BLOG No. EIGHTEEN

Welcome back to blog number 18. I hope you have enjoyed my foray into some patient cases, as it is a way for me to show examples of D2 dopamine issues. My next case regards a 60-year-old intelligent gentleman who spends his day trading stocks and investing money. He is well-educated, well read, and seems to do everything well—except pee.

Of course he saw the best urologist in town, who told him that his urinary system was completely normal and that he should be perfectly able to urinate. But he couldn’t. And so, somehow he ended up in my office at the urging of a friend. After talking to his urologist I decided that he had an anxiety disorder that was ramping up his adrenaline whenever he had to pee.

Now urination is a part of the parasympathetic system—the opposite of fight or flight. But when it came time for him to “drain his swamp” so to speak, his anxiety kicked up and his urinary system locked up. Numerous trips to the ER occurred, whereby nurses would place catheters to relieve the swollen bladder. But then it would just fill up again. So he learned how to catheterize himself. His previous family doctor tried a couple different SSRIs.

But of course they didn’t work.

And I still remember his anxiety and embarrassment as he related all this to me. I assured him there was an answer. I placed him on a D2 lowering agent, after questioning him about his anxiety.

He has not seen a urologist since.

Anxiety, according to the literature, is internalized fear. Perhaps a counselor has told you that. Mankind spent thousands of years sleeping with one eye open in fear of predators or hunters from other tribes who might try to pierce us with a spear.

But in modern times, with protection from our wonderful women and men in uniform has lessened that. Yet, the fight or flight still sits one layer deeper than the smile on our faces. And for many lucky individuals the gene for that anxiety never turns on.

They can’t fathom what depression is. Nor do they understand it.

I remember suffering from depression and anxiety as a teenager to the point I contemplated suicide. My parents took me to our family doctor, who took one look at me—the cigarette dangling from his mouth—and said, “What do you have to be depressed about?” He just didn’t understand. And although doctors now recognize depression and anxiety as diseases, most of them don’t have the savvy to treat them—sans a handful of SSRIs. And once again, I am not ripping into anyone. It is just the way it is. Until medical schools begin to teach the glutamic theory, we’re going to be stuck in the Prozac zone.

Well, as I look at my neighbor here on the Cabo Beach, I see her Chardonnay is almost gone. And boy is she going to be pissed when she gets back to her chair! Until next time we discuss another case, this is Dr. G saying, keep the faith.