Stress Dosing for Emotional Stress

When you’re sick or injured and have Adrenal Insufficiency, you have to double your steroid dose to cover the additional stress your body is under. This is because our bodies don’t make any or enough of the stress hormone cortisol. It’s sometimes confusing and hard to get right, but the general rule is if in doubt, stress dose: too little could kill you, too much in the short term won’t. 

Emotional stress is a whole other ball game. It can be more dangerous than physical injury or illness because it sneaks up on you, and then you have to try to work out how much extra coverage you’ll need e.g. A full double dose or a slight bump. Mentally you might be ok with whatever is going on but your body might not be- it reacts to your subconscious thoughts as well as your conscious ones. 

For some things it’s obvious. Bereavement or shock is a no-brainer- double the dose or inject if needed. But life is full of complexities and twists and turns and, like everyone, you can handle some things better than others on one day but be a mess the next, even if it’s the same thing. 

There are also a few things to think about regarding emotional stress which non-AI people take for granted (I did too before diagnosis):

1) The proximity to your last steroid dose. A friend was in a car accident and he waited until 30 minutes after my lunchtime dose to tell me. I was obviously still worried, but I was in a good place to mange my feelings about it. People with AI are best equipped to deal with bad news or emotional stress 30 minutes after their meds. 

2) The way in which you are told stressful news. If someone has bad news for me and it’s kind of dropped on me like a bomb shell e.g. via text or said in a really panicky way, my body explodes hormone wise and can’t cope. Even if practically and logically I can process it, my adrenal glands have other ideas. On the surface, I look the same but there’s a tsunami going on underneath causing massive problems. If a non-AI person is struggling to control their feelings or stress to news or an event, it will be potentially harmful for an AI person. The human body reacts to cues from other people as well as what they say- if you’re notably anxious when telling me something, my body will pick up on that. 

3) The situation or context you find yourself in, which is emotionally stressful. Arguments and conflicts wipe people with AI out for a lot longer than other people. We can’t just rant or get angry about it, get it off our chest and move on, even if mentally we want to. It takes a long time for our body to right itself after an argument. If someone with AI tries to walk away from an argument or situation, it’s probably because it’s necessary to keep them safe not because they don’t care about the other person. I hate ringing call centres to complain because my body doesn’t cope well with it. I am, however, very good at complaint emails because I can walk away and go back to it later if I feel things getting too much. 

4) Other factors. Other things might have happened that day, it could be hot, over exertion, feeling under the weather… because AI is so dependent on how the body is doing at any given time, sometimes you can do everything right emotionally and still end up needing to updose.

There are ways to protect yourself though. E.g. I try not to get sucked into other people’s unnecessary dramas and have started to avoid people who push negativity which can impact on me. I do a lot of meditation so I can observe my thoughts and feelings better, but not get washed away in them. My grandma is in the latter stages of dementia so my mum has agreed with my husband that she texts him first before contacting me with any updates- if I’m not able to deal with it at that point he can tell me the news when I am. I avoid situations I know wind me up or ask my husband to take care of things.

It is important to recognise that it’s not just my mental health which can’t always cope with stress, it’s physiological (not psychological). I still want to know things and don’t expect to be wrapped in cotton wool. Like most things, if in doubt, ask. Ask how I’m feeling, or when my last dose was or if I’ve had a bad day. Think of it in a similar way to how you would tell a child bad news (albeit not as patronising! 🙂 )- you’d gauge their ability to cope, prepare them for hearing something upsetting and listen to their questions or concerns afterwards. That method actually works well with me too! 😉 I also don’t mind if everything goes wrong and I still need to stress dose- it’s a learning curve: if I can’t get it right and actually have the illness, it would be massively unfair for me to expect other people to get it spot on!

I realise that it might not be clear what constitutes as a ‘stressful’ situation if you don’t have AI, so I’ll write another post soon about that. 

Sometimes emotional stress is unavoidable though because you can’t micro manage everything, which makes the illness an interesting one to manage! You kind of learn with experience what things feel like and how much to take, but it’s still easy to get wrong. For minor things, I take a small 2.5mg bump, 5mg if I feel particularly shakey or consciously upset. If I get any low cortisol symptoms soon after, I’d consider 5mg extra or doubling my next dose. A lot of it is trial and error. The best part is, if something is particularly stressful, I ‘forget’ that I’m supposed to take extra hydrocortisone and my husband and my friends have to work hard to convince me that that’s what I should be doing! There’s no one size fits all either- some people stress dose for things that I wouldn’t and vice versa. It’s all part of the great guessing game which is having Adrenal insuffiency 😉 


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