I recently suffered a serious health scare. The stress from this malady clouded my cognition. There was sharp pain and burning that came in waves. It interrupted my sleep and affected my quality of life. Upon sharing my tragic condition with my wife she said, “Stop being such a baby”, as she laughed at my predicament that afflicts women routinely.


The urgency was of a urologic nature, and thankfully I have made a complete recovery and will not suffer from any adverse sequelae. As many of you know, for a male in their late 20s like myself, a urologic issue may involve the kidneys, bladder, prostate, gonads, and penis. In my career I have diagnosed urologic emergencies that cause excruciating pain, such as kidney stones, epididymo-orchitis, and even a penile fracture. Luckily for me, I did not have any of these debilitation conditions. My diagnosis, however, will surprise you.


It was a ho-hum, administrative Monday, mundane in every sense. Then, rather  insidiously, symptoms I have never had developed. These symptoms to me were terrifying and included urgency, frequency, dysuria, and nocturia. Thankfully, there was no blood in the urine. The reader may think, “doc you were afraid of a little UTI?” and you would only be partly correct. I am well aware of Sir William Osler's wisdom of “the doctor who treats himself has a fool for a patient”. Then I foolishly did a urine dip in my office, and although the results were equivocal, I started swallowing broad-spectrum antibiotics to cover for gram negative bugs…  My symptoms resolved with one dose, which was very curious. Then the symptoms returned with a vengeance. Naturally, I wonder if I have contracted a gnarly resistant bug and if I choose the antibiotic that would cover for a wicked gram positive superbug...That is when things become interesting with my possible erroneous self-diagnosis. 


As you know, I am not one to panic when it comes to medical issues and the sight of blood. I have held retractors in the operating room for 19 continuous hours, caught the H1N1 swine flu, spent 33 hours of continuous wakefulness in the ICU treating sepsis, removed infected toenails, and drained countless abscesses in the Navy. But when my apparent UTI symptoms worsened while I was self-medicating with strong antibiotics, I imagined the worst. I imagined a superbug shooting up my ureters and setting up shop in my kidneys. This would lead to acute renal failure and septic shock in a matter of hours. Act within minutes or die of septic shock, those were my options.


I had no other option but to go to the nearest urgent care to seek treatment after I finished my own clinic. The VA Clinic was closed, so I had no other choice. The blood work, urine, and urine culture at the local Urgent care all came back normal, and I was told to stop the antibiotics. It relieved me to know that I was not dying of sepsis, but then I got the medical bill and almost died of shock. For just a few minutes of time with a quack and a few routine tests, I experienced first hand what “price gouging” is as reported by Dr. Makary, MD, in his excellent book on the broken healthcare system titled, “The Price We Pay.”   


There you have it, a routine urologic issue, that became an urgency, and spiraled into an emergency. It was mostly self-created and perhaps secondary to the stress clustering of 2020. The Year of the Stress ClusterF***!


Is it 2021 yet?


We can all agree that 2020 has been and continues to be beyond stressful. The onslaught of traumatic events has been constant, beginning with the pandemic and quarantine, stay-at-home orders, social-distancing, mask mandates, anti-maskers, conspiracy theories, fake news, deep fakes, QAnon, unemployment, remote work/virtual school nightmares, and oh yeah, severe illness and death with 1.7 million deaths globally and more than 300K  Americans dead from Covid-19.


The ensuing social and political unrest and economic recession sparked embers that had been smoldering for centuries. To add insult to injury, devastating wildfires have ravaged Washington, California, and our beloved Oregon this summer. And smack dab in the middle of all this, civil rights icons John Lewis and Ruth Bader Ginsburg come to the end of their lives. The rushed supreme court appointment put us on a roller coaster of emotions culminating with an election that had us on the edges of our seats but felt more like being on the edge of a cliff. And now we have a supreme court that ignores science and will allow hundreds of people to congregate like packed sardines spreading COVID-19 like wildfire…


WTF?!?


I do not even want to go there. To say we can’t take anymore. I am the last person to want to tempt fate.


But, WTF?!?


In a report on stress and health disparities, the American Psychological Association (APA) defines the concept of stress clustering as “the accumulation of multiple stressors from different sources.” The APA continued,


the burdens associated with an initial stress exposure may be intensified if the original stressor initiates stressful event sequences—new stressors that occur because of the effects of the original event.



The APA explained further how this exacerbates health disparities, which I took a deep dive into a few months ago:


stress clustering is a phenomenon that is more common for individuals facing social and economic disadvantages. [It] can add to the overall burden of stress exposure and exacerbate disparities. 


I know that I don’t need to go into the snowball effect that poor leadership has had on the clustering of stressful events we are currently dealing with. But, piggy-backing on the APA’s definition of such phenomena, I hereby proclaim 2020: TYSCF


The Year of the Stress ClusterF***


And I think that the Oxford English Dictionary would concur.



The Silver Lining


With all my heart, I am putting the intention that we will be on a better course soon. It feels like the fate of our nation is still hanging in the balance, but the storm will pass, our current person-in-charge will eventually acknowledge defeat, and peaceful transfer of power will ensue. We will rebuild. It's happening...


Some days, I find it hard to keep the faith, but I will because, well, I have to. Because doing so is part of putting the oxygen mask on first. It’s a part of self-care, and it is non-negotiable.


Acknowledging that stress impacts our physiology, I am concerned about the wellbeing of my patients considering we are in TYSCF, the effects of which will be felt for years to come. 


However, there is something that we can do about it. Don’t worry my friends. I got your back. It ain't over til it’s over, and there is a silver lining to all of this.


The good news is that in a study conducted at the University of Wisconsin–Madison researchers’ findings suggested that awareness of the relationship between mental states and physiology is a key component to psychological and physical well-being.


So that means that just being aware of the impact of stress on our mind and body helps counteract the harm done?


Yep, that’s right. So let’s get to it.



Mind Over Matter?


Let’s not underestimate the effect of mindfulness-based stress reduction (MBSR) discussed in my April post, Staying in Control When You Feel Anything BUT That. fMRI studies have highlighted the fact that our minds wander up to 50 percent of the time. Especially in times like these, this wandering or “monkey mind” has the tendency of catastrophizing about the future creating fear and even more anxiety. It also ruminates and perseverate about the past leading to sadness and depression. And the fixation our wandering mind has with the “to do” list and all that needs to get done doesn’t help either.


As so many of you are already well aware, the solution to this is to return our thoughts to the present moment. Harvard studies show that when we bring our awareness to the present moment, we can access joy and happiness even in the midst of difficulty. Other ways to impact the wandering mind are attention to diet, exercise, stress management, and social support. These measures can have positive effects on our mental and physical states, even within a few minutes of practice.



Stress is Bad, or Is It?


I’ll leave you with this Ted Talk by Stanford professor Kelly McGonigal which will blow you away. McGonigal’s premise is that stress is only harmful ... if we believe it to be so. We can “reframe” our mindset and view stress as energizing our body for positive action. We can shift our belief about stress to activate the “tend-and-befriend” response and release healing hormones. Or when we are confronted with a stressor, if our mind interprets it as “bad” we activate the fight, flight, freeze response and release harmful hormones that lead to premature aging. 


What about those of use who have been fortunate in 2020 with a good job, healthy family, drinkable water, modern plumbing, transportation, plenty of food and shelter but still experience anxiety, depression, negativity, unhappiness, and grievances regularly? That is an enormous problem. There is a solution.


In Buddhist psychology there is a general unsatisfactoriness and pain that comes with existence and life becomes mundane and we experience mental suffering. This is known as “duhkha”.  Of course the pandemic has made the experience of duhkha worse in 2020, however, it will still be here in 2021. Will you be ready? In my next blog, I will share a powerful tool to deal with unhappiness and transform the mundane into magic!