Break Up with Stress

April marks the beginning of a time filled with transition and activity. With so much happening this time of year, it can be very stressful for some, and it’s important we recognize this early. With the start of a new quarter, the countdowns towards the end of the school year, and even the segue into the heart of spring, stressful moments await; which is why April is recognized as Stress Awareness Month.

In small bouts, stress isn’t all bad. It may help motivate, perform under pressure, and even keep your body at a heightened level of sharpness. Conversely, when you’re under heavy amounts of stress, this can lead to major emotional, psychological, and even physical consequences. Today we’ll discuss ways of identifying stress, and also some of the best strategies to deal with it.

The International Stress Management Association (ISMA) lists the following ways to identify stress:

  • Psychological Signs
    • Memory lapses
    • Worrying
    • Negative thinking
    • Depression and anxiety
  • Emotional Signs
    • Mood swings and irritability
    • Lack of confidence and self-esteem
    • Feeling out of control
    • Extra sensitivity to criticism
  • Physical Signs
    • Weight loss or gain
    • Aches and pains as well as muscle tension and grinding teeth
    • Indigestion and heartburn
    • Hyperventilating and panic attacks
    • Menstrual changes and loss of libido
  • Behavioral Signs
    • No time for relaxation or pleasurable activities
    • Prone to accidents and forgetfulness
    • Social withdrawal
    • Insomnia
    • Increased reliance on alcohol, smoking, recreational or illegal drugs

Stress comes in different shapes and sizes, and will never affect any two people alike. While these effects vary, there are staple activities we all can do to help cope with, or eliminate stress. According to, here are some ways to cope:

  1. Get some fresh air – Sights, sounds and smells redirect your focus. Vitamin D from sunlight may elevate your levels of feel-good serotonin.
  2. Rely on rituals – A consistent routine not only helps you sleep, but our bodies naturally crave it. It can help take back control over part of the day.
  3. Get out of your head – Stress lingers on your mind so immerse yourself in creative, involving activities.
  4. Exercise – Exercise lowers the symptoms related with mild depression, boosts your energy, all while keeping you calm and focused.
  5. Express your gratitude – Writing down your feelings of gratitude and/or expressing them to friends, family, and other close ones, has positive impacts on the brain.

April is a great month that needs to be enjoyed and not hampered by stress. If you’re looking for more ways to celebrate the month, check out beliefnet on ways to garner recognition for stress awareness. Additionally, if you feel you may be exhibiting some of these symptoms, don’t rationalize them. Talk with your R-Health doctor for solutions.

The Truth About Menopause

Randi Protter, MD, FACP, NCMP

Menopause is natural and normal.  And sometimes so, so unpleasant. For many women, it’s also a bonding time – we wink when a colleague in a meeting deftly converts her handout to a make-shift fan, or when she peels off her cardigan to reveal a sleeveless top, regardless of the season.  The sisterhood unites when we glisten (we don’t sweat…)

Some women sail through, other women suffer.  There’s folklore and wives’ tales.  But what do we really know?  Lots!  And here is some info to help keep it real:

The average age of menopause in our country is 52.  Patients often ask for a hormone blood test to see if they are in perimenopause or menopause.  There is usually no need for this.  A woman’s hormonal status is determined by her monthly cycle history.  In perimenopause, women commonly notice changes in their monthly cycle years before their last and final period.  Sometimes there will be monthly skips, followed by months of regularity. Sometimes cycles will get closer together, and then further and further apart.  A woman is in the menopause when there has been no bleeding at all – not even one drop – for a full year.  If there is one drop of blood on day 364, the clock resets, and we wait for another full year.

Patients most commonly will seek treatment for the most annoying symptoms – hot flashes and night sweats.  Also top on the list – vaginal dryness, painful sex, insomnia, and weight gain.

Not every woman has symptoms associated with menopause, but for those women who do have symptoms, treatment is only indicated if the symptoms are bothersome.  Maintaining a normal weight, regular exercise, and quitting smoking (if applicable) may provide some relief of mild hot flashes.

Treatment for bothersome menopause symptoms should be customized, based on symptoms, coexisting medical conditions, and concurrent use of medications/herbs/supplements.    We have many non-hormonal and hormonal options, and many different ways to deliver the medication – oral, topical (patch, creams, gels, sprays, etc), and vaginal (creams, tablets, and rings).

The North American Menopause Society (NAMS) is a great menopause resource.

If you are having bothersome menopausal symptoms, discuss them with your R-Health doctor – some specialize in menopause medicine – they can help you through this sometimes challenging transition.

Be Responsible, Be Safe, Be Aware

April is Alcohol Awareness Month, a time to spread awareness about alcohol, alcoholism, and recovery. This month and movement not only serves as general awareness, but an opportunity for individuals to seek counsel and treatment with no judgment. Awareness has grown so much that the National Institution of Health started National Alcohol Screening Day, which is held every year on the Thursday of the first full week of April, allowing for free screenings of one’s alcohol usage.

Alcohol intake isn’t bad; however, excessive levels of consumption are very problematic and cause serious short and long term effects. Some of these may include the following:

Short Term

  • Slurring of speech
  • Emotional changes
  • Sleep disruption
  • Loss of bladder control
  • Temporary loss of consciousness

Long Term

  • Death of brain cells
  • Liver damage, which may result in cirrhosis (medical condition that may require liver transplant)
  • High BP
  • Memory problems (e.g. dementia)
  • Cancer of liver, colon, throat
  • Alcohol dependence (i.e. alcoholism)

While these effects are damaging they can easily be prevented when drinking responsibly. The online medical news outlet, VeryWell, published an excerpt on how to drink responsibly. Some of the main takeaways are:

  • Establish a drinking goal
    • Identify if you’re a suitable candidate for controlled drinking then establish a goal (i.e. Only drinking on weekends/events)
  • Calculate your limit
    • Discover your limit based on your Blood Alcohol Content (BAC) and keep track while consuming
  • Purchase alcohol in small, measured amounts
    • Don’t buy in bulk, purchase individual cans or bottles
  • Pace yourself
    • Remember your drink limit and coincide that with the pace with which you consume. Drink water and eat snacks in between as well.
  • Watch for peer pressure
    • Learn how to say no, and don’t stick around people encouraging you to drink too much.

As with most things, moderation is key. As you prepare for spring picnics and barbeques, always remember to drink responsibly, and most importantly, moderately. Talk with your R-Health doctor if you need help calculating your BAC level, or if you have questions on what’s best to consume for your body. Also, check out National Alcohol Screening Day this week, on the 6th and 7th.