Anxiety, Panic and Heart Arrhythmia

I think I would direct him to a therapist who specializes in anxiety and panic attacks. It sounds like his "medical issues" i.e., worrying about blood sugars that are normal and arrhythmia that was declared harmless, are really more anxiety related. Perhaps if he were to work on the anxiety issues, he would potentially not have the medical issues to be concerned about.

Therapists aren't cheap, but many work on a sliding fee scale - which could be to his benefit.

I'm sorry he doesn't have good insurance.

A general physician or family physician is a good place to start, but he can do something before that which might give him some insight.

And by the way, I'm kind of familiar with this since my dd has anxiety/panic attacks and a heart condition called Inappropriate Sinus Tachycardia which means that her resting heart rate is always above 100 - she takes medication and sees an electrophysiologist.

So, your cousin should do two things right now.

1. Purchase a blood pressure reader at the pharmacy. They're at Walmart and everywhere else and they are easy to use. Don't buy the ones that go on your wrist, buy the one that goes around your arm. All you do is put it on with the little arrow facing the correct way, and push a button basically. He'll see his blood pressure and pulse. Some have a memory button that will record up to a hundred or so readings.

2. Buy a cheap paper notebook and use a page per day. On each page, keep a log or journal. Write down symptoms and what's going on.

Example: 10 am. Drank a large coffee from Starbucks. Haven't eaten since breakfast at 6 am when I ate ______. Tested blood sugar and it's ____. Feeling anxious. Took blood pressure and it's _____ and it shows my pulse is ______. Took 2 aspirin.

12 noon. Had a Quarter Pounder from McDonald's. Walked 3 blocks there and then back to work.

4 pm. Feeling panicky. Sweating and my hands are shaking. Hearing a lot of noise from co-workers and it's hot in the office. I think my blood sugar is off but I haven't tested it.

Keep a constant journal of his activities, what's going on around him, what he eats, what his blood sugars and blood pressure and pulse are, what he drinks, how he's feeling.

Have him do these things for a steady period of time before seeing a doctor. Encourage him to be thorough. A doctor (or your cousin) may be able to see a pattern, but even if they can't, it will provide a good picture to a doctor about what your cousin is experiencing.

A journal is a great tool for someone who is unsure about a health issue. It has to be specific though.

That way when he sees a doctor he won't waste any time.

In 2016 my then 21 years old daughter had some arrhythmia issues and she sees a cardiologist who specializes in electrophysiology.

Her issues came on pretty suddenly after the sudden death of my husband in the fall of 2015.

Her diagnosis was SVT.

After several episodes of her heart getting out of rhythm, ER visits and overnight stays at the Baylor Heart Hospital.. in July 2016 she had an ablation which has been successful.

Last year she was cleared for 1 year by her Dr. who is a part of a Heart Arrhythmia Group.

We do have insurance but the deductible is $12,000 before it kicks in so of course, in 2016, we hit that deductible with 1 ER visit and everything else was covered. I know a lot of Dr's will give you a cash price for those who have to pay out of pocket.

I am not sure if you need a reference from a primary care to see a specialist. We did not have to go that route due to her being in the ER.

She has no glucose issues. The professionals at the hospital did teach her a couple of methods to try to get her heart back in rhythm before going to ER. ER is scary because they re-start the heart.

I hope your cousin gets some answers. I know it is very scary going through heart issues.

Start with a general practitioner and he should have his thyroid levels checked (TSH, Free T3 and Free T4).
Hyperthyroid can cause heart racing issues, panic attacks, vision problems and a bunch of other issues.

it's a shame about his insurance situation, because it sounds as if he could use a good team. a solid GP, a heart doctor, and a therapist.

if that's not an option then i think the good solid GP is the place to start.
khairete
S.

It looks like he needs to work on getting a primary care physician first. His PCP would be able to guide him in the right direction. A PCP might treat the arrhythmia himself or if it's more serious, then probably refer him to a cardiologist. Your cousin should definitely see a mental health professional for the anxiety and panic attacks. But this could also be treated by a PCP if medications are all he needs.

Medical issues need to be ruled out before any mental health issues are addressed.

You can call the county he lives in and see what medical services he is eligible for or give discounts for paying cash. He can also negotiate, in writing, a cash paying fee with billing department. This applies to both physical health and mental health services.

Check with local hospital. They often give free information, screenings or tests. Our local one does routinely.

Does his insurance offer any discounts? My husband’s offers one free physical (with blood work) a year. His old employment also had days where employees could schedule a physical onsite (including blood work).

Start with determining the extent of any physical health issues, then move on to focus of mental health issues.

Who diagnosed him as having anxiety or panic attacks? If it was not a mental health physician, he really needs to follow up with one after his physical symptoms are better understood.

Additional:
Medication does not treat anxiety or panic attacks. It treats the symptoms of anxiety and panic attacks. A person with these disorders has to learn better and alternative coping mechanisms from a mental health professional to reduce the chances of the (very uncomfortable and scary) physical symptoms returning and the need for medication.

If he is paying out of pocket he most certainly does not need a referral. Many insurance plans require a referral to see a specialist but if he is self pay he can go straight to a specialist.

Having said that I think having a great GP is very useful to run things by. It sounds like he needs 2 docs though...one to deal with the heart isssues and one to deal with his anxiety.

For the blood sugar issues? He needs to see an endocrinologist. He needs to figure out what is going on - maybe a thyroid issues? I don't know. What's "normal" for one - isn't "normal" for others.

For example - my "normal" blood sugar is about 130 - which according to the guidelines is "HIGH". My husband's is 95. And that's considered on the low end of good. Many factors SHOULD go into blood sugar levels. WHY does he think they are off? Have they changed over the years? For me? Until I got pregnant and had babies? I was ALWAYS at 85 to 95. AFTER babies? 130. My body changed. I don't like it.

For arrhythmia? He needs to see a cardiologist. They will typically give him a 48 hour chest pack that will monitor his heart for 48 hours, then a stress test and other things like an EKG, etc.

For panic attacks? A therapist - start with a PCP and then go from there.

He maybe a hypochondriac if the doctors are running tests and finding nothing wrong. In that case? He needs to see a psychiatrist.

ETA:
Re the comment above that he does not need a referral is he pays out of pocket: that's true on the surface in terms of financing, but I read this as he has poor insurance, not no insurance, and so I thought he might be paying MOST of it out of pocket. So, yes, technically if he is paying full freight, there's no insurance company to demand a referral. However, with such a mix of symptoms, I doubt a specialist in one area (say, cardiology) would take him without a preliminary workup by a primary care physician if he might also need an endocrinology and a psychiatrist. In any case, he needs someone to coordinate his care across various specialties if that's what's indicated, and if he chooses the wrong specialist because he's not that organized or clear on what his medical priorities are, he could waste a lot of money going the wrong direction.

Original response: I think he needs to start with a primary care physician, preferably an internist (internal medicine). He’s got several things going on anyway, and it’s unlikely he could be seen by a specialist (such as a cardiologist) without a referral anyway. If it’s indicated, an internist will be able to do an EKG right there in the office, for example, and will be able to see whether that heart issue is still there and whether it’s “something” or “nothing.” There can also be a discussion of the panic/anxiety and whether that is creating an actual arrhythmia or just a feeling of racing or fluttering. If anxiety medication would be a start, most internists will do that. The doctor will also be able to do at least a preliminary assessment of blood sugar issues.

If your cousin has significant blood sugar issues or diabetes, he might need an endocrinologist. If he has an arrhythmia that requires more work, he might need a cardiologist. If his anxiety is crippling, he may need a psychiatrist to manage his meds and do therapy (or a psychologist for therapy who consults with a psychiatrist regarding meds). But you’re not there yet. Far from it. And they won’t take him anyway (and insurance won’t cover it at all) without a work-up by a primary care physician.

The insurance issue is a problem, absolutely. But most plans cover preventive care (one physical per year) for free – on purpose. If he gets billed for lab work, he can make small payments every month until that’s paid off. He can set up a payment plan, or just make regular payments little by little so the account doesn’t sit there and then get sent to collection. Also, many of the pharmaceutical companies have foundations or patient assistance programs (you fill out a form and have the doctor sign that the med is prescribed, and then you get a card to present to the pharmacy). Also, some doctors still have free samples to give out. My husband’s primary care physician had a nurse in charge of medications, and she often had “donated” meds from secure sources that could be given out to patients in need.

I have heart arrhythmia as well as anxiety. I started with my go who completed some tests and referred me to a cardiologist. After some more tests, I was told that my arrhythmia is benign. One of my aunt's had a form of arrhythmia that would progress to heart beating too fast. My heart has never did anything strange except to have pre beats. It's the extra beat that causes my heart to feel like It's fluttering. The prebeats are harmless. I've found that the only time I have numerous flutters is when I am anxious.

I suggest your friends anxiety and panic attacks are related to his worry about his heart. Has he researched heart arrhythmias?.I suggest his first step be learning more about the different causes of arrhythmias and how most are harmless. Perhaps making an appointment with a cardiologist could help him understand more about arrhythmias. However, specialists are more expensive than a regular MD.

I suggest this because diagnosing arrhythmias is very expensive. I wouldn't be able to pay for testing without insurance. Another advantage to seeing an Internist, family doctor or general practitioner is that those doctors can also help him with his anxiety, depression and panic attacks. A visit with a counselor may also help.

For years snd still now, I'm frequently hungry and without energy. My glucose test, in the last few years, shows that I'm prediabetic. Before those my glucose tests were normal.

Early in my life, I learned that I felt best.when I ate frequently and focused on protein and eating less empty carbs. A snack is often cheese and fruit or nuts. I find again that when I'm more anxious my hunger increases.

Xanax (as well as a few other similar drugs) can be helpful for anxiety as well as magnesium (Epsom salt baths) Just taking some time to relax maybe do some deep breathing. make conscious efforts to avoid letting stress build up. Sometimes you have to detach from reacting to everything immediately or you will build up your stress and anxiety..be aware of your stress and anxiety levels and what sets them off..Foodwise it doesn't hurt to try to throw some good healthy stuff in. I swear by quaker oatmealand that is good stuff for your heart..You can doctor it up with some blueberries..ceylon cinnamon (which is good for blood sugar supposedly) So as far as doctors I would advise psychiatrist for the anxiety med..Maybe even visit a psychologist or read up on some techniques for managing stress and anxiety with conscious awareness. I would get a stress test/echocardiogram test and a wear a holter monitor for 48 hours if you haven't already and if you can afford it. I am not so sure I would call heart arrhythmia totally benign and wouldn't lump it in with anxiety. You might be able to take some comfort in the old cardiologist visit.(have symptoms changed a bit since the old visit?) You could ask the cardiologist or any of the other doctors if they think magnesium would be ok for you to try..I have a spray and I spray some on when I have issues sometimes and feel it really helps and the baths are majorly de-stressing..chamomile tea is relaxing too..You could google the magnesium..sometimes you have to make sure you get potassium..calcium etc a balance of sorts...best luck oh and I don't know if I would recommend it but splash of cold water in the face sometimes works..