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.

One of the most common contributing factors in lung cancer is smoking but a recent report suggests an alarming pattern in which cases among non-smokers are on the rise.

Pope Leo XIV was recently diagnosed with lung adenocarcinoma, a type of aggressive cancer that develops in the cells lining the lungs. He had no history of smoking. The 71-year-old pontiff underwent surgery to have part of his right lung lobe removed. According to reports, he is out of the hospital and recovering well.

Another case is of Stanford physician Bryant Lin whose stubborn cough led him to seek medical attention. After six weeks, he underwent an X-ray. The diagnosis stated that he had stage 4 lung cancer. Lin was less than a month away from turning 50, and he had never smoked a cigarette in his entire life.

“Definitely a shock,” Lin recalled according to The Washington Post. By the time doctors identified the cancer in spring 2024, it had spread to his liver, bones and brain.

According to the US Centers for Disease Control and Prevention (CDC), around 10% to 20% of lung cancers in the United States are reported in people who have never smoked or have smoked fewer than 100 cigarettes in their lifetime. That amounts to an estimated 20,000 to 40,000 cases annually.

For these patients, their no-smoking history can delay diagnosis and treatment. Hence, researchers are now looking into how environmental exposures, genetic causes and the biology of tumours may contribute to lung cancer in non-smokers.

Lung Cancer In People Who Have Never Smoked

Also read: Pope Leo XIV, Diagnosed With Lung Cancer, Undergoes Surgery As His Brother Battles Relapsed Multiple Myeloma

Smoking remains the leading risk factor for lung cancer. But other reasons like exposure to radon, secondhand smoke, air pollution and asbestos can also increase risk. Family history plays a role, especially when a first-degree relative has cancer before age 50.

Researchers are also examining genetic differences that may help explain why some people develop lung cancer despite never smoking.

A study published in September identified a rare genetic mutation concentrated in the southeastern United States that was associated with a 60-fold higher risk of lung cancer among non-smokers. The finding focuses on a possible role for inherited susceptibility, but it does not explain most cases in this group.

Lung cancer also has a different demographic profile among people who have never smoked. Women who have never smoked are more than twice as likely as their male counterparts to develop lung cancer.

“Two-thirds of nonsmoking-related lung cancer happens in women, so there’s certainly an association with female sex,” said Jaclyn LoPiccolo, a medical oncologist at Dana-Farber Cancer Institute who co-authored the mutation study.

She added, “Nonsmoking-related lung cancer is also more common in people of East Asian descent, but whether that’s a genetic or environmental association, we don’t yet know.”

These Cancers Are Often Diagnosed Late

Also read: Pope Leo XIV Resumes Daily Activities After Lung Cancer Surgery: How Recovery Looks Like After Lung Lobe Removal

People who have never smoked may not recognise a persistent cough or other respiratory symptoms as signs of lung cancer. Doctors may initially consider more common explanations if the patient has no smoking history.

Never-smokers are often diagnosed late at more advanced stages of the disease because their doctors initially consider lung cancer to be less likely.

Haiying Cheng, a medical oncologist at Montefiore Einstein Medical Center in New York, said the stigma surrounding the disease can compound the problem. “A cancer diagnosis should never become a judgment about a patient,” Cheng said.

She added that clinicians need to consider assumptions beyond smoking when it comes to lung cancer and focus on the patient’s risk profile and tumour biology.

Lin is receiving antibody therapy targeting a cancer-driving mutation. He had a positive response to treatment.

“The treatment has done wonders for me,” he said. “When I was a medical student or resident, I would have never thought a Stage 4 lung cancer patient could be very productive and have a high quality of life almost two-and-a-half years after diagnosis.”

In the United States, the US Preventive Services Task Force recommends annual low-dose CT screening for adults aged 50 to 80 who have a smoking history. People who have never smoked are not included in these recommendations.

As researchers dig deeper into lung cancer chances in non-smokers, there is growing interest in different screening recommendations. Taiwan, for example, has a national early-detection programme offering low-dose CT scans to non-smokers with a family history of lung cancer.

Lin has urged his own sons to consider screening at a younger age. “I’ve got two sons, and I told them, ‘When you hit 45 or even 40, think about getting screened,’” he said.

Many women in their forties come to my clinic with joint pain they have lived with for months, assuming it is part of getting older. World Arthritis Day is a good time to look at what changes in a woman's joints after 40 and why it pays to act early.

Why Does The Risk Rise After 40?

The biggest shift is hormonal. Oestrogen helps regulate inflammation and protects cartilage, bone and muscle. As levels fluctuate during perimenopause and fall after menopause, the joints lose part of that protection. A 2024 review in the journal Climacteric named this pattern the musculoskeletal syndrome of menopause, estimating that more than 70% of women experience joint or muscle symptoms during the transition and about one in four find them disabling.

Lower oestrogen also speeds up the loss of muscle and bone. When the thigh muscles weaken, the knee absorbs more shock with every step, which is one reason knee osteoarthritis becomes more common in women at this stage. Osteoarthritis, the gradual wear of the cartilage cushioning the bones, commonly affects the knees, hips, hands and spine. Old injuries, excess weight, and family history increase the risk.

Women are also two to three times more likely than men to develop rheumatoid arthritis, an autoimmune condition in which the immune system attacks the joint lining. It most often begins between the ages of 30 and 60.

Which Signs Should You Watch For?

One simple check is how long your joints stay stiff in the morning. Stiffness and pain that increases with movement is typical of osteoarthritis. Stiffness even with rest, especially with swelling in the small joints of both hands or wrists, suggests inflammatory arthritis and needs prompt assessment. Other signs include pain while climbing stairs or getting up from the floor, a grating feeling in the knee, firm bony swellings on the finger joints and tiredness out of proportion to your activity.

Not every ache after 40 is arthritis. Menopause-related pain, for instance, tends to move around the body. An examination, an X-ray, and simple blood tests can tell these conditions apart, so avoid self-diagnosis.

How Can You Protect Your Joints?

• Strength training: Muscle-strengthening exercise at least twice a week, focused on the thighs and hips, takes load off the knees.
• Low-impact activity: Walking, swimming, and cycling keep joints mobile without straining them.
• Weight: A study of adults with knee osteoarthritis found that every kilogram lost takes about four kilograms of load off the knee with each step.
• Diet: Get enough protein and calcium, and ask your doctor whether you need a vitamin D test.
• Daily habits: If your knees already hurt, limit deep squatting and long hours sitting cross-legged on the floor, wear supportive footwear, and avoid smoking.

When Should You See A Doctor?

Consult an orthopaedic specialist if joint pain or stiffness lasts beyond a few weeks or affects daily tasks. In rheumatoid arthritis, early treatment can slow the disease and prevent permanent joint damage. A suddenly hot, red, swollen joint with fever needs same-day attention, as it may signal infection.

Arthritis does not have to come with turning 40. Women who notice the early signs, keep their muscles strong, and see a doctor in time can stay active and independent well into later life.

By Dr Saurabh Bansal, Consultant Orthopaedic Surgeon, PB Health

Holding urine occasionally, such as during a long meeting or traffic jam, is generally not harmful for most healthy adults. However, repeatedly delaying urination for extended periods may affect urinary health, particularly in people who are prone to urinary tract infections (UTIs) or have existing bladder problems.

What Happens When You Hold Urine for Too Long?

When urine remains in the bladder for too long, it can become uncomfortable and may contribute to bladder overdistension. In some individuals, particularly those with underlying urinary retention or bladder dysfunction, regularly postponing urination may worsen existing problems.

While holding urine does not directly cause a UTI in every case, incomplete bladder emptying can increase the risk of infection.

Also read: Are People With CKD At Higher Risk Of Dementia And Cognitive Problems?

Why You Should Not Reduce Water Intake to Avoid Bathroom Break

People who work long hours or commute frequently should try to respond to the urge to urinate rather than routinely suppressing it.

Maintaining adequate hydration is equally important, as deliberately drinking less water to avoid bathroom breaks can lead to concentrated urine and may increase the risk of certain urinary problems like concentrated urine leading to crystallization and stone formation.

When Should You Seek Medical Advice?

If you experience persistent urgency, burning during urination, lower abdominal discomfort, difficulty passing urine or blood in the urine, seek medical advice. Developing regular bathroom habits and ensuring convenient access to washrooms can help support long-term urinary health.

It is also important to recognise when urinary symptoms may indicate a more serious problem. Inability to pass urine despite a strong urge, particularly when accompanied by severe lower abdominal pain or swelling, requires urgent medical attention.

Fever, chills or pain in the back or side alongside urinary symptoms may indicate a kidney infection and should be assessed promptly. Avoid assuming that such symptoms are simply the result of holding urine for too long.

By Dr. Vikram Kalra, Principal Director - Nephrology and Kidney Transplant, Aakash Healthcare Multi Speciality Hospital, Dwarka