Allostatic Load

I had a Twitter account for my business before I was diagnosed with Stage IV Metastatic Breast Cancer (MBC) in 2017 but I didn’t “know” anyone on Twitter or really understand how Twitter works. Oh, how times have changed!! A few years ago, I started getting more active on Twitter, specifically in the cancer advocacy space, and I’ve connected with so many people that I only know on Twitter. Some I’ve been able to meet in real life and @CoffeeMommy a/k/a Stacey Tinianov is just one of those amazing human beings that I first got to know (stalk) on Twitter and then met in real life. Others I plan to meet at some point when we can travel and be around people again.

Stacey Tinianov (@coffeemommy)is one of these instinctive connectors in the breast cancer space and she is taking her talents to a new height with the Advocate Collaborative (ACE) (@AdvocateCollab). You all should do yourselves a favor right now and follow both handles on Twitter for a wealth of timely information and lovely pictures from CA.

Stacey recently posted this tweet, which piqued my interest:

Allostatic load is defined as the cost of chronic exposure to elevated or fluctuating endocrine or neural responses resulting from chronic or repeated challenges that the individual experiences as stressful.

https://www.sciencedirect.com/topics/neuroscience/allostatic-load

Notice that this definition doesn’t require an objective definition of stress or challenge, the load is as an individual experiences stress and varies as a result. Stacey is referencing a really impactful webinar about the stress that black people face in our country as a result of structural racism and inequities. It is difficult for those of us who are white to understand how difficult it is for some in the black or other minority communities to simply do life, expecting to not be taken seriously, expecting a fight just to be heard, expecting to encounter a different standard than those who are white.

As Stacey suggests, this concept can be applied in other circumstances such as the lifelong treatment those of us with terminal cancer experience. We often use other words — PTSD, triggered, scanxiety etc., — to describe how daunting it is to walk into the the infusion center every month or to continue to see our doctors for life, knowing that we could receive similar or even worse news at each appointment. I wrote a blog post about our “Surge Capacity” not too long ago and this concept is similar.

At a bottom line, the biological response to stress and the resulting flood of hormones and other substances that allows our bodies to remain alert in stressful and difficult situations wears on the body at some point. Where that point is does seem to differ with different people and I think underlying resilience is part of that explanation, but to be human means that we only have so much resilience, only so much grit, only so much capacity. At the end of that capacity is what?

I think how each of us responds to the allostatic load we each carry personally can vary. Some of us (introverts) tend to withdraw to refill our tank. Some of us (extroverts) tend to need energy from other people surrounding them. Some of us process these issues internally, some externally. Some pick up projects, some ignore the world, some collapse, some act out, etc. There are so many different ways of responding that are as varied as there are people. And yes, some of these responses are more helpful or productive than others.

And then we add COVID and all the stresses and triggers that accompany a worldwide pandemic.

So what’s the answer?

Is there AN answer?

Since each person has a different capacity for stress and likely respond differently to different allostatic loads, I believe there is no one answer. If the allostatic load is defined by each individual person and the underlying stress is individual, then the answer or remedy has to be individual as well. Just as I found that the coping mechanisms I’d learned in my first 38 years of life didn’t handle the terminal diagnosis I received at age 38, the coping mechanisms we developed to deal with illness or struggle are not effective at handling a worldwide pandemic.

I think we all need to learn (me included) to be more gentle with ourselves, to put less pressure on ourselves, and to give ourselves permission to need help. I struggle with this and often carry far more of an allostatic load than I ever let on. I’m pretty skilled at putting my head down and just focusing on one foot in front of the other. Doesn’t mean it isn’t hard, doesn’t mean that I don’t struggle, doesn’t mean that I don’t need help.

Just think if we were to be gentle with ourselves, understanding how difficult life is right now, and then extend that gentleness to others … now that would be amazing for us all!