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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by netnanny on July 16, 2000, at 1:58:20
I have a problem I can't seem to handle. I have suffered from anxiety and panic attacks for many years. The first ones came out of the blue with typical symptoms plus voices fading out, out of body experiences, etc. At one point in my late teens (I'm 54 now) I would not even leave the house for fear of having a panic attack. (At that time I was sure I was having a heart attack). This lasted about a year. I worked really hard at self control and had it fairly well under control without medication. Later they returned, but then they were usually brought on by anything I saw or heard that was related to people being really sick, hurt,dying or dead. I worked in a hospital and wouldn't even walk by the E.R. for fear that something would set one off.
I again worked worked at self control (no meds) and was doing well for a number of years. Later I had a reaction to an injection (during the "well" period in the late 1970's) and ended up in ICU. From that time on I would not seek medical care and was terrified of medication, especially any that was "injected." It seemed that as long as I could avoid medical contact and medicine I could handle things most of the time with only a few breakthroughs.
I was diagnosed with colon cancer this past May and underwent surgery. The whole thing happened so fast and I was so sick that I really was not as terrified as I figured I would be. It was only by the grace of God that I got through that hospitalization. Thankfully, I was very calm and had no major problems. A few days after I got out of the hospital I had an "out of the blue" panic attack and took 5 mg of Valium. This worked well. I had three or four more attacks during the next six weeks and the Valium brought the attacks under control. I take it only on an "as needed" basis. I even had a panic attack in my surgeon's office on 7/3 and I knew he was just going to check my incision! (I didn't think I needed to take a Valium before this visit and so I didn't).
I saw my oncologist and started chemotherapy 7/10. I had taken a Valium before I went to the clinic (which is about 50 miles away). My blood pressure and pulse were so high I had to wait about an hour before they would give me the first treatment. I was really scared (injected medication, doctors, fear of the unknown, etc.) After the treatment I felt fine. They arranged for me to have days 2-4 of treatments at my hometown hospital. I took a Valium about 2 hours before going and, while my BP and pulse were higher than usual on days 2 and 3 of treatment, it was not alarming. On day 4 I took the Valium, went to the hospital and the minute the nurse put the BP cuff on my arm I felt panicky and could feel my heart pounding. My BP was initially 180/103 and pulse 151. This scared me and after waiting about 10 minutes it was then 185/113 and the pulse went up to 171. I took another Valium and waited until the BP came down to the 165 range and the pulse was around 120. The next day I took 2 of the 5 mg Valium about 45 minutes before going and the same thing happened as soon as the BP cuff went on my arm. The BP was a little better but the pulse was still over 150 initially. I always get Compazine 15 mg before treament for nausea and I understand this has some antianxiety effect as well.
I've got at least five more months of chemotherapy (given five days in a row - off for three weeks), other invasive tests, scans, doctors visits, etc. I don't know how I will ever manage at this rate. It is so overwhelming and frightening and I don't know how much more of this panic I can stand.
Is the Valium not working anymore? Is there something better I should take on a regular basis? I have to be cautious about how drugs affect my system with the chemotherapy, possible liver damage, dose limiting neutropenia, thrombocytopenia (which are already side effects of the chemotherapy), metabolism and so forth. I read the literature on Zoloft but that has some of the side effects I can't affort to risk with the chemotherapy.
I tell my doctors how I feel but they just tend to brush it off as "nerves." Is there any help for me or should I just give up? I'm at my wit's end.
Posted by JohnL on July 16, 2000, at 10:19:44
In reply to At Wit's End!, posted by netnanny on July 16, 2000, at 1:58:20
Netnanny,
In a book I read and scattered writings here and there I seems a very often overlooked cause of anxiety is either excess norepinephrine or an excess of norepinephrine receptor sites. If that is the case, Valium and similar meds will only counter the symptoms, but not correct the underlying problem. And may just complicate the situation by adding in troubling side effects. Another often overlooked cause is excess dopamine. All too often I think people are treated with serotonin enhancing meds like Zoloft or Paxil, or the benzos, when they in fact have nothing at all to do with the real problem. They can be real good at masking the problem, handing you some side effects, but not getting to the root of the problem.
Everything you wrote in your post seems to fit exactly this scenario. Excess NE or dopamine could easily be the overlooked culprits here. Especially the panicky, heart pounding, BP thing. Those are pretty strong and powerful clues, IF we know what clues we're looking for. I don't think most doctors are trained to diagnose that way though. I would confidentally bet they will prescribe you another benzo or an SSRI, and with good intentions accidentally and unknowingly miss the real target. I'm not second guessing your doctor. It's just my School of Hard Knocks at work.
So if Valium isn't that answer, and SSRIs aren't the answer, then what is? Well, two very often overlooked choices...1)An antihypertensive medication. Really. No joke. That normalizes excess NE chemistry and kills the symptoms right at the root of the cause; 2)a small dose of an antipsychotic like Zyprexa. It has some sedative relaxing quality to it, which may be a welcome relief to you, but it will also correct excess dopamine chemistry. So either a high blood pressure medication (even if you don't have chronic high blood pressure) or a small dose antipsychotic like Zyprexa. Just based on your post, I think your chances for total success would be far greater with either of these than with any kind of benzo or SSRI. Try a couple hypertension meds. If no good, try Zyprexa.
Just some ideas. As I said, I think these are very very often overlooked in cases of anxiety and panic.
John
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