Ask a doctor on the topic of Internal medicine

After cancer diagnosis constant fear of death attacks. What could be the cause?

March 11, 2013 | 15,00 EUR | answered by Dr. med. Frauke Gehring

My question will be a bit more detailed:
In 2005, I was diagnosed with lymph node cancer (at the age of 19) and was successfully treated with chemotherapy and radiation, the cancer is cured.
However, I had numerous side effects and have been in need of care since then (care level 3), among other things I am in a wheelchair, dependent on oxygen, have a permanent weakened immune system which limits contact with other people, also I am highly allergic and have already suffered an allergic shock.

For some time now, I have been experiencing panic attacks, my heart races (resting heart rate always over 100), at the same time my blood pressure is too low (60/50) and I wonder if this could be related to a hormone deficiency? Due to the radiation, I have an underactive thyroid and also became infertile as a result of the treatment, my body no longer produces progesterone and estradiol. I am taking hormone tablets, but the blood tests show that there is still a hormone deficiency. In addition, I am on a high dose of morphine (MST 110mg/day). Could the symptoms, the heart racing and the constant fear of dying, be caused by a medication?

I don't believe that it is solely the psyche responsible for this, but I have been in psychological treatment since the beginning of the cancer. Due to my need for care, I can only leave the apartment very rarely, but when I do, I always feel like I'm going to collapse and have even fainted while sitting in my wheelchair. No cause could be found, it was attributed to my poor general condition. As soon as I leave the apartment, the feeling of having to die intensifies, because I experienced the allergic shock outdoors, as I am allergic to numerous pollens, etc. Now I always fear that it will happen again.

I was prescribed Tavor for the fear of dying, but I did not feel any relief and it was discontinued. In addition, there are some additional stresses caused by the whole situation, I have been searching for an apartment for years because the current one is so small that I cannot move around in it with the wheelchair, but I cannot find a wheelchair-accessible apartment. Furthermore, there are numerous disputes with the health insurance company, constantly rejecting things due to my young age. All of this naturally adds to my burden.

Can you recommend something for me to investigate? Or a medication I could try?

Thank you very much!

Dr. med. Frauke Gehring

Hello, fate has hit you quite hard; I think you are very brave for dealing with it!

Of course, from a distance I cannot say for sure where your anxiety comes from, but it may be due to the fact that your illnesses have "caught" you at an age where one usually feels invulnerable.

Nevertheless, please have your thyroid hormone levels checked. An overactive thyroid caused by an overdose of L-thyroxine can cause such symptoms.

I am more concerned about the fact that the pulse is higher than the blood pressure, which is a kind of shock state that should not be ignored, and cannot be explained by anxiety. A cardiologist should take a look at the heart's pumping function; please make sure to stay hydrated!

Venlafaxine is a good treatment for anxiety that is hard to explain. It also brightens mood, which can be helpful, and alleviates anxiety. You can ask your treating physician about it.

I wish you a speedy recovery and lots of strength.

Best regards, Dr. F. Höllering, Specialist in Internal and General Medicine, Psychosomatic Medicine