My New Book!
Stress and Its Effects on the Mind and Body
I was sitting on a plane, flying home from Atlanta to Pittsburgh after completing the American Board of Surgery oral examination. I was tired and worn out from all the chaos I had experienced over the past several months leading up to the exam. Suddenly, I felt my pulse skyrocketing.
I checked it and found it was 126. A normal pulse is about 70 or so. Throughout the flight, I keep checking it—128, 130, 124. Why was my heartbeat so high? Something told me the sensations in my body went beyond the typical signs of burnout. I was worried I might have a serious medical illness.
At the time, I was five months into my fellowship at the University of Pittsburgh, where I was being trained in liver and kidney transplants and studying for the board exam in every free moment. The fellowship was much harder than I expected it to be.
Before this, I believed that my internship in general surgery had been the worst year of my life. I spent many sleepless nights replacing nasogastric tubes and IV catheters and waking up an hour before the 6:30 AM surgical rounds in an exceedingly competitive atmosphere.
The pyramid structure of the general surgery program allowed only six of the twenty of us who started together to finish in five years.
I made it through the first year and lived to tell the tale. I was promoted to the second and every year and by fifth, I became chief resident. That meant I was leader of the general surgery residency team. With that came some autonomy.
I was trained to operate and gained more and more responsibility in performing procedures alongside different attending physicians. So, I went from having no experience, to accruing enough surgical skills and knowledge during the ensuing four years to become a chief resident.
Completing general surgery residency was a milestone in my life and I was relieved and enthusiastic about starting the next adventure.
The past several months had been a whirlwind. Chaos came in many forms. As a first-year transplant fellow, it was like starting over again. I was adjusting to unfamiliar people, settings, and responsibilities.
On top of that, I was busy studying for the exam that I had just taken. As a pescatarian, I struggled to find the right foods to eat. Forget getting a nutritional balance; oftentimes I didn’t eat at all. I was losing weight and hardly sleeping.
In my fourth year of general surgery residency, I took the written exam and passed it, which made me board eligible to undergo the general surgery oral examination. This meant leaving home and flying to Atlanta in order to be examined by four board-certified general surgeons who grilled me on different scenarios.
They tested my knowledge about general surgery and case management to assess how I would manage any case, whether it was in the office, emergency room, the trauma unit or the operating room. This is the trip that I was returning from when my pulse began to skyrocket.
The Birth of Stress
Do any of the sensations and experiences I described sound familiar to you? Everyone goes through periods of stress throughout their lives. Stress is the human response to any type of demand, challenge, or chaos.
According to Harvard Health Publishing, “Stress is bumper-to-bumper traffic when you’re in a hurry. It’s a worrisome illness, an argument with your partner, a job turning sour. It’s the need to care for an ailing parent and a pile of unpaid bills.”
Acute stress is our protection and defense against threats and dangers. The fight or flight reactions that are triggered in these scenarios can be lifesaving.
During times of danger, our respiratory rate increases, our heart rate skyrockets, our muscles tighten, and our brains use more oxygen and become more active.
However, most of us aren’t under acute stress on a regular basis. We are more likely to experience chronic stress caused by our jobs, health conditions, the state of the world, focusing on past traumas, or any number of other causes, which may lead to psychological and physical illnesses.
The APA says, “Chronic stress destroys bodies, minds and lives.” I would say frequently it is minds, then bodies and lives. Rarely and unfortunately, stress destroys the minds and if unmanaged, leads to the loss of lives and bodies.
Worrying About the Past
We often feel stress when we are physically in the present moment, but our thoughts are stuck in the past, with all the accompanying emotional challenges associated with remembering those events.
Many of us feel depressed, sad, or angry about something that happened long ago. Childhood traumatic experiences are common sources of chronic stress.
A child, undergoing a stressful challenge, tends to bury the negative emotional responses in his or her unconscious, while creating a foundation of belief systems which is the source of stress for the rest of her or his life.
Belief systems are conclusions created by a child’s mind with a fragile nervous system with limited capacities and skills to face stressful situations. They could be the world is unfair, no one is listening to me, I am not good enough, or I am the victim.
These systems become the impetus for feelings, emotions, and decisions that create a source of unending stress, which can persist until the person does the mental or psychological work to unearth these belief systems.
Unearthing is the first step. Processing with knowledge is a second method to arrive at healing. However, no matter how much you remember, know or realize that these childhood events or stories and their associated beliefs or conclusions are no longer relevant, the resulting feelings and emotions are powerfully automatic.
No matter how much you tell yourself that a negative belief system is from the past, its resulting emotional baggage both creates and attracts similar situations in your present life.
The automatic results are feelings and emotions befitting the underlying belief system. In other words, utilizing the mind to manage the mind is an everlasting losing battle. Lasting and effective solutions are derived when one begins using awareness and managing one’s breath and body with resulting compassionate awareness and love.
Worrying About the Future
Another cause of stress is worrying about something that hasn’t actually happened.
According to the reports of the American Psychological Association or APA , 63% of the people surveyed stated that their most common source of stress is the future of our nation. The other most common reason stressors are money at 62%, work at 61%, the political climate at 57%, and environment and crime at 51%.
These findings are based upon online surveys conducted by Harris Poll on behalf of the American Psychological Association (APA) between January to August 2017, among 3,440 adults ages 18+ who reside in the U.S., including 1,376 men, 2,047 women, 1,088 White, 810 Hispanic, 808 Black, 506 Asian and 206 Native American adults. Interviews were conducted in English (n=3,187) and Spanish (n=253).
Follow-up surveys of these adults toward the end of 2017 revealed more data. It is very likely that these numbers are much worse now because of the continued political chaos facing our nation. If stress is not dealt with appropriately, holistically and medically, we experienced many possible complications—psychopathological, physiological, and physical.
Too Much To do – Not Enough Time Or Energy To Do The Tasks
One of the most common definitions of stress is having too much to do, too little time to do it, and not enough energy for the tasks at hand, the stress triangle.
If this is the case, isn’t there a way of cutting back? Well, with our current situation now, most of us have too much to do and can’t really afford to decrease our load of responsibilities.
Is there a way to squeeze more hours out of the day, to increase the amount of time that we have to meet our obligations? Not really. Already, most people aren’t sleeping enough; they’re cutting into their sleep times to be able to do more. Thus, we aren’t getting enough sleep. This is definitely detrimental to our health over a long period of time.
There is an epidemic of fatigue: tired of being tired, resulting in a booming industry of coffee shops and the increasing likelihood of amphetamine addictions. So how do we deal with this tired triangle epidemic?
The answers lie in assessing first whether there are physiological and therefore medical causes of this chronic fatigue through a medical history, physical and medical assessment. If there are none, lifestyle modifications are a healthier alternative than increasing expresso intake.
Beyond Fight or Flight
As I shared before, stress is our response to any time of demand, challenge, stress, or chaos. What do I mean by chaos? Chaos is disorder or disorganization.
If you look at the demands and stressful challenges we face, particular our response to threat and danger, we know that the two responses people often experience with these conditions are flight or fight. And that either of these could be life-saving when we are face with dangers.
Throughout this book, you will learn methods for handling stress that go beyond fight or flight reactions. In other words, you won’t need to run away from your fears.
You will stay, but not necessarily to fight. Some of the techniques shared in this book will teach you how to connect with your inner healer, your inner peace and how to find equanimity: that balance between fighting and fleeing.
The journey we will take together will involve finding this third way of being, where you’re not fighting. You are facing a challenging time with equanimity. Whether it’s a relationship or a difficult situation, you will deal with it without succumbing to either, fighting or fleeing.
In the face of life-threatening physical danger, fight or flight is the only viable choice. And when we face a difficult situation or a challenging relationship, a position of equanimity empowers us with inner strength and peace of mind.
It’s in that space of equanimity, of balance between the emotions, that we reach our inner clarity of mind to create healthy and viable solutions to our challenges.
And what’s powerful about that space is that you have more energy, you have more clarity, so actually you can defend yourself, if needed, even better.
And you are able to manage that situation in a more effective fashion because your emotions are not running wild like when you’re fighting. So, you’re still defending yourself, if this is what is called for.
And we do what we need to do to protect ourselves, but we are doing it from a different and more empowering space.
Complications Caused by Stress
If stress is not dealt with appropriately, holistically and medically, we experience many possible complications—psychopathological, physiological, and physical. Initial symptoms of being stressed may be mild psychological distress, decreased productivity at work, headaches, upset stomach or insomnia.
Psychopathological symptoms include loss of memory, depression, uncontrollable anger, insomnia, headaches, increased incidence of alcoholic, tobacco, and drug abuse.
Unfortunately, these may lead to suicide or homicide in a few people. Sadly, the rates of both suicides and homicides are increasing in our society. How to deal with these?
Some of the physiological derangements are caused by an increase in the stress hormone cortisol, which can lead to increased incidences of cardiovascular disease including high blood pressure, heart disease, and heart attacks.
According to research, other physiological derangement from chronic stress leads to abnormalities in the immune system. If the immune system is depressed with increased cortisol, there is an increase in infections, an increase in lower or upper respiratory illnesses, slow healing of wounds and increase incidence of cancer.
If the immune system becomes hyperactive because of stress, autoimmune diseases are increased in frequency. In children, developmental delays and a decrease in the growth hormone with serious medical complications are evident. This is why it is so crucial to learn methods for managing your stress.
How I Learned to Manage My Stress
This brings me back to my story about the plane ride from hell. When I get home from the airport that night, I checked myself; my heart rate was still extremely high.
So, the next day, I made an appointment with my primary care physician, who said that the history and physical exam with a small palpable enlarged thyroid gland or goiter indicated that I may be hyperthyroid. So, I was sent for lab tests that day.
When the lab results came back, they showed that I was severely hyperthyroid; my results were off the chart.
I was referred to an endocrinologist who discussed the three choices, one initial medical therapy which is likely to be temporary. The permanent choices were one medical and the other surgical.
The first plan was to stabilize the thyroid function with medications to prepare for either radioiodine therapy or surgical treatment.
The endocrinologist stated that the best choice for me was radioiodine therapy which destroys the thyroid gland producing permanent hypothyroidism overtime. This required taking thyroid hormone for the rest of one’s life, which didn’t feel good to me.
I was also evaluated by a general surgeon who voiced that the best option was for me to get a total thyroidectomy or remove the entire thyroid gland after stabilizing with one of antithyroid medications and another medication to slow the heart rate.
However, just with radioiodine therapy, I would start taking thyroid hormone afterwards and continue for the rest of my life. In other words, I would become hypothyroid. Not a good choice either.
To me, neither of these therapies sounded good. The whole point was that I didn’t feel good. I didn’t want to be hyperthyroid. And I didn’t want to exchange hyper for hypothyroidism and have to take medication forever after either radioiodine or total thyroidectomy. I also didn’t feel good about having radioactivity in my system either.
The third option was to start and continue either one of the two antithyroid medications. One is short-acting, taken twice a day. And then the other one is methimazole which is once a day.
The endocrinologist also shared that methimazole is quicker acting. In six to eight weeks, lab tests are repeated and dosing is adjusted as needed.
About forty percent of people who take methimazole are totally cured after a year or so. So, I hoped that I could just take it, manage my stress levels, and then get off it and be fine.
The endocrinologist asked me if I would take part in a study and I agreed to it. It was a double-blind randomized trial, where I didn’t know what I was being given and neither did my doctor. I was either taking methimazole, or I was just getting sugar capsules.
I was tired all the time and emotional. I was prescribed a thirty days medical leave of absence. I went to my sister’s home to relax in Miami and thought that I was starting to feel better, which led me to believe I was taking the methimazole instead of the sugar pill.
However, I woke up in the middle of one night and my heart rate was extremely high. I wasn’t really stressed anymore, so I knew it wasn’t just stress. I realized then that it was more than likely I was taking the sugar pill.
When I returned to Pittsburg, I was placed on methimazole. Instead of the recommended one-year therapy, I was on it for four years. Initially, it was very difficult to remember taking this tiny pill every day.
However, when I didn’t, by late morning, I knew it. I couldn’t manage the stress. Adding medication with a daily or twice-a-day habit that we perform every day is an easy way of being compliant with medications. So, this did it for me.
This is also when I started looking at techniques that minimize stress on the mind and body. I bought a tape and started a daily yoga practice.
Back in college, I used to bike and jog a lot, but since I had gotten into medical school and general surgery, I didn’t have time to exercise back then and still didn’t.
I also practiced zazen meditation in college. But I dropped that when I got too busy. Now I was making the time for yoga and meditation.
The next lifestyle change I instituted was improving my diet. I made sure I ate balanced nutritious meals. I started eating four small meals a day, instead of skipping meals like I had been doing before. I read more and becoming aware of vitamins and minerals and for the first time starting taking multivitamins and supplements.
I had decided to beat this on my own terms. I figured that I was under a great deal of stress in transplant fellowship and it would decrease as I continued. I needed more time even though the odds were in not my favors, I believed that when I had my own schedule, my own patients, it would be easier to get off the medicine by implementing lifestyle changes.
When I became an attending and re-started the liver transplant program at Howard University Hospital, it was finally possible to reduce methimazole. During that first year, I was definitely still hyperthyroid with the eyes’ changes and the goiter.
I kept my endocrinologic appointments and regular lab tests, and over the next ensuing year, I was slowly weaned off. Thankfully, since I got off, I’ve been tested yearly, my thyroid function has been totally normal and glad to be in the 40 percent cure rate with methimazole. I have beaten the odds while managing life’s stresses with lifestyle modifications.
What are lifestyle modifications? Healthier nutrition, proper hydration, vitamins and supplementation, increased physical activity, managing emotional and mental stress with knowledge, yoga, and meditation in the setting of yearly physical examinations and diagnostic tests.
My journey spanned from performing liver and kidney transplant surgeries, treatment of acute and chronic illness, end-stage organ diseases as well as mentoring, health and wellness coaching in maintenance of wellbeing, and achieving physical fitness.
The lifesaving nature of modern Western medicine is obviously evident to the majority of us. Diagnoses derived from initial and follow-up evaluations and tests, medications and other interventions are essential in the management of acute as well as chronic illnesses.
Throughout this book, I will provide you with techniques to handle stress that come from my experiences as a caring and integrative physician with active licenses in Western Medicine in Florida and Arizona.
At other times, especially in prevention and in the chronic setting, we also see how being mindful about the choices you make, can work wonders on your body and your mind. Integrative medicine is a passionate field for me.
Many of its practices are relatively new and many are rooted in ancient cultures. My purpose is to assist you in marrying the modern with the timeless.
I am also a volunteer teacher of Sudarshan Kriya Yoga (SKY) Breathing Meditation from the Art of Living Foundation and the International Association For Human Values created by the humanitarian and spiritual leader Sri Sri Ravi Shankar.
I am enthusiastic about assisting and coaching individuals to enhance their potential for inner self-empowerment and to achieve inner peace, health and wellbeing, through integrative and regenerative medicine, lifestyle modifications, SKY Breathing Meditation and other spiritual practices.
Lucid dreaming is a fascination of mine since childhood. It is perfected in Zen as Dream Yoga and other ancient traditions. Some of the unique features of lucid dreaming in the Patanjali Yoga Sutras were translated by Sri Sri as part of chapter 5, ‘Overcoming Obstacles’.
I hope that in reading this book, you will realize that the solution of humanity’s challenges is found, by going within, and rising from our meditation cushions with presence and wisdom to heal this planet, our communities and ourselves physically, emotionally and spiritually.
And as we do, we become inspired to prevent and maintain health and wellness in ourselves and in others. This is until we become conscious that ultimately, we are all one in a unified multiverses.
Copyright. 2019 RM Toussaintt MD. All Rights Reserved.