Overcoming Anxiety and Panic: Seeking Help from a Specialist

Q: Overcoming Anxiety and Panic: Seeking Help from a Specialist

Hello, online friend： Your description indeed reflects typical panic disorder combined with anxiety disorder. <br>Medications such as Xibin capsules (20mg), Xanax (0.5mg), and Ental (10mg) are standard treatments for these symptoms. <br>This condition can cast a significant shado

I really feel helpless and need Dr. Liao's expertise!

Hello Dr.
Liao, thank you for your dedication and professionalism in addressing everyone’s concerns.
After reading your previous responses, I believe you are a very competent physician.
I apologize for the lengthy message, but I would like you to understand my situation.

On the night of March 11, 2020, I had a hot pot with friends, and when I went to the restroom and looked in the mirror, I noticed my face was flushed, which made me feel like I had high blood pressure.
I started to feel dizzy and my heart began to race, so I went to the emergency room where my heart rate was around 145 bpm.
On March 13, I visited a cardiologist, and an echocardiogram showed normal results.
However, a 24-hour Holter monitor revealed 54 ventricular premature contractions (VPCs), which I didn’t feel at all.
Before this, I had always been a very optimistic and normal person.
On May 5, 2020, I visited an ENT specialist for a cold and experienced a drug allergy, resulting in a red rash on my arm and groin that felt like a burn.
From May 18 to June 4, I began to feel abnormal, experiencing many symptoms of autonomic nervous system dysregulation, starting with gastroesophageal reflux and stomach pain.
I began seeing a traditional Chinese medicine practitioner for improvement.

From June 4 to July 28, I started experiencing irregular heartbeats with the sensation of VPCs and a racing heart, often feeling anxious.
On June 8, I had another check-up at Chang Gung Memorial Hospital, where the echocardiogram was normal, but the 24-hour Holter monitor showed over 300 VPCs.
I became increasingly anxious and focused on these symptoms.
Since VPCs are considered benign arrhythmias in medicine, the doctor could only prescribe medication to slow my heart rate, which didn’t help much.
I felt helpless, and at one point, I experienced over 600 VPCs in a single day.

By July 2020, I began to have intermittent chest pain.
On August 26, I found a well-known traditional Chinese medicine practitioner online who specializes in arrhythmias.
I started visiting him weekly for treatment, as I genuinely wanted to resolve these symptoms.
My medication regimen fluctuated between good and bad until the night of September 25, when I experienced an inexplicable panic attack.
I felt restless and cold, as if my blood was ice, and I panicked, thinking I was going to die.
This was my first panic attack, and I went to the emergency room where I received an injection.

Later, I consulted a psychiatrist who prescribed me medication (20 mg of Xibin capsules twice daily and 0.5 mg of Xanax once at bedtime).
The dosage was gradually increased, and I still use this dosage today.
Although I’m unsure of its effectiveness, I take an extra 0.5 to 1 Xanax in the morning if I feel unwell.
When I feel very uncomfortable, I take the medications prescribed by my doctor, such as 1.25 mg of Klonopin or 10 mg of Entresto, but I am very reluctant to take heart medications, even though the doctor said it’s okay whether I take them or not.

This led to a series of ups and downs.
I am currently stable, seeing both a psychiatrist and a cardiologist when I feel anxious.
I rely on traditional Chinese medicine and acupuncture to self-manage my autonomic nervous system.
In May 2021, I found a good traditional Chinese medicine practitioner near my home who genuinely wants to help me.
I started treatment with him, and I stopped going to Tainan due to my panic disorder, as I was afraid to travel alone on the high-speed rail.
During May and June 2021, I noticed a significant reduction in VPCs due to the combination of traditional Chinese medicine and psychiatric treatment.

I believe the VPCs contributed to my growing anxiety, which ultimately led to panic attacks.
Until a couple of days ago, on July 4, I sometimes felt shortness of breath and had a slightly elevated temperature of 37.7°C.
I wondered if something was wrong with my body again.
The more I focused on my breathing, the worse it became, leading to panic on July 6 when I woke up feeling unable to breathe and took half a Xanax before seeing the doctor.
I visited a cardiologist, and both the chest X-ray and ECG were normal, but I still felt that my breathing was not smooth.
The more I thought about it, the more anxious I became.
I know I shouldn’t dwell on it, as it would help me feel better, but it’s difficult.

I’m also worried that if I start taking Xanax every morning, I might become dependent on it.
Now, if I don’t take my evening dose before 11:00 PM, I feel strange and my feet sweat.
I would like to ask you, doctor, if continuing this medication for a while can help me return to being a normal person? Or once panic and anxiety occur, will these symptoms frequently reappear? Is the feeling of shortness of breath and discomfort related to anxiety and panic? If so, should I be concerned about it? I also don’t understand why my heart rate goes up to 110-120 bpm after a little walking; could this be caused by anxiety or panic? I used to be a very optimistic and normal person.
Dr.
Liao, is it possible for me to return to my former self?
Most importantly, I hope you can provide me with any advice you think might help.
I really don’t want to spend every day lying down, fearing rapid heart rates, missed beats, or anxiety and panic.
I apologize for the lengthy message, and thank you for reading it.
I appreciate your hard work during the pandemic, and I wish you safety!

Nick, 20~29 year old female. Ask Date: 2021/07/06

Dr. Liao Dinglie reply Psychiatry

Hello, online friend: Your description indeed reflects typical panic disorder combined with anxiety disorder.
Medications such as Xibin capsules (20mg), Xanax (0.5mg), and Ental (10mg) are standard treatments for these symptoms.
This condition can cast a significant shadow over one’s life, and from your letter, it’s clear that the insecurity of “it can strike at any moment” greatly affects your previously optimistic outlook on life! In clinical practice, many of my patients gradually find their rhythm in life during the course of treatment, allowing them to emerge from this overwhelming shadow.

In fact, even when panic disorder is not active, individuals still feel the anxiety of “not knowing when it will suddenly occur,” which can permeate various aspects of life, making it difficult to relax.
One of the key goals of medication treatment is to achieve a sense of relaxation and to prevent the negative effects of panic attacks from lingering for long periods.
You may notice that while one cannot directly control their heartbeat (which can exacerbate feelings of helplessness and fear of losing control), one can control their breathing.
A sense of “loss of control” can amplify a 1 or 2 out of 10 panic attack to a 6 or 7, but through “controllable” breathing techniques, symptoms can be reduced back to a 1 or 2, and then using fast-acting Xanax can enhance the effectiveness of the treatment.

Once you learn the concept of “most things being controllable,” your mood will gradually lighten.
Besides medication, lifestyle adjustments are also essential.
For example, one of my patients, a senior executive, managed to address about 70-80% of his condition before retirement, allowing him to retire before the age of 50, and he is now in a very stable condition.
As you mentioned, you have an inherently optimistic personality, which serves as a great protective factor for you.
By making your body and life more “controllable” in various ways, the next step is to adjust it to be “predictable,” which will greatly improve your situation.

As you age, you will learn more about the “philosophy of subtraction,” slowing down your pace, and you will find that the feeling of losing control over your heartbeat will diminish even further.
Sometimes, physical ailments are an opportunity for you to confront your health; by taking this chance to adjust, you can achieve a healthier life and walk a longer path in life.
Wishing you success in regaining your health.
Dr.
Liao Ding-Lie

Reply Date: 2021/07/06

More Info

Thank you for sharing your experiences and concerns so openly. It sounds like you have been through a challenging journey with anxiety and panic attacks, and it's commendable that you are seeking help and trying to understand your situation better.
From what you've described, it seems that your anxiety has manifested in various physical symptoms, including palpitations, shortness of breath, and feelings of panic. These symptoms can be quite distressing and often lead to a cycle of fear and anxiety, where the fear of experiencing these symptoms can trigger further anxiety. This is a common experience for many individuals dealing with anxiety disorders, particularly panic disorder.

First and foremost, it’s important to recognize that you are not alone in this. Many people experience similar feelings, and it is entirely valid to seek help. The symptoms you are experiencing, such as the feeling of your heart racing, difficulty breathing, and the overwhelming sense of panic, can indeed be linked to anxiety. When we become anxious, our body goes into a "fight or flight" mode, which can cause physical symptoms that may feel alarming but are typically not harmful.
Regarding your question about whether you can return to your previous self, the answer is yes, many people do find relief and can return to a more balanced state of being with the right support and treatment. It’s crucial to continue working with your healthcare providers, including both your psychiatrist and any complementary practitioners like your traditional Chinese medicine doctor. They can help you find the right balance of treatments that work for you.

Here are some suggestions that may help you manage your anxiety and panic symptoms:
1. Consistent Medication Management: It seems you are already on a regimen of medications prescribed by your psychiatrist. It’s important to communicate openly with your doctor about how you feel these medications are working for you. If you have concerns about dependency, discuss them with your doctor; they can help you find a plan that minimizes risks while still addressing your symptoms.

2. Cognitive Behavioral Therapy (CBT): This form of therapy is particularly effective for anxiety and panic disorders. It helps you identify and challenge negative thought patterns and behaviors that contribute to your anxiety. If you haven't already, consider asking your psychiatrist for a referral to a therapist who specializes in CBT.

3. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help reduce anxiety symptoms. These techniques can help you manage your body's response to stress and anxiety, making it easier to cope when you start to feel overwhelmed.

4. Regular Physical Activity: Engaging in regular exercise can significantly reduce anxiety levels. It helps release endorphins, which are natural mood lifters. Even a daily walk can make a difference.

5. Healthy Lifestyle Choices: Ensure you are eating a balanced diet, getting enough sleep, and avoiding excessive caffeine and alcohol, as these can exacerbate anxiety symptoms.

6. Support Systems: Surround yourself with supportive friends and family who understand what you’re going through. Sometimes just talking about your feelings can provide relief.

7. Education: Learning more about anxiety and panic disorders can help demystify your experiences. Understanding that these symptoms are common and treatable can reduce the fear associated with them.

8. Gradual Exposure: If certain situations trigger your anxiety, gradual exposure to these situations can help desensitize your response over time. This should be done carefully and ideally under the guidance of a therapist.

Remember, recovery is often not linear; there will be ups and downs along the way. It’s important to be patient with yourself and recognize that progress takes time. If you ever feel overwhelmed, don’t hesitate to reach out to your healthcare provider for immediate support. You deserve to feel better, and with the right help, you can regain control over your life and return to a state of well-being.

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