My own journey with functional symptoms: struggles, lessons and hopes

One of the reasons why I'm so passionate about functional illnesses and functional neurological disorders (FND) is because it happened to me.  It occurred to me when I was 18 or 19 years old, for the first time, while I was in medical school. During that time, I was studying excessively because I wanted to finish two years of my medical career in one, as I wanted to graduate sooner to earn a salary and have enough money to be financially independent, live more comfortably, and to be able to help my family in Cuba, my natal country.

I have always loved everything related to medicine, I enjoy studying and reading very much, helping others have always come naturally, and those activities have brought me much joy and satisfaction throughout my life. Those months, I was also working very much because I had to pay for my university, and my living expenses, so, I was studying for many hours of the day, and when I was not doing my assignments, I was at work. I was not exercising, going out with friends, nor resting enough, neither doing any other fun activities… and what started happening? I started having panic attacks. I recall one event vividly: I was sitting in my reading desk and suddenly, out of nowhere, I felt like I was losing control, my vision darkened, I experienced fatigue, lack of energy, sweating, heart racing and I started to think that I was going to die. So, there I was, having many functional symptoms, in various organs and systems!

The first time that happened it lasted for a few seconds I believe, maybe one or two minutes, so I thought it might have been my blood sugar level going down, a wave of exhaustion or something else, minor in nature. But then, a week later, during the nighttime, perhaps at 9pm or 10pm, while I was still studying it happened again, more intense, and longer in duration. As I lived across from the hospital, I screamed for my mother and we both ran to get medical assistance, because I thought I was having a more serious illness, such as a heart attack or a stroke. Once we arrived in the emergency room, I started to feel better, as I was being interviewed and examined by a medical resident doctor, who also did an electrocardiogram. Of course, the outcome of my physical examination, and the test results were both normal. He then proceeded to ask me what I was doing those weeks, how was I feeling overall, and how my life was, and of course I described to him my forceful studies, demanding work schedule, lack of time to rest, recover and enjoy myself. Thankfully, he knew immediately what was happening and told me, "Yadira, you are having panic attacks. Dear, you are working too hard, studying extremely, not resting, not entertaining yourself, so, your nervous system and your physical body are getting overloaded."

When he told me that I thought "Oh, that is very interesting!" How in a completely subconscious manner, my physical body, and my mind, were working together to send me indications, and alarm signals to let me know that I was not leading a good life, that I was trying very hard. And if you reflect about it; it is amazingly wonderful how our emotions too, work united to convey such important messages to us! Because the truth is that I felt overwhelmed, sad, and lonely those months as I was not socializing, but I was pushing those emotions aside to carry out my intellectual goals. Mind, body, emotions, and the environment, were out of balance, in this case the environment represented by the lack of inter-personal connection, and subconscious pressures from family members prompting me also to finish my career faster than recommended.

And these are concepts that we will be reviewing and reflecting upon frequently during our educational programs, conversations, and projects together: “The Four Bodies”, and how they work together to protect us, to guide us to live a well-balanced life, to be able to achieve our life’s goals, and express our soul’s mission with health and wellbeing. That is why I always tell my patients, functional disorders and FND is a wakeup call, it is one of the ways how our organisms let us know that there is something in our lives that can be improved, that we are deviating ourselves for living a fulfilling and satisfactory life, and that we can be happier, that we can really enjoy life and the present moment at its fullest, because this is the only moment we have, and as far as science knows, this is our only opportunity to live.

What did I do after the medical resident doctor told me that in the emergency room? I thought: “Okay, I am not going to take additional classes anymore. I am going back to my fitness center, and I'm going to have more fun with my friends. And what happened next? The panic attacks never came back! That is why we will talk about the importance of recognizing early, diagnosing early, and making the necessary modifications promptly, to get better from functional illnesses, and also to prevent the recurrence of such disorders.  

I successfully finished medical school in Barcelona, Spain, and 6 years later, while I was doing my preliminary internal medicine year, part of my neurology residency, I was undergoing a lot of stress. I had to take care of many patients simultaneously and this was bringing a lot of worries to my mind, because some of them were severely ill. I had to do everything very quickly; review test results, change medications according to the exam outcomes, examine them, interview them, talk to family members, discuss the cases with nurses and attending physicians, among other tasks. As I consider myself a very attentive doctor, and a bit of a perfectionist, I recognize that my efforts were extreme too, because I not only wanted to do everything well, but I also desired to do it in a timely manner, so that everyone was well taken care of. What started happening then? I began to feel a strange pressure-like sensation in my upper chest and my throat; it felt as if my throat wanted to close, my chest was so constricted that I thought: "What is this? Am I having a heart attack? From so much stress!?

I took a moment and sat in the nursing station, and because I already knew the connection between mind, body, emotions, and environment, I tried to connect with my body, took some deep breaths, and observed carefully what was happening. To my delight, the feeling went away! And I knew immediately what was going on: it was another functional symptom, another sign from my body. I took a few more minutes and checked in with my mind, and my emotions, and asked myself: how is my life right now? What am I thinking? What emotions am I feeling? What is happening with my being right now? And there I was, with many tasks already fulfilled, and a lot of work still to do, feeling completely drained, anxious, nervous, worried, and stressed. Do you see the connection?

I recall that I was very sad that weekend, I went home crying because it was too much work, but I had to complete my first year of residency. I was in despair. How to continue fulfilling my duties while staying healthy? How could I reduce my workflow, my stress level, and stay in residence?

After thinking deeply for the entire weekend, my mind came up with a way to change my workflow. I found shortcuts, I started using technology to my advantage, creating templates, smart phrases, noticing and letting go a bit of my time-consuming perfectionism, certainly a damaging tendency. I made many changes, many of which were even adopted by many of my resident colleagues! And the symptoms, the uncomfortable physical sensations improved very much, although still occasionally appeared, letting me know that I was overloading myself.

As you can see through my own story, FND and functional problems represent a spectrum that goes from having uncomfortable bodily sensations, to having an illness; the latest appearing mainly when the medical system fails to recognize what is happening, and doctors do not prescribe adequate treatments, which should consist on self-investigation and modifying the triggers, and the root causes for the symptom appearance. I will emphasize this: If you do not recognize the meaning of the bodily signals, if you do not evaluate the dysfunction taking place and the reason why, it may take over your body. If you do not understand the connection between the symptom and its cause, and how the triggers are affecting your well-being, then you will not be able to make the necessary changes to improve, heal, and use your body as a source of wisdom.

Of course, I knew a lot more than most functional patients do, because I was studying medicine. It is very likely that most of you do not have medical training, so it is much harder, almost impossible, for you to recognize alone what is happening, whether it is the mind, the body, your heart, or your throat. Why would you know? How could you know with certainty? You do not have the proper preparation or studies, so you depend on the medical professionals, and we will talk during upcoming sessions about the limitations of the health care system, and how it has perpetuated some of the symptoms for many of you. But it is also important to learn to recognize your bodily sensations, what they mean, and the message they carry.

Imagine, what would have happened if I do not recognize the triggers, the causes of my symptoms, for whatever the reason? What would have been the outcome if I continue with the same pace, the same work style, without making any changes, because I did not see or was not taught to see the connection? Most likely my throat and chest pain would have come back every day, or every time I was at work. And this is so common! A pain here and there, low back soreness, tense muscles, or any other functional symptom; they come back often if the cause is unaddressed, and as it continues to happen frequently, the pathways that connect the brain areas involved, and the associated bodily regions, will become hypersensitized and permanent, giving origin to a chronic functional health problem.

Think about this analogy: if you go to the gymnasium and exercise every day, or 5 days a week, what will happen? Your muscles will grow permanently, or at least they will stay enlarged for months or years. Or if you are a pianist, a violinist, or a guitar player, and you use your musical instrument every day, what is going to happen? Your mind – body will create permanent pathways, between the mental circuits and the physical body parts, and you eventually will be able to play almost while sleeping. It becomes so naturally, so engrained, that you will be able to dance, sing, and play the instrument all at the same time!

So, if these symptoms, if the physical sensations keep happening every day or very often, then you are creating permanent paths between the mind, the body, and the emotions (fear, anger, sadness, frustration, etc), and then it will turn into a chronic state of being, a chronic problem. That is how functional illnesses goes from an occasional physical discomfort to a chronic permanent disabling disorder.

And the saddest part is that, often patients do not know what is going on in their bodies, because of course they have not been taught by their parents, who also did not know about the language of the body, nor the school system, the society, or the medical system. So, the problem tends to come back every day, and much more intense. The emotions begin to matter more because there is uncertainty, worry, dread, and they just grow and get more negative, as patients are let down by their doctors, undergoing dozens of unnecessary tests and treatments, even surgical procedures. And then the illness and the emotional states associated with it, begins to affect the family, the environment, the patient’s life’s mission, and soul’s purpose, and in the latter stages, patients give up.

But wait! Imagine again the academy analogy. Let's assume that you decide to become a bodybuilder for five years and later you decide to stop, change your diet and your routine. Or that you stop playing musical instruments for 10 years. What will happen? The changes in your mind and your physical body will be reverted. The strong man will become thin, and the musician will no longer be able to play in his sleep, he will lose skills.

Therefore today, I want to tell you that YOU CAN IMPROVE!  YOU CAN GET BETTER! And I will do everything possible to support you in your journey. I will teach you everything I have learned throughout my own healing path, and while talking to hundreds of patients with FND. Count me in as your Functional Disorder Healing Ally!

As always, at your service,

Yadira Velazquez, MD

PS: Important concept reviewed in this post:

• The importance of recognizing and tending to the link between environment – mind – emotions – physical sensations. This is reviewed more in depth during The Four Directions courses.
• The usefulness of investigating, recognizing, and changing hurtful patterns of thinking, feeling, and behaving. I spoke of my “perfectionism” as an example. These concepts are further discussed during our Three Worlds Program.
• The wisdom of the physical body to achieve our life’s mission and live a well-balanced life. These teachings are deepened during our Autumn and Spring courses.
• The spectrum of functional illnesses and FND. This is further analyzed during our module: FND: A New Path to Healing.