My struggle with Anxiety

This has been my story …

I keep having some symptoms that mimic a heart attack, but I know it’s not that. Doctors and numerous tests verified it. But I noticed it still happens right when I would normally feel anxious about certain life events, such as going on a family vacation trip or stress at work.

It almost ruined my family vacation because of these symptoms. I had chest discomfort, lightheadedness, and shortness of breath right when we were preparing to head out for the trip. My wife noticed and spoke with me about it. I confessed I was not feeling well (I tried to hide it from her so she wouldn’t worry) but refused to let it ruined our mini vacation. So I took a few minutes away from everything to relax and it slowly went away. I drove for two hours, mostly taking deep breaths and disputing negative thoughts until I felt better upon arrival to the hotel. When we went to eat dinner at a local restaurant, the palpitations started creeping up again. The restaurant was noisy and crowded, so I associated it with the anxiety I would normally feel at a busy place like this. I tried to ignore it by eating and it slowly went away.

Next morning while eating breakfast, I started feeling lightheaded again, but took deep breaths and kept going. I did not feel it again in that evening. So I spent the rest of the weekend with no symptoms and enjoying my family.

Next day at work, the palpitations started again. I was driving a client to his lab appointment while taking deep breaths and trying to do some mindful exercises. It went away as soon as I returned to my work office. It seemed like an eternity.

I went to the doctor for a follow up appointment. He recommended for me to simply keep taking anti anxiety medication and follow up with the GI (which I truly believe is a waste of time since I don’t think it is gastrointestinal related).

And to no surprise, the G.I. doctor thought that this was not G.I. related but still wants to do a small test just to be completely certain.

Today I attended a meeting at a city office and had to present the services offered at the program where I work at. There were judges, directors of other social services programs, and other city officials present. I was feeling OK until it was time for me to present and then I had an episode again. It came up suddenly. It began with heart palpitations, shortness of breath, and lightheadedness. I was feeling so bad that I almost stood up in the middle of the meeting and walked out of the room. But I began to take deep breaths, tried to do some mindfulness by observing my surroundings, and I even tried to snap a rubber band on my wrist to redirect my attention. It helped a little bit but I still felt extremely anxious.

I managed to give my presentation, although I made several mistakes and felt like I was rushing it. Words couldn’t come out of my mouth clearly. It was an embarrassment. I could’ve done a better job presenting to all these important people, but my anxiety got the best of me this time. I got up right before the meeting was done and stormed out of the room gasping for air. I couldn’t speak. I could hardly walk. I feel I made a fool of myself . And I’m upset about it.

This anxiety is affecting my personal life and my job performance. It’s not just an annoying nervousness that we all go through. It is actually a debilitating condition that cripples me and paralyses me. God forbid if I go to a job interview, give another speech to an audience, or go to the dentist.

So this has been my experience so far with what seems to be extreme anxiety.

It has been sort of a wake up call. I remember vomiting as a kid before heading to the school bus during the first week of school. I’ve also had extreme nervousness giving speeches. In the last 5 years or so I have tried to practice mindfulness, yoga, meditation , and exercise , but it seems I have not done enough of it. I have also waken up to the realization that I have been anxious most of my life and now is the time that my body is telling me to slow down. To catch myself whenever I am feeling anxious. To not let the small stuff get the best of me.

So I will schedule routine yoga, exercise, and meditation. And continue to manage this anxiety, almost as if it were a normal part of my life. I am learning to pay more attention to how my body responds to certain situations, and starting to catch myself before I get too anxious. The next time I have an episode, I will do my best to cope by taking deep breaths, being mindful of my surroundings, and changing environment if possible. I will also make positive self affirmations and remind myself I am not having a heart attack, high blood pressure, diabetes, acid reflex, or any serious medical condition.

I am having anxiety attacks.

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Have you dealt with Anxiety Attacks..?

Just a follow up on my previous post, I continue to experience these symptoms that took me to the ER for the second time. I have gone to see my doctor and they sent me to do some bloodwork and put a heart monitor on my chest for 48 hours. There were a couple of days that I experienced palpitations, pressure on my chest, and lightheadedness , on and off. They still can’t find anything wrong with me.

I went to the ER again two days ago for the same symptoms, however they found nothing wrong with the heart. ER doctor said that she would refer me to a G.I. specialist. And if this was not the cause of my symptoms, then it could just be anxiety .

So I have been thinking that , if this is truly just anxiety, then I really need to work on relaxation, more than what I have done.

I have worked all my adult life as a counselor and have helped people with all sorts of mental illness, including anxiety. But never have I worked with anyone with the symptoms I experience. Other people usually have racing thoughts, restlessness , and some palpitations . Some have described symptoms of panic attack, which I don’t think is what I experience either, since I don’t feel fear.

These are the symptoms I have experienced :

Lightheadedness, palpitations, shortness of breath, pressure on my chest, weakness , and a cold sensation on my extremities. I also felt a little nauseous this last time.

Has anybody else experienced anxiety problems with these symptoms ?

I would like to know if here are others who have had the same experience due to anxiety.

Thanks.

It’s (almost) all in our heads

Imagine living in a comic strip where every scene and character is in a separate box, with bubbles above everyone depicting and showing what everyone’s saying and thinking . What the reader would see in the pictures themselves is what is truly happening. What the reader reads inside each bubble above characters’ heads is what the character’s interpretation of what is happening . In other words, what’s inside their minds.

In their heads.

And this is exactly how we all live in our lives: inside of our heads.

Think about it. In your head. If you meet somebody and talk to them for a while and then walk away, you will still have the image of that person in your mind , but not the actual person. When you go to a restaurant and have the wrong plate served to you, you would have an unpleasant image of the restaurant in your mind for a while , but not the actual restaurant.

We fabricate what we decide to interpret in our heads, including people, places, things, and ideas. But we do it so automatically that we don’t notice it. So we live life constantly living and experiencing what our minds interpret, not what is truly out there.

We also create all these labels and ideas in our heads which helps us to identify with something. It could be gender , race, culture, religion, fashion, sports, or a combination of any of these .

It is the same as saying that we create our own realities. We assume that the ideas and images we have in our heads is really “out there.” But it’s not. It is in our minds. So we continue to live the delusions that our minds automatically create. And every time we encounter a new experience, either meeting a new friend, getting a new job, reading the news, or visiting another country , we process what we experience based on our delusions. We filter everything through our biased minds; through our preconceived notions.

It takes a large amount of courage and independent thinking to put our biased preconceived notions aside and experience life as it really is.

Mindfully.

When we meet someone with a different political or religious view, do we see them through our biased mind and delusion , and therefore, judge them as being wrong and delusional themselves? Or can we try to experience them with appreciation and unbiased acceptance ? We don’t have to agree, but we can certainly accept them as fellow human beings worth of respect.

I was seeing a video about a community that believes that the earth is not a globe, but rather a flat plane. My automatic preconceived respond would be to perceive them as ridiculous. But if I put my biased mind aside, I should be able to listen and accept their views even if they’re different than mine. And by doing so, I would be experiencing this moment in life outside of my mind; free from my own created delusions . Even though I still don’t agree with their views .

So stepping aside and experiencing every moment without biased is a difficult task; but it is essential

Note from a nihilist

Warning: the following note is a hypothetical sentiment about how I would feel as a true nihilist. This is Not a sign of a potential suicide.

My dear loved ones and acquaintances . I have come to conclude that this existence is no longer worth living .

I have struggled and questioned a lot and is worthless to continue to live. Everything we experience is based on our interpretation . Nothing seems to be objective . We create what is good and what is bad. Nothing that we do and prepare lasts forever.

Nothing.

Everybody does things to obtain some kind of self satisfaction and reward, including helping others with the real purpose of feeling good about themselves. Nothing is done with genuine selflessness. Every act of kindness is done based on self righteousness.

The only reason to make efforts to do good to others is with the hope that the good we do today will impact others in the future with favorable outcomes. But that is not guaranteed .

I have tried to do good. But I have realized that many times ( if not all the times ) I have acted out of selfishness . To relieve some guilt or alleviate a pain. And my mission, whatever it was, is over. I’ve done my part.

We fabricate meaning and purpose based on our own interpretation of reality.

It’s all subjective.

It really does not matter unless you give it importance. It has no meaning unless you give it meaning.

What is really out there except what is interpreted through my mind?

What is in my mind can be changed at any moment. There is nothing concrete and tangible out there.

So when I leave, I leave nothing behind except other people’s interpretations of my temporary existence. Memories .

Those who never met me will not care. Those who know me will eventually forget me.

And life will go on.

So don’t feel sad.

Because one day it will be your turn.

And we may (or may not ) meet again.

Ten Reasons why Life could actually be Meaningless

1. Nobody knows with absolute certainty the purpose of this existence.

2. Most people create their own meaning based on individual, cultural experience, with no clear evidence on an objective , collective purpose .

3. We are just beginning to understand the origins of human nature and our place in this vast universe.

4. Nature does not always follow a consistent and organized pattern. It is often chaotic.

5. Nature does not depend and does not seem to care about human condition.

6. We are all going to die, regardless of how much we accomplish and learn in life (and how much we try to ignore and deny it).

7. Nobody knows with certainty what happens to consciousness or the “soul” after we die.

8. Innocent people , children and adult , continue to randomly suffer and die out of starvation, natural disasters, and human caused wars . Do they deserve to die or is it simply chance?

9. The earth is billions of years old, and human race has existed only during a miniature fracture in this planet’s lifetime .

10. All organized religions that are based on the belief of a deity (s) claim to be the only right path to the true purpose of our existence . Who knows which one is right ?

There you have it. I could be wrong and completely out of touch with what is truly the purpose of this life , but this has been my experience so far .

Any thoughts?

Feeling Bad

I have been feeling bad lately.  Let me explain.

I work as a supervisor in a mental health program.   I manage other clinicians, nurses, and psychiatrist who serve people with severe mental illness.  It is a stressful job by itself and involves a lot of therapy, case management, medical follow up, consultation, traveling, etc.  It is a job that not anybody can withstand or even consider taking, because it is not a typical mental health facility.   The program is based on the PACT model (Programs of Assertive Community Treatment) and it involves intensive psychiatric and rehabilitation services , similar to what clients receive in psychiatric hospitals, but in the community.  So you can imagine the amount or work and tension that we often experience in trying to help individuals with paranoia, delusions, disorganized thinking, and poor social skills remain living in their homes.   Even though I may be describing it as a difficult job, it is very self rewarding.  We are actually helping people stay away from institutions and jails simply because of the severity of their illness.  We are helping them live normal lives like the rest of us.

But I recently started feeling really bad about my job because of the way the company sometimes treats our staff.   They are not usually paid the salary that other facilities and hospitals in the community pay their clinical staff, plus they started hiring more bachelor levels so that the  cost of hiring people would be less.  So the competition has been an uphill battle which results in a high turn over rate.

Since I started working for this PACT program in 2011, we have had two full time doctors, and recently two part times.  The two part time psychiatrists  shared the case load of a total of 101 clients.  The last two psychiatrists were working under a contract  instead of being regular employees.  But unfortunately , one of the two part time doctors decided to move out of the state for a better paying job (its usually  because of the money) and we found ourselves planning to have one part time doctor cover  while starting to recruit for another doctor to take over the other half of the caseload.   The situation became more complicated when the company advertised the position and found a candidate who was willing to work full time instead, as a regular employee.  Having a full time practitioner is what the PACT model is based on primarily and it facilitates the overall function of the program.    So needless to say, the company had to make the difficult decision to “get rid of the part time psychiatrist” so that we can officially hire the new full time practitioner (who happens to be an ARNP who can do the same type of job as a psychiatrist).   Of course, letting the remaining part time psychiatrist know was the hard pill to swallow.  Not to mention informing the clients (once again) that their psychiatrist was resigning and they were going to be seen by a different practitioner.   Our clients who all suffer from a severe and persistent mental illness, are already marked by difficult times in their lives, and change is one of the most difficult experience which can exacerbate their symptoms.

The CEO of the company is the one who negotiates with psychiatrists and makes the final decisions about which psychiatrist to hire.  My supervisor and I interviewed the new candidate and we liked her, but the CEO was the one making the decision about moving  forward with her, meaning that the part time psychiatrist who was still working with us had to go.   Part of me said we were doing the wrong thing… that we should’ve looked for a another part time psychiatrist so that we wouldn’t have to lose the one we already had.  I was informed that the CEO would then speak with the part time psychiatrist about our plans, which I was glad I did not have to do, although I wished we could have done something different so that we can keep the part time psychiatrist.  But that was not my decision to make.

To make matters worse, last week, the part time psychiatrist approached me and asked me about what the company was planning to do with her if they find a full time practitioner.  I was dumbfounded and caught off guard, not knowing what to say at the moment.  I thought that the CEO had spoken with her about his decision already,  but it turned out he had not informed her yet.  So I had to tell her the truth at that moment, I don’t believe in lying or hiding things from people, especially staff people who work with me.   But I also told her that the CEO should be speaking with her about the matter in more details soon.  So, understandably, the part time psychiatrist seemed upset and said she will just resign.

I felt as big as an ant.

Here we are, literally getting rid of a part time person, a human being with a family to feed and a career to keep, so that we can replace her with a full time person who will take her place to “serve our clients.”  The company has a budget to keep, so having one full time psychiatrist was more financially convenient.   I understand the technicality and the business part of the reason why we need to make this decision.  But the human side of the matter sucks.

So I feel bad.  I feel we made a mistake.  I wish I could have done something different and prevent having to get rid of the part time psychiatrist.  I wish the CEO would have contacted the part time psychiatrist early and offer her to stay with maybe less hours, but still stay working with us along with the full time ARNP.

But it is too late now.  She decided to suddenly resign , sooner than what the contract mandates.  I can understand her anger and frustration. I also understand the need to have a full time practitioner who also has more flexibility with traveling and visiting our clients.

So I am split in half, feeling glad that we found a full time practitioner soon;  but still feeling bad that we lost a very good psychiatrist and made her upset in the process.

At the end of the day, the ones suffering the most are our clients, who will have to face another change of providers.  And most likely run the risk of  increasing their symptoms of mental illness because of this transition they are forced to face.

It’s hard being a supervisor sometimes.

 

Identifying with the Self: Part Two 

 I had a counseling session with one of my clients.  She is a cutter and was questioning whether or not she would be getting any better in her life.  She was comparing herself with others who also receive therapy and who seem to be getting better faster. My client thought she was not improving like she should and asked about the concept of PTSD and resistance to treatment.

I try to explain to her that PTSD involves living in the past after a traumatic experience… versus learning from the past without necessarily reliving the past.  When we experience PTSD , we tend get stuck in the past and not move forward.  When the pain is avoided then we continue to experience PTSD and continue to relive the past and experience an emotional cycle which is nourished by substance-abuse, self harming behavior, and depression.

On the other hand, when we learn about the past, we develop new skills and we develop new ways to cope with the upsetting memories.  One of the ways is to talk about it, process feelings, write about it, and accept the fact that the pain was done.   When we choose to develop new skills and process feelings by accepting the pain, then we begging to acknowledge that it was a difficult time in our life and be able to move forward with new skills.

And then there was the question of why she is still cutting when she’s in her 50s now, when most of the cutters are either teenagers or young adults.

Then a lightbulb turned on in my head. I asked my client who she would identify as and she could not answer the question.  She first said “I’m already in my 50s why am I asking this question now? ” Then I asked her to not think about her current age but to focus on the question itself : who am I?

The observation that most cutters are teenagers or young adults gave me the idea that, since she has always been dependent on others to tolerate her who she is and what to do with my life, that sounds almost like what teenagers and young adults do in the early lives.

Basically my client is experiencing what most teenagers and young adults experience : finding their identities in life, facing the unknown after depending on the parents.  My client said she always depended on her parents and she was taking care of and nourished as a child even during her adulthood.  This can explain why she has difficulty identifying who she is now in her 50s. I explained that most of us experience the same identity crisis in different times of our lives. Most of us identify with what we have been assigned to be, for example our names, our ethnicity, our gender, and our religion. But we ultimately face a time in life, usually during young adulthood, where we start questioning  our assigned entities and find our own identities. And maybe that’s what my client is experiencing at the present moment.

Like I mentioned in my previous post, we mostly live inside our heads. Inside our thoughts and perceptions. We rarely get out of our thoughts and face reality. We don’t usually live in the present moment.  But we rather stay living inside our heads.  Inside our minds. But we rarely step aside and start perceiving ourselves as we really are.

Have the rest of us done the same thing in our lives?  Have we taken the bold step of “peeling the onion” all the way until we find our true selves?

In my own experience , that “true self” remains a mystery.  It remains a great part of the unknown, which is why I tend to ignore it and replace it with all the entities I have been taught to identify with.

I have learned to identify with being a Hispanic middle age male, an American, a mental health professional, a  Florida resident, a parent, a husband, a son, and many other entities.  All of these I can question and deny if I choose to.  What I have not identified with as much is what can never question or deny.

My true self.

But what is the true self?  Is it simply being human? Being a person? After all, isn’t that what we all have in common? Identifying with being Human beings ? Anything else could be used to separate and segregate us.  But being humans could only keep us united.