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M. P. Ravindra Nathan


Headlines such as "Air France Jet goes down in the Atlantic," "10 U.S. banks fail stress tests," "Tot kidnapped," "The hunt for Madoff's missing billions continues," etc., have become all too common. After 9/11 and the subsequent avalanche of calamities culminating in the current economic downturn, the worst since the Great Depression, you and I are on the verge of a veritable nervous breakdown. Hardly a day goes by without a major tragedy being reported.

During the past few months, I have seen my share of patients presenting with chest pains, fatigue, shortness of breath or other symptoms related to anxiety and stress. For many, it is not the big bad news in the daily newspapers that are bothersome. What happens in their daily lives is what nibbles them to death.

"I am 63 and I just lost my job, where am I going to get another one?" asked one of my patients.

"I have to do a million things every single day, get my children ready and take them to school, reach my work spot in time, do the grocery shopping and then get the dinner on the table before my husband gets home. There is no end to this daily grind," said a young mother during a casual conversation. Here is a totally stressed-out lady, I told myself.

The story of Dorothy, 75, was truly sad. Her BP was always high when checked in the office and it took me a while to get it under control. One day, she confided in me:

"My home is damaged by our 28-year-old grandson. He has ripped apart toilets, doors, carpets."

"Why on earth would he do that?" I asked in utter amazement.

"You know, Dr. Nathan, I am ashamed to say, he is into drugs and gets together with his junkie friends. Whenever we are away, he invades the house and throws wild parties. Finally, I called the police and got him arrested. Now, I am worried what he will do when he gets out of jail." She was literally weeping.

In short, stress has become all too pervasive in our lives. In today's go-go society, tension and rage run rampant as people begin to realize that the world has changed for the worst. 'Patience' is in short supply. Even if a particular tragedy reported in the media did not affect you personally, it still makes you jittery and anxious. Then there are the day-to-day irritations to cope with. People are working harder to maintain a decent lifestyle. To some, long hours and loads of work may be the way of life, but to many, this spells rapid burnout.

So, what is stress?

'The unpleasant reactions in the body to noxious or unpleasant external stimuli -'negative life events' - manifested as a multiplicity of symptoms,' would be a simple definition. Physiologically, when your body is under stress, the sympathetic nervous system gets stimulated and this rouses you to mount an effective 'flight-or-fight' response to the 'stressors' by secreting certain hormones such as cortisol, adrenalin, growth hormone, cytokines, etc.

These in turn stimulates your immune system triggering inflammation and other unwanted effects such as sweating, palpitations, fast heart rate, rise in blood pressure, etc. During this time, your parasympathetic system, which calms, relaxes and rejuvenates you, is turned off, so you lose its balancing and buffering effect. This takes a big toll on physical and mental health.

We need to distinguish 'stressors' (stressful life events) from psychological state of stress (feelings of threat, harm or loss) and stress responses (physiological, psychological or social consequences)

Stress can be manifested in the form of many common physical ailments. Psychologists will give you a standard questionnaire such as, "Do you feel irritable and snap at people? "Do you feel that your job performance is not up to par?" "Do you feel sex is not worth the effort" "Are you unable to concentrate on your work?" etc. And if you answered 'yes' to most of them, then you may be under stress.

A lot of people show behavioral changes like sleeplessness, anxiety, nervousness and depression. Some simply exhibit a variety of physical symptoms, because of the strong mind-body connection. There is hardly an organ or system in your body, adversely affected by stress. Keep in mind, stress is a diagnosis by exclusion; make sure you are not suffering from any organic disease by consulting a doctor.

Stressful jobs have been shown to have a direct biological impact on the body. Psychological stress poses a high risk for heart attacks; this became quite obvious after 9/11. Then there are diseases such as hypertension, ulcerative colitis or migraine, which can be aggravated by stress. The interesting fact is that most people, especially the executives, tend to deny if anything is wrong with them. But denial won't do, nor being indifferent. One has to accept the realities of life and take action. We are all aging fast and hence we must take steps to de-stress our lives.

"How to de-stress your life" . To be continued in the next issue.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville, lives in Brooksville.



The cheapest and most doable exercise at any age is walking. What do you need for a walk? Your destination and walking/running shoes. Where can you walk? Around your home, in your front or back yard, in the neighborhood, a gym, park, at the golf course, the beach or the trail. In short, everywhere on the ground!

We are in Florida, We have the best weather advantage, and yet we develop our life to be indoors. That is unfair to the body and mind. So, I would like to have you create the summer plan of being outdoors. Start with a 10-minute walk in the neighborhood or around your home and progress the duration up to 30 minutes minimum a day.

Walking is not a symptom-killing exercise; it is a preventive exercise. Walking make your entire body move. Your shoulder moves along with your walk, which gives normal movement to your upper body and keep the body in a proper posture. It relaxes the upper stiffed muscles by minor movements.

Your abdomen (stomach) muscles also are at work since other parts of the body need energy. Digestion becomes easier and metabolism increases. As digestion becomes rhythmic, you prevent acid reflux.

Your leg muscles, joints and lower waist benefit the most advantage from walking.

Think: Don't we all face a lower body pain or chronic problems after 40s?

We need to be careful with our movements after 40s; yet, if we perform constant exercises that help build our leg muscles and make our joints lubricated with appropriate movements, we do not need to worry about playing soccer with our kids.

Let's think of more common benefits of walking:

Managing your weight: If you watching the show "Biggest Loser," ask yourself: What is the first exercise that those trainers make each contestant perform? Walking. What is the last exercise that those trainers make each remaining contestant perform? Vigorous running. So, the key exercise to lose and manage the weight is walk or run.

Controlling your blood pressure: Walking makes your entire body move in proportion. Therefore, your body will create a normal rhythm of blood flow through the heart and the rest of the body. Daily walking with manageable diet will lower blood pressure and may even prevent blood pressure.

Decreasing your risk of heart attack and diabetes: Isn't it obvious that if you are in good shape, eating right and avoiding unhealthy lifestyle, your changes of chronic disease are low?

Follow the following tips to keep your promise of walking daily:

Walk with someone you like to talk to. Walk with your spouse, friend, kids, neighbor, etc. If the talking makes you breathe harder, then slow down your talk - not walk.

If there is no one available, make an iPod or music device your friend and listen to your favorite happy songs, which will increase your rhythm of walking.

Walk after lunch or dinner. It is easy to and beneficial. Take a 10-minute lunch break and go for a walk with a colleague.

Do this for a month and then we will progress it to running next month.

Achut Mashruwala of Fitness Guru Inc. can be reached at (813) 857-5103 or e-mail

Payal Patel

There comes a time in every toddler's life when parents feel it is the right time to start potty training. Therefore, many parents come prepared with a slew of questions about the right time for their child and how to proceed so as not to instill a fear of toilet training.

First, you have to assess whether your child is ready to toilet train or not. This is evident by the child demonstrating the ability to understand what pee-pee, poo-poo, potty or whatever term is used. The readiness is usually demonstrated at 15-18 months of age. Most children are ready by the time they are 2 years old to proceed to be completely trained and most children can be trained by the time they are 3 years old.

A child has to be able to understand what the toilet is for, and this can be learned by watching older siblings or parents using the potty. Also, a child signifies readiness to train when he or she can tell the difference between a dry and wet diaper and shows interest in changing so they are dry. Many children actually are able to tell you when they are about to wet their diaper or when they have to stool as well.

To help your child, read toilet-training books so they understand what they will have to do soon. Let them play with older children who are toilet trained so they see that it will be OK when they use the toilet. Teach them how the toilet works. Be positive and supportive of their trial and errors, and don't get frustrated, which they will be able to sense.

The best way to start training your child is by praising them when they are able to tell you if they want to pee pee or poop. Do not scold or punish them if they hesitate; instead, be patient and try to make it fun. Buy a potty seat together and let the child know why you are doing it. Let them feel like they are in control by purchasing the seat, bringing it home and then experimenting with it.

Let them sit on it with their clothes to get a feel of what it will be when they are ready. Praise them for doing it. Talk about a plan where action will entitle them to a reward such as stickers, or healthy treats such as raisins, crackers, etc. Practice first when you notice your child either saying pee pee or has signs they want to void or stool, and lead him to the potty. Encourage him to take his diaper off and sit on the potty. Try to make it comfortable by either holding a favorite stuffed animal, a toy or even reading their favorite book.

If they are able to do it, praise and reward him appropriately. If it does not go as planned, reassure your child that it's OK and to try again next time.

Your child may continue to have accidents during the day, which is perfectly normal. Let he or she know its OK and mommy or daddy is not mad, and that he/she will get it eventually. Once the child consistently uses the toilet, you can use pull-ups to encourage and give them a sense they are a big boy or girl. If your child refuses to train, stop training, until a few months later, or when they feel ready.

Dr. Payal Patel is a board-certified pediatrician at Sunshine Pediatrics, 18928 N. Dale Mabry Highway, Suite 102, Lutz. For information, call (813) 948-2679.

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