Health Anxiety and Q&A Live Presentation REPLAY

Hello and welcome to today's show on health anxiety. I'm your host, Dr. Donnelly Snipes. Let's first start by defining what health anxiety is and what it isn't. Health anxiety is a persistent fear that you will get sick, that you are sick, or that your illness is getting worse. Now, that's different from being cautious or being concerned. Health anxiety is so severe, so persistent, that it negatively impacts your life. It starts causing clinically significant distress in your life. Where does it come from? Well, we don't exactly know, but we can trace some correlations back. If a person has a history of illness, then they may be afraid, they may be fearful of getting sick again. So that can cause health anxiety. If they have a current chronic illness, like an autoimmune disorder or cancer or, you know, anything like that, then they could be constantly on guard and worried that they're going to get sick with something else in addition to what they've got or that their illness is getting worse. So they may be hypervigilant. There can also be reinforcement of physical hypervigilance. Whenever somebody has an ache or a pain, if a family member, especially a caregiver when they're younger, all of a sudden turned that into a catastrophe, then the child learned health anxiety. They learned that every time I've got an ache or a pain, it could be catastrophic. Cognitively, people who lack an understanding of the risks, protective factors, and probabilities of illness can have a lot more health anxiety because they hear stories, they see clickbait on the Internet, those sorts of things that make it seem a whole lot more likely to happen. And one of the things we're going to talk about in the interventions is the strategy that I talk about a lot. FCP facts, control and probability. What are the facts about how likely you are to get it and the risks and protective factors, what aspects are within your control? So a lot of times we have a certain amount of control to protect our health. And what is the probability that you are going to get this? Not the possibility. There's a possibility that anything could happen. But what's the probability if you do the things that are in your control that. That you're actually going to get this illness? We also could develop health anxiety due to cognitive biases due to exposure. When you are at school, for example, you may be taught that certain things are a lot more likely to happen, so you could be exposed to things that are a lot different, or you could be going into environments where other people are sick. So. So you think that you are more at risk, which to a certain extent you might be. But understanding, again, the difference between possibility and probability is very important. And I mentioned media and quote, clickbait. They actually have a term for it now, and they call it cyberchondriasis because there are so many websites that use headlines and title articles and blog posts and in ways that increase people's anxiety to get them to click on it. Like these five warning signs of lung cancer you might not even have known. Well, if you click on that, then automatically your anxiety is up. So it's important to recognize that media, unfortunately, because they are funded by us going to their sites, they tend to want to do things that promote that. So they could exaggerate the risk that you face, or they could exaggerate the likelihood that a particular symptom is actually catastrophic. It's important to remember that most things, most symptoms are found in multiple different disorders. So you could have, for example, pain, I'll give you the example. You could have pain in your low back and you could think, oh my gosh, you know, it must be kidney cancer. It could be that you slept the wrong way or you twisted the wrong way, or you might have a kidney infection. But going from I've got a pain in my back to the catastrophic end, that's where health anxiety plays in. And you want to look at the probability. And we're going to again, talk more about that in a minute. Environmentally, being in environments that are higher risk, especially if social distancing is not possible, can increase people's health anxiety, especially about contagious things. Obviously being in an environment where there's a bunch of people with cancer, you're not going to catch cancer. But being in an environment where you know there's a lot of people with a cold, could you catch a cold? Maybe doctor's offices and hospitals where people go when they are sick, obviously you have a higher risk of getting sick there. So people who work in those environments, or even people who have been in those environments, you know, maybe get to get a well check or because they were taking a friend to the doctor or something, they may have more health, health anxiety. And it, I'm going to keep saying it, possibility versus probability. You know, if you were in there, did you sit next to somebody who was sneezing and snotting and coughing? Did you wash your hands or disinfect your hands before and after you left? Did you practice good hygiene and social distancing? If you did, then even if they were in the room, you know, what's the probability. So anyway, jails and subways are also other examples. When people ride the subway to work, a lot of times they're crammed in like sardines. So social distancing is not possible. And law enforcement officers and correctional officers who work in jails are at higher risk because they're in environments where there tends to be less social distancing, and they're around people who tend to be sicker than the average population. Just being aware of what are your risks so you can mitigate them is important. Relational causes of health anxiety. Having a family member or a friend with a chronic illness. If this person has this chronic illness or this disease and you start to get a similar symptom, and then someone with health anxiety might assume that, oh, I have a symptom that's similar to theirs, I must therefore have this same problem again, it could be something completely different. Having a family member or friend who experienced medical trauma, being misdiagnosed, for example, and then going on to have catastrophic outcomes could be problematic. Not having faith or trust in medical providers, especially if the medical providers you've worked with in the past have been dismissive, you may have a lot of health anxiety because you're not sure that they're actually paying attention, paying enough attention to catch a problem. And medical providers that fail to provide information or informed consent information is important. Why is it that they think you have this condition? Or what is the likelihood if they're sending you for tests? What is the likelihood that the worst case scenario is, you know, actually going to happen? How concerned are they about that versus what else might it be? It's important for medical providers to communicate so people's minds don't go to the worst case scenario. So, so people's minds don't start to wander, or worse yet, so people don't go home and start going on the Internet and going, why is the doctor sending me for tests? What is he not telling me? You want to have faith and trust in your provider that they are actually telling you everything. And then informed consent is when providers give you all of the available options and provide you with information about all of the possible risks and, and benefits to the options. And if you're not provided effective informed consent and something bad happens, or you have an unexpected outcome, then again, you may start fearing every time you go into a new procedure or have something done, you may have a lot of anxiety because again, you're not sure if they're telling you everything. What are the consequences? And I call this chicken egg, because when we have high stress. When we have high anxiety, it suppresses our immune system, it suppresses our pain threshold, and it contributes to sleep disruption and a lot of other things. So health anxiety itself can actually cause you to get sick, and being sick can cause health anxiety. So we've got to kind of look at what, what came first, but also pay attention to what's going on in the present. So consequences of health anxiety. HPA axis hyperactivation. Remember, your HPA axis is your fight or flight system. And when you're stressed, when you're anxious about your health, which is your body functioning, then that causes you to feel, feel anxious, feel, you know, like you're in that fight or flight state. When that HPA axis gets stuck in the on position, when you have persistent anxiety, then it reduces your immunity, impairs your sleep, increases your pain, increases your risk for what you're fearing. They've actually correlated high stress with an increased risk of developing cancer. Why? Because that HPA axis hyperactivation throws so many different systems out of whack and promotes inflammation. They've correlated the two. So it's important to recognize that. And it's also likely or you have an increased likelihood of overdoing a good thing. And what do I mean by that? There are things that we can do to take care of ourselves, like exercise and eating a healthy diet that high in antioxidants. But some people are so fearful of getting sick that they can overdo a good thing and they start taking, you know, dozens and dozens of different supplements and things that are way over the amount that the body needs in order to function healthfully. And anything in excess can be problematic for the body. So again, any good thing that you do, if you over overdo, it could turn into a bad thing. But the fear of getting sick can make people think, well, if this much is good, then 10 times must be better. And, and that's just not necessarily the case affectively. When we have health anxiety, we have, well, of course, anxiety, but we can also experience depression, a sense of hopelessness and helplessness because we don't know how to fix it. We don't know how to keep ourselves safe. We can feel, and it can be exhausting to be anxious all the time. We can have increased anger and irritability because we feel like people aren't listening to us. We feel like there aren't any answers. We feel like we are being dismissed or not supported. And people can have guilt when they have health anxiety because they're afraid that people will be angry. With them for if they get sick, they can feel. They can feel guilty because they don't have the energy to go out and do things or because they're afraid to go out and do things. They're afraid to go out in public, so they may feel guilty because they can't do the things with their kids or their friends that they would do if they didn't have the health anxiety. Cognitively, when people's threat response system is in overdrive, when their fight or flight system is in overdrive, it makes it difficult to concentrate and problem solve. Your executive functioning higher order thinking is not engaged when you're in fight or flight mode. When you're in fight or flight mode that is very physical, you are trying to protect yourself from a threat. It's not time to start that higher order thinking. In order to be able to think more clearly and more effectively problem solve, it's important to be able to trigger the relaxation response or down regulate that fight or flight response so you can get into your wise mind, your logical mind and more effectively assess the situation. Environmentally, when we have health anxiety, we can have reduced productivity because we are stressed out, because we can't focus, because we're having more difficulty with problem solving, because we are constantly cleaning in order to avoid germs and things like that. So there are a lot of things that are impacted by health anxiety. And relationally, when we have health anxiety, we may withdraw from others because we are afraid of them getting us sick or us getting them sick. We may withdraw from others because we're not able to emotionally deal with anything else because we are so for clumped with our own anxiety, isolation or rejection due to being perceived as a hypochondriac. So it can impact our relationships negatively if people dismiss our concerns and our fears. Even if our fears are not grounded in fact, they are currently our fears, they are how we feel. Reduce self esteem, especially if you're experiencing isolation and rejection. You may start wondering, you know, am I crazy? You know, what? What are they seeing that I'm not seeing? An impaired support due to lack of secure relationships or craves. Lack of people in your life who are consistent, responsive, attentive, validating, empathetic, encouraging and supportive. All right, so the causes, the consequences, now what do we do about it? Avoid routinely reassuring the person that all is well and invalidating them. And that can include self reassurance. If you're just constantly telling yourself everything's fine, just ignore it. All you're doing is taking that anxiety and putting it in a little box and trying to shove it in the closet somewhere. You're avoiding it, you are ignoring it, but you're not dealing with it. Create an environment that provides safety, empowerment, voice and choice. Figure out what you need to do in order to feel safe, empowered and like you are being heard. And have a choice in the outcomes that you are empowered to affect the outcomes in terms of craves. Creating that secure attachment and you can do this for yourself. You can create that secure attachment with self as well as do it for other people who are experiencing health anxiety consistently. Listen, you know, if you're doing this for yourself, listen to yourself. Listen to what you're telling yourself. Respond to concerns. If you're having these concerning thoughts, then do something about it. Identify them, acknowledge them, and then figure out what to do with them. It's like, okay, I've got this now. How do I deal with it? Attend to prevention behaviors, strengths and desire to stay healthy. You know, if you're doing this for yourself, give yourself a pat on the back. You know, give yourself rewards for and acknowledgement for things that you're doing to stay healthy. You know, going through your checklist, I exercise, I eat well, I drink enough water, I don't smoke. You know, give yourself kudos for all of those things. Validate your feelings, even if they are not necessarily based in fact. They're your feelings right now. So if you're anxious about something, acknowledge it. Say, I'm anxious about this. All right, I've acknowledged that. Now what do I do to improve the next moment? And I'll give you a hint. The first thing is get the facts. Emotion based reasoning says I'm anxious, therefore I must look for a reason to be anxious. I must find facts to fit my feelings. Fact based reasoning says I'm anxious. Let me look at the facts and see if there is a reason to be anxious or if my internal smoke alarm is just kind of faulty right now. Empathize with how exhausting or terrifying it is. Give yourself some space. Give yourself a break if you are feeling anxious about something. I recently had surgery and I was terrified to go through surgery, especially after I signed away, signed all those papers that told you about all the horrible things that could happen, like really terrified, then empathizing with myself and recognizing all right, this objectively is can be very terrifying. And a lot of people are afraid of going in surgery again, going back to those facts, what are the facts in this situation and how likely is it that any of these horrific things might come true? But empathizing with people so you're not telling them that they should just get over it. You're saying, I can imagine how terrifying it must be if you're having those thoughts all the time. Support the development of distress tolerance skills. We've talked about these a lot. Thought stopping when you're having those catastrophic thoughts. Stopping those thoughts and replacing them with empowering thoughts. You know, what can you do? What is the likelihood that activities that distract your attention sometimes while you're, you know, getting ready to go into surgery or whatever, there is nothing you can do to guarantee the outcome? You have to be able to tolerate that distress. Figuring out activities that you can do in order to help you tolerate that distress until you get through it. Guided imagery can also be helpful for addressing anxiety as well as sensations. And I've talked about this before, but smell is one of our strongest memory triggers. If there are smells that trigger relaxation, that trigger positive memories, those can all be helpful information gathering and fact based reasoning. And now why do I have an asterisk by information gathering? Because going on the Internet to find information can be more harmful than it is helpful sometimes. It's important to if you're not able to separate possibility from probability, that you minimize how much random Internet searching you do. Because most places like you go that you go to, like WebMD or Mayo Clinic or any of those places are almost always going to tell you the most likely things that could be going wrong as well as the, you know, worst case scenario. There's a 0.001% chance that this could be it. Now they don't give you the percentages, they just say it could be any of these five things. And so that can be terrifying for people. So it's important to figure out where can I get my facts from that won't make my anxiety worse? What are some trusted sites that I can go to if I'm insisting on going to sites? And who are some trusted people that I can talk to address Catastrophizing. Catastrophizing means assuming that the worst case scenario is always going to happen and going back to that FCP based on the facts it if you do all the things that are within your control to help this situation, what is the likelihood that the catastrophic outcome is going to happen? All or none thinking I either have it or I don't. If I have it, it's going to be a catastrophe. That's all or none thinking. Cancer, for example. Lots of people worry about cancer. And yes, you know, a lot of people do get cancer however, you know, with the advances in, in medicine, it doesn't necessarily mean that there's going to be a catastrophic outcome. A lot of people recover from cancer now. So yes, you know, if you end up having it, you may have to go through treatment. But that all or none. Thinking if I get cancer, then it's, it's a death sentence is not an accurate thought anymore. And the availability heuristic, you know, a lot of times we hear about the worst outcomes. We hear about the plane crashes, we hear about the people who had, you know, catastrophic complications from surgery or other things. And so we assume that because we're hearing about it on the news or we read about it on, online, that that must be a common occurrence. Most likely it's not. The reason it got was newsworthy is because it doesn't happen that often. You know, they don't tell you about the tens of thousands of flights that go off without a hitch every single day. They don't tell you about the, you know, tens of thousands, probably of surgeries that happen every day that go off without a hitch. You hear about the ones where there's problems. Social support and it's important that people who have health anxiety get social support. Support groups can be helpful. Support groups for your condition, like if you've got POTs or autoimmune issues or cancer or anything else, those can be helpful because it can help normalize symptoms and prevent catastrophizing. And support groups for health anxiety, there's a lot of people who experience it. Back in 2010, the estimated number of people struggling with health anxiety was 20%. That was long before the pandemic. With the increased prevalence of the Internet and sites that aren't quite 100% truthful, as well as the pandemic, the number of people with health anxiety, my guess, based on what I've seen in practice and among my friends and family is probably, you know, much higher. More like the 60% range. Now differentiate possible from probable causes of the symptoms if you have X pain or symptom. Now, I'm not saying avoid it. Don't go to the doctor if you think there's a problem. Obviously it's important to go to the doctor, but it's also important to use good common sense. You know, my mother died of kidney cancer and so if I get a pain in my back, it. My catastrophic thinking immediately goes there. I'm like, oh my gosh. And then that is immediately followed by okay, does that make any sense? It all of a sudden started hurting. Let me think Did I sleep wrong? Did I pick up a dog wrong? Did I? What did I do? Same thing with, you know, sniffles lately. Anytime since the pandemic started, anytime anybody gets a runny nose at all or, Or a cough or sneezes, they automatically go into catastrophic thinking. And part of that is because that's been front and center for so long, it's like, oh, my gosh, I must be really sick. But stepping back and thinking is really important. I had the sniffles a couple of weeks ago, and, you know, obviously my mind first went to the catastrophic, and then my logical mind kicked in and I said, what's different today? That was not occurring yesterday. And I recognized that I had let the cats into my bedroom and I'm allergic to cats. So letting the cats into my bedroom and all up on my pillow and all up in my face, guess what? It's not a surprise I was sniffly the next morning. Play out the tape based on your individual factors. And we're going to talk about this more in just a minute. But cancer, and I keep going back to that one because, you know, we've been talking about that for decades now in the media and everything else. But yes, a lot of people get cancer. What are the risk factors? And for me personally, for example, I don't drink, I don't smoke, I do exercise. I am not significantly over fat. And because that's associated with higher estrogen, higher inflammation, and cancer, you know, going through all the risk factors for cancer, the big one that I have is stress. And I recognize that. So that is one that I work on controlling, I work on addressing. So based on my individual factors, the likelihood that I'm going to develop cancer is less, significantly less than some others. So it's important to play that out. Increase health literacy regarding prevention and protective factors. And I call this horse's mouth with redundancies. I don't know what else to call it. Ideally, start with your personal health care provider. Concierge physicians are becoming more popular, and I really love this model because concierge physicians and private pay physicians are invested in you feeling confident in their competence. And they spend more time listening to you. They spend more time hearing what you have to say and helping you feel comfortable. Now, not all of them are good. There's, you know, like anything that you have good ones and you have bad ones. But with concierge physicians, a lot of times, because of their need for you to want to keep paying them their monthly, their monthly enrollment fee or not enrollment fee, but membership fee, they're going to pay more attention. So that can be good. It also means concierge physicians. It also means that you have a doctor. If you start having a pain and you get worried, you can call up seven days a week and go, hey, I'm having this weird pain. And they know your medical history, they can go through things. A lot of the telehealth docs, my experience has been with my family members and stuff. When they called the telehealth docs, if anything it increased anxiety because the doc's response was, well, it's hard to say. Best thing you could do is go get a bunch of tests run. And so the telehealth doc didn't want to make any sort of diagnosis and so it felt pretty useless. Again, may not be true. With all the American blank society. There are a lot of things like the American Cancer Society, the American Diabetes association, the American Heart Association. A lot of these websites have a fair amount of user friendly information. Now they can be a little catastrophic at times, you know, telling you with some scare tactics, trying to motivate you to live healthier. So, you know, use a little bit of caution. Harvard Health and Cleveland Clinic are two other sites that I have gone to looking for information when I've been working on creating courses and stuff that tend to have pretty good information that is. Terribly frightening. They don't tend to be chicken littleing everything. Little note on statistics and I know I'm going long today, but this is one of my favorite topics. So hey, when you are evaluating a media story or a research article or whatever, who was observed? You know, if they say 40% of people have a lifetime risk of developing cancer, okay, who did they look at? Did they look at people in a first world country or were they looking at people all over the world, including people in third world countries that have much worse health healthcare systems as well as poverty and stress and all kinds of other things, were they looking at people who had similar age, race, ethnicity, gender? To me that makes a big difference. You know, people who are in their mid-80s are a whole lot more likely to be diagnosed with cancer than people who are in their mid-20s. Not saying it doesn't happen to young people, it does, but as we age, unfortunately our risk for some things goes up. So if you are a 30 something, you know, make sure that you're comparing yourself to research that's been done on other 30 somethings, not on 80 something year old people. Genetics, well, it's not changeable if you know that you have a genetic Predisposition to a certain condition like cancer, then being aware of that, it doesn't mean you are going to get it. It means that you're more likely to get it. So it's more important to attend to those prevention factors now. Things that are within your control. Remember facts, control and probability. Exercise in terms of cancer. That is, exercise, smoking, drinking, stress, dietary habits, and exposure to toxins are the top of the list for prevention factors. So if you are a younger person, if you are actually female, they have a slightly lower risk. And you have no genetic predisposition. And you exercise, don't smoke, don't drink, control your stress, eat, eat well, and avoid toxins. Your lifetime risk of developing cancer is probably significantly less than 40%. However, you know, there are other people who may engage in all of these behaviors, which increases their risk. So they may have an 80% chance where you have a 10% chance. So it's important again to compare apples and apples. Are there multiple studies that support this? Sometimes you'll get this one off study that indicates a problem and it's not replicated. So that's important to recognize. And what was the sample size? When we're talking about general health, you know, cancer and those sorts of things, there's so many factors, but. But ideally, you want to see a sample size that's in the thousands. You know, 3,000 people were studied, not 30. 30 people. There's a lot of room for bias there. Statistics know what they're actually telling you. 300% increase. Okay, that's scary. Now what does that mean, though? Does it mean that out of a thousand people, three got this problem last year and nine got it this year? Okay, that. Or does it mean out of 1,000 people, 300 got it last year and 900 got it this year? That doesn't help us much. What gives us more information is looking at, you know, the percentage of the population or the percentage per population. So three out of a thousand or nine out of a thousand, you know, that's still a 300% increase, but three out of a thousand, I'm really not worried. Nine out of a thousand, I'm still really not that concerned about catching it myself because that's still a pretty small percentage of the population that's getting whatever this problem is. On the other hand, if 300 out of a thousand got the condition last year, that's three out of ten or 30%. That's kind of scary. And then this year, 900 out of a thousand or 90%, nine out of ten people got it this year. That's freaking terrifying. All of these are a different way to say a 300% increase, but one way, you know, the first one is a 300% increase, but it's a negligible number. Another thing to focus on. And percentages can be abused so badly in the media because they can be very misleading. If you hear 95% of the beds are full, well, that's terrifying. How many beds were there to begin with? Around Tennessee, we have a lot of places where we've got big metro areas that have big metro hospitals, and then they have satellite hospitals in little areas. And those satellite hospitals may only have 16 beds. So, you know, if 95% of 16 beds are full, you know, that's a problem for the people in that area, but that's still not that many people. If we're talking about a large urban Hospital and 95% of 600 beds are full, that's a little bit more concerning because that tells us that a lot more people are getting sick. So we really want to ask, what exactly is this number telling us? And finally, dealing with doctors. Doctors can be challenging sometimes. And I don't just mean medical doctors. Mental health practitioners are guilty of this too. Bring a checklist. If you're concerned about X diagnosis, bring a checklist with your symptoms. If the doctor disagrees, ask them to explain why and provide an alternate explanation. If you don't think, I have this, okay, why? What makes you think that? And so what is causing my symptoms in mental health? Remember, it's also a matter of degree. Dementia versus aging. For example, as we age, our cognitive processes naturally slow. We naturally become a little bit more forgetful. That's just natural aging. That's not dementia. A lot of people mistake the two. So it's important to be aware of those things, especially with health anxiety. Research after the visit to verify and increase your knowledge. Ask your healthcare provider, where can I go? To find more information on this diagnosis? Again, that prevents you from going to Chicken Little sites where you're going to get yourself freaked out. Be clear about all of your symptoms. If you are not clear or if you minimize your symptoms, the doctor may not be able to get an accurate picture or may not get an understanding of the intensity, that of the problems that you're experiencing. So tell them about the frequency. How often is it occurring? The intensity, how bad is it really? On a scale of 1 to 10, how bad is it? The duration? How long has it been going on? And this can be like if you've got migraines how long do they generally last? You know, is it 30 minutes, which is probably not even in the ballpark for a migraine, or is it three days? Mitigating and exacerbating factors. This gives doctors and health, mental health care providers a lot of clues as to what might be going on. Because if you tell them, well, when I drink caffeine, it makes it worse. Okay, that helps direct me and narrows down some of the things that might be going on. So what makes it better? Which mitigating factors and what makes it worse or the exacerbating factors? When did it start? So if this is something that started six months ago, did anything change? Did you change your diet? Did you change your sleep habits? Did anything change that may have triggered this? That can also give us more clues as to what might be causing it. Health anxiety impacted over 20% of the population in 2010, which was prior to the pandemic. Health caution is important. You know, pay attention to your symptoms, you know, keep note of them. And if they get severe, if they keep on going, if they don't go away, you know, consult your healthcare provider. But when the fear of death keeps you from living a rich and meaningful life, that also becomes a problem. Many websites and news stories can actually worsen health anxiety because as I mentioned, they use clickbait strategies to increase your anxiety, which theoretically motivates you to go to their website and learn more about whatever it is they're talking about. Cognitive behavioral strategies can help people get into their wise mind so they can think clearly, use fact based reasoning, tolerate distress, even if the anxiety is not fixable at the moment, like getting ready to go into surgery, you've just got to tolerate that distress and take proactive steps addressing the things they can control. You can learn more@docsnipes.com YouTube this episode was produced by Mr. Charles Snipes and presented by Dr. Donnelly Snipes. They can be reached at 1633 West Main Street, Suite 902, LebanonTennessee 37087 or by email@supportocsnipes.com. What questions do you all have about health anxiety? And I'm sorry for your experience. The real thing, unfortunately, this is exactly what I'm talking about, that a lot of times providers don't listen and so people suffer for a long time when they needlessly because they were not listened to. And that can erode people's faith in the healthcare system and in providers. So I'm glad you don't have health anxiety anymore. I would have expected you to say just the opposite. So kudos. I'm glad that you finally got a diagnosis and you're finally hopefully on the men's some. But it really makes me upset when I hear that providers were not listening. The Mayo Clinic, Paula, generally has good information. Their information is accurate. That's true. Their information is accurate. I've never had a problem with accuracy, but sometimes it can be written in a way that anxiety provoking because they don't say, well, if you have this symptom, these are the most likely causes. But there's a 0.0002 chance that it could be this bad thing. They tend to just kind of list all of the possible reasons for your symptom and so you don't know the catastrophic end, you know, how likely is that? So that's my only beef with that particular site. But if you don't tend to focus on the catastrophic, then yeah, they do have accurate information. Can anxiety cause dizziness? Yes, there's a lot of things that can cause dizziness, but anxiety is one of those because when the fight or flight system kicks off, it dumps adrenaline, it dumps cortisol and it causes your liver to dump a bunch of blood sugar. So there's the sudden surge of all these things. Think about if you've ever had, you know, gone to Starbucks or something and drank coffee there and you're not used to it and you get that coffee buzz. Not advocating for it, just giving an example that most people have experienced. It's similar. It can cause you to feel kind of loopy or dizzy. That's not uncommon. But you know, obviously it's important to be aware that symptoms can be caused by a lot of things and you know, that's the whole liability part of me talking. But yes, the short answer to your question, yes, People who have had. And Alex, I'm sorry for your losses and I can empathize with you. My dad died at 50 and my mom died at 65, both with cancer. Both my dad, you know, fought it for a couple of years. My mother's was extremely aggressive and I have like everybody on my dad's side of the family seems to pass away of cancer. So I tend to be especially anxious about cancer and do a lot of research on it. But yes, it's certainly something to be aware of, be aware of the facts and know what you can do and in order to cope with that. But I'm also wondering because of the early death of your parents and even if when parents don't die early it still can be traumatic whether some of the anxiety might also be trauma related. But that's just me spitballing. I don't know you from Adam's house cat. So I'm wondering if that could be contributing to anxiety. Can. Well, anxiety in most cases can be put into remission, healed. There's a lot of different words you might use for it. The key is to figure out what's causing it. Anxiety is a feeling, the feeling is caused by a neurochemical reaction. So what is causing that neurochemical reaction? Is it memories from past traumas that are triggering just kind of free floating anxiety? You're not sure why you feel anxious. That involves one set of treatments. Is it anxiety because of your thought processes? You tend to think in all or nothing terms or catastrophically or over overly personal or, you know, there's a lot of thinking issues and perceptions that can cause us to fear rejection or isolation or abandonment. So that would be a different set of treatments that could be addressed. And then there's also anxiety that is, you know, that HPA axis being revved up. That can be caused by physiological things like hyperthyroid. So when your thyroid too active, it can cause anxiety symptoms. Dietary things like too much caffeine or problems with your body's ability to manage its blood sugar can also cause feelings of anxiety. And most of those things are very easily treatable. But it's important to understand that anxiety is caused by so many different things. It is incredibly important to what we call differentially diagnose to figure out what's causing your anxiety in order to get the most effective treatment. That being said, some people do have a genetic predisposition to anxiety. And there is some argument in the clinical literature and in the clinical communities that certain people may do better on like SSRIs, which are typically called antidepressants. But they do have a significant anti anxiety component to them. Some people need to be are helped by, let me say that instead of need, are helped by being on those indefinitely. But it really is so dependent on the person and what's going on. Trauma history is a big cause of anxiety, so exploring that can be crucial, but also looking at those physiological causes because most behavioral health professionals will look at your current cognitions, your current thoughts and how that's contributing to your anxiety. And that is your current thoughts are shaped by all of the experiences you've had until now. So yeah, you can start addressing your thoughts in the present, but you've got to figure out, you know, what's causing them. What is causing this underlying current of stress chemicals, The anxiety that comes from out of the blue, even when your thoughts are not negative. And I wish I could give you a definitive answer, but I just can't. It could be trauma history and trauma memories being triggered because that can impact us on a neurological and almost a cellular level. Or it could be a physiological issue like blood sugar or thyroid or even gonadal hormone changes like changes in estrogen or testosterone levels can contribute to feelings of anxiety. So getting a good physical, very helpful. Ruling out trauma issues, very helpful. And then if you rule out all of those things still having it, then there are other avenues to go down to try to, you know, narrow what might be contributing to it. Are there any other questions? Can I discuss or do I know if benzo and gabapentin both work off one's GABA receptors? Gabapentin? Well, benzodiazepines increase gaba. We do know this. Gabapentin is a GABA analog. So it's similar to GABA and in theory may increase GABA levels in the body. So both of them are technically may work on GABA receptors. But it's important to remember that it is, to the best of my knowledge, impossible to alter one neurotransmitter and not affect all of the others. So when you increase gaba, you're also increasing serotonin, you're also increasing dopamine, reducing norepinephrine and some of your other things. So it is important to recognize that the impact of what might be going on and reasons that it might be impacting your mood. Thank you for becoming a member, Kohler. I appreciate you having you around. Thank you, Mr. Doomguy. I'm glad to have you back. And Ivana, I'm sorry to hear that you have been struggling with health anxiety for so long and that the symptoms are so persistent and so intense that you're feeling the need to get those things and. Or that you are experiencing symptoms that are not getting accurately diagnosed and feeling unheard of. And Ivana, I would encourage you to really look at the research from the American Cancer Society on cancer. You know, get the facts, two CT scans, you know, how problematic is that really? And what protective factors do you already have? What things are you doing to help your body fight off cancer, so to speak. You might be surprised at what your risk level actually is. Good question, Paula. SSRIs and SNRIs. SSRIs are selective serotonin reuptake inhibitors. So those their primary action is designed to increase serotonin in the brain. But when they increase serotonin again, they increase dopamine. They increase some of those other neurochemicals, including norepinephrine, which helps people feel better. Typically, SNRIs are selective norepinephrine reuptake inhibitors. It's not. Their primary action is to prevent the. To make more norepinephrine available, to keep the norepinephrine in that synaptic space and keep it working longer. But when norepinephrine is increased, it also by default increases serotonin and dopamine. Now, the primary action is going to have the most robust response. So, SSRIs, you're going to see a much more marked increase in serotonin than the norepinephrine and the dopamine and those other things. Snris, you're going to see a more robust increase in norepinephrine and less so in the ancillary neurochemicals. But that is your basic difference. Now, serotonin is responsible for heart rate. Too much serotonin often contributes to anxiety. Too little contributes to depression. Serotonin is also involved in pain perception, heart rate, respiration, sleep, creation of melatonin so you can get good quality sleep. So serotonin's involved in a lot of things. Norepinephrine is actually an excitatory neurochemical. It's the precursor to adrenaline. It's actually noradrenaline is another name for it. And it tends to help us with focus and attention and energy and, you know, helps us again because it gives us more energy and focus and attention. It often helps us feel less fatigued and exhausted and depressed. So that may be the difference between why a doctor prescribes one versus the other. Typically, if somebody presents with depression or anxiety, the Doctors start with SSRIs. And if those don't work, they may consider SNRIs. But there is a fair amount of latitude, depending on the doctor, the exact presenting symptoms, etc. Derealization. Dissociation is unfortunately a very common experience, especially for people who've experienced trauma. And it can range from. Momentary dissociation and not feeling like you're part of your body to extreme dissociation and even dissociative identity disorder. So derealization has a broad swath of how it presents. And people with PTSD often have some level of derealization associated with their experience. Experience. And it's shameful. I will use that word. Yes, it's shameful. If behavioral health professionals are not at least familiar with dissociation and derealization and the impact that that can have on people. I worked with a clinician who was working with a client. I was providing consultation, and her client would regularly dissociate. And it caused a lot of anxiety because she would be in the kitchen cooking or doing something, and then she would dissociate. She would check out, as she would say, and she would lose time. And then when she would come back, come back again, you know, the food would be burned or whatever. And she was really terrified that she was going to burn the house down or that something bad was going to happen to her kids. And during a moment when she had dissociated, yes, there can be a lot of anxiety associated with derealization and dissociation for a lot of people. When for the people who feel like they are not connected to their own body, that can also be really anxiety provoking because, you know, we are. Our essence is kind of grounded literally through our feet in the ground. And if we don't feel like we're part of our own body, then we can feel extraordinarily vulnerable. So I think it's important that clinicians are aware of not only derealization, depersonalization and dissociation, the three Ds, but also the anxiety that can be associated with it and how that impacts people's life. Unfortunately, esoteric. You cannot get an accurate read on brain levels of neurotransmitters because your neurotransmitters are located throughout your body. So any neurotransmitter test just tells you how many neurotransmitters or what level of neurotransmitters you have in general. So that is generally not helpful. However, there is a test that can be done, a genetic test that can be done. Now that I've heard really good things about from a nurse friend of mine who is seen it in practice, that actually can help doctors identify which medication is going to likely be the most effective for a person. So, like, there's. I don't know how many anymore. There's dozens of SSRIs out there. And this test can actually help the doctor narrow down which ones are not going to be helpful for a particular individual. And a lot of people do struggle with dissociation. My suggestion, Spartan, would be to do some research on emdr, because EMDR can really help integrate some of the somatic experiences with the trauma experience and help the brain not feel like it's got to shut down, block out, go into survival mode. I'm not saying that's going to necessarily be the solution but EMDR has been shown to be very helpful for, for people with dissociation and trauma issues. Alrighty everybody, it is time for me to sign off. So I will see you next Thursday same time, same station. If you have any questions in the meantime, feel free to go to the All CEU's education YouTube channel and go to the community tab and you know, we try to answer questions as quickly as possible. I won't say as they come in we've started getting a lot more posts lately but we do, we do review your posts on a daily basis and try to respond as quickly as possible. Everybody, have a fabulous day. Have a fabulous weekend. If you are in the north or the northeast, please stay warm, stay safe. We've got quite a winter storm. That's, that's a bruin. So I'll see you next Thursday.