What is your stress load?

Season 2 Episode 42 -What is your stress load?

Take your ACE survey to calculate your ACE score:  https://stopabusecampaign.org/take-your-ace-test/

Full transcript to this episode: https://www.buzzsprout.com/1890983/13274871

References and resources:
https://www.cdc.gov/violenceprevention/acestudy/
https://acestoohigh.com/aces-101/
https://stopabusecampaign.org/

Get Season 1 podcast guide:  https://www.rheumcoach.com/season1
Use this guide to track your progress as you listen to the episodes. It has a list of all episodes included in 1st season, with checkboxes to mark off your completion. It also has a fill-in-the-blank guide to episodes to engage you as you listen - it will keep you focused so you will retain more information. 

RheumMate membership provides trauma-informed coaching and support for people with autoimmune conditions, chronic pain, and fibromyalgia Wait list   https://www.rheumcoach.com/rheummate2022

Please email me at rheumcoach@gmail.com if you have any comments, feedback or if you have questions. I would love to hear from you.

 www.rheumcoach.com - my website
If you are not part of my newsletter, please sign up; the link to sign up is on my website https://www.rheumcoach.com/

www.rheumcoach.com/FibroCard - Download your FREE copy of the "Fibromyalgia is real" postcard to share with your family & friends

www.FaceBook.com/rheumcoach - lots more information about fibro
Follow me on Instagram:  https://www.instagram.com/rheumcoach/

Disclaimer: This podcast provides information only and does not provide any medical or psychological services or advice. None of the content on this podcast prevents, cures, or treats any mental or medical condition.

Transcript

Episode 42

What is your stress load?

Welcome back to Season 2 of the Mind Your Fibro podcast, episode 42

Just a reminder, if you are just starting to follow this podcast and want to learn about fibromyalgia, I recommend starting with episode 1 of season 1. Also, please download the season 1 episode guide that will guide you through the content of season 1 – where I talk about what fibro is and how it is diagnosed and treated. Other episodes cover pain science, the pain-stress connection, self-care, diet, exercise, and sleep. This season also includes important topics on grief, relationship, and pushing & crashing. Use season 1 to keep track of your progress; the link to download is in the show notes-  https://www.rheumcoach.com/season1

 Additional disclaimer. My podcast episodes intend to provide information, but if any of this is triggering or activating your nervous system, please pause, do some self-care, and talk to someone. This is not intended to add more pain but rather provide education, another reason for self-compassion, show the common humanity of our experiences, and that you are not alone in your struggle. 

In my last episode, I discussed the concept of Adverse childhood experiences, or ACEs. What happened to you as a child that could explain your health challenges today. Everyone should calculate their ACE score. Many of my patients were surprised to know that they had ACEs or that their score was higher than anticipated. The link to the ACE score survey can be found in the show notes. If you have not listened to the prior episode, it may be helpful to start there, as today, we will build on it. 

One of the listeners commented that she does not have history of trauma and does not feel she has enough stress in her life to explain her stress responses or fibro stress, fear pain connection. So today, I hope to explain the concept of stress accumulation. 

 A lot has happened since the recording of my last episode. I half-wrote this episode when my employer became a target of a cyber attack, and it evolved over a 2-month ordeal for all physicians and other staff. We were completely out of external internet and other types of communications, including remote or home access, that I use a lot in order to come home early after work to spend time with my family and work on other projects. It is incredible how much our healthcare relies on internet communications. For example, I could not send prescriptions electronically - everything had to be called in or be written. We had no faxes in our out, which meant no external records, faxes from pharmacies, insurance companies, etc. We had no radiology results as all the images from our offices had to be electronically uploaded to be read. This was a newsworthy massive attack on a major healthcare system, and luckily for the patients and employees, it was averted, and our systems were not penetrated, but FBI is still investigating. But at least we are now back in business and our passwords now a mile long. 

 I also spent time applying for a fellowship I had been thinking of applying for some time. 

In the last few years, my focus has been to study psychology, pain science, the brain and neuroscience. Along the way I studied nutrition and other complementary therapies, like Reiki and coaching. Recently, I took a course on Ketamine-assisted therapy, and it completely blew my mind on how it can help with depression and chronic pain. 

So, I applied and was accepted to the Andrew Weil Вайл Center for Integrative Medicine Fellowship and received the prestigious Lovell-Jones Rheumatology Scholarship, which is awarded to one physician per year. I am so so excited to start this 2-year endeavor and, hopefully will take you along for the ride.  

 In Season 1, I talked a lot about the chronic stress and pain connection, the fear and pain cycle, the way we cope, and the physical changes stress elicits in our bodies. As I said then, one of the Merriam-Webster dictionary definitions: stress is "a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation." 

 This definition focuses on stress, as most of us think of it – the causes of stress. 

 We all can list the stressors of our lives –work, relationships, finances, health, politics, etc.; we are surrounded by experiences that stress us out. Stress can be acute – a one-time event like the stress you get when faced with a short-lived situation, like a confrontation with your neighbor who almost ran you over with his car pulling out of his driveway or your child losing his coat in the middle of the winter and you need to get him a new one before he goes to school tomorrow, or me applying to the fellowship. It can be somewhat short lived but longer than a few days – like the cyberattack stress that was going on for 2 months or a stressful semester at college with finals, planning a wedding or another event, but there is end in sight, you know it will not last forever, even though it feels like this stress will never end.  Stress can be ongoing – driving to work in heavy traffic daily, the toxic work environment, unsupportive people, and unreasonable workload, and being overworked and underpaid.

  But there is another way of looking at stress. Stress is a situation that is difficult to cope with and that creates a reaction in the body – physical, mental, emotional, and behavioral. 

 Different people cope with circumstances differently and have different reactions to similar situations. The same traffic jam, same work environment, planning a wedding, finals, annoying neighbor, or long line in a grocery store – will cause different reactions in different humans. Stress is universal, but our reaction to it is unique. 

Stress activates your survival responses – the fight or flight response or collapse/freeze response most of us know from the biology course on the nervous system. So, stress is the internal response of that our mind-body system creates in response whenever we experience a threat or challenge that activates our nervous system. It activates not only our nervous system but also hormones, a cardiovascular system with your heart pounding faster and changes in blood flow, breathing is altered, and vision and other senses get aroused. We are wired to produce stress responses under stress. Once that stress period passes, our body goes back to normal – rest and digest state - the state we should be in the majority of our life. 

This activation process from to a stressor and returning to normal, is called allostasis. 

Allostasis means "achieving stability through change"; it was introduced by Sterling and Eyer in 1988. So allostasis literally means "maintaining stability, or homeostasis, through change” – how we adapt to stressors and threats. 

When you are exposed to danger, an infection, or even overstimulation from the environment, such as too noisy and busy or an unsafe neighborhood, or giving a presentation at school or work, the body responds to the challenge by turning on an allostatic response, thus initiating a complex pathway for adaptation and coping using brain chemicals neurotransmitters and hormones like cortisol, and then shutting off this response when the challenge has passed. This process relies on the continuous re-evaluation of need and continuous readjustment of all parameters toward new set points. So allostasis allows our body and mind to mobilize the appropriate amount of energy and resources to focus and cope during and after the threat or a challenge and go back to our normal state once this stressful period is over. Our body, hormones, nervous and cardiovascular, and digestive systems get to reset using the relaxation responses. We return to the rest and digest state, the ventral vagal state of the nervous system – we feel calmness, curiosity, compassion, clarity, presence, playfulness, and connectedness.

However, with chronic or prolonged stress, our mind-body system does not return to the normal regulated state and remains activated. The stress and stress responses start accumulating, and we start feeling overwhelmed, wound tight, tapped out, and chronically stressed. 

Similarly, trauma, as you know it now, is a common human experience. Just like stress, it is universal, and most people have experienced at least one traumatic event as children and likely additional ones as adults. 

Trauma is also an internal response, and you can think of it as a continuum with stress. 

However, not all stress is traumatic – traffic, presentations, missed bills, or flight delays – stressful, yes, but not necessarily traumatic. 

Trauma can occur when during a stressful event or experience, you also feel powerless, helpless, and have no control over a situation. Each experience is unique. We will discuss different types of trauma in future episodes. 

Just like with stress, without adequate recovery, the mind-body system remains activated and does not return to its regulated state of equilibrium. So over time, with stress and or trauma, the systems become dysregulated – the brain, nervous system, hormones, digestion, pain perception, and cardiovascular system – the allostasis is disrupted, and we start accumulating dysfunction. 

This accumulation of stress responses leads to dysfunction, incomplete stress response, dysregulation, and the disruption of this equilibrium or allostasis, when we feel "tapped out" or chronically stressed out – is called allostatic load. 

Allostatic load is "the wear and tear on the body" a person is exposed to repeated or chronic stress. The term was created by Bruce McEwen and Eliot Stellar in 1993. It represents the mind-body consequences of exposure to repeated or prolonged chronic stress, including trauma. When allostasis stops functioning properly, we begin to accumulate or build this allostatic load. As the allostatic load builds up, so does the dysfunction and dysregulation of our body. The result is allostatic overload, directly related to mental and physical health declines.

Here is an example of the accumulation of the allostatic load. 

You may not have any history of trauma and an ACE of zero and still accumulate it over time and have a high allostatic load.  

We are wired to produce stress responses under stress. Once that stress period passes, our body goes back to normal – rest and digest state. Chronic stress accumulates because the body does not go back to the rest state. So, the examples below can be stress that you had, and your body reset or, if not, started to accumulate. Not everyone in these situations will have a high allostatic load, but many will. 

As a baby, were you cared for at home or daycare? Were you a primie, full-term, born into calmness or chaos? Bottle or breastfed? Did you get a lot of skin-to-skin contact, your parents holding you and connecting with you, making eye contact, rocking, and singing to you? Were there any health issues in you or your parents/siblings, stressors that affected your parents - like financial worries, unsafe environment, isolation? 

If it was daycare, was it nurturing environment or a stressful one, and at what age – 6 weeks like in the USA or older, low baby-to-staff ratio, nap time that was loud with lights on, frequent changes in caregivers due to high turnover, loving staff or staff who was stressed out and dysregulated. Later in childhood, how often did you worry about anything – your parents, finances, food, housing, was the neighborhood safe? Did you have a loving extended family, neighbors, and friends? Did you feel safe? Were you sick often, for example, with painful ear infections, or had frequent doctor visits? Did you play sports? Did you feel a lot of pressure to perform? Did the coaches force you to restrict your diet, push yourself, and harass you into better performance? Were you overextended with many extracurricular activities that prevented you from eating dinner at home but feeling rushed going from one activity to the next? Were you bullied at school? Have you had many stressed-out teachers who did not like to teach, did not get your learning style, or overloaded you with homework? Did you have support to help you learn, succeed, plan, and dream, or you felt you were alone? How did you spend time as a family on the weekend in front of the TV because your parents were exhausted or working, or did you play outside, go camping, or do other activities that promoted togetherness with family or friends? 

Now many of you may not consider these examples as stress but as a normal part of life. And it can be both. Many had stress and had a way to destress and reset. The point is the accumulation of stress leads to dysregulation with health consequences when the load becomes high, and there is no reset. The window of stress tolerance becomes smaller. 

Many people, with time, start to feel dysregulated and may feel that the current stress environment should not produce the amount of stress they feel. 

Their allostatic load has been building for decades. No wonder we start seeing the evidence of dysregulation in our health in our 20s to 50s, and this is when fibromyalgia symptoms often begin to manifest as well. 

If you have a heavy allostatic load due to stress and trauma, the symptoms of dysregulation may present with depression, anxiety, PTSD symptoms, nausea, constipation, poor sleep, headaches, hypervigilance, chronic physical illnesses, frequent infections, and also poor coping strategies like self-medicating, stress eating, overdrinking, overworking. Masking, suppressing, denying, avoiding, pushing, and crashing… 

I will discuss how to cope, learn how to reset your stress responses, and more information on trauma in future episodes. 

 If you are a listener, thank you for your support. If you know someone who can benefit from listening, please share. Let's create a global awareness of trauma.