The "twinges" of chest discomfort are arising secondary to trapped intestional gas and in the case of some patients, can be extremely painful. They can also be due to a syndrome that I've described on the forum before, known as Da Costa Syndrome. In either case, it is certainly not an indication of an impending cardiac event of any kind.

One of the reasons that your condition continues to spiral out of control on occasion is the rapid changes you are making with regard to treatment and self-help measures to bring matters under control. Because of this rather fast-paced expectation of your medications and general treatment, you need to see swift and constant results. You have been through many medications. Again, I must return to my original opinion in your case. This is IBS-C and would very likely benefit from the use of Zelnorm for 6 to 8 weeks of short-term treatment.

I find it interesting that you describe yourself as both anxious and depressed. While feeling anxious is quite common and the features most readily recognized by most patients, I'm curious to know what characteristics you are demonstrating or symptoms you are experiencing that leads you to conclude that you are depressed?

I will share with you, as I have with many patients, that making definitive changes to your emotional state with regard to anxiety or true clinical depression are more rooted in specifically how and what you are ruminating about, rather than what types of things you need to "do" in order to try and inflect change. More importantly, is the identification of environmental conditions that may be the root cause for situational emotional crisis. Habits that place you in a constant state of anticipating some type of crisis can work swiftly to slow you down to a grinding halt. One's outlook is severely attenuated and the drive to push ahead is all but stalled. Life circumstances falsely appear to be inevitable and in control of your destiny, whereby notions of escapism run high.

One key factor to remember about "relaxation techniques" is that they tend to bring to the surface all that you are seeking to relax from, the consequences of which can sometimes appear to be like trying to move an elephant with a feather. The actual origins of anxiety, while important, are not as critically important as the clear need to realize that the excessiveness of thought brings about absolutely no beneficial changes to the situation of concern and only serves to exacerbate physical symptoms. The basis for much anxiety is often rooted in perspectives of insecurity and diminished self-confidence, that you won't be good enough, or perform well enough, or be dependable enough or responsible enough, always trying to make certain that you've dotted all the "i"s and crossed the "t"s so that nothing will go wrong, a task too ominous for mortal being. No degree of anticipation can prevent the unexpected. It's a part of life. We deal with it effectively by logically assessing it in real time and responding in ways that successfully reduce negative outcomes to the greatest extent possible.

At bare minimum, Kathryn, you must surely realize after all these months that no true physical disease is present within you and despite broad fluctuation in your symptoms, the result is always the same. You are phyically healthy and try as you might to consider the possibilities, this simply will not change at a pace which you mistakenly believe to be capable. It is clearly inaccurate self-assessment through unbridled and illogical belief patterns and your uncertainty arises largely from self-doubt. Again, you presently must rely upon external reassurance rather than your own guidance and this is where things break down for you. It is a rather vicious cycle of creating your own labryinth of anguish whereby you must also retain and hold near to you the icons of reassurance in order to quell the panic and worry that arises as a consequence. In other words, you create the mythical monsters but feel compelled to lay your sword in the hands of another to slay the beast.

Many people also develop chronic anxiety because their life choices and circumstances have placed them in a position where the results are quite the opposite of their life-long expectations, feeling trapped as a consequence. Sometimes, the fear that catastrophic illness or terminal conditions may be upon them to rob them of ever obtaining their goals and moreover, they feel immensely guilty that they will not be there for their offspring or other loved ones. In addition, the life they so anxiously must draw out leagues ahead of them is instantly dimmed and snuffed out.  

All of these potential factors and many more all whirl around in the minds of the anxious individual and it can be exhausting, both mentally and physically. The worse an anxious person feels, the more elevated the symptoms can become. Just a reality check, Kathryn. Shake it off and buck up your fears. Get back in the saddle and get hold of the problem. Your heart will forever be fine and must become the least of your worries.

Best regards and Good Health          

My intent is not to hold you in condemnation or merely point out errors in thinking. You've come a long way since we first talked. It is important, however, for you to maintain vigilence on the matter and become determined to overcome your fears.

Many, many people fear success because they are too apprehensive about taking risks. Well, there is a clear separation between folks who simply take blind attempts versus people who carefully research their options, weigh the risks and various outcomes and then go after their goal. All of life is about risk and for those who take none, there is little reward because life does not exist behind a buffer of safety, but rather fully exposed in the fast lane and the more you want, the more relative risk you must potentially take. But the key is to sharpen your skills with regard to carefully examining the prospects so that you can anticipate and move accordingly such that it works in your favor as much as possible.

As I've shared on the forum before, I was a former combat pilot before leaving the service to enter medicine and I can readily tell you that the urge to take risks beyond reasonable safety is a constant pressure for every pilot. When you see and engage the enemy, you want to see them going down in flames, basically wanting to win and demonstrate overwhelming superiority. But in order to succeed, you must restrain those desires within the constraints of all the training and experience you've gained. Otherwise, it's more certain than not that you'll be the one going down in flames. It's a battle of logic, strategy and timing. It's knowing when to go for the kill or when to run away to fight again another day.

Life and all that we do is very much like any campaign of war, where discipline and careful use of resources can mean the difference between winning or losing. The most important factor I can share with you, however, is never be afraid to fail and never look upon failure as any indication of your potential. Failure is an instrument to thrive upon and reshape your strategy and skills. It's the greatest teacher of all. If you're afraid to fail, then you'll never know the true meaning of what winning is all about. There were many times during my life when I met with failure and it's the turning point for determination to take over. You don't walk away beaten, but rather poised to return with a more proficient and effective strategy for overcoming obstacles and succeeding.

Lastly for now, the consequences for failure are always temporary, but the consequences of never trying are life-long. It's your choice. Make a plan of action, test your hypothesis and then go for your goals with all your determination. It's a recipe for success. The only barrier between you and your goals is lack of persistent determination. We all get one life to live, so you can either choose to let it happen to you or take charge and make it happen the way you intend. Your choice. And if it's any comfort, I am certain that you hold the ability to achieve whatever it is that you wish.  

Best regards and Good Health