Resolved question:
Hi my names James Bettles, I'm 23 , 6ft weight 9stone, 10pounds
I've suffered from anxiety and agoraphobic symptoms for over 8 years, meaning I can't travel out of my comfort zone which is about 5 miles. I have ups and downs, my anxiety takes over my life sometimes. The main symptom I get is a tight chest / throat where I feel I can't get my breathe, I get the whole tingling in the hands and dizziness. Also my nose tends to feel like its blocked a lot, and that it's not allowing me to get air in properly. It's recently got a bit worse than Normal. I have a fear of death, and being alone. I'm currently on propranolol 40mg and was on citalopram 20mg but I have stopped the citalopram now after not much progression. I've also tried the linden method to overcome my anxiety. With no success. I just want to know what advice you can give me to overcome my anxiety, or if there is any other tablets I could ask my GP for.
I had a problem with my posture which is still quite bad, my posture has given me some back pain. But I've also had really bad pain in my sternum for the last few years. If you rub your hand along my sternum, there is a bulge where my bone from my sternum sticks out a bit and that is what is causing me pain. I've had an X-ray and everything came back ok. My GP said it could be cartilage fusion which is causing it to be painful. I personally believe it's because of my posture over the years. But I'd like to hear your side of the story and again any medication to treat the pain I get in my sternum and other postural positions.
I generally believe because of my sternum pain and posture, my mind believes that it's crushing my chest therefore not enabling me to breathe properly. It's a viscous circle. But I've had the X-ray and it's fine. So why the sternum pain.. I alliterate I only feel discomfort in certain positions I lay in.
Submitted:
4 Days
Category:
Family Physician-GP
Hello,
Thank you for choosing DoctorSpring.
The pain over the sternum is most likely due to a costochondritis or a painful floating rib syndrome. In both conditions the pathology lie at the joint between sternum and the rib. These are not dangerous or serious conditions. The pain can be troublesome I agree. One option is to user a constricting bandage around the chest for a weeks time and see if does any good (it should not be very tight and should be used for long term). Meanwhile take an NSAID otc medication like Ibuprofen 400mg twice daily for 3-4 days. If this approach is not working out then you will need to go offer interventions such as direct analgesic injection to the joint. You will need to get in touch with a Orthopedician for that purpose.
The anxiety - Generalised anxiety disorder or GAD needs proper management. Sure, life style modifications, exercise, youga, stress release techniques can all help. But one most important component is medication. There is a lot of negative propaganda about ant anxiety medications. But the fact is that modern anti anxiety medications are very effective and safe. Citralopam is a good start, but if it is not working the medication needs to adjusted and titreated. Additional medications might also be required. This is indeed a step by step process. (called stepped Pharmacotherapy )
"ALGORITHM FOR STEPPED PHARMACOTHERAPY —
Step 1 — Would typically start with a selective serotonin reuptake inhibitor (SSRI) antidepressant. SSRIs can provide effective treatment for both GAD and major depression, a common comorbid disorder.
Step 2 — Nonresponse after an adequate SSRI trial can be followed by a different SSRI, followed by a trial of a serotonergic-noradrenergic reuptake inhibitor (SNRI) or tricyclic antidepressant. A partial response to the initial antidepressant can be followed with augmentation with buspirone , or (if insomnia) hydroxyzine .
Step 3 — Nonresponse after an adequate trials of second-line antidepressants can be followed by trials of other less well studied antidepressants. Partial response can be addressed by augmentation. "
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Once you have initiated this ,general measures,life style modificaiotn and Cognitive behavioural therapy can help.
Hope this helps
Feel free to ask followups
Thank you
With my chest hurting I was wondering if it was due to the fact my posture is really bad and often brings me back and neck pain. Would you recommend me wearing or buying a posture brace to realign my posture.
Also I keep getting this nasty feeling like a I have to clear my throat all the time, like there is mucus there but when I try to clear the mucus from my airways there is nothing that comes out. It's really uncomfortable. It's been going on for months now. My nose Is generally blocked a lot of the time too. Never feels like I can breathe freely. Any ideas?
Hello,
I would not really recommend posture braces. They are not recommended or proven beneficial in individuals with no structural deformity. The main advantage is that they will 'remind' you to sit proper. But it can lead on to muscle weakness and related problems leater on. I would recommend you to adopt a good posture and make conscious effort to make sure that it is being maintained. This is the only long lasting solution. Once you are used to a good posture of 6 weeks or more, you will automatically follow it.
The throat clearing could be due a chronic allergic pharyngitis . You can take an OTC anti allergy medication like Allegra once a day along with steam inhalation twice a day ( alternating through mouse and nose). This should alleviate the symptoms.
Hope this helps
Feel free to ask followups
Thank you