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Hypochondriasis meets actual illness?
February 8, 2014 3:42 PM   Subscribe

How do you manage medical anxiety when it looks like it might be something?

I have a life-long terror of medical environments, which has resulted in me not having had routine medical care in a really long time (like since high school and I am a few days away from 31 right now). I have had some isolated medical appointments (dermatologist for acne, urgent care to figure out why I'd been sick for two weeks, things like that), but being in doctors' offices often results in me hyperventilating and generally embarrassing myself. Add to this, I am sporadically a pretty bad hypochondriac and have at various points thought I might have been stricken with a grave disease. Like in high school I thought I might have had a brain tumor (which was a sinus infection). I wonder if on some level, I thought that worrying irrationally about unlikely illness would seem to stave away actual illness.

Anyway, I am going through a health scare currently where the feedback I'm getting from doctors is more like, "Yeah, we really need to look into this ASAP" rather than "Oh, probably normal, we see this a lot" and I'm not exactly sure how to manage my anxiety. Basically, I went to the CVS Minute Clinic a little over a week ago because I had a lumpy place on my neck under my jaw, which I had assumed was normal-ish lymph node swelling following a cold that I just got over. The lady there sort of looked at it curiously and said it looked an awful lot like mumps and seemed to think it was cool because she'd never seen mumps before. She referred me to Urgent Care and they thought it might be an infection of my parotid/salivary gland and ordered antibiotics and told me to suck on lemons until the swelling went down. It didn't go down at all and when I went back in the new doctor seemed to think it was a good idea to go into overdrive testing to rule out lymphoma and I got kind of uptight because he was throwing out comments like, "Yeah, usually they get you in pretty quickly when it's something this suspicious" which sort of throws my anxiety siren into action. He ordered a CT scan and called me when the results came in, which basically looks like some kind of mass and he said on the plus side it has some cyst-like properties, and on the minus side, it apparently looked "perigenious" instead of homogeneous which means it had different shades of gray on it [ :( ] He sounded like he didn't really know what it was and said it could either be some kind of infection or a lymphoma. I am finding myself getting very tense during the parts of this which involve being in an actual doctor's office or getting needle sticks (immature) so I asked him if he could prescribe some anti anxiety medication for the actual procedure parts (which he did, .5 mg Atavan).

All other relevant details about my health situation (sorry, this is a lot):
- the thing in my neck is pretty large, like a few inches and you can see it bulging out and it doesn't hurt at all. The region is apparently either on, in or under my parotid/submandibular gland and underneath my kerotid(sp?) artery. nothing is painful. it's only on one side and seems to have appeared out of the blue (apart from it coming after a cold)
- They did bloodwork (CBC and amytase). My CBC was normal and the amytase which apparently measures something my salivary gland is doing, was high normal.
- I am in ship shape in terms of outward health and I don't have fevers or night sweats and my spleen is normal sized and the lymph nodes in my abdomen aren't swollen and I am not itchy or anything like that. I am training for a 5k and carrying on like a normal 30 year old woman. I don't smoke.

I have done the CT scan and on Monday I have an appointment with an otolaryngologist who is apparently doing a biopsy and I guess possibly a mysterious other battery of tests. I guess I am looking for advice in terms of how to manage my anxiety. I am aware on some level that cancer scares are sort of normal and I guess I feel some sort of guilt about being so clutchy about my personal mortality given that I'm just one of many mortal people and people deal with stuff like this and worse all the time. Also, I know that there's a good possibility this could still be nothing at all. But I feel really bad and I'm having a hard time being in the state of not knowing. I wanted general advice on managing anxiety, particularly in pre-diagnosis type situations. And also, I guess part of the reason I put all of that specific info is I wanted to see if anyone had any insight into the situation but I know YANMD applies etc. etc.
posted by mermily to Health & Fitness (14 answers total) 1 user marked this as a favorite
 
I am just throwing this out, but my son had this years ago and it turned out to be Cat Scratch Fever. No fooling.

His young pediatrician was not sure what he was looking at and he asked the older (about to retire) ped to come take a look, and he recognized it right away. (of course we did testing to rule out other stuff.)

So, have you been around any cute kittens lately? I am serious. (but if this is what it is, it ISN'T serious at all.)


As to the anxiety of not knowing-maybe it would help if you could pinpoint exactly what it is you fear. Is it the medical environment itself, or do you fear serious illness? Your approach might be just a bit different depending on where your anxiety is weighted.

Other than that, this would be a great time to get together with your close friends, and do something fun, even if all it is is eat cookies in front of Netflix. And don't be ashamed of how you feel, as even people who don't have generalized anxiety would feel a bit rocked by your situation.

((((hugs))))
posted by St. Alia of the Bunnies at 3:56 PM on February 8 [2 favorites]


I am currently experiencing something similar and I also suffer from the same anxiety issues you described here. In my case, the doctor is saying that the test results are consistent with a not uncommon benign thing that some people have, but the tests also can't rule out with certainty this other very rare thing that is not good. So more follow up is needed which will probably involve a biopsy. And I would "get inside my head" during the few days after a test waiting for the results. I convinced myself, immediately after each test, that I had a very bad disease. I was even trying to interpret--after the fact--the body language of a technician who conducted one of the tests and was in the position to see inside me in real time. I literally drove myself crazy with these thoughts. I was in extreme high anxiety mode until the results came in and my doctor talked me down each time. During those times, I found it extremely helpful to just talk with my closest friends about my anxiety and fears. That really calmed me down.
posted by Seymour Zamboni at 4:28 PM on February 8 [1 favorite]


Yikes! I would be anxious too.

As I was reading your post I kept thinking this is why it is so much better to have a primary care Dr. even if you only see them once a year. They know you and you know them. I know this is not a part of what you are asking for but it really helps when dealing with medically related anxiety.

I would do all I could to let go of this till your Dr. appt on Monday. I know that is hard but I would get out of the house, go to the movies, anything that will distract you from touching and staring at the lump in your neck. I also meditate and I don't know if you are into that or not but I find it helpful.

Good luck.
posted by cairnoflore at 4:29 PM on February 8 [5 favorites]


As a long-time hypochondriac who has experienced many imaginary tumors, my best advice to you is to take the Ativan when you find yourself in a downward spiral. There have been a couple of times in the past few years when it was all that stood between me and a flat-out panic attack.

I don't take it regularly, because my hypochondria comes in spells, and sometimes I can manage without it. But when I can't, the meds help.

(My room mate, reading over my shoulder, says "Seconding kythuen, as a person who lives with a hypochondriac. TAKE THE ATIVAN." Sometimes, she can see me getting out of hand before *I* do.)

It also helps to stay the hell off the internet. DO NOT GOOGLE YOUR SYMPTOMS. Dr. Google always thinks it's cancer.
posted by kythuen at 4:40 PM on February 8 [2 favorites]


I try to stay really busy so I can redirect myself to that activity when my mind starts spiraling. I also try to remember that even if it's really bad news, there is nothing between today and my appointment that's realistically going to change the outcome. I try to be matter-of-fact and to live enjoyably until I know for sure. I tell myself whatever it is, knowing will put the power back in my hands, but until then assume nothing. All of this helps bring my anxiety down to more manageable levels and it's not until the appointment day when I start feeling overly anxious again.
posted by Aranquis at 5:17 PM on February 8 [1 favorite]


If this is indeed a tumor of the parotid glad, the very good news is that most of them are benign. Like, 80% of them. The odds are in your favor.

I had a parotid tumor removed a few years ago (benign) and if it turns out that you need to have that done, feel free to MeMail me and we can talk. I'm currently recovering from pneumonia (with sepsis!) and to be perfectly honest, I would have rather had the surgery than ever be this sick again.
posted by cooker girl at 5:25 PM on February 8 [1 favorite]


you need to see a therapist that practices CBT. http://www.psychologytools.org/health-anxiety.html, http://umm.edu/health/medical/altmed/condition/hypochondriasis.
Try these books:
link
or google health anxiety.
you need to get exposure to going to the drs and feeling calm about it.
also stin mediation (google her) help me. you need to be comfortable with your body and being still.
peace
posted by TRUELOTUS at 5:29 PM on February 8


I feel really bad and I'm having a hard time being in the state of not knowing

You might feel less anxious if you choose to instead see this situation as having cancer and proactively getting treatment for it.
posted by yohko at 5:49 PM on February 8


As a long-time hypochondriac who has experienced many imaginary tumors, my best advice to you is to take the Ativan when you find yourself in a downward spiral.

This. I read the beginning of your question and thought it was going to be one of those "I have had this weird thing growing for five years and now I can't close my mouth but I am afraid of the doctor..." but no, you are doing great! Going to appointments! Handling things! Following up! It's so simple to just not make the next appointment because you're sick with anxiety about it (and I say this as someone who has been right there with you with the brain tumor sinus problem -- right there). What helps me is

- take Ativan if I'm being flippy, especially before bed because sleep is the most important thing as far as keeping stress levels down
- exercise and eat decently (looks like you are doing that)
- have one friend who you can talk to and be like "I am nervous about this...." and sort of pour out your fears and concerns and then they can be your "Hey how did that thing go?" person. Sometimes you might have to tell a friend/family member "Hey I am nervous about this appointment, wish me luck?" but if you wind up getting wished good luck, you're fine

Also the weird thing I decided to do that helped a lot with this were

1. wrote my will - so my "affairs are in order" in case something weird did turn out to be true
2. decided all things being equal that while I'd like to live longer, I wasn't really afraid to die. It sounds really weird and macabre but that helped me not be like OH GOD WILL MY NECK THING KILL ME??! because hey, something will kill me at some point and dying is sort of part of living. Not stoked about it but don't need to fear it

I've worked on my anxiety a lot over the past half decade and trying to not "live in my fear" by being aware when it's happening and pushing the racing thoughts out of my mind (some people call this mindfulness meditation "oh there is a thought... now I will let it go") and it's surprising how well it can work. It's weird because it feels like work, like it's more work to NOT think about your medical fears than it is to think about them, but it's more rewarding not to also.

You are really doing great. I wish you the best with whatever it turns out to be.
posted by jessamyn at 8:52 PM on February 8 [4 favorites]


I am a hypochondriac who has had about 20 years of constant crappy health. Hypochondria + an actual reason to be scared is the worst. But, you are not in pain. Thank goodness for that. When you are a hypochondriac and you're in pain there is no getting away from the worry, it's like a gremlin on your back, jabbing you all the time.

Distract yourself. Find something else to do, and do it whenever you start worrying. Get work done, watch movies, go for walks. Anything. And take your anti-anxiety meds. Talk to your shrink, if you have one. I would caution against talking about it too much with friends or family. Even if they are supportive, having somebody you can regularly rant to endlessly can actually keep your anxiety going. I am not saying you should bottle it up and not talk at all! But resist the urge to spend hours talking about it. Think of it like you're letting little bits of the crazy out, when you really need to. You don't want to have a lot of meltdowns.

Really, rejoice that you are not in pain. Until you get bad news, this is all hypothetical. It could turn out to be absolutely nothing. Try not to get upset about it, until you know if it's even a thing.
posted by Ursula Hitler at 9:22 PM on February 8 [1 favorite]


Maybe have a friend go with you to the next appointment. They can help keep you calm, ask questions, make notes, absorb info, and if it does turn out to be something really serious, act as a support person.
posted by spinifex23 at 10:21 PM on February 8 [1 favorite]


For me, and the times I've been awake in the middle of the night pre-doctor's appointment, I find it good to re-direct my nervous physical energy. Rolling coins, washing dishes, anything sort of repetitive but distracting. In the daytime I would just walk...and walk. Like Jessamyn said, you dealing with it, doing the right thing and most likely will be fine, so really you just need to be in distraction mode now. Netflix too! ,
posted by bquarters at 2:13 AM on February 9 [1 favorite]


I agree with "spinifex" -take a friend or relative with you. It helps very, very much.

There is a great forum on "health anxiety" at

http://www.anxietyzone.com/
posted by Tullyogallaghan at 9:49 AM on February 9 [1 favorite]


Thanks everyone. Especially the cat scratch fever suggester! I have two cats and it's pretty great having a non-scary alternate diagnosis "out" option! I will play the Ted Nugent song on my way to the appointment tomorrow. My aunt is coming with me to my appointment and she has been great so I'm lucky. Thanks to everyone that posted, I really appreciated that. It looks like it could really be all sorts of different things, some perfectly fine, some completely horrific and some slightly unpleasant. Will take it as a good sign that I am in outward good health minus my lumpy bits, take my atavan and put one foot in front of the other!!
posted by mermily at 2:14 PM on February 9 [1 favorite]


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