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August 24, 2006
Fear of crowds
Q I have never seen a letter to you about agoraphobia. I have it so bad that I am housebound. I am so discouraged and feel so hopeless because of it. Is there any way out of it?
A The literal translation of "agoraphobia" from Greek is "fear of the marketplace." It's panic attacks that occur when a person is outside the home and in a crowd, a mall, a supermarket, a busy street or other public arenas where many people congregate.
When an attack happens ––– and it can do so without warning ––– people's hearts race. They might become dizzy and tremble. Often they have chest pain, or believe they are choking. They are convinced that they're on death's door.
There's a glitch in the way these people's brains produce chemical messengers. The brain alerts the body to imminent danger when there is no real threat.
Agoraphobia can turn a person into a social hermit, but it is not a hopeless condition. A therapist can help you and others who suffer from this not-uncommon condition learn how to deal with these erroneous signals and how to subdue the irrational fear they initiate. Sometimes that's accomplished by exposing people to the situations that provoke an attack. It's a way of desensitising the brain to the triggering input.
Medicines can also restore the normal production of brain messengers, and they play an adjunct role in treating this.
There is no reason to feel hopeless. Phobias are common, and people can achieve mastery over them with the help of a professional. The family doctor can put you in touch with such a person.
Q I belong to an HMO. I have had three doctors and am on my fourth. They come and go. Today I went to my newest doctor, and he told me I have an irregular heartbeat and said it is atrial fibrillation. He said it could cause a stroke. He also said he is going to put me on Coumadin and monitor the thinness of my blood. I would like your personal opinion on this.
A The atria are the heart's upper left and right chambers and the place where the heartbeat originates. Atrial fibrillation is a degeneration of the heartbeat into a jumble of erratic signals that cause the atria to beat rapidly and feebly. The ventricles ––– the heart's lower pumping chambers ––– also beat rapidly and irregularly, but they can still function as pumps ––– in a slightly diminished fashion.
The great danger of atrial fibrillation is the formation of blood clots in the quivering atria. Pieces of those clots can break loose and be swept in the circulation to brain arteries. If they block a brain artery, as they frequently do, a stroke results. Atrial fibrillation is responsible for up to 20 per cent of all the strokes that occur yearly in the United States and Canada.
For this reason, most doctors put most atrial fibrillation patients on the blood thinner Coumadin. That's not just my opinion. That's the general medical opinion.
Q Would you tell me something about the drug Zetia? It's used for cholesterol. Are there any side effects, and if there are, how long do they last?
A Zetia (ezetimibe) is a more recent cholesterol-lowering drug that works quite differently from most other cholesterol medicines. It prevents the body from absorbing cholesterol in foods. It has few side effects ––– none worth mentioning, and none that lasts.
Dr Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write to him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475
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