All healthcare providers sometimes have to field questions from patients who are having aggravations in their symptoms despite being in treatment. Sometimes, an initial treatment is not working as planned. Other times, treatment seemed to progress well and there is a sudden downturn. There are many reasons symptoms may become aggravated, and depending on the severity and pattern of aggravation, a change in treatment might well be necessary.
Below is a list and description of some of the most common factors that accompany symptom aggravations while patients are in Chinese medicine treatment. This can happen even when some factors have been well controlled or unproblematic in the past. Sometimes, tiny changes, or several slight changes together, result in an aggravation of symptoms. Ideally, none of these factors would influence us – our bodies would be resilient in the face of change. But, whether because of the disease process or just because of a baseline sensitivity, some are more easily aggravated than others.
Review this list and consider whether any of these factors may contribute to your symptom aggravation. Use the advice listed, or come up with your own ways to bring your body back into balance. And, as already mentioned, it may simply be time for a change in your treatment – if none of these factors apply or if none of the remedies are helpful – coming in for an appointment to address your concerns is the right move.
Stress
Stress is a vague and often cited cause of all kinds of symptoms. You can think of stress as any force, internal or external, that pushes your body to adapt in order to maintain function. You’re going along your typical track, and suddenly something changes in your world. When the world changes, we change, there’s not much choice in it. Our stress tolerance is a resource that allows us to adapt better to these changes, and it is not an infinite resource. Chronic diseases and multiple stressors all reduce our tolerance to change, and increase our body’s reactivity when change is forced on us.
Stress can be both consciously perceived or subconscious, but it will affect our bodies regardless of our awareness. We are also affected by others’ stress – particularly close friends, relatives and partners. Even the stress of our pets, or our neighborhoods, or our larger communities can put pressure on our systems to respond.
It is important to note that stress is not equally distributed among people in our communities. And what might be a perfectly reasonable “stress relief technique” for a person in one socio-economic circumstance could be totally out of reach for another. There are so many larger patterns that influence our “stress landscape” over which we have little or no control. It’s very frustrating to know that, but it’s important to remember we do not have total control over our situations.
Stress is one of the most unsatisfying explanations one can receive when asking about symptom aggravation – particularly when we know that we’re stressed out. It can seem like a non-answer that adds insult to injury. But that doesn’t make it less true. And we are, most times, not powerless to combat the effects of stress on our symptoms.
I’ve listed some things to try below that have benefited me and my patients. Most of them are accessible to most people, though you may have to get creative. Ultimately, you just want to engage in activities that remove you from stressful situations, occupy your mind and/or body, and have some aspect of enjoyment.
- Get into nature, especially nature you’re not frequently exposed to
- Spend time by the water
- Move your body, especially full body movement (dance, hiking, sport)
- Call or write a letter to a friend or family member
- Try some artistic expression, even simply sketching on paper
- Prepare a new recipe
- Take a bath or sauna
- Read something that is not related to your job, your home responsibilities or your profession
- Stand or sit with your bare feet on the Earth and breathe
Food & Hydration considerations
Food, drink and substance consumption is a very common source of symptom aggravation in patients. Despite most of us believing that our patterns of eating and drinking are very uniform, there are often significant variations of which we are unaware. The more we are in stressful circumstances, or in situations over which we have little control, the more likely we are to have big variations in what and how we eat and drink.
Note that this isn’t just about the volitional activity of putting stuff in your mouth. The foods and beverages themselves also have variations. Leftovers in the fridge for one day may have one bacterial profile – but two days later the situation is significantly different. Natural materials differ from batch to batch. Even processed foods sometimes have quality control differences and changes as they age. Further, your body processes things differently under different circumstances. If you think about it, it’s surprising that anything feels “the same” from one day to the next!
Also – be gentle with yourself about this topic. While these things can be an influence, this area of life can also be filled with emotion. Food feels good, and many of us have deep connections to food that go back to childhood. Don’t penalize yourself with or about food. Don’t key in on these solutions to the exclusion of others. And above all, if working on this area is profoundly triggering because of your past or current eating disorders, or trauma around food, skip it.
Some Things to Watch Out For
- Under hydration (including increases in diuretic foods, drinks and supplements)
- Overuse of a food, beverage or substance. If you have something coming out of your garden, or bulk buy something at Costco, or are given a gift of some produce, you may eat far more of something than you do typically.
- This includes the influence of dietary changes like eliminating gluten. Substitutes for glutinous flour may contain ingredients you are sensitive to, or simply aren’t used to eating in large quantities. This doesn’t mean you have to abandon the dietary change, it just means some adjustments are necessary.
- Food quality, food contamination and spoilage. Unless you have total control of your food chain, from production until it hits your plate, there are unknowns in your diet over which you have little influence. Particularly if you have digestive issues, scrutinize the food you’ve been eating. Did you recently open a new package of something, or get into some new produce? Are you eating leftovers? Are you eating meat without following very strict food safety protocols?
- From a Chinese medicine dietetics point of view, consider the flavor and temperature balance of your diet. Sometimes, especially in the summer, we get excited about profoundly cooling, watery and often sweet or sour foods. This is fine, and a natural adaptation to our environment, but we humans do like to take things to extremes. Look at what you’ve been eating and drinking and consider the balance of the following five flavors, as well as the influence of warmth and cold.
Movement changes as a root of more symptoms
Some symptom aggravations, particularly those dealing with pain, can be traced back to movement and postural patterns. Again, we think of ourselves as quite consistent, when in reality we are often more variable. You may track and know that you take a walk for 30 minutes every day – you can verify that. But, the walk’s intensity, your body’s reaction to it, and the amount that you move otherwise during the day may change without you noticing it. Consider how you’ve been moving, and if the pattern of movement has changed recently.
Don’t forget about “everyday movement.” This includes cleaning house and vehicles, doing yard work, house maintenance, increases in laundry, recent shopping trips or other retail situations resulting in lots of lifting or work with tools. When you are doing a big yard cleanup in the spring, for instance, you may notice your hands hurt more. That’s an expected response in anyone over about 30 years old. It will probably pass soon without you having to do much about it.
This also includes allowing your body time to adjust to a new exercise routine. If you’ve recently started doing something new, or added/subtracted equipment, or changed shoes, or ramped up intensity, account for that as you consider your symptom aggravations. In these cases, some additional stretching, rest, and grace around your period of adaptation may be the only real response possible.
Consider, too, whether you’ve had to have your body in less than ideal positions more often lately. Common influences include:
- More driving than usual, or other travel
- A change in sleeping arrangements, including new pillows
- More or radically less work at a computer or other machine
- Yard work and housework as already mentioned
- Helping a child or other dependent more often with physical tasks
Weather and Other Environmental Factors as the cause of more symptoms
We are not separate from our environment. We are one with it. When you open your mind to the number of things that contact your body, you may well feel overwhelmed! Again, most of the time our bodies roll with these influences just fine – we adapt. But when the changes are too profound, or in some disease states, or if there are several minor changes happening at once – it can overcome our ability to adapt and symptom aggravations are the result.
I’ve listed below some common environmental factors that have worsened my patients’ symptoms in the past. Many of these factors are difficult or impossible to counteract on your own. The only answer here may be additional treatment or changed treatment while the aggravating factors are present. Sometimes this results in patients having seasonally based treatment flows. In the winter, for instance, when their joint pain is at its worst, they do additional acu-moxa, regular sauna and an increased herbal dose, along with OTC painkillers more frequently as needed.
In Your Home
- Mold and mildew
- Fleas and other insects
- Air quality problems
- Recent new furniture, textiles
- Recent renovations or damage to the home
- Poor ventilation
- Seasonal allergies from open windows
- Pet dander accumulation
Outside of Your Home
- Smoke and other pollutants
- Fires
- Inversion layers
- General pollution
- Vehicle exhaust
- Industrial emissions
- Noise
- Road noise
- Neighbor noise
- Industrial noise
- Construction work
- Light
- Artificial light pollution
- Sunlight increases and decreases
- Seasonal changes in day length
- Screen time and blue light exposure
- Barometric pressure
- Atmospheric pressure seems to impact pain the most, particularly headaches and arthritis. Most people find their symptoms get worse as the pressure falls – this generally happens when rain/clouds are incoming. Some people find their symptoms are particularly aggravated by big changes, whether those are a net rise or net fall in the pressure.
- Because of this, at least on the Oregon coast, nearly all of my migraine and arthritis patients will experience pain aggravation during spring and fall. March and October are the worst in a normal year, though “normal” is scurrying out the window as climate change progresses.
- Precipitation / Weather
- Outside of barometric pressure, we can be influenced by the weather itself
- Wetter or drier weather can have an influence on skin and mucous membranes
- Changes in sun exposure can affect body temperature, vitamin D status, and mood
- Humidity levels can affect joint pain and respiratory conditions
- Temperature fluctuations can stress the body’s regulatory systems
- Wind can aggravate certain conditions, particularly headaches and respiratory issues
- Seasonal transitions often bring multiple changes at once, challenging our adaptation abilities
What You Can Do if you’re experiencing more symptoms after starting treatment
While many of these factors may seem overwhelming or outside your control, there are several steps you can take to help manage symptom aggravations:
- Track Your Symptoms: Keep a simple diary, noting when symptoms worsen and what else is happening in your life at those times. Patterns often emerge that can help you identify triggers.
- Control What You Can: While you can’t change the weather, you can control your indoor environment, diet, and daily routines. Focus on these manageable factors first.
- Plan Ahead: If you know certain seasons or situations worsen your symptoms, work with your healthcare provider to develop a preventive strategy.
- Stay Connected: Keep regular communication with your healthcare provider about changes in your symptoms. Don’t wait until things become severe to seek help.
- Be Patient: Remember that healing isn’t linear. Temporary setbacks are normal and don’t mean your treatment isn’t working.
- Practice Self-Compassion: Managing chronic symptoms is challenging. Be kind to yourself as you navigate these challenges and celebrate even slight improvements.
When to Seek Additional Help
While some symptom aggravations are temporary and manageable, others require professional attention. Contact your healthcare provider if:
- Symptoms become severe or unbearable
- New symptoms develop
- Aggravations last longer than usual
- Your usual coping strategies aren’t helping
- You’re concerned about any changes in your condition
Remember, your healthcare provider is here to support you through these challenges. Don’t hesitate to reach out with questions about your symptoms or treatment plan. We are here for you!
