Cortisol: Understanding and Coping with Stress

Some people may not be aware that your body stores a hormone called Cortisol. This hormone in your body, as explained to me by an Emergency Room doctor, is your body's main stress hormone. It controls your mood, fear, and motivation. Since I was only given a brief explanation of cortisol in the Emergency Room, I decided to write an article about it to help spread the knowledge around, but also give techniques and coping mechanisms to help you in times of stress.


According to an article from The Mayo Clinic,

"Chronic Stress puts your health at risk

Chronic stress can wreak havoc on your mind and body.

Your body is hard-wired to react to stress in ways meant to protect you against threats from predators and other aggressors. Such threats are rare today, but that doesn't mean that life is free of stress.

On the contrary, you undoubtedly face multiple demands each day, such as shouldering a huge workload, making ends meet and taking care of your family. Your body treats these so-called minor hassles as threats. As a result you may feel as if you're constantly under assault. But you can fight back. You don't have to let stress control your life.



Understanding the natural stress response

When you encounter a perceived threat — a large dog barks at you during your morning walk, for instance — your hypothalamus, a tiny region at the base of your brain, sets off an alarm system in your body. Through a combination of nerve and hormonal signals, this system prompts your adrenal glands, located atop your kidneys, to release a surge of hormones, including adrenaline and cortisol.

Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain's use of glucose and increases the availability of substances that repair tissues.

Cortisol also curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with regions of your brain that control mood, motivation and fear.

When the natural stress response goes haywire
The body's stress-response system is usually self-limiting. Once a perceived threat has passed, hormone levels return to normal. As adrenaline and cortisol levels drop, your heart rate and blood pressure return to baseline levels, and other systems resume their regular activities.

But when stressors are always present and you constantly feel under attack, that fight-or-flight reaction stays turned on.

The long-term activation of the stress-response system — and the subsequent overexposure to cortisol and other stress hormones — can disrupt almost all your body's processes. This puts you at increased risk of numerous health problems, including:

Anxiety
Depression
Digestive problems
Headaches
Heart disease
Sleep problems
Weight gain
Memory and concentration impairment
That's why it's so important to learn healthy ways to cope with the stressors in your life.


Why you react to life stressors the way you do


Your reaction to a potentially stressful event is different from anyone else's. How you react to stressors in your life is affected by such factors as:

Genetics. The genes that control the stress response keep most people on a fairly even keel, only occasionally priming the body for fight or flight. Overactive or underactive stress responses may stem from slight differences in these genes.

Life experiences. Strong stress reactions sometimes can be traced to traumatic events. People who were neglected or abused as children tend to be particularly vulnerable to stress. The same is true of people who have experienced violent crime, airplane crash survivors, military personnel, police officers and firefighters.

You may have some friends who seem laid-back about almost everything and others who react strongly at the slightest stress. Most reactions to life stressors fall somewhere between those extremes.



Learning to react to stress in a healthy way

Stressful events are a fact of life. And you may not be able to change your current situation. But you can take steps to manage the impact these events have on you.

You can learn to identify what stresses you and how to take care of yourself physically and emotionally in the face of stressful situations.



Stress management strategies include:

Eating a healthy diet and getting regular exercise and plenty of sleep
Practicing relaxation techniques such as trying yoga, practicing deep breathing, getting a massage or learning to meditate
Taking time for hobbies, such as reading a book or listening to music
Fostering healthy friendships
Having a sense of humor
Volunteering in your community
Seeking professional counseling when needed
The payoff for learning to manage stress is peace of mind and — perhaps — a longer, healthier life."

Source: Cortisol Pathway




According to the American Psychological Association,

"Stress Weakens the Immune System


What the Research Shows

Stressed out? Lonely or depressed? Don't be surprised if you come down with something. Psychologists in the field of "psychoneuroimmunology" have shown that state of mind affects one's state of health.

In the early 1980s, psychologist Janice Kiecolt-Glaser, PhD, and immunologist Ronald Glaser, PhD, of the Ohio State University College of Medicine, were intrigued by animal studies that linked stress and infection. From 1982 through 1992, these pioneer researchers studied medical students. Among other things, they found that the students' immunity went down every year under the simple stress of the three-day exam period. Test takers had fewer natural killer cells, which fight tumors and viral infections. They almost stopped producing immunity-boosting gamma interferon and infection-fighting T-cells responded only weakly to test-tube stimulation.

Those findings opened the floodgates of research. By 2004, Suzanne Segerstrom, PhD, of the University of Kentucky, and Gregory Miller, PhD, of the University of British Columbia, had nearly 300 studies on stress and health to review. Their meta-analysis discerned intriguing patterns. Lab studies that stressed people for a few minutes found a burst of one type of 'first responder' activity mixed with other signs of weakening. For stress of any significant duration - from a few days to a few months or years, as happens in real life - all aspects of immunity went downhill. Thus long-term or chronic stress, through too much wear and tear, can ravage the immune system.

The meta-analysis also revealed that people who are older or already sick are more prone to stress-related immune changes. For example, a 2002 study by Lyanne McGuire, PhD, of John Hopkins School of Medicine with Kiecolt-Glaser and Glaser reported that even chronic, sub-clinical mild depression may suppress an older person's immune system. Participants in the study were in their early 70s and caring for someone with Alzheimer's disease. Those with chronic mild depression had weaker lymphocyte-T cell responses to two mitogens, which model how the body responds to viruses and bacteria. The immune response was down even 18 months later, and immunity declined with age. In line with the 2004 meta-analysis, it appeared that the key immune factor was duration, not severity, of depression. And in the case of the older caregivers, their depression and age meant a double-whammy for immunity.

The researchers noted that lack of social support has been reported in the research as a risk factor for depression, an insight amplified in a 2005 study of college students. Health psychologists Sarah Pressman, PhD, Sheldon Cohen, PhD, and fellow researchers at Carnegie Mellon University's Laboratory for the Study of Stress, Immunity and Disease, found that social isolation and feelings of loneliness each independently weakened first-year students' immunity.

In the study, students got flu shots at the university health center, described their social networks, and kept track of their day-to-day feelings using a handheld computer (a new technique called "momentary ecological awareness"). They also provided saliva samples for measuring levels of the stress hormone cortisol. Small networks and loneliness each independently weakened immunity to a core vaccine component. Immune response was most weakened by the combination of loneliness and small social networks, an obvious health stress facing shy new students who have yet to build their friendship circles.



What the Research Means

Emerging evidence is tracing the pathways of the mind-body interaction. For example, as seen with the college students, chronic feelings of loneliness can help to predict health status -- perhaps because lonely people have more psychological stress or experience it more intensely and that stress in turn tamps down immunity. It's also no surprise that depression hurts immunity; it's also linked to other physical problems such as heart disease. At the same time, depression may both reflect a lack of social support and/or cause someone to withdraw from social ties. Both can be stressful and hurt the body's ability to fight infection.

All of these findings extend what we know about how stress management and interpersonal relationships can benefit day-to-day health, doing everything from helping us combat the common cold to speeding healing after surgery. The research is in synch with anecdotal reports of how people get sick in stressful times, but understanding exactly how psychology affects biology helps scientists to recommend the best ways we can build up immunity.



How We Use the Research

Managing stress, especially chronic or long-term stress (even if it's not intense), may help people to fight germs. When burdened with long-term stressors, such as caring for an elderly parent or spouse with dementia, health can benefit from conscientious stress management.

Kiecolt-Glaser and Glaser confirmed this hopeful option by comparing the immune function of exam-stressed medical students given hypnosis and relaxation training with that of students without training. At first, the immune responses of the two groups appeared to both go down. However, closer inspection revealed that some students took this exercise more seriously than others. Those who didn't take relaxation training seriously didn't fare so well; those who practiced conscientiously did actually have significantly better immune function during exams than students who practiced erratically or not at all.

Finally, the newest findings on social stress underscore the value of good friends; even just a few close friends can help someone feel connected and stay strong. Social ties may indirectly strengthen immunity because friends - at least health-minded friends -- can encourage good health behaviors such as eating, sleeping and exercising well. Good friends also help to buffer the stress of negative events.



Sources & Further Reading

Edwards, K.M., Burns V.E., Reynolds, T., Carroll, D., Drayson, M., & Ring, C. (2006). Acute stress exposure prior to influenza vaccination enhances antibody response in women. Brain, Behavior, and Immunity, 20:159-68.

Glaser, R., Sheridan, J. F., Malarkey, W. B., MacCallum, R. C., & Kiecolt-Glaser, J. K. (2000). Chronic stress modulates the immune response to a pneumococcal pneumonia vaccine. Psychosomatic Medicine, 62, 804-807.

Glaser, R., Robles, T. F., Malarkey, W. B., Sheridan, J. F., & Kiecolt-Glaser, J. K. (2003). Mild depressive symptoms are associated with amplified and prolonged inflammatory responses following influenza vaccination in older adults. Archives of General Psychiatry, 60, 1009-1014.

Kiecolt-Glaser, J. K., Glaser, R. (1993). Mind and immunity. In: D. Goleman & J. Gurin, (Eds.) Mind/Body Medicine (pp. 39-59). New York: Consumer Reports.

Kiecolt-Glaser, J. K., & Glaser, R. (2002). Depression and immune function: Central pathways to morbidity and mortality. Journal of Psychosomatic Research, 53, 873-876.

Kiecolt-Glaser, J. K., McGuire, L., Robles, T., & Glaser, R. (2002). Psychoneuroimmunology: Psychological influences on immune function and health. Journal of Consulting and Clinical Psychology, 70, 537-547.

Kiecolt-Glaser, J. K., McGuire, L., Robles, T., & Glaser, R. (2002). Psychoneuroimmunology and psychosomatic medicine: Back to the future. Psychosomatic Medicine, 64, 15-28.

Pressman, S. D., Cohen, S., Miller, G.E., Barkin, A., Rabin, B. S., Treanor, J. J. (2005). Loneliness, Social Network Size and Immune Response to Influenza Vaccination in College Freshmen, Health Psychology, 24, pages.

Robinson-Whelen, S., Tada, Y., MacCallum, R. C., McGuire, L., & Kiecolt-Glaser, J. K. (2001). Long-term caregiving: What happens when it ends? Journal of Abnormal Psychology, 110, 573-584.

Segerstrom, S. C. and Miller, G. E. (2004). Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychological Bulletin, Vol. 130, No. 4."

Source: Cortisol Effects.





According to the Cleveland Clinic,

"Understanding and Managing Gastroparesis


Description

Gastroparesis is rapidly becoming a common diagnosis. This mysterious illness reduces the ability of the stomach to empty its contents. It can be especially detrimental to people with diabetes.

Gastroparesis is caused by damage to the vagus nerve. In its normal state, the vagus nerve contracts (tightens) the stomach muscles to help move food through the digestive tract. In cases of gastroparesis, the vagus nerve is damaged by diabetes and/or high blood pressure. This prevents the muscles of the stomach and intestines from working properly, which keeps food from moving from the stomach to the intestines. Gastroparesis is a chronic (long-lasting) condition. This means that treatment usually doesn’t cure the disease, but you can manage it and keep it under control.



About the Speaker

Michael Cline, DO, was appointed to Cleveland Clinic in 2012 with the department of Gastroenterology and Hepatology. Dr. Cline completed medical school at Ohio University College of Osteopathic Medicine in Athens, Ohio. His specialty is gastroparesis, and he offers treatments such as colonoscopy, gastric pacemaker, gastric pacer, and other general treatments and services for gastrointestinal diseases.




Let’s Chat About Gastroparesis

The Bottom Line


SamSeven: What is gastroparesis?

Michael_Cline,_DO: If you split gastroparesis into two words, it is by definition: Gastro (stomach) paresis (paralyzed) = slow stomach.

MapleLeaf: What are the symptoms of gastroparesis?

Michael_Cline,_DO: The typical systems are nausea, vomiting, abdominal pain, bloating and belching.

keroppi: Can gastroparesis cause pain on the left side, about an inch under your rib, that tends to worsen after eating? I've had this for years since I've been diagnosed. (Ultrasound, MRI and PET scan were done around that time, and were all normal.)

Michael_Cline,_DO: Gastroparesis can cause pain in some patients, but other sources including neurologic causes need to be ruled out.

Tests and Diagnosis
Fullmoon: Are their certain tests that will confirm I have gastroparesis? Are these tests accurate?

Michael_Cline,_DO: Basically, nuclear gastric emptying and a test called the wireless motility capsule are used. There can be a problem with the nuclear test, depending on how it is done. To be accurate, it really has to be a four-hour test done with scrambled eggs and nothing else.

ycco: Is a gastric emptying test not sufficient to diagnose gastroparesis? I had an abnormal one more than ten years ago and was told I just had "slow motility". Fast forward to three years ago when my health (not just my stomach) took a turn for the worse, I learned about gastroparesis, and it makes me wonder why I was never given the diagnosis back then, as I had the "classic symptoms" and an abnormal gastric emptying test. Thank you.

Michael_Cline,_DO: The gastric emptying test, if it is done the right way (four hours and with solid food), is one of the better tests we have. The problem is it does not coordinate with symptoms, so if it is abnormal, the numbers don't really mean anything.

holleywilliams: What is a good indicator of the need to move ahead to enteral feeding, a percent of weight loss over a defined period of time? Or would it be the length of time without adequate oral intake?

Michael_Cline,_DO: Typically, we don't want patients to lose more than 10 percent of their ideal body weight in three to six months. Another parameter is abnormal lab work suggesting malnutrition.

Fremont: Is the gastric emptying study the only way to diagnose gastroparesis? I've had it three times by three different providers. Two diagnosed mild gastroparesis, the third said it was normal (Mayo Clinic). I understand this test only represents how your stomach empties that particular day. I have pretty major symptoms and get so full so fast, can really only eat one meal and graze the rest of the day. I've also had obstructions just below the stomach. Is this related? Are there other tests that can accurately diagnose this condition?

Michael_Cline,_DO: Your history of having had multiple tests with various outcomes is fairly consistent with what we see regularly. That is one of the problems with the nuclear emptying test, especially when it’s borderline normal/abnormal, in proving whether or not someone truly has gastroparesis.

holleywilliams: Can you be more specific about what you mean by "global dysmotility" and "diffuse dysmotility”? What tests other than gastric emptying should be performed?

Michael_Cline,_DO: By global motility or diffused motility, I mean more than one area of the intestine. The most direct way to rule it out would be the smart pill. For more information, please read: Gastroparesis: ‘Smart’ Pill Uncovers This Mysterious Stomach Condition.

AOddone: What's included in a full gastroparesis/motility work-up?

Michael_Cline,_DO: There is a battery of lab tests looking for autoimmune antibodies that could be related to the motility disorder. Typically, patients will have an EGD or an x-ray of the intestine to rule out anatomic problems. If we are working-up a generalized motility problem, we would go to the smart pill test.

Multiple Maladies

AngelaOddone: What experience do you have treating patients whose gastroparesis is caused by Ehlers-Danlos syndrome in which there are multiple causes. These include poor vagal tone, stretchy tissues in the circulatory and gastrointestinal systems, mast cell activation syndrome causing inflammation, SIBO, leaky gut and endocrine issues such as adrenal fatigue and Graves or Hashimoto's resulting in hypothyroidism?

Michael_Cline,_DO: Ehlers-Danlos syndrome is not an uncommon cause of gastrointestinal dysmotility, and frequently leads to a diffuse motility disorder, not just gastroparesis. SIBO (small intestinal bacterial overgrowth) is a marker of small bowel dysmotility also.

DizzyGirl: I have gastroparesis related to POTS (postural orthostatic tachycardia syndrome) and EDS3 (Ehlers-Danlos syndrome type 3). The only thing that has been suggested for me is to "occasionally" take domperidone. I am a little nervous about taking it with my current drugs for POTS, and I really want something that will help me every day. Are there any other options or natural remedies that can be used to reduce the pain and nausea I have every day?

Michael_Cline,_DO: There are no real natural remedies that seem to be effective. It is very important when you have POTS and EDS3 that you rule out global dismotility.

sonjat: Good Morning. I was wondering if you see a lot of gastroparesis in patients with Sjogren's or other autoimmune conditions. Also, what symptoms do you typically see with this condition? Would excessive bloating and constipation be included? Would this condition cause shortness of breath or "air hunger" symptoms? Thank you.

Michael_Cline,_DO: The gastroparesis is directly linked to the autoimmune disease. We have to make sure, especially in someone who has constipation, that the entire gut is not involved. Typically, gastroparesis does not affect breathing or the heart. The autoimmune disease can, but gastroparesis won't.

keroppi: Is SFN (small fiber neuropathy) a known cause of gastroparesis? Is there any way to prevent the progression of gastroparesis if you don't know the cause? What if you just have idiopathic SFN, or mito issues?

Michael_Cline,_DO: There is an association with SFN and gastroparesis. Typically, SFN has to be fairly advanced to get gastroparesis, and unfortunately, there is no way to prevent it from affecting your stomach.

vateton: I was diagnosed with gastroparesis after a very slow stomach emptying test (eight percent vs. 50 percent normal), but I also have confirmed small fiber neuropathy. Is it possible that the diagnosis is incorrect, and I should consider dysautonomia? What tests will help me differentiate these diseases?

Michael_Cline,_DO: I think this will be best worked-up by a neurologist who specializes in small fiber neuropathy, because gastroparesis can be present in both.

WaveWolf: I am a T9 incomplete paraplegic and also have diagnoses of multi-systemic sarcoidosis (cause of paralysis), RA and several other autoimmune conditions. I have steroid-induced diabetes, which is managed with a strict diet and a chromium supplement. I eat small meals, but try to include fiber as part of managing my bowels and avoiding constipation. In eight years, I have not achieved a regular bowel program. I cannot maintain stool consistency, have a lot of gas and pain (from gas or from partial obstruction), but do not have much nausea or any vomiting unless I eat too much fat, too much food, or sweets. Should I be tested for gastroparesis?

Michael_Cline,_DO: Given the complexity of your history, it is best served to see you in the clinic. Appointment information will follow the chat.

Diet and Digestion
A-Aron: What are the basics of a gastroparesis diet?

Michael_Cline,_DO: It includes low-fat and low-fiber foods and frequent, small meals. Depending on the severity of symptoms, we use liquid nutrition as well.

DizzyGirl: Is the low-FODMAP diet at all beneficial for people with gastroparesis?

Michael_Cline,_DO: I am not a fan of the low-FODMAP diet. It goes in and out of favor, but had never really shown to do much for gastroparesis. It is also a very restrictive diet and is very difficult for patients to stay on long-term.

DizzyGirl: For mild gastroparesis linked to POTS and EDS3 (I am able to eat smaller amounts of solid foods, but have lots of pain and nausea), are there any "diets" that can help?

Michael_Cline,_DO: Stick to a low-fat, minimum fiber diet.

lgmac: How can my obese husband lose weight and keep his bowels moving? He bulks up with kidney beans and rye/wheat bread to keep his bowels going now. He has internal hemorrhoids, gastroparesis, paruresis, history of DVT, and CIDP, and won't eat any "rabbit" food. He says he can't take Miralax. Help!

Michael_Cline,_DO: When a person has gastroparesis, keeping the bowels moving is difficult because the diet becomes primarily carbohydrates. The rabbit food is much harder to digest, and if the stomach is not emptying it, it could make things dramatically worst. I would recommend a nutrition evaluation for weight loss along with a full gastroparesis/motility work-up followed by treatment of whatever is found.

liesel: I am a 77-year-old female. I live a very healthy life; I eat healthy and exercise daily. I do have heart disease and high blood pressure and take metoprolol ER 25mg and Losartan 50mg. I do NOT have diabetes. As long as I can remember, I have had problems with constipation. For the last year, I have constant difficulty with emptying completely. I always have the feeling that I need to go again. I go at exactly the same time every morning, right after one cup of coffee. But in the evening, I have the urge again and feel as if I am constipated to the point that I have been using glycerin suppositories, sometimes with good results and other times with more pain than stool. I do take a daily dose of Miralax and also drink plenty of water. Is there anything else I could be doing?

Michael_Cline,_DO: Given the complexity of your history, it is best served to see you in the clinic. Appointment information will follow the chat.

Talking Treatments

vateton: I started monthly IVIG infusions for small fiber neuropathy caused by sarcoidosis and found it positively impacted my gastroparesis. Is this ever used expressly for this purpose?

Michael_Cline,_DO: IVIG has now been shown to be effective in gastroparesis when there is a co-existing autoimmune disorder. We are using it more and more for gastroparesis.

Agurene: Dysautonomia and gastroparesis often appear together in patients. What is your recommendation for treating or managing gastroparesis in dysautonomia patients who cannot be exposed to neurotoxins in certain medications such as Reglan? What natural options are there – diet, supplements, lifestyle changes, etc. – that could help such patients?

Michael_Cline,_DO: Dysautonomia and gastroparesis frequently occur together. In dysautonomia patients, we have to rule out a global dismotility. We need the entire intestine, not just the stomach. There are very few natural substances that have been looked at. Ginger is used to help with gas, and there is a natural supplement called Imerogest that has been shown to be of some benefit to people. In dysautonomia, the biggest thing is to make sure we have the right diagnosis.

bafke: Is there any treatment that would help the vagus nerve work as close to normal as possible?

Michael_Cline,_DO: Unfortunately, not at this time. There is some research going on across the world in what's called vagal pacing.

DizzyGirl: I've heard some people mention that they have used Iberogast to manage their gastroparesis symptoms. Is that something you think would work or would recommend?

Michael_Cline,_DO: It is not well-studied, but has shown in case reports to be effective. There is really no harm in trying it. It's not going to hurt you, but it would really be trial-and-error process to see if it works for you.

Medication Messages
Iodine: What are some effective treatments for someone with EDS-related overall GI dysmotility, including gastroparesis?

Michael_Cline,_DO: When someone had general dismotility, the medical treatment options are limited. Two specific drugs we have available through the FDA are domperidone and Propulsid. They are drugs that have been designed to move more than just the stomach.

AOddone: Is domperidone FDA approved now? It wasn't a few years ago.

Michael_Cline,_DO: Domperidone is not FDA approved. We do have, however, through the FDA, a program to prescribe domperidone in the United States. It will not be covered by insurance and requires frequent office visits every eight weeks for the first year you're on the drug.

crystalclear: After being diagnosed with gastroparesis ten or 12 years ago, I took omeprazole every day until I read in 2016 that it could be linked to an increased risk of dementia. I have since read that those test results were inconclusive. What is your opinion about those test results? For a while (about a year), I seemed to be doing OK without the omeprazole, until about a month ago when the bloating returned. Should I risk taking the omeprazole again? It's been ten or 12 years since I've seen the gastroenterologist. Once one has been diagnosed with gastroparesis, do they always have gastroparesis?

Michael_Cline,_DO: Once you've been diagnosed with gastroparesis, it is very rare for it to go away. However, it may fluctuate in how severe the symptoms are. The article on dementia showed an association between Prilosec and dementia, but not a cause. In addition, that article used elderly patient and not young patients. So, the best answer would be to use the omeprazole as needed or as infrequently as you can to control the symptoms.





Diabetes Dimension

keroppi: Does gastroparesis affect hypoglycemic patients? Is it likely to cause more hypoglycemic episodes if it takes longer for food to digest and be converted to energy? If you're experiencing a hypoglycemic episode, will it take longer to correct and bring the blood sugar back to normal if digestion is slowed down?

Michael_Cline,_DO: It will make blood sugar control more difficult if you have gastroparesis, and it can activate hypoglycemia. So, it can mess with blood sugars significantly.

BEACHBABIES: Why and at what "stage" is gastroparesis linked to diabetes?

Michael_Cline,_DO: Typically, people with types 1 and 2 diabetes will have had diabetes for more than ten years prior to diagnosis. The more uncontrolled the diabetes, the higher the risk. One important factor with diabetes is the better the blood sugar control, the better the control of gastroparesis symptoms. Gastroparesis is almost never the initial complication of diabetes. Typically, the patient will have other neuropathy.






Specific Circumstances

gatorfrog: Six years ago, I had a subtotal colectomy because my food would not travel through. I don't know if that was gastroparesis or not, but since then, my food takes forever to digest, especially if I eat meat. I have Type 2 diabetes and am wondering what should I be doing or eating because of that? Is there something I should be looking out for and/or not eating? Thank you for any help.

Michael_Cline,_DO: Given the problems with the colon, the fact that you’re still experiencing symptoms and you have the risk factor of Type 2 diabetes, it will be a good idea to get the smart pill study to look at the motility movement of the entire GI tract.

keroppi: In the first few years of my gastroparesis diagnosis, my stomach puffing out after eating was one of the main symptoms. Once the food was digested, usually by the next morning, my stomach would be flat. Now, years later, I'm still waking up with the bloated/puffy belly, though it's smaller than the night before, it's still there, and the bigger the meal I've eaten the night before, usually the bigger the "morning belly”. Is it possible for gastroparesis to progress like this, where the food seems undigested even if it's been 17 hours after eating? I know it can be progressive in other ways, and I was wondering if this was the start? (I have mitochondrial dysfunction and presumed SFN.)

Michael_Cline,_DO: It is possible for it to progress, but more importantly, a work-up needs to be done to evaluate for more than just gastroparesis.

linbow: I had a Nissen Fundoplication (NF) in 2007. In 2009, I began losing weight (80 pounds total in almost a year), and was told my vagus nerve was damaged and was diagnosed with gastroparesis. In 2015, my heartburn and reflux returned, and I had a second NF done in June 2017. My stomach never seems to feel comfortable. Is this mainly due to my diet?

Michael_Cline,_DO: When there is post-surgical gastroparesis, the best approach would be further surgery on the stomach to allow it to empty faster. Typically, medication therapy is not very effective in post-surgery gastroparesis. Your condition probably is not diet related. A high-fiber diet will make symptoms worse, but you’re not going to manage the gastroparesis just by diet.

Clinic Connection
DizzyGirl: What is your normal regimen for patients you see with mild gastroparesis?

Michael_Cline,_DO: First, we do lab work and frequently follow up with tests to rule out causes of gastroparesis. Then, we will institute the four-stage diet with our multidisciplinary clinic. The patients will be evaluated for surgical options and pain management if they have pain issues. Also, we will consider behavioral medicine for non-pharmacological treatment and various medications based on other co-existing diseases and personal health.






Closing

That is all the time we have for questions today. Thank you, Dr. Cline, for taking time to educate us about Gastroparesis.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at http://my.clevelandclinic.org."

Source:http://www.tothegrowlery.com/blog/2017/4/18/six-different-types-of-grounding-exercises-for-anxiety-intense-emotions

Source: (in addition to being on the image itself)https://twitter.com/pookyh/status/882951668882710528









According to Living Well,

"Grounding exercises

Grounding exercises are things you can do to bring yourself into contact with the present moment – the here and now. They can be quick strategies (like taking three deep 'belly breaths') or longer, more formal exercises (like meditation). Different strategies work for different people, and there is no 'wrong' way to ground yourself. The main aim is to keep your mind and body connected and working together.

People who have experienced childhood sexual abuse or adult sexual assault can sometimes be confronted by flashbacks or intense memories of what was done, to the point that they are feel as if they are back there, re-living the abuse all over again. A flashback is an example of being in the 'there and then' rather than the 'here and now,' so grounding exercises can help to bring you back.




Grounding exercises are a way for you to firmly anchor yourself in the present

Grounding exercises are helpful for many situations where you find yourself becoming overwhelmed or distracted by distressing memories, thoughts or feelings. If you find yourself getting caught up in strong emotions like anxiety or anger, or if you catch yourself engaging in stressful circling thoughts, or if you experience a strong painful memory or a flashback, or if you wake up from a nightmare with a pounding heart, grounding exercises can help bring you back down to earth.

It can be helpful to have a selection of grounding exercises that you can draw upon at different times. Just like no one technique works for all people, we often find that not all techniques work at all times. One thing you can do is look over some lists of grounding exercises and write down all the ones you think might work for you. Carry your personal list with you. Then, when you find yourself needing relief, you can run your eyes down your list and pick out the strategy that will be most helpful in that situation.

Speaking of lists, we have one of our own below.

The following grounding exercises are about using our senses – sight, hearing, smell, taste, touch – to reconnect our mind and body in the present. It is our basic human senses that remind us we are here now, and we are safe.

In working through the grounding exercises suggested here, you might find one or two that work for you. Keep in mind to only to use the exercises that you feel comfortable with.



List of grounding exercises

Remind yourself of who you are now. Say your name. Say your age now. Say where you are now. Say what you have done today. Say what you will do next.

'My name is ________, and I am 54 years old. I am in my living room, in my home, in Woolloongabba, in Brisbane, in Queensland. I woke up early today. I had a shower and fed my dog. I just finished my coffee and toast. Soon I am going to walk to the train station and go in to work. I am going to walk down ______ street and then turn left at the bike shop. Then I am going to….'

Take ten slow breaths. Focus your attention fully on each breath, on the way in and on the way out. Say number of the breath to yourself as you exhale.

Splash some water on your face. Notice how it feels. Notice how the towel feels as you dry.

Sip a cool drink of water.

Hold a cold can or bottle of soft drink in your hands. Feel the coldness, and the wetness on the outside. Note the bubbles and taste as you drink.

If you wake during the night, remind yourself who you are, and where you are. Tell yourself who you are and where you are. What year is it, what age are you now? Look around the room and notice familiar objects and name them. Feel the bed you are lying on, the warmth or coolness of the air, and notice any sounds you hear.

Feel the clothes on your body, whether your arms and legs are covered or not, and the sensation of your clothes as you move in them. Notice how your feet feel to be encased in shoes or socks.

If you are with other people, and you feel comfortable with them, concentrate closely on what they are saying and doing, and remind yourself why you are with them.

If you are sitting, feel the chair under you and the weight of your body and legs pressing down onto it. Notice the pressure of the chair, or floor, or table against your body and limbs.

If you are lying down, feel the contact between your head, your body and your legs, as they touch the surface you are lying on. Starting from your head, notice how each part of your body feels, all the way down to your feet, on the soft or hard surface.

Stop and listen. Notice and name what sounds you can hear nearby. Gradually move your awareness of sounds outward, so you are focusing on what you can hear in the distance.

Hold a mug of tea in both hands and feel its warmth. Don’t rush drinking it; take small sips, and take your time tasting each mouthful.

Look around you, notice what is front of you and to each side. Name and notice the qualities of large objects and then smaller ones.

Get up and walk around. Take your time to notice each step as you take one, then another.

Stamp your feet, and notice the sensation and sound as you connect with the ground.

Clap and rub your hands together. Hear the noise and feel the sensation in your hands and arms.

Wear an elastic band on your wrist (not tight) and flick it gently, so that you feel it spring back on your wrist.

If you can, step outside, notice the temperature of the air and how much it is different or similar to where you have just come from.

Stretch.

Notice five things you can see, five things you can hear, five things you can feel, taste, or smell.

If you have a pet, spend some time with them. Notice what is special and different about them.

Run your hands over something with an interesting texture.

Get a sultana, a nut, or some seeds, etc. Focus on how it looks, feels and smells. Put it in your mouth and notice how that feels, before chewing mindfully and noticing how it feels to swallow.

Put on a piece of instrumental music. Give it all of your attention.

If you have a garden or some plants, tend to them for a bit. Plants, and actual soil, can be an excellent 'grounder!'"

Source: https://www.slideshare.net/ShannonCayer/grounding-techniques-explained



A while back, my doctor at the Mayo Clinic gave me print outs on relaxation techniques. These are breathing exercises but they can be found here: http://www.emilysstomach.com/2013/07/relaxation-breathing-techniques-from.html

The grounding technique is also used to not only help with anxiety, but to help people with PTSD. I have never tried grounding techniques before but I will be glad to try them for a week and then keep a comprehensive journal so that I can report my findings and if it helped me or not. The breathing exercises tend to help me when I am having a really bad panic attack and/or to calm down after I vomit due to Gastroparesis.


For more information about Cortisol, please check out this presentation from Pharmaphedia: https://www.youtube.com/watch?v=EFQS7e75vxc

Handling Holidays with A Chronic Illness

I know this time of year is really rough for all of us. As someone with GP, I cannot eat like normal people do on thanksgiving. I plan to cook for my family and friends, but I was wondering how to deal with the fact that I can't eat like normal people and what to do about it. I did some research and found some articles that might help the chronically ill deal with this issue. Additionally, I found some information for family members who always tell us to eat something or try to force us to eat when we are unable to. I hope this will help everyone a bit.

Image taken from: http://images.wisegeek.com/sad-dark-hair-woman.jpg


WebMD (http://www.webmd.com/balance/features/chronic-illness-holidays) gives us a wonderful source for how to deal with the holidays and loved ones as well. The key seems to be planning ahead and communicating your illness and requirements in advance to family and loved ones:

"Rosalind Joffe, MEd, once hosted a Thanksgiving dinner for 22 people at her house. She planned it months in advance. She hired someone to clean. She created a menu and delegated various dishes to guests. A friend came over the day before the holiday to set the table. Relatives were assigned jobs to serve dinner and clean up afterwards. Joffe has the planning sense of Martha Stewart. She also has multiple sclerosis (MS) and ulcerative colitis.

While it was challenging to host Thanksgiving, she says she'd have felt worse if she hadn't. "The key was advance planning," she tells WebMD. "What I've learned is if I ask for help in advance, even with my own family, people don't feel put upon. They feel they're a part of the event."

Joffe is among the many people living with chronic illness -- defined as lasting more than three months, being persistent or recurrent, having a significant health impact, and typically being incurable. So, with Christmas and Hanukkah at hand, times when everyone is supposed to participate and feel cheerful, what are some strategies for coping?



Do Holidays Make Chronic Illnesses Worse?

There's always the temptation to abandon healthful living routines around the holidays. Eating too much, not getting enough exercise, staying up late, worrying about family members getting along -- all these things can make you feel worse. But do they negatively affect your health?

Joffe, who coaches people with chronic illness in the Boston area to thrive in the workplace, says it depends on the disease. "With diabetes, heart conditions, or epilepsy, for example, you must take care of yourself or the disease gets worse. With autoimmune diseases, such as MS, fibromyalgia, or lupus, your symptoms will get worse but not the disease itself."

What about the holiday blues? Do the holidays really bring on episodes of depression? Michael Thase, MD, during a WebMD Live Event, said geography could play a role. "As people living in the northern hemisphere, we seem to be somewhat more prone to development of depression in the fall and winter months. The fact that this period of risk coincides with our holidays is kind of like a bad coincidence. For example, I'm not sure that I've encountered any writing about the holiday blues in New Zealand, Australia, or South Africa."



Speak Up

"Holidays act like a lightning rod where all the physical and social concerns around chronic illness get really highlighted," says Patricia Fennell, MSW, LCSW-R. She explains that the demands and expectations around holidays can "out" people whose conditions were hardly noticeable. During the year, they spend so much of their energy working and handling the daily chores of living that they have little time left for socializing. Come the holidays, they're expected to show up and contribute.

"Many chronic illnesses, such as diabetes, depression, arthritis, fibromyalgia, etc., are 'invisible,'" Fennell says. "People go to work or volunteer or shuttle kids to school. Most of the time, they don't look sick. When illness flares up, their pain is invisible. Or they have bone-numbing fatigue, so bad that they can't take a shower and go to the store in the same day. There's a cultural misperception that says you're not sick unless you look sick. They need to make their illness visible by talking about it."

Fennell, who is president and CEO of Albany Health Management, Inc., in Albany, N.Y., coaches patients on how to negotiate needs. "People don't know how to ask for what they need. They'll stay home from a holiday party because they can't stand that long. We need a new social etiquette for people with chronic illness."



Party Strategies: Ask for What You Need in Advance

Fennell describes a typical holiday scenario. "You're invited to Aunt Jane's. Let her know that you'll do your best to attend her party, but that if your illness flares up, you may have to bow out. Ask her how much lead time she needs. She'll say, 'Anything's fine.' Tell her you'll call her 48 hours in advance to let her know. Uncle Bob will still be annoyed if you don't come, but if you predict that you're unpredictable, people will generally handle it better."

She advises stating your needs in behavioral rather than general terms. "Don't just tell Aunt Jane you'll have to leave early. Tell her you've been feeling fatigued and can stay only two or three hours. Also tell her that standing tires you out, and ask her to have a seat for you. Putting it in behavioral terms makes it easier for Aunt Jane to conceptualize and to accommodate."

Many hosts and restaurants have become accustomed to considering various dietary needs for guests who have heart disease or diabetes or another condition that requires a restricted diet. "They should be offering options for people," Fennell tells WebMD. "If you don't know what's being served, carry a large handbag with snacks and water, or offer to bring a dish that can be shared with others."

When you're the host, whatever you do don't wait till the last minute to ask for help, says Joffe. "You may not get the help you need. And if people do help, they might resent it. Become an expert at planning. Asking in advance allows people to help gracefully."



Managing the Handicap Parking Space

Shopping and gift giving present special challenges, not the least of which is managing the mall. If your illness is invisible, the challenge can start when you get out of your car. Some less-than-jolly shopper who parked way out in left field will let you know that you have no business parking in a handicap space. Try to think of a humorous retort, like that of a cancer patient who plucks off her wig and smiles.

Joffe advises not letting presents and errands get out of control. "Many people with chronic illness aren't in the best financial situation but don't have the energy to shop for bargains. Plan in advance. Take a day off work so you can shop yet avoid the weekend crowds. The key is what matters most to you. Is it going into your bank account? Would a simple note do? Don't go into lock-step motion."



Ways to Relieve Holiday Stress

An article in Arthritis Today offers three tips for managing holiday stress:

Daily rest and relaxation. Don't get stuck in a never-ending to-do list. Do a crossword puzzle or take a walk or a nap. The mental and physical break will rejuvenate you.

Prioritize. Decide how much shopping, cooking, or partying you can do and stick to it. Ask for help.

Volunteer. Take toys to the Marine Toys-for-Tots Foundation, take food to homebound seniors through Meals on Wheels, or provide goods and services for Hurricane Katrina victims. It will boost your spirit and remind you what the holidays are about.

Patch Adams, MD, the real doctor whose life was the basis of the Robin Williams' movie, would agree that volunteering is good for you. He heads the Gesundheit! Institute in Arlington, Va. It's the umbrella organization for his work to raise funds for a variety of projects, including the building of a free hospital in rural West Virginia.

He tells WebMD, "My best advice for someone with chronic illness coping with the holidays is to work out with their families not to give presents, but instead to give money to local families who are poor, and consume half of what they normally consume. Make it about the spirit of giving."

The numbers of people with chronic illness are growing, and that's not necessarily a bad thing, says Fennell. "People are living today with heart disease and cancers that were once considered terminal illnesses, not chronic illnesses."

The growing numbers also mean you're not alone. Next time you go to a holiday party, look around. Some of those healthy looking people may have chronic illnesses, too."

Image Source: On Image.









This part is for your loved ones, family and friends and dealing with your loved ones, family, and friends. It's to help them understand what we go through and what they can do for the chronically ill. This source does talk about making food for your chronically ill loved one, but with GP, that can be a challenge. We have a very strict diet but you can modify this article to match up with your loved one's dietary restrictions.




According to Kevin M.D. (http://www.kevinmd.com/blog/2011/11/living-chronic-illness-holiday-season.html):

"In the U.S., we’re getting ready to celebrate Thanksgiving. Soon, people around the world will turn their attention to the holiday season. Chronic health problems can take a toll on relationships any time of the year. Most people have to experience unrelenting pain or illness themselves before they understand how debilitating it is, physically and mentally. Loved-ones (by whom I mean family and close friends) may be in some form of denial about what’s happened to you, or they may be scared and worried about the future. Bottom line, suffering from a chronic condition can be an ongoing crisis—for you and for those you’re close to.

That crisis can come to a head during the holidays when people’s expectations of one another are high and when stress levels for everyone are likely to be off the charts for any number of reasons—health, financial, relationship issues. If you’re like me, during the rest of the year, you carefully limit interactions with others in order to manage your symptoms; on a typical day, your most complex decision may be to choose between showering and shopping! But when the holidays arrive, you’re suddenly thrust into the middle of a lively and chaotic social scene where you’re expected to participate in a range of activities, often for days in a row. A bit of advance warning to loved-ones can go a long way toward minimizing stress levels over unrealistic expectations.

I know that this piece won’t apply to everyone. One of the heartbreaking consequences of living with chronic pain and illness is that some people are unable to be with loved-ones at all during the holidays, either because people are too disabled by their pain or illness to be able to gather with others, or because family and close friends having drifted out of their lives. I know the pain of that isolation; I’ll be writing about it in my next piece.

For those of you who are able to gather with others, the holidays can be a recipe for double disaster—the increase in activity exacerbates your physical symptoms, while coping with sadness, frustration, and maybe even guilt about your physical limitations gives rise to emotional pain. No wonder many people with health problems dread the approaching holidays.

If you’re one of the many people with chronic health problems who don’t look sick, the initiative is with you to make your condition visible. Here are some suggestions for helping loved-ones understand what your life is like and for giving them a heads-up on what to expect from you during the holidays.



Share information with them from the Internet or from books

Often the best way to educate loved-ones about chronic pain and illness is to use a neutral source because it takes the emotional impact out of the communication. A quick web search will yield a host of organizations devoted to every conceivable medical problem. Print out select pages or forward a few links to family and close friends. Alternatively, if you have a book about your condition, photocopy the pages that cover what you’d like them to know about you. In your accompanying note, keep it “light”—you could joke that “there won’t be a test.” But also make it clear that this favor you’re asking is important to you.



Write a letter

Many years ago, two friends of mine were in couples therapy. They weren’t able to speak to each other about their marital problems without one of them shutting down emotionally and the other reacting by shouting recriminations. Their therapist told them to write letters to each other expressing their feelings and their concerns about the marriage. It turned out to be a major first step in healing their relationship.

If you decide to write a letter, be sure it’s not accusatory. In composing it, use the word “I” more than the word “you.” Without complaining, express how difficult it’s been for you to adjust to this unexpected change in your life and how you wish you could be as active as you once were during the holidays.

You could briefly describe what your day-to-day life is like, including how unpredictable your condition is which means that you can’t know for sure how you’ll feel on the day of the actual gathering no matter how much you rest in advance. (This is the hardest concept for most loved-ones to comprehend—that we can spend weeks before a big event in full “rest mode,” but still feel very sick when the day arrives.)

I would end by telling them what to expect from you during the holidays—that you may have to skip some events, that you may have to excuse yourself right after eating to go lie down, that you may have to come late and leave early. In my experience, spelling out my limitations ahead of time is helpful not just to others, but to me, because I find it much easier to exercise the self-discipline it takes to excuse myself from a room full of people if I know that at least some of them are already expecting it.

P.S. It will be tempting to send an email, and if you have a lot of people you want to communicate with, it may be the most feasible way to reach everyone. But one thing’s for sure: people will read a handwritten letter, antiquated document that it’s become!




Find that ONE ally and enlist his or her help

If you have just one close friend or family member who understands what you’re going through, enlist his or her help in explaining your condition and your limitations. Before the holidays start, you could ask your ally to talk to loved-ones on your behalf or to be present when you talk to them. Ask your ally to be supportive if you have to excuse yourself in the middle of a gathering, or even to let you know if you’re wilting (as we call it in my household). It’s so helpful for me to be “prompted” by my ally because, when I start to overdo things, adrenaline kicks in which fools me into thinking I’m doing fine. But using adrenaline to get by just sets me up for a bad crash later on.

Your ally may be a close friend or family member who’s just waiting for you to enlist his or her help. Think long and hard before you decide there’s no such person in your life.




In the end, you may have to recognize that some loved-ones may never accept your limitations

Some family and close friends may refuse to accept that you’re disabled by pain or illness. I know this from personal experience and it hurts. Try to recognize that this inability is about them, not you. Don’t let their doubt make you doubt yourself. Your medical condition may trigger their own fears about illness and mortality, or they may be so caught up in problems in their own lives that they’re not able to see their way clear to empathize with you.

Just as you can’t force people to love you, you can’t force people to accept you. But getting angry at them just exacerbates your own symptoms. That’s why it’s important to protect yourself from allowing their lack of understanding to continually upset you. Think of it as protecting yourself from another chronic condition: chronic anger.

The physical suffering that accompanies chronic pain and illness is hard enough to endure without adding emotional suffering to it. When I feel let down family or close friends, the first thing I do is acknowledge how much it hurts. Then I reflect on the many possible reasons for their behavior. Finally, I work on genuinely wishing them well. These three steps immediately lessen my emotional suffering.

As you experiment with these suggestions, treat yourself kindly. Don’t blame yourself if one of them doesn’t work out. Instead, give yourself credit for having had the courage to try! My heartfelt wish is that your loved-ones come to understand and accept your limitations, but that if they don’t, you’ll be able to accept them as they are without bitterness."

According to EmpoHER (http://www.empowher.com/wellness/content/helping-chronically-ill-over-holidays):

"One of the unique problems that comes with chronic illness is that ... it lasts so long.

Some chronically ill people are fortunate to have a solid support network of family and friends. For others, things are very different.

If there were people interested in helping, while they may have been dedicated and compassionate at first, the long haul proved to be too long. The sprint they could run was too short for the marathon of chronic illness.

Many of us have outlasted our helping companions and carry on down the bleak road alone.

Do you know someone who is alone this holiday season? Maybe you can't commit great blocks of time or resources to their care and comfort.

But if you can spend a little time, and maybe even a little money, and you just need some suggestions, you're headed in the right direction.

You don't have to look for big things to make a difference for many who are chronically ill.

Things that you may take for granted, that seem like no big deal in your own life can be things that have stumped the chronically ill with a wall of impossibility for a long time.

Ever made lunch? Fixing something for your friend will not only brighten their day with your caring actions, it will also take care of a practical problem.

Some people who are chronically ill must spend most of their energy putting a meal together, needing to recuperate for the rest of the day afterward. Others just end up not eating.

Washing laundry, sticking it in the dryer and doing some folding are simple chores. Having a friend come over to go through these paces can bring a sense of order to a home that may be short on that quality.

Clean clothes, especially when they've been hung up and placed in drawers, bespeak affection and closeness for someone who may not feel that very often. Not to mention, you will save them their little energy quota for the day for other things.

When you have to run to the store, perhaps you could call or stop by to see if your friend needs anything as well. One trip, two sets of errands accomplished. Less stress and pressure on your friend, and you go home feeling like you've made a difference.

This time of year, snow can be a going concern in many areas of the country. Chances are your friend can't lift a shovel let alone clean a walk or driveway.

Whether we're talking about a shovel, a snowblower, or a snow plow -- whether you do the job yourself or pay someone else to do it -- removing their snow can also remove the burden of being faced with an insurmountable task.

And if you'd like some hot chocolate afterwards, you could come in and spend time with your friend ... and make hot chocolate for both of you.

The possibilities, really, are endless if you want to help someone who is chronically ill. The holes in their abilities and resources are often vast and widespread.

Do it for the holiday season, or just do it for a friend whose daily existence may be tougher than you can begin to fathom."

Dealing with isolation can be a huge problem for gastroparesis patient and also the chronically ill. Many of us are too sick to go out anywhere or even be around food. In that case, the source below will give you some tips on what to do when you're isolated during the holidays.






According to You Don't Look Sick (http://www.butyoudontlooksick.com/articles/guest-writers/tip-handling-isolation-that-comes-from-chronic-illness/):

"The title is ominous, I know. But for so many of us that suffer from chronic illnesses, it’s an all too true reality. I must preface this by saying that not all people who suffer with a chronic illness experience this. However, the subtleties of it grow as time passes and one is confronted with the reality of it, be it large or small, at some point in their lives.

It may be as small as the awareness of the decrease of invitations by friends due to our physical limitations. For some, that awareness grows to a more glaring, in your face, epiphany that friends that were always there before suddenly wish no part in your life…excuses a plenty. It’s not even relegated to just friends. Family roles play a big part of isolation experiences for the chronically ill. Those closest to us are often the ones to fall into one of two categories. Faithfully standing by no matter what or those that turn a blind-eye and deaf-ear to our honest answer to their question, “How are you?”

It’s important for the chronically ill to have a plan to handle times of feeling isolated. This is true whether you’re feeling isolated now or think it’s a possibility for your future. The realities of life are handled better if we understand the possibilities and have a plan on ways in which to deal with such times. Let’s talk about some ways to handle isolation times in your life.

We’re blessed to live in a time of the information super highway. Social network sites make it much easier to remain in our homes, if needed, yet still be interactive on a day to day basis. Whether it be local friends and family or online acquaintances, it’s there for our using and can keep us connected to the real world. Some suggestions might be the bydls.com on facebook or the butyoudontlooksick.com message boards

Not only do we have a multitude of e-social activities to participate in, we have a vast array of research at our fingertips. We can be pro-active in our medical care simply by spending time doing a bit of our own educating.

Can we say real life support groups? If ever there was a source of interaction for the chronically ill and isolated, it’s support groups. Some of the most wonderful people you’d ever want to meet are in a support group and can truly say, “Been there, done that!” Or, they say nothing at all but have golden ears to listen with.

Blogging is one of my favorites. It’s like your online diary. I like to be able to express myself, and even my feelings of isolation, in words. Many blog sites can be set to private so that no one, other than those you want, can read them. Many of the aforementioned support group sites offer their own blog space just for you. You never know when someone will read your blog and be totally blown away by the knowledge that someone else is going through exactly what you are.

So, you see, isolation doesn’t have to take over. Yes, there are times where quiet reflection is needed but no longer do we have to draw back into a dark place in our minds where loneliness rules. Like the old yellow pages ad said, “Let your fingers do the walking!” Get out there via the internet and keep in touch with friends and family. Find new friends that can relate to what you’re going through and can offer hope, encouragement and support that you may not have otherwise. It’s a good choice to make and certainly a good way to handle isolation for the chronically ill."

I really hope this article will help you deal with the holiday stresses. I know all holidays are centered around food, and it's hard to ignore. But, remember, even though the holidays are tough, YOU ARE TOUGHER!