The word stress has negative connotations with it but in adrenal insufficiency terms, it means anything which would be an added pressure to the body from what it normally deals with. And believe it or not, this includes happy or positive things too!
Cortisol production is one of those background processes that you take for granted if it works. Your adrenal glands produce cortisol on demand depending on what your body needs at the time, and they don’t just fire out extra for big things, like a car accident, they’re constantly monitoring what’s going on and making adjustments for smaller things too. If you think about cortisol production in relation to Christmas, here are some things where your body would naturally make more cortisol to compensate;
– getting annoyed with people who get in the way when you do the Christmas food shop
– losing their sellotape or scissors constantly when wrapping presents
– driving to see family or friends
– eating and drinking out of your routine and perhaps eating and drinking a bit too much
They don’t seem like big things, but they’re all seasonal activities needing more cortisol. Knowing I don’t make my own cortisol, I try to minimise the ‘stressors’ I can by either avoiding them completely or carefully planning. Which is fine when it’s a negative list, but for me it also includes positive things too. This is because the adrenal glands don’t know the difference between something that’s negative and needs extra cortisol and something positive which needs it- to them it’s just the same. Here are some positive Christmas things which will need extra cortisol:
– spending Christmas with 2 very excitable small children
– being excited about giving and receiving presents
– staying up later than normal
– being extra sociable
I could live in a bubble and not get excited or do things and therefore my cortisol replacement could stay the same. But it’s not living and life isn’t predictable. So I’ve already decided that I’m going to stress dose over the Christmas period.
Normally, I’d feel bad about stress dosing for happy things. A lot of endos take the view that emotional stress doesn’t count and you shouldn’t stress dose unless someone has died and you’re in shock from grief. But what I’ve found is that emotional stressors have actually caused me bigger problems than illness related ones because they’re unpredictable and tricky to manage. As a patient though, it’s difficult to challenge the opinion of so many different experts and go against their advice.
So why am I doing it? I’m not just being stubborn or ignoring it, I’ve got my reasons!
– my endo trusts me and my judgement. This has given me the confidence to know what I need and do it. There isn’t a scientific way to check what my cortisol level is at any point, so it has to all be done based on my judgement
– I’ll be away from home so I don’t want to get caught out and end up in hospital
– I’m tapering from having had illness, so I won’t be doubling completely, more just increasing slightly
– I spend a lot of time living a compromised life, so a couple of days where I don’t feel like I’m completely dying (or at least am able to enjoy myself even if I still struggle) won’t do me any harm. It’s only a few days
– it’s always better to give yourself slightly more than too little. You don’t die immediately from too many steroids but you can easily from too few.
– there’s new research into this type of dosing appearing, but it’s new which means lots of endos haven’t heard of it or it’s up for discussion
– every single charity for adrenal insufficiency says increasing steroids around Christmas is a good idea. Particularly if you’re a child with AI who’s very excited about seeing Santa!
So there you have it. Stress dosing for adrenal insufficiency isn’t straight forward and includes positive ‘stressors’ as well as negative ones. I should probably write a disclaimer here which says I’m not an idiot and don’t just increase my steroids whenever I feel like it and am aware of the long term implications of too many steroids 😉 But for now, I’m looking forward to Christmas where I hopefully don’t struggle too much and enjoy being a little bit excited 😉