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Mental Health (Expert Forum)
Is This Mental, Physical, Both?
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD) , bipolar disorder , dementia , electroconvulsive therapy (ECT) , learning disabilities, memory, obsessive compulsive disorder (OCD) , panic , personality disorders, phobias , post-traumatic stress disorder (PTSD) , schizophrenia , stress , transitions, and work problems.
Is This Mental, Physical, Both?
by Christine, Dec 01, 1999 12:00AM
This is going to be long and I'm feeling much despair today, so it might be more dramatic than it should be, but here goes:
I'm a 35 year old, married female with 2 children (ages 8 and 5). I have a history (self diagnosed) of minor hypochondriasis. All my life I have worried excessively about my health, but it has never intefered with my life. It usually came in spells which lasted a few weeks and then would disappear for months.
About 4 years ago I was diagnosed with thyroid cancer and given an excellent prognosis. As you can imagine for a hypochondriac, this did not go over well, but I actually handled the crisis very well. It is the "afterwards" that is the problem. Since being diagnosed and treated I have experienced LOTS of generalized anxiety that also seems to come in spurts. As long as I am feeling well, the anxiety is low--if I get any bodily symptoms, I freak out. I've been to two separate psycologists for this and haven't found either very helpful. I've also tried Prozac, Paxil, Celexa, Zoloft, and some others but the side effects are not tolerable. I get some relief with sporadic use of Xanax.
Unfortunately, for the past few years I've had several physical things crop up--all with no identifiable cause, such as:
Spells of fatigue
Lack of energy
Suspected parasitic (giardia) infection leading to IBS
Mild GERD which my doc says is exacerbated by "stress" which I cannot consciously recognize
Rapid heart rates which last for weeks (echocardiogram normal but rapid heart rate does exist)
Dizziness which started after a sinus infection and has occurred intermittently for 3 years now. (MRI detected no tumors).
My thyroid tests are always in the normal range even though my doctors would like me to take more thyroid hormone to help suppress cancer growth (standard procedure for thyroid cancer patients) but I cannot tolerate too much thyroid hormone.
Recently I have developed a "whooshing" sound in my ears that is in sync with my pulse. At first, my logical side determined that it was due to my nasal allergies. It has now lasted at least 2 months and I read that "neck tumors" can cause this. Given my history, I'm beside myself with worry and fear and am waiting to get an appointment. My IBS has flared up as well and I can't seem to sleep well.
I try to do some reading on my symptoms and there seem to be a multitude of causes and anxiety is always one of them. Can you provide me with some insight into this? Can you also tell me what you think of my situation and what I should do. I never have ignored my physical symptoms but they are always "nothing." I'm at the point now that I am embarrassed to keep going to the doctor. Can an anxiety disorder cause all the bad things I am feeling? I just want to feel good again like I used to and like the people my age do.
Christine
I'm a 35 year old, married female with 2 children (ages 8 and 5). I have a history (self diagnosed) of minor hypochondriasis. All my life I have worried excessively about my health, but it has never intefered with my life. It usually came in spells which lasted a few weeks and then would disappear for months.
About 4 years ago I was diagnosed with thyroid cancer and given an excellent prognosis. As you can imagine for a hypochondriac, this did not go over well, but I actually handled the crisis very well. It is the "afterwards" that is the problem. Since being diagnosed and treated I have experienced LOTS of generalized anxiety that also seems to come in spurts. As long as I am feeling well, the anxiety is low--if I get any bodily symptoms, I freak out. I've been to two separate psycologists for this and haven't found either very helpful. I've also tried Prozac, Paxil, Celexa, Zoloft, and some others but the side effects are not tolerable. I get some relief with sporadic use of Xanax.
Unfortunately, for the past few years I've had several physical things crop up--all with no identifiable cause, such as:
Spells of fatigue
Lack of energy
Suspected parasitic (giardia) infection leading to IBS
Mild GERD which my doc says is exacerbated by "stress" which I cannot consciously recognize
Rapid heart rates which last for weeks (echocardiogram normal but rapid heart rate does exist)
Dizziness which started after a sinus infection and has occurred intermittently for 3 years now. (MRI detected no tumors).
My thyroid tests are always in the normal range even though my doctors would like me to take more thyroid hormone to help suppress cancer growth (standard procedure for thyroid cancer patients) but I cannot tolerate too much thyroid hormone.
Recently I have developed a "whooshing" sound in my ears that is in sync with my pulse. At first, my logical side determined that it was due to my nasal allergies. It has now lasted at least 2 months and I read that "neck tumors" can cause this. Given my history, I'm beside myself with worry and fear and am waiting to get an appointment. My IBS has flared up as well and I can't seem to sleep well.
I try to do some reading on my symptoms and there seem to be a multitude of causes and anxiety is always one of them. Can you provide me with some insight into this? Can you also tell me what you think of my situation and what I should do. I never have ignored my physical symptoms but they are always "nothing." I'm at the point now that I am embarrassed to keep going to the doctor. Can an anxiety disorder cause all the bad things I am feeling? I just want to feel good again like I used to and like the people my age do.
Christine
Doctor's Answer
by HFHS-M.D-HG, Dec 03, 1999 12:00AM
Dear Christine,
From the information that is provided, it is difficult to say whether your symptoms are secondary to a psychiatric disorder or a medical disorder. Some of the symptoms that you are experiencing are seen in generalized anxiety disorder, somatization disorder or hypochondriasis. A combination of medications and psychotherapy are helpful in the treatment of these disorders.
Before coming to a psychiatric diagnosis, it is important that you get a complete evaluation by a physician to rule out any medical disorders that may be contributing to the symptomatology. Anxiety disorders can be treated with a combination of medications and psychotherapy (individual and group therapy, relaxation techniques). I hope this information is helpful to you. I wish you all the best.
From the information that is provided, it is difficult to say whether your symptoms are secondary to a psychiatric disorder or a medical disorder. Some of the symptoms that you are experiencing are seen in generalized anxiety disorder, somatization disorder or hypochondriasis. A combination of medications and psychotherapy are helpful in the treatment of these disorders.
Before coming to a psychiatric diagnosis, it is important that you get a complete evaluation by a physician to rule out any medical disorders that may be contributing to the symptomatology. Anxiety disorders can be treated with a combination of medications and psychotherapy (individual and group therapy, relaxation techniques). I hope this information is helpful to you. I wish you all the best.
First of all, I would suggest NOT reading up on your symptoms to see what could be happening. This is your first mistake. Over the past several years, I've convinced myself that I'm suffering from various medical conditions. For the most part, they all turned out to be anxiety related. I am taking Effexor for the anxiety and it has helped. To give you an example of my hypochondria/anxiety type problem: at the beginning of my problems, I was prescribed Valium to calm me down. I made the mistake of reading the warnings, one of which was a slow heartbeat. Of course within minutes of taking it, I couldn't feel my heart beating. Needless to say, it was. You and I are the same age and we have children the same age. Try to use your children as a way to help you hang in there. I would even suggest going to a different physician if your physician isn't doing it for you. I almost did that, but found the right medication.
Good Luck!
Mark
Thanks so much for your post. It is always helpful to know that others have the same thoughts. I neglected to also mention that I have lately become phobic about things. I recently responded to another's post on this board about "fear of poisoning." While I don't feel paranoid that someone is out to poison me, I do have a fear that things aren't cooked right, or may have been tampered with. If something, like candy, isn't wrapped right or looks funny when I open it, I refuse to eat it. I don't know where it comes from--probably catastrophizing articles/stories in the news about contaminated food. I don't know why I do that. I am also becoming uncomfortable in social situations. I have a group of friends that I lunch with almost daily. Lately, those lunches are becoming tense instead of relaxing times like they used to be. I know that this part stems from some of my gastrointestinal problems that I've been having (which the anxiety makes worse).
I honestly wish that I could find a good physician who would work with me. The psychiatrist that I saw was very good about changing meds; however, it was difficult to get into to see him and after a certain amount of time goes by my approval to visit him lapses with my insurance and I must then "start over" with the insurance company and be pre-screened by one of their social workers. A real pain in the butt!!!! I have found that my GP and endocrinologist aren't to "up" on medications for this. They just know the basic Prozac stuff and that is it. What type of doctor gave you the Effexor and what type of medication is it?
Christine
I take 75mg Effexor XR (extended release) one time per day with food. Effexor is an anti-depressant. Since I have been on it, I think it's done wonders for me. My mood is usually fine and I do a much better job remaining calm in tense situations. My internist prescribed it for me after a different medication did nothing for me. It should be taken with food, and the few times I've taken it without food, I have felt a bit strange. I haven't had any other side effects. I'm sure Effexor could have some side effects, so if you can get on this medication (or any other), have your husband read the pharmacy printout and you relate whatever you're experiencing to him and he can tell you if it is a side effect.
Good Luck!
Mark