Internet searches for 'panic attacks' more common during COVID

Q: I had this scary episode happen where all of a sudden, it felt like the world wasn't real. My heart was racing and I thought I was going to pass out. The friend I was with said it was probably a panic attack. Is there any kind of treatment? I really don't want that to happen again.

A: Not a day goes by in our practices without there being a discussion about anxiety or panic with at least one of our patients. In fact, the data collected by internet search engines shows that searches for the keywords “anxiety” and “panic,” which began to rise in March, have surged in recent weeks.

Considering the length of time we have all been dealing with the many uncertainties of life during the pandemic, as well as the social isolation that it has caused, it's not surprising that the rigors of this strange new normal are taking a psychological toll.

From what you described, it does sound like you had a panic attack. These often occur as an acute manifestation of anxiety. In addition to major life stresses such as a grave illness, job loss or the death of a loved one, people with a family history of anxiety disorders may be at increased risk of experiencing a panic attack.

The symptoms, which appear suddenly, include the rapid heartbeat and shortness of breath you described. Additional symptoms include sweating, heart palpitations, chest pain, weakness, chills, nausea, stomach pain, numbness in the fingers or hands and trembling. For many people, a panic attack is accompanied by an extreme emotional or psychological response, which can include the feelings of unreality and disconnection you experienced. People also report feelings of looming peril and of hopelessness. Most share your distress at the thought of having to navigate another panic attack in the future.

The first thing to know is that no matter how intense the experience, it's temporary. If you should find yourself having another episode, try closing your eyes, bring your awareness inward and focus on taking deep, steady breaths. Breathe in deeply through your nose, to the bottom of your lungs, hold your breath for a beat or two, and then breathe out just as slowly. Some people find it helpful to count from one to five on each inhale and exhale. Be careful not to hyperventilate, which can make you feel worse.

Although a panic attack is frightening, it's not dangerous. However, due to an overlap in symptoms with other health problems, such as a heart attack, getting a professional opinion is important. In addition to breathing techniques, many people find cognitive behavioral therapy, yoga and mindfulness to be helpful. Lifestyle changes, such as getting regular aerobic exercise, spending time in nature and steering clear of caffeine, nicotine, alcohol and recreational drugs, can make a difference.

If you continue to struggle with panic attacks, your doctor may prescribe anti-anxiety medications. Some of these can be addictive, though, and some have potential for abuse, so we discourage taking that path unless all other approaches have failed to bring relief.

Home remedies for toenail fungus: A recent column about the challenges of dealing with toenail fungus has brought a bumper crop of mail, with many of you sharing home remedies. Although the evidence for these types of natural agents remains limited, some people do find them helpful, and the approaches readers have shared here are not harmful.

• A reader from Napa, California, had success with a friend's approach. “I was plagued with this on both large toes, and several remedies, including Vicks VapoRub, didn't help,” she wrote. “A friend recommended powdered Ajax cleanser, and that did the trick. A small amount on a nail brush used to scrub the affected nail every day was effective.”

• A reader from Newport News, Virginia, also followed a friend's advice. “I did everything I could to rid myself of the dreaded toenail fungus, and nothing helped. Then a friend suggested rubbing a capsule of vitamin E oil on my affected nails daily, and it worked!” she wrote. “Of course, it has taken awhile for the nails to grow out, but soon they looked normal again.”

• Several readers shared that, although various home remedies for toenail fungus yielded temporary improvement, it was only when they used a systemic antifungal medication prescribed by their doctors that they saw long-lasting results.

A sauerkraut fan: In a column about gut health, we mentioned the benefits of fermented foods, including sauerkraut. We heard from a sauerkraut fan, who asked us to make clear the difference between the canned or bottled kind, which is pasteurized, and the fresh variety, which is not. “For years, I ate pasteurized sauerkraut, not realizing that all of the probiotics had been killed off through heating,” he wrote. That's correct, and we thank him for the clarification. If you're eating sauerkraut for the probiotics, be sure to shop the refrigerator case rather than the canned-goods shelf. If the label states the product has been pasteurized, it means the good bacteria have been killed during processing.

Road trips: Regarding a column about motion sickness, we heard from several of you that, when you're unable to be the one behind the wheel, keeping one eye closed can help keep nausea and dizziness at bay. We also heard positive feedback for the elastic wristbands we mentioned in the column, which keep a small plastic knob pressed into an acupressure point inside the wrist. “I use them in the car on windy roads, on ships and airplanes,” a reader wrote. “They are amazing, inexpensive and available at most pharmacies.”

Mask etiquette: Quite a few of you have asked us to clarify that both the mouth and the nose must be covered when wearing a face mask to slow the spread of COVID-19. This is important, because the newest research shows the virus can spread not only through sneezing and coughing, but also through speaking and even breathing.

Finally, we'd like to close with a thank you to Mr. Carter. Your kind letter about these columns really made our day.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.