STRESS - Full extract 

Helen is a trained nurse who works part-time at the local hospital. Things have been so busy recently that she has been working almost full-time. She is married and has two children at primary school.

Everyone admires Helen. She is one of those remarkable people who always seems to manage. Things were going along fairly well until recently, around the time her father had a heart attack. She had been spending extra time with her mother as well as visiting her father in hospital.

In the last few weeks she was having difficulty sleeping. She has also had some palpitations and one episode when she felt she couldn't breath properly. Being a trained nurse, she felt that these were symptoms she couldn't ignore; she made an appointment to see me the following day.

Helen got straight into her symptoms and finished off by saying " Look. All I really want to know is whether I have asthma or I'm about to snuff it with a heart attack." I listened carefully to her chest and everything seemed normal. The story sounded like stress or panic symptoms but I wanted to go through things in more detail.

I booked her in for a longer consultation later that week. She recounted several episodes at home when she became agitated and had numbness of the fingers and around the mouth. She also said that her marriage had been under a lot of strain in recent months. She couldn't remember the last time that she and her husband had been out to dinner, or even had some uninterrupted time together. Their sexual relationship had also been very unsatisfying for both of them for some time. The clinical examination was perfectly normal, and Helen did seem reassured by this. I arranged some basic tests and these were also normal.

When I saw her for review she already seemed more relaxed. We spoke for a while about stress and I gave her an audio cassette and a booklet on stress management. She had reorganized things at home a little and was going to speak to the director of nursing at work about getting a set working roster. We also discussed other options such as further counselling. However, if her response so far is any indication, this may not be necessary. 

Imagine walking down a darkened street and hearing from the shadows what sounds like the snarling growl of a large dog. You get a sinking feeling in the stomach, your pulse starts to race and your vision becomes more sharply focused. Hair rises on the back of your neck, blood is diverted to the muscles and you are ready. This whole response is a primitive reflex that serves to protect us from attack. In this setting, it is fully appropriate and may prevent injury or death.

However, many people experience the same symptoms at other times...like walking into a room full of people, going shopping, or even when trying to get to sleep. In these situations the response is clearly not appropriate and it can have a very disruptive effect on a person's life.

A certain amount of stress can be a good thing. It can get us pumped up a little and performing at our best. While some thrive on a degree of stress, others struggle to cope. Some people have difficulty harnessing stress and find that it spills over into other parts of their lives. Problems occur when there is an imbalance between stress and the coping skills that are available to deal with it.

People have their own ways of coping. These probably result from a combination of individual personality, childhood experiences, home environment and other factors. The way we look at life and its problems is partly inherent and partly learnt. And if the number of self-help books around is any guide, we can certainly go on learning. The way people handle stress seems related to the observation of how their own parents reacted in similar situations, and to the self- esteem that has developed during childhood.

Much research has been done on the most stressful situations that occur in people's lives. Death of spouse and divorce top the list and it extends down to include things like children leaving home and minor law violations. Even Christmas and going on holidays can be stressful. Life is full of major and minor stresses that regularly test our coping skills; some situations would cause any person to develop stress symptoms.

As a GP I often see people who overload themselves with too many responsibilities. Doing a part-time university course is a great idea. However, when it is combined with being coach of the school basketball side, secretary of the kindergarten and running a household, stress symptoms are very likely to occur. It might be better to leave the basketball coaching to someone else. We all need to be aware of our limitations and be able to say No to excessive commitments.

The effects of stress become evident when there is a shortfall in our coping skills. There is a vast number of symptoms that can occur, for instance, palpitations, dry mouth, difficulty taking a full breath, abdominal pain, diarrhoea and sleeping problems. Strains may then appear in relationships with people at home and at work. A negative spiral can follow with lowered self-confidence, further stresses and family disharmony. Chronic stress is very debilitating and often leads to depression.

Some medical conditions can mimic stress symptoms. An overactive thyroid gland can cause palpitations and anxiety symptoms, as can certain medications and stimulants like coffee and smoking.

Stress can have a profound effect on many parts of the body. High blood pressure, angina, diabetes, migraine, eating disorders, cancer and many other illnesses can all be aggravated by stress. Of greater interest is the growing impression that several of these conditions may actually be caused by stress.

We all experience stress at times. However, these days people are more open about stress and there is more that can be done to help.

Health tips:
* Talking with a respected friend can help. We are all a little reluctant at first, for fear of being considered a non-coper.

* Try to say how you feel to those that matter most, rather than lugging around negative feelings.

* Learn how to relax by a method you feel comfortable with, such as relaxation exercises, yoga, meditation or tai chi.

* Be prepared to make lifestyle changes to reduce stress. Reorganize your time to include things such as going for a walk, a picnic or a swim. Regular exercise and a healthy diet can also help.

* If stress symptoms are particularly worrying, see your doctor for advice. After ruling out other health problems, a course of counselling or referral to a specialist might be advised. Sometimes a short course of medication may also be recommended.

* Avoid overuse of alcohol and sedative medications. Using alcohol to relieve stress nearly always worsens stress problems in the long run.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001