Baptist HealthTalk

'Tis The Season Of Stress

December 08, 2021 Baptist Health South Florida
Baptist HealthTalk
'Tis The Season Of Stress
Show Notes Transcript

The most wonderful time of the year can also be the most stressful. Holiday preparations and gatherings are fun, but the stress of the season can put a strain on your physical and mental health. Studies have even shown that heart attacks are more frequent around Christmas and New Year’s. 

 Learn what you can do to combat the stress of the season and make the holidays merry and bright with host, Jonathan Fialkow, M.D., and a panel of experts from Baptist Health South Florida. 

 Guests:

·      Carlos Penaherrera, M.D., Associate Medical Director at Baptist Health Hospital in Doral
·      Carmen Barresi, L.M.H.C, psychotherapist with Community Health & Wellness at Baptist Health
·      Andrea Vitello, M.D., cardiologist at Miami Cardiac & Vascular Institute.

Announcer:
At Baptist Health South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist HealthTalk podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life.

Dr. Fialkow:
Welcome Baptist HealthTalk podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a Preventative Cardiologist and Lipidologist at Miami Cardiac and Vascular Institute where I'm also Chief of Cardiology at Baptist Hospital and the Chief Population Health Officer at Baptist Health. There are many great reasons why the holiday season is called the most wonderful time of the year. But while holiday preparations and gatherings can be fun, they can also be stressful, putting a strain on your physical and mental health. Studies have even shown that heart attacks are more frequent around Christmas and New Year's.

Dr. Fialkow:
What can you do to combat the stress of the season and make the holidays merry and bright? In today's podcast, I'll share some great advice I got recently when I hosted an episode of Baptist Health Resource Live program. My guests were Carlos Penaherrera, MD, Associate Medical Director at Baptist Health Hospital in Doral, Carmen Barresi, a Psychotherapist with Community Health and Wellness at Baptist Health and Dr. Andrea Vitello, a Preventative Cardiologist at Miami Cardiac and Vascular Institute. Let's hear what they had to say. Let's kick it off Carlos, with a question to you. We know that getting together for the holidays is stressful enough, and now we're throwing a pandemic into the mix. We can say it's normal for people to feel particularly stressed this time of the year. When it comes to family gatherings, are there any precautions that one should take regarding the pandemic and stress?

Dr. Penaherrera:
When it comes to getting together safely, the key thing is to keep in mind the wellbeing of yourself and your loved ones. So if you are going to do a gathering, ideally do it in an outdoor setting or a well ventilated place. And then if you are having any symptoms or concern potentially of any recent exposure, it'd be best to stay away.

Dr. Fialkow:
I think that's a great recommendation. I mean, people will sometimes want the urge to be with family, it could override common sense. So if someone's feeling a little sick or ill, stay at home. Somebody hearing my congestion and I developed just a respiratory cold, fortunately it wasn't COVID a few days ago and I had to cancel a bunch of family obligations because I didn't want to expose people. So I think Carlos, your recommendations are not just COVID related, but with any kind of infectious illness, wouldn't that be true?

Dr. Penaherrera:
Correct.

Dr. Fialkow:
Yeah. Great. Carmen, some people think that they tend to feel more depressed or anxious during certain seasons. Is there such a thing as seasonal depression?

Carmen Barresi:
Interesting enough, there is a clinical term known as seasonal affective disorder. That basically, what it means is that you're experiencing symptoms of depression. Now what makes it different from depression is that it starts off during the fall season, lasts through the winter months, and then once spring and summer comes, the symptoms kind of go away. Now there's a majority, and you tend to see it more up north, and some people will experience the symptoms in the spring and summer, but for the most part, you'll see the symptoms arise in fall and winter, and then it happens consecutive. So it's not that just one winter you're starting to feel depressed. You'll see it reoccurring.

Dr. Fialkow:
It's fascinating. Is it related to anything in the environment or is it related to festivities, time of year? Is that anyone able to address why it occurs?

Carmen Barresi:
It's related to the change in season and also think of the location. So Alaska and up north, where there's more rain and it's more gloomy. So that affects our vitamin D levels. So we're getting less exposure to the sun. That plays a role with our hormones and our levels of kind of mood. And we may feel a little more lethargic and moody. So it does play a role where we're at and the season, which is why it's attributed to seasonal depression.

Dr. Fialkow:
It's also a great time to mention that Baptist Health is providing free mental health visits this holiday season via the Baptist Healthcare on demand app. Use the code mindwell for anyone in the community, that's mindwell, one word, M-I-N-D-W-E-L-L. The promo codes valid through January 31st, 2022. Over to you Andrea, the pandemic has increased anxiety levels and combined with the normal stress of the holidays it could take a toll on heart health. How does stress affect the heart?

Dr. Vitello:
Great question. You know, stress is something that we all encounter every day, and this is just how our body deals with a certain situation. We release certain stress hormones like cortisol and epinephrine to be able to survive a stressful situation. And for a small period of time, that's probably very beneficial to be able to deal with a stressor. But in the long run, if you have prolonged exposure to cortisol and epinephrine levels, that can actually be very harmful to the cardiovascular system. Cortisol raises blood sugar, it increases blood pressure. Epinephrine raises heart rate. And those combination of factors, elevated blood sugar, elevated heart rate, elevated blood pressure, can actually be very detrimental to the cardiovascular system. In addition to that, beyond just the stress hormone response to stress, there are changes within our own behaviors for how we cope with changes to stress in our life.

Dr. Vitello:
And so some of these behaviors may not be so healthy, including increased tobacco and alcohol use, eating too much. So the stress eating type of behavior, or maybe not eating the right types of foods. Lack of physical activity, just because the stress seems to take over your time and you can't really include physical activity into your regular routine. Changes in weight, not taking medications regularly, maybe because of forgetting them or even maybe changes in your sleep can all negatively impact the cardiovascular system. And in very rare circumstances, but really in extreme situations, there can be a very profound response to stress, so-called the broken heart syndrome. But that's a rare cause and tends to be reversible, but can cause cardiomyopathy or a weakened heart and sometimes even heart failure.

Dr. Fialkow:
So you talk about quite a few components and there's hormonal components, so it's real physiology. When people are feeling that extra level of stress, they shouldn't beat themselves up. They shouldn't dismiss it, it's really happening. And then you talked about certain behaviors that happen during holiday time, which we can get into as well, that might make things worse. So it's a real phenomenon is the take home point. It's something we see as providers and people really experience. Yeah. So, Carmen, here we're talking about the holidays, it's supposed to be such a wonderful time of the year. But here we're talking about physical manifestations of stress through holiday time and other psychological manifestations. What is it about the holidays that makes people feel so anxious and nervous in your experience?

Carmen Barresi:
When we think about the holidays, it's a change from our day to day life. And just like Andrea mentioned, it's a response to change and exposure to something new. So when we think about whether we're feeling anxious or stressed, we may see it in our body, physical symptoms, but really what it comes down to is also how we're thinking about the situations. So oftentimes when it comes to holidays, we may be setting up some unrealistic expectations or high of expectations that cause us to feel more anxious and more stressed. In addition to that, another factor that may contribute to the elevated level of stress is think of the cost and the financial pressure that takes place during this time, whether it be traveling, hosting, gifts, all that plays a role and contributes to the increased level of anxiety, whether we perceive it or even think about it or create more pressure for ourselves.

Dr. Fialkow:
I think that's well said, it's the change in the routine. Everyone has coping mechanisms between work and finances and family relationships and their own personal needs. And then it gets disrupted with having to go to busy shopping centers for presents or scheduling dinners and family occasions. And of course, financially. And even in our cardiology practice, we would always say between Thanksgiving and Christmas, the anxiety level would creep up. People would want everything at the last minute. Deductibles were met. So if they have a medical problem, they would want it to be handled before the year is out. So I think these are all driving these types of trends in the stress that we're all seeing. And I think now we can pursue what we can do to mitigate it, which would be the next part of the conversation. So to Carlos, in terms of staying safe through the holidays, let's talk specifically now about booster shots and flu shots. And should people put those off because the holidays are coming up?

Dr. Penaherrera:
No, Jon, I think right now would be the time to have even more of a push to get these booster shots for COVID and then for the influenza virus. We're seeing more and more flu cases just throughout the community. And the CDC guidelines now are recommending that adults 18 years of age or older receive the COVID booster. If you had received the Moderna or Pfizer vaccine, six months after that second dose. Or if you received the Johnson & Johnson vaccine, two months after that first dose. And that's really just trying to protect as we see these new variants popping up both globally and locally. At the end of the day, we want to make sure that the holidays are as safe and fun as possible for everyone.

Dr. Fialkow:
And the vaccine, as you're saying, getting that shot, the booster and the shot, doesn't just protect you, but your family members who you'll be engaged with during the holidays. Speak a little bit though about potential side effects. We do know that people do have some side effects from the shots. So when people get a shot, should there be any planning involved regarding timing?

Dr. Penaherrera:
Yeah. So if ideally possible, you would have maybe a day or two as a buffer. You might develop some muscle aches, fever, headache, typical cold symptoms. Your body, when it receives a booster or the vaccine shot is basically gearing up those immune systems to try to fight off the virus if and when you are exposed to it. So it's not abnormal to feel those symptoms. And if you do, in that case, it's always nice to have a day of rest if possible.

Dr. Fialkow:
So, Andrea, you mentioned broken heart syndrome and acute intense stress, which can lead to heart dysfunction, which resolves. What about some of the other things that we hear in the cardiac world, Christmas coronary, or holiday heart? Can you just speak to it a little bit. But more importantly, what are the symptoms one may experience that we would recommend they then say, I need to get taken care of.

Dr. Vitello:
So, holiday heart and Christmas coronary are certainly sometimes seasonal related cardiovascular disorders, seemingly, but holiday heart really speaks to an alcohol induced arrhythmia. And said another way, it's really associated with increased amounts of alcohol intake, which can negatively affect the heart rhythm. And so people can present with atrial fibrillation, that's the very common heart rhythm disorder, specifically because of increased alcohol use in someone without other evidence of cardiovascular disease.

Dr. Vitello:
And so atrial fibrillation oftentimes presents with the feelings of a rapid heartbeat or an irregular heartbeat. Maybe sometimes the feeling that you might not be able to catch your breath or that you feel a little bit anxious or jumpy or that even your chest might feel like it's quivering a little bit. Usually this is a reversible disorder if you stop drinking alcohol or dramatically reduce the amount of alcohol that you are consuming. But if it's left untreated, it can actually cause heart failure or other cardiovascular disorders.

Dr. Vitello:
So very important to recognize the signs and symptoms of this and recognize if maybe this is why you might be experiencing holiday heart, so to speak. And there's not really one test that you can check that says, oh that's definitely holiday heart. It's really an EKG would be able to diagnose an abnormal heart rhythm disorder and then putting everything in context that could help you understand this is maybe what's going on.

Dr. Vitello:
A Christmas coronary, as you mentioned, is something slightly different. And as you know, around the times of the holidays, there's a spike in stress and cardiovascular disease. There's a peak in cardiovascular death specifically around the December, January timeframe. And there's a lot of factors that are responsible for this, increased emotional stress, overindulgence, poor dietary choices, respiratory problems, maybe the viral infection doesn't necessarily have to be COVID related, but other viral infections, being around particular matter, a wood burning fireplace, for instance, if you're visiting someone you're not usually around, that can lead to respiratory disorders.

Dr. Vitello:
And these can certainly increase the risk for cardiac events. And lastly, delaying or delaying seeking medical care for symptoms that you might not be fully aware of, or just trying to ignore until the holiday festivities are over, is particularly dangerous. So really not wanting to ruin anyone's holiday plan, so they wait until the family's gone before they seek medical care for, for instance, a heart attack. And those signs and symptoms of a heart attack can be chest discomfort, pain, pressure, heaviness, tightness, difficulty breathing. Those are some of the symptoms, but really delaying seeking medical care for that can substantially raise your risk for a very serious cardiovascular event.

Dr. Fialkow:
I think your last comment is most cogent. I'm sure Carlos can agree. We always know in the cardiology world, the busiest day is not Christmas day, it's after Christmas, it's after New Year's. And the vast majority of the people coming in with cardiac conditions, they started prior to the holiday. And obviously that can lead to more catastrophic concerns. So not denying your symptoms and getting them checked out. No one wants to be in the hospital during the holidays, but obviously your health and getting it checked out is more important and will allow you to have more holidays with your family in the future. So keep that point in mind above all the others. So now some tips on how we can manage the stress. So Carmen, what tips can one take to manage the stress levels that occur during the holiday season?

Carmen Barresi:
A good place to start is to acknowledge how you're feeling and to recognize that you're not the only one that's feeling a little bit more stressed during the holidays or during this season. Once you do that, you can practice some tips that'll be helpful to help minimize some of the added stress or anxiety that you may be feeling. For example, one of the things that you could do is reach out or identify who you can go for for help. So here's a scenario. You you order five presents. You realize they won't make it on time. Amazon won't have them delivered on time. So now you have to resort to curbside pickup, and you're finding yourself having to drive all over south Florida in two days. So identify who you can reach out to, maybe a friend, a family member that lives near the Target or the store that you need to pick up the gift from and ask for help.

Carmen Barresi:
Another thing that could be helpful is if you're feeling isolated or alone, find out, there's support available online. You mentioned the code for virtual counseling or opportunities to volunteer, especially during this time of we're feeling a little disconnected or isolated, don't wait until it's too late, or your symptoms get worse to get the help. Another tip that may be helpful is to be flexible. Sometimes we set up these expectations for ourselves. We're not perfect and neither are holidays. So be flexible and mistakes may happen and roll with it. That'll help ease some of the normative stress and even the heightened anxiety that we'll experience during this time. And lastly, it's okay to say no. During this time, we'll get a lot of invitations. We'll get a lot of requests and we may find ourselves spreading ourselves thin. But remind ourselves, it's okay to say no and ask for help and seek support if needed.

Dr. Fialkow:
So, as we've spoken about emotional components of stress and holiday time and physiological components, one thing that really happens of course, are injuries. So, Carlos, what kind of injuries do you see in the emergency department during the holidays? And would there be any kind of precautions that one should take to avoid holiday season related injuries?

Dr. Penaherrera:
Yeah, so the holidays are very active for many people in terms of running to get presents, putting up decorations. We do see a lot more traumatic injuries. So from fender benders to falling off of ladders while you're trying to put Santa Claus on the roof or lacerations or cuts due to cutting Christmas wrapping paper I think it's a good thing to take pause when we're doing our activities. Take your time. A lot of times we're just rushing to try to get to the next task, especially during this holiday season where we aim to please our loved ones and family members, and we sometimes lose track of taking care of ourselves. So really just taking your time, I think, during this time and if there's any concern or you do think you need to seek attention, not delaying it as it was mentioned earlier.

Dr. Fialkow:
Now again, back to the heart. You elucidated various drivers of stress and cardiac conditions during the holidays. What are things one can do during holiday seasons to decrease the chances of any cardiac issues?

Dr. Vitello:
As you mentioned, Jon, avoiding some of those triggers, including increased alcohol, tobacco, those types of substances, but they can come in hidden forms as well. You know, you might receive a gift, the gift basket that has holiday ham or processed meats and those tend to be very bad for cardiovascular health. Being mindful of the types of foods that you are consuming. Eggnog has a lot of eggs and high fat dairy, which is not so good for cardiovascular health. A lot of cheese, loaded with sodium and cholesterol. Opting for a more plant based diet in making those types of dietary choices.

Dr. Vitello:
In addition, when you are being invited to go to various holiday festivities, don't go to a party hungry. You might want to plan in advance what your strategy for eating at that event might be. Fill your plate only once, don't go back for seconds or thirds. Maybe pick one thing that you might want to indulge on for the holiday season, but don't do it excessively, not two, three, four, five, 12 days of holiday indulgence. Maybe just the one time. Try to stick to healthy exercise habits. So if you go for a walk every day for 15 minutes, try to stick to that and know that it's just as important as everything that you do every single day. And again, don't delay seeking help if you notice symptoms that seem out of the norm for you.

Dr. Fialkow:
Well, it's great information guys. I'll ask you if you have any final comments, anything you want to add that wasn't said or restate a priority? Carmen, any final comments or thoughts?

Carmen Barresi:
Sure. A quote that came into mind, a saying, is you can do anything but not everything. And I think that's important as we go into the holiday season to keep that in mind. We mentioned and highlighted that taking care of ourselves and prioritizing our health and sometimes that stress related to holiday, we may not pay attention to kind of our thoughts and how we're feeling. So keep that in mind and prioritize not only your health and also what needs to go on to plan accordingly for the holidays. Plan ahead and be kind to yourself, especially during this season.

Dr. Fialkow:
To our listeners, remember that you can send us your comments and suggestions for future topics at BaptistHealthTalk@baptisthealth.net. That's BaptisthealthTalk@baptisthealth.net. On behalf of everyone at Baptist Health, thanks for listening and have a safe and healthy holiday season.

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