Why Am I So Nervous About Going to the Doctor?

Woman anxiously sitting on exam table

If you worry about going to doctor’s appointments, you aren’t alone. Many people feel anxious about upcoming medical appointments and tests. This ‘scanxiety’ affects people of all ages and backgrounds.

It is perfectly normal to be anxious in a medical setting, according to Rachel Kaplan, LCSW, a clinical social worker at The Mount Sinai Hospital, who explains why you may feel uneasy and what you can do to counter those feelings.

Why do people get anxious about going to see the doctor?

There are almost as many reasons for being nervous as there are people who worry. For instance, you might anticipate that your doctor will criticize you for your weight, for smoking, or for another habit. Or you could be scared of needles, blood work, or some other medical test. You might dread hearing a certain diagnosis—or you might know your diagnosis but worry about the treatment plan. You might suspect the doctor still won’t know what’s going on or be reluctant to hear that you are better and will have to ‘fly free’ without regular medical oversight.

Sometimes people are concerned not just about the message, but about who is telling it. If you’re not thrilled with how your medical care has been handled in the past, you might be reluctant to go back. You might anticipate feeling rushed and not getting all the information you need. It is also possible you just don’t like a particular doctor or other health care provider.

Any—or all—of these reasons can leave you feeling disappointed, upset, frustrated, scared, annoyed, or just hopeless.

Sometimes people who are nervous about doctor visits walk in the door with sweaty palms or a knot in the pit of their stomach. Others try to treat ailments by themselves in hopes that they will never have to head into the exam room. Still others make appointments, but keep rescheduling for days, weeks, or even months.

Can ‘scanxiety’ affect how my body feels?

Absolutely. Sometimes, in the days or weeks before an appointment, you might find yourself feeling on edge, irritable, or you could have difficulty sleeping. When you actually get to the office, you might notice your muscles are tensing. It’s possible that you will start breathing quickly or taking shallow breaths. You could feel it in the pit of your stomach or in your bladder, with a sudden and urgent need to go to the bathroom. It might even raise your blood pressure. When your blood pressure goes up while you are in the doctor’s office, we use the term “white coat hypertension.” To repeat, all of this is perfectly normal.

Should I ignore these feelings?

No, don’t ignore your emotions. You should acknowledge how you are feeling, realize that it affects a lot of us, and tell yourself that it is okay to feel this way. This may sound simplistic, but paying attention to your emotions and then identifying and acknowledging your feelings can be very powerful. You can say out loud—to yourself or to someone you trust—that you’re feeling really worried about your upcoming appointment.

Some days, it may seem easier to just push your feelings aside and ignore them. It can be uncomfortable or even scary to think about your anxiety. But ignoring your emotions does not make them go away. It just means they will come out in some other way—such as irritability, muscle pain, headaches, and sleep problems.

What do I do about my anxiety?

Once you acknowledge what is going on, you can practice self-compassion. Give yourself permission to worry. If that’s hard to do, think about what you would say to a friend or family member if they were going through what you are experiencing. Often, we are much harder on ourselves than we are on others. So try to show the same patience, empathy, and nurturing to yourself that you would show to someone you care about.

Also, try to figure out what is causing your feelings. If, for instance, you feel uncomfortable with a particular doctor, consider switching to a different health care provider. If you are worried about the possibility of a needle prick, speak with someone in the office when you make your appointment to find out what you can expect. If it’s general anxiety, try some meditation and relaxation tricks to help you cope.

Finally, remember that anxiety is normal and self-care is very important. It’s helpful to remember this for now and in the future, if these issues come up again.

Three Simple Ways to Help Lower Your Anxiety

Young man practices deep breathing to lower anxiety

Everyone feels anxious now and then. Sometimes it’s a particular situation that makes your stomach clench, like visiting the doctor or meeting someone you don’t know; other times, you may experience a wave of anxiety for no particular reason.

There are some simple steps you can follow to relax. Rachel Kaplan, LCSW, a clinical social worker at The Mount Sinai Hospital, shares three tools you can use anywhere—without signaling your distress to everyone around you.

Breathe mindfully

You’ve probably heard that breathing can help you relax. But mindful breathing is more than just holding your breath.

What is mindfulness?

Mindfulness involves being aware of the moment and not judging yourself. Just notice how you feel and allow yourself to feel that way. Try not to force yourself to be relaxed as that can backfire and make you feel more stressed. You want to remind your body that you are safe

When you’re anxious, you tend to take shallow breaths. This is part of our ‘fight or fight’ response that kicks in when our brains sense a threat.  To counteract this and help relax the body, try a technique called belly—or diaphragmatic—breathing. Start by placing one hand on your chest and one on the lower stomach area. Take a deep breath, inhaling through your nose, for four counts. Hold your breath for three counts. Then exhale slowly, through your mouth, for six counts. Deep breathing helps to ground us and signals to our brains that we are safe, lowering our anxiety level.

As you breathe, watch to see which hand is rising and falling—you’ll want it to be the hand on the belly. Take another deep breath and imagine that you’re pushing air into that lower hand. Repeat this exercise 10 times.

Focus on your senses

Use all your senses to focus on small details of the here. This will help you ground yourself and will take your mind off your anxious thoughts.

Think about the small details of your surroundings: 

  • Start by naming five things you see around you. This could be the table you’re sitting at or your water bottle.
  • Name four things you can touch: your sweatshirt, hair, necklace, or shoes.
  • Acknowledge three things you hear, such as a car horn honking outside or the click-click of someone typing.
  • Name two things you can smell, maybe the remnants of last night’s dinner or your cat’s litter box.
  • Finally, acknowledge one thing you can taste.

By focusing on the exercise, you don’t have enough brain power to analyze and worry. Your concerns drift away, and you feel calmer.

Use your peripheral vision

This isn’t easy and requires concentration.

Start by looking straight ahead (not on a phone or computer screen) and pick one spot to stare at. It can be a mark on the wall, a doorknob, a tree branch—whatever jumps out at you. Focus your gaze on that spot for 5 to 10 seconds. Keep that focus, then widen your field of view without looking away from your focal point.

Notice what you see in your peripheral vision. Start on the right side and observe what you can see without moving your head or straying from your focal point. You may just see colors and movement or you may see objects. Do this for about 10 seconds. Then, for about 10 seconds, notice what you see on the left without looking away from your focal point.

By focusing on your peripheral vision, rather than your anxiety, your breathing will slow and your face muscles will relax. When you feel calmer, you can bring your attention back to the view straight in front of you.

Vaccine Facts: Immunocompromised People Should Get a Third Dose

Immunocompromised people have a reduced ability to fight infections and are more vulnerable to severe COVID-19. That is why the U.S. Centers for Disease Control and Prevention (CDC) is recommending that people with moderately to severely compromised immune systems receive an additional dose of the Pfizer-BioNTech or Moderna vaccine.

In this Q&A, Meenakshi Rana, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, and the Director of Transplant Infectious Disease, explains why immunocompromised people, who make up almost three percent of the U.S. population, should get this third vaccine dose and why it is important to take other protective measures.

New Guidance on COVID-19 Vaccines: In April 2023, the Food and Drug Administration and the Centers for Disease Control and Prevention announced some major changes for COVID-19 vaccines. Click here to read more about what you need to know.

What did the CDC recommend?

The CDC and the Advisory Committee on Immunization Practices took an important action to prevent COVID-19 infection in our immunocompromised population and among transplant recipients. They now recommend that people who are moderately to severely immunocompromised receive an additional dose of an mRNA COVID-19 vaccine, either Pfizer or Moderna, at least 28 days after the completion of the initial series. The Food and Drug Administration (FDA) now allows for the additional dose for these people as well.

To be clear, this is not considered a booster dose. A booster dose is given to a patient whose immunity to the vaccine may have waned over time. This is considered an additional dose, given to immunocompromised patients to improve their initial response to the vaccine series. These patients are essentially receiving a three-dose mRNA vaccine series instead of a two-dose series.

Who is considered immunocompromised and should get the third dose?

Meenakshi Rana, MD

Immunocompromised patients are a very large and heterogeneous group. For the purposes of an additional COVID-19 vaccine, the CDC has defined a specific moderately to severely immunocompromised group, which includes:

  • Patients who have been receiving active cancer treatment for tumors or cancers of the blood
  • Patients who had a solid organ transplant, such as a heart, lung, liver or a kidney, and currently take immunosuppressive medications
  • Patients who had a bone marrow transplant within two years or had a bone marrow transplant and are currently taking immunosuppressive therapy, or patients who receive CAR T-cell therapy.
  • Patients who have advanced or untreated HIV
  • Patients who have another medical condition that require high-dose steroids or immunosuppressive therapy for that medical condition

If you think you fall within this category, it’s important that you speak to your physician to determine if you are eligible for an additional dose of mRNA COVID-19 vaccine.

Why is the CDC taking this action?

Patients who are considered moderately to severely immunocompromised are more vulnerable to COVID-19. They are more likely to have severe disease, and more likely to be hospitalized with COVID-19. In addition, there has been data suggesting that moderately to severely immunocompromised patients may not have as strong an immune response to the initial COVID-19 vaccine series, and we have seen breakthrough infections in vaccinated immunocompromised patients, occasionally requiring hospitalization. The CDC also now has data suggesting that a third vaccine would be safe.

What should I do if I think I am affected by this action by the CDC?

If you think you are considered moderately to severely immunocompromised, talk to your doctor to see if you are eligible for an additional dose of COVID-19 vaccine. The CDC recommends that you receive a third dose with the same mRNA vaccine. For example, if you received an initial Moderna vaccine series, then you should complete your series with an additional third dose of the Moderna vaccine.

What if I am immunocompromised and I received the Johnson & Johnson vaccine?

When the CDC made this recommendation, they did not have enough data on whether immunocompromised patients who received the J&J vaccine would have an improved response after receiving an additional dose of the same vaccine. For this reason, we are currently awaiting more guidance from the CDC on what to recommend for these patients.

If I am immunocompromised, what else should I do to protect myself?

In addition to receiving an additional dose of an mRNA vaccine, you should continue to practice all those protective precautions that we’ve been discussing: social distancing, hand hygiene, and masking. It’s also very important that all of those around you, your family and your friends, are all vaccinated.

The FDA has also authorized the use of a medication, known as a monoclonal antibody, for what is termed “post- exposure prophylaxis.” That means, if you are exposed to a loved one or family member with COVID-19, this medication can be given to you to prevent COVID-19 and progression to severe disease or hospitalization with COVID-19. You should call your physician to see if you are eligible.

Should I get an antibody test to see if I am eligible for the third dose?

We are not recommending that you get an antibody test for this purpose, because we don’t know what level of antibodies is considered protective. We recommend that if you are considered immunocompromised, you should receive an additional vaccine dose, regardless of antibody response.

I Have Obstructive Sleep Apnea. Should I Get a Drug-Induced Sleep Endoscopy (DISE)?

Loud snoring. Gasping for air. Feeling tired after getting plenty of sleep. Nearly one in every 15 adults in the U.S. suffer from obstructive sleep apnea, a common sleep disorder that causes the airway to collapse and breathing to be repeatedly interrupted throughout the night.

The first line of defense for individuals with this condition is a treatment known as continuous positive airway pressure (CPAP), a machine that helps push air into the lungs and keep the airway open. Unfortunately, as many as half of those who use the machine do not have success, and look to surgery as an alternative to CPAP to treat their sleep apnea.  But what surgery is the right one for the patient?  Drug-induced sleep endoscopy helps to answer this question.

Known as DISE, this advanced diagnostic tool allows sleep surgeons to assess the anatomy of the upper airway in 3D under sleep-like conditions. Studies have shown that the evaluation technique, which has become increasingly popular over the last 10 years, improves surgical outcomes in patients that do not respond to CPAP.

How does DISE help patients with sleep apnea?

Courtney Chou, MD

Courtney Chou, MD

“Every individual’s anatomy is different,” explains Courtney Chou, MD, a sleep surgeon in the Department of Otolaryngology – Head and Neck Surgery at the Icahn School of Medicine at Mount Sinai, who specializes in treating patients with obstructive sleep apnea. It is her job is to figure out what is blocking the patient’s flow of air. In some patients, for example, the base of the tongue or the soft tissue palate collapses, which then causes the airway to close.

“DISE allows us to locate the sites of obstruction in individuals with sleep apnea and figure out a plan to alleviate these blockages,” says Dr. Chou. “There are several different types of sleep surgeries, and DISE really helps determine which one will benefit the patient the most.”

According to a recent study in Sleep and Breathing, the results of DISE changed the surgeon’s original treatment plan as much as 75 percent of the time. In the past, surgeons relied only on medical history, patient evaluation, and the results of a standard sleep study to decide on the best intervention.

“In general, sleep surgeries are quite successful for patients with obstructive sleep apnea. We really try to meet each individual’s needs. When we are deciding on a surgery, it is important to think about what the patient’s main complaint is—are they snoring so much that it affects their bed partner, or is their oxygen saturation dangerously low?” she explains. “It is also important to consider how severe their sleep apnea is on their sleep study.  But the key to identifying the intervention that is going to be maximally effective is understanding the patient’s anatomy. DISE is an important piece of the puzzle that helps us do that.”

In rare cases, DISE can also be used to troubleshoot nonsurgical therapies. If a patient is having some benefit with CPAP or an oral appliance, DISE may be used to evaluate if there is a tweak that could make the current treatment more effective or improve their ability to tolerate it.

What should patients expect during the procedure?

DISE is a minimally invasive, same-day procedure that is well tolerated by most patients. However, people who are pregnant, allergic to sedatives, or have severe cardiopulmonary disease that would prevent them from having surgery would not be candidates for DISE.

On the day of the surgery, after the patient checks in, they will meet with an anesthesiologist for a short evaluation. Afterward, a sedative will be administered intravenously. Once the patient is asleep, a sleep surgeon will place a thin flexible scope into one nostril that passes through to the upper airway. This scope has a small camera on the end that sends 3D real-time videos back to a monitor, allowing the surgeon to visualize exactly where and how the airway is collapsing while the patient is sleeping. The patient is then taken to a recovery room as the sedative wears off.

The procedure takes 30 minutes to an hour, is not uncomfortable, and patients do not deal with side effects besides post-surgery drowsiness, which means they will need a ride home after the procedure.

“Sleep is so critically important to our health,” says Dr. Chou. “With tools like DISE, Mount Sinai can help those who are struggling find the right plan and not suffer in silence.”

Dr. Chou is currently treating patients at New York Eye and Ear Infirmary of Mount Sinai. To make an appointment, call 212-979-4200.

Is My Skin Care Routine Too Complicated?

Woman Applies Mud Mask

It seems that everywhere you look, there are new skin care tips and tricks that can range from the elaborate, such as a 10-step nighttime routine, to the bizarre—like vampire facials. But not all viral trends are good, and they certainly may not be good for your skin.

Angela J. Lamb, MD, Associate Professor of Dermatology at the Icahn School of Medicine at Mount Sinai, explains some of the most popular trends and provides advice on how you can determine what works best for your skin.

What is one of the more overrated skin care trends?

I see a lot of videos on TikTok about the 10-step process that include two different cleansers and multiple serums and treatments. This method is overrated as it uses too many products, which is often not a good idea.

A good skin care routine is simple. I recommend using a cleanser, a ‘power product’—which can be a serum or an eye cream—and a moisturizer. You’re better off investing in a few of these high-quality products that are going to do what you want them to do, instead of using 10 different things.

What ingredients should I look for in products if I have facial hyperpigmentation and/or excessive redness?

For hyperpigmentation, look for products that have a retinol or a vitamin A derivative as this will help to brighten the skin. There are also a variety of other ingredients, including mandelic acid, kojic acid, and azelaic acid, which will help your hyperpigmentation.

If you have some redness, look for something that has acetamide as that will help to calm the skin and improve texture. Also, the product you use will depend on the reason for the redness. For example, if you have rosacea, a product that contains green tea would be best to decrease redness.

Are sheet masks effective?

Sheet masks are very effective. Most of the masks on the market have a high concentration of hyaluronic acid, which is great at hydrating skin. Other masks contain clay—which is great at drying out blemishes and minimizing the appearance of pores—or lactic or glycolic acid—which exfoliate skin. In general, sheet masks are great, a lot of fun, and feel good.

When should I see a dermatologist for my skin care?

You should see a dermatologist if you’ve tried a couple of over-the-counter solutions and you are still having skin issues.

Here are some examples:

If you have eczema and have tried a few over-the-counter cortisones, anti-itch creams, and moisturizers, and your skin is still keeping you up at night and making you feel self-conscious, then you need to see a dermatologist.

  • If you’re dealing with hair loss and have tried over-the-counter shampoos and you’re still losing more hair, that’s when you need to see a dermatologist as there may be a vitamin deficiency or scalp condition that needs prescription treatment.
  • If you have acne and have tried over-the-counter treatments for a few months and you’re not satisfied, see a dermatologist. Over-the-counter products are a good compliment to prescription remedies, but if you have severe acne that goes untreated, it can cause indented scars in your skin, which is hard for a dermatologist to treat. You should get treatment sooner rather than later.

This advice extends to anti-aging treatments. If the serums, potions, and masks, are not getting you to where you want to be, then that is the perfect opportunity to go to a dermatologist. We can recommend very noninvasive treatments including chemical peels and lasers. You don’t need to get Botox®. Some people get nervous thinking that they will have to get invasive procedures, but there are all sorts of things we can do, like prescribing a retinol.

Are there any other skin care tips you would like to offer?

Prevention, prevention, prevention. Too often, people come into my office with acne scars when I really wish I had treated their acne more aggressively upfront. If I had seen them earlier, we could have gotten the acne under control and prevented facial scarring or pitting.

The same goes for wrinkles. I want to get all of my patients to their skin care goals. But when you have had damage from years of not using sunscreen, treatment is difficult. Simply wearing sunscreen will help to prevent your skin from looking more mature than you would like later on.

Use sunscreen and make sure any skin problems you have are addressed aggressively at the beginning so that you don’t have long term consequences that are very hard to treat.

How Do I Keep My Kids Safe When They Return to School In Person?

As the Delta variant surges, and the timeline for vaccinating children under 12 remains uncertain, concerned parents are wondering how to keep students safe. But there are smart strategies for school children of all ages that can help protect them in the classroom.

In this Q&A, Roberto Posada, MD, a pediatric infectious disease specialist in the Jack and Lucy Clark Department of Pediatrics at Mount Sinai Kravis Children’s Hospital and Professor of Infectious Diseases and Medical Education at the Icahn School of Medicine at Mount Sinai, shares the best ways to help keep kids safe from COVID-19.

Given the current concerns about COVID-19, should parents be worried about sending their kids back to school?

I think it’s important for kids to go back to school not only for their education, but also for socialization and healthy development. But it’s also important to take precautions to make sure they return to the classroom in a safe way. If in-person learning is done safely, the benefits will outweigh the risk. According to the Centers for Disease Control and Prevention, children have been less affected by COVID-19 compared with adults. But kids can develop serious illness, especially those with underlying medical conditions, such as obesity, diabetes, and asthma; those with certain genetic, neurologic, or metabolic conditions; or those with congenital heart disease. In general, the best way to protect children is to make sure adults in the household are vaccinated.

What advice can you give to worried parents about keeping their kids safe at school?

It’s important to continue the things we’ve been practicing for the last year and a half: The main thing is that children over the age of two should wear a mask when they go to school. Children should also be encouraged to wash their hands, either with soap and water or with alcohol-based sanitizer frequently. Children should be encouraged to practice respiratory etiquette, which means coughing or sneezing into their elbow and washing their hands after coughing or sneezing. And they should be taught to maintain a safe distance at all times.

In addition, parents shouldn’t send their kids to school if they have a fever, cough, abdominal pain, or any symptom whatsoever of an illness, including COVID-19.

How worried should people be right now about the increasing cases of COVID-19?

The number of COVID-19 cases has been going up for the last several weeks in the United States, mostly due to the Delta variant. Vaccination is very important. Every child aged 12 and older should be vaccinated. The vaccine is safe, and in some cases it fully protects against COVID-19; in some cases people who are vaccinated may still get COVID-19, but usually it’s a much milder disease.

Is there any guidance for older vaccinated kids that you would recommend to parents?

What I want to stress is that even people who are fully vaccinated should be wearing a mask whenever they’re inside, whether they’re in school, on public transportation, in a store, or anywhere indoors. That applies to adults, as well. The reason is that even people who are fully vaccinated may have breakthrough infections, and they can still pass on the infection to other people. So by wearing a mask—in addition to getting the vaccine—you’re helping decrease cases in your area, which is what we all want.

When do you think the vaccine will be available for children 11 and under?

The original timeline was for this to be available in the fall. So let’s hope that’s going to be the case.

Is there anything else people should know about keeping their kids safe from COVID-19?

Any parent who has a particular concern about their child due to a chronic medical condition medical condition should talk with their pediatrician to come up with an individualized plan.

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