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Panic Attacks Post Appendectomy. Marijuana Smoker. On Medication. Reason For Panic Disorder?
Hello, In October of 2002, I had a trans abdominal, left appendectomy. There was a tumor the size of a grapefruit engulfing the gland, so the gland had to be removed along with the tumor. Until recovery, I had never experienced anxiety or panic attacks, and I was an avid user of Marijuana and occasional user of psychedelics. In my entire life I had never had a panic attack or anxiety attack. After the surgery, I developed SEVERE panic disorder, but not until I stopped using the prescribed pain killers I was on. 11 hours to the hour of stopping my pain medication intake, I had my first post-surgical panic attack. It sent me to the hospital. I may point out that I may have had an adrenal spike 1 week into my 2 week surgery window, which ramped up my schedule by 1 week. I blacked out, and awoke several seconds later in convulsions, making it very difficult to walk or even raise my arms, it was as if I had no strength at all. Yet, upon arriving at (yes, I went to the ER), they found nothing wrong with me. Then surgery, then recovery, which included an epidural and anesthesia, followed by an 8-day morphine drip (I had never been put under nor taken morphine), and then 1 month of Hydrocodone for pain. It was not until after stopping my Hydrocodone intake that I developed CONSTANT symptoms, that have not gone away to this day. After many trials of antidepressants, none of which alleviated symptoms, I was prescribed xanax, which works. I now take 4mg's a day to keep symptoms at bay. This has been my life for 11 years now. I am also a marijuana smoker, but I find it increasingly harder to smoke it as it now agitates my symtoms. Any ideas as to why the SUDDEN change from no history of symptoms, to surgery, to MASSIVE attacks? I am 6'6" tall, no stranger to trauma, I have a strong stomach, Ive had multiple compound fractures with bone sticking out of my skin by inches and not been bothered by it. I am a lifelong martial artist, so why the flip? I do not believe this is a psychological condition but has definitely created psychological dependance on my 2 medications, xanax and metoprolol tartrate (beta blocker for tachycardia). Am I nuts or have I been miss-diagnosed? I may also point out that I have constant heart palpitations without the beta blocker. My surgeon suggested that I may have a damaged beta receptor on my heart. Funny, it was not there before, and upon consulting a cardiologist and wearing a 30-day event monitor, all of my readings were considered normal....I don't think so, normal people do not have palpitations every 3-5 seconds and major arrhythmia every other minute. Any insight would be appreciated. I am not expecting much on this but thought I'd give it a shot, I stumbled upon this site...thank you.
Fri, 12 Jul 2013
User's Response
Dr. Balaji Bharadwaj,
Psychiatrist's Response
Psychiatrist's Response
You have mentioned your symptoms and clinical history in great detail.
I understand that you developed panic attacks only after your surgery and not before that.
Did you have abdominal cramps, churning sensations or diarrhoea as part of your panic attacks or did these occur even prior to the surgery?
How was the tumour around your appendix suspected or why did you get investigated in the first place and how did the tumour come to be diagnosed? What symptoms did the tumour cause?
I am asking these questions because there are certain rare tumours (carcinoid) that arise around the appendix and can cause panic attacks especially with abdominal symptoms and diarrhoea.
The reason for your current symptoms can be:
1) Use of alprazolam. Alprazolam is a wonderful drug for panic attacks. However, it is very short acting. Once its effects wear out after 4 to 6 hours, the panic attacks come back with even greater severity. This leads to an increasing use of alprazolam over the years. (You might have started with 0.25 to 0.5 mg per day and now you are using 4 mg). It does not help the root cause of panic attacks - which need other types of drugs.
2) A more serious concern however is you may be having some more tumours lurking in your body. The group of neuro-endocrine tumours are a set of rare tumours. They are usually small (
I suggest you look back at the surgery notes and biopsy report of the surgery you have undergone and have a consultation with an endocrinologist to rule out this possibility. Meanwhile you can also consult a psychiatrist who will help you get off alprazolam with another drug that is easier to taper and stop. If the above medical possibilities and hyperthyroidism are ruled out by your endocrinologist, you may be having panic disorder which is a treatable condition.
I understand that you developed panic attacks only after your surgery and not before that.
Did you have abdominal cramps, churning sensations or diarrhoea as part of your panic attacks or did these occur even prior to the surgery?
How was the tumour around your appendix suspected or why did you get investigated in the first place and how did the tumour come to be diagnosed? What symptoms did the tumour cause?
I am asking these questions because there are certain rare tumours (carcinoid) that arise around the appendix and can cause panic attacks especially with abdominal symptoms and diarrhoea.
The reason for your current symptoms can be:
1) Use of alprazolam. Alprazolam is a wonderful drug for panic attacks. However, it is very short acting. Once its effects wear out after 4 to 6 hours, the panic attacks come back with even greater severity. This leads to an increasing use of alprazolam over the years. (You might have started with 0.25 to 0.5 mg per day and now you are using 4 mg). It does not help the root cause of panic attacks - which need other types of drugs.
2) A more serious concern however is you may be having some more tumours lurking in your body. The group of neuro-endocrine tumours are a set of rare tumours. They are usually small (
I suggest you look back at the surgery notes and biopsy report of the surgery you have undergone and have a consultation with an endocrinologist to rule out this possibility. Meanwhile you can also consult a psychiatrist who will help you get off alprazolam with another drug that is easier to taper and stop. If the above medical possibilities and hyperthyroidism are ruled out by your endocrinologist, you may be having panic disorder which is a treatable condition.
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