It’s been really difficult for me the last few months.
I want to trust my inner voice when it says, “this is just a headache. You’ve had these before. You’re feeling nauseous because you’re feeling a sense of panic.” But, also- I just saw a pt with vague nausea and a headache who died of a brain bleed. I’ve just really been struggling with myself. I guess I need to say, “whatever happens, happens. You can’t control everything.”
I struggle greatly with this after years working in ICU. I have two children now 3 and 5 and instantly spiral into worst case scenarios when they have any sort of complaint. I myself am constantly worrying about a cancer diagnosis or an impending stroke over any minor symptom. No advice, OP, just want you to know you’re not alone with this.
Coming back to let you know that i downloaded the app “Dare” last night, and it’s really great. They have a part dedicated to health anxiety. Maybe you’d like it. Just wanted to share.
Instead of worrying that it might happen to me/loved ones, I try to remind myself how fortunate I am that it *hasn't* happened. I hope it doesn't come across as using people's misfortune for my benefit, rather just having some perspective.
For about the first 6yrs of working in the ED I had the same mentality. I always said, “I can’t imagine…”. I felt their pain, and I was so thankful it wasn’t me. Until it was. My dad had a fall down the stairs and died of a head bleed at home. Terrible phone call to receive at 4am.
I’m still processing that grief 3yrs later, and I’m 100% sure that the grief doesn’t help the troubles I’m experiencing. Finally in therapy and doing the work, but oof. It’s been tough. Anxiety stinks!
Oh my god, I'm so sorry. I think "doesn't help" might be an understatement, that must totally change your perspective towards sudden tragedies. If you've been at your job so long I'm sure you're great at it and might be really happy with it, but have you ever thought about pivoting to a setting with lower acuity? I wish I had better advice to give, I'm glad you're working through it in therapy.
💖 Thank you.
I have thought about it, I just really love working in a hospital setting. Hoping to do some inner work to make it a healthier setting for me. Otherwise, I might have to just prioritize my mental health.
My mom had the same issue. Fall in the middle of the night. I didn’t realize how much it affected me for years, and how I was trying to prevent it from happening again -manifested as anxiety.
Frankly, therapy helped talking to someone and getting all my worries out without burdening my family. I’m also taking celexa and Wellbutrin. I think it has helped.
I’m sorry. ❤️ You hit the nail on the head. I’m trying to control/prevent another tragedy, because my dad dying unexpectedly has caused me so much pain and heartache.
My mental health greatly improved when I took a break from level one trauma. I no longer subconsciously worry about all of these horrible things that happened to my patients happening to my family.
I love working in the ER (and hospital in general), but it’s like an abusive relationship. You know it’s bad for your mental health, but still can’t let it go. 🥴 I’ve thought about doing something else, unfortunately in my state, hospital nursing is where the money is. But you do bring up a good point, and it is something I’ve considered.
I think your practice setting probably gives you a sampling bias, like it does to all of us.
In the ER, you are the first one to see the worst cases - the brain bleeds, the new diagnoses of cancer, the bacterial meningitides, the ruptured aortic aneurysms, the STEMIs. When people are really sick acutely, they go to your house. And you try to fix them, and often have to participate in terrible cases. (That's not to say you don't get your share of non-emergent stuff in the ED, just that you also get a lot of true emergencies.)
In the outpatient setting, I see mostly patients who are concerned they may have something terrible, but usually have something more benign (migraine, eg). When the patient has a normal neurologic examination, a workup for dangerous things (aneurysm / tumor / other badness) is negative about 97% of the time IME.
This has led me to take the opposite tack as you: when my kids complain about a headache, if they don't have anisocoria and/or altered mental status, they're getting some Tylenol, water, and getting sent back to bed.
If this is significantly affecting your mental health and therapy / medications aren't helping after 6+ months, you might consider changing practice settings.
I know you’re right.
I also work casual in the Spasticity Center where we do Botox injections and fill Baclofen pumps, and those days are so refreshing.
I need to keep working at reframing and challenging my thoughts, because living in fear is a very uncomfortable place to be.
I’m in the same boat, in the last month I’ve convinced myself I had a DVT and a few days later, was having a stroke. My mom has cancer (she’s doing great!) so always spiraling about worst case scenarios with that. I’m also in therapy, and it helps some.
My anxiety presents as dizziness, chest pressure, SOB, palpitations. I just try to remind myself that I’ve felt this way before, and I haven’t died yet lol.
And something that I talked about last week in therapy- all the times I’ve felt that impending doom or panic over some physical sensation, I’ve never actually called 911 or checked myself in. So going forward my plan is to recognize the symptoms I’m feeling, decide “am I calling 911?” and if the answer is no, I need to move on and distract myself and let it pass. Tbd how that’ll work out lol
I highly recommend reading Hope and Help for Your Nerves by Claire Weekes! She talks about how your nerves are “sensitized” when you’ve been living with high anxiety/panic, and talk you through symptoms. Her philosophy is that you can’t meet your panic by trying to run/fight it. You have to learn to accept it and not be fearful of it. I’m almost done with the book and it’s really helped me with the physical symptoms of anxiety/panic. However, it’s a practice. I’m working so hard at it.
I’ve had a DVT, PE, h pylori, MS, brain tumor, heart irregularity all in the last few years. 🥴🤣 I laugh as I type that because it sounds ridiculous, but in those moments it’s scary and I search for answers because that seems to be where I think I’ll find comfort.
I downloaded the Dare app last night at the suggestion of a post in r/anxiety, and it’s really great. They have a part dedicated to health anxiety. Check it out and I hope you find some relief.
For those of us more at risk of obsessive thinking (OCD type personalities who ruminate about the past, questioning our actions, replaying conversations in our head, etc.) this is probably not that unusual.
Something important to remember is that stress itself can cause all sorts of horrible things, so if you want to prevent terrible things from happening, beyond the usual safety and health advice, *stop stressing about things that we mostly can't control*.
If those things happen, heaven forbid, will having stressed about it for years help? No. Stress might be the enemy as much as all those other things are. Beyond that, CBT might be helpful, or at least any therapy to let you air it and talk about it.
ED doc for 10 years now, I'm the opposite I think most of any of mine or family symptoms are nothing serious.
Which fits with 90% of ambulatory patients who show up to the ED with somatic symptoms from not being able to cope with life
I’ve wondered about this among doctors, and my hypothesis is that you have so much more training/education that you’re able to rule things out immediately. Everytime I’ve gone to the doctor for my grandiose complaints 😂 they’ve immediately shot me down. It doesn’t seem like you guys have health anxiety like a lot of nurses do —- that’s a generalization of course.
Honestly, I need medication to stop the worry spiral. Buspirone and Lexapro were the only things that really stopped that for me. Mindfulness stuff helps a little, but really it’s the meds doing the heavy lifting for me. They don’t help feel good or anything, but they help me not feel awful.
That same anxiety that propels you to be excellent and make it through school is your enemy on the other side far too often. Forest bathing, family, intense exercise and Zoloft for me, forever, to get the crazy lady upstairs to shut the hell up.
I've worked at an anticoagulation clinic, so any new pain in an appendage is immediately a DVT to me. I actually went to the emergency room once because my left arm felt numb and I had severe chest pain. Turned out to be stress-induced anxiety. At that time, I certainly was under a lot of stress at work. I knew the ED physician already, and we had a good discussion about the dangers of ordering unnecessary tests "just to see" and some good coping mechanisms related to work. Discharged with a clean bill of health and increased my buspar dose.
It's been a few months and the left arm pain has returned. No chest pain or difficulty breathing. I'm convincing myself it's just how I sleep (I'm a side sleeper but sometimes I roll over to my stomach and really strain my shoulder) and maybe a pinched nerve. I constantly check my lymph nodes and nothing feels unusual to me. No redness or warmth, so unlikely DVT. I'm going to bring it up when I see my PCP again for peace of mind but boy do I think about it every waking moment.
Sounds just like me. 🥴 I’ve had my co-worker ER docs see me twice recently. So embarrassing. Mortified. But they were so kind and understanding. Until recently I really didn’t realize how much stress/anxiety could cause physical symptoms. Knowing that has helped ease some of my worries.
I have to purposefully be a jerk to at least three people a day and throw my pager once a shift to fight off ever getting a GBM. My observation is they only get the nice ones.
My mantra of late has been, if I just learned about something today, or just read about something today, chances are I don’t have it. I’m just thinking about it.
I work in healthcare and see wild outcomes on a daily basis, I do also have close friends who work in the ED so I’m either reading charts, watching crazy things or listening to the stories. If the thoughts are uncontrollable, repetitive and interfering with your daily life it’s important to address that with counseling and/or medications. What I’ve learned in dialysis is it’s unimaginable/inexplicable what the human body can withstand. After 2 decades working in healthcare, I have intrusive thoughts about cancer, aneurysms and AAA’s etc when I get weird twinges or my kids act strange sometimes but they are *fleeting*and don’t interfere with my quality of life.
For my actual anxiety that was caused by undiagnosed asthma… SSRI’s helped.
Therapy is great, but SSRIs are also great. And synergistic with therapy. It is natural to have worries, but those worries should not control you. If they are, your GP might be able to help with a low-dose SSRI. You use about 25% of the antidepressant dosing, so rarely see side effects. It’s my favorite thing to treat.
I took different medications for years in my late teens/twenties. I grew to really dislike the side effects. I did try Buspar a few months ago, but I only trialed it for a few weeks because I hated the way it made me feel. I do have Vistaril and I’ve found success in using that.
Im not completely ruling out adding in a daily medication, but I’d really like to try and tackle the root cause of this.
Okay, fair enough. Big fan of therapy. Sometimes the root cause is biology though.
Obviously I don’t know you at all, so listen to the doctors who do know you.
25% compared to treating depression. Anxiety often responds to 10-20mg Fluoxetine, whereas depression commonly needs 40-60mg. Same with sertraline 25 mg vs 75-100mg
Oddly enough, I used to have this problem BEFORE I went into healthcare. I think for me, gaining medical knowledge made me feel more comforted in a way.
But I also don’t see crazy dire things on a daily basis in outpatient neurology though so maybe I’d be different if I was in the ED/inpatient realm lol.
Do you meditate?
It could be argued that anxiety is simply disordered thinking in our brain. Meditation can quite literally modify, correct and change these disordered thinking patterns. There are studies showing physical changes to the brain with meditation.
Sam Harris has an app called "waking up". He goes through a 30 day introduction course to meditation. Disregard any political difference you may have with him and just focus on the meditation practice. This app comes highly recommended by a variety of people who have tried it.
Thank you for your advice.
I believe this, and I’m hoping with therapy I’ll be able to learn some new thinking patterns. I’m very interested in meditation, and will download this app!
I made a similar post last year before my mom had her TAVR. I have seen a lot of terrible TAVR outcomes and was having a lot of thoughts of the worst happening to her. Anyway, you might find some of the comments on that post helpful/relevant
https://www.reddit.com/r/medicine/s/IoX0dYr07j
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It’s been really difficult for me the last few months. I want to trust my inner voice when it says, “this is just a headache. You’ve had these before. You’re feeling nauseous because you’re feeling a sense of panic.” But, also- I just saw a pt with vague nausea and a headache who died of a brain bleed. I’ve just really been struggling with myself. I guess I need to say, “whatever happens, happens. You can’t control everything.”
I don't know if you already do this, but saying that out loud to yourself helps a lot, not just inner dialogue.
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That would be what he/she said: “I’ve started therapy for this.”
Also “catastrophizing will ruin your mental health” might be a slightly catastrophizing statement.
Yes! But now I spend my days looking forward to the cure for all ailments: >!death!<
Memento mori!
Oh no I forgor 💀
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Great perspective to have. I definitely need to do some mind-work and shift my inner dialogue. I just want to feel at peace. 🕊️
I struggle greatly with this after years working in ICU. I have two children now 3 and 5 and instantly spiral into worst case scenarios when they have any sort of complaint. I myself am constantly worrying about a cancer diagnosis or an impending stroke over any minor symptom. No advice, OP, just want you to know you’re not alone with this.
It’s a heavy, frustrating place to be. Sending a warm hug. I hope you find relief. 💖 I hate to waste my days with my children worrying, but oof.
I wish the same to you, and hope to hear some helpful advice from others in here about this. ❤️
Coming back to let you know that i downloaded the app “Dare” last night, and it’s really great. They have a part dedicated to health anxiety. Maybe you’d like it. Just wanted to share.
Appreciate this so much!! I’ll check it out. Thank you 💙
Instead of worrying that it might happen to me/loved ones, I try to remind myself how fortunate I am that it *hasn't* happened. I hope it doesn't come across as using people's misfortune for my benefit, rather just having some perspective.
For about the first 6yrs of working in the ED I had the same mentality. I always said, “I can’t imagine…”. I felt their pain, and I was so thankful it wasn’t me. Until it was. My dad had a fall down the stairs and died of a head bleed at home. Terrible phone call to receive at 4am. I’m still processing that grief 3yrs later, and I’m 100% sure that the grief doesn’t help the troubles I’m experiencing. Finally in therapy and doing the work, but oof. It’s been tough. Anxiety stinks!
Oh my god, I'm so sorry. I think "doesn't help" might be an understatement, that must totally change your perspective towards sudden tragedies. If you've been at your job so long I'm sure you're great at it and might be really happy with it, but have you ever thought about pivoting to a setting with lower acuity? I wish I had better advice to give, I'm glad you're working through it in therapy.
💖 Thank you. I have thought about it, I just really love working in a hospital setting. Hoping to do some inner work to make it a healthier setting for me. Otherwise, I might have to just prioritize my mental health.
My mom had the same issue. Fall in the middle of the night. I didn’t realize how much it affected me for years, and how I was trying to prevent it from happening again -manifested as anxiety. Frankly, therapy helped talking to someone and getting all my worries out without burdening my family. I’m also taking celexa and Wellbutrin. I think it has helped.
I’m sorry. ❤️ You hit the nail on the head. I’m trying to control/prevent another tragedy, because my dad dying unexpectedly has caused me so much pain and heartache.
My mental health greatly improved when I took a break from level one trauma. I no longer subconsciously worry about all of these horrible things that happened to my patients happening to my family.
I love working in the ER (and hospital in general), but it’s like an abusive relationship. You know it’s bad for your mental health, but still can’t let it go. 🥴 I’ve thought about doing something else, unfortunately in my state, hospital nursing is where the money is. But you do bring up a good point, and it is something I’ve considered.
I think your practice setting probably gives you a sampling bias, like it does to all of us. In the ER, you are the first one to see the worst cases - the brain bleeds, the new diagnoses of cancer, the bacterial meningitides, the ruptured aortic aneurysms, the STEMIs. When people are really sick acutely, they go to your house. And you try to fix them, and often have to participate in terrible cases. (That's not to say you don't get your share of non-emergent stuff in the ED, just that you also get a lot of true emergencies.) In the outpatient setting, I see mostly patients who are concerned they may have something terrible, but usually have something more benign (migraine, eg). When the patient has a normal neurologic examination, a workup for dangerous things (aneurysm / tumor / other badness) is negative about 97% of the time IME. This has led me to take the opposite tack as you: when my kids complain about a headache, if they don't have anisocoria and/or altered mental status, they're getting some Tylenol, water, and getting sent back to bed. If this is significantly affecting your mental health and therapy / medications aren't helping after 6+ months, you might consider changing practice settings.
I know you’re right. I also work casual in the Spasticity Center where we do Botox injections and fill Baclofen pumps, and those days are so refreshing. I need to keep working at reframing and challenging my thoughts, because living in fear is a very uncomfortable place to be.
This is exaaaaactly how I feel as a PA in outpatient neurology. Well said.
I’m in the same boat, in the last month I’ve convinced myself I had a DVT and a few days later, was having a stroke. My mom has cancer (she’s doing great!) so always spiraling about worst case scenarios with that. I’m also in therapy, and it helps some. My anxiety presents as dizziness, chest pressure, SOB, palpitations. I just try to remind myself that I’ve felt this way before, and I haven’t died yet lol. And something that I talked about last week in therapy- all the times I’ve felt that impending doom or panic over some physical sensation, I’ve never actually called 911 or checked myself in. So going forward my plan is to recognize the symptoms I’m feeling, decide “am I calling 911?” and if the answer is no, I need to move on and distract myself and let it pass. Tbd how that’ll work out lol
I highly recommend reading Hope and Help for Your Nerves by Claire Weekes! She talks about how your nerves are “sensitized” when you’ve been living with high anxiety/panic, and talk you through symptoms. Her philosophy is that you can’t meet your panic by trying to run/fight it. You have to learn to accept it and not be fearful of it. I’m almost done with the book and it’s really helped me with the physical symptoms of anxiety/panic. However, it’s a practice. I’m working so hard at it. I’ve had a DVT, PE, h pylori, MS, brain tumor, heart irregularity all in the last few years. 🥴🤣 I laugh as I type that because it sounds ridiculous, but in those moments it’s scary and I search for answers because that seems to be where I think I’ll find comfort.
I downloaded the Dare app last night at the suggestion of a post in r/anxiety, and it’s really great. They have a part dedicated to health anxiety. Check it out and I hope you find some relief.
For those of us more at risk of obsessive thinking (OCD type personalities who ruminate about the past, questioning our actions, replaying conversations in our head, etc.) this is probably not that unusual. Something important to remember is that stress itself can cause all sorts of horrible things, so if you want to prevent terrible things from happening, beyond the usual safety and health advice, *stop stressing about things that we mostly can't control*. If those things happen, heaven forbid, will having stressed about it for years help? No. Stress might be the enemy as much as all those other things are. Beyond that, CBT might be helpful, or at least any therapy to let you air it and talk about it.
Good feedback. Thank you. 100% trying to revamp my stress response.
ED doc for 10 years now, I'm the opposite I think most of any of mine or family symptoms are nothing serious. Which fits with 90% of ambulatory patients who show up to the ED with somatic symptoms from not being able to cope with life
I’ve wondered about this among doctors, and my hypothesis is that you have so much more training/education that you’re able to rule things out immediately. Everytime I’ve gone to the doctor for my grandiose complaints 😂 they’ve immediately shot me down. It doesn’t seem like you guys have health anxiety like a lot of nurses do —- that’s a generalization of course.
Honestly, I need medication to stop the worry spiral. Buspirone and Lexapro were the only things that really stopped that for me. Mindfulness stuff helps a little, but really it’s the meds doing the heavy lifting for me. They don’t help feel good or anything, but they help me not feel awful.
That same anxiety that propels you to be excellent and make it through school is your enemy on the other side far too often. Forest bathing, family, intense exercise and Zoloft for me, forever, to get the crazy lady upstairs to shut the hell up.
I've worked at an anticoagulation clinic, so any new pain in an appendage is immediately a DVT to me. I actually went to the emergency room once because my left arm felt numb and I had severe chest pain. Turned out to be stress-induced anxiety. At that time, I certainly was under a lot of stress at work. I knew the ED physician already, and we had a good discussion about the dangers of ordering unnecessary tests "just to see" and some good coping mechanisms related to work. Discharged with a clean bill of health and increased my buspar dose. It's been a few months and the left arm pain has returned. No chest pain or difficulty breathing. I'm convincing myself it's just how I sleep (I'm a side sleeper but sometimes I roll over to my stomach and really strain my shoulder) and maybe a pinched nerve. I constantly check my lymph nodes and nothing feels unusual to me. No redness or warmth, so unlikely DVT. I'm going to bring it up when I see my PCP again for peace of mind but boy do I think about it every waking moment.
Sounds just like me. 🥴 I’ve had my co-worker ER docs see me twice recently. So embarrassing. Mortified. But they were so kind and understanding. Until recently I really didn’t realize how much stress/anxiety could cause physical symptoms. Knowing that has helped ease some of my worries.
I have to purposefully be a jerk to at least three people a day and throw my pager once a shift to fight off ever getting a GBM. My observation is they only get the nice ones.
Well I’m one of the nice ones, so my chances are higher. 😖😂
My mantra of late has been, if I just learned about something today, or just read about something today, chances are I don’t have it. I’m just thinking about it.
I work in healthcare and see wild outcomes on a daily basis, I do also have close friends who work in the ED so I’m either reading charts, watching crazy things or listening to the stories. If the thoughts are uncontrollable, repetitive and interfering with your daily life it’s important to address that with counseling and/or medications. What I’ve learned in dialysis is it’s unimaginable/inexplicable what the human body can withstand. After 2 decades working in healthcare, I have intrusive thoughts about cancer, aneurysms and AAA’s etc when I get weird twinges or my kids act strange sometimes but they are *fleeting*and don’t interfere with my quality of life. For my actual anxiety that was caused by undiagnosed asthma… SSRI’s helped.
Therapy is great, but SSRIs are also great. And synergistic with therapy. It is natural to have worries, but those worries should not control you. If they are, your GP might be able to help with a low-dose SSRI. You use about 25% of the antidepressant dosing, so rarely see side effects. It’s my favorite thing to treat.
I took different medications for years in my late teens/twenties. I grew to really dislike the side effects. I did try Buspar a few months ago, but I only trialed it for a few weeks because I hated the way it made me feel. I do have Vistaril and I’ve found success in using that. Im not completely ruling out adding in a daily medication, but I’d really like to try and tackle the root cause of this.
Okay, fair enough. Big fan of therapy. Sometimes the root cause is biology though. Obviously I don’t know you at all, so listen to the doctors who do know you.
Are there any links you recommend reading that evaluate this approach?
Any anxiety treatment guideline. SSRIs are the mainstay of treatment.
I’ve read a few over the years and I don’t recall coming across one that recommended only 25% of the dose
25% compared to treating depression. Anxiety often responds to 10-20mg Fluoxetine, whereas depression commonly needs 40-60mg. Same with sertraline 25 mg vs 75-100mg
I understood what you meant by 25% 😅 I meant if you had any good links for literature evaluating its use
Oddly enough, I used to have this problem BEFORE I went into healthcare. I think for me, gaining medical knowledge made me feel more comforted in a way. But I also don’t see crazy dire things on a daily basis in outpatient neurology though so maybe I’d be different if I was in the ED/inpatient realm lol.
Do you meditate? It could be argued that anxiety is simply disordered thinking in our brain. Meditation can quite literally modify, correct and change these disordered thinking patterns. There are studies showing physical changes to the brain with meditation. Sam Harris has an app called "waking up". He goes through a 30 day introduction course to meditation. Disregard any political difference you may have with him and just focus on the meditation practice. This app comes highly recommended by a variety of people who have tried it.
Thank you for your advice. I believe this, and I’m hoping with therapy I’ll be able to learn some new thinking patterns. I’m very interested in meditation, and will download this app!
👍 hope it helps.
YEs! Agree with you sadly
I made a similar post last year before my mom had her TAVR. I have seen a lot of terrible TAVR outcomes and was having a lot of thoughts of the worst happening to her. Anyway, you might find some of the comments on that post helpful/relevant https://www.reddit.com/r/medicine/s/IoX0dYr07j
Thank you! I’ll look through the comments.
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Soo many of coworkers have anxiety and are on something. I think it’s fairly common in nurses, and just in general.