Panic Disorder, Bone Graft, and Halcion

[healthyteeth]

Hello everyone,

It's truly wonderful that these forums exist. I've actually already found some incredibly optimistic posts that have eased my mind significantly. That being said, I'd really appreciate any insight on the following.

Just to give you the general idea of my situation, I am 37-years-old. I've had at least minor anxiety a majority of my life. However, it's gotten much worse in the past few years. As in, multiple ER visits due to my heart racing non stop. Still, none of those experiences were necessarily terrifying. Just concerning and a bit exhausting.

About a month ago I was struck with the most terrifying experience. My heart rate went up to about 165 beats per minute. I truly thought my heart was about to explode. A few days later I was struck with yet another panic situation. That afternoon I had the worst panic of my lifetime. My heart rate was about 177 beats per minute for an hour straight. It was brutal. I lay in bed for twenty hours after that, breathing myself into a calm. I basically felt like I could have a panic attack at any moment that entire while. It was completely hellish.

Since then I've seen both a psychiatrist and have started therapy. That's actually going quite well so far. I've been given beta blockers and put on a mood stabilizer. I actually feel considerably better from that alone. I've also done a good bit of reading about panic attacks, and am attempting to recover from this. I have not been in a car in about three weeks now. I'm just terrified of having another panic.

All of that being said, about a week after the panic episodes, I did get in a car and see the psychiatrist for the first time. The following day I went in for a blood test. Normally I'd be alarmed by this a bit, but I was actually just fine. I haven't had a panic attack since that crazy weekend. In general, I'm feeling good.

My therapist has diagnosed me with Panic Disorder and Agoraphobia.

I have a situation that requires a bone graft in the back of my mouth. Honestly, I wasn't too concerned about this. I get periodontal cleanings every few months, so I'm fairly accustomed to being under the gun on a regular basis. I've also had four wisdom teeth extracted at once (I was definitely sedated for this), and had a root canal (with no sedation).

During the root canal they accidentally numbed the back of my throat. It resulted in me feeling like a metal instrument was hitting it non stop. Talk about a gag reflex nightmare. It wasn't the procedure so much as feeling like that thing was about to make me throw up. After about half an hour of this I couldn't take it. I had them pause the root canal and had to calm down. Thankfully, they managed to finish up afterward. But that experience alarmed me as to just how anxious I could actually get during a dental operation.

I have "white coat syndrome", and my blood pressure runs high whenever I'm at a clinic. Still, I wouldn't consider myself to have a severe issue here. I've managed to handle it. Definitely no 177 per minute heart rate or anything like that.

But that was before. Now, I have this nasty panic disorder.

My procedure is scheduled for Friday morning. My therapist recommended pushing it back a few weeks. The thing is, I am sick of anticipating it. I think it's causing my anxiety than it's worth. So here is where your wisdom and experiences come in:

Firstly, thank you so much for digesting the information above. I just hope I can paint an accurate picture for you. I told the dentist office about my situation. They told me that they are giving me Halcion. I don't know if there's any other sedation at their office. I think they is not, as they seemed a little confused when I asked about it.

They are prescribing me three .25mg Halcion pills. They told me that I'll be taking one the night before the surgery. They then want me to take the second one about an hour before I come in. They said to hang onto the third pill, and bring it with me to their clinic.

Part of me is super relieved by this. Especially after reading some of your stories on here. Still, I can't help but wonder. Is that dosage strong enough? .25mgs? The thought of my heart suddenly jumping to lightning speed while strapped down to a dentist chair really doesn't sound too appealing to me.

Fellow Dental Fear Central People, any reassurance would be so very appreciated. Or, for that matter, cautionary tales. Am I rushing into this too soon? Frankly, if that Halcion does the trick, I'm all for it. I'd love to get this out of my mind and over with.

 

[geos]

Could you ask your psychiatrist to talk with your dentist so they can both evaluate your situation and evaluate what would be best for you?

At least, with sedation they monitor your vitals and would know if your heart rate goes way up.

 

[healthyteeth]

To be honest, my psychiatrist is incredibly far removed. I can't even get ahold of them without coming into their clinic. I am almost positive they wouldn't do that for me, unfortunately.

 

[healthyteeth]

By the way - By sedation, do you mean Halcion?

Thanks so much for your feedback, I really appreciate it.

 

[Animalhouse]

I feel like an expert when it comes to Halcion. Since April, I have had 4 sedation appointments and took it for each one. Let me assure you that it is super strong. My instructions were different. The first 2 visits, I was given one 5mg valium the night before and 2) .25 halcion one hour before the appointment. The valium didnt do much for me so for my other 2 appointments, I took 3) .25 mg halcion one hour before the appointment. My husband had to describe the experience because I barely remembered a thing! He practically had to carry me to the car because I was so wobbly, but again, my dose was quite high and all at once. Upon arriving, they started working on me immediately and I really don't remember much about it. I was given nitrous as well so nearly 5 hours ended up feeling like maybe one hour. No pain, no gagging, really didnt have much of a care about anyone or anything. I knew where I was and could respond when spoken to, but i dont remember it. Afterwards I came home and took a nap. I think it will work out well for you. Halcion used to be commonly prescribed as a sleeping pill so you shouldn't have any trouble sleeping. Then your morning pills will put you at ease for your visit. Just make sure you have someone with you so you don't do anything stupid

 

[Enarete]

Dear healthyteeth,

sorry to read about your experience one month ago, it sounds scary.. and trying to breathe yourself into calm for twenty hours, wow..

From what you write you started a therapy immediately and keep educating yourself about panic attacks and how to conquer them, which is great. It's also impressive that you got into a car after three weeks instead of falling into avoiding behavior. You would be surprised how many people just do their best to avoid confrontation with their issues and it sounds like you jumped right into it and are determined to work on the problem. So it's amazing to read that you are addressing the issue intensively and with this approach there is no way for you to fail.

Reading about your root canal experience where they numbed your throat, it sounds like you were trying to toughen it out for quite some time before you told your dental team. I would like to encourage you not to next time. If you notice any discomfort during a procedure, it is very important to stop your dentist immediately and ask for a breather. In this way you can get into control and do some meet and greet with the sensation before other triggers (treatment) will be added.

Having a throat numbed is scary and I too get heavy sickness from it, but it's actually not too different from taking a lozenge against sore throat (that one with lidocaine), the sensation is the same. The point is that it is quite a difference between having it during a treatment where there are some other things you cannot take control of or having it in everyday life. Sometimes, interrupting treatment, getting out of the chair or even out of the treatment room for a moment or just having a good chat with your dental team about the sensation might help you to cope and finish the treatment. These are all ways that show your brain that YOU are in control and that this is just a sensation.

It might be also beneficial to have a good chat with your dentist about what happened, if you haven't already. Local anesthesia doesn't numb your throat, it sounds more like a bit of the topical anesthetic got too far back. If you tell your dental team about this they may be able to make sure that it won't happen again. I also used to practice with sore throat lozenges to intentionally numb my throat just to get used to it.

Animalhouse's reply sounds like you do not have to be worried about anything with the Halcion now, but I thought some non-sedation advice can't do any harm

All the best wishes and keep us posted

 

[healthyteeth]

I feel like an expert when it comes to Halcion. Since April, I have had 4 sedation appointments and took it for each one. Let me assure you that it is super strong. My instructions were different. The first 2 visits, I was given one 5mg valium the night before and 2) .25 halcion one hour before the appointment. The valium didnt do much for me so for my other 2 appointments, I took 3) .25 mg halcion one hour before the appointment. My husband had to describe the experience because I barely remembered a thing! He practically had to carry me to the car because I was so wobbly, but again, my dose was quite high and all at once. Upon arriving, they started working on me immediately and I really don't remember much about it. I was given nitrous as well so nearly 5 hours ended up feeling like maybe one hour. No pain, no gagging, really didnt have much of a care about anyone or anything. I knew where I was and could respond when spoken to, but i dont remember it. Afterwards I came home and took a nap. I think it will work out well for you. Halcion used to be commonly prescribed as a sleeping pill so you shouldn't have any trouble sleeping. Then your morning pills will put you at ease for your visit. Just make sure you have someone with you so you don't do anything stupid

That is so very kind of you. Thank you so much. I don't think they're using any nitrous oxide. Hopefully that doesn't end up being an issue.

What's reassuring is that the dentist is having me pick up that third pill, and said to bring it with me to the clinic. Something tells me that's a "just in case" back up pill. I find that super wise. She seemed incredibly intelligent when I met with her. She's a specialist, so I have never worked with her before.

I'll be taking .25mg of Halcion. I have a feeling my wife will be laughing at me later on in the day.

 

[healthyteeth]

Dear healthyteeth,

sorry to read about your experience one month ago, it sounds scary.. and trying to breathe yourself into calm for twenty hours, wow..

From what you write you started a therapy immediately and keep educating yourself about panic attacks and how to conquer them, which is great. It's also impressive that you got into a car after three weeks instead of falling into avoiding behavior. You would be surprised how many people just do their best to avoid confrontation with their issues and it sounds like you jumped right into it and are determined to work on the problem. So it's amazing to read that you are addressing the issue intensively and with this approach there is no way for you to fail.

Reading about your root canal experience where they numbed your throat, it sounds like you were trying to toughen it out for quite some time before you told your dental team. I would like to encourage you not to next time. If you notice any discomfort during a procedure, it is very important to stop your dentist immediately and ask for a breather. In this way you can get into control and do some meet and greet with the sensation before other triggers (treatment) will be added.

Having a throat numbed is scary and I too get heavy sickness from it, but it's actually not too different from taking a lozenge against sore throat (that one with lidocaine), the sensation is the same. The point is that it is quite a difference between having it during a treatment where there are some other things you cannot take control of or having it in everyday life. Sometimes, interrupting treatment, getting out of the chair or even out of the treatment room for a moment or just having a good chat with your dental team about the sensation might help you to cope and finish the treatment. These are all ways that show your brain that YOU are in control and that this is just a sensation.

It might be also beneficial to have a good chat with your dentist about what happened, if you haven't already. Local anesthesia doesn't numb your throat, it sounds more like a bit of the topical anesthetic got too far back. If you tell your dental team about this they may be able to make sure that it won't happen again. I also used to practice with sore throat lozenges to intentionally numb my throat just to get used to it.

Animalhouse's reply sounds like you do not have to be worried about anything with the Halcion now, but I thought some non-sedation advice can't do any harm

All the best wishes and keep us posted

Thank you so much for the kind words and encouragement. Yeah, there is no way under the sun I'm letting panic control my life. I've begun meditating in the mornings, cut back on caffeine intake. Just trying to wrap my head around it all.

Similar to you and the throat numbing, I've come to realize a lot of this really is a matter of being familiar with physical sensations. For example, my racing heart. Was it life threatening? Not at all. But in that moment it was so unfamiliar that I couldn't help but panic. These past weeks if I feel anxiety, I try to think of it this way, "Oh, okay. There's some adrenaline pumping. That's a good thing. Means I'm ticking properly. It's not unpleasant. It's healthy. Now, why am I even having adrenaline? My heart is good. Let's focus on that instead." It's helped immensely.

It felt silly, but after those panic episodes I couldn't handle my heart rate increasing. It was terrifying. I am fortunate in that I own an exercise bike. I decided to pump the heck out of my heart on that thing, even if it freaked me out at first. The first try was a flop. I was all kinds of anxious, kept watching my heart rate increase, and was super bummed out afterward. One week later, not only did I ride that exercise bike at full speed, but I did it with a sigh of relief. I think a huge concept for many of the people on here: Become familiar with the sensations. Visualize the fear. Even if it's very "small" steps, the end result is having a confidence over your terror.

That root canal, yeah. You're very correct. I should have said something sooner. With the dental dam and a block they put in my mouth, I just assumed there was some object constantly jabbing my throat. It was incredibly unnerving, but I figured it came with the territory and I'd have to run with it. They stopped immediately when I expressed concern, removed everything, and told me to get some water and walk around their clinic for a moment. When I returned, you could sense they were working double time to get me on my way. In fact, they said this was the case.

Tomorrow is the day. I won't even call it a "big day", because it's not. In reality, even if I have a full blown panic attack, I will be alive and well. But it sounds like this Halcion will have me plenty sedated. This is my first venture outside my neighborhood in weeks. So I'm just a little unsettled, seems a bit extreme. But on the positive side, I get to be ridiculously sedated for that first experience out. So perhaps it's actually going to be a tool to recovery in the end.

Thanks again for the kindness.

 

[Enarete]

Wow. I don't even know what to say. You're a champ and this is how control over oneself looks like. L ook forward to read how it went tomorrow

 

[Animalhouse]

I don't think not having the nitrous will be a big deal. I remember towards the end of my appointment (at least 3 hours into it) I was getting annoyed by the plastic around my nose and I asked if they could take it off. I went through the rest of the appointment without it and I remember a bit more about that part, but mostly I just remember feeling really calm. This was during the part when they were placing a temporary crown and poking around my gums to get rid of excess cement. I went through the same thing a few days ago for my permanent crown without any sedation and I was silently freaking out the whole time. I think you will do just fine!

And yes, you might say some silly things. I remember laughing at my husband because he had two heads lol.

 

[healthyteeth]

Well everyone, it went super well.

I had no panic in the least. In fact, it was an incredibly calm experience. In the end I took .5mg of Halcion. As reported earlier, .25mg an hour beforehand. They had me take an additional .25mg once I was there.

For me, I didn't fall asleep. I didn't forget anything. It's all a bit fuzzy, but I honestly was good to go after I left. For anyone curious, I simply felt very calm. From driving there to heading home, there was not even a second of panic, anxiety, or discomfort.

Thanks so much for the kind words and support. Be well this week.