with production of thyroid hormones, but the evidence is conflicting.  One study showed that people with borderline (called subclinical) hypothyroidism are more likely to progress to clinical hypothyroidism if they eat a lot of soy foods.

There is evidence that eating a LOT of soy (2 grams daily per kilogram of body weight, or 5 ounces for a 150 pound person) can affect thyroid hormone levels very quickly, but the effects do not appear to be permanent.  Eating soy can interfere with the absorption of synthetic thyroid hormone replacement, but so can eating any food too close to taking your thyroid medication.

On the whole, it appears that for healthy people who get enough iodine in their diet (most multivitamins contain the 150 mcg of iodine that people need on a daily basis), eating soy foods does not lead to permanent thyroid problems.

In short, soy is a healthy food that provides plenty of plant-based protein and isoflavones that help reduce blood pressure, heart disease and the risk of breast cancer.  There is no significant danger to the reproductive or hormonal health of people who choose to eat soy.

If you would like to add healthy soy to your diet in an easy, tasty form, please check out Shaklee’s Life Shake.

QUESTION: Do you eat soy?  Why or why not?  (I have soy every single day.  I love it!)

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