Youve come a long way baby

I just came across a blog post by an MD in the Times Union of Albany: Medical Mystery Monday #80: the case of the chest pain.

A 24 year old woman comes to the Emergency Room with intense chest pain, palpitations, and nausea. She states she has been feeling this way for about 10 minutes, and took a cab straight to the ER after the onset of symptoms. The patient was sitting reading the paper when the symptoms started suddenly. She states the chest pain is located in the middle of her chest, and worse when she takes a deep breath. The patient has experienced a similar episode two months ago, and her family history is unremarkable

Most readers of this blog know the solution to this medical mystery only too well. The chest pain is caused by a panic attack, a fact noted by the majority of the post's commenters.

In the 1980s, when I had my first panic attack, most doctors weren't trained to recognize them, and how like a heart attack they could feel, and would have discharged the patient after tests showed her heart was healthy. Without a word about the possibility of panic. Either because they didn't know better, or hadn't been trained to say something. And so I went to the emergency room the first time I panicked, and then again and again over the years.

For me, the result wasn't sweetness and light. At the behest of cardiologists, ENTs, gastroenterologists, neurologists, and the likes, I took a parade of medical tests, all of which showed me to be in good health. The cognitive dissonance was jarring: Inside, I was dying, each and every time, yet others -- experts -- told me I was the picture of health. By the time I finally figuring out what was happening, neurosis had slipped into the cracks where confidence had lived before panic came into my life. I was skipping many of the activities I used to love. Sometimes, I couldn't even get myself out of the house and to the corner market for the fear.

The approach in many ERs has evolved quite a bit since then. A neighbor recently told me about a friend who'd just had a panic attack. After the appropriate tests, the ER where she'd gone with what she imagined was a heart attack discharged her, but told her she'd quite possibly experienced panic, and referred her to a mental-health clinic. As this anecdote and the Times Union blog post illustrate, the medical profession has come a long way when it comes to recognizing panic.

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