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History Of Anxiety And Panic Disorder. Muscle Stiffness, Feel Hungry, Headache. Taking Propranolol. What Is The Problem?
Question: Hi, I've been suffering with anxiety disorder and panic disorder since September 2011.
Weight: 144 lb
Height: 5' 7"
Normal weight before I developed panic/anxiety problems back in Fall 2011: 165 lb (felt I was fairly thin back then).
I don't smoke.
I find it very difficult to gain weight, though I eat very often. I get hungry frequently and snack quite a bit on crackers and chips. Lately, I' ve been consuming an occasional sweet snack that is in the vicinity of 8 grams of sugar or less per serving; however, I avoid sugary stuff like the plague though. No caffeine ever (except for what's in chocolate, but I rarely touch chocolate stuff), and I don't drink alcohol anymore (a year and a half sober).
I've been having lots of tightness/stiffening of muscles in my neck, back, upper chest, knocking, jolting, sharp pains in my chest and ribs, and ever worsening stomach pain and gas problems (gas going up chest, especially when hungry. I usually get the "hunger-level" gas as I call it every night). Exertion seems to heighten my anxiety, so it's been a bit hard to commit to exercising. In August 2012, I started suffering with worsening eye strain which over the following 2 months led to photophobia, tension headache, occasional migraine headache (light-headed, pounding headache, heartbeat in my head with nausea) chronic ophthalmic migraine (flickering lights, light trails, in front of my eyes frequently all the time, though the optometrists I've seen didn't find anything wrong (there's a scar on the bottom of my left eye, but my problem is with both eyes). I also have been aware of having so called "Visual Snow" for several months now. It's like a really faint overlay of static over my vision.
I recently read about Meningism, and I wonder if that might be part of my problem. Maybe I have some kind of fungal infection messing my system up? I've got this bruise-like discoloration on my chest cavity. There appears to be some kind of stuff on it, like a mold or something. It has a faint but odd smell to it when I wipe it with my finger and sniff. It flakes a bit. I've tried scrubbing when I shower, but it doesn't go away.
I thought I saw mention that images could be uploaded here, but I don't see a place to put them. I've uploaded them to my personal web server just in case; here's the links to the pics of the stuff on my chest cavity (sorry, they may be bit low quality, as my digital camera is a bit old):
WWW.WWWW.WW
WWW.WWWW.WW
I've had blood work twice (November 2011, then I believe it was December 2012 when I went again). Had an EKG back in November 2011 as well, nothing unusual.
Background story of the genesis of my anxiety disorder (if it's useful):
My first ever panic attack was at a party at a friend's place. We were drunk, and I shared in using a large amount of marijuana (shared 3 medium sized vape bags with a friend). I didn't smoke that often, it was a new thing for me. I'd tried it a few times before at 3 different parties over the past few years, but this time I knew my friend, so I started to smoke it often there. This was my 4th or 5th time using the vape with my friend, and I had a rough panic episode lasting a good hour or so until I finally fell asleep. Tried to get high again after that some 4 weeks later, but I panicked again just after a few hits. So I quit for good. That was early to mid summer 2011. Then I had my first sober panic attack in following fall, which set off my anxiety and panic disorder.
It started with the first panic attack coming in response to what was just a minor ache in my left chest after I had an energy drink at college (drinking energy drinks was a common habit of mine, though I didn't normally drink more than one in a day). Having experienced my first sober panic attack, I was horrified that I could encounter panic at any time (not just when intoxicated). This made me panic just from fear of panicking; I became hyper-vigilant over the possibility of panicking. The more days I panicked, the worse the physical symptoms became. Soon I was suffering with being aware of my heartbeat all the time, tense most if not all of the time. and having stomach pain. I made great progress suddenly with my panic problems toward the end of the semester at college. It was in response to having to give a presentation with my team in class; I was panicking in my chair waiting. Thinking about things, I had a moment of lucidity I guess; I realized it wasn't such a meaningful event that I should be making such a big deal of it. I went to the front of the class with my team finally, and had no nervousness (first time in my life giving a presentation while being calm. I've always had terrible stage fright). I haven't had any presentation classes since then though. I found a nice job where I work remotely from home now.
I went without trying medication for a long time. I didn't start trying meds till maybe August 2012.
My diet had changed immediately and tremendously early Fall 2011, shortly in response to the start of my anxiety problems. I just about stopped consuming junk food; very little sugary stuff sometimes, but not too often (it seemed increased my anxiety). I quit all caffeinated beverages cold XXXXXXX (99% of what I drink is just water. Very occasionally I consume a small amount milk or orange juice). I completely quit alcohol immediately (felt naturally forced to; drinking made my stomach get really tense and panic would come on). I was fear-driven to quit; the only thing on my mind was getting past panic disorder, so drinking bore me no challenge to quit. I had been in the habit of drinking 1 - 2 six packs (occasionally 3) per week since I was 22 (I began drinking when I was 21 though). Again, these changes were made shortly after the onset of the panic problems, and I've been on a very similar diet since then. Still haven't touched any alcohol.
Thanks!
Weight: 144 lb
Height: 5' 7"
Normal weight before I developed panic/anxiety problems back in Fall 2011: 165 lb (felt I was fairly thin back then).
I don't smoke.
I find it very difficult to gain weight, though I eat very often. I get hungry frequently and snack quite a bit on crackers and chips. Lately, I' ve been consuming an occasional sweet snack that is in the vicinity of 8 grams of sugar or less per serving; however, I avoid sugary stuff like the plague though. No caffeine ever (except for what's in chocolate, but I rarely touch chocolate stuff), and I don't drink alcohol anymore (a year and a half sober).
I've been having lots of tightness/stiffening of muscles in my neck, back, upper chest, knocking, jolting, sharp pains in my chest and ribs, and ever worsening stomach pain and gas problems (gas going up chest, especially when hungry. I usually get the "hunger-level" gas as I call it every night). Exertion seems to heighten my anxiety, so it's been a bit hard to commit to exercising. In August 2012, I started suffering with worsening eye strain which over the following 2 months led to photophobia, tension headache, occasional migraine headache (light-headed, pounding headache, heartbeat in my head with nausea) chronic ophthalmic migraine (flickering lights, light trails, in front of my eyes frequently all the time, though the optometrists I've seen didn't find anything wrong (there's a scar on the bottom of my left eye, but my problem is with both eyes). I also have been aware of having so called "Visual Snow" for several months now. It's like a really faint overlay of static over my vision.
I recently read about Meningism, and I wonder if that might be part of my problem. Maybe I have some kind of fungal infection messing my system up? I've got this bruise-like discoloration on my chest cavity. There appears to be some kind of stuff on it, like a mold or something. It has a faint but odd smell to it when I wipe it with my finger and sniff. It flakes a bit. I've tried scrubbing when I shower, but it doesn't go away.
I thought I saw mention that images could be uploaded here, but I don't see a place to put them. I've uploaded them to my personal web server just in case; here's the links to the pics of the stuff on my chest cavity (sorry, they may be bit low quality, as my digital camera is a bit old):
WWW.WWWW.WW
WWW.WWWW.WW
I've had blood work twice (November 2011, then I believe it was December 2012 when I went again). Had an EKG back in November 2011 as well, nothing unusual.
Background story of the genesis of my anxiety disorder (if it's useful):
My first ever panic attack was at a party at a friend's place. We were drunk, and I shared in using a large amount of marijuana (shared 3 medium sized vape bags with a friend). I didn't smoke that often, it was a new thing for me. I'd tried it a few times before at 3 different parties over the past few years, but this time I knew my friend, so I started to smoke it often there. This was my 4th or 5th time using the vape with my friend, and I had a rough panic episode lasting a good hour or so until I finally fell asleep. Tried to get high again after that some 4 weeks later, but I panicked again just after a few hits. So I quit for good. That was early to mid summer 2011. Then I had my first sober panic attack in following fall, which set off my anxiety and panic disorder.
It started with the first panic attack coming in response to what was just a minor ache in my left chest after I had an energy drink at college (drinking energy drinks was a common habit of mine, though I didn't normally drink more than one in a day). Having experienced my first sober panic attack, I was horrified that I could encounter panic at any time (not just when intoxicated). This made me panic just from fear of panicking; I became hyper-vigilant over the possibility of panicking. The more days I panicked, the worse the physical symptoms became. Soon I was suffering with being aware of my heartbeat all the time, tense most if not all of the time. and having stomach pain. I made great progress suddenly with my panic problems toward the end of the semester at college. It was in response to having to give a presentation with my team in class; I was panicking in my chair waiting. Thinking about things, I had a moment of lucidity I guess; I realized it wasn't such a meaningful event that I should be making such a big deal of it. I went to the front of the class with my team finally, and had no nervousness (first time in my life giving a presentation while being calm. I've always had terrible stage fright). I haven't had any presentation classes since then though. I found a nice job where I work remotely from home now.
I went without trying medication for a long time. I didn't start trying meds till maybe August 2012.
My diet had changed immediately and tremendously early Fall 2011, shortly in response to the start of my anxiety problems. I just about stopped consuming junk food; very little sugary stuff sometimes, but not too often (it seemed increased my anxiety). I quit all caffeinated beverages cold XXXXXXX (99% of what I drink is just water. Very occasionally I consume a small amount milk or orange juice). I completely quit alcohol immediately (felt naturally forced to; drinking made my stomach get really tense and panic would come on). I was fear-driven to quit; the only thing on my mind was getting past panic disorder, so drinking bore me no challenge to quit. I had been in the habit of drinking 1 - 2 six packs (occasionally 3) per week since I was 22 (I began drinking when I was 21 though). Again, these changes were made shortly after the onset of the panic problems, and I've been on a very similar diet since then. Still haven't touched any alcohol.
Thanks!
Hello
First of all a brief summary of your condition-
You are a young male with average weight, average height, with no significant past history of any chronic medical illness. You have personal history of occasionally smoking marijuana and occasional alcohol intake but you are sober for a year now. You have total duration of illness of about one and half year. You developed panic attack after smoking marijuana and then again the symptoms recurred with even energy drinks. Then the symptoms of panic occurred even while you were sober. Due to panic you became very stressed. Anticipatory anxiety developed in you with fear of panic. Ultimately you started remaining anxious (awareness of heartbeat, restlessness, and fear) and you were not able to even give presentation to class without anticipatory anxiety. You have been always stage shy. You have also picked job in which you work from home. You are allergic to amitryptilline, and currently you are taking Propranolol 10 mg twice a day. You have also complaints of tension headache, migraine for about 8 months now.
Now coming to discussion and management about your problem-
First of all I would like to tell you that your weight is pretty normal and is proportionate to your height and age. It is not in lower range, still if you want to increase it a little bit you can exercise daily. Secondly difficulty in gaining weight is a feature of your problem of anxiety.
From available information I can tell you that you have three main conditions that should be looked upon.
One is your problem of stage shyness. You have mentioned that you have been always shy of stage. You are also working from home. Although it may be considered normal, but unconsciously out mind works to avoid anxiety and it tend to pick comfortable situations only. This is a part of heart rate, sweating, tremors, butterfly sensation in epigastrium, light-headedness, dizziness, etc. Due to this anxiety you started remaining low and problem of tiredness, weakness and tightness in neck etc. have developed in you.
Now coming to management part-
I would advise for some investigations even thought blood examination was normal. Thyroid hormone profile is most important of them. Patients with hyper thyroid states may show inability to gain weight and symptoms mimicking anxiety and panic. If thyroid levels come normal then we can proceed to treatment plan.
You are taking Propranolol 10 mg twice daily. This drug is a very nice drug for episodic control of anxiety. It is found to be very useful in Social Anxiety Disorder and it is also covering migrainous headache. But as per my opinion as your symptoms are not in mild grade, you need additional medications.
Medicines like SSRI (Sertaline, Paroxetine, and Fluoxetine) can be prescribed in your case. These are very good anti anxiety medicines and will also cover depressive symptoms associated with anxiety. They will also help to gain a little bit of weight. These medicines will tend to correct biochemical abnormality in you due to which anxiety occurs.
For episodic control of anxiety apart from propranolol other medicines like Etizolam, Clonazepam are also useful. They are comparatively safer drugs and can relax an individual with anxiety.
You should also practice Yoga and meditation. These will help to boost your self confidence and will help in relaxation.
Behaviour therapy by a trained Psychiatrist is mainstay of treatment. Methods like Progressive Muscle Relaxation Exercises and Deep Breathing Exercises are included in it. They help individual to understand the change in body during anxiety sates. Then individual is taught to relax himself even in anxiety. With time individual can control symptoms by self control.
Your psychiatrist will know about these drugs and the behavioural therapy. I suggest you to consult a qualified psychiatrist and discuss about these options. I expect you to feel better with this type of treatment.
Regarding the bruise like discoloration on your chest, it appears to be a mild fungal infection. You can apply any anti fungal cream like Fluconazole on it. If the rash persists despite a week of antifungal use, it would be worth to consult a dermatologist. I do not want the presence of this rash to add to your anxiety.
Hope I cleared your doubt. If you have more questions you can ask again.
Thanks
Dr. Seikhoo Bishnoi
First of all a brief summary of your condition-
You are a young male with average weight, average height, with no significant past history of any chronic medical illness. You have personal history of occasionally smoking marijuana and occasional alcohol intake but you are sober for a year now. You have total duration of illness of about one and half year. You developed panic attack after smoking marijuana and then again the symptoms recurred with even energy drinks. Then the symptoms of panic occurred even while you were sober. Due to panic you became very stressed. Anticipatory anxiety developed in you with fear of panic. Ultimately you started remaining anxious (awareness of heartbeat, restlessness, and fear) and you were not able to even give presentation to class without anticipatory anxiety. You have been always stage shy. You have also picked job in which you work from home. You are allergic to amitryptilline, and currently you are taking Propranolol 10 mg twice a day. You have also complaints of tension headache, migraine for about 8 months now.
Now coming to discussion and management about your problem-
First of all I would like to tell you that your weight is pretty normal and is proportionate to your height and age. It is not in lower range, still if you want to increase it a little bit you can exercise daily. Secondly difficulty in gaining weight is a feature of your problem of anxiety.
From available information I can tell you that you have three main conditions that should be looked upon.
One is your problem of stage shyness. You have mentioned that you have been always shy of stage. You are also working from home. Although it may be considered normal, but unconsciously out mind works to avoid anxiety and it tend to pick comfortable situations only. This is a part of heart rate, sweating, tremors, butterfly sensation in epigastrium, light-headedness, dizziness, etc. Due to this anxiety you started remaining low and problem of tiredness, weakness and tightness in neck etc. have developed in you.
Now coming to management part-
I would advise for some investigations even thought blood examination was normal. Thyroid hormone profile is most important of them. Patients with hyper thyroid states may show inability to gain weight and symptoms mimicking anxiety and panic. If thyroid levels come normal then we can proceed to treatment plan.
You are taking Propranolol 10 mg twice daily. This drug is a very nice drug for episodic control of anxiety. It is found to be very useful in Social Anxiety Disorder and it is also covering migrainous headache. But as per my opinion as your symptoms are not in mild grade, you need additional medications.
Medicines like SSRI (Sertaline, Paroxetine, and Fluoxetine) can be prescribed in your case. These are very good anti anxiety medicines and will also cover depressive symptoms associated with anxiety. They will also help to gain a little bit of weight. These medicines will tend to correct biochemical abnormality in you due to which anxiety occurs.
For episodic control of anxiety apart from propranolol other medicines like Etizolam, Clonazepam are also useful. They are comparatively safer drugs and can relax an individual with anxiety.
You should also practice Yoga and meditation. These will help to boost your self confidence and will help in relaxation.
Behaviour therapy by a trained Psychiatrist is mainstay of treatment. Methods like Progressive Muscle Relaxation Exercises and Deep Breathing Exercises are included in it. They help individual to understand the change in body during anxiety sates. Then individual is taught to relax himself even in anxiety. With time individual can control symptoms by self control.
Your psychiatrist will know about these drugs and the behavioural therapy. I suggest you to consult a qualified psychiatrist and discuss about these options. I expect you to feel better with this type of treatment.
Regarding the bruise like discoloration on your chest, it appears to be a mild fungal infection. You can apply any anti fungal cream like Fluconazole on it. If the rash persists despite a week of antifungal use, it would be worth to consult a dermatologist. I do not want the presence of this rash to add to your anxiety.
Hope I cleared your doubt. If you have more questions you can ask again.
Thanks
Dr. Seikhoo Bishnoi
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Above answer was peer-reviewed by :
Dr. Prasad
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