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Arthur not a Shamal

Arthur not a Shamal

On one of my new patient visits recently, a woman who was a vice president of a local company asked me, "Why do you measure a fasting cortisol?" I looked up at her smiling, "You'll see." She was not happy with my answer, "Well, I think that's a strange test to order. It's just a stress hormone." Many different responses ran through my head during the moment of silence that followed her snappy reply. However, I chose to take the high ground and decided to continue on in my usual direction revealing the story of her test results.

Think back on your life for a moment and reminisce about the past. Run through the types of people you have encountered over the years. Think about their temperaments, personalities and styles they have used in dealing with their lives and yours.

I remember a guy named Arthur. He was the physician that recruited me to Memphis to create and maintain a Toxicology Center at the University of Tennessee, Memphis. He was in the prime of his life both personally and professionally. By all estimates, he was a success to everyone who knew him. He had done well financially, was married to a successful lawyer, had a handsome young son and he never went hungry. He grew up in a wealthy family located in southeastern Tennessee. Arthur had done extremely well in the hierarchical academic world that dominated most of his waking hours. He was good at what he did, had completed several major research projects and was the Number Two man in the Department of Internal Medicine. He desperately wanted to be Number One though, envisioning the Chairman position as ripe for the taking, since his boss was old, complacent and a bit of a slacker.

I could never call Arthur satisfied, since he never really was and probably never had been. Something always seemed to gnaw at him making everything a battle. The mere presence of another successful physician in our department would agitate him. I saw many in-your-face personal provocations that were unnecessary. He trusted no one, he had no friends, his subordinates gave him a wide, fearful berth because of his tendency to take his frustrations out on them. He and his wife had a roommate type relationship and he barely knew his son. When anyone asked him about his accomplishments, all he could talk about was having a chairman position in an academic department some day. He continued to not be the Number One Man.

Contrast Arthur with Shamal. He too was in the prime of his life and Number Two in his department. He had chosen a different route to get to his position in life. Since he was a kid, he negotiated his way to his position, working well with others, helping those in need and others come to his aid when he needed help. He was a consensus builder, team player and if he ever got frustrated about anything, you would not know it, he did not take it out on others. He simply reflected on his own behavior and tried another route. Shamal was given the opportunity to move into the Number One position in his department, but he walked away from it. He had made enough money to put his children through college and graduate schools, had enough money for food and shelter and he reached the realization that his wife who was suffering from leukemia at the time, was more important than fighting his way up the hierarchy and being the boss. At last I heard, he was doing very well, was healthy and happy. His wife survived chemotherapy as well as her disease. Two of his sons were in medical school, his daughter was a lawyer in Nashville.

These are two people I know who are polar opposite personality types. Arthur's personality type comes with some physiological correlates. Elevated basal glucocorticoid levels(cortisol) reflecting a continuous low grade stress response because life is one big stressor for him. Elevated resting blood pressure and an unhealthy ratio of good to bad cholesterol both are associated with chronic active stress. He was probably in the early stages of serious atherosclerotic disease. If I had to guess, he was heading for a premature death in his late middle-ages.

Shamal on the other hand had a personality type that was quite different from Arthur's. Shamal was almost opposite on every stress-related measure. He enjoyed a robust good health because he embraced life's challenges in all it has to offer. I suspect he was destined to live to a ripe old age, surrounded by his children and grandchildren. His wife seems to have benefited from his compassion already by surviving leukemia.

We all know people who are driven sharks, they avoid ulcers by giving them to others, they see the world as full of opportunities and most of those are unfulfilling. They tangle with everyone they meet. They seem to believe they have a duty to instill their worldview on everyone they encounter. Everything is black and white, there is no gray. Human are usually strongly individualistic and they are astonishingly different in their personalities, temperaments and coping styles. These differences carry some distinctive physiological consequences and disease risks related to stress.

It turns out that it is not the external stressors that have great impacts on our health, it is instead how an individual perceives, responds to and copes with those external stressors. Knowing what is a threat to one's personal space verses assuming everything that happens is a threat to one's personal space is half the battle in creating a healthy existence. I find that most patients who have some form of chronic active disease experience a number of stress related alterations in their glucocorticoid levels, their ability to make antibodies and their cholesterol profiles.

Interpreting clinical data is difficult, since I would like to get information that reflects a basal, non-stressed condition. Unfortunately a patient who is in the throes of sickness, drinks alcohol beverages daily, is actively stressed over a confrontation or have had sexual intercourse before getting their blood drawn tend to unintentionally alter their basal results. I have to take those factors into account when reviewing the laboratory results. However most of the time, the fasting basal cortisol matters a lot.

As I reviewed the data of this impatient, somewhat confrontational woman, I kept hearing her words, "Well, I think that's a strange test to order. It's just a stress hormone." When I showed her that her basal cortisol level was three times what it should be, she was overcome with emotion. "It's your stress recovery hormone, and it's off the charts high," I said sternly. Tears began to well in her eyes. At that moment, she realized she was not coping well. She was living a profoundly unhealthy life. She needed to change greatly in order to lose weight, to stop experiencing flairs of her autoimmune disease and to have a healthy fulfilling relationship with another person, at least just one in her life.

Sadly, I realized she was an Arthur and not a Shamal.

Posted by Amanda Sanders at 11:20 AM
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