Panic Attacks and Reality Checks

I am in the grocery store, checking the ingredient list on a package. Innocuous music is piped in from somewhere above me. I can smell the fresh bell peppers from the next aisle. The fluorescent lighting flickers, slightly blue, and I take my glasses off to focus on the small type. Suddenly, I am sweating. My breathing is tight and fast. My head swims, my eyes dart about, trying to make sense of why I cannot see clearly (forgetting, for the moment, that my glasses are in my hand). This is panic, washing over me without warning, without an obvious trigger.

An all too familiar feeling

As a stage IV lung cancer patient edging toward my five-year post-diagnosis mark, I am now well versed in recognizing panic attacks. In support group meetings and online forums, it has been a subject often shared with other patients. So many of us know the feeling of inexplicable dread, the unexpected tapping on the shoulder of the specter of our disease. For some of us, it can be debilitating. For others of us, just a passing inconvenience that we can self-correct and move along from.

For the most part, however, it is an unwelcome part of our new normal, this life with cancer that requires seemingly constant new adjustments. The term “scanxiety” has become much more commonly used to represent the fears and anxious feelings experienced by both patients and caregivers with the approach of scheduled imaging tests. Panic attacks certainly are common aspects of scanxiety. But they are not relegated to those weeks immediately preceding those scans.

Anxiety triggers aren’t easy to pinpoint

I cannot say what triggered my last panic attack. Maybe it was associated with my migraine condition. Maybe there was some other invisible cue that my brain picked up on in the subconscious. It could have been a scent that wafted by, an out of context comment by some passer-by, or even just a latent thought I had not yet processed fully. The reason does not matter, really. Panic is just a symptom of the underlying fear we often repress or have difficulty expressing in an honest fashion.

Dealing with our fears

Patient fear will manifest for various reasons. Some patients are afraid of death, others are afraid of suffering, some are afraid of the treatment itself, for many, it is all of the above. To get on with life, we have to deal with our fear. Sometimes this entails getting a viable support system in place to help mitigate our fear, to understand the shared experience, and to focus on the aspects of our lives that the fear cannot touch.

Sometimes patients will choose a spiritual course, assuaging their fear through the use of religion or other metaphysical tools. Psychiatry, therapists, social workers, and a host of complementary professions offer ways for patients to reframe their views and cope. From guided meditations to anti-anxiety medications, there is no shortage of approaches available to help patients navigate these troubled waters.

Cancer breeds uncertainty

But the reality is that cancer breeds uncertainty. It has a nasty knack of returning after remission, and treatments for metastatic disease almost invariably stop working at some point. We all know this. It lingers in the back of the mind, impossible to shake completely free. And sometimes, for whatever reason, it rises to the surface. Maybe just for a moment before it is pushed back down by rational thought, but it manages to poke through. Panic washes quickly over the body, tightens the breath, for those few heartbeats there is no rationale, only the fear and dread — but then it is gone. There is that breath, steady and controlled, calming. There is the pause, the moment to collect thoughts, then another careful breath.

Recognizing these moments & moving past them

Panic attacks happen. With practice, they can be short, quickly forgotten events. But they still happen. Learning how to recognize them is an important part of learning how to move past them. And being understanding of this, acknowledging that patients and caregivers alike might have an attack right out of the blue, provides an opportunity to comfort others.

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