One of my least favorite phrases in clinic is “it may just be stress.” Usually, the phrase comes after a patient describes truly miserable but surprisingly typical symptoms like migraine headaches, gastric distress or chronic pain. Typically, one or all of these have been present for multiple years and have never been fully explained. Patients are frustrated, almost embarrassed to talk about them, and usually end the discussion with a sigh and surrender to: “I dunno, it may just be stress.”
My issues with the phrase start with the fact that even if the symptom is caused by stress, it doesn’t make what a patient is experiencing any less real. Chest pain is chest pain, a headache is a headache and diarrhea is diarrhea. In addition, stress is relative. One person may be able to cope with the death of multiple family members without issue, while another breaks down when a loved one gets mildly ill.
My personal fascination with stress involves the intersection of emotional and physical health. There is one specific medical condition that I think brings a bit of awareness and a lot of validity to this junction.
Ever heard of Takotsubo cardiomyopathy? You probably have without even knowing it. More commonly known as “broken heart syndrome,” this stress-induced condition can mimic a full-blown heart attack. First identified in the 1990s and named after a Japanese octopus trap, Takotsubo cardiomyopathy occurs primarily in 60- to 75-year-old women after the death of a spouse. Stress causes the left ventricle to physically bulge into a round balloon shape resembling the clay pot (tako-tsubo) octopus traps used by Japanese fisherman. Chest pain, shortness of breath, elevated cardiac enzymes, and even EKG changes all make this episode look and feel exactly like a heart attack. Pretty intense for “just stress.” Fortunately, most individuals heal after a short hospital stay without much treatment in two to four weeks.
Chronic emotional stress can lead to chronic physical signs and symptoms including headache, elevated blood pressure, decreased sex drive, depressed immune system and poor sleep quality. Often there is no blood test or imaging study that can tell physicians exactly what is wrong. If you ever discussed a symptom with your physician and were told that your blood, urine and imaging was “all normal” — consider the possibility of stress. I can’t tell you how many times patients stop having migraines after they retire from demanding jobs, or who no longer have irritable bowel disease after getting out of abusive relationships.
One simple, free and easy stress reduction exercise I often teach patients is the 4-7-8 breath. Anytime you are feeling overwhelmed, simply close your eyes, take a slow inhale through your nose while counting to four. Hold this breath while counting to seven, then breathe out through your mouth while counting to eight. Repeat these five to ten times to lower your heart rate, calm your breathing, and eliminate tension.
Just like diet and exercise, stress reduction is vital to your health.