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Debilitating anxiety which came out of nowhere

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Posted 9/24/2010 11:23 PM (GMT 0)
Hi All,
I'm a very happily married 27yo (I think?) physically healthy man who has increasingly debilitating anxiety which came essentially out of nowhere a year ago. Obsessive, toxic thoughts that I'm dying all of the time absolutely plague my life from dusk until dawn, 24/7--they primarily revolve around vascular disease, like stroke, aneurysm, heart attack, etc. I also seem to get many accompanying symptoms, like the pain in my left arm right now, but I never know what's in my head and what's a true physical manifestation of disease. Unfortunately, being a second year medical student (starting my second year, so I still don't know much at all about being a physician) becoming intimately familiar with all of these pathologies isn't helping whatsoever! In addition, as soon as a physician finds out I'm a medical student with anxiety, they IMMEDIATELY write me off and say that I'm just fine--it doesn't help my situation! I believe the last school physician I saw said, "Oh, you're back like a bad penny, huh? I looked at your blood tests, you're fine." Ugh. I've been to the school physicians (seen 3-4 of them) about 5-6 times in a year. That's a lot for me, but I didn't think it was "that" much... I often don't go and just suffer due to embarrassment.
I've got family history of depression, and my dad had some of those "rare" side effects with benzo's (hallucinations, suicide attempt about 10 months ago) so I'm a bit averse to taking the Xanax sitting in my backpack. But, it's just getting so bad... I usually drive everywhere when my wife and I go places, but the other day I just had to sit in the passengers seat and cry. I've never done anything like that in my life.
I'm sitting here right now trying to struggle to study for a massive test I'm bound to fail, I'm missing mandatory classes, and although she would never complain about it because she's absolutely amazing, I know I'm bringing down my wife's quality of life.
Next week I have an MRI of the head schedule, and I'm going to attempt to get a cardiovascular stress test if I can get a physician to help me out and write a referral. Hopefully at that point all will be well and I can get on to psychological treatment (which I've initiated, but am waiting to hear back about).
Anyway, that's my story. After having experienced this first-hand, I can definitely sympathize with you all and I wish you my absolute best. It's an exceedingly frustrating existence. Hopefully I'll get over this soon, and when I do I know I've made a very solemn personal commitment to never, ever treating my patients with psychological / psychiatric conditions the way I've been treated. While it's typically not intentionally malignant, the end result is the same and I hate to think that anybody else is going through what I've been going through.
EDIT: As an aside, I must say another very strange emotion I get from anxiety is guilt. I honestly feel super guilty for feeling the way I do when I'm probably physically healthy and so many other people are not. *sigh* Just wanted to get that out...
Posted 9/24/2010 11:38 PM (GMT 0)
Hello and welcome,

I am a professional and the one thing I try to do is not tell a new Dr. my profession as immediately they pick up the anxiety dx and who I am only to brush me off. On HealingWell I am a peer like everyone else. smile

I know how you feel and it seems to me you would do well if you could get an appointment with the school counselor to talk through your concerns. I have major depressive disorder, GAD, PTSD and all that comes with these fun dx. I do not have a lot of physical sx.

Have you ever tried the CBT therapy ? Learning cognitive behaviour therapy skills for preventing and coping with depression/anxiety may be worth a try. There is a free online course that many of our members have tried. All you have to do is sign on and work the program for free. I will post the link below - just click on it.

the] http://moodgym.anu.edu.au/welcome
I wish you the best and stick with us as we are here to support and help each other.
Kindly,
<font color=black>Kitt
Posted 9/24/2010 11:53 PM (GMT 0)
Thanks, Kitt!

The school of medicine at our school has their own counselor dedicated to just the med students, but ours just retired and we're in a bit of a transition phase. So, unfortunately, I'm waiting on one of my dean's to put me in touch with someone. My dean is a very nice guy, and he said he's on it, but I'd love to hear from someone soon :( I'm very lucky to have these services available to me (although, they come with a $35k/yr price tag, lol), but I've put it off so long and allowed things to get so bad that waiting has become almost intolerable.

As for CBT, I actually just signed up for MoodGYM recently after finding this forum. Now I just need to find the time to work through the program. I'm getting so desperate, I'll try anything. (And luckily, I hear great things about CBT). If you don't mind my asking, have you tried CBT and has it worked well for you?
Posted 9/25/2010 12:18 AM (GMT 0)
UPDATE: I just got a referral to see a clinical psychologist. :) Now I need to harass some people to get a cardio workup...
Posted 9/25/2010 3:32 AM (GMT 0)
At the rate you are going you may not finish med.school,they may think you wont be a stable dr............
Posted 9/25/2010 4:45 AM (GMT 0)
Ha, ha. Thanks for the input Snowy, but I think that's (a) an (no offense) uninformed opinion, and (b) a very bleak outlook! However, I have to admit that I did think the same thing for a while.

(a) I'm perfectly capable of making logical, and even quick decisions. I performed in the top 10%tile for my two most recent nationally standardized shelf examinations under high pressure conditions. In addition, I can still keep a very calm composure. Just by looking at me you wouldn't know what's going on in my head. That's why I came here--to do something I never get to do, to vent!

The problem is an irrational fear for "my" health. What does that have to do with the health of my patients or their safety? I'm not insane or dangerous... Plus, although I imagine my case is a more severe than most, it's actually very common for medical students to develop health anxiety--that's the reason the medical school HAS a dedicated psychological/psychiatric team ^_^ . A physician I "just" consulted with actually had his own bout with anxiety during his residency, and I can honestly tell you he provided me with the very best patient experience I've had since I developed this anxiety! Having said that, despite the intense misery that can at times accompany this anxiety, I've said repeatedly that, in a limited set of ways, it's a blessing in disguise. E.g. I absolutely appreciate life much more, I appreciate my loving wife much more, I'm much more sympathetic to other people, I'm more sensitive and responsive to the needs of patients, and I think overall it's shaping some parts of me positively.

(b) This is probably the bigger, although more brief, point of the two. If they actually thought that I wouldn't be a stable physician, then that would be them believing that treatment will not produce results. Now THAT would be an exceedingly bleak prognosis for anxious/depressed/etc individuals. Believe it or not, physicians are still human and they too are often sick in a number of ways--even psychologically / psychiatrically. It's a very emotionally taxing profession. E.g. you don't "see" the ER physician break down into tears when he can't save the child who was run over. They remain composed and do what they must when other people depend on them. They break down when they're on their own time, at home or being counseled.

Having said all of that, I have definitely reconsidered my specialization options. I'll probably opt for a less demanding specialty, like family medicine.

EDIT: Just looked it up, here is a quick excerpt on physicians and stress. "There is also evidence to show an increased rate of psychological morbidity, for example, depression, anxiety and substance abuse amongst doctors. Local data are still limited, but there is preliminary evidence to suggest elevated anxiety, depression and stress in Hong Kong medical students and interns (unpublished data). Rates of stress are elevated in all doctors, regardless of the setting in which they work, but junior doctors and female doctors are particularly at risk."

If you're interested in the whole article, I'm sure I can PM you the link or something.

Post Edited (trn450) : 9/24/2010 10:56:28 PM (GMT-6)

Posted 9/25/2010 1:00 PM (GMT 0)
I too suffer(ed) with health anxiety. With the help of CBT I am in recovery. The tendency is still there, but I am no longer plauged with daily worry and panic about dying. You will do well in therapy-you are intelligent and pro-active in wanting to be healthy (body and mind!) Be patient as CBT can take time result wise. It is worth the time and effort though. Good luck, and let us know how you are doing.
Scaredy Cat
Posted 9/25/2010 4:55 PM (GMT 0)
Thanks for the encouragement, scaredy cat! Hopefully I can report back here in a few months in recovery as well.
Posted 9/26/2010 11:38 PM (GMT 0)
I had a similar thought to the one Kitt raised when you mentioned that you get sloughed off when you mention being a med student, in that you could see someone who doesn't know your profession and keep that tidbit to yourself. But then again, if you have a staff dedicated to med students specifically they may be more inclined to appreciate the tendency of doctors-to-be to have anxiety and health concerns when learning and studying all these different ailments as well as the other unique stressors that you're under while in med school. I guess in the end though it just comes down to finding the right person that you can be open with and develop a comfortable relationship regardless of where they work (through the school or off-site).

I also agree with what you said about med students being more prone to health anxiety. I don't know though if I agree necessarily with your quote about women being more at risk than men, as women may simply be more likely than men to fess up and admit that they're anxious and seek out help. But still I think you're in an interesting situation. You know that what you're experiencing may be strictly psychological, but at the same time you know that you have to first rule out anything medical. That's the right approach. I just hope that you can trust the medical results when they come back saying that you're fine.

If you continue to have the same fears and anxiety as you continue to learn more and more at school, then maybe as you said you'd want to at least consider making a career adjustment such as changing your specialty or even a similar career with less pressure but that still allows you to use your talents, abilities, and interests. I'm not suggesting that you drop out of school, only that as you talk with the psychologist and look further into the anxiety that you consider whether this anxiety is an acute issue that you feel you can work through and that won't detract from your ability to serve your future patients or if it's something that would potentially affect your day to day career life. You need to look after both your patients and yourself. Doctors and other professionals often have a tendency to put the well-being of others before themselves. But if you're not taking care of yourself, then you won't be at your best, and in turn you won't be serving your patients as well as you know you can and as well as they deserve. So.... I guess what I'm saying is it sounds like you're taking a good approach with the situation and I encourage you to keep moving forward looking at both the immediate situation at hand as well as the larger picture that is your future. I wish you the best.

BTW, I don't have a medical background but if you're concerned about Xanax because of the family history... would another similar drug make you more comfortable?
Posted 9/28/2010 1:17 AM (GMT 0)
Hi Fugs,

The team dedicated to the med school is the psych team, but the main psychologist just retired so we're in a transition phase. The PCP's are not dedicated to the med school, they're just the general PCP's at my school. I got a hold of one of my old clinical preceptors though, so she's going to try to help me get a cardiac evaluation this week. :-)

As for the quote, that was from a research study. Not my opinion ^_^

I've already considered other career options, but it's too little too late, IMO. The problem is, the knowledge that is bugging me a bit is already in my head so no matter where I work I'll still have that base knowledge. LOL. I just need to adjust my mindset, which I'm working on. I am, however, considering the possibility that stress may make my anxiety worse, so I'm considering going into low-stress specialties, as an employee (not self-employed). However, as odd as it sounds, I really don't think that school/work stress actually affect my condition that much. I honestly worry about that stuff less than I should.

As for the xanax... I'll probably just stick myself in a safe place and try it sometime. I'm not my dad, even though we share many of our genes, they're still in much different combinations. I'll just be mindful of the possibilities. Having said that, i definitely don't want to rely on any medications. I"d like to be both anxiety free and medication free.
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