Episode Transcript
[00:00:00] Speaker A: Foreign.
[00:00:11] Speaker B: Welcome to the Comeback with Boomerang Healthcare, your podcast for relief, recovery and restoration.
I'm Dr. Peter Abachi.
[00:00:21] Speaker A: And I'm Dr. Sarah Guzet. As doctors, we know healing isn't just about treatment. It's about having the right tools, mindset, and support to move forward.
[00:00:31] Speaker B: You can have pain, you might be injured, even hurting on the inside, but with all that you got going on, you can still have a really great life. And that is what we are here for. This is the Comeback. Let's get started.
[00:00:47] Speaker A: Fantastic. So today we're going to talk about a topic that is near and dear to my heart. It's something that I talk a lot about with patients, and I'm sure you do too, Peter, and that is talking
[00:01:00] Speaker B: about my own stress.
[00:01:01] Speaker A: That is stress. Yes. I'm sure you've never experienced any. You have no idea what we're talking about today.
[00:01:07] Speaker B: Every 30 seconds. Pretty much.
[00:01:10] Speaker A: Absolutely. I can only imagine. And so today we're going to talk about what stress is, debunk a couple myths about it, and more importantly, what you can do to help manage it and have a better quality of life despite the stress.
[00:01:24] Speaker B: Such. Such an important topic. And, you know, I think one that our patients are always are interested in learning more about, and I'm excited to be talking to you about it. A clinical psychologist with years of expertise in understanding stress at a deeper level and managing it with strategies more effectively.
So I'm looking forward to learning today.
[00:01:52] Speaker A: Likewise. Likewise. So why don't we start off by just talking about what stress really is?
Right, yeah.
[00:02:00] Speaker B: Stress.
How would. How would you define it from a. A psychological standpoint? And then we can also talk about the. The physical side of it.
[00:02:09] Speaker A: Ab Absolutely. So I actually usually draw the connection of where the term stress even came from.
So the term stress isn't actually its roots, isn't in medicine. Its roots were in engineering and in physics.
So have you ever drove.
Drove across an old bridge and you see a sign and it says, stress load, three tons. Right. I remember being in Hawaii and I came across this old, like, wooden bridge and I was like, in a rental suv and I look over my husband, I'm like, how much does this car weigh? And he's like, you're fine, you're fine. Because I knew what that meant. I'm like, this may be a problem if I come across this bridge and it can't. Right. Manage the weight. And what stress really means in engineering is we. What is the maximum weight or capacity or force before something actually breaks or snaps and so when we think about that, we couldn't find a better term in medicine. And so we went and used a term from, from engineering that talks about your breaking point, you know, because.
[00:03:08] Speaker B: Yeah, stress is a part of physics. If I remember from a couple years ago when I was in college.
[00:03:13] Speaker A: Yeah, absolutely, absolutely. And so the truth of the matter is, is all of us have a load that we carry, right. Responsibilities, OBL allegations. But when we get to the point that we feel like we're about to break, that's where we start to feel stressed. And so that's how I kind of explain it to my, to my patients in a more psychological manner. Not to mention, of course, the roots of what's happening in the body. And I imagine you get into that with, with your patients.
[00:03:42] Speaker B: Yeah, that's, that's, that's a great example, I think, a great way to think about it.
I think, you know, with the physical body, we, you know, we feel it in different places, I think, depending on, you know, where we're injured sometimes, you know, like, for example, you know, if you have a bad back or back injury and you get really stressed, I think sometimes things tighten up maybe there, you know, when you start to feel it there and, you know, or if you have a bad neck or something like that. I, I think the, of course, you know, the mind body connection, but I think we, we hold stress sometimes in places where we feel the worst and probably where, where we, it would, you know, be ideal if we did not push it into the places where we're the most injured. But it seems like we, we do that along with all the physiologic changes that, that we'll, we'll talk about as well.
[00:04:44] Speaker A: Absolutely. And I think you make a good point. Right. The specific parts of the body that probably need the most. Right.
Support are the ones that are to show like, the most stress. Right. Whether it be your low back, your neck, patients with chronic headaches. Right. We definitely see when they're stressed that we see that pain flare. Right. Come up and increase. And so one of the things I talk about a lot with my patients is the sympathetic nervous system.
And I imagine you do too.
And so for those who've never heard of the term sympathetic nervous system, sometimes it's ref, referred to as the nervous system that's in charge of the stress response. So your fight or flight or even freeze, and it has good intentions.
The purpose of this nervous system is to try to keep you essentially alive. And so if you're going for a hike, you know, and you hear some, like, rustling in the bushes kind of a thing, right? It's your sympathetic nervous system that's going to make you go alert, listen, and decide, do I need to run for my life, right? Do I need to fight for my life? Should I freeze and play possum, right. Or play dead, right? It's that nervous system. And in an ideal state, it would do that for just when the threat is right there.
And then it would calm down and go back into a parasympathetic state, which is more relaxed, and you'd be able to hopefully enjoy the rest of your hike. Right. Right. Now, in a perfect world, that's the way your nervous system is meant to behave. However, we live in a society and a lifestyle that has one repetitive stressor after another, and it's these multitudes of chronic stressors that keep your nervous system dysregulated. And you're constantly in a state of fight or flight. And if you think about it, I always, like, compare it to a lot of, like, animals because we see it in, like, cats and dogs. We see it right on the Discovery Channel. Their shoulders will go up, their goes high. They try to look bigger, right? And commonly when I see patients, I'm like, where do you carry your stress all the time, right? Their neck and shoulders. They have headaches. And I'm like, yeah, you're protecting your jugular, right? And your body doesn't know the difference between a bear or a deadline, right? Or an unexpected bill or sitting in traffic. It reacts the same. It goes into fight orf flight. There's no reason for you to be opening your mail, right?
Ready to fight. But your body does go into that sympathetic fight or flight mode.
[00:07:15] Speaker B: One one of the classic, I think books that I often reference with patients, it goes back, I think he's done a couple of additions, but you know, that classic, why don't zebras get ulcers? By, you know, Robert Sapolsky from, from Stanford.
You know, the whole idea of the fight or flight response when you're getting chased by a lion, you're in the jungle, you're the zebra, and you got to get away, right?
You know, what do you go through and how do you mobilize your systems and your body to run as fast as you can?
But also, interestingly, what makes us sometimes very different is once the zebra gets away, it chills out immediately, right? That fight or flight turns off the sympathetic nervous system, starts to slow down the parasympathetic, which sort of calms down things, starts to to take over and it's all good again, you know, and it kind of, it kind of lets it go and, and letting go and resetting more quickly is something that humans have a hard time doing because we're so emotionally charged and. But, you know, a great, you know, tools to have in a toolbox to work through that is part of, you know, what we want to work on and what we want to talk a little bit about today.
And I always felt like, you know, if he'd have spent some of his book money on getting a haircut, it would have been money well spent. But if anyone has. Has a chance to, to read that, it's a classic in understanding stress. And maybe you could speak to a little bit about the difference between acute stress and chronic stress and maybe good and bad stress, and we can go into that a little bit.
[00:09:10] Speaker A: Absolutely, absolutely. So first let's talk about good stress, because that sounds good, but it also sounds like an oxymoron. Right? And so what does it mean to have good stress? Oftentimes when we talk about stress, we're thinking about bad stress. We're thinking about filing our taxes, we're thinking of, you know, deadlines at work, we're thinking about marital issues, really major stressful events. But the truth of the matter is, is some things that can be stressful can also be really happy occasions. So things like planning a wedding, having a baby, right? Planning, whether it be a bar mitzvah, a large birthday party, you know, you often see the parents looking all frazzled. Everybody's telling them, congratulations, and they're just like, oh, thank God we made it to the event. Right. And they look so stressed because it's true. It's a lot of things they have to coordinate, a lot of things they need to manage. Right. A lot of pressure on the day, even though it's a very joyous occasion. So keep that in mind. Even good stress, right? Good events, right? Preparing to go away on a vacation. Right. The week prior. People are usually frazzled, trying to get things wrapped up before they leave. Right. I'm sure we both have experienced that.
And you have to remind yourself this is a good thing. It's because I'm going to be out of here for a little while and I don't have to check my email for a little while. And so that helps into the reframing. But the other thing too about, you know, stress is what it does to your body. And when you start to realize what it's doing and it has good intentions, I find a lot of my patients are able to help kind of regulate it because I start to see the signs. And so there's two things that happen in your body when you have acute stress. So such as, you know, the zebra that's being chased by the lion, right.
What happens in that moment is everything in that body is going to regulate all of its emotions or all of its energy. Not emotions, all of its energy to try to support and increase the livelihood of the zebra. So you see things like heart rate go up, blood pressure go up, breathing increase. Right. It's rapid but shallow at the same time. Because we're doing everything we can so that zebra has a chance to get away from that lion. Right. All the blood goes to the major muscles, not so much the fine motor. Right. So you're going to be able to. Right, be able to fight or flight. And we're the same way. We're going to have that same experience.
And so what happens in return is your body, because it redirected its energy to the systems to help you run, it, turns down systems that it thinks aren't so critical. And that includes things like your GI tract. Right. So a lot of patients will report, like, stomach upset. You even hear about, like, actors and actresses who will, like, you know, unfortunately vomit or get, like, stage fright. And it's so bad, they. They vomit before a show. And that's because their body essentially is going into fight or flight. And it's not a patient.
[00:12:08] Speaker B: I had a patient come in last week throwing up because her back was hurting so bad.
[00:12:13] Speaker A: Oh, my goodness. And she was, I imagine, really stressed about it.
[00:12:18] Speaker B: I think so. Yeah.
[00:12:19] Speaker A: Yeah, yeah, absolutely. So. So I see that a lot. And it's tough too, because sometimes you're like, are you on a medication? You gotta try to rule out, did you change a medication? Is it a medication? Side effect. But oftentimes you start talking to them and you can see where their thoughts are and you're like, oh, stress reaction.
[00:12:34] Speaker B: Seeing a new doctor for the first time, going to a new place, having all this back pain, and she just started throwing up. Yeah.
[00:12:41] Speaker A: Oh, poor thing. Poor thing.
And I imagine once she met you and realized she had a great ally on her side, better than Pepto Bismol. She was as good as new.
[00:12:51] Speaker B: Then she really started throwing up.
[00:12:53] Speaker A: I find that hard to believe, but it is, it is true. The other thing too, and I point this out, you know, a lot of times my patients too. Cause a lot of patients will get other types of GI upset. So, you know, sometimes it's diarrhea or constipation. And I'm like, yeah, your entire GI tract gets dysregulated. Because right now it's not so important if you're digesting your sandwich from lunch. Right. It's more important that you go into that. That fight or flight. And so your blood and all your energy gets redirected.
Another system that doesn't get as much energy when you're in a, you know, stress state also is your reproductive organs. And so we see that a lot with individuals who are putting a lot of pressure on getting pregnant. Right.
[00:13:37] Speaker B: Fertility.
[00:13:38] Speaker A: You got it.
[00:13:39] Speaker B: Talk about some stress.
[00:13:41] Speaker A: Oh, my goodness.
[00:13:42] Speaker B: Some people, fertility is a humongous stress.
[00:13:46] Speaker A: Absolutely.
[00:13:47] Speaker B: And it sounds like it just makes it that much harder to. To conceive. Yes.
[00:13:51] Speaker A: How many times have we heard about a celebrity, right, who was like, trying to get pregnant and then they take the pressure off and they go and adopt and then surprise, six months later, they announced they're pregnant? You know, and so something to be said about that.
And I always thought it was interesting.
And I have gotten patients referred to me from OB GYN that were dealing with infertility. And I remember sometimes they'd be a little resistant. They're like, it's not in my head. I'm like, I don't think it is. I'm just here to help you regulate your nervous system so that everything is firing. And that includes, Right. Your reproductive organs. And sure enough, oftentimes that was helpful, along with other modalities, yoga, acupuncture, all sorts of things. But it is really important. And so we see that all the time with young couples trying to get pregnant. We also see even skin issues. And so I actually remember getting a patient referred to me from a dermatologist. And I was kind of like scratching my head. It was like 14 years ago. Not your typical pain patient that was being referred to me then. Sure. She had a low back injury, was an older woman. And as I was interviewing and getting to know her story, and I think trying to figure out why. Did a dermatologist send you over to me? And she shared with me in her medical history. She's had a history of weird rashes, kind of like hives, and they've given her. Poor thing, has tried every ointment, every cream, she has changed every soap, laundry detergent. She was so thorough. And as I got to know her story, I found out that her, like, the love of her life, her husband of 50 something years, had passed away a year prior and her son the same year. You know, Two major losses. And she was trying to be all stoic and hold it together.
And she's like, I still have grandchildren. And she's, you know, trying to be strong. And as we talked about it, we started to realize her hives were worse around the anniversary of their passing, their birthdays, her wedding anniversary, you know, and sure enough, we got into therapy and her skin cleared up, and she's like, this was great. I didn't get side effects. You know, there was no stinky ointment. This was the best thing ever. So she had such a good experience in therapy, and it then made sense why the dermatologist. I guess the dermatologist, over a few sections, appointments had figured out, oh, I don't think this is a, you know, a reaction. I think this is more internal from her.
[00:16:05] Speaker B: I can. I can share a skin story, too.
[00:16:07] Speaker A: Oh, you got one.
[00:16:08] Speaker B: I love the story myself. Yeah, so when I was growing up as a kid, I had really bad eczema problems. I would get it, like, all over, and I was always going to the dermatologist, and I had ointments all over the place and plastic wraps and all this stuff. And I wear certain clothes and not certain shoes, and we did all this. And then as I got older and went away to college and stuff, it mostly went away, although, you know, winter time, sometimes it would. It would flare up a little bit.
But mostly I didn't have issues where I had to buy ointments or see a doctor or anything for years and decades. And then a few years ago, my mom had to have major heart surgery, and she had to stay with us for about three months afterwards.
And during that process, all of a sudden, I'm breaking out in eczema everywhere.
And I'm like, yes, a little bit of childhood flashback, a little bit of stress, and eventually figured it out and.
And things got better again.
[00:17:24] Speaker A: Did it clear up within three months?
[00:17:26] Speaker B: Yeah, right about that time.
[00:17:29] Speaker A: What a coincidence. Just as mom was visiting. Right?
[00:17:33] Speaker B: Yeah, I was. It was not lost on me, The. The.
[00:17:36] Speaker A: The.
[00:17:36] Speaker B: The connection there of that. But. Yes, but.
[00:17:40] Speaker A: Yeah, that's another common one is the eczema. We also see hives, and we also see acne, where people will tell me, I haven't had acne in, you know, 20 years. Why am I breaking out like this? And I'm like, yeah, it's not hormonal, it's stress. So. Absolutely. And I think with. When it comes to dermatological issues, the. The convenience is you can actually physically see it.
And so I often refer to it as your dashboard, Right. Your body is like a car engine. And most of the time you'll see like a check engine light. You'll see, you know, low tire pressure. Most of us would typically pull over and see what's wrong with the car and address it. Right.
However, when it comes to our body and it gives us a warning, whether it be, right hives or nausea or a back spasm, unfortunately, sometimes we just keep pushing ourselves. Right.
And so ideally, you know, with stress management, you can think of it as regular car maintenance. Right. We're going to change the oil and rotate the tires, Right. You got to take care of yourself just like you do your car.
[00:18:43] Speaker B: Well, Sarah, talk to us about, you know, when the stress becomes chronic. Right. You know, when, when we're, when we're not the zebra and, and we don't get past it and whatever's stressing us out continues, or just our sort of fixation on it, you know, we can't let go and that continues. And what does that do to us health wise, mentally, physically, spiritually? You know, I think it's a big deal, right?
[00:19:16] Speaker A: Oh, absolutely, absolutely. The body is designed to be able to handle stress for short periods of time.
And when we have either a multitude of stressors or we enter a period of chronic stress, right.
Insecure housing, unemployment, multiple losses of life, whatever it might be, these are major stressful events. And when we go into a chronic state, it starts to impact our hormones and impacts our entire body. We often hear about what it does to our cortisol. But the truth of the matter is, is our hormones are all interconnected. And that's why we see things like it impacting our hormones, reproduction impacting our thyroid, impacting our sleep. All of these are regulated by hormones. And I think of hormones like dominoes, careful not to knock one over. Right.
And so I often point that out to my patients that when that does happen, we're gonna see. Right. Because your whole body's being dysregulated. We're gonna see things like hard time sleeping and the quality of the sleep isn't good. Some patients will have hypersomnia, not just insomnia, but with the hypersomnia, they'll still tell me, I am so beat up and I'm so tired and I'm so fatigued.
Yeah. Because that quality of sleep isn't happening.
Additionally, we see things like the one I'm sure we both see a lot is the chronic pain is so much worse. Right.
Having major pain, flares, muscle cramps, spasms, increase in Headaches. And then, of course, unfortunately, we see an increase in things like blood pressure, which increases your risk for heart disease and heart attacks and things like that.
[00:21:03] Speaker B: And so there's an interesting one that I was reading a little bit about yesterday that I've been following a little bit for myself too, is heart rate variability.
I don't know if you come across that, but I think it's a hot topic with tech geeks.
And everybody's following their heart rate variability as a way of, I think, kind of gauging how good are they managing stress and when it looks like it's out of whack, what sort of relaxation techniques and heart rate monitoring and, you know, stress management tools do they need? It's kind of. It's kind of interesting. And for those who maybe have never heard of that, heart rate variability, when the numbers are higher is considered good, you know, and when. When the. When it's low and the beat to beat, variation in the heart rate is about the same always.
I guess it's a sign that our relaxation and stress management side of our nervous system is not working as well for us.
And when it's more variable, when the heart rate variability scores are higher, it's a sign that we're keeping our sympathetic nervous system better regulated. Our parasympathetic nervous system maybe is working better.
Interesting and different ways. There's not a great way to always measure it accurately, but there's a couple of devices out there that are commonly used, like the Oura ring, which I use, but I think Apple watches are good at that.
Other, you know, monitors that people might use.
We'll check that out. But that seems to be kind of one of the hot topics in the tech world right now.
Yeah.
[00:22:53] Speaker A: Oh, absolutely. And I love to use the technology also to support the health. So instead of it just telling you and monitoring, but also what can you do about it? And so you can use, whether it be an aura ring, whether it be a watch, what's the other new device? The whoop. Right.
Yeah. And so one of my favorite things is, have you ever taken your. And I was tell this patient, have you ever taken your blood pressure while doing some deep breathing? Right. Or after, you know, a couple minutes of breathing? And whether it be meditation or prayer or quiet reflection time. Right. Watching the bird feeder outside and then see what it does. And so many patients are surprised. They're like, you know, you mean to tell me all I had to do was take a couple of deep breaths and it would have actually made a difference? And I'm like, yeah, surprisingly, it works faster than blood pressure medication.
[00:23:43] Speaker B: Power of the breath.
[00:23:44] Speaker A: It really. I got a. I got a fun, funny little story.
I was in, I think, grad school, and I was running late to a doctor's appointment between traffic, couldn't find parking. It was downtown, I think. I finally got parking on, like, the fourth floor. I'm not waiting for the elevator. I'm running down the stairs. I'm running across to the hospital building. I'm running up the stairs.
I barely make it before they cut off time. Of course. I'm like, I'm horrible. I'm like, I'm so sorry. You know, Please, will you still see me? And they're like, yeah, I don't want to have to wait two more months. And they can take my blood pressure. And they were concerned as I'm, like, out of breath. They were like, your blood pressure is really high. And I looked at it and I looked at the numbers, and it was. It was alarmingly high. And I was like, I can do better. Hold on a second.
I took it as a challenge. I was like, no, no, no. Just give me a minute. And I took a couple deep breaths, and I had her take it again.
And I was in a healthy, normal range. And the truth of the matter is, I'm usually actually low. So I was still upset. I was like, I can do better. And she's like, no, no, it's okay, ma', am, let me room you.
[00:24:43] Speaker B: It's not a competition.
[00:24:45] Speaker A: This poor ma was not paid enough to put up with me that day.
[00:24:48] Speaker B: Well, since you brought up breathing, which is a simple topic, but, like, so mission critical to. To talking about stress management, that sort of long, deep exhalation is what brings down the stress levels, right?
[00:25:06] Speaker A: Yes, absolutely. What they have found. And there's a number of techniques, and I'm sure some of our listeners have heard some of these different techniques. We have things like box breathing. We have the, you know, 4, 6, 4 pattern. We have all sorts of different patterns of breathing and grounding techniques and things like that. But the truth of the matter is, find one that just works for you and slow down your breathing to four to six breaths a minute. That's the goal. And I also don't want my patients to stress about their breathing because I've had patients with, like, asthma and things like that, and when they're starting to, like, think about their breathing, they actually tense up because they're like, I don't know if I can hold my breath for that many seconds. And Then let go of it that many seconds. I'm like, just do your breath to slow it down. And over time, you'll feel more comfortable, you'll increase your lung capacity.
But the key thing, honestly, in research has shown this thousands of times over and over and over again. You don't need a supplement, you don't need a device, you don't need anything fancy. The most effective way to get your body out of the sympathetic nervous system into the parasympathetic or the relaxation state is your breath, is to slow down your breathing. And all you want to do is ideally breathe in through your nose.
And I usually tell my patients, try to. Try to start with four seconds. Breathe in slowly through your nose for four seconds.
Try to hold it for at least five if you can. And for some, again, they don't feel comfortable yet. So I just try to get them to. To work on it. But ideally five. And then I want the exhale to come out of their mouth like they're blowing out the candle on a birthday cake, slow and controlled. And with that, try to hold that for six seconds. And so it's a really simple 4, 5, 6, 1. It's an easy one to remember. And my goal with that with my patients is just to help them reset. And of course, as you know, we work with people who have chronic pain, and so I often remind them, go ahead and let your chair really support you. Like, lower your shoulders. They should not be friends with your ears, right? Like, really let your arms, your legs, let your low back be supported while you're doing this breath. And ideally, if you can do this on a regular basis, what would happen is instead of waiting until we feel very stressed out and on the edge of, like an anxiety attack or a panic attack, if you do this on a regular basis, you can actually prevent them from happening in the first place.
And so I think of breathwork as sunscreen before you get sunburned, as opposed to a whole bunch of aloe vera when you're already red like a lobster. Right.
[00:27:39] Speaker B: That's a great, great example. I've noticed that when I focus on the exhalation and a deeper, longer exhalation, it sort of does clear your thoughts. And it's when. When you're doing the. The inhalation is when you start thinking about things again. And it's a great way to release that.
Hey, gang, thanks for joining in on this discussion on stress.
I know you want to hear more. We got more. Stay tuned for part two of this
[00:28:13] Speaker A: episode, and thank you for joining us today on the Comeback with Boomerang Healthcare. We're grateful to have you here. If you've enjoyed today's episode, be sure to subscribe so you never miss an update. You can always follow us on social media for more tips, information and inspiration. Hope to see you in part two. Until next time. Keep moving forward. Keep your comeback is just getting started.
