I was recently in the ER at Cooper Hospital and admitted and discharged after 24 hour observation on Saturday, June 23, due to prolonged shortness of breath (SOB) lasting at least 12 hours. I've had shortness of breath at rest but very intermittently over the years, lasting on average 5 minutes, and at most maybe 20 minutes (I never timed it), so I didn't think anything of it because it wasn't bothersome or troubling, being so short-lasting and not severe.
In the past, sometimes these brief SOB episodes will appear while I have brief periods of subjective vs. objective tachycardia (fast heart rate)--these were really prominent when I was hyperthyroid due to Grave's disease. Before Grave's, my SOB came out of nowhere, and infrequently, from anxiety and stress, but they were manageable.
However, the past month, these episodes were more frequent, lasting longer than usual, and worsened the past week until all Thursday night while asleep, I had shortness of breath lying flat (orthopnea) and struggling to catch a deep breath the whole night through. At work on Friday, it continued, so I went to urgent care after work, as of course I wanted to avoid the ER. The physician's assistant there noted exertion on inspiration, as well as decreased inspiration and expiration, and recommended I go to the ER for full work-up.
At the hospital, the positive news is that all the dangerous life-threatening causes of worsening SOB was ruled out. My chest x-ray, serial CKs and last serial EKG (to rule out heart attack), D-Dimer (to rule out pulmonary embolism) were all normal. My lung examination was probably normal since I was no longer out of breath. Although these were preliminary tests (i.e. not ALL medical causes of SOB were ruled out), the Hospitalist insisted that this was due to a panic attack.
But, even though he felt that this might be anxiety-related, he frequently assured me that the medical work-up will remain the same, i.e. getting an outpatient stress echo, so I MUST admit to him that this was due to anxiety.
He really persisted that I tell him this is a panic attack, especially as my pulse ox (determination of oxygenation) was at the "ideal" 99% even upon walking, which he says was the "unreachable Mt. Rushmore" for him, as his pulse ox is usually only at an abysmally low 93% (smoke much?).
I then informed him that I've experienced a panic attack before, fortunately only once in my lifetime, which occurred when I was in bed. When the panic came on, I bolted out of bed, gasping for breath, my heart pounding and sweating profusely. This only lasted a few minutes, certainly not 12 hours straight.
I discussed with the pushy Hospitalist that if these were in fact panic attacks, I wouldn't be lying in bed all night quite calmly, occasionally shifting around to get a deeper breath. Rather, I would be out of my bed gasping for breath. And at work, I would've gone to the bathroom as I wouldn't want anyone seeing me go into a panic. Instead, I continued my duties, albeit out of breath when talking.
I then admitted to the overbearing Hospitalist that I suffer from Generalized Anxiety Disorder (GAD), that is characterized by chronic, excessive worries that cause dysfunction and stress, since I was in the womb, possibly fretting if my organs are forming correctly during the first trimester.
So, throughout all these decades, worries and stress have never led to 12 hours of SOB. I explained to him that with me, the dysfunction is more relational rather than causing functional problems--I annoy my friends by overanalyzing and thinking through the worries repetitively where they can't take it anymore. They visibly cringe when I say, "Let's revisit the issues at hand".
He then said I had GAD (as if he were the one to diagnose me with the condition), as his rationale was that there's no way I could be walking around if I were short of breath for 12 hours straight. Indeed, there is something called dypsnea (SOB) due to hysteria or neurasthenia, which is due to anxiety and other mental illnesses in the somatoform category. If no medical causes are shown, and there are no findings on physical exam such as SOB while talking, decreases in inspiration and expiration, and so forth, then this can be chalked up to psychiatric issues.
As the team kept harping on the idea that this is due to GAD, and I keep arguing that it was not (indeed, they were probably thinking that I was protesting too much), I was nearly brainwashed into thinking that they may be right, that this is all due to anxiety. Therefore, I decided to "test" myself at home today.
I've avoided opening notice from the IRS because I had to "gear" myself up to it. However, this was a great opportunity to see how I'll react, and if it will impact my breathing. Upon opening the "present" from the IRS, they claim I was delinquent at around $9000.
I think anyone can understand how a delinquent IRS bill at this high amount would cause immense anxiety and stress, as thoughts of the IRS having to garnish wages are sure to freak out most people, with catastrophic thinking of losing their homes and livelihood.
However, I calmly wrote to my tax accountant, took a picture of the bill as attachment, and surprise, I had absolutely no SOB or heart racing. Due to resting over the weekend, my breathing if anything has improved.
Indeed, even now, I'm not out of breath despite being concerned as to what can be causing these worsening symptoms. Tomorrow, I have a post-hospitalization follow-up with my primary care doctor. We might not find anything, but my thoughts are that this may be due to any of these issues:
Hyperthyroidism (i.e. TSH was normal, but I wasn't tested for T3 and T4), PFTs are indicated (pulmonary function tests), and we need to rule out if I have any weird auto-immune diseases such as Sarcoidosis, since I'm the textbook definition of inflammation with the Grave's disease, eczema, environmental allergies, and ALL forms of urticaria (skin welts upon touch, heat, cold, and so forth). Indeed, I'm allergic to the outdoors. Hopefully, the stress echo will be negative and not show any issues with pulmonary hypertension, which I'll be getting in 2 weeks as an outpatient.
In addition to being triggered about not having my medical issues taken seriously by the Hospitalist, this is a wake-up call for me to take care of myself better, as we video gamers are notorious for having awful health habits.
If you suffer from a psychiatric illness, have you received any discrimination at work or in medical care?
The How of Happiness Review
In the past, sometimes these brief SOB episodes will appear while I have brief periods of subjective vs. objective tachycardia (fast heart rate)--these were really prominent when I was hyperthyroid due to Grave's disease. Before Grave's, my SOB came out of nowhere, and infrequently, from anxiety and stress, but they were manageable.
However, the past month, these episodes were more frequent, lasting longer than usual, and worsened the past week until all Thursday night while asleep, I had shortness of breath lying flat (orthopnea) and struggling to catch a deep breath the whole night through. At work on Friday, it continued, so I went to urgent care after work, as of course I wanted to avoid the ER. The physician's assistant there noted exertion on inspiration, as well as decreased inspiration and expiration, and recommended I go to the ER for full work-up.
At the hospital, the positive news is that all the dangerous life-threatening causes of worsening SOB was ruled out. My chest x-ray, serial CKs and last serial EKG (to rule out heart attack), D-Dimer (to rule out pulmonary embolism) were all normal. My lung examination was probably normal since I was no longer out of breath. Although these were preliminary tests (i.e. not ALL medical causes of SOB were ruled out), the Hospitalist insisted that this was due to a panic attack.
But, even though he felt that this might be anxiety-related, he frequently assured me that the medical work-up will remain the same, i.e. getting an outpatient stress echo, so I MUST admit to him that this was due to anxiety.
He really persisted that I tell him this is a panic attack, especially as my pulse ox (determination of oxygenation) was at the "ideal" 99% even upon walking, which he says was the "unreachable Mt. Rushmore" for him, as his pulse ox is usually only at an abysmally low 93% (smoke much?).
I then informed him that I've experienced a panic attack before, fortunately only once in my lifetime, which occurred when I was in bed. When the panic came on, I bolted out of bed, gasping for breath, my heart pounding and sweating profusely. This only lasted a few minutes, certainly not 12 hours straight.
I discussed with the pushy Hospitalist that if these were in fact panic attacks, I wouldn't be lying in bed all night quite calmly, occasionally shifting around to get a deeper breath. Rather, I would be out of my bed gasping for breath. And at work, I would've gone to the bathroom as I wouldn't want anyone seeing me go into a panic. Instead, I continued my duties, albeit out of breath when talking.
I then admitted to the overbearing Hospitalist that I suffer from Generalized Anxiety Disorder (GAD), that is characterized by chronic, excessive worries that cause dysfunction and stress, since I was in the womb, possibly fretting if my organs are forming correctly during the first trimester.
So, throughout all these decades, worries and stress have never led to 12 hours of SOB. I explained to him that with me, the dysfunction is more relational rather than causing functional problems--I annoy my friends by overanalyzing and thinking through the worries repetitively where they can't take it anymore. They visibly cringe when I say, "Let's revisit the issues at hand".
He then said I had GAD (as if he were the one to diagnose me with the condition), as his rationale was that there's no way I could be walking around if I were short of breath for 12 hours straight. Indeed, there is something called dypsnea (SOB) due to hysteria or neurasthenia, which is due to anxiety and other mental illnesses in the somatoform category. If no medical causes are shown, and there are no findings on physical exam such as SOB while talking, decreases in inspiration and expiration, and so forth, then this can be chalked up to psychiatric issues.
As the team kept harping on the idea that this is due to GAD, and I keep arguing that it was not (indeed, they were probably thinking that I was protesting too much), I was nearly brainwashed into thinking that they may be right, that this is all due to anxiety. Therefore, I decided to "test" myself at home today.
I've avoided opening notice from the IRS because I had to "gear" myself up to it. However, this was a great opportunity to see how I'll react, and if it will impact my breathing. Upon opening the "present" from the IRS, they claim I was delinquent at around $9000.
I think anyone can understand how a delinquent IRS bill at this high amount would cause immense anxiety and stress, as thoughts of the IRS having to garnish wages are sure to freak out most people, with catastrophic thinking of losing their homes and livelihood.
However, I calmly wrote to my tax accountant, took a picture of the bill as attachment, and surprise, I had absolutely no SOB or heart racing. Due to resting over the weekend, my breathing if anything has improved.
Indeed, even now, I'm not out of breath despite being concerned as to what can be causing these worsening symptoms. Tomorrow, I have a post-hospitalization follow-up with my primary care doctor. We might not find anything, but my thoughts are that this may be due to any of these issues:
Hyperthyroidism (i.e. TSH was normal, but I wasn't tested for T3 and T4), PFTs are indicated (pulmonary function tests), and we need to rule out if I have any weird auto-immune diseases such as Sarcoidosis, since I'm the textbook definition of inflammation with the Grave's disease, eczema, environmental allergies, and ALL forms of urticaria (skin welts upon touch, heat, cold, and so forth). Indeed, I'm allergic to the outdoors. Hopefully, the stress echo will be negative and not show any issues with pulmonary hypertension, which I'll be getting in 2 weeks as an outpatient.
In addition to being triggered about not having my medical issues taken seriously by the Hospitalist, this is a wake-up call for me to take care of myself better, as we video gamers are notorious for having awful health habits.
If you suffer from a psychiatric illness, have you received any discrimination at work or in medical care?
The How of Happiness Review
Sorry I missed this consult...as I'd just left for the night in the early hours of Saturday morning...though most of what I might say while he was there would've been along the lines of "As a practicing psychiatrist, I suspect Dr. Chang has a sense of how a psychological illness might present itself..."
ReplyDeletethanks Todd! The primary care doctor felt it might be either asthma or deconditioning, if not then anxiety, but at least he didn't jump to anxiety as the primary suspect.
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