Stress management for those in dentistry ... and those nearby

May 31, 2011

By Dr. Bob Kroeger

Libya. Egypt. Middle Eastern revolutions. Japan’s tsunami and nuclear meltdowns. Foreclosures. Bankruptcies. Random killings. Recession. Depression, either financial or personal. It’s something new every day.

Heraclitus, a Greek philosopher in the 5th century BC, stated: “Nothing endures but change.” By definition, stress involves any change in our environment. In 1967 psychiatrists Holmes and Rahe surveyed 5,000 hospital patients and formulated a survey of life events, assigning points to each. They calculated a correlation between life events (changes) and risk of disease. If you accumulate over 300 points in a 12-month period, you have a 79% chance of contracting a disease. In 1970 they replicated the survey on 2,500 sailors. Other scientists found similar results.

The key to understanding the Holmes-Rahe scale is realizing that it’s your interpretation of and your ability to deal with the event, not simply the event itself, that determines whether you stay healthy or become sick. So stress in itself, although usually viewed as negative, is simply a neutral change.

Funny isn’t it, that when you talk to people they say they “understand” stress and they can “handle” it, yet our hospitals are teeming with folks with stress-related and stress-induced diseases. The Mayo Clinic estimates that 85% of its admissions are due to stress, and they’re treating more than colds and flu.

In my own life, I reached the 300 point level six years ago when my wife of 33 years contracted a terminal cancer and had an incredibly risky operation by a world-famous surgeon, followed by months of chemotherapy and radiation. I had a hard time witnessing her pain and watching her die a little each day. Her brutal “medical treatment” made me somewhat calloused toward the medical profession, especially when she lived only three months after treatment ended. A study that examined 3,000 long-term marriages in New York City (marriages ending when one of the spouses died) discovered that, within six months of death, a significant number of surviving spouses developed cancer. I survived, thanks to my physical condition and knowledge of stress management.

Going back a few decades to the mid-1980s, I became a stress management consultant through a program designed for psychologists. Stress and burnout were hip words then. Researchers had begun to scientifically link the immune response with prolonged distress, but this field was (and still is) in its infancy. So, armed with some scientific literature, I began giving seminars to dental and lay groups on this topic (and on dental phobia, too). And when you lecture, you tend to absorb some of your material, which is lucky for me.

In the early ’90s I left the lecture circuit since our five children needed their daddy at home more than they needed me on the road. By that time I figured I had made a contribution to dentistry and that my place should be with my young family. Those were happy years — family vacations, coaching all kinds of sports, seeing the kids grow, and just being involved in life at its fullest. But then, about halfway through our marriage, my wife made a dramatic revelation about her childhood, a factor that probably played a key role in her death about 15 years later. And, when her cancer hit, I researched the connection between childhood trauma and cancer. It was like opening Pandora’s box.

Last summer I retired (I had become financially independent several years earlier) and decided to resume giving seminars on stress management on a limited basis. On, I will be sharing ideas on successful stress management. Hopefully these articles will motivate and help you, your staff, and families.

Many years ago a government survey ranked occupations according to stress. Dentists ranked No. 35 (with No. 1 being the most stressful), but our poor dental assistants merited the 13th position. Control is always an issue, isn’t it? So please share this column with your staff, spouse, and families. Your teenagers, who presumably know more than you do (at least mine did), may not want it. The more readership, the more likely these articles will continue (maybe a concerned dental company will adopt me). I have a lot of good stuff to share.

Like you, I took more than my share of continuing education and found some courses better than others. In the early ’80s, Pete Dawson taught me to always challenge (at least mentally) each speaker/author. Does research back up him or her? Can the speaker walk the walk? I found that approach useful. And I hope that I can walk the stress management walk.

I am retired comfortably (something the ADA claims that less than 5% of dentists can do) and I run seven to nine marathon (yes, the 26.2 mile variety) each year, most in under four hours. I have less than 15% body fat, after having lost 40 pounds and keeping it off since 2005. I have remarried (let me tell you, us widowers are wimps), and I am able to enjoy the present moment despite whatever slings and arrows the world throws at me. (My current wife is presently dealing with an MS-type condition, and my four-year-old grandson requires heart valve surgery every few years.) We also have seven adult (I guess that’s a good word) children between us. So there is never a dull moment. Change happens.

I’m not going to get too technical in these articles. For those who want detailed scientific studies (upon which I back up my writing), read “Why Zebras Don’t Get Ulcers” by Stanford neuroscientist Robert Sapolsky. Being able to laugh, especially at oneself, is an important part of stress management. Another great little bible is “Don’t Sweat the Small Stuff” by Richard Carlson, a clinical psychologist. And then, of course, there is the Bible. Which leads us to the content of these articles.

After delving into the nature of stress and the results of distress, including physical and mental disease, I will elaborate on the ways to cope with stress — avoid disease, and live a long, healthy, happy, and meaningful life. Success in this regard involves a 12-step approach — self-image psychology, the relaxation response (obtained in ways other than drinking a cold beer), physical fitness, nutrition, relationships, communication, time management, assertiveness training (helped me a lot recently), impossible goals, financial independence, transitions, and retirement (important even for you 20-somethings).

The first step is to realize that we all have stress. Not even the extremely wealthy can escape it. But the good news is that stress, as I mentioned, is neutral. For example, let’s consider the traffic jam. You’re late and stuck. Going nowhere. Even worse, consider the jerk that cuts you off, missing your front bumper by inches. How do you feel? Angry? Calm? Me, I could care less. What saddens me is driving on the highway and watching one driver weaving in and out of traffic at a high rate of speed who, in turn, is followed by another doing the same, presumably because the latter is angry at the former for cutting him off. That is an accident waiting to happen.

So the stressor (what initiates the stress) is the wild driver or the traffic jam. This stress can turn into distress (negative stress) if we get angry, or even worse if we lose concentration while driving. It can become eustress (positive stress) if we use the energy to concentrate on our own driving. We can also elicit the relaxation response if we stay calm and forget it. Anger, even in brief periods of time, will harm us. Being human, we have a choice in how we want to react to such situations. Prior exposure to stressors can also help. In states such as California (where traffic jams are a normal part of existence), folks become used to stalled traffic and should be behaviorally equipped to handle it.

In the next installment, I will explain when and how distress can cause disease. In the meantime, if you’re stuck in traffic or a rude driver cuts you off, remember that you have a choice. Good luck!

Editor's Note: To read future installments from Dr. Kroeger, please click here.

Dr. Bob Kroeger retired after practicing general dentistry for 33 years. A stress management consultant, he presents seminars to the dental profession as well as to general industry. In addition to lecturing and writing, he runs seven to nine marathons a year and is a certified personal trainer. Contact him at [email protected].