You’re going to be OK | Essay | Chicago Reader

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You’re going to be OK

Dealing with health anxiety during COVID and beyond

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"I'm afraid of the idea that one day, something will happen to me and I will not be prepared. It will rear its head when I'm not paying attention, which is why I always need to be paying attention." - VALERIE VON RUBIO
  • Valerie von rubio
  • "I'm afraid of the idea that one day, something will happen to me and I will not be prepared. It will rear its head when I'm not paying attention, which is why I always need to be paying attention."

Here is how you explain to a doctor that, despite the fact that you seem OK and are not visibly dying, you do have a rare illness that requires immediate medical attention. You do it calmly, because if you reveal that you're freaking out, then they'll know you're a lunatic. Panicking is intimate; it's meant for the close friends and family, if any, that you've been frenetically recounting your symptoms to as they talk you down. You explain your symptoms with detailed precision: when they started, which symptoms started on which day. You point to every inkling of a physical symptom: Here's where the rash was. Here's where the swelling is a little bit right now, but when I'm home sometimes it's worse. Here is where I'm feeling cold. Then, before the doctor can tell you to wait a few days to see if it gets better, you slip in a few conjectures on what you think it is, based on your careful research. You throw in an "I think it could be . . ." or a "Maybe it's . . ." so that you don't sound too confident, and the doctor doesn't think you're crazy. The doctor explains why both of your self-prescribed diagnoses are unlikely or impossible, based on your symptoms. You protest, but not too much—panic is not for the doctor, and plus, the last time you panicked at the doctor, she got stressed out, prescribed you Xanax and left the room—but the doctor sees where you're going and lets you know, sometimes gently, that you're OK. This reassurance should mean something, but it doesn't. You're back to googling, trying to find a workaround because even though you know in your head somewhere that you probably are OK, the louder part of your brain is scared of what happens if you're not.

I've experienced anxiety around my health for a long time. It was only within the last few years that I put a name to it. Whenever I'm worrying excessively about my health, being able to remind myself that my symptoms are of anxiety lets me acknowledge that there is something wrong, but also that there's a solution to the problem.

Health anxiety is not a categorized disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Rather, it's anxiety that's health related that can show up in different types of disorders, according to Dr. Shona Vas, an associate professor of psychiatry and behavioral neuroscience at the University of Chicago. It can manifest in panic disorder (i.e., feeling physical symptoms of anxiety and believing that those are symptoms of an illness), generalized anxiety disorder, and obsessive-compulsive disorder, to name a few. With COVID, health anxiety can manifest in different ways. "People who have panic disorder are almost constantly scanning their bodies, looking for symptoms and then worrying if those are COVID symptoms," says Vas.

During the pandemic, health anxiety has been complicated by the fact that there is a legitimate threat of a scary illness, especially when factoring in one's personal level of risk. Many people are having COVID anxiety, but some people are experiencing it more severely in terms of worries over catching the virus. This worry leads to people taking extreme measures—for example, not leaving the house at all. "That baseline concern is pretty normative, but when we're thinking about health anxiety, we're thinking about something that really gets in the way of people being able to think or function. When you're taking measures that in your mind are safety precautions, but they're safety precautions that cause notable inconvenience or notable disruption of your day-to-day activities, then that's when we would consider it to be excessive," says Dr. Inger Burnett-Zeigler, an associate professor of psychiatry and behavioral sciences at Northwestern University who practices through Northwestern Medicine. In her experience, individuals who are at higher risk experience COVID-related health anxiety the most aggressively. "There are people who are in circumstances where they have not been able to work from home, or they have preexisting health conditions," she says. "So when you take into account their personal circumstances, and consider that as their trigger for an increase in anxiety, I wouldn't necessarily consider that excessive."

The first time I experienced health anxiety was in the third grade, when I told my pediatrician that I didn't feel like my head was connected to my body. She suggested that I eat more ice cream. There was a second time somewhere around then too, when I had what I described as an unending stomachache. The time after that was in the fifth grade, after a few stray headaches convinced me I had brain cancer. I remember drinking a tall styrofoam cup full of a thick, bland liquid to prep for a CT scan. The nurse comforted me, saying, "You're going to be OK." I felt guilty that she didn't know that this was just part of the rotation. She didn't know that I was in there because I had begged my mom to take me, that I had protested against my pediatrician's assessment that there was nothing wrong with me.

It would always start with something innocuous—a headache, a suspicious bruise, an especially visible vein. Then, the others would follow: dizziness, increased heart rate, feeling hot, feeling cold, my fingers and toes swelling and burning. I'd go to my campus health center; I'd text pictures of rashes to my cousins who were doctors; I'd spend hours worrying. I had a hard time believing that mental health was real then. I thought that anxiety was something that rich kids at my predominantly white university made up, and that I wasn't soft like them. If it were real, you could see it. When my fingers would swell up like little red blimps, a patchy rash spreading across my arm and chest, my head clouded with dizziness and my heart racing, I would take that as confirmation that I had a rare illness that was so rare, no doctor would think to diagnose it unless I did the research first. Even though I know now that these are symptoms I have when I feel anxious, it's still hard to not imagine the worst case scenario.

A few weeks ago, I hit my head against a towel rack in my bathroom. I like to think it happened because I am a beautiful, leggy model who is too tall to keep from getting attacked by bathroom fixtures, even though it's actually because I do not watch where I'm going. After it happened, one side of my nose started dripping (hot, I know), and I self- diagnosed it using my degree from the WebMD School of Medicine. I called my cousins who are doctors, who asked: "Did you pass out?" "Do you have a headache?" "Do you have a fever?" The answer to all of them was "no," which meant they weren't worried. I imagined Technicolor liquids dripping and oozing and falling through my nasal passageways, dripping down my throat and into my stomach, infecting my intestines, colluding in my bowels. Weeks later, I couldn't stop googling cerebrospinal fluid—or, as I affectionately called it, brain juice—wondering if there was any chance that a head injury from three weeks ago could leave time for a brain leak, and if it had been happening the whole time, and that my brain was running out of stuff to slosh in, and that I was dying very, very slowly—despite my only symptom being a minor headache, and even though my cousins and the Internet told me this was impossible. For every forum full of people detailing their weird medical emergencies, why isn't there another website where people share stories about times they felt normal after an Advil?

When I feel health anxiety, it's like I'm drowning in a swimming pool full of syrup, the viscous liquid oozing into my ears and nose and between my fingers, a warm familiar feeling that reminds me this has happened before—a strange comfort—yet still paralyzes me. I'm scared that I will die. I am convinced that it's happening. I imagine the ways the inside of my head is dripping, pieces of my brain getting ready to slither down to the inside of my nose. And the second part is vindication. I want to be right. I want something to be wrong so that I can prove that I wasn't out of my mind, and that what I was feeling was real, and that everyone was wrong to doubt me. Health anxiety can be all-consuming and simultaneously absurd. When I'm panicking about my health, it initially feels very scary, and then it feels both scary and normal. My inner monologue adjusts to what it thinks a woman who is about to die sounds like: Oh, I'm so excited for my haircut! Would you be a little more gentle with my left temple? I bumped my head recently and now I'm going to die.

Vas believes there are two main factors that pertain to health anxiety that are heightened with the threat of COVID. The first is uncertainty. "Uncertainty, in general, is not something that we like as human beings. We want to know. We want to be able to make a plan. And what we do know about it is that it is, for specific groups of people, a very dangerous and scary disease." The second is the lack of control we have over the situation. "Because we don't know how to manage this in general, and we also can't control other people's behavior, it makes us more anxious," she adds. Vas explains that taking precautions varies based on one's own individual risk, and the best thing to do is to follow public health guidelines.

It is the uncertainty that scares me, both with COVID and general health anxiety. I'm afraid of the idea that one day, something will happen to me and I will not be prepared. It will rear its head when I'm not paying attention, which is why I always need to be paying attention. When my brain tries to convince me that this is true, I try to take a step back. Like Vas and Burnett-Zeigler both say, assessing the likelihood of a risk is important. What are the chances that I have a rare illness? Not a ton. I reasoned with myself: what would a doctor do? A doctor would tell me to wait it out to see if it gets worse. What would the ER do? Ask me why I don't have insurance and then charge me thousands of dollars to tell me to wait it out. I waited it out. Eventually, after a few days of certainty that my head wasn't getting worse, I relaxed. Finally, I could watch 90 Day Fiancé without wondering whether my last words would be, "Oh my god, this bitch is making a huge mistake."

I am lucky. I have a boyfriend who will research WebMD for me when I don't trust myself to be alone with my brain, and talk me down when I feel myself getting dizzy and choking on air. I have cousins, who, even if they don't know exactly how to address the symptoms, can give me advice on what I should do next. I don't go to my cousins unless I really have to, because even though they are always there to help, I also know that you can only cry wolf so many times before you stop being taken seriously. Instead, I go to my checklist: Did you drink water? Did you get enough sleep? Did you take deep breaths? Is your nose stuffy because your brain's falling out of it, or do you have allergies? Are you drowsy because you're losing consciousness due to a parasitic worm squatting in your kidney, or because you drank a glass of wine immediately after taking an allergy pill? Your body is smart, and if there's something that's really, really wrong, you'll know. Sometimes it's easy to hyperventilate after reading the article about how you can die hours after a head injury; it's harder to focus on the fine print that says that you'd feel really, really bad before something like that would happen.

In therapy, Burnett-Zeigler works with patients to assess the risk involved in getting a rare illness, "helping someone to see that the likelihood of that outcome manifesting is rare and to reframe their worry, and then use that alternative thinking in the moment when that intense fear or worry turns up," she says. For people who don't have access to therapy, Burnett-Zeigler recommends mindfulness, which involves paying attention to how the body reacts to stress and figuring out what triggers it in order to better respond when that stressor comes up. "People with anxiety feel like they're worried all the time when in fact, there are specific peaks and valleys to that worry," she says. "If the person can identify those peaks and valleys, then in the moment when there's a peak, we can really dive into that and see and use those mindfulness tools, use those body relaxation tools, to really work with how anxiety manifests in the body."   v

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