by Harvey Widroe, M.D.
American Reporter Correspondent
September 11, 2007
ORINDA, Calif. -- Ed, a 42-year-old divorced mortgage broker, explained that his job was demanding and often left him feeling tense and stressed. Although Ed had a girl friend, he lived alone. He had come to see me only at the insistence of his primary care doctor.
"I knew I was dying. There was no other answer for it, waking up in a cold sweat in the middle of the night with my chest tight and my heart racing and pounding. I couldn't get my breath. I was certain I was having a heart attack. That's when I dialed 911," he explained.
"After what seemed like a year, the paramedics came. Once they arrived, they worked like a well-drilled football team, each member swiftly executing his or her often practiced job. In no time they slapped a cardiogram device to my chest, plugged a needle attached to an IV into my arm, and stuck an oxygen mask on my face. Then in what felt like a minute, I was whipped into the ambulance. Sirens blaring, we were off to a nearby emergency room.
"My cardiogram had been sent to the ER by wireless, and the ER doc had had a chance to look at it before I even got there. The doctor saw me within a few minutes of my arrival. He looked so young. Was he a real doctor, or just a medical student pretending to be a doctor? Did he know what he was doing? Or was it me feeling very scared and very helpless? My life hung on his wisdom. Or, if he was too young to have wisdom, my continued existence depended on his being real smart."
He quoted the young doctor. "'Nothing bad, But we will have to get some blood tests to check out your cardiac enzymes, just to be sure.'"
It was even strangely comforting, Ed recalled, to be lying on the hospital gurney in his ER cubicle with a bunch or wires and tubes attached to him. As he explained, "A monitor on the wall measured how alive I was. I didn't know what I was looking at, but the regular patterns of heartbeats and rhythms were very reassuring. I knew that behind the nursing station a duplicate screen showed the identical information to the hospital staff, giving me the sense that I was under continuous observation.
"I was given a shot to help me calm down. Later I was told that I had been given a rapid-acting tranquilizer. Now began the long wait, until the lab results showed whether or not my heart muscle had sustained any damage. Partly from the drug and partly because I knew that help was all around me, I started to calm down. My heart stopped pounding, and my chest didn't feel so tight. When my breathing became normal, I forgot all about it.
"After an hour, a nurse turned off my oxygen and removed the tubes from my nose. [She said] 'Your doctor says you don't need this.' Happy that I was still alive and that my condition seemed to be improving, I drowsed off."
Then, he explained, "The doctor awakened me with the cheerful report that my cardiac enzymes were normal, that the whole thing had been a fierce panic attack. I was free to go home. I was given a bottle of tablets to take as needed for anxiety. The ER doc suggesEd that I see a psychiatrist or at least have a visit with my regular primary care doctor."
Ed didn't want to see a psychiatrist. "I knew I wasn't crazy," he said. He thought about calling his family doctor. "But I was so busy, I put it off week after week."
The next time the symptoms hit him, despite what he had been told before he was certain that this time "I really was dying. I was convinced that they had missed something the first time when I was evaluated." Not surprisingly, the result of another trip to the ER was exactly the same. There was no evidence that Ed was having a heart attack.
"So here I am," he said, "in a shrink's office."
Panic attacks are a symptom of a particular type of anxiety disorder. Some people have them often - even several times a day. After a few ER visits, victims of anxiety often come to recognize panic attacks for what they are. Nonetheless they are frightening every time they occur. It is common for people who suffer from these attacks to be so frantic that, when they appeal for help, they believe they are having a nervous breakdown. As a psychiatrist I reassure them that they are not becoming psychotic. I tell them that what they are experiencing is entirely a product of severe anxiety.
Panic attacks may appear at any time and for no identifiable reason. People who have repeated anxiety attacks often come to relate them to particular situations such as speaking before groups, standing in line at the supermarket, social situations with strangers, being alone, shopping in malls, driving over bridges or through tunnels, or boarding airplanes.
To avoid these attacks, the potential sufferer seeks to solve the problem by avoiding the situations that seem to have precipitated the onslaught of the anxiety symptoms. Sufferers may stop driving, or restrict driving to a few nearby stores. They may refuse airplane travel. They may no longer shop in malls or supermarkets; and other family members do all of the shopping and errands for them. Invitations to parties or even family dinners are refused.
All this rearrangement of life to avoid anxiety is known as a "phobic restriction of functioning." The phobic restriction can become so severe that victims literally are house-bound.
The treatment consists in part of using a rapid-acting tranquilizer to stop the symptoms should an attack occur. I advise my patients to keep a tranquillizer tablet with them or at the bedside at all times, just in case. Even more important is preventing the occurrence of anxiety symptoms. Prevention can be achieved by the regular use of other medication, plus some easy to use thinking techniques called cognitive behavioral therapy. An example of one of these techniques is counting to 10. Another might be focusing one's attention on taking slow, deep breaths. With freedom from anxiety, phobic patients can begin the gradual step-by-step return to normal functioning. Each success in doing something without the return of anxiety attack symptoms helps build self-confidence. To someone who has been phobic, the first trip to a mall or drive over a bridge is experienced as a triumph.
With treatment, it is possible for the anxiety-disorder sufferer to gradually achieve a symptom-free life and return to a normal level of functioning, sometimes even better than ever before.
Harvey Widroe, a longtime practicing psychiatrist, is the author of the recently published, "The Smart Dieter's Cheating Guide: Eat and Watch Pounds Melt Away," with Ron Kenner (Outskirts Press)