When a patient walks in with stomach pain or complains of recurring headaches, the doctor is likely to ask, "How's your job?" or, "How are things at home?"
Dr. James Forsberg estimates that at least 10 percent of the patients who visit him or his colleagues at Carroll Primary Care have ailments resulting from or worsened by stress.
"You explore their life circumstances. You talk about when the symptoms come on, what makes them better," said Forsberg, a family practitioner at the Washington Road medical office.
The answers to those questions sometimes reveal that stress -- whether from job, familyor finances -- is the underlying problem, he said.
"Sometimes yougo through the whole list and you get nothing," Forsberg said. But, he said, the patient might call a few weeks later and say, "You know,I didn't really think about it at first, but I really hate my job."
The availability of stress-management classes, offered by hospitals, health-maintenance organizations and employers, has resulted in a public that knows stress can lead to physical problems, Forsberg said.
"There are a fair number of patients who come in and say, 'I've been under a lot of stress, and my stomach has been bothering me,' " he said.
"I think stress is a pretty widely accepted problem, especially in our society, where we basically have so many things we expect to accomplish in so short a time."
Although physical ailments can be unrelated to stress, Forsberg said some that may go hand in hand with it are:
* Ulcers -- the eating away of the lining of the stomach or opening to the small intestine.
* Gastritis -- the inflammation of the lining of the stomach and a frequent precursor to an ulcer.
* Heartburn -- excess stomach acid splashing back up the esophagus, causing a burning sensation in the chest.
* Diarrhea or irritable bowel syndrome.
* Headaches -- either migraines or tension headaches from constricted muscles.
* Neck or back pain -- usuallyfrom constricted muscles.
* Chest pain. Although stress probably won't bring on a heart attack in a person with a healthy heart, it can lead to angina, or pain, in a person predisposed to heart problems,Forsberg said.
Just as climbing a set of stairs can increase the heart's workload, going through an emotional ordeal can raise pulse, blood pressure and demand for oxygen, the doctor said.
Harry A. Olson, a psychologist with offices in Manchester and Reisterstown, saidstress doesn't have to be a negative factor. It all depends on a person's ability to deal with it.
Stressors -- causes of stress -- can be anything that causes a noticeable change in a person's life: grief, traffic jams, moving to a new home, insults from friends or problems at work.
"The stress that we feel is our internal reaction tothose kinds of things. People feel they have a hard time coping withall the pressure and demands," Olson said.
Money seems to be the most common stressor these days, he said. But the heaviest stress hasalways come from the death of a loved one, divorce, getting fired orundergoing a bankruptcy, he said.
"And, now, having a loved one over in Saudi Arabia," Olson said.
Stress experts say the key to dealing with the problem is to take control of whatever is bothering you, accept what you can't control, and learn to tell the difference --a synopsis of what is often called the "Serenity Prayer."
"You can't change the course of events for some of these things," Olson said. "We do create a lot of our stresses, but none of us have very much control in this world."
An example of a stress that people create for themselves could be spending beyond their incomes or not managingtheir money well, he said.
Instead of fretting over past mistakes, which brings on stress, these people should accept their problems as a life lesson and move on from there, Olson said.
Jim Doolan, now the supervisor of pupil transportation for the Carroll County Boardof Education, learned to combat stress brought on by his previous job.
At age 31, after nine years in education and counseling, Doolansaid he began to feel burned out. While attending a professional conference, he "happened into" a stress-management class and had his eyes opened.
"I didn't even realize it was going to be helpful," saidDoolan, now 43 and "happy" in his career. "The bottom line was, I learned I had control over how I react to things.
"Stress is exactlybetween your ears, anyway," Doolan said. "What is good stress for memight be bad stress for you. You can't live without stress. It's part of life."
Olson, Forsberg, Doolan and others suggested ways -- other than one-on-one counseling with a psychologist -- through which people can learn to manage stress.
* Stress-management classes. Leaders are often health educators, social workers or counselors who teach people a variety of ways to cope, set priorities in their lives, and learn to relax.