2009 July | PreEmptive Healing

Physiological Responses to Fear and Anxiety

Thursday, July 16th, 2009

There are dozens of psychological responses when we face a perceived threat. The more evident responses, however, are physiological. These physical manifestations can be harder to suppress, and, at times, can lead to health problems.

The most evident form of physiological response is that which is known as the “fight or flight” response. When we are faced with what we consider to be a dangerous situation, 19275070.thbfight the first noticeable change is an increase in perspiration, as well as heart and respiratory rates. This physical reaction is due to the activation of a small, walnut sized structure in the fore-brain, called the amygdala. This structure, in turn, then stimulates the hypothalamus to produce CRH, or corticotropin-releasing hormone. This hormone, then, triggers the production of adrenocorticotropic hormone, known as ACTH, in the pituitary gland, a small, oval gland at the base of the brain. Finally, this signal travels to the adrenal gland, sitting just above the kidney, which produces cortisol, causing an increase in glucose production to provide additional fuel for the muscles and brain to deal with the stress. This complex series of direct communications between the hypothalamus, pituitary gland, and adrenal gland is known as the hypothalamic-pituitary-adrenal, or HPA, axis, a vital and major part of the neuroendocrine system that controls the reaction to stress, amonsgt other body processes. Clearly, the simple physical responses to fear are the product of a chain of biological events.

When one is confronted by a perceived threat, there are many more physical responses that are less evident, such as: pupil dilation; increased muscle tone; decreased blood flow to the skin, intestine and kidneys; and bowel and bladder emptying. Consider the last time that you watched a horror movie. When you were startled by a suspensful scene, the first thing that you probably noticed was your heart and resiratory rates quickening. After that, you would probably have begun sweating. Your skin became paler as the blood flow was redirected to your muscles, which increased in tone and strength to facilitate the “fight or flight” response. Even in a situation that is a false alarm, so to speak, your body would still respond to the stimulus. This is because the amygdala responds before the conscious mind can make any determination. While the degree of these reactions can vary, the response is still the same.

When the stressor that triggers these fearful responses is inescapable, such as an impending medical procedure, the fear often leads to anxiety. Anxiety is a period of prolonged fear, or worry, and is usually accompanied by heart palpitations, fatigue, nausea, chest pain, shortness of breath, stomach aches, or headaches. Think back to your high school years. Many of us experienced a great deal of anxiety at this time, most often during our final exams. As most students do, you were probably concerned about how you would do. You studied for hours, trying to remember everything that you went over throughout the semester. Even after the test was taken, you worried about the score that you would receive, and wondered if you could have studied harder.

Often, manifestations called panic attacks can develop. These episodes carry many of the same symptoms as heart attacks, and are often misinterpreted as such. Anxiety can last for as long as the stressor is evident, and it has been linked, through various studies, to a myriad of health issues, such as arthritis, migraines, allergies, and thyroid disease.

Most commonly, continuous anxiety has been linked to gastrointestinal problems, such as peptic ulcers. While a mechanism tying these disorders together has yet to be discovered, studies have shown a remarkable correlation of people who have experienced both generalized anxiety disorder, or GAD, and stomach ulcers. Chronic anxiety has also been linked to cardiovascular disease. Once again, specific links have yet to be identified, but it is believed that the link is due, in part, to prolonged stress on the heart from physical responses, such as increase in both heart rate and blood pressure.

Anxiety can cause both physical and mental scars, and can easily complicate one’s life. Given this, it is important to regulate fear and anxiety. . The key is not to eliminate fear, but to effectively manage it so it doesn’t spiral out of control.

If you enjoyed this post, make sure you subscribe to my RSS feed!

Realizing The Need for PreEmptive Healing

Wednesday, July 15th, 2009

Conquering My Own Fears Before A Medical Procedure by Dr. Anthony J. DeMarco

The Setting
Have you ever looked at your doctor and thought “he (or she) has no idea what I am going through”? Well, you might be right. I am an anesthesiologist and for the first time I got a close and look at the patient experience.Re I was working in a gastroenterology office with a “stomach doctor”, giving anesthesia to patients before colonoscopies and upper endoscopies. In case you are not familiar with this procedure, this means that a tube with a tiny camera on the end is inserted into the colon or upper digestive tract to see inside. 41810407.thb

It was October 2003; I was 41 years old. I had worked with the gastroenterologist for a month, and thought he had good medical judgment, common sense, and was great with the optical fiber scope. We were becoming good friends, so I asked him half-jokingly if and when I should get a colonoscopy. I know that everyone should have one before the age of 50. He asked me for my family’s medical history, and I told him that my father had a history of colon polyps and that my grandfather had survived three bouts of colon cancer.

To my surprise, the gastroenterologist insisted that on the basis of my family history alone that I should get a colonoscopy immediately. I was shocked and afraid. I walked over to the appointment desk and heard myself saying “Karen I need a colonoscopy”. As I waited at the desk, I felt strangely disconnected, as if all this was happening to someone else. “We can fit you in next month” Karen said, bringing me back to reality.

The Reality
This was it. In a month I was going to have to fast for 24 hours, drink lots of liquid and then spend half the night following the procedure in the bathroom with a book. Karen handed me an information packet welcoming me as a patient of the “scope club”. Now I was no longer just a board-certified anesthesiologist—I was now officially a patient. Panic, anxiety and confusion set in. Now what? What was going to happen to me? How would it feel? I forced myself to focus, and decided that I needed to read the instructions. I did not want to be one of those patients who didn’t read the instruction booklet.

As soon as I got home, I discussed the appointment with my wife, and that helped me feel better. She would be off work that day and could drive me to and from the doctor’s office. Everything was set: the time, the date, and transportation. But it was a whole month away. A month!

The Fears
For the next 4 weeks, I tried not to think about the colonoscopy. During the day I was fairly successful at putting it out of my mind because I was busy working and taking care of the kids. At night it was a different story. I had no problems getting to sleep, but I was waking up at 2:00 or 3:00 a.m. every night. Once awake I would think about the painful parts of the procedure, like getting an IV.

41810603.thbp3 Believe it or not, I hate needles. Ever since my grandfather, who was also a physician, gave me flu shots every year, I have hated needles. I remember when I was about 7 years old, running away and climbing a tree to get away from the injection. Eventually I gave in because my father threatened me with worse than a needle! It is funny how frightful memories come back when you’re feeling vulnerable.

My own memories helped me realize where my needle phobia came from. I also realized that without being injected, I would not get the medication called propofol that would put me to sleep. I knew that having a colonoscopy fully awake was not a very good idea! Besides, I had gotten an IV years before when I had a bad stomach flu. I remember not eating all day, and an IV was started so that I could get a liter of saline into my system. I remember feeling much better after the IV, and was also surprised to remember that it had hurt much less than my childhood shots! This was because the IV needle is much smaller, and also the vaccine was injected directly into the muscle.

I had worked through one worry. The IV would make me feel better and would not hurt that bad. But, I had other worries. What if I had complications? I might be nauseous and vomit afterwards. I worried that I may not be able to pass the air trapped in my colon after the procedure. And worse, what if the doctor found a mass, cancer, or even a perforated bowel?

Being a doctor is a double-edged sword, because I knew that these complications were real even if they were very rare. I repeated to myself that these complications were very rare, and that FEAR is False Evidence Appearing Real. There is no point in getting all worked up over problems that have not even occurred and have little chance of occurring. I also knew that I needed to sleep so that I could perform my job as anesthesiologist to the best of my ability.

What Helped
This reasoning worked a little, but I was still awake and worrying every night. I started reading a simple “how to” book on meditation exercises that suggested I focus my attention on something else. One exercise in particular was simple and effective. To try it, count from 1 to 10, visualizing each number as you say it in your mind. Say “1” and visualize the “1” with your mind’s eye. Do this up to “10”. In my case, I was usually asleep by 4 or 5. Because this worked so well for me, I used it every night until the day before the procedure, when I drank a lot of fluids. During the “preparation” night before the procedure, I had no problems with falling back asleep. I was too exhausted from being on the toilet!

The Results
The day of the procedure arrived. I woke up as late as I could (6:00 a.m.), took a shower and helped my kids get ready for school. We got to the doctor’s office around 11:45 a.m. and I waited until my name was called at 1:30 p.m. That’s right—I got no special treatment, even though I knew all the doctors there! While waiting, I talked to my wife, tried to read a book and watched T.V. At this point I was more fed up of waiting than worried, and I just wanted to get it over with.

When I was finally called in, I remember being relieved to know it was almost over. I also remember that I was not at all hungry. In just a few minutes, it was all over. All the anxiety, sleepless nights and anticipation had been for nothing. The procedure was quick, relatively painless and uneventful. The doctor did find some polyps in my colon, but they were harmless. I breathed a sigh of relief. Getting it done had put my fears of whether I had colon problems to rest. I was glad to have had it done and have even had another one since then. In fact, I will continue getting one every 5 years.

Let Me Help You
My experience as a patient made me realize what an isolating and frightening experience even a simple procedure such as a colonoscopy can be. I now understand from the patients’ perspective how important it is to be really prepared for a medical procedure. Knowing the facts about the procedure is important, but it is also good not to imagine the worst. It is possible to analyze your fears and overcome them, whether it is by meditation or by realizing that the procedure may not be that bad.

The things I feared about my procedure were:
1. Pain getting the IV
2. The doctor not getting the tube around in my colon
3. Nausea and vomiting afterwards
4. Gas pains after the procedure
5. Cramping afterwards from not passing gas
6. Having a perforated colon
7. Having a mass in my colon
8. Having colon cancer
I worked through each of those fears prior to having my procedure.

Before a procedure, it is necessary to not only prepare the body, but also to prepare the mind by reducing fear and anxiety. Such preemptive healing empowers and helps bridge the gap between scheduling the appointment and having the procedure done. I can show you how, visit PreEmptiveHealing.com to learn more.

Blessings to all,
Dr. Anthony DeMarco

If you enjoyed this post, make sure you subscribe to my RSS feed!

Archive for July, 2009