STRESS MANAGEMENT FOR WOMEN Utilizing Tai Chi/Qigong and Yoga for Total Relaxation of the Body, Mind and Spirit. by Cynthia Knorr-Mulder RNC, MSN, NP-C,CS, C.Ht

When we talk about stress management one thing we always have to remember is that we can’t change stress. It is always there and always will be. However, what we can do is decrease our perception of it by utilizing complementary modalities that have been practiced for over hundreds of years to maintain a healthy lifestyle. Tai Chi/Qigong, which has been practiced in China for over 600 years, does exactly that. Moving through Tai Chi/Qigong postures gently works the muscles and helps to combine mental concentration with coordinated breathing. Often called meditation in motion, Tai Chi is becoming very popular in the US and appeals to women because the synchronized movements are easy to learn, perform, and can fit into busy lifestyles.   As women, we have a tendency to nurture all of those around us and in doing so we forget to nurture ourselves. Self-care plays a vital role in how we manage stress. Women all over have recognized the positive outcomes of self-care and are attending weekly classes for Tai Chi/Qigong and yoga. Women attending these classes state that they feel less stressed throughout the week and are better able to face the challenges ahead. Outcome research has shown that even after only one week, women will have a reduction in heart rate, blood pressure, anxiety, depression, fatigue and pain and a general increase in their overall perception of health.

I had a 42-year-old women who was referred to me by her physician for anxiety and high blood pressure. During her fourth week into a yoga program her blood pressure was within normal range and she was feeling less stress by utilizing the techniques she had learned in the program. As she expressed how wonderful she was feeling she stated, “Okay now I’m done, I just wanted to get better so I could go back for my doctors appointment next week with a low blood pressure”.  I advise participants that including these modalities into your lifestyle can indeed be very beneficial for stress management and total health although one must practice these modalities weekly if not every day in order to incorporate it into your philosophy of life. 

As a Complementary Medicine Nurse Practitioner I not only recommend these modalities for women seeking stress management, but I also feel that it significantly benefits women with chronic conditions.  It is an ideal practice for women at any age that experience increased stress resulting from chronic pain with arthritis, fibromyalgia, or back injuries. Women with this type of pain need a milder and more soothing exercise. Tai Chi/Qigong and Yoga facilitate low impact movements that increases muscle strength and balance while promoting general pain relief and an improved quality of life.

By participating in these modalities women report a decrease in pain, depression, anxiety and fatigue increased flexibility and an overall increase in their perception of health. These classes are an ideal lifestyle addition for women of any age to help decrease stress. Not only are the classes inexpensive, but they can be practiced almost anywhere at any time with no special equipment or clothing.

Tai Chi/Qigong and Yoga are not a vigorous workout like traditional exercise and participants reap the added benefit of balancing mind and spirit. Most female patients with chronic illness don’t want a vigorous exercise regime, but they want the benefits of exercising. If they don’t like to exercise they will not stick with any program designed for them. Since Tai Chi/Qigong and Yoga are something people really enjoy, they tend to stick with it.

In most classes you can find a large group of women ranging in age of 28-83 participating weekly to master gentle postures and movements with an emphasis on breathing and inner stillness. The women continue daily to practice Tai Chi/Qigong or Yoga, and state they would never go a day without it because it makes them feel physically, mentally and spiritually fit.

Not only do I advocate these modalities for my clients I also stress the importance of self-care and therefore can be seen weekly joining group sessions of Tai Chi/Qigong and Yoga and include meditation in my daily practice. Practicing these modalities increases my mind-body-spirit connection and reaffirms my commitment to self-care. This serves as the foundation of what I do as a complementary medicine practitioner and that is first and foremost to build a therapeutic relationship with each and every one of my clients. 

How To Age Well by Shirley Madhère, M.D.

Aging is a natural phenomenon; we will all experience it. How we age is a matter of a number of variables, including genetics, lifestyle, health, stress, the environment, and choice. One such choice that is popular in age management is within the realm of plastic surgery. For those who choose to undergo some “intervention,” it may be in the form of minor, in-office procedures as injectables (Botox, fillers, etc.) and skin rejuvenation (laser, chemical peel, Vitaglow, etc.), or a “nip/tuck” (operative plastic surgery). Nevertheless, regardless of how one chooses to manage and show one’s age, whether or not with the help of a surgeon’s needle or knife, it is beneficial to age well and to look good for one’s given age, i.e., to be a better version of one’s current self. Before one can undertake an age management program, it is important to empower oneself by understanding how we age and what can be done to influence the process.

There are a number of factors that contribute to aging. These may be generally classified as intrinsic and extrinsic. Intrinsic factors are those with which we were born and thus cannot be controlled Extrinsic factors are typically learned or acquired and therefore can be altered. Factors that lend to aging which may not be adjusted include genetics, skin type, and pore size, while those that may be changed for improved health include lifestyle, nutrition, and stress. Of note, appearance and how one feels about different variables of his/her life are now believed to play an increased role in wellness. In fact, the World Health Organization modified the definition of health as “… a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Moreover, wellness has been defined by the National Wellness Association as "an active process of becoming aware of and making choices toward a more successful existence." Therefore, aging well is an individualized and holistic process that encompasses internal and external aspects of health and living.

The outward manifestations of aging occur on the level of the skin and begin by age 30. As we age, the facial skin becomes dry, less elastic, less firm (from the loss of collagen), and may show signs of sun damage. It may also be uneven, discolored, sagging, and develop wrinkles and loss of volume or facial fat. These manifestations are the result of a combination of natural aging (intrinsic) as well as extrinsic aging. Although each individual is genetically programmed differently and the rate of aging will vary from one person to the next, these changes will nonetheless occur to some extent at some point. For example, the 40 year old woman will have hopefully built a healthy skin foundation that she began in her 20’s, adjusted for her 30’s and now, in her 40’s, will modify to suit the particular changes her skin has undergone, namely dryness loss of firmness and elasticity, and possible sun damage. Typically, more definitive steps should be taken to address these issues. While a healthy skin regimen should be a part of every woman’s (and man’s) routine, it may be appropriate also for women in their 40’s to consider office-based rejuvenation procedures as Botox (to soften hard facial lines), fillers (to add lost volume), chemical peels (to even out skin tone), Vitaglow (to help increase facial blood flow and help stimulate collagen), and plastic surgery to help manage excess, sagging skin that may not respond to other therapeutic modalities. The decision to undergo any of these procedures is highly personal, where one considers one’s beauty philosophy, budget, time, and expectations, and should discuss with her plastic surgeon.

Taking a holistic approach to beauty and wellness is how I advise my patients to look as great as they feel. I believe that beauty emanates from within and that healing occurs from the inside out. Therefore, to age well, I “prescribe” the following 10 tips to looking fabulous at every age:

1. Establish a good foundation: take care of your skin. Moisturize it, protect it from the sun, and stop touching it throughout the day! Whether with injectables or actual surgery, healthy, well-moisturized skin responds better to the needle and the knife;
2. Practice a holistic approach to beauty. The healthier you are overall, the better your skin and tissues will respond to a surgeon’s “interventions” or any other treatments. Also, know who you are and know who you are not: understand what effects look good on you; know your own face. What fits your best friend’s cheeks may not be suitable for yours;
3. Keep your mind active and your brain performing; engage in lifelong learning;
4. Stop smoking. Period. If you need help, get it;
5. Avoid prolonged, unprotected sun exposure. Enough said; you have heard it all before;
6. Be emotional: maintain an optimistic attitude and try to live an emotionally enriched life every day. Also, nourish your spirituality and have fait. Explore your metaphysical core. Be present. Practice detachment. Look for deeper meaning;
7. Honor your temple with good nutrition. A proper eating regimen will help to ensure normal healing, maintain active metabolism, and encourage efficient elimination of toxins. If healthful eating is lacking, take vitamins and supplements as directed by your physician or nutritionist as a complement to eating well. Limit intake of sugar, fat, and alcohol and stay hydrated to help your body clear itself of toxins. This is particularly helpful after surgery when your body enters into a state of relative dehydration and is briefly deprived of nutritional support;
8. Remain social: studies have shown that a strong social network may improve health and that close friendships may increase natural immunity;
9. Exercise regularly. There is really no way around it;
10. Manage stress effectively and often. Get consistent and adequate sleep every night. Listen to your body.

Aging well is as dynamic as the aging process itself. To look and feel well involves a balanced lifestyle that incorporates a variety of factors to help achieve successful living. With or without the knife, it cannot be argued that beauty is health and healthy is beautiful!

Dr. Shirley Madhère is a plastic surgeon who practices “holistic plastic surgery” in New York City. 

"50 Most Common Signs of Stress --SuperStress Busting 101" byline: Roberta Lee M.D.

Stress is a word used so commonly to describe uncomfortable situations it’s hard to know the exactly what it means.  The concise oxford dictionary defines stress as “a disease resulting from continuous mental stress.” Most people think of stress as an unpleasant situation or distress.

But times are different we are moving at a much faster pace and stress has transformed into a whole new kind disease of monster proportions – one I call SuperStress.  This silent and deadly transformation of stress evolved when we acquiesced to answering emails within a minutes of their receipt and felt obligated to consider practically sleeping with our PDAs , cell phones and blackberries to make sure that we were “ available”,  even on our vacations .  In cooperation with our new values and compounding the problem is  the presence in airports, banks, elevators and even in taxis of television screens streaming news reports which tell us of the latest crises around the world—“keeping us informed “ so we don’t have to chase every disaster 24/7 – it can chase us. Great—or is it?

When we feel stressed our body reacts by sending signals via the limbic system, a special area of the brain designed to trigger a rapid physiological  response, to flee. Stress experts believe that this response is an evolutionary adaptation whose purpose enabled victims of dangerous predators to run, escape or flee. 

So, when danger is perceived, real or not, the “fight or flight” response triggers  neurohormones from the limbic system of the brain  to be released into our blood stream  and   in turn signals  the adrenal glands to secrete  another  host of hormones known as catecholemines:   epinephrine, norepinephrine  and cortisol. All of these molecules  mobilize energy in the body with the intent of  fleeing.  For example, if I hear that I have just lost my job my body goes into a fight or flight response just as much as if a mastodon or tiger were chasing me.  In this situation what follows from the adrenal surge is a body response that reduces digestive processes to save energy, enhance our immune system to protect us from potential wounding in battle and massive releases of blood sugar (vital energy for mobility). 

In a short term emergency the changes made by SuperStress do very little to harm the body – we use up more vitamins and calories but we can recover from the damage.  The problem comes when this response is triggered over and over with no time for rest. The relentless wear and tear of mobilizing for danger takes a different course – digestion gets out of whack, blood sugar surges begin to push the body into a near diabetic like state and immunity instead of being strong and robust becomes weakened and myriad of medical conditions start emerging in the chronically stressed individual

Here are the fifty most common signs of stress identified by the American Institute of Stress:

1.  Frequent headaches, jaw clenching or pain

2. Insomnia, nightmares, disturbing dreams

3.  Gritting, grinding teeth

4. Difficulty concentrating, racing thoughts

5.  Stuttering or stammering

6. Trouble learning new information

7.  Tremors trembling of lips, hands

8.. Forgetfulness, disorganization, confusion

9.  Neck ache, back pain, muscle spasms

10. Difficulty in making decisions.

11.  Light headedness, faintness, dizziness

12. Feeling overloaded or overwhelmed.

13.  Ringing, buzzing or "popping sounds

14. Frequent crying spells or suicidal thoughts

15.  Frequent blushing, sweating

16. Feelings of loneliness or worthlessness

17.  Cold or sweaty hands, feet

18. Little interest in appearance, punctuality

19. Dry mouth problems swallowing

20. Nervous habits, fidgeting, feet tapping

21. Frequent colds, infections, herpes sores

22. Increased frustration, irritability, edginess

23. Rashes, itching, hives, "goose bumps"

24. Overreaction to petty annoyances

25. Unexplained or frequent "allergy" attacks

26. Increased number of minor accidents

27. Heartburn, stomach pain, nausea

28. Obsessive or compulsive behavior

29. Excess belching, flatulence

30. Reduced work efficiency or productivity

31. Constipation, diarrhea

32. Lies or excuses to cover up poor work

33. Difficulty breathing, sighing

34. Rapid or mumbled speech

35. Sudden attacks of panic

36. Excessive defensiveness or suspiciousness

37. Chest pain, palpitations

38. Problems in communication, sharing

39. Frequent urination

40. Social withdrawal and isolation

41. Poor sexual desire or performance

42. Constant tiredness, weakness, fatigue

43. Excess anxiety, worry, guilt, nervousness

44. Frequent use of over-the-counter drugs

45. Increased anger, frustration, hostility

46. Weight gain or loss without diet

47. Depression, frequent or wild mood swings 

48. Increased smoking, alcohol or drug use

49. Increased or decreased appetite

50. Excessive gambling or impulse buying

These are symptoms described by many of my patients. I wish I could say that the frequency is dwindling but a recent survey by the American Psychological Association in 2007 known as the “Stress in America Report” verifies that one third of Americans are suffering from extreme stress and  the prevalence of stress is now up to 79% ( up from 59% in 2006). I could write page upon page about why and how the body responds in a stressful situation but I am a medical pragmatist and ultimately like to see people gain control over stress so here are my top 10 suggestions to reduce stress that I share with patients:

1.      Realize that whatever is stressing you will eventually resolve itself—nothing lasts forever

2.      If you have symptoms that impact your effectiveness to work, think and behave with civility to your loved ones or work colleagues – get psychological support to figure out how you can cope in a more constructive way

3.      Preserve your health sleep at least 6- 7 hours so your body can rejuvenate itself from daily the wear and tear of stress

4.      Eat breakfast it will give you more energy to get thru it all

5.      Take a 10 minute break in the middle of the day- this gives you a mental energy boost

6.      Take a multi-vitamin we use up more vitamins under stress

7.      Eat  wholesome whole foods like whole grains, fish  and lean meats, veggies and fruits your body needs nourishment under strain not junk food

Mobilize and take a 20 minute daily walk—physical activity mobilizes endorphins the “feel good” hormones

Answer the question “What 5 things am I grateful for today?” and find something inspiring to read every day

Make a commitment to yourself to go visit a friend in person this week—we all need each other One more stress buster it’s not intuitive under circumstances of strain but it works —do something kind for someone, compliment somebody, wish someone well – for no good reason or help someone out. Reaching out to help someone reminds us of the interconnected nature of the human experience—and our capacity to aspire to our highest nature something we often forget under stress. As the author of One Door Closes, Another Door Opens, Arthur Pine, put it “Caring can start a domino effect.

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