Panic Attacks

[ramakentesh]

Also celexa is different than an antidepressant, it is an anti anxiety

Actually Celexa is an SSRI as well - its an antidepressant selective serotonin reuptake inhibitor.

There are a few things going on in POTS. Firstly your sympathetic system (flight or fight related branch of the nervous system) is overactive when you stand and sometimes all the time. it is this way either as the primary problem (according to a few theories) or is activated to compensate for a circulatory or autonomic abnormality that is causing abnormal blood flow.

The results of this activation are that we can sometimes feel hyped up, jittery, sensitive to fright and startle and we find that all the things that engage the sympathetic nervous system - scary movies, over stimulating environments, or minor stress or nervousness - make our bodies over react to the stimuli or actually bring on POTS symptoms. Sometimes the body will shoot of adrenaline to try and reroute the abnormal blood flow but this can actuall make us worse - incrase sympathetic stimulation and cause more vasodilation from beta 2 receptor activation or trigger vagal/parasympathetic withdrawal.

True panic attacks are psychogenic in nature. A thought or a fear cascades into a full blown fear episode. Research suggests that in true panic attacks there is a massive increase in serotonin reuptake and turnover in the brain.

In POTS there can be true panic attacks, but more often there are what people call adrenaline surges - simply the results of sympathetic excess or adrenaline being used ineffectively by the body to correct the blood flow problems abnormalities. But the same branch of the autonomic system that is partially involved in making the adjustments to standing is also involved in preparing the body for flight or fight and the brain can actually misinterpret these symptoms.

In terms of working out what 'type' of POTS you have its pretty hard because you cant really tell from symptoms (as all POTSies have increased sympathetic activity) and secondly the research understanding of the delineations is in its infancy and subject to wide disagreement between research groups. Some break them up based on leg blood flow, others claim that true hyper patients are those that are hypovolumic (low blood volume), others that its to do with the faulty reuptake of a chemical that activates the sympathetic nervous system. None of these various theories haev at this stage translated into different treatments.

Normally what they do is try florinef or a beta blocker and see how you respond to those. But you will find wide variation in people here because POTS may actually represent 12 or more separate diseases. Confusing or what?

[ramakentesh]

can I ask - is your hand warm when its swollen or cold?

[ramakentesh]

Last bit of advice - if I lived in the states I would try hard to get into Vanderbilt autonomic centre or Dr Julian Stewart over any of the other groups. Stewart's group now see patients up to 28 or so I think and these two groups are leading the research on POTS.

[juliegee]

Kalamazoo from Alaska??? LOVE your name. My husband & I met in Kazoo during our undergraduates studies. Good times

Have you ever tried taking an antihistamine (like benadryl) during your "panic attacks"?

[sue1234]

Kalamazoo, I seem to have similar issues as you. I also get low blood sugar AND hand swelling. Let me tell you what I've found so far.

20 years ago I was told I had anxiety/panic attacks. I accepted the "label" and began taking anti-depressants. For the most part they helped, but I still had some breakthrough panic. Fast forward over the years, I get off of AD, still have occasional panic, and begin eating to calm it down. Three years ago I bought a glucose meter and waited for my next panic attack, which I'm sure was the next day. I tested and my blood sugar was in the 50s. I can correlate my shaky, panicky, hot flush symptoms that happen while sitting to low blood sugar. If I eat every 1 1/2 hours, I keep it at bay.

No, I also have the adrenaline issue for no reason, like Rama pointed out. If I have to talk to strangers, etc., I get anxiety symptoms which are aggravating.

And, I also get the swelling. It happens randomly throughout the day. If I get hot, above about 75F, my hands begin to swell(my feet to some point). I feel overly hot at this temperature, so I live in air-conditioning for half the year.

Can you tell me a little more about your hypoglycemia?

[juliegee]

Kazoo-

You are a very lucky girl. With so much input, I feel like you are the patient of-the-episode with a bunch of House-wannabe's Trust me, you will not find a more helpful or caring bunch as we've been there...and back.

Too much coffee- Giggle

Julie

[bellgirl]

I have learned that when I get one thing done a day, it's a good one Sometimes it's getting a bath, sometimes it's being on the computer, sometimes I can get out to get groceries, sing or go to prayer group, but mostly I stay at home, because if I overdue it, I suffer the consequences!! Beta blockers are great for tachycardia, clonazepam helps with dizziness and sleep. Somedays I just appreciate being alive and breathing It's the little things in life that are important, like family, friends, and God is good all the time! You need to find a good doctor, who will listen, too! I think going to Mayo is a great idea, but you need to find a doctor at home, too!

[janiedelite]

For me, a beta blocker did help with the adrenaline surges. I was diagnosed with erythromelalgia as well as pernio (chronic frostbite). However, I met someone with true EM and my extremities don't stay red once I elevate them like hers did. Mayo, Rochester, ended up diagnosing me with small fiber neuropathy as the cause of my blood vessel dysfunction (vasomotor neuropathy). They ran tons of tests for all of the underlying causes of neuropathy like diabetes, cryoglobulinemia, amyloidosis, autoimmune, etc. It was very comforting when none of the scary stuff came back positive, although I almost wished that it had because then I may have been able to treat the underlying cause successfully.

Do you have a good neurologist who is familiar with treating erythromelalgia? I was a part of an EM forum for a while and it seemed that many of those folks ended up being diagnosed with small fiber neuropathy. If you found a neurologist in your area who was familiar with treating/diagnosing neuropathy, he could maybe check for underlying causes of neuropathy. My local docs were able to do a lot of that before I went to Mayo (Mayo just re-ran all of their tests and did testing that my local docs weren't capable of doing).

I wasn't able to tolerate the one SSRI I tried (Paxil). I was on it for 3 months and by the end I was having severe flushing, burning skin, and other intolerable side effects.

[juliegee]

I concur with Thankful (Janie)- I was think small fiber neuropathy, too.

[McBlonde]

Also celexa is different than an antidepressant, it is an anti anxiety

Actually Celexa is an SSRI as well - its an antidepressant selective serotonin reuptake inhibitor.

There are a few things going on in POTS. Firstly your sympathetic system (flight or fight related branch of the nervous system) is overactive when you stand and sometimes all the time. it is this way either as the primary problem (according to a few theories) or is activated to compensate for a circulatory or autonomic abnormality that is causing abnormal blood flow.

The results of this activation are that we can sometimes feel hyped up, jittery, sensitive to fright and startle and we find that all the things that engage the sympathetic nervous system - scary movies, over stimulating environments, or minor stress or nervousness - make our bodies over react to the stimuli or actually bring on POTS symptoms. Sometimes the body will shoot of adrenaline to try and reroute the abnormal blood flow but this can actuall make us worse - incrase sympathetic stimulation and cause more vasodilation from beta 2 receptor activation or trigger vagal/parasympathetic withdrawal.

True panic attacks are psychogenic in nature. A thought or a fear cascades into a full blown fear episode. Research suggests that in true panic attacks there is a massive increase in serotonin reuptake and turnover in the brain.

In POTS there can be true panic attacks, but more often there are what people call adrenaline surges - simply the results of sympathetic excess or adrenaline being used ineffectively by the body to correct the blood flow problems abnormalities. But the same branch of the autonomic system that is partially involved in making the adjustments to standing is also involved in preparing the body for flight or fight and the brain can actually misinterpret these symptoms.

In terms of working out what 'type' of POTS you have its pretty hard because you cant really tell from symptoms (as all POTSies have increased sympathetic activity) and secondly the research understanding of the delineations is in its infancy and subject to wide disagreement between research groups. Some break them up based on leg blood flow, others claim that true hyper patients are those that are hypovolumic (low blood volume), others that its to do with the faulty reuptake of a chemical that activates the sympathetic nervous system. None of these various theories haev at this stage translated into different treatments.

Normally what they do is try florinef or a beta blocker and see how you respond to those. But you will find wide variation in people here because POTS may actually represent 12 or more separate diseases. Confusing or what?

Wow.... that's really a great explanation ..... Thanks for spelling it out like that!

[kalamazoo]

Kalamazoo, I seem to have similar issues as you. I also get low blood sugar AND hand swelling. Let me tell you what I've found so far.

20 years ago I was told I had anxiety/panic attacks. I accepted the "label" and began taking anti-depressants. For the most part they helped, but I still had some breakthrough panic. Fast forward over the years, I get off of AD, still have occasional panic, and begin eating to calm it down. Three years ago I bought a glucose meter and waited for my next panic attack, which I'm sure was the next day. I tested and my blood sugar was in the 50s. I can correlate my shaky, panicky, hot flush symptoms that happen while sitting to low blood sugar. If I eat every 1 1/2 hours, I keep it at bay.

No, I also have the adrenaline issue for no reason, like Rama pointed out. If I have to talk to strangers, etc., I get anxiety symptoms which are aggravating.

And, I also get the swelling. It happens randomly throughout the day. If I get hot, above about 75F, my hands begin to swell(my feet to some point). I feel overly hot at this temperature, so I live in air-conditioning for half the year.

Can you tell me a little more about your hypoglycemia?

This sounds exactly like me! I was having super fast HR after eating and after a year or so of the doctor telling me it was anxiety (which made no sense) I finally got myself a glucose monitor. it was drop after I would eat, so horrible! My blood sugar levels are super low in the morning, I was up shakey with a fast heart rate. My blood sugar was as low as 45 one time when I hadn't eaten in like 3 hours. All my fasting glucose were super low too. I now eat very health and try to keep my blood sugar within 80-110 range. I eat every two hours, pretty much like clock work. IF my blood sugar is low, all my symptoms are aggravated.

As for the swelling, at about 65 I start swelling, and tingling. I can see the swelling starting in my veins. My hands and feet get very hot and red, some time my knees do it. This also happens if I'm laying down for a while or sitting for long periods of time. My heat intolerance is the worst part, sometimes I have to leave work because I'm so hot from walking around (which is painful and horrible)

[kalamazoo]

can I ask - is your hand warm when its swollen or cold?

Red - very very bright red.

[kalamazoo]

Kalamazoo from Alaska??? LOVE your name. My husband & I met in Kazoo during our undergraduates studies. Good times

Have you ever tried taking an antihistamine (like benadryl) during your "panic attacks"?

My name is Kala, kalamazoo is a nickname I picked up some time ago

And no, I pretty much avoid all medications, ALL. I don't even like taking and pretty much refuse to take aspirin. Although I've heard it helps with my erythromelalgia (which it didn't)

[Chaos]

Kalamazoo- Have your doctors checked you for an insulinoma? My doc said that having low blood sugars in the morning was a symptom that would trigger looking for that issue. If you only get the drops in blood sugars after you eat (but not in the morning) they don't think it's likely to be an insulinoma.

Welcome to the forum. Hope you can get some answers. I'm not a fan of taking meds either but have become a big fan of being functional and for me the meds have given me help maintaining a degree of function I had lost when I wasn't taking anything. Good luck in your search for info! Mayo Rochester also does the autonomic testing and may fit your need for cooler temps better than Phoenix.

[heissovereign]

Kalamazoo, I am sorry you are dealing with this... Lemons is right I am new here just about a week and a half i guess and everyone is so helpful. Hang in there!! I don't have a doctor that knows what i'm talking about either, I did but he left. It can be very frustrating, I am glad you are going to Mayo, as soon as I can get insurance I am going to Vanderbilt as it is close to me ( only 4 hours) my neurologist wants to send me because he and my cardiologist really don't understand whats going on with me. and they are right it is probably the Pots, rather than panic attacks. again I am sorry you are going through this, I know it is scary and frustrating. I don't know much about this as i am still learning but you can PM me anytime and we can talk I am only 2 yrs older and have dealt with this for a very long time so we can at least pass the time talking about whatever girls our age are talking about lol, listen to the advice lemons gave and I hope you feel better, and get some answers soon...

[sue1234]

Yep, if you have fasting hypoglycemia, that's a good case to get worked up for an insulinoma. Also, some post-prandial hypos(after meals) can be insulinomas, 5% of Mayos insulinoma patients over a 20-year history had only post-prandial hypos. I feel I fall into this category, OR my pancreas just has too many islet cells producing insulin. I had a really bad hypo week two weeks ago, some called up Mayo in Florida and am heading there in a few days to see an endo over this.

I've done some reading and found interesting information that states insulin vasodilates the vessels in the large muscle groups--arms and legs. Do you ever go through periods where your limbs feel like dead weights? The study showed a certain level of insulin caused a 30% increase in blood to the muscles, and then a next higher level caused a 70% increase. My insulin was double those levels in my OGTT for 2 1/2 hours! If this happens often enough from day to day for me, I can see why I end up with pooling.

My hands turn bright red, too, especially my fingertips.

[bellgirl]

Medication can be very helpful with this condition. I didn't want to take any either, but it has made all the difference in the world for me. Beta blockers are great for increased heart rate. I have had adrenaline surges, and panic attacks, and there is a real difference between the two. Adrenaline surges are physiological and random, and can be somewhat controlled with medications, but I still have them often. Panic attacks do have a physiological component, but they are also somewhat psychological, too, because they can become worse, depending on how you react to them. I've had two major panic attacks, and taking deep breathes, drinking small amounts of fluids, and sitting down in a quiet place is key in getting past these. I avoid situations where I receive too much input, but sometimes, like when my aunt was in the hospital and I thought she was dying, for instance, I didn't have control over that, which can exacerbate an already overwhelming problem with several issues coming at you at once. This was the time when I had just gotten off a beta blocker to be put on a new one, and I was very tachycardic, so that made it worse. The other time, I was not on any meds at all, and I was late for an first appointment and lost, and frustrated! Hope this helps...

[kalamazoo]

Insulonomia ... I've never even heard of that, definitely something to bring up to my endo, thanks for the suggestion! Everyone on this site has such good advice from personal experience, It's great getting all these feedback, thanks everybody! I've been told my insulin levels were high before, but that's about as far as that went, I'll definitely look into that. And I'm so terrified of taking a beta blocker, heck I'm afraid to take anxiety medication. Anything that can alter my HR in anyway just scares the crap outta me, but I'll try anything.

[jenglynn]

Hi Everyone,

My cardiologist said I needed a Beta Blocker to contol my HR which would get into the 150's while sitting. When I was still walking it would go between 150-200 so he was pretty adamant that I needed a BB (tried Propanol- sure that is spelled wrong) and it DID lower my HR but I am also Orthostatic Hypotensive and I don't think either one of us realized to what severity until I tried it. On the third day, after several syncope spells- which was nothing new- but I had a serious syncope episode and I feel and hit my head and ended up with a nasty head injury and concussion- I only needed 12 staples and a day of obsSi ervation in the hospital. It was my first "real" injury in two years from syncope. I had many, many horrible episodes of fainting even after that... and then ten days later I had another head trauma and concussion- although this one was was much worse. This time I was admitted again to the hospital and I think I was inpatient for about a week. I realized while inpatient just how low my BP was dropping (even though I was taking Midodrine and Florinef) because I didn't have BP monitor at home. So the BB was very dangerous for me... even sitting upright, not standing, it was dropping to 40/20. So when I would stand it would be so low it wouldn't even be detectable. They tried a different BB for me (I am sorry, can't recall the name) while inpatient and nothing changed... so Beta Blockers are definitely very dangerous for me because of the OH but it is disappointing because it REALLY does work with lowering my heart rate. Nothing else does.

I am still on Midodrine and Florinef for now- and many other drugs.. but not sure I will stay on the Florinef. It is helpful and I would hate to give it up.. but I don't know how much longer I can tolerate the headaches and the head pressure I get with it. I think that my Post Concussion Syndrome contributes a LOT to my headaches because I have them so often- and with Florinef the intensity is just not even tolerable. It is like a vice is squeezing my head and it last for hours. So I will need to find "something" to replace the Florinef as well. It is a never ending battle if you choose medication with this illness (many choose not to take any) because it changes all the time (in my case anyway). Always changing doses, trying new things (also tried Mestonin- also couldn't tolerate) and just trying to keep tabs on what I am taking and any new symptoms that crop up- that happens a LOT to me! It seems as if I am constantly noticing something new, usually very odd and something I've never had before, or maybe something I had as a teen but not since (I am 37).

Good luck to you... I really wish you luck and hope that you can find the right combination of meds if you should decide to take any. Just start at low doses and really do your research on any before you try them and you can always run them by here for some feedback. Of course, we all react differently, but I have found this forum to be such a valuable resource and I hope you will as well.

Jen

[bellgirl]

Bystolic is a new beta blocker; it doesn't have a generic yet, but It saved me from being so tremulous and tachycardic, and didn't cause my blood pressure and heart rate to plummet, like atenolol did. I also take a medication for hypertension, too; I would keep trying to find a balance. It has made such a difference for me.