How Many Medical Doctors Do I Have to See?
*Karen, a 33 year old married school teacher and mother of 3 young children, had been feeling “constant” lightheadedness, weakness and nausea for several weeks on end? When her family Doctor could not find a medical cause for her complaints, he referred her to an Ear Nose and Throat (ENT) Specialist for a further medical investigation. Karen was sick of feeling sick and just wanted a concrete answer for the “awful feelings” that would not leave her body. After an extensive work up with her ENT specialist, the Doctor told her the tests were within normal limits. She then returned to her Family Doctor feeling more confused and discouraged than ever. All she wanted was an explanation for the unbearable nausea she suffered with every day.
What is the Cause of Medically Unexplained Symptoms?
Her Family Doctor was eager to get to the bottom of her complaints and immediately referred her to a Gastroenterologist (GI). Karen was beginning to feel like a ping pong ball. The GI Doctor conducted his own evaluation. Karen waited apprehensively for the results for two weeks, convinced the Doctor would discover some dreaded disease progressing throughout her body. When the Doctor called and left a message that the tests all were within normal limits, Karen got fed up! She immediately scheduled a visit with her Family Doctor, who continued on a search for medical causes. Next, he immediately arranged for a Neurology consult. Karen was getting very frustrated and discouraged. She began to take matters into her own hands. She started researching causing for Medically Unexplained Symptoms.
Panic Attack Symptoms with No Beginning and No End!
She discovered her symptoms were some of the same symptoms commonly reported in panic attacks. But these were not panic attacks with a beginning and an end. The nausea, lightheaded and drained feelings were there when she woke up in the morning and she took these same symptoms to bed with her at night. “Could constant symptoms be part of panic disorder?” she wondered.
Dr. Blumberg’s Commentary
My panic disorder patients often complain of “a constant symptom” or symptom constellation. When conducting a cognitive-behavioral analysis, we observe a specific symptom-thought pattern. You feel nausea and you think “Why do I feel nausea all the time?” without realizing that the dwelling distressing thought “What is causing my nausea?” is actually activating the flight or flight response and producing adrenaline which feeds the nausea feeling. You can walk around wondering why you feel such awful sick feelings without even recognizing how you are feedings the feelings with subtle fearful thoughts. Dwelling thoughts are not as easy to detect as the more classic False Catastrophic Thoughts of Die, Heart Attack, Faint and Lose My Mind typical of intense panic attacks. While these dwelling thoughts are more embedded they can produce more prolonged periods of suffering with panic attack symptoms.
The Benefits of Early Diagnosis of Panic Disorder in Medical Settings
Naturally, we never want to miss a medical diagnosis for Medically Unexplained Symptoms. Therefore, a thorough and extensive medical investigation must be undertaken. There are three potential diagnostic possibilities for Medically Unexplained Symptoms; (1) a medical diagnosis (2) a psychological diagnosis, like panic disorder and (3) both a medical diagnosis and a psychological diagnosis.
Improve Recognition Rates of Panic Disorder
Panic disorder can be a progressive condition, leading to more intense somatic distress over time and sometimes disabling symptoms. The introduction of brief effective diagnostic procedures for panic disorder and patient education early in the diagnostic process can enhance early recognition of panic disorder and improve their quality of care. Given the well documented low detection rates of panic disorder in emergency medicine, primary care and cardiology practice, there is a ripe opportunity to improve recognition and the overall quality of care of panic disorder patients.
*This educational information should always be used in consultation with your doctor to confirm a diagnosis and review available treatments for panic disorder. References to real persons, places and events are made in a fictional context, and are not intended to be in any way libelous, defamatory or in any way factual.
The ideas in this blog are developed from Dr. Blumberg’s panicLINK Program. PanicLINK is a comprehensive, twelve session, four phase, multi-media educational program on panic disorder. The material in this Blog and the panicLINK Program are copyright protected by Out of the Blue Network, LLC. No permission is granted to reproduce this blog for commercial purposes. For more information about the panicLINK Program connect at www.paniclink.com.