Lifestyle Corner

We've marked the one-month anniversary of the terrorist attacks. While autumn's cool brilliance may help us begin to heal and move forward, chances are each of us still feels stressed out, uncertain, even fearful. Chances are, these feeling may linger.

Our bodies are fine tuned to handle short-term stress. They're programmed to anticipate stress, respond to it, re-assess it, and relax, once it's gone. The hormones adrenalin and cortisol are the major players in your body's stress defense. In a stressful situation, these hormones flood muscles and tissues to prepare your body for action. Once the stress subsides, they gradually leave the bloodstream and your system regains its balance. But, when stress comes in waves, or worse, is constant, adrenaline and cortisol levels remain high, putting your body into chronic overdrive and off balance.

Chronic stress is toxic to most body systems. You become more vulnerable to colds, flu and other infections. You also may feel fatigued, have trouble concentrating and be sleeping poorly. Nonstop stress affects your eating habits. High blood levels of cortisol associated with toxic stress almost always trigger a raging appetite and inappropriate eating patterns. Toxic stress can lead to heart disease, diabetes and other conditions. Other destructive behaviors, such as drinking excessive alcohol, may follow if stress is left unchecked.

Now is the time to assess how you're coping with the stress and uncertainty generated by September 11th. Now is the time to regain control by renewing your commitment to your health and stopping toxic stress from poisoning your system.

Routine, Regroup, Resilience

I'd like to introduce you to "R" words - or re-introduce you, as the case may be:
Routine, Regroup, Resilience. The behaviors these terms define are tools at your disposal to manage the chronic stress and anxiety that we feel today. Most important these tools can prevent long-term stress from becoming toxic.

Routine: Keep it Healthy, Not Toxic

As days and weeks separate us from the horrific events of September 11, our routines undoubtedly have returned more or less to "normal." You're back to work or school and you're back to your everyday responsibilities. Life doesn't have the suspended feeling it sometimes does immediately following a disaster or a personal tragedy. Routines help us manage stress. They keep us focused and moving forward. But, stress always finds a way to inch back in - especially stress caused by trauma. It's like dust in the closet.

As important as it is to return to your workaday routines, it's equally important to return to your health goals. Have you let your workouts slip? Forgotten to take your daily walk? Take a minute to review your health goals. Maybe you were just about to start eating more healthfully and begin to include physical activity into your schedule. Now is the time to re-commit to those goals.

A balanced state of mind requires regular physical activity or movement and healthful eating. Toxic stress keeps you off balance. Use the comfort of your routine to energize you and renew your commitment to health.

Regroup: Bending, Not Breaking

Regrouping is an important skill for women. I consider it an art form. Life continually throws us curve balls and we typically put everyone else's needs before our own. Though recent events are far more traumatic than life's usual ups and downs, the process of regrouping is essentially the same. Regrouping can help you control your stress hormones and prevent chronic stress from making you sick. Try to focus more time and energy on yourself, for a change, and take these steps to regroup:

• honor your feelings and acknowledge the psychic ordeal you've been through even if you were not directly affected
• accept the fact that life is sure to be more uncertain now than ever but that you are up to the challenge
• do the best you can to work through the day's hassles in a healthy way
• reward yourself by recognizing what you achieve every day
• know that bending isn't the same as breaking
• use "Plan B" until you can get back to "Plan A"

Regrouping helps you move from one activity to another - or one emotional state to another. It's the art of making a transition and adapting. Regrouping allows you to be mindful of the stress at hand, but prevents it from leading to unhealthy behaviors, like overeating or eating poorly. It's your "Plan B." Perhaps it's not your ideal plan, but it's one that will work for you and help you make the transition back to a routine that includes healthy eating and exercise.

Resilience: Letting Go

Becoming stress-resilient means learning to let go. It's a bit like learning to let waves (in this case, waves of stress) wash over you without knocking you down by triggering self-destructive behaviors. Stress can be a mighty opponent. With your health at stake, it's critical to learn how to diffuse this foe, especially since it may be with us for awhile.

Use stress as an opportunity. Make it work for you, not against you. Here are some ideas for becoming stress resilient:

Keep a journal during stressful times. Write down:

• things you find stressful and the behaviors they trigger
• what you did to manage the stress or how you would like to manage it in the future
• your "comfort zones": activities (healthy ones) or people that you give you strength and comfort; seek these activities and people out when you feel stress becoming overwhelming

Another way to become stress resilient it to convert your feelings of unease and uncertainty into positive action by helping others. Try:

• donating blood and financial support to relief efforts
• finding a relief group that reflects your interest and talents; the Humane Society, for example, or local artisans, may be doing innovative things to help individuals affected by September 11
• calling the Red Cross to find out how you may be able to donate your time to your local community, your local ambulance squad and fire department and/or their auxiliary groups may be in need of volunteers, for example
• resisting the temptation to isolate yourself or give up activities that you used to enjoy
• reconnecting with friends and family members you may not have heard from in awhile who can help you remember positive and happy times and look to the future with hope.

Find Help, If You Need It

Chronic stress can spiral into anxiety disorders, depression and post-traumatic shock disorder (PTSD). If you feel overwhelmed to the point of feeling paralyzed with fear, fatigue or sadness, know that these feelings are not unusual after trauma, but they do require medical treatment. They may be symptoms of an anxiety disorder, depression or PTSD.

Here are signs to look for to help you know whether you, a family member or friend is developing PTSD or another mental health condition that should be evaluated:

• After trauma, many feelings become intense and unpredictable. People with PTS reactions may feel less able to cope with many of life's typical daily stresses.

• You may be irritable, anxious, and your thoughts and behavior patterns may be disrupted.

• Sleeping and eating may be disrupted and become chaotic. Re-experiencing the event through nightmares is common.

• Reoccurring emotional reactions are common, and may be triggered by sounds, sights or watching something on TV.

• Relationships with loved ones may be strained.

• Conflict at work and home is common. Some people begin to isolate themselves and avoid social activities.

• Physical symptoms such as headaches, backaches and stomach distress, often accompany extreme stress.

For more information on PTSD, see my column from the week of September 17, "Post Traumatic Stress Disorder: How to Recognize it and What to Do." For more information on anxiety disorders and depression, visit these topics in the Health Center.

Pamela M. Peeke MD, MPH, Pew Foundation Scholar in Nutrition and Metabolism, is Medical Advisor to the NWHRC; she also is an Assistant Clinical Professor of Medicine at the University of Maryland, Baltimore, and author of the best selling book Fight Fat After Forty (Viking Press, 2000).

Click www.drpeeke.com, Dr. Peeke's Web site featuring health and wellness issues for women.