Sunday, January 28, 2007

I’ll Show You a “Little Pinch”!

You might be surprised to learn that medical professionals are some of the most needle-phobic people around. You should hear the whining in the line for the flu shots every year: “Which nurse looks like she hurts you the least?” “Is it a big needle?” “I hope I don’t faint!” Not to mention the ones who just avoid their shots. “But don’t you have to stick needles in people all the time?” you may be wondering. Well, yes. Into other people. Most (though not all) needle phobics don’t have too much trouble with a stranger’s blood or pain; it’s our own we’re concerned with. I have an (untested) theory that needle phobics may in fact be drawn to medical careers; there’s an aspect of phobia that involves deep interest in the object of fear. It’s invested with such power in your mind that it becomes fascinating.

There are different broad types of needle phobia (that site I just linked to is pretty good, by the way); I had a combination of the two most common, vasovagal and associative. The vasovagal type involves the symptoms typically associated with phobias: nausea, rapid heart rate, sweating, and a drop in blood pressure, resulting in lightheadedness and even fainting. A tendency toward becoming vasovagal seems to be just the way some of us are made, and usually we have more than one phobia to contend with. (A couple other phobias of mine are spiders and phones. I did have a fear of public speaking, but overcame this in quite a different fashion — maybe I'll tell that story too one day. Snakes, heights, and mice bother me not at all, so you never can tell.)

“Associative” needle phobia usually develops from an unpleasant experience with needles in childhood (whether your own trauma or something you witnessed). Mine probably started when I had two separate episodes of scarlet fever that necessitated very large injections of penicillin into my butt. They held me down while I screamed and fought. (Not the best way to go about it, one would think; I hope this isn’t a typical pediatric procedure anymore.)

From then on, anytime I knew in advance that I was going to have to get a needle of any kind, I would live in anxiety for days. Those who suffer from needle phobia often avoid necessary medical testing and treatment (some avoid pregnancy solely for this reason). I usually made it through, but not always, and I definitely delayed my infertility workup due to this. I vividly remember the days before my first bloodwork, wondering how I was ever going to be able to get through ART. That blood draw went ok, but the relief I felt after it was “It’s over with! Never again!” rather than “That wasn’t so bad!”

The first time I had to have an injection at home, I premedicated with an anxiolytic (the good stuff), but I was still so tense that I put my husband through a good half hour of “OK! — No, wait! Wait! — OK! No no no!” It ended with me in tears, though the injection was eventually administered.

Then I learned the first trick that helped me. It’s a simple technique for overcoming vasovagal reactions. Most people make the mistake of trying to relax as much as possible before and during the experience, but it turns out this makes things worse, because it allows your blood pressure to plummet, and makes your symptoms more severe. Whereas if you cross your legs hard and clench your fist on the side opposite the injection or blood draw, you help maintain your blood pressure, and then you don’t feel woozy, and the cycle can be (temporarily) halted. (Take care not to make it look like you are about to punch the phlebotomist; they can be touchy about this. I actually pinch my thumb really hard between my other fingers, and scrunch up my toes.)

The next trick I learned was visualization. Most people have categories of pain: some pain is ok, some is scary, and some is actually good. Everyone’s different, of course, but some examples of good pain might be: tweezing a stray hair; lancing a boil; popping a pimple; getting a tattoo; bikini waxing; digging out a splinter; having a newborn latch on to tender nipples … you get the idea: sudden pain that serves a worthy purpose. If you can pretend that the needle stick is actually one of the “good” pains, it seems to hurt much less.

The technique I learned that was most helpful for the “associative” part of the phobia was re-associating the procedure with something good instead of bad. What helped me the most for this was focusing on the goal: a baby. At the last infertility clinic I went to, they had pictures of patients’ babies up on the wall facing you as you had your blood drawn. Some people were offended by this, but if I could find a really cute one and focus on it, it went much better: it’s for a baby! Ouch! Not so bad!

A technique that helped with both aspects of my phobia was distraction. When my husband had to give me deep intramuscular injections of progesterone in oil—with the BIG needles—he developed what I called his “patter”: he would think of an interesting story to tell me, and right when it was getting to the good part, WHAM! he’d stick me. Sometimes he’d forget to talk (an amazing lapse, if you know my husband), and I’d have to yell “Patter! Patter!” as I lay on the bed with my pants down.

And finally, a great treatment for most phobias is habituation. This can be hard to achieve with needle phobias—playing with needles is not generally practical or savory. But infertility treatment was just what the doctor ordered, ha ha. Intramuscular injections daily—hell, twice daily, why not? Blood draws, let’s see—let’s do them every other day, just in case! It’s not clear why habituation works, but after a few days of this, most phobic people just chill out. (You will rarely see a really ill needle phobic in the hospital. Rather, you will see them, but you won’t realize they were ever phobic.)

The one thing I wondered was whether I would be back at square one once infertility treatment was done with, because habituation often fades if the stimulus isn’t continued. But not too long ago I came down with strep throat, and realized that rather than take pills for a week, I could just get a shot in the butt. I looked at the syringe beforehand, and it was the biggest, longest, fattest freaking needle I had ever seen. In addition, the quantity of liquid was prodigious, and was a disturbing milky white color. I gazed at it for a moment, then said, “Eh, stick me!” and dropped trou. It was only later, as I was limping around the office, that I realized that this was the very thing that had triggered the whole problem in the first place. And I finally felt cured.

29 comments:

The MSILF said...

Heehee so explain this - when I have to get a blood test that someone ELSE is doing, I almost faint...yet have no problem sticking myself, or even letting students practice on me. It's a control issue, I think...

Cory said...

Ay, you've described my situation to a T. I'm a fainter myself, and I think that's the reason the dentist is such a terror to me - that there is just enough time in between visits and dental work to get needle phobic all over again. (The few times I've been in the hospital, I've 'lost' the phobia).

Magpie said...

And when you get good and habituated with the infertility needles, you get so you can give yourself the IM PIO shots. I think back on that with awe and bewilderment - I really did that?

Anonymous said...

An infertile friend of mine was getting a blood draw during IVF. They were seaching for a vein and she was getting teary, so her husband came over to comfort her. He saw the needle go in, passed out, hit his head on the table and came to vomiting, with a concussion.

Xavier Emmanuelle said...

I'll definitely try your tips. I have a terrible needle phobia and I've been working on getting rid of it, but so far no luck. I'm a vasovagal-er (I definitely just made up that word, but I don't know how to conjugate it properly) and no matter what I try I always get tachycardic and pale and then I end up getting picked up off the floor.

Xavier Emmanuelle said...

P.S.: You're absolutely right - I can give needles just fine, it's only when they're pointed at me that a problem arises.

Denise said...

When I was in the Peace Corps we had to get shots every few months. I wasn't phobic, but many of my friends were and would always question each other anxiously when they came out of the nurse's office. I guess being phobic doesn't make you any more sensitive to others' pain, because one guy always came out and teased the others, "It wasn't too bad...right in the eyeball!"

I'm working on a study right now where the treatment is an intravitreal injection. I'm not phobic at all but the thought of a real shot right in the eyeball makes me queasy as hell.

Wendy Power said...

My husband is type 1 diabetic, has given himself shots since he was eight, and agonizes about every one. S-l-o-o-o-w shots; he just can't pop the thing in and get it done. I'm so glad he has a pump now...one "stick" every three days instead of four a day. He appreciated your tips, thanks. We're about to start AR and I hope I don't need injectables - he'll be useless!

Jo-Ann said...

WOW I needed your post. I have been a fainter since they had trouble finding my vein as a kid. they still cannot find my veins. the people giving me the injection or taking my blood always laugh at me I am covered in tatoos and can't take a needle

Jessica said...

I'm a third year med student, and have a big-time needle phobia. I don't like to touch them or anything. Or have them pointing at me. Recently, a resident had me hold a bottle of medicine and he stuck the needle in it. It surprised me, and I felt like I might pass out. Very strange.

Anonymous said...

If I can lie down, I'm usually okay. But you wouldn't believe how med personnel act all put out when I ask for a place to lie down. Would they rather pick me up off the floor? Jill

Old MD Girl said...

Yep, I'm a fainter too. Completely hit the deck when I got my ears pierced, and almost did again for my DTaP this past fall. I'll try clenching my fist next time to see if that helps.

But, DM, do you donate blood? I couldn't for the first few years of college because of Malaria risk. Now that I no longer have that excuse and I'm in medical school, there's all this pressure to donate. I'm relatively light weight (but over 110), have low BP, and a tendency towards low blood sugar, and I *totally* know that I will pass out. Do you have any advice? Should I just not donate?

Incidentally, I was totally ok with an IV when I had surgery a few years back. But then they were drugging me with some pretty heavy stuff. That must have made a difference.

Orange said...

I thought everyone clenched their muscles to get through needle sticks, dental cleanings (when you've built up a lot of tartar), etc. I've always done that, and the only time I ever came close to passing out in a health-care setting was at the orthodontist. The combination of jaw pain and leaping out of the horizontal chair gave me a wicked vasovagal/orthostatic hypotension one-two.

ozma said...

Great post but I'm sorry I read this since it's reactivating my own fear of needles.

Current major problem with needles--when my kid gets shots. I'm worse with others than I am with myself. I've just started to leave the room to avoid making it worse for her.

Alexa said...

When I was very, very thin I used to be a fainter, but now I hold out my arm with aplomb. I think it helps that I have excellent veins, though. If I had the sort of veins that needed resticking and digging for, I don't know that I would be so brave.

Diane said...

Funny, as I received weekly allergy injections since the age of 3, I quickly got over my aversion. You can stick me with a needle any time, anywhere, EXCEPT the stomach. For some reason, the thought makes me queasy.

Have had an irrational fear of rabies my whole life as I live in fear of needles in the stomach.

Weird, I know.

Val said...

Well, I apologize in advance that my comment is NOT about needle phobia...
After all these years, I finally learned how to achieve the elusive "runner's high": go to the gym on an empty stomach & crank up the treadmill! After about 20-25 min, your head is floating nicely ;-)

Not on Fire said...

I am delurking to tell you that I love you. I can so relate to the needle phobia. After IVF and 2 pregnancies with daily injections of Lovenox I am cured too.

Larki said...

Oh, thank you for this post. I'm not needle phobic myself, and have always had a very unsympathetic, "Oh, suck it up, it doesn't hurt that bad," attitude about shots. But now that I spend most of my working days sticking needles into people--I suture all the time, and do a lot of I&D's and toenail removals--I have really discovered how deep needle phobia runs in other people, and have had to develop all kinds of approaches to help people get through the procedures I do. This post is incredibly helpful! Not only does it give me lots of tricks, but it also gives me a clear window into what so many of my patients are feeling, and makes me MUCH more compassionate.

You are SUCH a useful blogger, woman. Can we clone you?

Anonymous said...

You didn't mention my favorite way of getting through a shot - look the other way while rubbing the shoulder of the arm getting the shot. Between not seeing what is going on and the sensory distraction, I sometimes don't even know I got the shot!

I do agree with the habituation. I have to give my self shots twice a day and after a few days didn't mind it a bit (on the other hand it isn't an intramuscular shot!)

Jenny F. Scientist said...

Oooh. I've not had a shot in the tush since I was a kid. Sounds unpleasant. But habituation? Totally the way to go. Weekly allergy shots for six months... yeah.

CA Momma said...

Thanks for the suggestions. I'll try anything. I actually kicked someone taking my blood once. Accident of course.

Liza said...

Great post!

Of course, I'm sitting here feeling all proud of myself for not fainting from reading all the way through.

The nurses at my RE's office were fabulous at the distraction technique, usually asking questions about the book or magazine I was reading. It worked very well!

I'll have to try the crossed legs & clenched fist next time I need a shot. I usually have relaxed, but then have to stay prone for another 5 minutes after the shot.

E. said...

I used to be needle-phobic as a kid. I actually escaped my allergist and his nurse and my dad and made it out of the office onto the street before they caught me once during a weekly injection. (Those injections helped! I'm no longer allergic to cats.) But at some point I realized the fear was worse than the actual jab.

That said, some kinds of shots are worse than others, and I think it really matters who's giving the shot and whether they're skilled. I feel terrible b/c my son's pediatrician's nurse is a bruiser and she hurts him every time. He didn't used to be particularly needle-phobic, but he's developing it b/c this damned nurse just doesn't have the hands. Last time I requested a different nurse and the pediatrician apologized and said you have to take whoever is on that day. (In other words, he couldn't borrow a more needle-skilled nurse from one of the other peds in the practice? DoctorMama, do you have a perspective on the politics of this?)

DoctorMama said...

MSILF—I can’t really explain that, but maybe you have!

Cory—strangely, I’ve never been too bad with the dentist’s needles. It’s the cleanings that I can’t stand.

Magpie—I never did give myself a PIO shot. You’re brave indeed.

Anonymous 1—same thing happened to someone I know as his wife was having a c-section. She was pissed off.

Xavier Emmanuelle—let me know how it goes.

Denise—never tell my husband that story. He once passed out just from getting the glaucoma test.

Wendy Power—wow, your husband must be immune to habituation. That sucks. Maybe he’ll be like a doctor though—willing to stick someone else.

Jo-Ann—the worst is when you say to them, “Everyone has trouble finding my vein,” and they get all swaggery and say “Well not ME,” and then they dig for half an hour, right? (Doesn’t happen to me, but to my stepdad, poor guy.)

Jessica—you’d probably do well with some formal habituation exercises.

Jill—I was always too embarrassed to ask to lie down, and they yelled at me for NOT asking. You can’t win.

Old MD Girl—no, I don’t donate blood. On an off day, I don’t make the weight requirement, and I figure if it makes my husband (who is not big, but is 50% larger than I am) out of it for a couple of days, what would it do to me? (I also know someone who lied about her weight and later passed out cold from the hypotension and ended up with a depressed skull fracture.) I know this is not very generous of me. (I don’t have a coveted blood type anyway, is one of my other rationalizations.) I’d say, given that you’re small, a fainter, need to keep your wits about you, and exercise a lot, you should get a pass on donating.

Orange—no, some people snooze through such procedures.

ozma—sorry to reactivate you. Yeah, probably better not to let the kid see it; there’s a powerful phobia by association reflex.

Alexa—most people don’t know what a gift it is to have excellent veins. (For those of you not well endowed in that department, weightlifting helps.)

Diane—guess what? Rabies shots don’t go in the stomach anymore!

Val—hmm, I don’t know if that’s runner’s high, or hypoglycemia. But as long as you’re enjoying it …

Not on Fire—it’s nice to be done with that fear, isn’t it?

Larki—yeah, it’s not the pain that’s the problem; I can take MUCH worse pain with no problem at all. It’s the IDEA of it. But now you’ve given me a cloning phobia, I think.

Anonymous 2—sensory distraction is definitely a good technique. How do you rub the shoulder while getting a shot in it, though? Or do you rub really high up?

Jenny F. Scientist—only six months? Were you cured in that short of a time, or did you give up on the allergy shots?

CA Momma—ah, getting violent during a procedure is something else again. I had a student who had been held down for allergy shots as a kid and now he has to get a security guard to restrain him when he has to have something. They never believe him at first.

Liza—let me know how it goes with the clenching.

E.—“But at some point I realized the fear was worse than the actual jab”—well, sure, but that was enough to get over it? You must have great powers of self-convincing. As far as the politics of the ouchy nurse thing, hm. I’m not sure. I should think that if you were to request it in advance, they should be able to accommodate you? I don’t think there’s a standard protocol. I know that when I need a shot, I try to get the “best” nurse to give it to me. Poor kid. (Some doctors will do the shots themselves, too, though they don’t usually have particularly good “hands.”)

SuperStenoGirl said...

I'm supposed to get a blood test for hormones and fasting glucose to solidify 2-3 doctors' claims I have PCOS. I have had the req. since November and I still have not gone. I did attempt to go; I got no sleep at all the night before panicing about it, I was nauseous on the bus ride, and my legs felt like jelly walking into the outpatient lab across the hall from our transcription room. My heart was going a mile a minute and I was sweating profusely. My throat and mouth were dry and my hands were cold and clammy; I was ready to faint right there.

I hand the req. to the girl and she goes "sorry, you need your hormones checked so you need to be here before 10 am. You can get the fasting glucose done now and come back though." I said "no bloody way am I coming back twice."

Then I read on the back of the req. I had to be there under 2 hours after I woke up and since I work afternoons/evenings it WAS only 2 hours since I had woken up. Nice.

When I had a nervous break down when I was 15 (it's possible, I was in the psychiatric ward for 2 months) they had to draw blood. It was the first time I'd actually passed out from it and what I remember, while amazing and peaceful, is nothing I want to experience again.

I can however trace my fear all the way back to being 3 years old and getting blood taken at the local D&T Clinic in our small mining town. I had 3 nurses holding me down, plus my father yelling at me to grow up and stop crying, the doctor threatening to tie me to the bed and my mother wrenching my arm out to be stuck. I ended up squirming bad enough I got blood on the bed which caused my dad to freak out and give me the spanking of a life time afterwards and then I was told since I had been a "bad girl" I would not be getting a sucker OR the Care Bears band aid. For a 3 year old, I'd say that was pretty traumatizing.

I had another shot when I was 5, sat on dad's knee and looked the other way with no problems. In grade 6 another vaccination with no problems in the principal's office. Grade 9 final vaccination in school; me dressed out in goth attire (a strange sight for a 200 population high school). The nurse pinched my arm, stuck me, pulled it out, stuck me again, pushed hard enough to make me tilt over, pulled it out, stuck me again, wiggled it before injecting me. The bruise on my arm lasted 3 weeks and I was unable to move my arm at all for 2 weeks; the other students were fine within about 3 days.

I used to have difficulty watching needles on tv or here in the hospital but not so much any more. The thought of me getting one however is enough to make me shake, struggle to breathe and get extremely anxious.

When I was 16 I had incredible right lower abdominal pain and the emerg. doc thought I had appendicitis. He called for a blood test and I told him "I want cream, numb me first". The doctor said, to my face, infront of my mother "excuse me?" I told him again and he goes "Your appendix could rupture, you're an idiot." and walked out. I did get the cream (EMLA) and was able to have the blood taken though I hyperventilated and threw up.

Turns out my white cell count was only slightly elevated (or something) and I was told if I was still in pain to come back again the next day for another test. I was still in pain come morning but it eventually went away. I did not go back. I was insulted by the doctor and kept thinking that maybe I was just a big baby.

I never did any real research on it until I started my training for a transcriptionist (which I completed at home, through correspondence with no help whatsoever) and realized it's a real, true, serious phobia.

Thanks to your tips and tricks I now have a resource to pull from on how to overcome this issue. As you mentioned it is one of the main reasons I never, ever want to have children (probably the top with the second being I do not feel all that maternal; the maternal feelings come and go) and I am also terrified of spiders and dying which includes even loved ones dying.

And also like your assumption, while most likely unrealistic, I too wish to be a physician one day but again, the needle thing has kept me back along with the math (suck at math).

Thank you again for writing this post, it has given me a lot to think on and a lot of information to use in overcoming my fear.

Cheers-
SuperStenoGirl

Women on the Verge said...

The near constant blood draws we dealt with when our youngest daughter had auto-immune neutropenia cured me... watching my 2 year old daughter scream cause she had to get the blood draw done through her hands and feet cured me of any fear... now needles just piss me off...

ozma said...

Just wanted to say: I had some mongo blood tests last week. I took her in there and decided that I would just show her it didn't hurt and I would be very brave. Did she want to watch? Somehow, because I was trying to show her not to be afraid I was fine! I admit it was a risk. I've only fainted once but I just knew I could do it.

She saw it and she wasn't freaked out and neither was I. I don't know if that's the right choice but I thought it might help her avoid a phobia.

Anonymous said...

OMG the habituation part is ME, lol. I am such a needle phobic. However that quickly came to an abrupt stop with severe preeclampsia and the mag. I had my blood taken every single hour, to the point they had to take it out of my hands and feet because it would not come out of my arms.

Pregnancy #2 - was a little woozy at the initial draw. By the end of pregnancy, a pro.

Then I had to get blood tests this year (baby is 18 months old now), I got so pale and white they had to stop. However a couple of months later, a pro again when they had to do the clotting tests for 14 tubes. I got stuck 5 times for 14 tubes because my blood all of a sudden decided to clot.