Caring for and listening to patients fuels my passion for the practice of Emergency Medicine-- until flu season! This year we have not even reached the traditional seasonal flu season (Dec-Feb) and we are caring for scores of patients with "influenza like illness" or confirmed cases of Swine Flu (H1N1) infections. Decided it's time to talk about influenza and stress.

Ongoing stress suppresses the immune system. Having a suppressed immune system makes you more venerable to all kinds of illnesses- including influenza. Here is how it works.

The immune system protects the body from foreign organisms including; bacteria, viruses, parasites, fungi, cancerous and other disease cells. Usually are intact mucous membranes block most foreign substances. The immune system can identify and eliminate foreign substances by detecting foreign surface proteins that differ from your body proteins.

There are two types of responses when foreign things invade the body. A nonspecific response and a specific immune response. The most common nonspecific response is inflammation. Inflammation involves increased blood flow to an area of invasion. The blood contains substances which produce the redness warmth and irritation you experience as inflammation. The immune specific response is made up of white blood cells. There are four types of specific immune cells; macrophages,B cells, T cells, and natural killer cells. B cells produce antibodies which can provide immunity.

Immunity is a term used in the TV show survivor to mean that a group has been previously exposed to something and is no longer at risk of being kicked off the show--but only that specific episode. Immunity in your body is a very specific and rapid response to a foreign microorganism based on previous exposure. After exposure, generally you are no longer at risk for getting that disease--but only that specific episode.

Vaccination is the way to induce immunity. A weakened form of the virus or bacteria is into your body to simulate the production of antibodies. Your immune system is strengthen specifically to reduce your risk.

Here is the link with stress. There is overwhelming evidence that stress reduces the effectiveness of the immune system. What about 'colds' and influenza? Almost 20 years ago a rigorous study by Dr. Sheldon Cohen of Yale University published in the New England Journal of Medicine, Psychological Stress and Susceptibility to the Common Cold. 154 men and 266 women all in good health were given nasal drops containing a low infectious dose of one of five respiratory viruses. Three valid measures of psychological stress were used. Subjects were determined to have the cold if they had detection of the virus, a significant increase in antibodies to the virus, and if the subject imposition rated symptoms demonstrating the presence of a clinical cold. The results demonstrated that rates of both respiratory infection and colds increased in a ' dose dependent' manner. Higher stress levels resulted in higher infection rates. Specifically, infection rates (evidence of increased antibodies or presence of the virus) range from approximately 74% to approximately 90% depending on the level of psychological stress. The incidence of clinical colds (runny nose, cough, congestion etc) range from approximately 27% to 47%. These results were not altered when controlled for age, sex, education, Allergic status, or the number of subjects house together or the infectious status of the various subjects sharing the same housing.

Common infectious respiratory tract diseases are by no means equally contagious. Flu refers to illnesses caused by a number of different influenza viruses. Flu can cause a range of symptoms and effects, from mild to lethal.

Two strains of flu, seasonal flu and the H1N1 (Swine) flu, are currently circulating in the United States. The good news is most healthy people recover from the flu without problems, but certain people are at high risk for serious complications. (go to www.flu.gov for excellent information and answers to common questions)

The likelihood that an organism will spread from one person to another (transmissibility) and that disease will result (contagion) is determined by many factors including the status of your immune system. (see figure below) In addition to whatever remedy you use to reduce your risk for H1N1- think about focusing on how you manage your stress to reduce your risk of getting influenza.

Here are a few quick tips to better manage your stress and stay healthy this flu season:

1. Energy. Don't forget what you learned in high school physics. Energy is a capacity. Unlike time which is finite. We often get these concepts confused. Go for the low hanging fruit. Right now, identify two situations or tasks that require a great deal of emotional or physical energy that are a drain on your capacity. Make a commitment to make an adjustment--today.
2. Purpose. Revisit your purpose. Who you are and what you really are meant to do. What is important to you. Think of your purpose is the fuel that drives your efforts every day. Keep your purpose or personal mission sharply in focus as you make choices throughout the day.
3. Simplify. You thought of doing this before --now is the time to act. revisit the tasks that are time consuming and not necessarily related to your mission. Ask yourself the following questions: is this really necessary to be done at all? Is it necessary to be done so frequently? Is there an alternative? What would happen if it were not done at all? Can somebody else do it?
4. Sleep. Sleep allows your body to recover. Revisit your schedule and plan to get seven hours of sleep every night. If you are a worrier and that 'to do' list just can't get out of your mind here's a solution. schedule 10 minutes just before you go to bed to do a mind dump of all the things that are worrying you on a pad beside your bed. If you really can't let it go, keep a pen light beside the bed or your electronic device and make a record of what's on your mind let it go and go back to sleep.
5. Revisit your Relationships: The single greatest cause of stress for most people is related to interpersonal relationships. Make a commitment to revisit unresolved conflicts. I always see it in the ER at the bedside of someone with an unexpected critical or life threatening illness. Say it now. Think about forgiveness. Also, everyone need someone talk about your true feelings, share on a regular basis your fears, your worries, your hopes, what delights you, and what scares you. It is important to have someone you can really talk to without worrying about being embarrassed, making a good impression, or appearing silly. Make a plan to communicate regularly with this person or persons in your life.
6. Guilt: Most often due to 'should s' and 'musts' either self imposed or your unconscious acceptance of someone else's ideas. Replace I should with I choose to. Eliminate any ambiguity about what you you expect and what is expected from you at home and at work. What constitutes fulfillment. Be specific! Get rid of the guilt.
7. Exercise. Just increased physical activity will directly and immediately provide tangible benefits in reducing stress and promoting relaxation. The natural release of endorphins from continuous exertion is a healthy alternative to artificial stimulants and depressants. Exercise also promotes a natural cycle of sleep.
8. Personal Demand Management. Time is finite. Only you know the value of your time. Think about how to say "NO" yet again.
9. Control. Rethink what you want and need to control. Recognize issues, situations that are beyond your control and create a plan to avoid ongoing stress.
10. RELAX. True Relaxation is a mind and body state that is the opposite of the stress state. Relaxation is a natural and innate protective mechanism each of us possesses. Relaxation involves learning a simple set of skills that produce a very specific biologic response --the relaxation response. Combined with specific 'mind-shifting' techniques, I call this experience a PowerPause. The relaxation response which was discovered when Dr. Herbert Benson, then the director of the hypertension section of Boston's Beth Israel Hospital studied the physical and mental effects of a variety of methods of evoking a calm state, including yoga and several forms of meditation. The PowerPause triggers the release of anti-stress hormones, decreases your heart rate, and lowers your metabolic rate and your rate of breathing right at your desk! To learn more go to: http://www.stressreliefcoach.com/files/mp3/Track7.mp3

Next blog....Holiday Stress.

Learn more about my new book; Optimal Stress: Living in Your Best Stress Zone. 

http://www.wiley.com/WileyCDA/WileyTitle/productCd-0470068515.html

Available for pre order now at Amazon.  .

http://www.amazon.com/s/ref=nb_ss?url=search-alias%3Daps&field-keywords=optimal+stress&x=15&y=19