Do I have anything to freak out about, except freaking out itself?

February 23, 2009 1:49 PM

Almost two weeks ago I suddenly started having strange feelings of lightheadedness, abnormal difficultly concentrating, a lack of coordination (feeling as though I might fall over or run in to things), and visual issues (difficulty focusing on distant objects, seemingly less aware of my periphery - though there are no noticable gaps in my visual field). I've had these, albeit with decreasing frequency and severity, since that time. I'm often very fearful during these episodes (which can last 4-5 hours at a time, the dizziness/lightheadedness sometimes all day), fearing permanent brain damage and having extreme feelings of derealization. I've come to the conclusion that at least some of these symptoms are due to panic attacks. Does that explain it all though?

The things is, while I've had some academic reasons to be stressed out, that's nothing new for me, I've never been overly anxious about it. Right around the time things started getting bad I was actually having a pretty good week - so I can't help but shake the feeling at least some of the symptoms preceded the anxiety.

I've been to the university clinic twice since this started, and the first time a nurse practitioner did the standard host of neurological tests - reflexes, balancing with eyes closed, asking me to smile, checking for nystagmus - which I passed with flying colors. She thought it was likely some sort of labyrinthitis, which should clear up in a week or two. I'm not sure whether that matches my symptoms well - I haven't had any difficulty staying upright or gaging my movement, it seems to be more of an issue of coordination.

Are all these symptoms safely ascribed to anxiety, even if they seem to have started before I felt anxious, and recur without apparent shifts in affect? If not, what sort of tests should I ask to have done by a doctor - if only to assure myself that I don't have a more serious issue? Any advice on dealing with panic attacks?

The "brain fog" or lightheadness is something I remember feeling when I was younger, leading me to get checked out for anemia (none detected, it cleared up). The feeling is a diffuse vacuum or fuzziness in my forehead, at a point about equidistant between my temples and an inch behind where you'd see a hindu woman wear bindi. I realize there isn't any innervation there, but it's still unsettling.

I had been on Concerta for several months, but stopped taking it last Wednesday as a precaution, which seems to have made me a bit less anxious (I'd noticed some anxiety in the past when going on the medication after a period off).

Just to prempt the question, I haven't been high lately.

posted by elektrotechnicus to health & fitness (25 comments total)

Cut your caffeine intake to 0 immediatly. Caffine in high enough doses can cause a panic attack and if you keep a steady intake after reaching that level, well, things go downhill fast.
posted by tiamat at 1:57 PM on February 23

I'm no doctor, but generaly it's probably a a good idea to get a physical, including blood work, and make sure they check your iron, B12, thyroid levels, etc., to rule out physical causes of the symptoms.
posted by gudrun at 2:02 PM on February 23

Labrynthitis can present like this--I have a friend with very serious labrynthitis who has never had issues with balance, but who has had many of the issues you describe here (and also a thing that she describes as "motion sickness while standing still.")

Some viral and bacterial infections can present like this, including severe sinus infections. Loss of balance and visual issues can result in panic and anxiety, so it's possible that there's something organic going on and the panic stuff is a sequela to that.

You're going to have to be a partner with your doctors in a long series of experiments until you find something that works for you. tiamat's suggestion of cutting out caffeine is probably one good place to start--it helped my labrynthitis friend, and it has helped my friends with panic issues.
posted by Sidhedevil at 2:03 PM on February 23

Oh, I should mention I have a crippling fear of needles and bloodwork, to the point where I almost always pass out afterward. So while I'll go get that done I'd like to have something to tell myself to justify it. There would be considerable irony in having a panic attack over getting blood work to rule out non-panic causes.
posted by elektrotechnicus at 2:05 PM on February 23

Well, I don't have any medical advice, but I can say that I have experienced similar things. I have had issues with panic attacks for and generalized anxiety for 10-15 years. The last few years it has tended to take less the shape of acute panic attacks, and more the shape of feeling faint, often accompanied by derealization, blurred vision, and tingling skin. It never seems to come on as the result of a specific stressful environment or experience – I'd say it's more free-floating. But it does tend to occur with greater frequency when I am more stressed out with life in general.

For a while I pursued a couple different avenues with doctors (thyroid testing, hypoglycemia, even anemia, like you mentioned!) which, for me, didn't go anywhere. FWIW, I am not on any meds nor do I use marijuana; I've just come to attribute it to the way my weird brain & body process anxiety. Even though it doesn't feel like a classic panic attack I try and deal with it in a similar way: deep breathing, trying to override the sensations with logic ("you are NOT going crazy. you are not going to faint. this will pass." etc etc), and simply riding it out.
posted by allisonrae at 2:21 PM on February 23 [2 favorites]

Although I cannot explain what is causing your symptoms, I am grateful for your question because I too experience the same symptoms and it is very difficult to find a remedy for it. I have been to the psychiatrist as well as the ER for a CT scan to eliminate brain damage. I never knew there was a term to describe what I happens to me. The description of derealization is spot on what happens to me. It is often overwhelming to the point where I have had to leave work. I have found that alcohol increases the symptoms, as does caffeine. I have completely eliminated both from my diet. And most important in my prevention is getting a good night's sleep. I can almost guarantee it will happen if I get 5-6 hours of sleep. This may sound like a full night's sleep for many but not for me.
posted by kemah201 at 2:31 PM on February 23

This strikes me as one of those questions where a bunch of amateur, non-professional speculation could do more harm than good.

elektrotechnicus, it seems like you should discuss this question -- which symptoms are psychiatric and which are physical and how best to deal with each -- with a doctor. You say you've been to the clinic twice and describe one visit. Was the other visit helpful? Is there a way to get an appointment with an appropriate doctor or specialist?
posted by salvia at 2:46 PM on February 23

It could also be a problem with the Concerta. Methylphenidate can have adverse effects that sound like what you're describing, and it can also cause physical dependence* that would lead to negative side effects from suddenly stopping it. You really ought to talk to a doctor about this.

* Not addiction. Just that your body adjusts its chemistry to take the drug into account, and can't instantly adjust back to normal when the drug is suddenly stopped
posted by vytae at 2:53 PM on February 23

This strikes me as one of those questions where a bunch of amateur, non-professional speculation could do more harm than good.

During the second visit the nurse (same one) thought panic attacks fit the bill. The university clinic generally passes you on to a doctor only if a nurse thinks it's appropriate (she obviously didn't). The university has a large research hospital, so there is no shortage of doctors, I think if I had something really serious they would have brought in a "real" doctor. I plan to make an appointment with university psychiatric services, which I understand to be staffed by MDs, but it takes a while.
posted by elektrotechnicus at 3:33 PM on February 23

How's your diet? I was having very similar problem during a period where I wasn't eating any more than dinner every day, and drinking at least one highly caffeinated beverage per day along with low-dose (5mg) dexedrine- not concerta, but not entirely dissimilar. I went to the doctor who suggested anxiety, but that was more of a residual symptom of the greater problem, which was an insufficient diet. I cut caffeine/dexedrine entirely for about 6 months and started forcing myself to eat better. At first I could only stomach 2 meals a day, but I've settled (finally, 9 months later) on 3 square meals plus snacks. I also made efforts to cut the 'trash' out.

I would be wary about putting too much stock in an 'anxiety' diagnosis, if you're anything like me. That only made it harder to manage, before I started looking to improve the things I could control.

oh and,

* Not addiction. Just that your body adjusts its chemistry to take the drug into account, and can't instantly adjust back to normal when the drug is suddenly stopped

yeah, that's addiction, it's just physical instead of psychological...
posted by sunshinesky at 3:45 PM on February 23

I have to agree with salvia. I have diagnosed panic disorder, and my husband is on Concerta for ADHD, but anything I'd tell you is purely anecdotal and may not relate to your situation at all. University clinics generally suck. Make an appointment with an MD directly; if your insurance allows it, I'd see a neurologist, no matter what the nurse said. You don't want to fuck around if the problem could indeed be neurological.
posted by desjardins at 4:02 PM on February 23

The university clinic generally passes you on to a doctor only if a nurse thinks it's appropriate (she obviously didn't).

Thanks, elektrotechnicus, and I'm sorry if I sounded rude above (that bold turned out awfully bold). I'd just encourage you to take what's said in this thread with a grain of salt, particularly if it increases your concerns. Hopefully you can find a doctor who will take the time to discuss your concerns and symptoms with you and help figure out good strategies for addressing them.
posted by salvia at 4:05 PM on February 23

I am not anything approximating a doctor, but my father works in a medical field. One of the many things that I learned growing up with him is that you do not mess around with brains. If you think something is wrong with your brain, take it seriously, and go to the doctor.

It may very well be something harmless, but it could also be something bad, and there's a small chance it is something terrifyingly bad. It seems like you aren't even clear on whether your problem is neurological or psychological. No one here has any way of knowing any of those things.

Getting two different answers on two different visits doesn't sound like a great situation to be in, knowledge-wise. You really need to call the health center back and ask to see a physician who can do a more thorough evaluation and explain things to you more fully. It kind of sounds like that nurse is mostly guessing.

Oh, I should mention I have a crippling fear of needles and bloodwork, to the point where I almost always pass out afterward. So while I'll go get that done I'd like to have something to tell myself to justify it. There would be considerable irony in having a panic attack over getting blood work to rule out non-panic causes.

Such irony is inconvenient and slightly embarrassing. Even more inconvenient is having this continue for the rest of your life.
For what it's worth, I fear needles the way I fear imminent death, but I also give blood regularly. So I don't really understand why your fear matters, here. Stop thinking up excuses and go to the damn doctor.
posted by Commander Rachek at 4:11 PM on February 23

Nothing wrong with discussing it here, but good advice go see a doctor.
posted by kemah201 at 4:22 PM on February 23

If there is any possibility at all that you may have a urinary tract infection, get checked out for one. No needles involved, you just have to pee in a cup, and maybe get a swab taken, which is poky and and unpleasant but not anywhere near the realm of needles. A UTI is not as likely as in a female, but on the other hand if there's any possibility that you've got chlamydia apparently that's the most common symptom.

I've lately had some of these symptoms - my vision's been not quite right for a few weeks, concentrating doesn't seem to happen properly, I know exactly where the weird feeling is in your head - and I'm now on my second round of antibiotics for a UTI that's turned into a kidney infection. I cannot describe adequately exactly how much you do not want this to happen to you. Pissing razor blades was just the start of the nastiness, but it's highly likely that the actual infection had been hanging around painlessly (and maybe my pee was a little dark sometimes, and maybe almost cloudy sometimes, and maybe some people laughed at me for needing to go to the loo twice as often as anyone else, but it wasn't painful) for a few months.

Untreated UTIs are commonly recognised as causing mental health problems in elderly people, but no-one seems to recognise any possibility that they can have similar effects on younger people, probably because we are more scared of possibly going mad and put more effort into hiding it.
posted by Lebannen at 5:05 PM on February 23

Lebannen: Interesting you should mention that.

The last time I remember feeling this way I was fairly young. Around that time I had actually been hospitalized for kindey problems as a result of a urinary tract infection. Haven't had problems with that in years, but about a week before all this started I had a dull ache in the kidneys (which happened last time) after running particularly hard (around a half hour jog, when I hadn't run in a long while).

I've been keeping a close eye on my urine (this is why I have a sockpuppet account...) and nothing seems out of the ordinary, but I'll bring it up when I get in front of a doctor.
posted by elektrotechnicus at 5:23 PM on February 23

I used to experience this when i was a child..eventually it just passed away. I know, not very helpful, but reading your description is the first time in a long time that i remembered these "attacks".

It felt like i was going out of my mind and whenever i tried to tell anyone about it, they didn't understand or thought i was faking some illness (i was very young and not able to put proper words on it). So i never got it checked out at a doctor but i haven't experienced it since my childhood. But now i do wonder what i was experiencing back then.

For those who haven't tried it, it can most closely be compared to being very drunk. But the derealization part is absolutely terrifying and feels like being in a nightmare for a couple of hours.
posted by kampken at 5:29 PM on February 23

I somehow forgot to include in the original description that I have often felt near to passing out, or weak, but haven't actually lost consciousness. Also, the last time I had a serious "attack" was Saturday. If I have another I'll probably go the emergency room, but until then the plan is to wait to see one of the university psychs.
posted by elektrotechnicus at 5:56 PM on February 23

Check for gas leaks in your building.
posted by Brian B. at 7:18 PM on February 23

I agree with those who say this thread is not going to be much use to you. You really need to be working with a doctor.

I think if I had something really serious they would have brought in a "real" doctor. I plan to make an appointment with university psychiatric services, which I understand to be staffed by MDs, but it takes a while.

Well, I think you need to insist that you need to see a 'real' doctor. It can't just be on the nurse's determination alone. You aren't comfortable with this level of treatment, and you need a referral to a doctor, thank you. If you don't get it, get on the horn to the dean of students. You need to see a doctor.

You need to see a doctor.

You need to see a doctor.

Make the appointment with the psych office tomorrow - it may take a while, but don't waste any more time. It can sit there on the calendar while you go back to student health and tell them

you need to see a doctor.
posted by Miko at 7:41 PM on February 23

I experience a similar set of symptoms before I get a migraine...
posted by hapax_legomenon at 8:05 PM on February 23

I also fear needles If you choose to get blood drawn request to lay down while they extract. This has never been a hassle. Don't look at the needle. Stay horizontal for several minutes after they're done. No big deal if you do pass out because you'll be around a bunch of people who know what to do !
posted by Jason and Laszlo at 8:56 PM on February 23

So I'll preface my response by stating that you should see a doctor until you get an answer or answers that ring true and satisfy you.

However, the symptoms you described are identical to the panic attacks I experienced in college over the course of two or three years. I saw a psychologist at my university for primarily talk therapy. It didn't do much good but at least I had a name for it and didn't feel totally loony anymore. I was too stubborn to take medication. The panic attacks passed eventually but I wish I had tried the pills now that I look back. Even thought the panic attacks went away, the anxiety is still stubbornly hanging around. (I'm on a low dose antidepressant to treat my anxiety now and grateful for it).

I wish you luck. The symptoms you describe are scary to experience. I experienced derealization often throughout childhood when I was anxious. For me it felt like I was moving out of time. As if I was going much faster or much slower than the rest of the world. Sometimes if I was still, it was as if I was alternately getting much larger or much smaller than everything else, either sucking up the world or being sucked up by it. I didn't know what it was, but it frightened me and I never told anybody about it until I was much older.

So, I guess my advice is to go see the psychologist at your university as soon as possible but also make sure you rule out possible medical reasons. a good psychologist will support you doing the same.
posted by dchrssyr at 12:14 AM on February 24

See a doctor and keep us posted. Seems you are not the only one experiencing this and looking for answers.
posted by kemah201 at 5:14 PM on February 25

Okay, so I went to the clinic again, saw the same nurse and a student of hers. Proffered the UTI theory, so they tested urine. That was perfectly fine, no sign of a UTI at all. In a wonderful test of my stoic ideals I went ahead and did the blookdwork, and they had a dedicated lab for it - the woman who drew mine did nothing else all day, and as soon as I mentioned I was phobic she began a stream of rapid fire questions that didn't stop until the needle was removed. Brilliant, restored my faith in humanity.

Anyway, they tested for:

* Blood sugar (109, fine)
* Blood count (normal)
* Kidney and Liver function (perfect)
* Thyroid (perfect)

So I'm feeling pretty good in considering this a psychological issue. The nurses haven't offered any explanation, they just told me to keep reporting when I have issues (they aren't being dismissive at all, but my test results are the picture of health). I haven't been really symptomatic since Saturday (I've been a bit sleep deprived due to poor time management, so it's been somewhat hard to tell if I'm out of it because of that or Mystery Syndrome).

Right now, and for the past few hours, I've felt a bit symptomatic, but it seems to pass fairly quickly. The one new thing I have noticed is that I'm asking people to repeat themselves a lot during "episodes"... so maybe this is at least partly an inner ear thing?

So... what next? I've still got the appointment with the psychiatrist, who I hope will be able to judge whether other specialists should be called in. I'm generally feeling more relaxed about the whole situation now, but I wonder if I shouldn't see an ENT or neurologist just in case. Is there anything they could really rule out? Should I get a precautionary CAT scan or something? What makes that a warranted procedure?

I'm going to call my home doctor (hopefully tomorrow) and ask these things, but I'd still be interested in the guidance of the hive mind, if only to give me ideas of what to go over in those conversations.
posted by elektrotechnicus at 7:44 PM on February 26