Paul continued to seek treatment and consulted with at least two more medical doctors and entered therapy with a psychiatrist. But, the diagnosis was always the same; anxiety and panic disorder. But, Paul had adapted to his panic and the anticipation of panic. He could work and at times use sickness to leave work, or use the restroom at work to let the attacks pass. For the entire ten years, Paul was using tranquilizers to just barely function.
And then, one day at work, his heartbeat was so rapid and he was sweating so much, that he felt that a heart attack was imminent. But it felt different than usual and he was truly afraid that he would die this time. He called a nearby cardiologist and described the symptoms to the nurse and she advised him to either go to the emergency room or to their office right away. Paul feared the hospital and opted for the office visit.
Upon arrival, he was given an EKG, blood was taken, and a stress-test was started but could not be completed. His heart rate was already so high that it exceeded the stress-test parameters. The EKG showed no heart problem, and the cardiologist realized that there was something unusual happening but did not discuss anxiety. He gave Paul a shot using a tranquilizer to slow down the progression of elevated heart rate and advised him to return the following day to review the blood work and plan a strategy.
The visit on the following day changed Paul's life in several ways; first, there was no heart concern, and second, his thyroid levels of TSH, (Thyroid Stimulating Hormone) were sky-high! The cardiologist recognized Paul's problem as Graves Disease, or hyperactive thyroid. There was no anxiety or panic disorder, but a biologically based problem. High levels of TSH show all of the symptoms that Paul had been suffering with for years. A referral to an endocrinologist confirmed the thyroid problem and Paul had the thyroid surgically removed. He is now on a synthetic thyroid replacement medication and the panic has subsided. But, you would infer from this procedure that if the symptoms were from a hyperactive thyroid, and if the removal and subsequent correct levels of TSH were consistent, the problem with anxiety would be resolved. Not quite so!
The brain is a very flexible and pliable organ and can be programmed and re-wired with learning. Over the years that Paul's "anxiety" had been diagnosed, he learned to fear many of the environmental parts of life. Being in public places, waiting in line at stores, being in stopped traffic, and several other common occurrences continued to be anxiety producing events. It may take years to "unlearn" these destructive behaviors.
We tend to believe that medical doctors and professional psychiatrists have the ability to diagnose and separate biological and psychological problems. But, in Paul's case, at least four doctors and two psychiatrists failed to identify the underlying physical problem causing the anxiety. And, I continue to see the same mistake being made all of the time. For me, the take away here is that we have to be strong advocates for ourselves, and not accept the diagnosis that doctors make at face value. Ask questions, seek alternative opinions, and consider all of the options available. Doctors are human and make mistakes, but that alone should prepare us for being proactive. And it is important to remember that some anxiety is perfectly normal and comes with life. But, when it becomes an interference in daily life, then, seek some assistance and correction.
Next time we will investigate obsessive-compulsive disorder and the remaing topics associated with aniety...