Panic Attacks

Monday, March 25, 2013

Tuesday, August 21st, 2012. Started like a fairly average day. I had an iced coffee. Got some work done. Went for a long run (about three miles) around the neighborhood and picked up about a hundred feet of rope light for the terrace at a funny little Jewish lighting shop that seemed to specialize mostly in tacky chandeliers. Grabbed another iced coffee. Then a meeting with Bob Giraldi that afternoon to make plans for “The Interactive Idea,” the class we teach at SVA. And after seeing Bob, I started feeling a mite peckish (I hadn’t eaten much that day), so I decided to walk over to Hill Country Chicken at Madison Square Park to get one of those upscale Chik-Fil-A-style sandwiches I love. I had my headphones in and was listening to a podcast, as I often do whilst wandering the city. “Savage Lovecast” this time, I remember quite well.

Around 22nd street and Broadway I started feeling a little lightheaded. Probably just hungry. Let’s get to the restaurant. Then, as I hurried my walk I felt dizzy. Then my heart started fluttering and I quickly became very quickly dissociated. The audio in my ears sounded weird, so I pulled out the headphones. I walked quicker, just to get some food, I suppose, but also out of fear. Then tingling in my fingers, hands, legs. My vision tunneled. My heart went berserk. My mind fixated: A heart attack. I’m having a heart attack. I’m dying. I started dialing 911 on my phone and got as far as “9” and couldn’t get any further. So I stumbled to the first random stranger I saw walking towards me on the street, handed them my phone, and said in a strained voice, “I think there’s something wrong with my heart — can you dial 911 for me?” He was another guy about my age (Merlin, I think he said his name was), and I imagine his first reaction was a kind of confused annoyance — crazy people are not rare on the streets of Manhattan — but as soon as he realized what was up, he became immediately helpful. Called the ambulance and communicated between emergency dispatcher and me. Had me sit down. Kept an eye on me. Asked if there was anything I needed. I calmed down. My heart stopped feeling like it would explode. My limbs stopped tingling. The ambulance eventually arrived and a couple of EMTs helped me inside, stuck a bunch of plastic monitors all over my chest and arms, and gave me the once-over. I mentioned the heart thing. “Your heart seems fine — healthier than mine, in fact,” one of the EMTs informed me. I hadn’t eaten all day and had consumed three iced coffees. And had been running and walking around almost all day, apart from the meeting with Bob. Probably just a blood-sugar crash mixed with a little dehydration. No need for the hospital. Get something to eat. Go home. Relax. Maybe take it easy on the caffeine. I got a hot dog from the closest street vendor and took a seat at one of the tables set up on Broadway by Madison Square Park. (A very nice spot on a weekend afternoon, by the way.) I called my parents and Christin (who was in Florida) to let them know about it and see if they had any thoughts on the matter. I still felt weird — and very freaked about my heart — but I eventually caught a cab home and tried my best to relax. Going to sleep that night I still felt on the edge of something catastrophic. Like my heart might just go out on me at any moment and I’d fall over dead. Doom.

I didn’t die. In fact, the next day I felt better. Christin arrived at home. I laid low and didn’t really leave the apartment. Until Thursday. We decided to go walk and get some breakfast. I got about a half block before it came on, again. Light-headedness. Heart beginning to accelerate (although nothing as severe as the first episode). I immediately sat down. It got worse. Call a car, we’re going to hospital. Which we did. Good old Wycoff Heights Medical Center, the same place had my fingers fixed after those two episodes a few years ago. Emergency room. I sat there, still thinking that, once again, I was having some kind of minor heart attack. I say for almost two hours while those idiots apparently forgot about me. I was somewhat out of it, feeling like shit and like I might die, but if I remember correctly they basically forgot that I had been sitting there. My understanding is that they’re pretty much supposed to clear the way when someone thinks they’re having a heart attack, time is so much of the essence. Maybe I’m wrong. But either way: They took their sweet time. I finally made it into the ER, where I got probulated for about six hours. My blood pressure was through the roof. No one seemed to have any idea what was up, except to keep informing me that nothing appeared to be wrong. Except the blood pressure. Which as I calmed down also came down.

My regular doctor was unavailable, so I made an appointment with someone else at his clinic the next day and went in with Christin. “You had a panic attack” were basically the first five words out of his mouth.

Okay. So I finally had a firm diagnosis. I assume Manhattan physicians see panic attack patients about, oh, a dozen times a day. I don’t have any numbers, but I wouldn’t be surprised at all if New York were the panic attack capital of the United States or the world. Or the solar system. Probably not the galaxy — many of those new exoplanets they’re discovering look pretty stressful. I’m honestly surprised the EMTs didn’t suggest it — and I’m not reassured that the doctors at Wycoff Heights couldn’t figure it out after a day of running tests of me. Especially since, now that I’ve read a thing or two about panic attacks and general anxiety disorder, I realize just how common panic attacks are. Two good friends have had them and I didn’t find out until after I started talking to people about my experiences. Tony Soprano had them (and so did his son). I just today happened to watch a video interview with one guy from the web comic Penny Arcade about his history of panic attacks. People talk about panic attacks quite often in all sorts of media — and knowing about them makes some of the behavior of over-scrutinized celebrities make more sense because they can make you act really, really bizarre. I never thought twice about them, but now that I’m acutely aware of their existence, I see stuff about them everywhere. Weird.

So I had a couple of panic attacks. And not particularly major ones — I didn’t collapse or anything like that. And only the first one had any major symptoms like the racing heart and tingling in the limbs and the imminent threat of fainting (“syncopy,” as the cool kids (doctors) call it). But it triggered my awareness of something else in me which had been building for a while: general anxiety disorder. The term sounds silly, but it’s definitely a thing. Ever since that panic attack I’ve had problems doing things like going out and doing things in the city, I’ve had problems being in crowded spaces, sometimes the idea of walking a single city block seems unsurmountable, sometimes for no reason I’ll just feel Fear and have trouble holding my shit together — it feels like I’m literally about to die sometimes. Or, failing that, like I’m going insane. Like there’s something I can feel broken in my head. My understanding is that people with this condition often feel like they’re about to have a heart attack or like they’ve got a brain tumor. I understand why this is — that’s how I felt. That’s how I still feel sometimes, although now I know enough about what’s going on to be able to see through the shitty illusion my anxious brain is creating for me. I’m not dying. I don’t have heart problems. I don’t have a brain tumor. I am, as far as anyone can tell me, pretty healthy. Even my blood pressure is even just fine, despite the initial fear that there might have been some problem there.

I’m writing this because one thing that has helped settle me when I’m experiencing a rough patch is to get online and read other people’s experiences with panic attacks (PAs) and general anxiety disorder (GAD). I’ve never been one for using the internet to diagnose medical conditions, but PAs and GAD are mental issues and, as far as I’ve been told and experienced, the way to deal with them is to not get caught in their downward spiral. The slightest trigger can build into a spot of worry which can cascade until you’re having a full-blown attack. The trick is to understand when you’re experiencing a little trigger and to psychologically not allow yourself to go down the dark path. Reading about how other people have experienced something similar and helped themselves helps me.

My primary doctor, when I finally got to see him a few weeks after the event, likened it to being chased by a bear. Like: A bear jumped out at me from the clear blue and scared the living shit out of me. So for a while, anything that reminds me of that experience will cause me to clench up, fearing that once again the bear will leap out. Again: Sound a little goofy to write, but it’s relatively accurate. I guess it’s a very, very, very light form of PTSD.

I joked about this with Christin, but it’s sort of true: We watch Dexter, the show about the serial killer who also works for Miami Metro Homicide. He regularly blathers on about his “dark passenger.” That’s kind of what this feels like. I’m not going to murder anyone, of course, but I feel like there’s something wrapped around some of the nerves in my head, neck, shoulders, and back. Something that can take over and put me in this bad state if I don’t control it. That sounds cheeseball, but it’s honestly how I feel sometimes. The GAD can feel like a physical thing that I want excised from my body.

Okay. So this has been going on since August — about seven months or so. And I am getting better. It’s what I would call a controlled problem at the moment. I haven’t had a real panic attack episode since October (I was in Austin alone and also had the flu, which all combined into an obnoxious series of attacks). While I have had some issues going out in public and going to crowded restaurants or music shows, that seems to mostly be behind me. I don’t feel afraid to do basic things like I did for a while. I don’t feel unhealthy. (In fact, besides this I feel quite healthy, especially since all of the tests I’ve had as a part of this have come up clean. And my exercise levels are also back up, which is a good general barometer. And I’m very attuned to my physical health at the moment.) I’m getting better, so I wanted to briefly discuss what I’ve been doing and thinking to help fix the situation.

The main fix has been a combination of going to therapist and being my own therapist. The “anxiety” in “general anxiety disorder” comes from somewhere. Work, for me, has been consistently pretty stressful for about the past two or three years. This past summer isn’t the worst it’s been, but I had a lot of work stress and I think it had just compounded and compounded until I finally blew a gasket. And, let me make this clear: It’s not a particular client or project. I really like almost all of my projects and clients! Especially now that I’ve got the ability to be selective about who I work with. They’re smart, interesting people who like making things. I get along with my clients. The work stress more came from how I worked. I put a lot of weight on my own shoulders when I work. I can make things much harder on myself than they need to be. I guess I don’t want to get into too many specifics, but the past seven months I’ve been doing much more deep thinking about how I want to work and what my work-life balance should look like. I’m not a graduate student anymore: I can’t just blast through projects, spending 14 hours each day banging out ideas and code. It’s very stressful. And it’s been, I feel, a major contributor to my GAD. So I’m working on that.

My therapist has been good. Christin pushed me towards this option, though I was resistant at first. I’ve been seeing her for about four months, now, and she’s been good at giving me techniques for managing the disorder (like breathing and stretching exercises) and she’s been good at giving me perspective when I talk about how I’m trying to do things like reassess how I work to reduce stress. And I talk about my tricks. I come up with a new trick every now and then which actually prove quite helpful with stress. For example! I guess my natural mental image of the people I’m working for is that they’re somehow angry at me for not being good enough or fast enough or whatever. They’re totally not in real life (for the most part!), but even when things are going great, that’s an odd kind of pressure. And it’s probably rooted in something much deeper in my past — the details, there don’t even really matter. But there’s a part of my brain that drives pretty damned hard to always better, always improve, and it’s really hard for me to shut that part of me up. It’s got to be connected to that. So. Just consciously envisioning people I work with being happy with me can help out quite a bit when I’m feeling overwhelmed. Minor trick. Seems silly! But just thinking of them being happy with me appears to help. (This was made easier a couple of weeks ago: I launched a couple of apps for clients who I also hung out with in Austin and they were visibly happy. As an aside: It can be tough for a developer to gauge client satisfaction. Tell your developer when they’re doing a good job — otherwise, all they ever hear is BUG REPORT: YOU DONE BAD! I exaggerate a bit, but it can be tough to read whether people think I’m doing a good job or not.)

Like I said above, just reading other people’s experiences online has been important. One trick someone pointed out on some forum or other: If they felt an attack coming on, they’d tell themselves that it might happen, but in ten or fifteen minutes it’ll be over. Like it’s a bit of aircraft turbulence and shortly you’ll be back in smooth air. Which I’ve done. It just kind of breaks you out of the feeling of falling into the endless abyss to know that even if you do you start feeling strange, you’ll be out of it soon enough. Takes the pressure off. Another technique someone mentioned is to just decide to let the panic attack happen. My therapist even once suggested that it might not be bad for me to actually faint from a panic attack just so I would know what that felt like and that it wasn’t the end of the world. This trick is similar to that, but it actually kind of scary to do in practice. The idea, though, is that it’s stressful just trying to hold yourself together when an attack starts to come on and that if you’re just like “fuck it, I’m not going to die, let just get this over with” you neutralize the fear that causes the attack in the first place and you mitigate it. Another thing I’ve found myself doing lately is reacting to the feeling of an attack not by saying to myself, “oh, fuck fuck fuck fuck,” but instead saying to myself, “Christ, not this horseshit again.” Being dismissive of it seems to help. Anything that removes the feeling of fear.

Another thing I’ve been doing with myself: Aversion therapy. I think that’s what it’s called. But the basic idea is to dive straight into those things the GAD has made me irrationally afraid of. Driving. In October in Austin I could barely drive without causing myself to go into a state. I wasn’t unsafe, but just sitting in a car made me feel enormously and irrationally afraid. Sort of a random thing, but probably connected to the feeling of being trapped or out of control. So I had some issues driving after I got to Austin a few weeks ago for SXSW. I want to stress, here: I never felt like I was unsafe driving or I wouldn’t have done it. I just felt a big irrational fear. So I kept driving. Short drives in the neighborhood at first seemed daunting. But eventually I got myself up to driving thirty minutes out to the Salt Like and to the airport and by the time I left Austin last week I was quite enjoying driving again. I’ve always found it fun to drive around Austin, now I have that back. Aversion therapy.

Same with running and doing things in New York. When you’re constantly worried that your heart might explode, running and exercise gets kind of hard to do. It’s uncomfortable to try to run a few miles and have “I’m going to die any step now, I’m going to die any step now” racing through your brain. It’s irrational. But that’s how it works. But I’ve forced myself to keep running and playing soccer and am doing much better, now, as well. I’ve run more in March than I had in any month since July, when we were in Berlin and I was taking regular long-ass meandering runs all over the city.

Also, for Christmas Christin got me a book called When Panic Attacks by David D. Burns M.D. I’ve read about half of it, and it has some good advice and perspective. And, again, it’s been helpful just to understand what I’m feeling and what’s actually going on with me. But I tried to do some of the written exercises he recommended and, honestly, they didn’t do that much for me. I’m probably getting the same effect (but better) just doing my own thinking on the issues and talking with the therapist. The only thing it’s left me with so far is my new habit of asking myself “what’s the worst that can happen?” when I get anxious. Just answering that in a realistic way can kind of take the edge off of a stressful situation, even something like flying where the answer might be “die in a fireball” I can follow it up with, “and what are the chances of that happening?” To which: Well, basically zero.

One thing I haven’t done, yet: Medication. Well. I had a prescription for lorazepam that I was told to take to calm down if things got really bad. I took one every once in a while. And then had a super-stressful week working in New Orleans during which I popped a couple a day. But that’s it. SO my doctor recently suggested I get on a light Prozac prescription for a while. I’m resistant to that idea at the moment for a few reasons: 1) I feel like I’m getting better on my own and that maybe it’s more important to solve some of the underlying psychological issues through thought and therapy that it is to spackle over the problems with drugs. 2) While my GAD feels shitty, I’ve heard of people who’ve had much more debilitating forms. I think I’ve got a relatively light case. It’s still a huge piece of shit, though, so when I hear about people who faint regularly from PAs or who have essentially become shut-ins because they can’t bear even stepping outside — well, I can only imagine how completely crushing that might feel. But I feel like I’m managing mine — and I suspect that no one would even know I had an issue unless I mentioned it. My behavior hasn’t become weird. (Well, it hasn’t become any weirder, anyway.) 3) Related to the above, I just don’t want to take pills if I don’t need to. Simple as that.

I got a light prescription for Prozac, but I haven’t filled it for the above reasons. Next week I’ll see the doctor again and we’ll go over where I’m at. I’m 100% in favor of taking input and advice from all angles, even if I ultimately decide to not do something.

And I think that’s the biggest thing. I’ve found a lot of help just talking to people — friends, doctors, etc — about the situation. People I know who have gone through this have offered good advice and perspective. So much of controlling GAD and not getting panic attacks appears to simply be not letting yourself get wound up about it. (If only all disease were so easy to cure.) Hearing about other people who’ve gotten through the worst helps give perspective.

I’m sure I’m leaving out some major thoughts, here. This has been a topic I’ve thought about every day since my first panic attack back in August. It’s consistently with me. So I’ve got a ton of thoughts on the matter. And this is maybe odd to say, but I think that overall it’s been a strangely positive experience. The PAs and GAD suck, but I’m confident that I’ll get it under control and maybe even get rid of it entirely. But it’s shocked me into realizing my own mortality in a way that’s got me making changes for the better. I’m off caffeine, for example. And I’m exercising more, now. And much better at understanding and managing life’s stresses. So, y’know. Lemonade from lemons.