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I've posted a lot lately, but it's all been about BIND and the research paper we just published. I wanted to take today to just touch base and say hi. And perhaps ramble on a bit on a non-sequitur, as I often do.
I started working on this anxiety article yesterday morning, and then walked away from it for a while. This is also common for me. Sometimes I never return to the topic, and it stays in my draft folder until I delete it. And sometimes I return to it a bit later, with new focus and energy, and create a post out of it. This time, thankfully, it was the latter.
During the time I stepped away, a dear friend called me for some counsel. She was struggling with some fear of an upcoming event, and we connected over the similarity of our struggles. After that conversation, I knew the topic might be useful to others and that I needed to finish it. So, here it is.
Laying the Groundwork of Fear
A cornerstone of Easing Anxiety and the Benzo Free Podcast has been honesty — from day one. And that often includes sharing much of myself — even my flaws, my failures, and my embarrassments. By doing this, we have connected, and that connection is the heart and soul of what we do here.
Since January, I've been dealing with some health difficulties which I shared on occasion with you. In an effort to keep this short — a quest who's goal continues to elude me — I am not going to repeat them in detail here. Suffice it to say, I've had about 15 doctor visits, tests, and procedures since the first of the year.
And that brings me to June 23. A couple of weeks ago, I had what I like to call a triple-header procedure — a colonoscopy, endoscopy, and esophageal dilation. The endoscopy was diagnostic for my dysphagia (difficulty swallowing), the esophageal dilation was an attempt to help with that condition, and the colonoscopy was preventive.
The good news is that everything turned out pretty good. A few polyps removed, some acid reflux which we knew going in, and some pain for about a week from the dilation. But, all in all, things were better than I had expected.
But, that's far from the whole story. That's the "after." What about the "before?" What were things like leading up to the procedure?
Fueling the Fear
Seven years ago, I visited the gastroenterologist about my stomach distress. I was a year or two off clonazepam (Klonopin), which I had taken for 12 years prior, and I was having some strong benzo belly symptoms. The doctor scheduled me for an endoscopy, and since I had recently turned 50, a colonoscopy too. I didn't like the idea, but I thought it was needed.
Well, it didn't take long for me to twist an upcoming medical test into a Greek tragedy. My anxiety was already through-the-roof from the benzo withdrawal and BIND, and adding this upcoming event was the lighter fluid, gasoline, TNT, and nuclear warhead it needed to send me over the edge. In the month leading up to the procedure, I obsessed about every little thing that could go wrong. Trust me, I left no stone unturned. The "what if's" were endless.
Here are some examples:
What if they find something? Throat Cancer? Colon Cancer?
What if they make my throat worse? What if it tears?
What if I have a reaction to the anesthesia, and never wake up?
What if they want to give me a benzodiazepine? Do I say yes? No?
What if they want to give me fentanyl? What would be my reaction to that?
What if I screw up the prep? Eat something? Drink something? Forget any part of it?
What if I can't go through with it, and have to cancel at the last minute?
Another factor, was that I have a tendency to wake up during surgery and medical procedures — something common with gingers, of which I am one. The last time I had an endoscopy, I woke in the middle of the procedure with a large tube down my throat, gagging. It's a memory that has stuck with me, and one I would prefer not to repeat — as you might imagine.
And on top of all of this, is the shame — why am I so embarrassingly weak and full of fear?
Ah, there's the rub. The eternal threat of the anxious mind. Why am I so weak, when others — millions in this case — do this every year? Why am I lying awake night after night, sleepless, obsessing about something that is as common as having a physical? Why am I so broken? So screwed up? Such a useless and utter loser? It's harsh, I know, and mostly unrealistic —but these are some of the thoughts we have. I had some anxiety before I started taking benzos, but never anything like this. This was extreme.
Four days before the procedure, I cancelled it. I couldn't do it. The anxiety was so severe, and my symptoms so elevated, I almost couldn't function. Once I cancelled it, I felt immediate relief. I found a new gastroenterologist, explained my complications, and he was okay postponing it a while. I knew I still needed the procedure at some point, but for now it would have to wait. I never thought it would be seven years, though.
While I felt much better immediately after cancelling the procedure, there was another side effect of this whole experience. A very significant side effect. One that I hadn't anticipated.
Creating a Fear Event
The whole experience of the fear, worry, and eventual cancellation of the procedure created what I like to call a "traumatic anxiety event." The ruminations were so intense, lasting for weeks, that it left its legacy in my psyche. While not formally PTSD, some of the reactions I experienced were quite similar.
This dark cloud hung over me for seven years, affecting my reaction to any topic that was even remotely related. A general visit to the doctor, a neighbor diagnosed with cancer, the latest Cologuard commercial — you name it. Even a diet ad for laxatives could set me off. It didn't take much. Anything that would remind me that I I still needed this procedure would send me into an anxiety spiral. I had built the event up to be this mental maniac of misery, who's sole purpose was to scare the hell out of me — and it was quite effective. And I wondered, if I can't handle this, what would I be like if I was actually diagnosed with cancer, or some terminal illness?
The irony of the situation is that the anxiety I experienced those seven years was far worse than if I had just had the procedure the first time. At the time, I just couldn't go through with it. My anxiety levels just off of Klonopin after 12 years of use were too severe. But, if only I could have pushed through back then, my life would have been less fearful.
And then there's the embarrassment of the whole thing. I'm even feeling pangs of shame as I write this. I'm a 57-year-old man afraid of a very common medical test and procedure. It's ridiculous. I have to admit, I am not proud of being this way. In fact, I've had second thoughts of posting this article right up until I hit "publish." Still, I know that by sharing my experiences, even my most embarrassing experiences, that others' fear may be lessened. And I'm okay with that.
Being a Person in Fear
I have neurological damage. It's a fact. Long-term prescribed use of a benzodiazepine has reduced the effectiveness of my GABA-A receptors. I can get revved up easily, but I can't calm down like I used to — I just don't have the brakes. And that makes me more susceptible to anxiety from daily stressors and events.
This is not a matter of will for me, or for many like me. Whether the cause is genetic, traumatic, environmental, iatrogenic, or something else, some of us just feel more anxiety than others. We're "wired" differently, and it's harder for us to let go of the fearful thoughts. Even though there are tools and techniques we can practice that can help us manage our reactions to these events — and I'll mention a few of these below — they don't eliminate the problem. They just help us ease it a bit.
Get it? "...ease it a bit?" "Easing Anxiety?" Yes, that is where the name came from, in case you were wondering. While we rarely can do anything to eliminate the anxiety completely, we can ease it, and that alone can make a huge difference.
Easing the Fear
So, how did I get through it in the end? Well, I used some visualization and focus techniques. Here are a few that worked for me:
LESSEN THE SEVERITY — The first one that helped me was learning to lessen the severity of the upcoming event in my mind. If I was reminded of my upcoming procedure by some external stimuli, and my thoughts started to go there, I'd try and lessen its effect. I'd tell myself that millions of people have this procedure every year, without complications, and that it will be fine. And then I'd immediately go back to what I was doing before, attempting to put it behind me. And sometimes it worked.
ANTICIPATE THE SUCCESS — Another technique I used was to anticipate the success after the procedure was over. I would think about how amazing it would be to have this procedure done. After seven years of worry, what would it feel like to have it behind me? It must be amazing. And that positivity would help me get through.
BUILD ON SUCCESS — And once we have those successes, we can build on them. In October 2022, I had foot surgery. This event was also fearful for me, although not to the degree of the endoscopy / colonoscopy. Still, that foot surgery, that success, was a building block. Having overcome my fear back in October, gave me a foundation of courage and confidence which helped to push through on this one.
Help Others with Their Fear
Another technique that I found useful, was to be less selfish. The truth is, anxious people are often selfish. I'm not saying this to put any of us down, it's just that managing our anxiety and trying to control the world around us is a 24/7/365 kind of job. It's overwhelming. Our fear demands that we focus all of our attention on avoiding being triggered. The penalties if we don't, can be quite severe. Purposefully thinking of others can pull us out of our own mind and its misery, at least for a little while.
Here's an example. Leading up to my procedure, I'd envision a child. I'd be in a bed at the hospital waiting for them to wheel me in, and next to me was a 5-year boy waiting on the same procedure. The boy is frightened, and I need to be strong for him. I'd imagine what I'd say to him, how I'd soothe his fears. Soon, I actually felt stronger myself, and my fears lessened. I'd also realize how ridiculous some of my fears, and even my behaviors, might have been in context.
I'm not a parent, but I'm sure that this is something parents have to do every day. Sometimes we have to be strong for others, and that action can help take our minds off our own problems. This process was perhaps the most successful for me of the ones I've mentioned here. When I'd focus on helping another, my worries seemed small.
In case you're wondering, the boy I envisioned was me, as a child. I had my first endoscopy at six-months-old, and my first pre-ulcer at five.
Living with Fear
Whether you struggle with chronic anxiety, panic attacks, or perhaps your nervous system was damaged by medication, there are techniques that can help. I've only listed a few here, but there are hundreds more. Changing the way we think, even in the slightest degree, is a good first step.
By using the above techniques, the week before my procedure was relatively manageable.
I'm not proud of my fear leading up to it, but I'm also not ashamed by it. This is me. I have anxiety, and I have to deal with it. And perhaps, by sharing my fears here, others may get on that plane, speak at that seminar, ask the girl for dinner, or even have that medical procedure that's been plaguing them for so long. Perhaps.
Take care and be at peace,
D :)