Wednesday, December 25, 2013

Let's get excited: Performance anxiety and autonomic failure.

American Psychological Association article on getting excited versus calming down.

A recent study suggests that trying to "calm down" focuses one on the negative, whereas "getting excited" promotes positive feelings about an upcoming performance and helps one better negotiate the situation. I have no idea how this observation relates to anxiety produced by physical triggers, such as with Dysautonomia. So I decided to do an experiment.

Orthostatic intolerance is one of the syndromes associated with Dysautonomia. It is a fancy name for the inability to stand – specifically it describes a condition wherein the normal autonomic response to standing fails. When a healthy person stands up their body automatically regulates their blood flow to compensate for the change in direction (vertical versus horizontal), ensuring the organs continue to receive blood, oxygen, and nourishment. Normally, we don't have to think about this. But for those with autonomic failure, the body cannot make this shift (or any other changes that are normally regulated automatically). Instead, blood swells up the legs and feet, leaving one's head oxygen poor. Keeping in mind that dysautonomia patients already suffer from low blood pressure and reduced blood volume, you can perhaps imagine how dire this situation may become. Without oxygen, the brain flounders, unable to function. Some of us pass out repeatedly because of this failure. Many dysautonomia patients are relegated to a wheelchair, with an oxygen tank below and IV bag above, to prevent them from losing consciousness and their veins from collapsing.

But the real fun begins when the body attempts to compensate for the lack of oxygen by triggering repeated adrenaline surges. These hormonal surges speed up the heart rate and the flow of blood through the body – but do not solve the problem. Rather they create additional problems because an adrenaline release is always accompanied by anxiety and panic. It's just the way our bodies have evolved. One does not occur without the other. Each time a dysautonomiac stands up, we instantly panic. There are frequent and alarming surges in heart rate and palpitations. Chest pain, intense pressure, and a feeling of suffocation are not unusual. The problem compounds the longer we stand, as blood pressure continues to drop until the time we can get our head down as low as possible and our feet up high.

So here is the experiment: I decided I would stop trying to "calm down" (which allegedly promotes negative thoughts), and instead, each time I stand up, I will "get excited".

Yay, I am standing! Fantastic! I can do it! I won't fall over! I will stand up and walk into the kitchen! Feet: step forward – not sideways! What a glorious excursion - past the bedroom window, stepping over the threshold, walking along the hall. Outstanding! Legs don't fail me now! The performance is about to begin! I will pour some water – and I won't spill! I will not choke and spit up! No, not today! For today's performance is special. I will bend down and pet the doggy – without getting dizzy and sitting down! Dizziness go away! I am excited, and my excitement WILLS you away. Vertigo, be gone! It's show time! Confusion, numbness, terror – you, too, are banished! I am turning over a new leaf! I am standing on the great stage of the kitchen! Fuck "Top Chef". We are "Conscious Chef" today, and we will NOT sit down! We will not lay down in the middle of our finest hour!

Not sure how long I can stay excited. It's tiring. I'll let you know how it goes.

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