Health Anxiety, White Coat Hypertension and Hospitals, Oh My.

In my last post I wrote about why I had surgery and the impact it will have. What I didn’t mention was my anxiety. Ironic considering this blog is about anxiety.

It would be “normal” to be anxious about any procedure in which one is put under general anaesthetic. Interestingly, the anxiety I had about the operation itself I would classify as normal.

One of my areas of intense anxiety is health. I’m a germaphobe and, thus, a chronic hand washer. If I’m near someone who is sick I become anxious that I’ll catch it. I’m particularly frightened of stomach bugs. My fears in this area are not “normal”. That being the case, I was very anxious prior to surgery that any number of the drugs used could make me feel or be sick. I was mildly anxious about waking up on the table or never waking up but far more scared of becoming nauseated from morphine. I was also worried about the post-operative pain I knew I would have from the carbon dioxide pumped into my body during surgery, not to mention the pain from the actual surgery.

Being hungry and/or thirsty makes me feel weak, which makes me more vulnerable to anxiety, which intensifies the physical symptoms of the hunger/thirst, and so the cycle goes on. Before my procedure, I had to stop eating at midnight the night before, stop drinking at 6am and be at the hospital by 7am. My surgery wasn’t scheduled until late morning so I was also anxious that I’d faint during those hours between my arrival and my surgery.

Having had two day surgeries in the past nine years at the same hospital, I expected, after admission, to be put in a bed in a waiting area. My plan, once I got there, was to sleep. Admission took quite some time and, when I finally made it to the surgery waiting area, there was very little space. Consequently, I was put in a small room that had a sofa and two armchairs instead of a bed. There were three other women there, too. I was barely there when I had to leave to meet with my anaesthetist. Following that, I had to give blood. When I got back to the small room, one woman was leaving for surgery and the other two and I began to chat. Something went wrong with my blood so I was called to give another vial. I then went back to the room and we continued chatting. The next woman was called and we were down to two. Eventually, I was also called. The time had flown by and I’d barely realised I was hungry and thirsty. There was no weakness or faintness. Distraction is a wonderful thing.

Having health anxiety causes one to do body scans. That’s when one mentally scans one’s body – usually without even realising – for pain, discomfort, illness, anything out of the ordinary. I don’t set out to do them but I’m aware when I do. That was the first thing I did when I woke up in recovery. Body scan. No nausea, a little pain. Good outcome.

The power of suggestion is a curse for those of us with anxiety. As I was wheeled to the ward, I remembered a friend of mine saying she felt sick after her trip to the ward. I madly body scanned all the way to the ward and as the bed came to a halt. I was relieved that I felt fine.

I spent three nights in the hospital and never felt sick. The pain was there but it was managed by regular doses of paracetamol. Sleeping was uncomfortable due to both internal pain and pain from my “stab wounds” (from laparoscopic surgery) The first night I had sharp upper stomach and neck pain from the carbon dioxide and an extremely sore throat from the tube.

It will take several weeks before I can conclusively say that I’m glad I had the procedure done. What I can say now is that I have spent all of my adult life suffering from anxiety – some times worse than others – and I’m happy to be at a point where I can manage it to the extent that I can go in and have surgery without suffering too badly from my irrational fears.

Surgical Rites of Passage

Off the top of my head I can tell you the year in which I got my first period and how old I was. If I were to go hunting through my old diary of that year, I could even tell you the date. It’s important to me because it was a rite of passage. Even though I was still a child emotionally, technically it meant I was a woman and could have children of my own.

I can also tell you the date my last period started. It was 21 July 2013. That should mean I’ve been menopausal for some months now. Not so. You see, it never stopped. Since September 2013, I’ve been on hormones, had a Mirena, been on more hormones and been on antibiotics. None of them, however, could stop the bleeding for more than a couple of weeks. At the beginning of this year I went four weeks without a bleed and began to feel optimistic that it was all over. And then it came back.

So, on 7 May I had a hysterectomy. I didn’t just have my uterus out, however; I also had my ovaries and fallopian tubes removed. There was no medical reason for that choice. I chose that option for peace of mind. My mother was in a very low risk group for ovarian cancer and got it. Ovarian cancer is insidious. For the most part, diagnosis occurs at the advanced stage so the mortality rate is high. Some women are “lucky” in that they have pain or bleeding that allows an earlier diagnosis but my mum wasn’t one of them. It was more likely that I wouldn’t get it but I wanted to remove the risk.

That means I’m now in “surgical menopause”. One day I was peri-menopausal. I was put under general anaesthetic and, a few hours later, I was menopausal. No slow petering out of the ovaries for me. No last period, no counting down of months to officially mark the occasion. I’m here already. Of course, if I’d only had my uterus removed, I’d be in a similar position but my ovaries would lead me slowly into menopause. I haven’t slowly glided into it; I’ve crashed headlong.

And so, I’ve been through another rite of passage. My childbearing years are over and I’m menopausal and it all happened in a few short hours. This time it was done surgically. I can tell you the date, how old I was and even give you an approximate time.

I like things clear-cut and am not good at going with the flow. I wonder if any of us who suffer from anxiety are good at it. Consequently, I’m glad it’s done and dusted. I know I have a can of worms waiting to be opened and that it may be a rough ride. Nevertheless, I’m here on the other side now and that works for me.

Do Anti-Depressants Blunt our Feelings?

Recently I read an interesting article about women and anti-depressants. You can read it here. I would encourage and recommend you to read the entire article so that nothing I write is taken out of context.

I can only speak for myself when it comes to experiences and side-effects of anti-depressants. A handful of friends have used them and have had positive experiences. Others have experienced what the writer is talking about and have stopped using them. I don’t know if they’re overused by women or not; I was once prescribed Prozac for PMT. I didn’t take it because I didn’t need it. What I felt I needed was something to help balance my crazy hormones at the time. In fact, I found another doctor who put me onto Indol-3-Carbinol which aids in the clearance of oestrogen. The I3C worked for me. I believed that taking anti-depressants would be inappropriate because I was suffering from neither depression nor anxiety at that time.

There is one paragraph of the article, in particular, that I want to address.

The most common antidepressants, which are also used to treat anxiety, are selective serotonin reuptake inhibitors (S.S.R.I.s) that enhance serotonin transmission. S.S.R.I.s keep things “all good.” But too good is no good. More serotonin might lengthen your short fuse and quell your fears, but it also helps to numb you, physically and emotionally. These medicines frequently leave women less interested in sex. S.S.R.I.s tend to blunt negative feelings more than they boost positive ones. On S.S.R.I.s, you probably won’t be skipping around with a grin; it’s just that you stay more rational and less emotional. Some people on S.S.R.I.s have also reported less of many other human traits: empathy, irritation, sadness, erotic dreaming, creativity, anger, expression of their feelings, mourning and worry.

Let’s start with sex! I’ve alluded to an on-going health issue which has played a role in why I’m on anti-depressants. Basically, in July 2013, I began a period and it’s never really stopped. First of all, I was put on the Pill but that didn’t work so I was taken off of it and put on a high dose of progesterone to stop the bleeding so I could have tests done. The Provera held it at bay for five glorious weeks. Following that, I had a D&C and had a progesterone releasing IUD (Mirena) inserted. After a year of waiting for the bleeding to “settle” I was put back on the Pill for a month to “reset” things. It didn’t work. Most recently, I’ve taken a course of antibiotics for a pelvic infection. I certainly had an infection but I’m still bleeding. In all fairness, I experienced four blood free weeks after the antibiotics. It’s been back now for over a month, though. Needless to say, with all this happening, my libido went from healthy before the big bleed to non-existent way before I was on anti-depressants. I can’t conclusive say that they’ve reduced my sex drive. I used to have sexy dreams a lot, too. I haven’t had one in ages. I don’t know if that’s from the meds or the hormones. I think, however, that they stopped before I went on the SSRI. The truth is that I was too distressed to notice anything, except in hindsight.

SSRIs tend to blunt negative feelings more than they boost positive ones. This is true. It’s exactly what I wanted and needed when I went on them. As well as the bleeding which was terrifying me because my mother died from a gynaecological cancer, I was dealing with three other on-going issues in relation to my family. I was tired, scared, angry, anxious and depressed. I hadn’t felt happy in months. I didn’t care so much about feeling happy again; I simply wanted the edge taken off what I was going through. The SSRI did exactly that and I’m grateful. My health issue and two of the other issues are on-going so I still feel like I want to be on my SSRI. I’m considering a hysterectomy. When that’s done, I think I’ll be in a better position to deal with the rest and will ease off the meds then. It will be interesting to see how low my lows go, if my anxiety worsens and if my libido and sexy dreams return.


As far as the other feelings go, I may have lost creativity. I can’t be sure because I think my creativity, like my libido, was waning in the light of the other things going on in my life. In 2012, I was more creative than I’d ever been in my life. By 2013, just holding it together took all my energy. And that was before the anti-depressants. I’m doing well enough to write blogs and think about a novel.

Being on an SSRI has done nothing to blunt my empathy, especially in relation to my loved ones. In fact, I feel I'm better able to help them with their issues because I'm not falling apart myself.

Ultimately, I like to believe that we’re smart enough to know if we need anti-depressants or not and to experiment, in conjunction with our healthcare providers, to find the right one. It’s not my place to say whether they’re overprescribed or not. I found the article great food for thought, though.

Acceptance Commitment Therapy Part Two

At the heart of ACT is action. It could well be called Action Commitment Therapy instead and the acronym is meant to pronounced as the word, act, rather than as initials.

The actions one takes in ACT are those that help create a life, living out one’s values. Goals are seen as stepping-stones to those values. The idea is that, if one lives according to one’s values, they will create a full and meaningful life. It isn’t possible to be happy all the time. As I wrote in part one, thoughts and emotions come and go and change. It is, however, possible to live a life full of meaning. That is contingent on action.

Values: Values are different for each individual. In The Happiness Trap, there is a vigorous questionnaire to help the reader identify his/her values. It covers all aspects of life, including family, friends, work, health, spirituality and recreation. The idea is to determine what one wants to bring to each of those areas of one’s life.

Values are broad so it’s acceptable to make a sweeping statement such as, “I want to be a loving, supportive, interested, fun and thoughtful partner.” Values are like a compass by which we set our lives and are on-going.

Goals: Once one determines what their values are, it’s time to set goals. Goals are achievable steps that enable one to live by values. Goals are the action one takes in order to live a meaningful life. For example, I identified one of my values as being a loving, supportive, interested, fun and thoughtful partner. That’s pretty broad. My goals are the action I take to live by that value. I may incorporate small acts into my life such as calling my partner at lunchtime to see how his day is going, make sure I give him hello and goodbye kisses and hugs every day and give him my full attention when we’re interacting.

The Happiness Trap suggests setting long and short-term goals and doing something each day to facilitate them. I’m still at a point where my goal for the day may simply be getting out of bed and caring for my family. That’s okay by me because that’s one of my values and I’m taking action – no matter how I feel – to do so. I would, however, like to stress that, if someone is suffering from depression, even doing that may be difficult. The Happiness Trap is not meant in any way to be a treatment plan for depression, although ACT can be one form of therapy. Furthermore, if someone’s depression has made them too ill to do so, medical help should be sought.

The book also talks about urges and willingness. Urges are something we all experience and they can be strong. Another one of my values is to take care of my body. I really enjoy chocolate and that’s not a problem. Sometimes, however, if I’m upset, I’ll binge on sugar. Ultimately, I feel much worse after doing so and I know it’s not in line with my value of taking care of my body. The Happiness Trap suggests dealing with those urges by using de-fusion, expansion and action. The action that I would take in that situation might be to do something that is in line with my value instead of sugar binging. I could go for a walk instead. Even better for me, I could crank up the sound on my ipod and dance that urge away.

I’d like to stress that urges and addiction are two different things and I’m referring to the former. ACT may work for someone as an adjunct to a twelve-step program but an addiction requires greater help.

Willingness is an essential component. One must be willing to embark on a course of action to meet goals and live by one’s values. Furthermore, one must be willing to do so, even if – and maybe especially if – there is a chance of failure. Maybe the goal may not ultimately be met. By trying, however, one is living one’s values and also giving oneself the satisfaction of trying.

To put ACT in a nutshell, one defuses from one’s thoughts, expands to allow emotions to be there instead of fighting them and commits to a course of action based on one’s values. Once taking action, it is best done mindfully, fully connecting with it. Furthermore, it is an on-going process.

I suppose that incorporating ACT into my everyday life, rather than just using it when I’m anxious is now one of my goals. The value? To live as calmly and peacefully as I’m able.

Acceptance Commitment Therapy Part One

I finished reading The Happiness Trap and am glad I did so. It helped me to understand Acceptance Commitment Therapy better. I’d now like to share my interpretation, based on my readings.

Although the word, therapy, is in its name, I think it’s more of a lifestyle choice than a therapy. Therapy can imply a course of action on which one embarks to make oneself better. ACT can be incorporated into a well person’s life, as easily as an unwell one’s. I think it’s a tool for improving the quality of one’s life, regardless of one’s mental or physical state.

ACT can initially be broken down into three components: thoughts, emotions and actions.

Thoughts: thoughts can be looked at as the stories the mind creates to interpret and make sense of our lives, situations etc. They may not, in fact, be true. For example, if I pass a friend at the shopping centre and she seems to look right through me, it’s possible that she hasn’t seen me. My mind, however, may tell me the story that she doesn’t like me anymore. That’s not a fact; yet, my mind has told it to me and I’m likely to agree with it. I have “fused” with that thought and am now feeling pretty upset about the fact that my friend doesn’t like me anymore.

The first step in ACT is to “defuse” with our thoughts. There are several ways to do so but they all work on the idea that thoughts are not facts. My favourite way to defuse is to slightly distance myself from the thought by saying to myself, “I’m having the thought that Hermione hates me” instead of “Hermione hates me.” Another way to do so is to say to oneself, “Oh it’s the old Hermione hates me story.” The idea is to acknowledge the thought without fusing with it. It’s just a thought.

Emotions: Let’s say that it turns out that Hermione actually does hate me. I’m going to be very upset when I find out. This is where, in ACT, “expansion” comes in. Instead of feeling bad that I feel like bad and guilting myself for a perfectly normal emotional reaction to the situation or trying to make myself feel better with positive platitudes, I’m going to make room for the feelings. I’m going to sit quietly and, rather than thinking about Hermione or something distracting, I’m going to focus on how my emotions are manifesting themselves physically. I’m going to notice that there’s a knot in my stomach, a lump in my throat and tears just behind my eyes. The idea of expansion is to make room for the feelings and allow them to be there. Once I notice them, I address each one separately, and simply let it be there. Whilst it doesn’t make one feel better – that’s not the point of it – it can circumvent both an escalation of the feelings and the barrage of unhelpful thoughts.

As a society, we tend to think of emotions as being “good” or “bad”, and that we have a choice as to how we’re going to feel. Emotions are just the way we feel; they’re neither good nor bad. Some groups even believe that happiness is our natural state. I disagree. I believe emotions are a response to what is happening in our lives or in our heads. I wasn’t at all happy when my mum passed away; I experienced the normal reaction of grief. We expend a lot of energy trying to fight and or deny the ones which make us feel bad. In ACT, we just have to make room for them.

The other day, I felt really happy for an unknown reason. My immediate reaction was to try to work out why and then tell myself that whenever I felt happy like that, something bad would happen so it wasn’t good to feel happy. First of all, I used “defusion” to distance myself from the unhelpful thought. Then, however, I thought that, if my thoughts were true, wouldn’t the best thing to do be to enjoy the feeling while it was there, rather than make it go away with such thoughts. Consequently, I used “expansion” with a “good” feeling. I focused on the way my mouth was shaped into a smile, my stomach had delicious butterflies and a laugh was a bubble in my throat waiting to be released. Eventually, like all feelings, it passed. This time, however, I fully experienced the feeling and simply allowed it to be there. It was very enjoyable, too. Maybe something bad is going to happen. Who knows? If it does, I have a lovely feeling of happiness to remember that may just help.

Action: Another important part to ACT is living by one’s values. I’m going to deal with that in my next blog post. The idea of action is the third component to the first part of ACT. Having defused from one’s unhelpful thoughts and expanded to allow room for whatever one’s emotions are, one commits to a course of action doing something one values or working towards a goal that allows one to live by one’s values, and giving it one’s full attention.

The most frequent situation in which I use ACT is when I’m out and about and feeling nervous. I simply commit to continue what I’m doing. I value being able to get out, after having experienced agoraphobia. Even though my mind is telling me that I’m going to have a panic attack and die and my heart is trying to beat its way out of my chest, I choose to commit to being wherever it is that I am and doing whatever it is that I’m doing. Furthermore, I try to notice all that is going on in that situation. I do so by sense. I focus on what I can see, hear, smell, taste and feel, depending on what I’m doing. Of course, thoughts and emotions always come and go. I try my best to let them do so without engaging.

We can’t help what we think or feel; all we can do is defuse from our thoughts and expand for our emotions. We can, however, control what we do and how we do it. There will always be “unhelpful” thoughts and “negative” emotions, over which we have no control. To be able to walk out the front door, say no to another drink, walk away from a futile argument with a loved one, say no to that chocolate cake because your doctor has told you that you’re morbidly obese and you want to be around to see your kids reach adulthood are actions which can be chosen to live one’s values.

None of it is easy. That’s why it’s important to identify what matters to one in one’s life. That’s coming in the next post.

ACT, values and goals

I’m currently reading a book titled, The Happiness Trap, by Dr Russ Harris. It’s essentially an in-depth look at Acceptance Commitment Therapy (ACT). My psychologist taught me ACT but reading the book is leading me to a deeper understanding.

ACT involves accepting thoughts, beliefs and feelings rather than challenging them. That’s what I like about it. I’ve learnt to disengage myself – to a certain extent – from my thoughts and feelings by simply acknowledging them. “Yes, I’m feeling very anxious about such and such.”

Following that, I commit myself to a particular course of action. Usually, it’s to continue what I’m doing. I’ve just come back from being on holiday and I always seem to move more out of my comfort zone when I’m away. Consequently, I use ACT a lot. I don’t want to miss out on the things that I’ve come a long way to do so I have to accept my anxiety and commit to doing those things, regardless of my feelings.

Another aspect to ACT is values. The idea is to commit to action which is in accordance with one’s values and goals. This is my stumbling block. I very much use ACT to get through whatever situation I’m in, thinking only of the short-term goal of what I’m doing at that moment.

To be honest, I don’t think about values and/or goals anymore. It’s all I can do to keep my head above water and get through each day. At this stage, any goals I have are purely short-term and informed by my PAD. A few months ago, just as an exercise, I wrote a “life plan” but, again, it was written within the boundaries of my disorder.

When I finished my allocated round of sessions with my psychologist and was doing better, I said to her that I felt like a cage door had been opened but that I didn’t know how to walk out. I don’t think she quite got what I meant. I saw her again recently for other reasons and it came up again. I still didn’t feel as if I were pointed in the right direction.

For a control freak and list maker, it’s uncomfortable to careen from day to day without any tools for planning how I want my life to be. I can plan my week, based around chores, errands and appointments and I can daydream about living in Paris and writing in smoky cafes but I find it impossible to look at what my values are and use them to determine the kind of life I want to be living. Of course, I can use ACT to deal with those feelings of discomfort!

Therein lays the difference between the book I’m reading and my therapy. Although I have no one to bounce ideas off of, the book has a part – which I haven’t read yet – about using ACT and values to make plans and goals. If ACT can add that extra layer to the acceptance and commitment I’m already using, it will be a great therapy, indeed.

(Just to clarify, I think my psychologist is wonderful!)

Anchors

I was in Year 10 in 1978. I lived in what I thought was a stable, nuclear family. I couldn't be sure, however; it had splintered once. I attended a small all girls' school that was in the process of going co-ed and I went to ballet classes regularly. Although I adored ballet and had been good at it when I'd been younger, my body seemed to be finding it progressively more difficult to do moves that had previously been easy. At that point, I was built for ballet; small and painfully thin.

At the beginning of 1979, my parents separated, the last of the girls on the former girls' school campus moved across to the now co-ed former boys' campus for Year 11 and I decided it was time to quit ballet. It was to be a significant year for me. Even now, I feel as if I left something behind in 1979 and, if I could just go back, maybe I'd find it and feel whole again. I wrote a novel - never to see the light of day - which was set in 1979 and one of my very astute friends asked me why my heroine travels back to that particular year. I think, however, she already knew the answer since she was there with me back in '79.

So, there I was living in what now felt like an incomplete and wounded family, going to a strange school and dealing with the fact that, now that there were boys around, my close-knit group of friends became less supportive of and more competitive with each other, and not dancing away my cares any more.

At the time, none of it seemed like a big deal; I was just trying to survive it all. I finished school and went on to university without looking back. It was only when I began to experience anxiety and depression that 1979 took on significance. With the benefit of hindsight I knew it had been a life-changing year but I could never really put my finger on why that was so. I've had many other life changing years. In 1994 I began a new job, moved house and had a baby, for goodness' sakes, but it hasn't haunted me and left me with the feeling that I have to go back.

Sometimes when one's busy doing something else a vital piece of information lands in one's head, as if it has nothing to do with one's own brain and thought processes. That happened to me the other morning. I don't remember what I was doing or thinking but suddenly, out of the blue, the following thought randomly ran across my mind, "You lost three significant anchors in 1979." An anchor can be "a person or thing which provides stability or confidence in an otherwise uncertain situation." Bingo!

Not one but three anchors! Wow. No wonder it's significant. I lost the security of my family, my school, my group of friends and the thing that I was most passionate about at that time. Of course, it all turned out okay. I got used to having separated parents and to the new school and learnt how to navigate the scary world of girls competing over boys. I replaced ballet with rowing and, within months of stopping ballet, my body did what it had been longing to do: grow. Suddenly, I was tall and curvy.

Nevertheless, it did damage me and I still wear the scars. Now, however, thanks to that random thought popping into my head, I finally know that what I left behind were my anchors. I was set adrift without anyone or anything to provide stability and confidence. That's pretty tough for a fifteen year old. Over the years, new anchors have come and gone. None, however, have provided the feelings of stability that a child feels in a close family or friendship group.

Being able to identify the root of my longings for 1979 has led me to think about what anchors I already have and what ones I can create to increase my feelings of stability and confidence. Given my past, I'm loath to nominate people or situational anchors. They're too changeable and volatile. I suspect my husband is one, though. Rather, I've been thinking about the constants in my life; the things that have always been there that I've never considered to be anchors. With a small shift of perception, they now are. Knowing that, gives me a sense of confidence and stability.

You're reading from an anchor, by the way. Not this blog or post; writing. I've been journaling since I was eleven years old and have no plans to stop. Writing always makes things better and provides me with a sense of peace or purpose, depending on the piece. In the past few years, I've become a sporadic reader. With social networking and digital technology, my attention span has decreased, making it tedious to read a book long enough to fall in love with it. Reading, however, is another anchor for me. With that in mind, I'm reading a novel and making sure I read at least one chapter each day. Reading fiction provides me with an escape from my own mind and all the dark brooding therein.

The last one is the beach. A couple of years ago I was very upset and got into my car and just drove. It was no accident that I ended up in a car park staring out to sea. When I was younger I lived in a beachside suburb. I went to the beach at least once each weekend, rain or shine, winter or summer. I don't care much for ocean swimming but I could walk for hours on the beach. The closest I get these days is driving along the esplanade when I bring the children to school. I plan to change that and commit to spending some time walking on the beach. I know that doing so will also provide me with confidence and stability.

I don't think that suddenly understanding about lost anchors and current ones is going to cure me from anxiety and depression. I do, however, believe that they can boost me in such a way that I can better cope with both. I think that deep down inside I may still be that hurt fifteen year old who lost her anchors. Providing her with some new anchors will help both of us.