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Anxiety and Stress Disorders

Dealing with Anxiety and Past Trauma

02/26/2008

Question:

I`m 52, otherwise healthy and have recently been having what I think are panic attacks (waking up in the middle of the night with a severe feeling of dread, like a heart attack, drove to the ER a few times then realized that it`s all in my head; but it sure felt real.....sweating, pounding heart etc.). I almost asked a nurse who I knew to draw cardiac enzymes as I was sure that I was having a heart attack.......but then I realized that the problem is not real.

To compound matters, I recently had a lengthly surgery in which the anesthesia pretty much failed, so I was in agony for the entire 1 hour procedure; so now I have a morbid fear of anything medical where I don`t have control. This despite being in a fairly responsible medical profession (I should know better). After the surgery, the anesthesiologist spoke with me, reviewed the notes and made a sincere apology for what I had experienced. She took responsibility and documented the errors in the medical record. I was so surprised at the transparency that I can hardly be angry (after all, no medical procedure comes with a money-back guarantee), but I`m still having nightly flashbacks many months later. The problem is: I need to have more surgery (not optional) and just can`t do it. Twice got as far as the OR, then insisted on local only (could be done, but inappropriate), then walked out.

My question: What should I do? I know that my fears have a factual basis, but I`m blowing them out of proportion and it`s ruining my life and I`m getting very depressed. Any ideas? Thanks.

Answer:

I think you may have done a good job "diagnosing" yourself, but as you can tell, "treating" yourself will likely require seeking out some medical and mental health care.  Knowing what we "should" do and being able to do it are totally different things.  I may know how to perform a minor medical procedure, but I wouldn't want to do it on myself.  Why should treating a serious and important mental illness be any different.

You certainly are displaying signs of anxiety, possibly some panic attacks and some PTSD (Post-Traumatic Stress Disorder).  The first thing you should do is get yourself to a good psychologist or psychiatrist for an evaluation.  Treatment is usually with a combination of medications (usually starting with selective serotonin reuptake inhibitors (SSRIs)) and counseling (cognitive-behavioral therapy (CBT) has excellent results).  You will want to find a good therapist that you feel comfortable with and with whom you establish a good working relationship.  Treatment may take as long as 6 to 24 months, but generally has good results.

Good luck.

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Response by:

Nancy   Elder, MD Nancy Elder, MD
Associate Professor
College of Medicine
University of Cincinnati