Monday, July 20, 2009

Do I Have Panic Disorder?

What is Panic Disorder?

Starting with the dry stuff: The Diagnostic and Statistical Manual, 4th edition [DSM-IV], published by the American Psychiatric Association, defines Panic Disorder with or without Agoraphobia. In Panic Disorder the key identifying features are:

  • 1. One or more episodes of abrupt, intense fear or discomfort, i.e., a panic attack. and

  • 2. Persistent apprehension about the recurrence of the episodes of intense fear of discomfort.

At least one of the panic episodes must be unexpected and not caused by a situation in which one is the focus of attention. Fear of death or losing control or losing sanity generally accompanies these attacks.

It's important to distinguish between general feelings of anxiety and panic. In a panic attack anxiety and fear rapidly surge to a very uncomfortable point, then subside after 10 to 30 minutes with some symptoms possibly lasting for several hours. Anxiety tends to be more generalized and stable in nature.

A panic attack can be understood as the body reacting naturally to a panic situation when there is no real danger present. You might be browsing the local bookstore for a new cookbook when suddenly your body goes into a fight or flight reaction for no apparent reason. To those who've not experienced it, it almost sounds comical, but it's no laughing matter when it happens to you!

Since there is no logical explanation for why you are feeling these sensations, the mind goes to work rationalizing, am I having a heart attack, am I going insane, am I dying? Even after the surge of panic and emotion subsides the mind keeps working, what was that, why did it happen, will it happen again? Hence the apprehension component of the disorder. If another attack occurs the apprehension intensifies. It can become an endless cycle, apprehension triggering panic, panic triggering increased apprehension.

Often Panic Disorder is accompanied by, or can be the cause of, Agoraphobia. The tendency to avoid places or situations in which escape may be difficult should a panic attack occur, such as a large crowded shopping mall, airplanes, busses, etc., is called Agoraphobia. Agora being Greek for the ancient marketplace Agoraphobia literally meaning fear of the marketplace.

Debate rages over whether there is a physical or chemical cause for panic disorder and, so far, there is no proof one way or the other. It is evident that there are neurochemical differences in people experiencing Panic Disorder but it seems likely that the imbalance is caused by the disorder rather than the reverse (likely, at least to those of us who are inclined to agree with that assessment). The irrefutable fact is that people are overcoming the disorder and living normal lives without the benefit of drugs. To me this implies that the cause is not chemical imbalance. Even if it is, proper treatment can effect a lasting recovery from Panic Disorder.

How Do I Know If Panic Disorder Is What I've Got?

  • Do you experience surges of anxiety or fear, sometimes fearing that you are dying or losing control?
  • Do you feel like you are having a heart attack?
  • Do you feel dizzy, shaky and weak?
  • Do you feel short of breath or feel like it is difficult to get a word out?
  • Do these experiences seem to come out of the blue, such as when you are otherwise enjoying yourself?
  • Do you find yourself worrying about these events, trying to anticipate or stave off the next one?
  • Do you find yourself avoiding experiences you used to enjoy such as shopping, driving, going to church, etc.?
  • Do you find your self focusing on your pulse, breathing or blood pressure, trying to monitor them?
  • When in public do you often think of possible ways to escape should an attack occur?
  • Do you worry that you might collapse, loose control, or be embarrassed in public?

If you can relate to items on this list, the likelihood is that you are having panic attacks and associated anxiety.

Following are two actual case histories. Read them and see if you can relate to some of Bill and Ann's experiences:

Bill was a 24 year old married man who worked in a metal processing plant as inventory manager. He began suffering repeatedly from episodes of dizziness, feelings of suffocation, blurred vision, racing heart, loss of concentration and feelings of impending doom. The first episode happened at home while visiting with a friend. He began to feel light headed and disoriented. He couldn't focus on the conversation and soon began to feel he was suffocating. He finally asked his friend to drive him to the emergency room. He felt like he might faint or lose control and he had no doubt something was wrong with him.

After a thorough exam the doctor in ER told him he was in perfect health and was just hyperventilating. Bill continued to have episodes like this and by the time he finally discovered this program he had suffered heart palpitations, chills, sweating, racing heart, numbness, but the worst was the feelings of losing control or feeling he was dying. Bill would sometimes awake from sleep in a panic, thinking his heart had stopped, or that he had stopped breathing. Between the panic episodes Bill was plagued with feelings of anxiety, jittery nerves, difficulty relaxing, he would often check his pulse, he had feelings of pressure in his chest.

He had lost much of his self esteem. He had lost his job at the metal processing plant because he feared it was the environment there that was causing his problems. He had a hard time holding any job because his symptoms were so severe. Once a great outdoorsman, he now avoided leaving the city for fear of being too far away from a hospital. He also avoided situations like crowded stores, theaters, waiting in lines, barbers' chairs, and wouldn't even consider a situation like flying in an airliner where he felt he would be trapped if he panicked.

Bill's friends and family didn't understand what he was going through, nor did he for that matter. "It's just in your head." "Get over it." "That's crazy, Bill." He heard the advice, the ribbing, the anger at his bizarre behavior. He saw the rolling eyes, the shrugs, the shaking heads. He felt like they were right and It broke his heart.

Ann completely overcame her panics by following this program. She was 24 years old. She was having repeated attacks of dizziness, breathlessness, palpitations, chest pain, blurred vision, a lump in her throat and a feeling of unreality, accompanied by feelings of impending doom. She was afraid that she was going to have a heart attack or just lose control.

The problem began with a "bad trip", an unpleasant drug experience. The experience had been horrifying and she began to experience the symptoms described above. When she went to the doctor he told her that her symptoms were due to hyperventilating because of anxiety. Ann completely stopped all drug use. She even became nervous about and eventually avoided prescription drugs such as antibiotics.

The attacks varied over the years in both intensity and frequency. She worried about having another attack most of the time. She felt uneasy in situations where she thought she would be trapped if an attack occurred, but did not actually avoid many places. She took alprazolam (Xanax) to help her cope with her panics and it helped a great deal, but she wanted a cure, not a Band-Aid.

Bill's and Ann's stories are typical of those experiencing panic disorder. If you are having similar experiences it is very likely you too are experiencing Panic Disorder. Please keep in mind that panic disorder mimics other, very serious physical ailments. Before embarking upon this, or any other treatment plan, please see a doctor to make sure you are in good health. Please do not
rely only on the info you find here to make a self diagnosis.

Is Panic Disorder Common?

Panic attacks are very common. In the United States alone over 12 million people suffer from panic disorder. In combination with other phobic and anxiety disorders this constitutes a larger percentage of the population than those with alcohol or drug abuse problems, making anxiety disorders the number one mental health problem in the United States.

The experience of panic and avoidance occurs across all levels of socioeconomic status, professions and types of persons. It is present in different cultures worldwide, although it may be labeled and understood differently.

Coping With Panic Disorder.

The most common coping method leads to a topic we have already mentioned, agoraphobia, or avoiding situations, places and activities you fear may trigger an attack. There are many tactics used to cope with panic. Many help people get through a panic attack but most do nothing to prevent future attacks. Some can be outright dangerous.

Distracting

Many people use distractions to help cope with panic attacks. Diagram 1 shows examples of common ways people distract themselves when they feel the possibility of a Panic episode.




These tricks often become habitual. For example, if you forget your reading material you may have to go home to get it. You may not go somewhere you had planned to go because you realize you don't have your distraction. These tactics are generally not helpful because they don't get at the root of the problem. They may actually perpetuate the problem, for example, you might be driving to visit some friends, everything is fine, but as you pull into their drive and see them waving, you realize you forgot your pill bottle, this realization triggers a panic episode and your visit becomes a very unpleasant experience.

Avoiding

Avoiding is not always agoraphobic. For example, Diagram 2 shows various things and activities which may be avoided.

These forms of avoidance may be connected to your panic attacks and should disappear when you successfully complete this program.

More Tactics and Superstitions

A list of what might be called "superstitious tactics" actually used by some people is presented in Diagran 3.


How Are You Coping With Panic Attacks?
Some of these items might also be used as distractions.

Drugs and Alcohol

This is probably the most dangerous coping tactic. If you carry drugs prescribed by your doctor and use them according to instructions, this is probably not a problem. Unfortunately, many turn to very dangerous alternatives such as alcohol. It has been demonstrated that as many as half of people with alcohol dependence began their habit as a coping method for panic and anxiety. The trouble with alcohol and other drugs is the results become less effective over time. More alcohol is needed for relief until eventually it is of no benefit at all, and, in fact, may even increase your anxiety and promote depression. If you are currently in this situation, we strongly recommend you seek professional help to overcome your dependence.

Panik disorder: A true story

I'm Arin. Russel asked me to write my story, so here it is... Well... Some of it anyway.
I was born and raised in a small country town. My family was a model happy family living in a model happy community where everything was lovely almost all of the time. Really! It's true!
While I was a happy child, I was also a nervous one. My mom says even as a brand new baby I would fret. I used to get very nervous over things like piano recitals, plays, dance reviews etc. I would literally get sick to my stomach and beg my mom not to make me perform. She never forced me, but she had a way of encouraging me so that I always ended up going on with it, in spite of the fear and cramps, and feeling better for having done so when it was over. Dad was (and is) nothing but supportive as well.


In spite of my ideal upbringing, I eventually fell in with a less than model group of friends in college. I began experimenting with marijuana and eventually started using cocaine, LSD, and other fairly hard drugs.


By the age of 24, I was starting to have some serious problems. I was failing in grad. school. I was having problems with relationships. I felt very guilty about the way I was living my life. It was a very stressful time.


One night at a party I took LSD. I'd done this many times before, but for some reason, this particular night it affected me differently. I got very scared and started crying and screaming. I couldn't get a grip. I just desperately wished I could get over it. I swore that night I'd never do hard drugs again.


The very next day I experienced my first panic attack. I felt breathless and started to get dizzy. My first thought was that the drugs had done something to me. It got very intense then went away. It was a couple of weeks before I had another attack.


Eventually the attacks began to happen quite often. Doctors told me I was fine, just hyperventilating and probably having panic attacks. I was convinced it was related to my drug use and I eventually quit everything. I became afraid to take prescription drugs or even aspirin.
This went on for about three years. I was lucky, I guess. I was always nervous about the next attack, and I worried when I went into stores and stuff, but I never actually avoided anything. It was a constant bother but it didn't really interfere with my life outside of the discomfort of it.
I met Howard through his sister in law. I had known his wife's little sister for years and the topic of my PAD came up in a conversation. She told me Howard had the same thing for many years and got over it. I was quite surprised to hear he had it. I never really knew him, but he just didn't seem the type. He rode motorcycles and hung out with a scary crowd. My friends weren't model citizens, but his were downright scary! I don't know where he found that picture he has with his story! I know it's him, but I've never seen him look like that. I'm going to make him put a better one on there one day! Anyway, at that time he wasn't involved with promoting or doing therapy or anything like that. I got up my nerve and talked to him and he gave me a book which contained the program he eventually based this online program on. I couldn't stand to just read the book and so I bothered him constantly about why this and why that and how did you this and how did you that. I was amazed at how friendly and helpful he was. It took me a while. A lot longer than 15 weeks to be honest, but I finally got through the program and I've been pretty much panic free, if still somewhat nervous, ever since!


I doubt he'd admit it, but I think I was the inspiration for him getting into this. I think he figured if he could get me through it, he could get ANYONE through it! Another secret about Howard... I've never heard anyone but his wife, son and people who don't know him call him that. Unfortunately, he won't let me say what everyone does call him. Says it doesn't sound very professional.

Monday, June 22, 2009

Calling Your Doctor

Is it okay to call your doctor? Of course it is. Often a phone call to the doctor or advice nurse is all you need to manage a problem at home or determine if a visit is needed. Here's how to get the most from every call:

Prepare for your call.


  • Write down a one-sentence description of your problem and why you are calling (list two to three questions at most).

  • Have your symptom list handy.

  • Have your calendar handy in case you need to schedule an appointment.

Leave a clear message.

  • Tell your one-sentence description to the person who answers and ask to talk with a doctor or advice nurse.

  • If no one is available, ask the receptionist to relay your message and have someone call you back. Ask when they might call.

  • If a call-back is needed, keep the phone line clear so you can take the call.

Follow through.

  • When the doctor or advice nurse calls back, briefly describe your problem, ask your questions, and describe any major symptoms.

Work in Partnership With Your Doctor

You, the individual, can do more for your health and well-being than any doctor, any
hospital, any drug, and any exotic medical device.

Joseph Califano

The Wise Medical Consumer

The quality and the cost of medical care depend more on you than on your doctor.

To become a wise medical consumer, start with three basic principles:

  • Work in partnership with your doctor and health care team.
  • Share in every medical decision.
  • Become skilled at obtaining medical care.
By following these three principles, you will gain more control over the quality and cost of your health care than you have ever had before.

Work in Partnership With Your Doctor

Good partnerships are based on a common goal, shared effort, and good communication. If you and your doctor can make these things happen, you will both gain from the partnership. You will get better care and your doctor will practice good medicine.

Five Ways to Be a Good Partner

1. Take good care of yourself. Both you and your doctor would prefer that you don't get sick in the first place. And if problems arise, you both want a return to good health as soon as possible.

2. At the first sign of a health problem, observe and record your symptoms. Your record of symptoms will help both you and your doctor make an accurate diagnosis. And the better job you do recording early symptoms, the better you and your doctor can manage the problem later.

Keep written notes on the symptoms. Record when, how long, how painful, etc., for each symptom.
  • Note anything unusual that might be related to the problem.
  • Measure and record vital signs.
  • Add regular updates and watch your progress. Are your symptoms getting better or worse?

3. Practice medical self-care at home. As the front-line partner, you can manage a lot of minor health problems on your own. Use this book, your own experience, and help from others to create a self-care plan.

  • Learn all you can about the problem.
  • Keep notes on your self-care plan and what you do.
  • Note whether home treatment seems to help.
  • Set a time to call a health professional if the problem continues.

4. Prepare for office visits. Most medical appointments are scheduled for only 10 to 15 minutes. The better organized you are, the more value you can get from the visit.

  • Prepare an Ask-the-Doctor Checklist (right).
  • Update and bring your list of symptoms and your self-care plan.
  • Write down your main concern (chief complaint) and practice
  • describing it. Your doctor will want to hear that first.
  • Write down your hunches or fears about what is wrong. These are often helpful to your doctor.
  • Write down the three questions you want answered the most.(There may not be time to ask a long list of questions.)
  • Bring along a list of the medications you are taking.

5. Play an active role in the medical visit.

  • State your main concern, describe your symptoms, and share your hunches and fears.
  • Be honest and straightforward. Don't hold anything back because of embarrassment. If you don't intend to fill a prescription, say so. If you are getting alternative treatment such as acupuncture or chiropractic treatments, let your doctor know. To be a good partner, your doctor has to know what is going on.
  • If your doctor prescribes a drug, test, or treatment, get more information.
  • Take notes. Write down the diagnosis, the treatment and follow-up plan, and what you can do at home. Then read it back to the doctor to be sure you have it right.
Finding the Right Doctor

If you don't have a family doctor (primary care physician), now is the time to get one. Everyone needs a regular doctor. A host of specialists working on separate health problems may not see the whole picture. In choosing a doctor there are lots of questions to ask, but these three matter the most:


  • Is this doctor well-trained and experienced?

  • Is this doctor available when needed?

  • Will this doctor work in partnership with me?

Training and Experience

For most people, a good choice for a family doctor is a board-certified family practice doctor or internist. For children and teens, a pediatrician is a good choice. These doctors have broad knowledge about medical problems.

Availability

Because health problems rarely develop when it's convenient, it helps to have a doctor who can see you when needed. Call or visit the office. Tell the clinic receptionist that you are looking for a new doctor. Ask these questions:

  • What are the office hours?

  • If I called right now for a routine visit, how soon could I be seen?

  • How much time is allowed for a routine visit?

  • Will the doctor discuss health problems over the phone?

  • Does this doctor work with nurse practitioners or physician assistants? These primary care providers have special training for managing minor and routine medical problems. For many health problems, these professionals can often see you sooner, spend more time with you, and help you just as well as a doctor can.

    Also ask if the doctor is eligible for maximum payments under your health plan.

Partner Potential

During your first visit, tell your doctor that you would like to share in making treatment decisions.

Pay attention to how you feel during the visit.


  • Does the doctor listen well?

  • Do you think you could build a good working partnership with this doctor?

If the answers are "no," consider looking for another doctor.

But I Want a Take-Charge Doctor

Not everyone wants to be a partner with his or her doctor. Maybe you don't like to ask your doctor questions and you don't want to share in any decisions. Would you rather just let your doctor tell you what is best for you? If that's what you prefer, tell your doctor. Most doctors have a lot of patients who don't want to be a partner. Let the doctor know what you expect.

Is It Time for a Change?

If you are unhappy with how your doctor treats you, it may be time for a change. Before you start looking for a new doctor, tell your current doctor how you would like to be treated. Your doctor would probably be pleased to work with you as a partner--if only you would tell him or her that that's what you want. Otherwise, your doctor may think that you, like many patients, want him or her to do all the work.

Notes:

Ask-the-Doctor Checklist

Before the visit:

* Complete the Healthwise Approach and take it with you.

* Take a list of medications and record of last visit for similar problems

During the visit:

* State your main problem first

* Describe your symptoms

* Describe past experiences with the same problem

Write down:

* Temperature

* Blood pressure

* The diagnosis (what's wrong)

* The prognosis (what might happen next)

* Your self-care plan (what you can do at home)

For drugs, tests, and treatments, ask:

* What's its name?

* Why is it needed?

* What are the costs and risks?

* Are there alternatives?

* What if I do nothing?

* (For drugs) How do I take this?

* (For tests) How do I prepare?

At the end of the visit, ask:

* Am I to return for another visit?

* Am I to phone in for test results?

* What danger signals should I look for?

* When do I need to report back?

* What else do I need to know?

The Healthwise Approach

Step 1. Observe the problem.

* When did it start? What are the symptoms?

* Where is the pain? Dull ache or stabbing pain?

* Measure your vital signs:


  • Temperature

  • Blood pressure

  • Pulse

  • Breaths

* Think back


  • Have you had this problem before?

  • What did you do for it?

  • Any changes in your life (stress, medications, food, exercise, etc.)?

  • Does anyone else at home or work have these symptoms?

Step 2. Learn more about it.

* Read the Healthwise Handbook

* Other books or articles in Internet

* Advice from others (lay or professional)

Step 3. Make an action plan.

* Your tentative diagnosis

* Home care plan

* When to call your doctor

Step 4. Evaluate your progress.

* Are your actions working?

Warning Signs of Cancer, Diabetes, Heart Attack, Stroke

Some symptoms act as warning signs that a serious disease is developing. If you know these warning signs and heed them, you may detect the disease before it becomes life-threatening. Some diseases, like cancer, are often curable if they are detected early. Other diseases, like diabetes, cannot be cured, but early detection and treatment may reduce the injury they cause the body.

Here are the warning signs for four diseases that, if detected early, can often be stopped or controlled.

Cancer

The American Cancer Society lists the following seven warning signs for cancer. Let your doctor know immediately if you experience any of these signs.


  • Change in bowel or bladder habits. Most people occasionally have a brief period of constipation, diarrhea, or a change in the frequency of bowel movements or urination. These do not necessarily indicate cancer but can be due to flu, changes in your diet, stress, etc. Tell your doctor about any changes in bowel or bladder habits that last two weeks.

  • A sore that does not heal.

  • Unusual bleeding or discharge. Coughing up blood, blood in vomit, blood in the urine, or significant amounts of blood in the stool should be called to your doctor's attention. Small amounts of blood in the stool can be due to hemorrhoids. Tell your doctor about even small amounts of blood in the stool if it does not go away in a few days.

  • Thickening or lump in breast or elsewhere. Most lumps, even in the breast, are not cancer. However, they should not be ignored.

  • Difficulty swallowing or indigestion that lasts more than a month and causes more than occasional minor discomfort.

  • Change in the appearance or size of a wart or mole.

  • Nagging cough or hoarseness. Cough and hoarseness are commonly associated with a cold. However, if either lasts more than a few weeks, tell your doctor.

Diabetes

The warning signs of diabetes are often vague and might not cause you to think you need to see a doctor. However, if you have any of the following symptoms and there is no other obvious cause (fatigue from working hard, or frequent urination because of drinking lots of fluids, for example), discuss the symptoms with your doctor.


  • Increased thirst

  • Frequent urination (especially at night)

  • Increased appetite

  • Unexplained weight loss

  • Fatigue

  • Frequent unexplained skin infections

  • Slow-healing wounds

  • Frequent vaginal infections

  • Difficulty with erections

  • Persistent blurred vision

  • Persistent tingling or numbness in hands or feet

Heart Attack

Call 911 or other emergency services immediately if you or someone you are with has warning signs of a heart attack.

  • Chest pain that is crushing, squeezing, increases in intensity, or occurs with other symptoms of a heart attack is the key warning sign of a heart attack.

Other symptoms of a heart attack include:
  • Sweating

  • Shortness of breath

  • Chest pain radiating to the arm, neck, or jaw

  • Nausea or vomiting

  • Dizziness

  • Rapid and/or irregular pulse

Stroke

The National Stroke Association lists five warning signs of stroke. If you or someone you are with experiences any of these symptoms, call 911 or other emergency services immediately.

  • Weakness, numbness, or paralysis of the face, arm, or leg, especially on only one side of the body, that does not go away in a few minutes

  • Blurred or decreased vision in one or both eyes that does not clear with blinking

  • Newly developed difficulty speaking or understanding simple statements

  • Sudden unexplainable and intense headache

  • Severe dizziness, loss of balance, or loss of coordination, especially if another warning sign is present at the same time

If the symptom was definitely there and then goes away in a few minutes, call your doctor immediately. Symptoms that go away in a few minutes may be caused by a transient ischemic attack (TIA). TIAs are a strong sign that a major stroke may soon occur.
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