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Question 35: Dr. Duncan, I am a 35 year old male professional with TS. I have been ticking like crazy all summer due to the stress of buying a house, moving, renovating and starting a new job. I click my throat so much that it hurts at night when I go to bed and I am afraid I am going to damage my larynx or vocal cords. I am not taking medication as my condition is not that severe, but are there any herbs or foods that can alieve my ticking, or anything can can bring my stress level down? J.S., NB, Canada

Dear Dr. Dunc, I read from some sources that environmental factors can magnify TS symptoms. What are considered environmental factors? How can I help my 61/2 year old to form a good environment for him to help him control his tics. Does it mean that as his mom I may have may his tics worse? I am having a very hard time coming to grips with his TS and tics. Please help!!!!!! G.W., ON, Canada

Hello folks:

I have put these 2 emails together to reply to because they are somewhat related -- G.W., you ask what are meant by 'environmental factors' that can magnify symptoms, and J.S., you provide an excellent example of what some of those environmental factors might be and the impact they can have. A number of studies have tried to ascertain if there are certain factors that ALWAYS exacerbate tics and others that ALWAYS attenuate tics: for example --


Silva, RR, Munoz, DM, Barickman, J & Friedhoff, AJ. (1995). Environmental factors and related fluctuation of symptoms in children and adolescents with Tourette's disorder. Journal of Child Psychiatry, 36(2), 305-312.


In general, however, it's been found that what DECREASES tics in one person may INCREASE or NOT IMPACT tics in someone else. My own belief is that it is stress that increases tics, and since what an individual finds stressful is largely idiosyncratic, large sample studies would have difficulty finding conclusive results. In essence, each participant would be reacting differently in different situations depending upon whether or not they find those situations stressful and so general results are impossible to find.

It is also worth mentioning that I define 'stress' in the sense of 'anything that impacts the resources of the body' (something that 'strains the system', so to speak). Hence a whole variety of things can be considered stressful beyond those traditionally thought of (the psychological stress of studying for an exam, for instance). Being too hot, too cold, hungry, thirsty, being in a room full of people vs. being alone, etc. are all physical stressors. Big events (such as J.S.'s move) are stressors even though they are 'happy' events -- often a birthday or Christmas is one of the worst times for TS'ers because of the excitement around these events.

Regarding how to control stress, there is not any TS-specific advice to give -- everyone has stress in their lives, and everyone reacts to it (for example, when an individual finds that he or she can sing when along, but his/her throat constricts as soon as others are in the room). The only difference between 'normies' and those with TS is that OUR reactions to stress are more obvious. Think of TS symptoms as the music and stress as a volume control -- anything you can do to turn that knob to a lower setting will de-amplify the music.

Some people find herbal supplements or different 'comfort foods' to help alleviate stress, yes, but there is no rigorous research yet to demonstrate any reliable and valid results. In other words, we don't know yet if the different herbs people try will work every time, and whether it is REALLY the herbs that is making the difference or something else (maybe the person's BELIEF that the herbs are helping).

Some try meditation (my ex-fiancée); others use chiropractic (myself). Some go to massage therapy or use hot baths at the end of a day. Exercise is important, as is eating regular, healthy meals. A good night's sleep is an all important foundation. Good psychological health is important too -- talking out problems or emotions with someone, disclosing your TS to your work environment or classroom, using tools like a DayTimer to keep life organized, predictable, and to develop routines, ensuring you have some 'personal time' (a 'haven' is very important for example -- a place of solitude that is yours alone), and balancing work with personal pursuits/hobbies all contribute to minimizing stress.

None of these suggestions (and this is by no means an exhaustive list) are earth-shatteringly new, and none of these suggestions on their own are necessarily the ultimate or right answer for each of you. What I wish to simply convey is that every little bit counts -- each trick turns that volume control down a little bit more.

There will always be stress in a person's life -- times of transition (like that of J.S.) are unavoidable...........after a recent change in credentials/city/job/life myself, J.S., BELIEVE me I can commiserate! Also, no one should expect others to 'insulate' them from any and all of life's stressors G.W. -- do not feel guilty if sometimes you have subjected your son to a stressful situation. By allowing him the dignity and opportunity to face the real-world you ultimately do him many favours (such as helping him to learn to increase his tolerance TO stress) and, through doing so, show a lot of love.

I hope this has helped somewhat -- fingers crossed that you are now getting your life (and hence your tics) re-settled J.S.!!

Dr. Dunc.

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