HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

question-icon

How To Deal With Anxiety Issues And Panic Attacks?

default
Posted on Fri, 13 May 2016
Question: I have had issues with anxiety since 2008. It started when I finished college and moved across the state. It all started with a knot in my back. I had been running with a group called Teams In Training that trains for various running events and honors a hero that has survived a blood cancer at each run. On one of the first training runs, a man talked about his wife who passed away after dealing with lymphoma that was first found as a lump in her back. I immediately worried about the muscle knot that I had been dealing with for months. I ended up in a downward spiral that started with my obsession with the knot, ended up casing dizziness that made me fear a brain tumor, which caused more panic which made me think I was having heart issues. I had everything from ekgs, to echoes, to brain mris, to a VQ scan to who know what. Months later, my symptoms were gone and I stopped worrying.

I was okay for years, although I did notice that I would get a lot more tense when I was irritated or nervous. About two summers ago, I was watching TV after a 6 mile run (in XXXXXXX in July) and I felt kind of dizzy. I panicked and went to the ER. They ran numerous tests and sent me home with the diagnosis of a panic attack. The next week, I felt an odd sensation in my legs (almost like they were tingly - not sleeping, but more of a light staticky feeling). I googled my symptoms and MS came up and so did my next spiral. I saw my PCP who sent me to a neurologist who didn't see anything in my neurological exam except for quick reflexes (or something like that) but sent me for an MRI. You can see my MRI results on the normal site. I had no brain or cervical lesions, but he didn't do a spinal MRI so I continued to worry for months. Eventually I felt normal again.

I have has other health issues that have never turned out to be anything significant. At the beginning of February my daughter had a stomach flu that left her lethargic for about a week after it ended and of course I was very concerned. Shortly after that, I got the same flu mad I feel like my symptoms started at around that time. I was at work and after a cup of coffee felt extremely shaky. I was also having extreme tightness in my left arm, back and neck. I went to an urgent care center and they ran an EKG, blood work, and chest X-ray and sent me home with another anxiety diagnosis. That was on the 11th of February and I have been crazy since. I felt terrible for a week and went back to the ER thinking they missed something. Last week (the 24th) I suddenly felt lightheaded but got through it. I went for a run at lunch and afterwards I felt very dizzy. I went back to the ER again and again nothing.

I have taken .5mg of ativan on Monday and Tuesday of this week and felt tired, but pretty normal - no tension in my neck, back,etc. I did not take it today because I do not want to become dependent on it but I sure felt like I needed it. I have to say that today was my best day this week, but I have gone from normal the week before Valentines Day to a nervous wreck this week.

I don't do any drugs (never have). I do like to drink on the weekends, but not too much (I'm over that).

I do not know anxiety issues in my family except for a couple of cousins.
doctor
Answered by Dr. Alexander H. Sheppe (3 hours later)
Brief Answer:
Private Followup

Detailed Answer:
Thanks so much for this information! This is very helpful.

Your story is obviously very personal to you, but it fits very well with a common clinical picture of panic disorder. Symptoms started in your mid-20s, seemed to be linked to a traumatic event (hearing about the man's wife who passed away), an intense focus on the idea something may be bodily wrong with you, physical symptoms such as tingling, dizziness, lightheadedness, and the like that you interpreted as dangerous, and a series of spirals that then would remit and get better for a while. I feel very comfortable diagnosing you with panic disorder.

How do you feel about this diagnosis?
Do you feel it is accurate?
Do you still question whether something is very medically dangerously wrong with you?

One of the goals of therapy will be to study your automatic assumptions of extreme danger, and hopefully adjust and adjunct them together.

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
default
Follow up: Dr. Alexander H. Sheppe (14 minutes later)
Writing the question made me feel like it is in my head (anxiety) and the rational person inside me says that is what it is. I would be lying if i didnt say that i still worry about it being MS sometimes .
doctor
Answered by Dr. Alexander H. Sheppe (8 minutes later)
Brief Answer:
Private Followup

Detailed Answer:
There's nothing wrong with worrying that it might be MS. Being honest is very important. It's clear that this remains a serious concern for you. This is how your mind has been attempting to deal with stress -- it's important that you be honest about your thoughts so that we can work through them together.

The way panic works is that it hijacks the fight-or-flight system that we all have in our brains. This is a good system -- when a gunshot goes off, we get startled and afraid and run, and this can save our lives. But when stimuli that are NOT dangerous start to set the system off, then we have a problem.

For some reason, your fight-or-flight system is very sensitive and is getting activated by things that most people would not worry about -- tingling here and there, lumps and bumps, aches and pains -- rather than brush these things off, your brain seizures on them as dangerous and makes you worry about them.

The way therapy works is we STRENGTHEN the rational part of your mind to combat the fight-or-flight system. For example -- you had an extensive medical workup, and you didn't have lymphoma.

That lump was probably a muscle knot, or something else totally harmless. The tightness in your arm and neck that you were worried might be serious -- also totally fine. We call your type of thinking "catastrophizing," and negative "automatic thoughts." We can work together to talk through this.

Have you experienced any serious traumas in your life?

Any people in your life who were seriously ill, that might cause you to also worry about becoming seriously ill?

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
default
Follow up: Dr. Alexander H. Sheppe (23 minutes later)
That makes sense and I can see how my body is "false alarming" all the time.

I don't know what has caused this to happen. I have family members that have had various ailments. My maternal grandfather had heart disease, cancer, and diabetes. My grandmother had a stroke. My paternal grandfather had dementia. As far as my parents and siblings, they have been relatively healthy, although they probably aren't all a healthy weight so I kind of worry about them too.

My husband and I have been together for almost 15 years. We have had various issues (early on) but we are very happy together and are raising a perfect little girl. Sometimes things seem too good to be true and I worry.

My upbringing was not a bad one, but I moved around a lot. My mom had a lot of different jobs and struggled. Thankfully my dad was always the more stable and rational one so he played a big part in me not turning out worse.

As much as I worry, I worry that I would end up purchasing a million questions from you in one day. For now I am thinking maybe 2 sessions per week for a while until I start to feel normal again. What do you think?
doctor
Answered by Dr. Alexander H. Sheppe (37 minutes later)
Brief Answer:
Private Followup

Detailed Answer:
I think exploring the people in your life who have been sick may be an avenue to explore that may be useful to us. Talking more about your mother and father may be a good place to start on that front. Your worries that things may be too good to be true also merit some attention. You can choose any of these things to start with in our next thread. Two sessions a week would be fine! That is plenty to work with.

Go ahead and close this thread, and open up a new one whenever you'd like. I'll be waiting!

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Prasad
doctor
default
Follow up: Dr. Alexander H. Sheppe (4 days later)
Thanks for your response. I went ahead and addressed most of the questions below.

My upbringing was not a terrible one. My parents seemed to have a good relationship when I was very young. When I was about 10, my mother started hanging out with some of our neighbors and going out to parties and nightclubs with one of them (a girl in her early 20s) and her friends (my mom was in her early 30s at the time. She became disinterested in my dad and he was suddenly too boring. They ended up divorcing after a few years. The divorce was difficult. Looking back, I realize that my mom made my dad seem like the bad guy for being a workaholic (aka having his priorities straight). My brother and I lived with her and I remember my dad and mom arguing a lot. I also remember that after my dad moved out, he would drive by the house sometimes. We stayed in that house for a while, but my mom couldn’t afford it so we ended up moving…a lot. She finally met a man who ended up becoming my step dad a few years later (I was about 12) and we moved in with him. He was a hard-working man that had a good job and a house of his own. A few years after they got married, he was in a bad accident and ended up losing his job which caused us to struggle a lot. We moved around a lot and later (after my mom again got tired of him) they ended up divorcing. My mom has not gotten remarried and continues to struggle. She has a low-paying job and moves around a lot. Though she hasn’t asked me for help in a while, she does still ask me for money when things get rough. I worry about her because she is in her 60s and probably will never have a stable life. My dad also recently was laid off (about a year ago). He is 65 years old so he was approaching retirement, although he is a workaholic and I know it kills him that he isn’t working. I worry about both of them because they are getting older and are alone. My brother is in his late-20s and lives with my dad. He lived on his own for a while but he is an artist (he got his degree in art) and cannot find a stable job. I have tried to get him to become a teacher, but he says he wouldn’t like it. I just want him to have a dependable income and to be able to support himself.

As far as my thinking that things are too good to be true…I have not had a lot of stability in my life besides my husband. I have worked very hard and have a good job, as does he. We have a nice house and are able to do so many thing for our daughter that I was never able to have as a child. I want to give her so many things that I didn’t have.

I am not sure when I became so obsessed with my health. When I was young, I remember reading through my grandmother’s book about health ailments and thinking I had a goiter and was going to choke on food…Not sure why I thought that. When I was in college, I also once had a very stiff neck and was convinced that I had meningitis. The first time I had to do an HIV screening, I was terrified that I would test positive (although I don’t really have any reason to have thought that). When I first moved away from home over 8 years ago, I had a bout with panic attacks that sent me to the ER numerous times. I had everything from a heart echo, to an brain MRI and nothing was ever found…Everything eventually passed. Then again a couple of years ago I had an issue of feeling dizzy when sitting on the couch and went into a tailspin about MS. I had an MRI (brain and cervical spine) that didn’t have anything significant, but it still bothers me that it was not a full spinal MRI to put my mind at ease. The most recent anxiety started shortly after my daughter battled the stomach flu (my husband and I also had a shorter lived version). I had a panic attack at work on February 11 and have been going downhill since. I keep on complaining about a pain in my left shoulder down my arm and that is my biggest worry since it is also the symptom of a heart attack. I have been to the ER 4 times and they do not see anything to worry about, but I worry that maybe it is just not coming out in the bloodwork or EKG. Or maybe it isn’t a heart attack, but is a problem with my heart.

Anyway, that is my rant for today.
doctor
Answered by Dr. Alexander H. Sheppe (5 hours later)
Brief Answer:
Private Followup

Detailed Answer:
Thank you so much for sharing so much of your life with me. This is very interesting and very helpful.

Can you tell me a bit more about your stepfather's accident that led to the loss of his job?

It is interesting that your concerns about your health began at such a young age (thinking about having a goiter). This suggests the root of the problem probably lies in childhood, and has developed/worsened with age (worrying about HIV, meningitis, MS, worrying about a heart attack). Worrying about these illnesses are actually common concerns I hear from people with anxiety who tend to somatize (their anxiety amplifies otherwise small bodily concerns).

I think it would be useful to focus on anything in your childhood that may have triggered concerns about illnesses. That's why I ask about your stepfather's accident, but there may be other things that come to mind.

We appear to be at the end of our 3-response thread -- open up a new question thread via my private link, and we'll continue there.

tinyurl.com/DrSheppeAnswers

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
default
Follow up: Dr. Alexander H. Sheppe (8 hours later)
Hi, i had already purchased a few more questions.
The issues with health anxiety started really early. I am not sure why I thought I had a goiter. I think I had a sore throat and ended up reading something about it and was scared to eat pancakes for fear of choking. Lol.

My step dads accident was many years later. He worked as a sound technician and would do the sound and lighting for all the big nightclubs in the area. One night, he was leaving a job and his car had a flat tire. He decided to walk home since it wasn't too far and was attacked by someone and stabbed in the right(dominant) arm. It damages a lot of nerves in his arm and he didn't have movement in his fingers for a long time. He ended up getting it back, but wasn't the same since his job requires very precise hand work. He started drinking a lot and ended up opening his own studio, which did well, but he was doing better before. I don't really think this is what started my obsession with my health.

When I was really young I was at a birthday party at a swimming pool one time and found myself where I was drowning. I couldn't swim to the surface so I was just jumping and ended up getting ahold of a bigger boy that was standing near me. I was nowhere near losing consciousness, but i was scared and realized that I almost drowned. It was one of those crazy situations where unless there was a very good and observant lifeguard they would have thought I was just playing.

Some of my issues might come from watching my parents fight. They were never physically violent, although my mom would sometimes do things like purposely fall to be dramatic.

I work in the health and fitness industry and I get annoyed when people that are meat heads try to give me advice based on the knowledge they got from reading a fitness magazine, but then I end up doing the same thing by googling symptoms and thinking that I understand as much as the doctors. :(. I think that it is easy for me to go to the doctor and be like, well if I have symptoms a, b, and c, why wouldn't he run this test rather than understanding that there are a lot of other signs that doctors look for when they are doing things like shining a light in my eyes and making me walk in a straight line. I tell myself that but then I still am always worried about a wrong or missed diagnosis.

I am Hispanic so I have a lot of heart disease and cancer that has run in my family, but as I am typing this I am realizing that my maternal grandfather is the main one that had ailments (and my mom's brother that died of an Mi at 49). For the most part, my family live well into their 80s.

Maybe it's just my personality. I worry about everything. My mind never stops.
doctor
Answered by Dr. Alexander H. Sheppe (21 hours later)
Brief Answer:
Private Followup

Detailed Answer:
For my private therapy I really prefer to keep the threads to a three question/answer length only, otherwise it isn't profitable for me. Since this is your first thread we can finish up the followups, but then let's open up a new one and continue there.

You certainly have many foundations to be a worrier about your health given your history here. Your stepfather's career was ruined by a health accident. You from a young age had a focus on health as a dangerous thing to worry about. You almost drowned, which is extremely scary. Your brain has become very sensitive to anxieties about these things.

One thing I think would be helpful to do would be to realize that doctors spend ten years training and see thousands of patients, and have a very good idea about how to properly diagnose and treat illness. Your fears make you question competence, but this is your fear, not the doctor's shortcoming.

What other aspects of your personality suggest to you that you may simply be an "anxious person"?

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
default
Follow up: Dr. Alexander H. Sheppe (23 minutes later)
I understand but actually paid an additional $35 which was what i was charged for the initial 3 sessions with a specialist. I paid $35 for the first three questions and was given the option to pay an additional $35 for 3 more. I'm not really sure what is different - i did just check and the charge went through. I would at least like to finish this thread of questions before I close the thread. Sorry. :(

Please don't think I don't respect the doctors that diagnose me. I have all the respect in the world for them and know that their years and years of schooling make them experts in their respective fields. I just am someone that always assumes the worse and thinks I will be that 1 out of thousands that is misdiagnosed.

As far as my personality, I am extremely impatient and I wish I wasn't. I tend to hold in my impatience with most people and people that I am not close to usually think I'm passive, which I'm so not. I also am just a worrier in general. I worry about everything from being hit by a tornado (I live in tornado alley), to having a terrible illness. As I am typing this I am realizing that I worry about things I can't control. For example, I don't get very stressed about work projects or presentations. Although lately I am very paranoid about being anywhere in public because I feel dizzy and it makes me worry. I visited the doctor and they didn't find anything and believe it is panic. I have been able to get myself to go to the gym and stores this week, but every time I think about how I'm feeling I feel heat come over me and I get worried.
doctor
Answered by Dr. Alexander H. Sheppe (41 minutes later)
Brief Answer:
Private Followup

Detailed Answer:
Ah, I see. In the future, it's usually better to open a separate thread. No worries!

I understand what you mean regarding doctors. Your mind does something called "catastrophizing" -- you think the very worst is going to happen, like a 1 in 1000 misdiagnosis. This is a prominent feature of your anxiety, how your brain is tricking you into worrying.

I think it is an interesting observation of yours that you worry about things you can't control. What about the lack of control frightens you? I think this is a very important question.

Dr. Sheppe

tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Prasad
doctor
default
Follow up: Dr. Alexander H. Sheppe (13 hours later)
I am not sure what frightens me about it. Being scared of the unknown? Being afraid to die? Like I mentioned earlier, I think when things are going well they are almost to good to be true and something is bound to mess them up .
doctor
Answered by Dr. Alexander H. Sheppe (1 hour later)
Brief Answer:
Followup

Detailed Answer:
I understand. The unknown can be scary. But I wonder why your fear is one of death, considering you are young and healthy.

Have there been times in your life when things were going very well, and then something terrible and unexpected happened? You mentioned some examples above of people around you suffering from sudden poor health, but I wonder if there are other examples in other areas of your life.

Dr. Sheppe
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
Answered by
Dr.
Dr. Alexander H. Sheppe

Psychiatrist

Practicing since :2014

Answered : 2236 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

159 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
How To Deal With Anxiety Issues And Panic Attacks?

Brief Answer: Private Followup Detailed Answer: Thanks so much for this information! This is very helpful. Your story is obviously very personal to you, but it fits very well with a common clinical picture of panic disorder. Symptoms started in your mid-20s, seemed to be linked to a traumatic event (hearing about the man's wife who passed away), an intense focus on the idea something may be bodily wrong with you, physical symptoms such as tingling, dizziness, lightheadedness, and the like that you interpreted as dangerous, and a series of spirals that then would remit and get better for a while. I feel very comfortable diagnosing you with panic disorder. How do you feel about this diagnosis? Do you feel it is accurate? Do you still question whether something is very medically dangerously wrong with you? One of the goals of therapy will be to study your automatic assumptions of extreme danger, and hopefully adjust and adjunct them together. Dr. Sheppe