Introduction

Dr. Bob: And welcome to The Dr. Bob Show. I want to thank you for taking your time to watch this show to learn a little bit about being healthy and being happier. I'm very excited about this show. We're going to be talking about stress management. Has anybody out there been stressed at all? What causes stress? Why are we so stressed out? What do we do when we get stressed? Is stress dominating your life or can you handle stress pretty good? We'll be talking about those things. Stress is very interesting to me. I've always considered myself one who really wasn't stressed very much but we'll find out about positive stresses and negative stresses. I have an outstanding guest.

My guest is a clinical psychologist, Dr. Parinda Khatri and you're going to love her on this show. I'm Dr. Robert Overholt and I will be your host for the next 30 minutes on The Dr. Bob Show. After talking about stress management, we'll talk a little bit about that cough you have, especially when you exercise. Could it be hidden asthma? We'll be talking about other parts of your health. We've got a very interesting show so you'll want to stay tuned.

Dr. Bob: We're talking with Dr. Parinda Khatri and we're going to be talking about stress management. Anybody worried about stress? I think we all are. Parinda, welcome to The Dr. Bob Show.

Dr. Khatri: Thank you very much.

Dr. Bob: Now, you trained at what major college?

Dr. Khatri: I got my PhD at the University of North Carolina at Chapel Hill which is just one state over and then I did my post-operative fellowship at Duke University Medical Center.

Dr. Bob: Now, let's talk about stress management and stress. What is stress really?

Dr. Khatri: Really, stress is any demand on your body and that can be physical like the climate or if you've got a heavy weight or psychological. And what most people today find is the stress they experience most is the psychological stress.

Dr. Bob: And why do you think there is psychological stress on people?

Dr. Khatri: Well, people have a lot of challenges and ties just to get through the day. And so, as we go through our lives, we take on more and more challenges and I think people don't think as much about building up their coping resources to help manage those extra burdens and demands we place on ourselves.

Dr. Bob: So, there are some coping resources and some things that we can do as we acquire more things that cause more stress and want to stretch out the day. I was just hoping that God would make a 36 hour day and then there wouldn't be any stress at all. Are there good stresses and bad stresses?

Dr. Khatri: Well, there is certainly good stress and bad stress. When most people think about stress, they're actually thinking about what we call distress and that's what we consider more the negative stress and we have a hard time coping with. But there is also something called new stress which is the good stress. It helps motivate us. It helps give us energy and we actually perform better when we have new stress.

Dr. Bob: Is it easy to be able to develop new stress, you know the good kind of stresses. Can people develop those to develop their personality and make them better people?

Dr. Khatri: Absolutely. I think that's the good news about this is that you're able to always work on yourself and learn to become better at coping with stress and know your stress response.

Dr. Bob: Now, let's talk about some situations that are very common that get people into a stressful setting that they don't know to handle. What would be some situations for instance?

Dr. Khatri: I think when you ask most people, they have stresses coming from all areas of their lives. We have chronic stressers and these are longstanding stressers. People may have poor health, financial difficulties. These are stressers that kind of go on day after day. We also have acute stressers and that may be something big happens, maybe a divorce or a loss. We also have kinda daily hassles and that's little things. You're late to work. You get stuck in traffic. You lose your keys. And what's interesting is for a long time we thought it was the big things that really get to people. But when you ask them, it's the little things that really bring them down. The little daily hassles that really effect them.

Dr. Bob:You mean, like waiting in a grocery store, you can't get through the line or that person who just won't move over in their car?

Dr. Khatri: Absolutely.

Dr. Bob: How does the body handle those?

Dr. Khatri: Now, remember, stress is any demand placed on our body. Our body doesn't know is it a physical stress or is it a psychological stress? It reacts the same way. Our heart rate goes up. Our blood pressure goes up. Our immune system goes down. Our digestive system gets depressed and so everytime we are faced with these stressers, our body reacts to it. Now, we may not be aware of it but it is slowly kind of wearing away at our system.

Dr. Bob: Can it make people sick?

Dr. Khatri: Absolutely. It can not only make people sick, it makes them more vulnerable to being sick and then once they are sick, it can really impede their recovery. So, people who are stressed out, take a lot longer to recover from a cold, other illnesses as well as even major chronic illnesses.

Dr. Bob: So, stress would be important with any type of illness that any patient has in any situation they see their doctor. Because if they are stressed, they don't handle their illness as well and you said their immune system doesn't work as well. One of the things that I have always talked about is laughter. People that laugh a lot versus sad people their immune system works better. They have less colds. Stress does what to the immune system? It makes it to where you can get sick easy?

Dr. Khatri: Yeah, it can suppress your immune system but also stress keeps you from taking care of yourself so people who are stress don't get enough sleep. They're not eating as well. They're not doing the things they would normally do to take care of themselves. They're not doing those things so it can effect you in lots of different ways.

Dr. Bob: Now, what are some of the major illnesses that improperly handling stress can cause?

Dr. Khatri: Well, certainly the biggie is heart disease and that's the #1 killer for men and women in this country.

Dr. Bob: So, stress causes heart disease or can contribute to heart disease.

Dr. Khatri: The major contributing factor to heart disease and certainly for people who have heart disease, stress can make it worse. It can make recovery from a heart attack last longer. People are more likely to have a hard time coping with the heart disease so it can be a really important risk factor for heart disease.

Dr. Bob: Could heart disease… if someone has a heart attack, sometimes I call it a wake up call and sometimes it changes people's life to the better. They learn that there are important things about life that they should be adjusting to. That would be a positive stress. Is that right?

Dr. Khatri: I think the way people cope with stress really changes their behaviors. And so if they look at their heart attack or any kind of illness as a wake up call, they need to learn to sort of change the way they are coping with stress. And it's not just heart attack, it's cancer, arthritis, any of a number of illnesses.

Dr. Bob: How does stress handle the stomach?

Dr. Khatri: Well, this is another biggie.

Dr. Bob: It's a huge one.

Dr. Khatri: It's a huge one where people when they get very really stressed out, naturally, it's not uncommon for people to get ulcers. Their stomach is releasing a lot of these juices and acid. Also, they tend to get headaches so this can really effect people's GI system pretty significantly.

Dr. Bob: Do people recognize if they've got headaches, if they've got stomach problems, if they've get chest pain, if they get nervous, if they get upset easy, do people recognize that stress is doing this? Are there any tips that some people, I've got to get on a program.

Dr. Khatri: Well, you would think that people would recognize that stress is really effecting them. Unfortunately, people wait too long that they really, their body has to really fall down and break before they seek help but I typically tell people, "look at your emotional reaction. Do you feel distressed a lot? Do you tend to be upset? And then also notice your functioning. Are you functioning at your optimal level at work, with your family, with your friend? Are you living the live you would like to live?

Dr. Bob: Gosh, those are great, great questions. Are there tips that you can give people on coping with stress.

Dr. Khatri: Absolutely.

Dr. Bob: And that's what we are going to be talking about in a little bit. We'll be talking about tips that you can help handle your stress to make your life better, to make you handle illness better, to make you perform better at home, to make you a better person.

So, we'll be learning about those tips but first, let's talk to a patient that used stress management in their life to improve their quality of life.

Dr. Bob: Name me the different jobs that you have.

Missy Kane: Oh, how many hats do I wear? Well, I work for The Dr. Bob Show. I have a Missy Kane Fit and Fun Show.

Dr. Bob: That's a television show.

Missy Kane: Exercise television show and I'm health promotions coordinator for Covenant Health and work for Fox television occasionally with Track and Field.

Dr. Bob: And you're a mother.

Missy Kane: A Mother, first of all. A mother of two little girls.

Missy Kane: Wife, yes.

Dr. Bob: So, you've got about four jobs full-time. What do you do to manage stress? When there is just too much going on, what do you do?

Missy Kane: First thing that comes to mind is I usually get my exercise in. Even if it's 18 minutes. Sometimes I've had a day where I've got much juggling and I've got the baby and I may take her on a fast 18 minute walk with the dog and the baby at the same time. But after that walk, after about 15 minutes even, I can already feel like, you know, don't worry about that didn't get done or don't worry that you weren't perfect in that speech or whatever.

Dr. Bob: Now, so, you use exercise as one of the ways. Tell me about how do you find enough time to sleep? Do you get adequate sleep? You've got young children. You've got a husband. You've got to cook. You've got to get up. You've got to do certain things. How do you handle adequate rest and relaxation?

Missy Kane: I do, yeah, I think, that's a good point. Because I think when people exercise, one of the by-products from exercising regularly, is that when I go to sleep, I might read about five pages, I am out and I sleep throughout that entire night, 7 l/2 to 8 hours. So, I think exercise helps me. When I go to sleep, I do sleep. I don't get up through the night and I don't worry about things and another thing I do besides sleep, is I get a massage, a regular massage once a month. That's a treat to myself and I've read more studies about how they've had studies of infants even that massage will help those infants bond better so that just shows that massage can help our body reduce stress.

Dr. Bob: How about eating habits? What would be your advice on stress? Now do you think eating properly has something to do with it?

Missy Kane: Well even so many people will talk about when they are stressed out, that they really indulge in overeating and I think that is perfect. I love to have a piece of dark chocolate and that's one of the things I love but I think it is moderation and realizing that if you are going to straight to food when you are stressed out, that's going to make it even worse and just don't go to food without thinking about it. Don't stay up and eat up all those cookies and those cheese nips without thinking about it. Make eating a fun thing. Sit down with the family or with friends and make that an enjoyable time in your life.

Dr. Bob: We're talking with Dr. Parinda Khatri, clinical psychologist. We've been talking about stress, the different kinds of stresses. Everybody has stress because it's a change in your life and now we're going to be talking about some things that we can do to help handle that stress. Parinda, tell me. What would you like for people to know about stress management?

Dr. Khatri: Well, I think the first thing I would like people to do is to become more aware of the role stress plays in their life. Understand their specific reaction to stress. Stress can elicit physical reactions in people. It can elicit emotional reactions. Some people become very irritable, sometimes angry and sometimes sad. It can elicit more attention focusing problems what we call cognitive problems. People have a hard time paying attention and it can elicit behavior differences in people. They act differently when they are stressed. So you should know what's your specific stress response.

Dr. Bob: So, you have to know your specific stress response. Now, let's give some helpful tips on stress management. How do you tell people to handle different stress? I recognize mine as something makes me irritable or stress would be too much work to do but. Give me some examples in how people cope. Let's give some good tips.

Dr. Khatri: The first thing people need to do once they recognize their specific response to stress is, what are the triggers? When do they notice they get more stressed than others? Often I will ask people to keep a stress diary. And then what they need to do is beef up those coping resources. Make a list of all the things that help you cope with stress. Is it exercise?

Dr. Bob: So, exercise can help.

Dr. Khatri: Exercise is a wonderful way of coping with stress and not only but it is a great prevention tool, so you would tend to feel less stressed if you were exercising regularly.

Dr. Bob: Another one, I cut you off. Exercise is one.

Dr. Khatri: Social support is another wonderful way. Make sure you spend time with family, loved ones and friends. Not just talking with them about your stressers but also to do something fun with so they can be your companions and now you have someone to be close with.

Dr. Bob: So, having fun is an important way of losing stress. Now, some people just don't take time. How do you get people to have fun? I mean, what do they do?

Dr. Khatri: You know, people don't really understand the pay off of having fun. They think it's a waste of time or it takes away from their work. But, this is really good work. It's actually investing in yourself.

Dr. Bob: O.K. So, we've got exercise. We've got having fun, doing something that you really like to do with the family, social support.

Dr. Khatri: Social support. And then, also people need to learn to become good problem solvers. A lot of these other coping resources are good if you don't have control over a stresser. But if you do have control over a stresser, say it's financial stress or a problem at work, you need to learn to become a good problem solver so you can maybe even eliminate the stresser.

Dr. Bob: So, if finances would be a stresser, what you have to do is figure out why you are in financial trouble, get help. Is that what you do?

Dr. Khatri: Exactly. Sit down and look at what is the specific problem and generate some solutions for it.

Dr. Bob: What if, if I'm just having trouble sleeping, could that be stress?

Dr. Khatri: Absolutely, as I said, this physical response to stress can be having trouble sleeping. Also, for people appetite change. Some people eat more when they are stressed and some people eat less. hoarseness that way.

Dr. Bob: So, how do you tell people to handle it? I think you've already said, you recognize and then you problem solve.

Dr. Khatri: You problem solve if it is something you can control. Sometimes there are situations that you can't control and in that case, what you want to do is change your emotional reaction so you realize that stress is not something you can change but you can change the way you cope with you, you can change the way you think about it and this is what's the key. A lot of the stress we experience comes from up here. The way we look at life. The way we think about stress. The way we think about our live. And, in fact, we know that people who are optimistic, upbeat and more positive, they tend to experience a lot less stress and they cope with stress better.

Dr. Bob: When people say, I've just got too much to do, I just can't do it all, you can just see them just tightening up. What do you tell people that have just got too much in their bucket?

Dr. Khatri: Yeah. I think that the first step is they need to take an account of their life. And take some time and have some time in learning some stress management techniques and for some people that may mean time management and for some people, that may mean learning to be assertive, learning to say no that they've said yes to too many things.

Dr. Bob: Now, that's an educated art to be able to say no when people ask you to do too many things and you are too busy. Any other stress management techniques?

Dr. Khatri: I think the key is prevention. That if people recognize the role that stress plays, they recognize that it can be motivating but then they are already doing things that make them feel good, exercising, getting plenty of social support, building in that time for themselves, then that will reduce the overall level of stress. And then, always have a bunch of stress management techniques kinda in your pocket you can pull out whenever you are stressed.

Dr. Bob: I'm just smiling as I'm thinking here because one of the things I do is I exercise every night and I get on an elliptical stair stepper but after that I've got a heavy bag and I put on my boxing gloves and I'll hit the heavy bag. Now, what does that tell you about me? (laughter)

Dr. Bob: Is that a good stress reliever?

Dr. Khatri: That's a great stress relief. For you it may be the punching bag. For someone else, it may be a walk. For someone else, it may be swimming. So, everybody has their own special way of coping with stress.

Dr. Bob: You know, I've always looked at myself as and maybe it's what you said, I'm a happy person and I like what I'm doing and stress really doesn't bother me that much and I've always sort of said, well, I'm a quarterback on the football team and the quarterback can't be stressed and that's sort of is a coping mechanism. The information that you've given us has been wonderful. Any last words on coping?

Dr. Khatri: Well, I think it's important for people to understand that there are lots of different ways of coping with stress and there's no one perfect way. They have to find coping mechanisms that work best for them but also know that some coping, some coping strategies work best with some stressers and maybe not to others. So, always have lots of different strategies in your pocket and then learn to match it with the stresser.

Dr. Bob: When do you seek professional help?

Dr. Bob: Are there certain clinical psychologists that deal with stress management specifically or is that part of clinical psychology?

Dr. Khatri: It's part of clinical psychology but every psychologist has a different speciality. So, if you're going to go to a psychologist, I would interview them. I would ask them, do you specialize in stress? Can you help me with stress management?

Dr. Bob: Parinda, I want to thank you so much. You are a charming person.

Dr. Khatri: Thank you.

Dr. Bob: And I love listening to you about stress management and I know it has helped lots of people.

Dr. Khatri: Thank you very much.

Conclusion of Interview

Dr. Bob: And you're going to want to stay tuned. We're going to be talking about that cough with exercise. We'll be talking about oh, may be some things in the central nervous system. We'll talking about is smoking in public places dangerous to your health? You better bettcha.

Announcer: Up next on The Dr. Bob Show, Dr. Bob answers his mail.

Dr. Bob: I want to thank Dr. Parinda Khatri for a wonderful discussion on stress management. I think I'm going to keep on exercising and hitting that punching bag, that heavyweight bag. But also, getting enough sleep, eating properly, exercising, and having that laughter. Those are things that do all help on stress management. So, I hope we remember those things as we think about The Dr. Bob Show and we think about your health.

And now, some questions that I think you will enjoy.

Letters

Letter #1: Dr. Bob, how dangerous is athletic asthma?

Response #1: Well, we call that exercise induced asthma. There are some people when they exercise, they'll begin to wheeze. The airway will actually go into spasm and people can't get air in and out as well, really getting the air as well. Usually this occurs when people exercise for seven minutes and it's much worse if they are exercising in cold air. Air under 55 degree temperature or real dry air. So, if you're exercising in moist warm air, it's harder to get exercise induced asthma. If you do have exercise induced asthma, you need to think about some other problems. Are you waking up in the middle of the night with asthma? Are you having a little bit of wheezing at other times? When you laugh are you wheezing? If you've got any of those problems, you want to be sure you see your doctor, that you have appropriate lung studies and get on proper medicine, that's in exercise induced asthma.

If you do find that you cough and you wheeze when you exercise, and it is very, very common, there is a puffer called Albuterol. And you simply use the Albuterol before you go out and exercise and it will allow you to exercise without having exercise induced asthma. Don't let it keep you from exercising. Don't let it keep you from being the kind of person you want. There are some good excellent olympic athletes who have asthma and they have been well portrayed as using their Albuterol so that they can perform properly.

Letter #2: Dr. Bob, do you think cigarette smoking should be eliminated from all public places?

Response #2: I think that is sort of a loaded question. Should we not allow cigarette smoke in a public place? Well, and what are some of the actual scientific evidence? And there is some really interesting information available. If we look at some of the Greek communities where the males are the smokers, we find that the women in houses of male smokers have increased incidence of cancer, increased incidence of chronic obstructive lung disease, chronic bronchitis, heart disease so they get the problems of a smoker. Well, that's in a house. How about a restaurant? How about a bank? How about some other public places?

A very interesting study came out in the New England Journal of Medicine that measured the blood flow in the coronary vessels, the blood flow that supplies the heart its nourishment and what they found out was that people who smoke cut down their blood supply to the heart. And low and behold, what was so maddening and problematic was that if people breathed in somebody else's smoke, the reduction in their blood flow into the heart was very similar to a smoker. So, there are a lot of reasons where we should completely eliminate smoking from public places and even though that's a loaded question, I think it is a very important thing. In our society we have to step up to the fact that cigarette smoking does endanger our life. It increases the chances of cancer not just of the lungs but cancer of the bladder, cancer of the throat, the cause of heart disease and stroke , 400,000 upper respiratory infections from breathing in somebody else's smoke. A bad thing for our society and we need to be able to face those issues medically.

Letter #3: Dr. Bob, is there a relationship between the heart and stroke?

Closing

Dr. Bob: So that's all the time that we have for this show. I hope you have enjoyed it as much as I have. I hope you will be able to use stress management. You may need to be doing exercise or time management. I think it was a wonderful discussion. And now I leave you with those four things that I think are important to your life. #1. Exercising 20 minutes five, six or seven times a week. Start that day off with a breakfast of fruit and fiber. Get eight hours sleep and see what that does for your life and most of all, we want laughter in your life.

If you have a question for Dr. Bob, write to The Dr. Bob Show - 6700 Baum Drive, Suite 1, Knoxville, TN 37919 or send your e-mail to letters at letters@drbobshow.com