Stress is an unavoidable part of life, and while it often carries a negative connotation, it is actually a fundamental survival mechanism. When faced with a perceived threat, whether physical or emotional, the body instinctively reacts to protect itself. This automatic response is commonly known as the "fight, flight, or freeze" response. While it serves an essential function in dangerous situations, chronic activation of this response due to daily stressors can have significant consequences for mental and physical health.

The body’s response to stress is rooted in human evolution. When our ancestors encountered a predator, their nervous systems immediately prepared them to either confront the threat (fight), escape to safety (flight), or become still and unnoticed (freeze). While modern-day stressors may not include wild animals, our nervous system reacts similarly to job pressures, financial worries, or social conflicts.

According to the Cleveland Clinic, stress is the body's response to change, activating a physiological reaction that helps us adapt and protect ourselves. While short-term stress can be beneficial, prolonged exposure can lead to an overactive stress response, negatively impacting overall well-being.

The Three Stress Responses: Fight, Flight, and Freeze

1. Fight

The fight response prepares the body for direct action. When triggered, the nervous system releases adrenaline, increasing heart rate, blood pressure, and muscle tension. While this reaction once helped early humans fend off predators, today it manifests as irritability, frustration, or aggression.

For instance, the employee who has experienced too much workload may work extremely long hours just to succeed. In short term, the action may produce good results but mostly ends in burnout, anxiety, and physical illness, for example, tension headache or digestion problems.

2. Fight

The flight response triggers an intense need to remove oneself from a stressful situation. Just as our ancestors would flee from danger, modern individuals may avoid conflict, quit jobs impulsively, or detach from relationships when overwhelmed.

Flight mode is linked with restlessness and anxiety. Individuals may have a sense of needing to get up and go-pacing, changing environments constantly, or avoiding tasks that seem too overwhelming. Someone with a flight response might have the desire to change jobs constantly, relocate constantly, or become reclusive in order to avoid perceived dangers.

3. Freeze

The freeze response occurs when the nervous system perceives a threat as too overwhelming to fight or flee. Rather than taking action, individuals shut down, feeling numb, disconnected, or paralyzed by fear.

Unlike fight or flight, which involve heightened activation, freeze mode slows down physiological functions. A person experiencing freeze mode may feel physically unable to move, struggle to make decisions, or find themselves dissociating from their emotions. This can manifest in situations such as public speaking anxiety, where someone might "blank out" or feel stuck in the moment.

What Happens in the Body During A Stressful Event?

When faced with a stressor, the autonomic nervous system (ANS) activates, triggering physiological changes, including:

• Increased heart rate and breathing: The body pumps more oxygen to muscles and the brain in case action is needed.
• Muscle tension: The body prepares for movement, sometimes causing trembling or stiffness.
• Dilated pupils: Vision sharpens to detect potential threats.
• Dry mouth: Saliva production decreases as the body redirects energy to essential functions.
• Changes in skin tone: Blood flow is directed to vital organs, sometimes making the skin appear pale or flushed.

For those experiencing the freeze response, the body undergoes a different reaction, often reducing heart rate and causing physical immobility rather than heightened activation.

Strategies for Coping and Managing the Stress Response

While the stress response is necessary for survival, frequent activation due to daily stressors can take a toll on health. Recognizing your default response—whether fight, flight, or freeze—can help in developing effective coping mechanisms.

1. Moving to a Safe Space

If possible, changing your environment can help signal to your brain that the threat has passed. Stepping outside for fresh air, finding a quiet place, or distancing yourself from overwhelming stimuli can help regulate emotions.

2. Practicing Controlled Breathing

Deep, slow breathing can be used to counteract the stress response by engaging the parasympathetic nervous system, which promotes relaxation. Techniques such as diaphragmatic breathing or the 4-7-8 method (inhale for four seconds, hold for seven, exhale for eight) can be particularly effective in calming the body.

3. Engaging in Physical Activity

This helps release pent-up energy and aids in the endorphin cascade, natural boosters for our mood.

4. Seeking Social Support

Relieving oneself from stress can come in many ways, but sharing it with trusted friends, a family member, or a good therapist will sure give that psychological boost of hope. Social support is an especially effective way of cushioning people against the stressors that they are subjected to in chronic forms.

When to Seek Professional Help

While occasional stress is normal, chronic activation of the fight, flight, or freeze response can indicate underlying mental health concerns, such as anxiety disorders or post-traumatic stress disorder (PTSD). If stress is affecting daily life—leading to sleep disturbances, difficulty concentrating, or persistent feelings of fear—it may be time to consult a mental health professional.

Diwali is traditionally associated with celebrations, family gatherings, illuminated homes and the sound of festivities. However, for women who are pregnant, the festive season can bring an additional health concern that often goes unnoticed: deteriorating air quality. The combination of firecracker emissions, vehicular pollution, construction dust and seasonal changes can significantly increase the concentration of pollutants in the air, making it particularly important for expectant mothers to be mindful of their surroundings.

Pregnancy is a period of considerable physiological and developmental change. A woman's respiratory and cardiovascular systems undergo adaptations to support the growing baby, and exposure to pollutants such as fine particulate matter (PM2.5) can add to the body's environmental burden. These particles are small enough to penetrate deep into the lungs and trigger inflammatory responses. Research has associated maternal exposure to air pollution with adverse pregnancy outcomes, including preterm birth, low birth weight and babies being small for their gestational age.

However, this does not mean pregnant women need to withdraw completely from festive celebrations. The objective should be to make informed choices, reduce unnecessary exposure and understand how precautions can be adapted at different stages of pregnancy.

First Trimester: Prioritising Early Development and Reducing Exposure

The first trimester, particularly the initial 12 weeks, is a critical period of embryonic development, when major organs and body systems begin forming. During this stage, expectant mothers may also experience nausea, fatigue, dizziness and increased sensitivity to certain environmental triggers.

Exposure to firecracker smoke and heavily polluted environments should be minimised. Although an isolated exposure does not automatically indicate harm to the pregnancy, repeated or prolonged exposure to poor air quality is best avoided.

Women in their first trimester should consider the following precautions:

- Avoid standing near areas where firecrackers are being burst or smoke is accumulating. Even brief festive activities can result in unnecessary exposure when pollution levels are high.

- Check the local Air Quality Index (AQI) before stepping outdoors. Reschedule non-essential outdoor activities when air quality deteriorates.

- Avoid participating in activities involving firecracker lighting, including sparklers and other fireworks.

- Keep indoor environments as clean as possible by avoiding excessive incense, dhoop and other smoke-producing substances.

- Maintain adequate hydration, eat balanced meals and prioritise rest, particularly if experiencing pregnancy-related fatigue or nausea.

The first trimester is also when women should be particularly mindful of their overall health rather than attempting to maintain their usual festive routines at the cost of adequate rest.

Also read: Delhi Becomes World's Most Polluted City Ahead Of Diwali, Says Swiss Agency: Experts Recommend Precautions

Second Trimester: Balancing Mobility, Physical Activity and Environmental Safety

The second trimester is often considered a relatively comfortable phase of pregnancy. Many women experience a reduction in early pregnancy symptoms and may feel more energetic, making social gatherings and festive activities easier to manage.

However, feeling physically better should not translate into overlooking environmental risks. Continued exposure to fine particulate matter and other pollutants can affect maternal respiratory health and has been associated with adverse fetal growth outcomes.

A few practical adjustments can help women enjoy the festivities without unnecessary exposure.

- Choose indoor celebrations or smaller family gatherings instead of crowded outdoor events, especially in areas with visible smoke.

- Avoid evening walks or outdoor exercise when AQI levels are poor. Physical exertion can increase the volume of air inhaled, potentially increasing pollutant exposure.

- If outdoor movement is unavoidable, a properly fitted N95 mask may help reduce exposure to particulate matter. However, it does not eliminate all pollutants or replace the need to avoid heavily polluted environments.

- Keep windows closed during periods when outdoor pollution is particularly high. Ventilate the house when outdoor air quality improves.

- Continue pregnancy-appropriate physical activity as advised by the treating obstetrician, adapting the routine according to local air quality conditions.

Women should also avoid prolonged standing, excessive physical exertion and crowded spaces where access to clean air may be limited.

Also read: Can Prolonged Exposure To PM2.5 Increase The Risk Of Blood Clots And Stroke?

Third Trimester: Protecting Maternal Respiratory Health and Avoiding Physical Strain

During the third trimester, the growing uterus places additional pressure on the diaphragm, and many women experience breathlessness, fatigue, disturbed sleep and reduced physical mobility.

When these changes coincide with poor air quality, the importance of limiting exposure becomes even more relevant. Maternal exposure to air pollution has been associated with an increased likelihood of preterm birth and low birth weight, although these outcomes are influenced by several factors and cannot be attributed to a single exposure.

At this stage, the focus should be on maintaining comfort, avoiding unnecessary physical strain and ensuring timely medical attention when required.

Expectant mothers in their third trimester should:

- Avoid crowded firecracker celebrations, open-air events and prolonged exposure to smoke.

- Prefer celebrations at home or in well-ventilated indoor environments with cleaner air.

- Avoid lifting heavy decorations, climbing ladders or undertaking physically demanding festive preparations.

- Keep antenatal appointments on schedule and discuss any respiratory discomfort or concerns about pollution exposure with their obstetrician.

- Avoid unnecessary late-night outings, particularly when pollution levels tend to remain elevated.

Women experiencing persistent breathlessness, chest discomfort, wheezing or unusual fatigue should not dismiss these symptoms as routine pregnancy-related discomfort.

Beyond the Trimester: Five Air-Safety Habits Every Expectant Mother Should Follow

While pregnancy progresses through different developmental stages, the need to minimise pollution exposure remains consistent throughout all three trimesters. A few simple measures can make festive celebrations safer.

1. Make AQI checks part of your daily routine

Do not rely solely on visible smoke or haze to judge air quality. Check the local AQI through official monitoring platforms such as the Central Pollution Control Board before planning outdoor activities. Pollution levels can vary considerably between neighbourhoods and throughout the day.

2. Keep indoor air cleaner

Indoor spaces are not automatically pollution-free. Smoke from incense sticks, camphor, candles and firecrackers entering through open windows can affect indoor air quality. Avoid unnecessary smoke-producing activities and consider using a properly sized HEPA air purifier, if available.

3. Choose celebrations that do not involve firecrackers

Lighting diyas, decorating the home, preparing festive meals and spending time with family are meaningful ways to celebrate without adding to firecracker-related pollution. Staying away from areas where fireworks are being burst is particularly important.

4. Do not compromise on hydration and nutrition

A balanced diet containing seasonal fruits, vegetables and adequate protein supports maternal health. Drinking sufficient water helps maintain hydration, although neither hydration nor antioxidant-rich foods can neutralise the effects of inhaled pollutants.

5. Know when to seek medical attention

Persistent coughing, wheezing, chest pain, significant breathlessness, dizziness or other unusual symptoms warrant medical evaluation. Pregnant women with asthma or existing respiratory or cardiovascular conditions should discuss an individualised pollution-safety plan with their healthcare provider.

A Healthier Diwali Begins With Informed Choices

One of the biggest misconceptions surrounding pregnancy and pollution is that precautions are necessary only when air quality becomes visibly poor. In reality, exposure to particulate matter can occur even when the air appears relatively clear. This makes awareness and preventive action important throughout the festive period.

It is equally important to remember that pregnancy does not mean putting life on hold. Women can continue to participate in meaningful traditions, enjoy family gatherings and celebrate festivals by making sensible adjustments to their environment and activities.

There is no single trimester in which exposure to air pollution can be considered completely safe, and no precaution can eliminate exposure entirely. The emphasis should be on reducing avoidable exposure, following local air-quality advisories and seeking individualised medical guidance.

Diwali should be a celebration of light, happiness and togetherness. For expectant mothers, a little extra planning can help ensure that the festivities remain centred on what matters most: their health, comfort and the well-being of their growing baby.

By Dr Sudeshna Ray, Associate Director Obstetrician, Gynaecologist, Jaslok Hospital and Research Centre, Sr Consultant in Breach Candy & HN Reliance

You may not smoke, exercise regularly, maintain a healthy weight and have no known medical condition. But could the air you breathe still increase your risk of stroke?

The answer is yes. Air pollution affects more than the lungs; it is associated with cardiovascular disease and stroke. PM2.5 fine particulate matter measuring 2.5 micrometres or less in diameter can penetrate deep into the lungs and trigger biological responses affecting blood vessels throughout the body.

How can polluted air affect the brain?

A stroke occurs when blood flow to part of the brain is interrupted or when a blood vessel ruptures.

PM2.5 exposure may contribute to inflammation, oxidative stress and dysfunction of the endothelium, the inner lining of blood vessels. It may also influence platelet activation and normal blood-clotting mechanisms, potentially favouring thrombosis.

Over time, prolonged exposure may contribute to atherosclerosis, the build-up of plaques inside arteries. If a plaque ruptures and a clot blocks an artery supplying the brain, an ischaemic stroke can occur. Air pollution may also affect blood pressure and cardiovascular function.

However, exposure does not inevitably cause a clot or stroke. It is one of several factors that may influence an individual's risk.

Also read: Breathe Easy This Diwali: Early Warning Signs & Precautions to Protect Children & Senior Citizens

Can apparently healthy people also be affected?

Yes. Having no diagnosed hypertension, diabetes, high cholesterol or heart disease does not eliminate pollution-associated stroke risk.

A systematic review published in the British Medical Journal in 2015 found that a 10 µg/m³ increase in short-term PM2.5 exposure was associated with approximately a 1.1% relative increase in stroke admissions or mortality. This is a population-level association, not an individual's absolute risk or proof of causation in a particular patient.

Who needs particular attention?

Older adults and people with hypertension, diabetes, dyslipidaemia, coronary artery disease, atrial fibrillation or a previous stroke or transient ischaemic attack (TIA) warrant particular attention because their baseline vascular risk is high.

Five practical steps to reduce exposure

• Check the AQI: Monitor air-quality readings, particularly during periods of severe pollution.
• Modify outdoor activity: Reduce prolonged or strenuous exercise when air quality is poor; choose cleaner environments or indoor exercise.
• Use appropriate protection: A well-fitting N95 mask can reduce inhalation of fine particles when outdoor exposure is unavoidable.
• Improve indoor air: Consider appropriately sized HEPA filtration and minimise tobacco smoke and other combustion-related pollution.
• Manage vascular risk: Monitor blood pressure, glucose and cholesterol when appropriate, and follow prescribed treatment.

Do not start aspirin or anticoagulants solely because pollution levels are high. These medicines carry risks and should be used only when clinically indicated under medical supervision.

Individual precautions help, but sustained improvements require cleaner transport, effective industrial emission controls and prevention of waste burning.

Stroke prevention must address established medical risk factors as well as avoidable environmental exposures. The air may look clear, but that does not guarantee it is clean. Protecting the air, we breathe is also an investment in the health of our brains.

By Dr. Ashish Susvirkar, Senior Neurologist and Movement Disorders Specialist, Bhailal Amin General Hospital, Vadodara

Patient developed severe malaria affecting his platelets, liver, kidneys and lungs, with the lung injury progressing to Acute Respiratory Distress Syndrome (ARDS) and requiring ventilator support.

A 45-year-old motorman developed life-threatening complications after malaria progressed to multi-organ failure, affecting his lungs, liver and kidneys and causing a significant drop in platelet count and blood pressure.

His lung function deteriorated severely, leading to Acute Respiratory Distress Syndrome (ARDS), a serious condition in which the lungs are unable to provide enough oxygen to the body. He required ventilator support with high levels of oxygen and pressure to help him breathe.

Malaria Progresses To Multi-Organ Failure

The patient was admitted in a severely ill condition after being diagnosed with malaria. By the time he reached the hospital, the infection had affected multiple organ systems.

His platelet count was low, while his liver and kidneys were affected. The most critical complication was severe lung involvement. The patient developed ARDS, resulting in significant difficulty in maintaining adequate oxygen levels and requiring mechanical ventilation. His blood pressure had also dropped significantly, necessitating medicines to support his circulation.

Also read: NHS Data Shows 12% Increase In Kidney Cancer In People Under 50: Experts Flag Overlooked Signs

Severe Lung Injury Requires Ventilator Support

Malaria can sometimes become severe and affect multiple organs. In this patient, the lungs were particularly badly affected and he developed Acute Respiratory Distress Syndrome, or ARDS.

In ARDS, the lungs become severely inflamed and are unable to transfer sufficient oxygen into the bloodstream. He therefore required ventilator support, including higher oxygen and controlled pressure to help maintain adequate oxygenation. At the same time, we had to support his blood pressure and closely monitor his liver and kidney function.

Intensive Treatment Helps Patient Recover Without Dialysis

The patient was treated with appropriate anti-malarial therapy along with intensive supportive care. He was placed on ventilator support because of severe respiratory failure and was given medicines to maintain his blood pressure. His fluid status was carefully managed, while his urine output and kidney function were closely monitored.

Despite the initial kidney involvement, his urine output gradually improved and he did not require dialysis. Over the next several days, his lung function also began to improve. As his oxygenation and overall condition stabilised, the medical team was able to gradually reduce the level of ventilator support and eventually take him off the ventilator.

After approximately 7–8 days of intensive treatment and monitoring, the patient showed significant clinical improvement. He was successfully weaned off ventilator support, regained his strength and was able to walk before being discharged from the hospital.

The patient came in a very critical condition, with the lungs, liver and kidneys affected and blood pressure requiring support. The first few days were particularly important because we had to support several organ systems simultaneously while treating the malaria. His urine output improved without the need for dialysis, and his respiratory status gradually recovered. Within about a week, he was off the ventilator and eventually walked home.

When Can Malaria Become Life-Threatening?

The case highlights that malaria can, in some patients, progress beyond fever and routine symptoms and cause severe complications involving multiple organs. Lung involvement can be particularly serious, and conditions such as ARDS may require prolonged respiratory support in an intensive care setting.

Doctors advise people with malaria to seek timely medical attention, particularly if fever is accompanied by breathing difficulty, reduced urine output, unusual drowsiness, persistent vomiting, bleeding, severe weakness or low blood pressure. Early recognition of complications and appropriate supportive care can be critical in preventing further deterioration.