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Family Medicine (Expert Forum)
Nightmares and joint pain.
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Nightmares and joint pain.
by sinnequan, Nov 19, 2001 12:00AM
i am 29 years old and seem to have some kind of health trouble all the time.currently, i am going to a physical therapist for what my doctor thinks is bursitis (though both my joint and right buttock hurt) but my right sholder blade hurts too. i am also taking protonix after abdominal pain could not be diagnosed.... well, for the past month and a half i have been having terrible nightmares almost EVERY night.they are VERY vivid- and i dread going to sleep because of this.right now i am taking 5 mg of paxil, 200 mg of celexa (which doesn't help), 40 mg of protonix--and calcium and prenatal vitamins (i don't plan on becoming pregnant). i am REALLY scared about my nightmares--i have a psychiatric history of depression and hypochondria (i am convinced i have bone cancer right now)-- should i see a neurologist about these nightmares?what is the likely hood i have an undiagnosed illness causing these nightmares? do nightmares usually mean something serious??? please help me.
Doctor's Answer
by Forum-M.D.-DT, Nov 20, 2001 12:00AM
After reading your question carefully, I can tell you that I suspect, without a doubt, that you are dealing with a problem with chronic Anxiety. My first thought is why 5mg of Paxil? This is a very low dose and as you will read within the content of this response, there are treatments for anxiety. Paxil is one of them and I would recommend speaking with your doctor about a "regular" dose of Paxil (20mg/day). You also have symtpoms of Fibromyalgia and Irritable Bowel Syndrome. Both of which are common in patients with chronic anxiety. My feeling is this ... controlling your anxiety will, in addition to helping to reduce nightmares, will help you "feel" better in general.
Anxiety is a common emotional state causing feelings of worry, apprehension, or uneasiness. Physical symptoms may be present as well. These include increases in heart rate and breathing rate, tremulousness, sweating or fatigue. We all experience stress or anxiety at some time or another in our lives. It’s a normal part of life. However, when this stress or anxiety affects the ability to function in every day life, it is time for some changes to be made. This week we will discuss both medical and non-medical ways of relieving these all too uncomfortable feelings.
Generalized Anxiety Disorder (GAD)
Anxiety can be divided into 3 main classes. Generalized anxiety disorder, panic attacks and social phobias. While these may be considered distinct, in many cases a person with GAD will commonly have a history of panic attacks and/or social phobias as well.
GAD is present in about 5% of the population. It is more common in women than men and usually is gradual in onset, most often beginning during childhood or adolescence.
There are many symptoms associated with GAD and there are also many conditions the doctor examining the patient must consider when evaluating the anxious or “stressed” patient.
Symptoms which may indicate GAD
1. Restlessness or feeling “keyed up”
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle Tension
6. Sleep Disturbances (trouble falling or staying asleep)
Physical Signs with may indicate GAD
1. Clammy hands
2. Dry mouth
3. Urinary frequency
4. Nausea, diarrhea or stomach pains
5. Sweating
6. Headaches
7. Dizziness
8. Rapid heart beat
Some medical conditions the doctor should consider
1. Irritable bowel syndrome
2. Gastritis
3. Asthma or Emphysema
4. Migraine headache
5. Thyroid disease
6. Diabetes
7. Heart disease and cardiac arrhythmias
8. Menopause
9. Drug reactions
10. Excessive alcohol or caffeine use
With a thorough examination (with blood and urine test) your doctor will be able to rule out most common medical causes for anxiety. An EKG, chest Xray and possibly further examination of the intestinal tract may be needed in some cases.
Treating Stress and Anxiety without medication
Stress! With our busy lives and schedules this seems to become a more and more common underlying problem in the majority of patients coming to the doctor’s office.
Stress can worsen hypertension, diabetes and the body produces more cholesterol under stress. Stress also increases the amount people smoke and drink alcohol and those under stress are less likely to exercise regularly.
Exercise: Certainly exercise burns calories and fat and builds muscle but it also RELIEVES TENSION! Getting onto and sticking with a regular exercise routine (as little as 30 minutes of walking 3 times a week) may do wonders for helping relieve stress and anxiety. Also, learn to stretch your muscles. Important muscle groups to consider include the neck, arms, legs, and back particularly if you sit at a desk for much of the day.
Well balanced diet: More fruits and vegetables, grains, and low in fats and sugars. Also avoiding caffeine, nicotine and alcohol tremendously helps reduce once feeling of “stress.”
Get enough sleep: Most adults need at least 6 hours of sleep each night. Usually getting 7 or 8 hours is most beneficial at helping relieve stress and improve symptoms of anxiety.
Avoid large meals, sugar or caffeine for at least 4 hours before going to bed.
Know your body: Learning the physical signs your body gives you when you are beginning to feel stress. These may include neck stiffness, headache, fatigue, rapid heartbeat, irritability, anger, worry or difficulty concentrating. Know what causes you stress. Is it arguments, being late, having to wait, meeting new people, your work environment, loud noise or traffic? In some cases you may be able to avoid the stress or alter the situation, if not learn some relaxation techniques and practice them.
Learning how to relax
Deep Breathing: When the stressful situation arises try this. Breathe in slowly through your nose and exhale through your mouth. Take long deep slow breaths while telling yourself “relax” with each breath. Do this for 10 breaths .. or longer if necessary. This helps increase oxygen delivery to the bloodstream and eases muscle tension
Anxiety is a common emotional state causing feelings of worry, apprehension, or uneasiness. Physical symptoms may be present as well. These include increases in heart rate and breathing rate, tremulousness, sweating or fatigue. We all experience stress or anxiety at some time or another in our lives. It’s a normal part of life. However, when this stress or anxiety affects the ability to function in every day life, it is time for some changes to be made. This week we will discuss both medical and non-medical ways of relieving these all too uncomfortable feelings.
Generalized Anxiety Disorder (GAD)
Anxiety can be divided into 3 main classes. Generalized anxiety disorder, panic attacks and social phobias. While these may be considered distinct, in many cases a person with GAD will commonly have a history of panic attacks and/or social phobias as well.
GAD is present in about 5% of the population. It is more common in women than men and usually is gradual in onset, most often beginning during childhood or adolescence.
There are many symptoms associated with GAD and there are also many conditions the doctor examining the patient must consider when evaluating the anxious or “stressed” patient.
Symptoms which may indicate GAD
1. Restlessness or feeling “keyed up”
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle Tension
6. Sleep Disturbances (trouble falling or staying asleep)
Physical Signs with may indicate GAD
1. Clammy hands
2. Dry mouth
3. Urinary frequency
4. Nausea, diarrhea or stomach pains
5. Sweating
6. Headaches
7. Dizziness
8. Rapid heart beat
Some medical conditions the doctor should consider
1. Irritable bowel syndrome
2. Gastritis
3. Asthma or Emphysema
4. Migraine headache
5. Thyroid disease
6. Diabetes
7. Heart disease and cardiac arrhythmias
8. Menopause
9. Drug reactions
10. Excessive alcohol or caffeine use
With a thorough examination (with blood and urine test) your doctor will be able to rule out most common medical causes for anxiety. An EKG, chest Xray and possibly further examination of the intestinal tract may be needed in some cases.
Treating Stress and Anxiety without medication
Stress! With our busy lives and schedules this seems to become a more and more common underlying problem in the majority of patients coming to the doctor’s office.
Stress can worsen hypertension, diabetes and the body produces more cholesterol under stress. Stress also increases the amount people smoke and drink alcohol and those under stress are less likely to exercise regularly.
Exercise: Certainly exercise burns calories and fat and builds muscle but it also RELIEVES TENSION! Getting onto and sticking with a regular exercise routine (as little as 30 minutes of walking 3 times a week) may do wonders for helping relieve stress and anxiety. Also, learn to stretch your muscles. Important muscle groups to consider include the neck, arms, legs, and back particularly if you sit at a desk for much of the day.
Well balanced diet: More fruits and vegetables, grains, and low in fats and sugars. Also avoiding caffeine, nicotine and alcohol tremendously helps reduce once feeling of “stress.”
Get enough sleep: Most adults need at least 6 hours of sleep each night. Usually getting 7 or 8 hours is most beneficial at helping relieve stress and improve symptoms of anxiety.
Avoid large meals, sugar or caffeine for at least 4 hours before going to bed.
Know your body: Learning the physical signs your body gives you when you are beginning to feel stress. These may include neck stiffness, headache, fatigue, rapid heartbeat, irritability, anger, worry or difficulty concentrating. Know what causes you stress. Is it arguments, being late, having to wait, meeting new people, your work environment, loud noise or traffic? In some cases you may be able to avoid the stress or alter the situation, if not learn some relaxation techniques and practice them.
Learning how to relax
Deep Breathing: When the stressful situation arises try this. Breathe in slowly through your nose and exhale through your mouth. Take long deep slow breaths while telling yourself “relax” with each breath. Do this for 10 breaths .. or longer if necessary. This helps increase oxygen delivery to the bloodstream and eases muscle tension