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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by WhatToDoNext on July 28, 2008, at 19:32:41
Hi again everyone, I have been having bouts of Hyperventilation that last as long as 3 hours, then resolve on their own. My rate gets up to 35-45 breaths per minute at rest. I'm 5'10" 200lbs, in good shape for the most part. I went to the ER a month ago for the same and they said I was having a panic attack. I know what a panic attack is as I've had them when I was younger, and these are not panic attacks. I've also been experiencing tachycardia 120-145 at times with no exerction. I'm wondering how this can be while on a beta blocker.
It happened again today, and I was taken to the ER as after 3 hours, I was still breathing 35bpm. At first the ER MD offered my Ativan. He thought I was having a panic attack. I refused it, as, believe it or not, I wasn't anxious or panicking. I started getting angry and told him to treat this as a medical condition or I wanted another ER MD to treat me. He than began to take me a little more seriously and ordered a head CT with contrast and a chest CT with contrast. The Chest CT was normal. My blood gas was also normal. Here is the report from the Head CT:
[b]
The report Conclusion is as follows: No acute intracranial process. Tortuous looping left vertebral artery contacting the medulla and left inferior cerebellar peduncle.[/b]
The ER MD said it's nothing to be concerned about, but couldn't even tell me what this meant. My other symptom is tachycardia sometimes with the hyperventilation and sometimes without. I'm on a beta blocker (Propanolol 20mg bid), Klonopin 1mg bid, Xanax 0.5mg-1.0mg prn, Zoloft 50mg QD. I do suffer from anxiety and thats why I'm on this board, but for the most part I have not had anxiety with these episodes. My only recent med change was stopping Xanax XR 1mg bid, and switched to Xanax 1mg qid. I also increased my Klonopin from 1mg bid to 1mg tid.Thanks in advance,
Steve
Posted by okydoky on July 28, 2008, at 19:56:14
In reply to Need some serious help here guys..Just read inside, posted by WhatToDoNext on July 28, 2008, at 19:32:41
First let me apologize. This is way over my head. I wanted to suggest to you to post this or repost it on "Neurotranmitters". There might be someone there with this kind of knowledge.
Hope you get some answers,
oky
Posted by Phillipa on July 28, 2008, at 20:24:07
In reply to Need some serious help here guys..Just read inside, posted by WhatToDoNext on July 28, 2008, at 19:32:41
Did he hook you up to a monitor to record BP, Pulse, and a pulse oximetry? Did he do an Ekg? Not trying to be rude but may I ask your age? And you mentioned a cardiologist before was he informed you were there? Phillipa
Posted by Hygieia's Bowl on July 28, 2008, at 20:58:43
In reply to Need some serious help here guys..Just read inside, posted by WhatToDoNext on July 28, 2008, at 19:32:41
If your ABG was WNL you aren't blowing off CO2 and while your resp rate is above normal, you are compensating.
I suggest a good going over physical and re-evaluation of your meds.
Posted by blueboy on July 29, 2008, at 10:09:14
In reply to Need some serious help here guys..Just read inside, posted by WhatToDoNext on July 28, 2008, at 19:32:41
I don't know what to tell you. I doubt even an MD who specialized in the area would want to make a diagnosis from an internet post, and I am not an MD. But it sure sounds like a panic attack to me.
Or at least, psychosomatic. I've had similar problems, complete with the heart workup, that turned out to be non-heart related. In my case, rapid heartbeat (but not the fast breathing) can be triggered by ingestion of too much high-glycemic-index carbohydrate, like sugar or even a lot of white break or popcorn.
Anyway, I suggest that you try to admit that it *might* be a panic attack, as part of your treatment plan. That way, you can treat it whether it's physical or whether it's anxiety-based. I know from personal experience how freaked out you might be and how hard it is to get rid of a fear that the symptoms are physical.
One differentiation that might help. Perhaps if you are actually hyperventilating, you aren't having the kind of trouble breathing that is typical of a heart problem. If you are just breathing hard due to lack of oxygen, that's a whole different matter, but I'd think that the doctors would see this reflected in your blood oxygen levels.
Posted by thinkingitover on July 29, 2008, at 19:19:55
In reply to Need some serious help here guys..Just read inside, posted by WhatToDoNext on July 28, 2008, at 19:32:41
Hi Steve,
I would recommend that you make an appointment with a cardiologist and have an EKG done.
Given your history of anxiety (your meds indicate this) are you positive it isn't a physical manifestation of anxiety? It might be, it might now be. Anxiety pops up in strange places. perhaps keep a diary of when these symptoms occur, especially if you have to go to the ER again, etc..
Posted by Hygieia's Bowl on July 30, 2008, at 5:40:27
In reply to Need some serious help here guys..Just read inside, posted by WhatToDoNext on July 28, 2008, at 19:32:41
I think manifestations of anxiety are difficult to accept when one does not feel anxious as one would define it or has defined it from past experiences. For me, the symptoms can be varied and it's only with a ruling out of exclusion and hindsight that I'm able to accept.
Somatic anxiety symptoms also has caused me much hypervigilence and catatrophic thinking processes so an upward anxiety spiral starts....
I would not begin to assume there isn't a problem other than anxiety going on but anxiety challenges and symptoms present themselves in various ways that can change.
I found ruling out, attempting to understand *my* specific anxiety issues and finding a good treatment plan were keys to my recovery.
Posted by jflange on July 30, 2008, at 23:56:02
In reply to Need some serious help here guys..Just read inside, posted by WhatToDoNext on July 28, 2008, at 19:32:41
Hi!
In my experience, any change in meds or med doseage will give me the physical manifestations of anxiety. This is true even when I am feeling mostly fine on a medication and then if I forget a pill or accidentally double-dose in a day, I get weird cardiac responses, usually tachycardia. I don't feel anxiety per se, or panic feelings, rather, I get chest tightness and poundy heart. No diagnosed heart problems in my case, though.
So my guess is that it was your med change. Give it 3-4 days after you level off at your med doses and see if your heart doesn't quiet down. If not, make sure to pursue it with a cardiologist.
Be well, jflange
Posted by yxibow on July 31, 2008, at 1:48:37
In reply to Need some serious help here guys..Just read inside, posted by WhatToDoNext on July 28, 2008, at 19:32:41
> Hi again everyone, I have been having bouts of Hyperventilation that last as long as 3 hours, then resolve on their own. My rate gets up to 35-45 breaths per minute at rest. I'm 5'10" 200lbs, in good shape for the most part. I went to the ER a month ago for the same and they said I was having a panic attack. I know what a panic attack is as I've had them when I was younger, and these are not panic attacks. I've also been experiencing tachycardia 120-145 at times with no exerction. I'm wondering how this can be while on a beta blocker.
>
> It happened again today, and I was taken to the ER as after 3 hours, I was still breathing 35bpm. At first the ER MD offered my Ativan. He thought I was having a panic attack. I refused it, as, believe it or not, I wasn't anxious or panicking. I started getting angry and told him to treat this as a medical condition or I wanted another ER MD to treat me. He than began to take me a little more seriously and ordered a head CT with contrast and a chest CT with contrast. The Chest CT was normal. My blood gas was also normal. Here is the report from the Head CT:
> [b]
> The report Conclusion is as follows: No acute intracranial process. Tortuous looping left vertebral artery contacting the medulla and left inferior cerebellar peduncle.[/b]
>
>
> The ER MD said it's nothing to be concerned about, but couldn't even tell me what this meant. My other symptom is tachycardia sometimes with the hyperventilation and sometimes without. I'm on a beta blocker (Propanolol 20mg bid), Klonopin 1mg bid, Xanax 0.5mg-1.0mg prn, Zoloft 50mg QD. I do suffer from anxiety and thats why I'm on this board, but for the most part I have not had anxiety with these episodes. My only recent med change was stopping Xanax XR 1mg bid, and switched to Xanax 1mg qid. I also increased my Klonopin from 1mg bid to 1mg tid.
>
> Thanks in advance,
>
> SteveAs a sufferer -- and this can be transference, so take it for what its worth, of somatoform disorder, this sounds like some of the classic cases that appear in ERs every day of some form of Somatoform Disorder.
Don't get me wrong, these are real physical symptoms, and no they're not panic attacks, but ultimately they are anxiety generated. The most common kind seen are pseudoseizures -- more often in females than males I believe, I forget, but at any rate, people will manifest "caught" and "trapped" anxiety directly into a seizure. Palleative care such as Valium to stop the seizure may be offered, but referral to a doctor who specializes in somatoform disorders is the best place to start.
They're not the most common of things to diagnose, and mine doesn't even fall into the category 100%, but I have been suffering from an amplification of normal psychiatric vision for close to 7 years, an orphan somatoform disorder basically, combined with OCD and other things.
You're have quite a list of duplicative anti-anxiety medications but they may not be addressing an undiagnosed somatoform thing lingering in the wings. The tachycardia with and without hyperventilation is key for someone in "good shape for the most part." And in fact focusing on the symptoms themselves could land you in the ER again as there is a loop to the whole somatic presentation in the first place.First thing -- this isn't your fault, none of these syndromes ever are, and as noted before they are real. You are experiencing real bodily symptoms instead of the anxiety that is built up within.
In the old days they used to use conscious sedation (e.g. with Versed) to try to "figure out" someone's root cause for somatoform symptoms. Its not only bad medical practice, its illegal in a lot of hospitals. And the patient doesn't learn from it because they never remember it, they're put out in a daze, like a truth serum.
I would highly suggest asking your doctor about what he or she thinks about somatoform disorders or whether he knows of someone who might be able to evaluate you.As they say, your miles may vary -- you could still have some sort of also very real heart condition, but it doesn't sound like it from what the doctor had performed on you.
-- best wishes
Jay
This is the end of the thread.
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