Chest pain + anxiety + how to break this spiral

[anxiouscoder]

Hi all,

I’ve kinda been wanting to write all this down anonymously somewhere and see if there’s somewhere on the internet I can find experiences of others that may be similar. I found OSMI and wonder if it’s the place.

I’ll post a summary first, then a more detailed back story, and then I have questions at the bottom.

Summary

• I’ve been having weird chest pains on and off for about 14 months.
• I THINK these are partly acid reflux, partly anxious tension, and partly musculoskeletal back/chest/neck pain moving to my chest.
• BUT they totally freak me out and I’ve got it into my head that when it happens it’s some kind of heart problem.
• I’m also really struggling with the UK lockdown and it consequences on me.
• This has lead to a few nighttime panic attacks.
• My doc has prescribed omeprazole for the acid and a low dose of sertraline.,I’ve not started taking the Sertraline yet - still figuring out if this is a good idea or not.
• I have a call this week with our community mental health people.
• I just can’t seem to break the spiral and release myself from the anxiery and catastrophic thoughts.

Back story

I should say I’m early 40’s, male, generally active and healthy, not overweight, but with a generally over-sensitive brain.

About 14 months ago, I was out running (actually walking) an errand in my neighborhood and I had a strange, mild chest pain that I’d never had before. It persisted and I felt like it was moving to my back, so I called our non-emergency health line that we have in the UK. They decided it should be checked out and sent an ambulance. My ECG was a tiny bit weird so they sent me to hospital for blood tests and more ECGs but all came back clean and they let me go.

The chest pain kind a came and went and I ended up seeing my doc who was pretty certain on it being acid reflux and prescribed me something for that. Which I took, and I’m not really sure if it helped or not. I stopped taking them when I ran out.

I think I then had a good long stretch of everything being OK. I had odd, mild pain in my chest again from time to time but, despite occasionally freaking out a bit, I mostly got past it.

Then, late last year (2020) it started to become more frequent again. Initially I decided it was more muscular. I was very tense in my back and neck and shoulders, so I sought help from an osteopath. This seemed to help somewhat. But the pain did sometimes persist.

I called the doc and he prescribed more omeprazole for the acid again. The doc seems entirely unworried about these chest pains.

However, I ended up starting to panic more about it, until, in early Jan 2021 I ended up having what I guess was a panic attack one night where my body shook uncontrollably for about half an hour.

Because the doc didn’t seem interested I called the community mental health people and they scheduled an appointment for a chat in mid-February.

In the meantime, I think the omeprazole helped a bit, but I still had twinges and aches. Sometimes I felt pain in my jaw and back too and these are symptoms of heart problems, so I was still freaking out. Until, in late Jan, I had another panic attack.

I called the doc the next day and he chatted things through with me, said that half an hour of physical shaking was pretty serious and offered me a low dose of Sertraline. I’ve picked up this prescription but not taken any yet while I research it.

I’ve been cutting out caffeine and alcohol. Not that I drank a huge amount of either - 2 cups of caffeinated coffee a day and at most a few units of alcohol a week. But I started noticing possible patterns involving them. This seemed to help me this week, but - and this is what has caused me to write this all down here - just now I had some sudden pain come on in my chest and my brain totally freaked out to the point where I just had to go and seek solitude and rest.

This is starting to become debillitating though. And despite having learned some congitive behavioural therapy and applying that tell myself the right things about what is going on, and despite using the “Calm” app to practice breathing and dealing with my thoughts, I’m really struggling to break this cycle.

I don’t know where my brain has got this idea about heart problems from. But it takes huge mental effort to persuade myself that that’s not what it is. But I still have this worry: what if I’m wrong? What if it IS a heart problem? The CBT says:

• You’ve been through this and been to hospital and been tested, your heart is fine
  and
• Your doctor is completely unworried about your heart
  and
• You’re SUPER low risk for heart issues
  and
• You’ve experienced this so many times before and it’s fine, it’s just acid or muscle pain

But something in me won’t accept it. And it’s a downward spiral. Of course, the anxiety creates more tension, adding to the physical symptoms I already have.

And this is all, of course, not helped by the pandemic and lockdowns and my current situation with small children stuck at home because schools are closed and bouncing off the walls bored and anxious themselves. I’m pretty broken from all that. And, being in the northern hemisphere, I have low levels of daylight and crappy weather and thus I’m not exercising as much as I normally would.

Questions

• Has anyone else been here?
• Has anyone actually experienced a heart attack and can reassure me that “You’ll know when this is actually happening” or something?
• What are opinions on Sertraline or brain meds in general? Should I just get on these things ASAP?
• Any other help or encouragements to be offered here?

Thanks for any experiences and advice you can share.

[SMotaal]

Hey @anxiouscoder,

Sorry you are going through you own version of this dilemma. What I learned personally, neurodivergence in today’s society comes with a hefty cost of what we call “masking” that often goes as far back as early development, and so, when there is progressive anxiety along with pain, it can be easily seen by others either way:

• Anxiety can represent trauma, which can lead to Complex PTSD, which would manifest with pain, especially in the chest.
• Pain in the chest not being resolved can lead to hypervigilance, which has more recently been substantiated as a heightened cell danger response pathology.

Without objective confirmation, the next best way for the determination is often times the individual themselves.

As you may know by now, a negative result is only a partial elimination, not confirmation, where it is plausibly a false result to a certain statistical degree, and plausibly a false test to an uncertain statistical degree if consider both our limited medical understanding in general and that specific to the doctor(s).

A lot of people spent years in the mental health leg of this, including myself with 19 years of different diagnoses, until we eliminated the false subjective confirmation that comes from what we refer to as the double-empathy problem and the prejudices of the neurotypical looking-glass. Many of us discovered that we were masking symptoms of our neurodivergence, including sensory processing differences for myself, along with their compounding manifestations that leave it harder for us to identify with both emotions and pain, which often results from a less known but separate condition known as Alexithymia.

I will tell you that my life only started to make sense when I finally took the first step and landed here, back in 2018, and more so when I later happened upon a Quora answer that was just spot on in November, 2019.

What I will emphasize to you once again, your best compass to figure out where you want to focus your efforts is yourself as the individual. The idea here is to mindfully reflect to seek out the knowledge slowly and cautiously, so that you do not end up overwhelming your mind and body. The more informed you become, the more you will learn to harmonize your mind with your body, the more readily you will be able to trust your instinctual capacity to tell the difference.

I would recommend doing some searching on Quora, and to check out spaces like Neurodivergent, which happened to also be the very first stop for myself a little over a year ago.

Answers

• Has anyone else been here?

Answered, I hope.

• Has anyone actually experienced a heart attack and can reassure me that “You’ll know when this is actually happening” or something?

For me it is not heart attacks, but I have a condition known as POTS, where my heart rate would fluctuate with ≥ 30 bpm differences between when I am sitting or lying down and when I stand.

I found that having the newer Apple Watch models with the in-crown closed-loop high-resolution heart-rate monitor was a great way to become more mindful of my heart rate, which does not check for heart problems but makes it more likely for my mind to differentiate stress-pains from stress-compounded-pains related to actual chest pain.

• What are opinions on Sertraline or brain meds in general? Should I just get on these things ASAP?

I have personally tried so many medications over the years, and have slowly learned to carefully research and mind how the medications are affecting me on many dimensions.

For antidepressants, there are several classes, Sertraline belongs to the SSRIs, but there are several other classes that prove more or less effective on an individual basis, ie it is a learning process. You will likely want to not ASAP things but rather be patient and mindful with how things progress and more so that being on them will affect your subjectivity. So be sure to start them when you are ready, and to take things slow, because there is nothing wrong with needing to switch to alternatives in the same or even different families.

In 2015, I was taken of Wellbutrin, which I was on for almost 8 years at the time, and we tried different medications without any luck. In 2016, my doctors decided that it was now treatment-resistant depression and even suggested ECT.

Thankfully I was able to go online and sift through recently approved medications — yeah many doctors have their own mental issues when it comes to the web but that can easily just be because they were using IE — anyways, one of the medications was almost certainly based on my own experience and understanding that they lacked my best bet. We tried it, it worked, and it worked for a number of those they had promoted to treatment-resistant.

Doctors do not know everything, they do not tell you everything, and it is best to know this going in because the more reckless ones out there will not even see it when they make mistakes and will just add fuel to the fire when they gaslight you out their lack of awareness and/or self-awareness.

• Any other help or encouragements to be offered here?

In 2018, I was a mess, and I said it in one of my first posts here, I am a problem-solver by birth, but I suck at solving my own problems I waited 16 years to take full stock of things and made my first post, that was my mistake.

If I read it correctly, it only took you 14 months, but you started to observe and take charge of things already, and so I cannot promise you what you will find, but I can promise you that you are doing a far better job than many of the people I met along my journey.

Just remember, take it slow, take it in, and be kind to yourself.

Hope this helps

[LeDrudkh]

Hey! It’s really brave of you to reach out and seek support. Writing things down and finding a community that understands can be incredibly helpful. OSMI sounds like it could be a good place to share your experiences.