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Hypochondriac And Taking Erythromycin. Experiencing Severe Hypnic Jerks And Anxiety. Taking Clonazepam And Propranolol. How Long Should I Take?
Question: Hi there I'm a doctor who just completed my medicine and have been preparing for post graduate examinations for some time now. My problem is that I think I am a hypochondriac.. Two months back I had a throat infection for which I had taken erythromycin.. during the same time I had experienced sever hypnic jerks for one night which made me very anxious... I also had a little difficulty breathing the following morning I'm not sure if it was physical or psychological.. I thought of the throat infection to be haemophilus induced epiglottitis and got more scared and nervous in order to over come the breathing difficulty I used salbutamol inhaler like 5 to 6 times within a span of 20 minutes and that is what triggered the sever panic attack in me... I was hospitalized in some time and was under observation for about 5 hours... My blood pressure when I checked in was about 140/95 and my heart beat was around 150 with normal rhythm ...other vitals like oxygen saturation and everything else were normal.. I was given clonazepam tablet which got my pulse rate to 120.. Later I had a consultation with a physician who checked my heart and Lungs and told me that everything was fine and referred me to a psychiatric evaluation... Later the attending psychiatrist went through my detailed history which included a sedentary lifestyle since about a year and late hours of rigorous studying for examinations,over thinking about the out come of examinations and irregular sleeping patterns and told me that I'm suffering from clear case of anxiety and prescribed me a combination of clonazepam 0.25 mg and propranolol 10mg and asked me to take half tablet in the morning and one before bedtime... Initially I did not take those medicines because of the fear that they would cause dependency but after a week or so I started taking them because I was all time having unpleasant feeling like another panick attack might set it any minute and more over I was not able to concentrate on my studies either I also at times used to feel numb in my extremities and I used to hyper ventilate whenever I got anxious and to top it off I also developed globus hystericus which was very unpleasant and aggravated my anxiety considering all these symptoms I started taking the medication.. Which really did help me to over come those unpleasant symptoms and as of now I have tapered the dose and I'm only taking one pill during night b4 bed time and I'm doing considerably well... But at times if I stay awake late at night or do a night out I feel pain localized near my lower sternum it sometimes subsides almost immediately after I take pantoprazole and sometimes takes a little while like about an hour or two... Two days back I felt like I had an episode of arrhythmia for about 3 or 4 seconds which subsided almost immediately but since then I've become more anxious and started having palpitations I can also feel my abdomen move slightly with every pulse.. I know I'm being over reactive.. My height is 5'10 and I weight around 70kgs.. Presently I'm taking one clonazepam and propranolol combo during night and a centrum multivitamin... I would like to know as to how long should I continue taking clonazepam and should I get checked with a cardiologist for the palpitations and one arnica? And few tips on relaxing and being positive would be of great help... Thanks a lot
Brief Answer:
Please find detailed answer below
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
You might be knowing the human physiology and pathological disease conditions being a doctor yourself. You have taken medical advise on earlier occasion and also got admitted for observation. The various tests and investigations do not point towards any physical disease but more of an anxiety stress related condition. Taking psychiatry consultation is the right step taken by you.
Clonazepam and propanolol seem to be working well with you. These medications should be dose adjusted according to your symptomatic improvement and under supervision of your psychiatrist. Please do not attempt dose tapering by yourself even if you feel much better.
Psychological therapies along with relaxation techniques may help resolve the problem. This can be done while on medications. The basic relaxation techniques include the following.
1. Meditate
A few minutes (15-30) of practice per day can help ease anxiety. The process can be simple. Sit up straight with both feet on the floor. Close your eyes. Focus your attention on reciting -- out loud or silently -- a positive mantra such as “I feel at peace” or “I love myself.” Place one hand on your belly to synch the mantra with your breaths. Let any distracting thoughts float by like clouds.
2. Breathe Deeply
Give yourself a 5-minute break from whatever is bothering you and focus instead on your breathing. Sit up straight, eyes closed, with a hand on your belly. Slowly inhale through your nose, feeling the breath start in your abdomen and work its way to the top of your head. Reverse the process as you exhale through your mouth.
3. Be Present
Take 5 minutes and focus on only one behavior with awareness. Notice how the air feels on your face when you’re walking and how your feet feel hitting the ground. Enjoy the texture and taste of each bite of food as you slowly chew. When you spend time in the moment and focus on your senses, you should feel the tension leave your body.
4. Reach Out
A good social support system is one of the most important resources for dealing with stress. Talking to others -- preferably face-to-face or at least on the phone -- is a great way to better manage whatever is stressing you out.
5. Tune In to Your Body
Mentally scan your body to get a sense of how stress affects it each day. Lie on your back or sit with your feet on the floor. Start at your toes and work your way up to your scalp, noticing how your body feels.
For 1 to 2 minutes, imagine each deep breath flowing to that body part. Repeat this process as you move your focus up your body, paying close attention to sensations you feel in each body part.
6. Decompress
Place a warm heat wrap around your neck and shoulders for 10 minutes. Close your eyes and relax your face, neck, upper chest, and back muscles. Remove the wrap and use a tennis ball or foam roller to massage away tension.
7. Laugh Out Loud
A good belly laugh doesn’t just lighten the load mentally. It lowers cortisol, your body’s stress hormone, while increasing brain chemicals called endorphins that boost your mood. Lighten up by tuning in to your favorite sitcom or video, reading the comics, or chatting with someone who makes you smile.
8. Music therapy
Research shows that listening to soothing music can lower blood pressure, heart rate, and anxiety.
9. Physical exercise
You don’t have to run in order to get a runner’s high. All forms of exercise -- from yoga to walking -- can ease depression and anxiety by helping the brain release feel-good chemicals and by giving your body a chance to practice dealing with stress. You can go for a quick walk around the block, take the stairs up and down a few flights, or do some stretching exercises like head rolls and shoulder shrugs.
10. Write your diary
Keep a gratitude journal or several (stash one by your bed, keep one in your purse, and one at work) to help you remember all the things that are good in your life.
Use these journals to savor good experiences like a child’s smile, a sunshine-filled day, and good health. Don’t forget to celebrate accomplishments like mastering a new task at work or a new hobby. When you start feeling stressed, spend a few minutes looking through your notes to remind yourself what really matters.
I am sure the above mentioned relaxation techniques will help you.
I do not think you have any arrhythmia or serious heart condition. If you strongly feel and because you are a doctor yourself, you may consult a cardiologist for peace of mind.
Keep a schedule for studying and do not extend your study hours beyond a certain time. Have a healthy diet and fitness plan.
Hope your query is answered.
Should you have any doubts, please write back.
Regards,
Dr.Vivek
Please find detailed answer below
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
You might be knowing the human physiology and pathological disease conditions being a doctor yourself. You have taken medical advise on earlier occasion and also got admitted for observation. The various tests and investigations do not point towards any physical disease but more of an anxiety stress related condition. Taking psychiatry consultation is the right step taken by you.
Clonazepam and propanolol seem to be working well with you. These medications should be dose adjusted according to your symptomatic improvement and under supervision of your psychiatrist. Please do not attempt dose tapering by yourself even if you feel much better.
Psychological therapies along with relaxation techniques may help resolve the problem. This can be done while on medications. The basic relaxation techniques include the following.
1. Meditate
A few minutes (15-30) of practice per day can help ease anxiety. The process can be simple. Sit up straight with both feet on the floor. Close your eyes. Focus your attention on reciting -- out loud or silently -- a positive mantra such as “I feel at peace” or “I love myself.” Place one hand on your belly to synch the mantra with your breaths. Let any distracting thoughts float by like clouds.
2. Breathe Deeply
Give yourself a 5-minute break from whatever is bothering you and focus instead on your breathing. Sit up straight, eyes closed, with a hand on your belly. Slowly inhale through your nose, feeling the breath start in your abdomen and work its way to the top of your head. Reverse the process as you exhale through your mouth.
3. Be Present
Take 5 minutes and focus on only one behavior with awareness. Notice how the air feels on your face when you’re walking and how your feet feel hitting the ground. Enjoy the texture and taste of each bite of food as you slowly chew. When you spend time in the moment and focus on your senses, you should feel the tension leave your body.
4. Reach Out
A good social support system is one of the most important resources for dealing with stress. Talking to others -- preferably face-to-face or at least on the phone -- is a great way to better manage whatever is stressing you out.
5. Tune In to Your Body
Mentally scan your body to get a sense of how stress affects it each day. Lie on your back or sit with your feet on the floor. Start at your toes and work your way up to your scalp, noticing how your body feels.
For 1 to 2 minutes, imagine each deep breath flowing to that body part. Repeat this process as you move your focus up your body, paying close attention to sensations you feel in each body part.
6. Decompress
Place a warm heat wrap around your neck and shoulders for 10 minutes. Close your eyes and relax your face, neck, upper chest, and back muscles. Remove the wrap and use a tennis ball or foam roller to massage away tension.
7. Laugh Out Loud
A good belly laugh doesn’t just lighten the load mentally. It lowers cortisol, your body’s stress hormone, while increasing brain chemicals called endorphins that boost your mood. Lighten up by tuning in to your favorite sitcom or video, reading the comics, or chatting with someone who makes you smile.
8. Music therapy
Research shows that listening to soothing music can lower blood pressure, heart rate, and anxiety.
9. Physical exercise
You don’t have to run in order to get a runner’s high. All forms of exercise -- from yoga to walking -- can ease depression and anxiety by helping the brain release feel-good chemicals and by giving your body a chance to practice dealing with stress. You can go for a quick walk around the block, take the stairs up and down a few flights, or do some stretching exercises like head rolls and shoulder shrugs.
10. Write your diary
Keep a gratitude journal or several (stash one by your bed, keep one in your purse, and one at work) to help you remember all the things that are good in your life.
Use these journals to savor good experiences like a child’s smile, a sunshine-filled day, and good health. Don’t forget to celebrate accomplishments like mastering a new task at work or a new hobby. When you start feeling stressed, spend a few minutes looking through your notes to remind yourself what really matters.
I am sure the above mentioned relaxation techniques will help you.
I do not think you have any arrhythmia or serious heart condition. If you strongly feel and because you are a doctor yourself, you may consult a cardiologist for peace of mind.
Keep a schedule for studying and do not extend your study hours beyond a certain time. Have a healthy diet and fitness plan.
Hope your query is answered.
Should you have any doubts, please write back.
Regards,
Dr.Vivek
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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