Stress and Health

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Everybody has a story.

  • The unreasonable boss or lousy job,ben_franklin
  • The injury or illness
  • Money problems
  • The loved one with an addiction
  • Something.

Most of the stories are real — things with which the person has to deal every day. (A few people make up stories to get attention; that’s a different topic for another time.)

In the lexicon of research, all of these things are stimuli. They’re things that happen that require some kind of response. In physics, Newton’s Third Law makes it easy —

For every action, there is an equal but opposite reaction.

Unfortunately, that doesn’t apply to thought and emotions. Instead, human responses can be —

  • Proportional (optimal)
  • Inadequate (hypofunction/allostasis, or inadequate adaptation to a stimuli)
  • Excessive (hyperfunction).

In neurology, these stimuli are called “stressors.” How you respond to them is the “stress response” or “stress.” Stressors are perceived threats, and the human body reacts to them in ways not unlike when early humans stumbled into the path of a dinosaur. The body releases a variety of hormones that impact almost all major systems in the body.

The stress response is mediated by the stress system, partly located in the central nervous system and partly in peripheral organs. The central, greatly interconnected effectors of this system include the hypothalamic hormones arginine vasopressin, corticotropin-releasing hormone and pro-opiomelanocortin-derived peptides, and the locus ceruleus and autonomic norepinephrine centers in the brainstem. Targets of these effectors include the executive and/or cognitive, reward and fear systems, the wake–sleep centers of the brain, the growth, reproductive and thyroid hormone axes, and the gastrointestinal, cardiorespiratory, metabolic, and immune systems.  (1, emphasis added)

Inadequate or excessive stress reactions are linked to a massive array of both physical and behavioral problems.

  • Physical: Asthma, exzema, migraines, low or high blood pressure, cardiovascular disease, indigestion, diarrhea, constipation, obesity and Type II diabetes, sleep disorders, panic attacks and psychotic episodes. In children, it may be related to stunted growth. In women, osteoporosis.
    • Recent research is placing greater emphasis on the role of stress in cardiovascular disease.(2)
  • Emotional: Anxiety, depression, mental errors, loss of sex drive, OCD, alcoholism, etc.

Dr. Chrousos argues that stress response hormones were designed for limited use (e.g., see dinosaur, release hormones; lose dinosaur, stop release). In the modern environment in which stressors operate continuously over a long period of time (e.g., the bad boss), long term release of these hormones can have profound negative effects on the functioning of the body.

The portion of the brain that controls emotions is the amygdala. Recent research has shows that severe stressors cause physical chances in the amygdala, most notably enlarging it. (3)

What’s Important to Know:

  1. Stress (or the stress response) is inside you. It’s not what someone does to you; it’s how you react.
  2. Some of the stress response is automatic. You don’t tell you body to release hormones. And when someone is chasing you down a dark alley, be grateful that’s true.
  3. However, you may have some ability to influence how long those hormones are released and the damage your body sustains.
    • You can take yourself out of a stressful situation.
    • You can “let go” of something that’s happened after it’s over.
    • You can use meditation, yoga, tai chi or other tools to moderate reaction to stressors.

Keeping the stress reaction alive when it’s not needed hurts you, not the stressor.

 


Sources:

  1. George P. Chrousos, “Stress and Disorders of the Stress System,” Medscape, 2009. http://www.medscape.com/viewarticle/704866
    Dr. Crousos is professor and chair of the Department of Pediatrics at the University of Athens, Greece. With 1,100 articles, he is one of the most quoted doctors and researchers on the planet.
  2. Marlene Busko, “Study Links Stress-Related Amygdala Activity to Future CVD Events,” Medscape, 13 January 2017. http://www.medscape.com/viewarticle/874435
  3. Megan Brooks, “PTSD May Be Physical, Not Just Psychological,” Medscape, 21 July 2017. http://www.medscape.com/viewarticle/883251

 

Interstitial Lung Disease

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Interstitial Lung Disease is nasty and can strike people at any age, regardless of physical condition.

What is it? This is a scarring of tissue in the spaces supporting air sacs in the lungs. The 8353disease causes stiffness in the lungs, and can eventually make it impossible for the victim to get sufficient oxygen. That can presumably lead to a range of issues including dementia.

Symptoms:  Unfortunately, the symptoms can be hard to distinguish from other diseases:

  • Dry cough
  • Shortness of breath during exercise or at rest.

By the time these symptoms appear, there is probably irreversible damage to the lungs. In fact, the only known treatment for this disease is a lung transplant.

Causes:  Not all the causes of this disease are known.

The known causes include:

  • Environmental factors
    • Asbestos fibers
    • Bird protein (live pets and feather-containing products)
    • Coal dust
    • Grain dust
    • Mold from indoor hot tubs, showers and prior water damage
    • Silica dust
  • Radiation (especially the higher doses used in cancer treatment)
  • Medications
    • Chemotherapy/immunomodulating drugs, such as methotrexate and cyclophosphamide; methotrexate is also used for treatment of rheumatoid arthritis and psoriasis as well as other serious skin conditions
    • Heart medications, such as amiodarone (Cordarone, Nexterone, Pacerone), propranolol (Inderal, Inderide, Innopran), and hydralazine
    • Some antibiotics, such as nitrofurantoin (Macrobid, Macrodantin, others),  sulfasalazine (Azulfidine), sulfamethoxazole/trimethoprim (Bactrim). The last is described as a “relatively rare cause” of this disease.
    • Seizure medications such as Phenytoin (Dilantin) and carbamazepine (Tegretol)
    • Aspirin and other NSAIDS (ibuprofen, naproxen)

Air quality at home and workplace matters. Spider plants can help clear indoor pollutants. However, having someone test air quality is probably a good idea. Any water leaks need to be addressed because that’s breeding ground for mold.

Taking drugs is something you need to do wisely. Talk to your doctor about side effects and getting rid of prescriptions that you really don’t need. Once a drug has stopped helping you, it might in fact hurt you.

 


Sources:

  1. Mayo Clinic, “Interstitial Lung Disease.” http://www.mayoclinic.org/diseases-conditions/interstitial-lung-disease/basics/definition/con-20024481
  2. Dr. Sharon Orrange, “These Medications Could Harm Your Lungs,” Good Rx, 10 JUly 2017. https://www.goodrx.com/blog/these-medications-could-harm-your-lungs/?rs_oid_rd=1180733755670560&utm_medium=email&utm_source=sendgrid.com&utm_campaign=em_newsletter&utm_content=lungs&e=66e4013215cd54de978d8ff77403d770&c=fixed_69_2017-07

Life Planning Fail

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In preparing for battle I have always found that plans are useless, but planning is indexindispensable. Dwight D. Eisenhower

Life happens, but that’s no excuse for not knowing where you want to go. That’s a particular issue in healthcare.
People don’t like to think about negative events that are going to happen in the future. They’ll still happen, just the same. For Americans, the difference between life expectancy and “healthy life expectancy” is nine years.  They won’t necessarily come as a block toward the end of life. If fact, you don’t know when they’ll come.
A new study points out that people are often faced with making snap decisions about healthcare without adequate information. (1) That’s due to the failure to anticipate something that’s actually rather likely to happen.
People get hurt and sick. The roughly 320 million Americans generated 130.4 million visits to Emergency Rooms in 2016.(3) What are the odds you’re going to need one?
If you don’t know where you want to go in an emergency, you may get stuck someplace you don’t want to be.
Even if you’ve never had an illness in your life, you will. Nothing on this planet is immortal.
Like it or not, here are some questions for which you need to have answers.
  • Financial
    • How do I cover sudden and potentially large medical bills? What does my insurance not cover that I’m going to have to pay?
    • How do I cover normal bills if I’m out of work for a few months? Or longer?
  • Medical
    • In an emergency, where do I want to go for care? (Related: is my doctor affiliated with where I want to go?)
    • If I’m hurt and need rehab therapy, where do I want to go for care?
    • Does someone have access to my Living Will if I can’t speak for myself? (Having one isn’t a question.)
    • Who will advocate for me with medical personnel if I can’t speak for myself?
  • Living
    • Whose going to care for me if (temporarily or permanently) I can’t care for myself?
Seriously, this matters. We have several local hospitals, two of which are problems.
  • The ER department at one of them has misdiagnosed my wife twice out of two visits. That’s a 100% rate of being wrong. Do we want to test them a third time?
  • The nurses at another consistently ignore a severe allergy that causes anaphylatic shock. Breathing is really nice, but you don’t really appreciate it until you can’t do it. It turns out, the nurses don’t pay attention to wristbands. (One nurse at that facility told us that they assume the allergy bands refer to drugs and not to more mundane and potentially lethal issues like iodine and latex allergies.) Going to that facility is like going to a casino. You might get fixed and you might die. How lucky are you?
As you age, where you go matters more. With seniors, for example, if taken to an ER for a serious fall, there’s a 50% chance of additional problems within six months of the initial injury, including death. Some of that risk is the result of decisions doctors make about medication.(4)
There’s no need to overthink this. Do your homework, ask questions, make decisions, and then get on with the rest of your life. Just get it done.
Aristotle was  right. Anything taken to excess turns bad. That includes both planning and lack of planning.
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Sources:
  1. Emily A. Gadbois, Denise A. Tyler, Vincent Mor. Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives. Journal of the American Geriatrics Society, 2017; DOI: 10.1111/jgs.14988
  2. American Geriatrics Society. “Hospitalized older adults may need more help selecting skilled nursing facilities.” ScienceDaily. ScienceDaily, 7 July 2017. <www.sciencedaily.com/releases/2017/07/170707211128.htm>.
  3. Centers for Disease Control and Prevention, “Emergency Department Visits.” https://www.cdc.gov/nchs/fastats/emergency-department.htm

  4. Jiraporn Sri-on, Gregory P. Tirrell, Jonathan F. Bean, Lewis A. Lipsitz, Shan W. Liu. Revisit, Subsequent Hospitalization, Recurrent Fall, and Death Within 6 Months After a Fall Among Elderly Emergency Department Patients. Annals of Emergency Medicine, 2017; DOI: 10.1016/j.annemergmed.2017.05.023

Exercise Improves Bone Health

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A new research study from the University of North Carolina suggests that

  • There is fat in bone marrow. Higher levels are linked to weaker bone density and higher risk of fracture.
  • Exercise reduces marrow fat, and causes improvement in bone mass.
  • Exercise has a greater impact on the bones of obese people than those who are already lean.
  • The effects can show up in a matter of weeks.

“Obesity appears to increase a fat depot in the bone, and this depot behaves very much like abdominal and other fat depots,” said Styner. “Exercise is able to reduce the size of this fat depot and burn it for fuel and at the same time build stronger, larger bones.” (1)

The research is based on a study of mice, but establishes that the cells producing fat in mouse marrow are also found in humans.

Although research in mice is not directly translatable to the human condition, the kinds of stem cells that produce bone and fat in mice are the same kind that produce bone and fat in humans. (1)

Please excuse me while I go for a jog.


Sources:

  1. Maya Styner, Gabriel M Pagnotti, Cody McGrath, Xin Wu, Buer Sen, Gunes Uzer, Zhihui Xie, Xiaopeng Zong, Martin A Styner, Clinton T Rubin, Janet Rubin. Exercise Decreases Marrow Adipose Tissue Through ß-Oxidation in Obese Running Mice. Journal of Bone and Mineral Research, 2017; DOI: 10.1002/jbmr.3159

How Safe Is Your Kitchen?

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An exploration of a sample of kitchens in Philadelphia by a research team at Drexel findsth that most have serious food safety violations that could affect the health of those who cook and eat there. How does yours compare?

The study: the researchers visited 100 homes with a visual checklist that inspectors use for health inspections for restaurants.

What they found:

  • In 97% of the homes, raw meat was stored improperly. In some cases, juice from the raw meet was dripping down on ready-to-eat food.
  • In 43% of the homes, raw meet was stored at an improperly high temperature, allowing bacteria to flourish.
  • Traces of pests were found in 65% of the kitchens.
  • Fecal coliform bacteria was present in 44% of the kitchens.
  • E. coli was found in 15% of the kitchens.
  • At least one foodborne pathogen was discovered in 45% of the kitchens, and 12 percent had more than one type. Listeria was found in 15%.

The key problem areas were sinks, sponges, dishcloths and refrigerators set to a too-high temperature.

Recommendations:

  1. Check the temperature setting for the fridge.
  2. Microwave your sponges for one minute each day.
  3. Disinfect the sink.
  4. Wash hands before handling food.

Common sense would be nice, too!

It’s hard to complain about healthcare costs when we’re making ourselves sick!

Disclosure: My son attended Drexel University; I’ve very impressed with that school.


Sources:

  1. Patricia A. Borrusso, Jennifer J. Quinlan. Prevalence of Pathogens and Indicator Organisms in Home Kitchens and Correlation with Unsafe Food Handling Practices and Conditions. Journal of Food Protection, 2017; 80 (4): 590 DOI: 10.4315/0362-028X.JFP-16-354
  2. Drexel University. “Most home kitchens in Philadelphia study would earn severe code violations: Bacteria-laden sponges and poor raw meat storage main culprits.” ScienceDaily. ScienceDaily, 9 May 2017. <www.sciencedaily.com/releases/2017/05/170509132844.htm>.

ATVs, Children and ERs

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With summer temperatures hitting much of the US this week, this is a timely topic.

In the most recent year for which data is available (2013), there were 99,600 ATV accidents in the US that required treatment at an Emergency Room. One-quarter of these involved riders younger than 16. That’s approximately 25,000 kids.

Five states account for 80% of child deaths on ATVs: Texas, California, West Virginia, Pennsylvania and Kentucky.

The Consumer Products Safety Commission actually warns against having kids drive or ride as a passenger on an adult ATV. That and the lack of safety gear are what make this a public health nuisance and a contributor to health insurance rates.

ATVInfographicStates


Sources:

 

  • Wake Forest Baptist Medical Center. “ATV-related injuries in children remain large public health problem.” ScienceDaily. ScienceDaily, 15 April 2017. <www.sciencedaily.com/releases/2017/04/170415182157.htm>.
  • US Government Accountability Office, “All Terrain Vehicles,” April 2010.
    US Consumer Products Safety Comission, “ATV Safety Center.” https://www.cpsc.gov/Safety-Education/Safety-Education-Centers/ATV-Safety-Information-Center/
  • US Consumer Products Safety Comission, “Five States Account for 25 Percent of All Reported ATV-Related Deaths in the United States,” 17 Feb. 2017.

British Columbia bans mandatory high heels at work

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I’m sure there will be mixed comments on this, but it makes sense for several reasons:

  • Safety
  • Comfort
  • Productivity
  • Gender equity

As noted in a previous blog, US emergency rooms treated an average of more than 12,000 injuries each year between 2002 and 2012, and the trend is increasing. (1)

Health insurance costs being what they are, how does requiring employees to wear heels make any sense?

So, one Canadian province has taken action. (2) The government of British Columbia has stipulated that employers can no longer require high heels as part of a work dress code.

Very intelligent.  No wonder people live longer in Canada.

This discussion calls to mind a classic issue that has arisen in relation to motor cycle helmets, seat belts, physical fitness, impaired driving, and vaccines — an individual’s actions affect others.

What do you do when one person’s choice can raise health insurance costs for everyone else? Each person who pursues a risky behavior adds a small increment to the costs borne by health insurers, and the little pieces add up. Of course, the health insurer response is to raise rates to cover these costs. Everyone who has insurance pays more. 

US public policy in this area is at best erratic. Some rules support individual liberty; some what is best for the majority. Very inconsistent.


Sources:

  1. Mary Elizabeth Dallas, “Injuries from high heels on the rise,” Spectrum Health Healthbeat, 13 JUne, 2015. http://healthbeat.spectrumhealth.org/injuries-from-high-heels-on-the-rise/
  2. Jamie Feldman, “New Canadian Law Bans Mandatory High Heels At Work,” Huffington Post, 10 April 2017. http://www.huffingtonpost.com/entry/high-heels-at-work_us_58eba4b9e4b0c89f9120220c?arq&utm_medium=email&utm_campaign=Lifestyle%20041017&utm_content=Lifestyle%20041017+Version+A+CID_8acfd2db7513e868287551b794356c32&utm_source=Email%20marketing%20software&utm_term=Read%20more&%20041017