I am a doctor and I need help

[Oblique]

Yes its true.

I am struggling with unbearable symptoms, and I honestly don't understand them.

I am miserable with constant 24/7 nausea and "tight" feeling in my stomach. I vomit most mornings. I have diarrhoea faily constantly with undigested food. I have had all sorts of antibiotics, antispasmotics and anti nausea therapies and none of them have worked, although I had a similar episode in november last year lasting 2 weeks and amitriptylene helped but now it has stopped working

I have been very anxious for many years, and I feel constantly terrified I have cancer. I have seen so many people die. I don't want to put my family and loved ones through that. I am obsessional and usually very creative when I am asymptomatic.

now I just feel exhausted. I have had every test you can possibly imagine for nausea and bowel issues. endoscopy/colonoscopy, CT scans with contrast, ultrasound, head scans, all sorts of bloods, celiacs, dietary even rare tumor markers like pheo and carcinoid.

I have seen 3 doctors and a psychologist. they are all stronly convinced that anxiety is the cause of my strife.

So I have come to this community with open arms, to try and understand and learn. My symptoms have defied all my power to explain them. they just don't make sense. Why are all my tests normal?

I would humbly welcome any advice and I respect the experience of people on this forum if they have any similar experiences

many thanks

Oblique

[Robbed]

I honestly don't know how much training doctors get about anxiety above and beyond 'It's a chemical imbalance: take 15mg Lexapro once a day, and everything will be peachy'. But I guess not much. Anyway, anxiety disorder is often looked at as being the 'great imitator' in the sense that it can have SUCH a wide variety of symptoms. And these symptoms can basically be interpreted to be the result of the serious illness of your choice. GI symptoms such as nausea, vomiting, and diarrhea are all EXTREMELY common. Exhaustion is also common, as are headaches, body aches, weakness, and various weird sensations which can defy description. All of this is simply the result of a high stress state. After all, when you are afraid of something that is REAL, you tend to experience the same exact symptoms. But you don't feel fearful of them, because they are appropriate for the situation.

So what causes this sort of thing to happen? Chances are you have been told somewhere in your medical training that this is a genetic condition which causes an imbalance of serotonin in your brain, which MUST be corrected with something like an SSRI. I personally don't buy into this. Although some people MAY be more susceptible to anxiety disorder than others, I don't believe that the anxiety state is something that is inherited. FAR too many people recover from anxiety without medical treatment for me to believe this. I fully believe the idea that this is caused by stress. And in your case, it sounds like ALOT of your stress is coming from your job. After all, seeing people sick and dying day in and day out HAS to be rough. This stress causes you to experience symptoms, which you them become afraid of. In fact, the fear of symptoms SO often takes precedence over your original stressors. In any case, according to Dr Claire Weekes, when you start to fear symptoms, you have anxiety disorder.

SO what to do about anxiety disorder? I personally am not a fan of antidepressants. And, given the fact that you don't mention being on them (except for your prior stint on amitriptyline), I am guessing that you aren't, either (after all, as a doctor, you probably see first hand that these are not very good drugs). I personally find that ACCEPTANCE (aka Claire Weekes) is the best way to deal with anxiety. Accept that you dd symptoms are the result of anxiety disorder. Accept that they are not harmful. And accept that, while they may last for some time to come, they will go away as your stress levels decrease. In the meantime, try to live your life as best as you can. You may not be able to go at it 100% with anxiety disorder. But locking yourself in your room doesn't help, either. Other people might mention TEA forms. And although I am not a fan of them when it comes to symptom reduction, they might be of ALOT of help when it comes to dealing with stress on your job, as this is something you REALLY need to take care of in order to recover. Therapy might help as well, but it could be hard to find a therapist who is good, and who will not try to coerce you to take antidepressants. In other words, you might have to look around quite a bit. Anyway, hopefully thi helps.

[northstar]

hi oblique,

sorry to see that you're going through such a tough time! i just wanted to ask you one thing. your physical problems seem to be mainly with your stomach, have you tried looking at your diet? checking for food allergies or watching how much processed foods, sugar or fast burning carbohydrates you consume? or even if you drink a lot of things like tea, coffee, alcohol or soft drinks like coke? it's certainly worth checking out, that 24/7 tight feeling sounds familiar to me and food was the key my own recovery.

also, i totally agree with robbed when he talks about therapy. you should really consider it. it can help you deal with the trauma of the type of difficult work that you face every day. i hope you will think about it :)

[DCPsychotherapist]

As a psychotherapist I've worked in settings where your symptoms are very much the norm. Most of these settings rely on heavy management oriented approaches to anxiety including Rx. I think these work well for a while for some people. For others the anxiety pops back up, sometimes in different, surprising forms.

In my private practice, I gave up telling people to manage their symptoms because I didn't think it was helping. I learned about something called natural multiplicity of the mind, and suddenly things that didn't make sense in traditional medical-model-disorder-centered approach. The therapy was started by a guy named Dick Schwartz who was puzzled about why eating disorder clients stayed "sick" even when the entire family changed how they interacted with them. He learned from these clients that they had parts of themselves that provoked them into the extreme behavior/anxiety even when the extreme behavior of those around them stopped.

It's worth looking at. Look up Self Leadership and get Dick's introduction to IFS book from his website.

[joey9]

One very simple reason why eating disorders are so hard to extinguish is the fact that many people with eating disorders are perfectionists, and their eating disorders, brought on by stress/anxiety/depression, are the expression of their perfectionist value systems. Hence the thinner they get, the more perfect they feel. It is notoriously difficult to change the underlying value system of a perfectionist as they see their perfectionism as a positive attribute, although they acknowledge that it can cause them distress. The 'puzzling' reason that people with eating disorders don't start eating again when others around them change their behaviour is probably because it has very little to do with others in the first place.

[DCPsychotherapist]

The part I left out was that Schwart'z approach, IFS, is a sytematic way of finding the parts of a person, say, that are provoking other parts of them to be perfectionists in the example you gave. When the parts are "unblended" from one another's polarization, they are usually willing to talk about why they feel the need to do whatever extreme belief/behavior that is happening (usually some fear that only makes sense to that part)...then you can find other ways to address that fear, without the extreme behavior, by the parts of the person that can handle it. It's a strengths-based approach in a lot of ways.

[Oblique]

THankyou for your replies

with each etst that comes back 'normal' I worry more and more that something even more rare and fatal has been missed. and the cycle continues.

The feeling of "tightness" in my stomach is sometimes upper abdomen and sometimes low on the right side. its feels like my whole gut is a tight fist... or it feels like I have been winded like someone kicked me in the stomach but it lasts 24/7.

The symptoms lastsed even when I didn't eat for 3 days, but I am still looking for specific dietary allergies.

Yes I am a perfectionist- although I have never really been one about my own health. I feel so exhausted and afraid. I feel like my last hope is a diagnostic laparoscopy but none of my family want me to go through that

I really can't believe that sympoms can be this severe for so long without some kind of tumor causing them. surely its impossible. I am barely functional. I wake up each day exhausted.

Also I vomit nearly every morning- and have done so for many years- only when I am about to go to work- out of anxiety. it seems to help the anxiety a bit even if I dry wretch. it usually does not occur at weekends or on holidays.

[joey9]

Hi Oblique,

You didn't mention whether or not you had taken time off work to try to de-stress? Have you attempted a sustained period away from work to try to monitor your symptoms? What types of things have you done to try to calm down your lifestyle whilst you sort yourself out? If you really are suffering from anxiety then every scary medical test that you put yourself through will be making your anxiety far far worse. I don't get health anxiety but i went through a 3 year spell of unexplained stomach symptoms - severe pain and vomiting etc. I had a lot of tests and they found nothing, until I went to casualty one day as it was happening and they found a bowel spasm. After the threat of a barium meal, however, my symptoms went away and never came back. I never put it down to anxiety at the time but in hindsight all my episodes came during periods of stress e.g exams. If this is anxiety and its the stress of your job that's causing it you might need to think about what you can do to make it less stressful.