If you suffer from symptoms such as headaches, shortness of breath, chest pain or weight gain, your initial thought is probably not “I should evaluate my emotional health”. But in fact, our emotions have significant effect on our physical body. Psychological studies prove that our minds and our bodies are intimately connected. Therefore, good mental health can improve physical health and poor emotional health can cause a decline in physical health.

As a family physician, I would estimate that about two-thirds of my office visits are partly due to stress-related symptoms. What has been interesting in seeing my patients with physical symptoms caused by stress-related issues, is that almost universally, they have an extremely difficult time accepting that the root cause is mentally related.

For example, I have had numerous patients experience chest pain that despite multiple tests, no physical identifiable cause is found. Even with multiple visits to the emergency room, EKG’s, lab work and other testing, no cause for the chest pain is found. When I ask them about stress, 99% of the time, they are anxious, depressed, or going through an extremely difficult time in their life. Yet, undoubtedly, these patients were reluctant to accept that the stress, worry and anxiety in their life is causing their physical symptoms. It takes multiple visits, numerous tests and a lot time in discussion to convince them that mental health can cause real physical symptoms. This relationship is called somatization – an unconscious process through which psychological distress is converted to physical symptoms.

What we don’t hear very much of is that stress is linked to the six leading causes of death: 1) heart disease 2) cancer 3) lung disease 4) strokes 5) accidents and 6) Alzheimer’s. This is partly because the body does not distinguish between physical and psychological stress. Research shows that those who repress their emotions suffer more physically. One specific study in the Journal of Psychosomatic Research found that cancer patients who chronically avoid expressing their feelings die sooner and in greater numbers than those who freely express their emotions. The ways in which emotions are managed is one of the most relevant but least examined issues in medicine today. Despite all the evidence, unfortunately what is lacking in an annual physical exam is spending adequate time assessing emotional and mental health.

But, there is good news! You can take control of both your mental and physical wellbeing. The first step is to recognize the warning signs in order to prevent poor emotional and physical health. Symptoms such as memory problems, diarrhea or constipation, frequent colds, loss of sex drive, inability to concentrate and others could be a warning sign of poor mental health. Once you recognize these symptoms, spend time reflecting on whether your emotional state could be contributing to these symptoms. Then, seek help from a medical professional, either a counselor or your physician. It is important that you express to your healthcare professional all of your symptoms including your emotional state. With ample insight into your overall health, you will assist your healthcare professional in adequately diagnosing and treating you.

So I recently saw an extremely sad movie. I was warned ahead of time that it was emotional and I thought I was prepared to experience some sadness. But I wasn’t. It was an unbelievably moving movie and I don’t remember crying that much for any movie. Ever. Don’t get me wrong, I loved the movie, but I cried during and well after the movie was over! As I usually do when I see a good movie, I shared with my friends that it was a ‘must see’. But I also warned them to be ready to cry. What I didn’t expect was the overwhelming response of my friends of: “I don’t want to cry, I’m not going to see it”, or “I hate crying, I’ll pass.”

I don’t consider myself a crier, however, I do appreciate a good cry every now and then and usually feel better afterwards. So why do we hate crying so much? And where did the saying “have a good cry” come from? I dug a little deeper and here is what I found.

One of the most important functions of crying is protecting our eyes from irritants like dust. It also helps lubricate our eyeballs. However, crying can have healthy psychological benefits. Crying is a natural emotional response to feelings such as hurt, sadness or happiness. Crying is also thought to give us a psychological boost by reducing stress and giving us a sense of relief because it is a physical response to an emotional situation. According to the American Academy of Ophthalmology tears (specifically tears linked to emotions) have a higher level of ACTH which is a precursor to the “stress hormone” cortisol. Cortisol is increased during emotional stress and we can literally cry out the stress. Crying also helps lift our moods and deal with painful experiences.

Crying can help express deep emotions that may be inexpressible in any other way. You may even feel cleansed or lighter afterward. Crying can also lead to some sort of physical contact when shared with someone. We tend to hug or hold someone we see crying, and physical touch has also been linked to helping stress reduction.

Sometimes crying helps, and sometimes it doesn’t. However, frequent or prolonged crying may be a sign of more serious condition, such as depression. If you feel like you can’t control your crying, see your doctor or counselor

The poet Ovid wrote “It is a relief to weep; grief is satisfied and carried off by tears.” So go ahead and have a good cry.

I willing to bet that you have seen at least one Marvel movie! I’m not a huge comic-superhero- movie-going kinda girl but somehow I’ve managed to see all the Marvel movies. There’s something about these characters, learning how to use their special abilities to save the world, that I just cannot resist.

Some of my favorite Marvel characters? Iron Man (of course!), Storm, Hulk and Black Panther. To be honest, I think these characters are my favorite because I enjoy the actors more than the characters they play. Robert Downey Jr (Iron Man) has an amazing comeback story — from alcohol and drug addiction, prison and being basically unhireable as an actor, to becoming one of the highest paid actors in Hollywood is amazing.

But Halle Berry (Storm) is a real life hero (of mine anyway) because she has demonstrated the special ability of vulnerability, transparency and truth telling as she has disclosed that she deals with depression and has attempted suicide.

It absolutely takes a special ability to tell millions of people – in a world where perfection is not optional – that you are not only not perfect, but struggling and battling with a mental health disorder. Other heroes? – Jada Pinkett-Smith (Depression and Suicidality), Demi Lovato (Bipolar Disorder), Adele (Post-Partum Depression) and Gina Rodriguez (Anxiety).

You may disagree with me but I do consider them heroes in this aspect. Our culture, and our pride, forces us to hide, feel guilt or shame, believe that we are alone in our struggles and keep our mouths shut.

We may not be able to fly or travel through time, but we are able to tell the truth. So I encourage you to use that special ability. Be different. Be vulnerable. Be open. Be a hero and tell the truth about what is really going on in your life. You may be surprised, you may become your own hero.

“Mrs. Jones, your CBC, BMP and TSH are all negative. Your BMI and LFTs are elevated and I’m worried about NAFLD so you need to diet and exercise more. You’ll need to stop taking the statins and I’ll order a RUQ US.”

Say What?!?!?!

Do you ever feel like your doctor is speaking in some secret code that you don’t understand? You’re not alone. According to the National Action Plan to Improve Health Literacy, about 90% of American, Englisht-speaking adults have problems is health literacy. Health literacy is the ability to obtain and understand information about your health, but it has nothing to do with your intelligence.

Medical terminology is essential in the healthcare world, but it is often heard as gibberish by patients. This may be because often doctors speak to their patients as if they are speaking to another physician. I have to admit, I pride myself in being a good communicator to my patients but there have been plenty of times where I’ve said something and the look on my patient’s face clearly shows that I just rambled out a bunch of acronyms and abbreviations and I need to start over.

Health literacy is actually a bigger problem than most realize. Studies show that patients with low health literacy are more likely to be hospitalized, use medication inappropriately and receive fewer recommended preventative measures. You can find more information on those studies here: Updated Systematic Review So, before you go to another doctor’s appointment, here are 5 tips to increasing your health literacy.

1. Ask questions. In fact, write down questions before your appointment. Most people have a lot they want to ask their doctors but by the time you wait an hour in the waiting room and the doctor starts with her own agenda, the questions usually are forgotten. If you write them down, you are more apt to remember and have your questions answered.

2. Bring a list of all medications. This includes supplements, vitamins and all over the counter meds. It’s important for you and your doctor to know who is prescribing what meds and watch for any potential interactions.

3. Don’t pretend. If you don’t understand what your doctor is saying, stop immediately and ask him to use simpler language. Often patients are afraid to admit that they don’t understand medical terminology. It is absolutely okay to ask for clarification.

4. Use reflective listening. This means restating what the doctor is saying. This will ensure that instructions are clear. Simply say, “Let me see if I understand. You are saying……”

5. Take another adult with you. This should be a trusted relative or friend in order to have an extra set of ears and maybe to take notes.

The doctor’s office can tend to be an intimidating place. But it’s important to know that YOU are in control of YOUR health and your doctor is there to provide a service for YOU. Do not leave your appointment feeling unsatisfied. It truly could be a matter of life and death.