Does the thought of surgery throw you into a panic attack? Let’s discuss how to mentally prepare yourself for invasive medical procedures, especially if you already struggle with anxiety on a daily basis. Today’s show was recorded a day after our host Gabe’s surgery, so the anxiety and experience was still fresh in his mind. Click on the player below to listen now!


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Computer Generated Transcript for “Medical Procedures- AnxietyEpisode

Editor’s NotePlease be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Lisa: You’re listening to Not Crazy, a Psych Central podcast hosted by my ex-husband, who has bipolar disorder. Together, we created the mental health podcast for people who hate mental health podcasts.

Gabe: Hey, everyone, and welcome to this week’s episode of the Not Crazy podcast, my name is Gabe Howard and with me, as always, is Lisa Kiner.

Lisa: Hey, everyone, today’s quote is from Hippocrates, healing is a matter of time, but sometimes also of opportunity.

Gabe: Spoiler alert, today’s episode is about medical procedures and anxiety and panic disorder.

Lisa: And this has a particular relevance today because Gabe actually had surgery yesterday. Gabe, how are you doing, how do you feel?

Gabe: I’m doing OK. Obviously, nobody is their best self the next day after surgery, but I’m really happy with how everything is doing. I feel pretty good. I’m really glad to be here. And speaking of which, we are going to be talking about surgery. You know, medical stuff brings up how surgery works and.

Lisa: It squicks some people out.

Gabe: I do want to give people a little bit of notice that Lisa often describes surgery in words other than using surgery. So if you are squeamish, this might not be the episode for you. And Lisa, please try to make the squeamish comfortable. Just try to be try to be reasonable.

Lisa: I’ll do my best.

Gabe: I know, I know.

Gabe: I had surgery yesterday and decided that today would be a good day to record a podcast because I really like the lived experience aspect of the show.

Lisa: And there’s no way this could possibly go wrong. And, Gabe, this was not an unexpected surgery, you’ve had this planned for months and you’ve also had the idea of recording this podcast planned for months.

Gabe: We put it on the calendar

Lisa: We did. For the day after. You’re less than 24 hours postop.

Gabe: And do you remember what you said to me? I was like, OK, I’m going to have surgery on this day and then the next day we should record.

Lisa: Yes, I said, I don’t think you can count on that. How do you know how you’re going to feel? You might not be able to record on that day.

Gabe: And I said that is very helpful for somebody with anxiety and panic disorder, just go ahead and tell them that they won’t be available the day after their surgery. Good one, Lisa. Good one.

Lisa: I think having actual information is always better. Knowledge is power and all that.

Gabe: What was the knowledge? That Gabe will have a bad outcome? Of course,

Lisa: No.

Gabe: I immediately said, what am I going to be dead?

Lisa: No.

Gabe: That was not the desired thought process

Lisa: No.

Gabe: Of somebody who is worried about having surgery.

Lisa: Being realistic about the outcome and having realistic expectations for your body. Surgery is a huge trauma to the body. Think about it. You’re cutting into your flesh. This is not a natural thing. This is not something humans are meant to do. It just takes a lot more time to heal than most people give credit to.

Gabe: I want everybody to know that this was an outpatient procedure, I was awake the entire time.

Lisa: Were you literally awake the entire time?

Gabe: Yeah, yeah, it was,

Lisa: Oh.

Gabe: Yeah, I want to reassure everybody in the medical procedure landscape, this was an easy one. It was just at a little local surgery center. I was home that evening. My wife was with me. I was well taken care of. And I did feel basically fairly optimistic about it, probably because I’ve had much more invasive surgeries in the past. And I thought, well, this is just a revision. That’s what it was. It was a revision of a surgery that I’d had over a decade ago to kind of fix some stuff that healed incorrectly. I’m trying not to say that it wasn’t a big deal because, like Lisa said, it’s always a big deal. But I felt like it wasn’t a big deal. But that did nothing to help my anxiety. But I was also optimistic because I scheduled a podcast for the next day. So I don’t know what’s up with that.

Lisa: Well, the proof is in the pudding, you had the surgery, so apparently you were in fact, able to overcome whatever panic or anxiety you were feeling. So the real question is how? What did you do? What did you say to yourself? What were you thinking?

Gabe: I was thinking that this is scary. You remember, Lisa, a long, long time ago I had a vasectomy.

Lisa: Yes, I remember.

Gabe: And I told the doctor that I needed to be put under and the doctor said to me, look, this is a little five-minute surgery, I always do these awake, it’s going to be fine. And I said, look

Lisa: And there are risks to anesthesia, so obviously, if you can at all avoid it, let’s avoid it.

Gabe: Yeah, and I say to the doctor, look, you can’t cut on the genitals of somebody with panic and anxiety disorder while they’re awake. It’s a really, really bad idea. And the doctor said, OK, done, we’re doing the anesthesia. I was under for like 10 minutes. The surgery was fine. So I am impressed that 10 years later I was able to have a two-hour surgery awake, whereas 10 years ago I needed to be put under for a five-minute surgery. 

Lisa: Wow, I did not think of that.

Gabe: Yeah, yeah, I’m doing well, I’m doing better.

Lisa: That’s a good point, because back then, a lot of people said to me, oh, he’s really going to get anesthesia? Because, one, it costs more. And even though the risk is very small, it’s still not zero. And that’s overkill. When my husband had a vasectomy, he didn’t get anesthesia, blah, blah, blah. And what you said was, look, sometimes I’m just laying on the couch and I have a panic attack. So what do you think the odds are that I’m going to be laying on a surgical table and I’m not going to have a panic attack? I thought that was very logical.

Gabe: One of the first issues that I had with anxiety and surgery happened when I had my very first surgery. I had had gastric bypass and this was, what, 18 years ago, Lisa?

Lisa: Yeah, who does that? His very first surgery was a gastric bypass, and keeping in mind back then, they did open procedures. This was not laparoscopic.

Gabe: Yeah, it was, I was in the hospital for five days, I was terrified, but I was also excited because I weighed 550 pounds. Really everybody should go back and listen to the eating disorder episode because it really talks a lot about when I was so heavy. You know, now I weigh 260. So, I lost a Gabe. I lost an entire Gabe Howard.

Lisa: Your surgery was extremely successful and you’ve kept it off all this time.

Gabe: But that was my first surgery, so and also I didn’t know that I had bipolar disorder, so I really didn’t know that I had an anxiety disorder. So I didn’t know what was going on. I was up. I was down. I was back. I was forth. Everything was, it was really the wild, wild West when it came to Gabe. And I had this horrific panic attack while I was waiting for surgery. And the way that they handled it was just to knock me out. Luckily, I had already had the IV in, and the thing that I remembered with thrashing and kicking and hitting, and that’s all I recall. And I said to Lisa while I was still in the hospital, maybe on day two or three, I said, I, I think I kicked the doctor and

Lisa: Of course, you were drugged, you were fuzzy and you weren’t sure if it had been a dream, if it had been real and it was bothering you that you didn’t know.

Gabe: It bothered me a lot and I said to Lisa, I, I, I, I think I hit the doctor, I think I kicked people. And Lisa said, look, you’re on a whole bunch of painkillers. You didn’t hit the doctor. It’s fine. You don’t need to worry about it.

Lisa: That is not what I said.

Gabe: All right, what did you say?

Lisa: I said that it was fine and you didn’t need to worry about it, but that doesn’t mean it didn’t happen. The doctor understands you were drugged. This is a known thing. Some people react this way to the drugs. He’s not going to think anything of it. He’s not going to take it personally.

Gabe: I remember it, of course, as you saying, look, that didn’t happen, you’re on painkillers, you just had surgery, you’re drugged up. Don’t sweat it.

Lisa: I’ll tell you why I know I didn’t say that. Because that was the first thing when the doctor comes out to talk to the family members after when you’re in the recovery room, but the surgery is over, the first thing he said was that you got very upset and started to get, I don’t think he actually said panic. I think he said emotional or something like that. But that was the very first thing out of his mouth that you had been so worked up, so upset the moments before surgery.

Gabe: This is the first I’m hearing of the doctor told my family

Lisa: I told you.

Gabe: From any of you. And here’s why I’m questioning whether or not you’re having some memory issues there, my middle-aged friend.

Lisa: You’re the one with memory issues.

Gabe: Really, I’m the only one with memory issues?

Lisa: No, I’m just telling you are not remembering this correctly, which makes sense, the drugs, the anesthesia, the trauma, the emotional roller coaster you’re on at the time for untreated bipolar disorder, it’s not really shocking that you don’t remember this very well.

Gabe: There was a lot going on, but I remember I was released from the hospital a couple of days later and again, this is all 18 years ago. So we’re relying on both, you know, Gabe and Lisa’s 18-year-old memory. And, of course, as Lisa said, Gabe just had surgery and is all kinds of fuzzy. But one of the things that I specifically remember is asking the doctor about it at my follow up appointment, which would have been about a week after surgery, because, remember, I was in the hospital for six days.

Lisa: Yeah, I remember that.

Gabe: And here I am, I’m sitting in his office and he says, do you have any questions for me? And I said, yes. Do you remember before I fell asleep? And he goes, Yes, yes. You started kicking. You were a little scared, it seemed like. But don’t worry, we are trained to handle it. And everything was fine after that. And I said, oh, my God, I started thrashing. And he said, oh, this happens more often than you think. I was shocked.

Lisa: You didn’t even finish asking the question before he started answering, he knew immediately what you were asking about.

Gabe: I believed at the time, and I don’t know if this was the doctor led me to believe it, if I misunderstood, it’s bad memory or a combination of all the things. But he made it seem to me that this was just a reaction to the anesthesia. This had nothing to do with anxiety, that I was just, this was just a known side effect of the anesthesia process and.

Lisa: Sometimes it is. That’s a possibility.

Gabe: This, of course, is where it gets so tricky, right? I believe now unequivocally it was not a side effect of anesthesia. It was absolutely a panic attack that just came up at an inopportune time when I am not in control of all of my faculties because of things like anesthesia and painkillers and other drugs. So it’s like the perfect storm, right? It’s, panic attacks can be controlled a little bit when you have full brain capacity. But of course, you don’t have full brain capacity because you’re having a panic attack. But now you’re on the drugs. The whole thing was just very disconcerting to me.

Lisa: You were extremely upset about it for a really long time, much more so than I thought really made sense because so what? So what if you had this negative reaction? The doctor isn’t going to take it personally. And also, sometimes you have panic attacks for no reason or we’ll be watching a TV show and you start to panic. You’re perfectly safe. You’re at home, you’re sitting on your couch. Nothing bad is happening. You’re surrounded by friends and family. There is no danger. Well, you’re about to have surgery. That makes sense to me as something that people would be anxious about, worried about or panicking about.

Gabe: And this is where it gets a little difficult for me to try to explain, you know, one of the things that you just said there, Lisa, is it’s perfectly normal to have anxiety or panic or be nervous or fearful or stressed out or worried when you’re having surgery. I agree with you 100%, but it’s not normal to have anxiety and panic disorder, which, of course, is a medical diagnosis. So how do those two things intersect in the world? It sort of reminds me of when I say to somebody, well, I have bipolar disorder and they say, well, I believe that everybody’s a little bipolar, Gabe. No, everybody’s not a little bipolar. Everybody does have emotions. But bipolar disorder is this massive illness, of course, that takes medical intervention to manage. Not everybody needs a little medical intervention to manage their lives. To say that everybody gets anxious about a medical procedure is absolutely true. But I have to believe that the type of anxiety, the level of anxiety and the outcome of the anxiety for people with anxiety disorder has got to be different. It just has to be.

Lisa: You don’t like me saying that because you feel like I’m dismissing you, you feel like it’s I’m not taking you seriously, I’m just fobbing you off and telling you everything’s OK, forget it. But this is one of those spectrum things, right? Everybody is nervous or anxious before a medical procedure, before surgery. And if you’re not, that is probably its own problem.

Gabe: Yeah, if you get excited about having surgery, there’s probably some sort of counseling that you need.

Lisa: Well, I’m just saying we were discussing this before the show, and it actually bothers me a little bit that you are so intent on the idea that no, no, no, my fear and phobia is different. My fear and phobia is somehow, I don’t want to say better, but more extreme, needs more care, has to be looked after in a different way. Why are you so special? You don’t think everybody has these feelings?

Gabe: I don’t think that I’m special, I think that I’m different and I think that that’s like extraordinarily important, right? You’re a female and I’m a male. You don’t think that you’re special for being female, but you wouldn’t want me to start calling you sir or Mr. Lisa or addressing you in some fashion that dismisses your gender. You also wouldn’t want me to say, well, we’re all exactly the same because there are differences in being a  

woman in our society and culture. You’re not telling me that you’re special. You’re just pointing out that you are different from me. I believe that while we are both human, there are differences between men and women, not as many differences as society places on us, but there are some differences between men and women that you should rightfully want acknowledged. And if I said to you, oh, this is nonsense, there can be the same number of toilets for men as

Lisa: [Laughter]

Gabe: For women, you are immediately going to say, well, that’s not true. We take longer to go to the bathroom. This is why there’s lines around women’s bathrooms and not lines around men. And you’re missing something here. And I would say, well, what makes you so special that you get double the toilets? And you would say nothing makes me special. I feel that my anxiety is abnormal. It’s not the normal anxiety that people will experience during a surgery. There is another level. To dismiss that extra care that I need is to allow me to flounder and suffer needlessly. I do, in fact, think that my anxiety and panic is worse and needs a higher level of care, not because I’m special, but because frankly, I’m unlucky.

Lisa: I don’t know that that’s true. Doing the research for this, I discovered there is a specific phobia called tomophobia, which is a fear of surgical procedures or medical intervention. I’d never heard of it. Again, it’s on a spectrum. Mental illness is culturally constructed. Why wouldn’t you be afraid of this? The thing that they said turns this into a specific phobia is the avoidance of medically necessary procedures makes this potentially dangerous. If you have such a high phobia that you don’t go get the heart surgery that you need, well, that’s another level. You’re not at that level. And someone might say, well, I need extra handholding or coddling. Well, maybe everybody does. Maybe that’s just about sometimes we need doctors and medical professionals to give us a little bit more emotional support than they’re used to giving us. Maybe it’s not so much that you need it as it is that everybody needs it.

Gabe: It’s interesting that you brought up tomophobia, because you’re right, I do think that somebody with tomophobia has it worse for lack of a better word.

Lisa: Suffering Olympics

Gabe: Yeah, yeah,

Lisa: Gold medal.

Gabe: Yeah. I do think that somebody with tomophobia needs a higher level of care than somebody with anxiety and panic disorder, just as I think that somebody with anxiety and panic disorder needs a higher level of care than somebody who does not have anxiety and panic disorder. All you’ve really illustrated is that there is, in fact a spectrum. So you’ve actually proven my point for me. In the example that you gave originally, you were talking about no anxiety and panic disorder versus anxiety and panic disorder. You’re trying to say that’s same same. I’m saying that no, unequivocally that’s not the same same. To maybe make this a little clearer, I want to point out that one of the things that you keep saying is who wouldn’t be anxious about having surgery? Well, when addressing tomophobia, who wouldn’t want to avoid surgery at all costs?

Lisa: Right.

Gabe: So we’re just moving the line. Some people are willing to avoid the surgery at their own peril. Well, but we should all strive to avoid surgery. When does it become a mental illness? When does it become problematic? When does it need psychiatric intervention? You are right, there is a societal construct here, and that level is going to be different for everybody. And the type of care that people receive or need is going to be different for everybody. But I didn’t want to do a show about the normal anxiety that people have surrounding surgery. I wanted this show to be about the type of anxiety that the people like me, people with anxiety and panic disorder experience. And Lisa, we have established that my level of anxiety is higher than your level of anxiety. And both of us have had an atypical number of surgeries for our age and both of us have experienced them differently.

Lisa: No, no, no, if we’re playing surgery suffering Olympics, I win. OK, I’ve had a lot more surgery than you have.

Gabe: I concede this point.

Lisa: Yes, it has been pointed out to me, possibly because of this, that I do not have a lot of sympathy for people with various medical problems, or when you tell me you’re worried about these things. Because I just think, oh, please suck it up. You people don’t know. Oh, you think you got problems? You should see problems. But again, I’m trying to get over that and be a better person and be a more supportive friend. I tried very hard not to do that. Success, I think. I’m being more supportive now. I’m taking your concerns seriously. I’m validating your worries and not saying, yea, suck it up, buttercup. I think modern medical science has enabled all of us to be so desensitized to this idea of surgery. Can you imagine people a thousand years ago or even 200 years ago hearing about how often we are cutting into our flesh? They would be horrified. This is an extremely invasive process that it’s just very, very traumatizing to the body. And not for nothing, it also requires you to just passively submit. Anesthesia as the ultimate loss of control. But you’re still not answering the question I asked earlier, which is back in the day, you had such incredible anxiety that you had a panic attack. It’s been 18 years. You’re having a completely different reaction to this than you did all those years ago. It sounds like it was pretty smooth. What’s the difference?

Gabe: Knowledge is power, right? Experience, Lisa, knowledge, diagnosis, medication, therapy, practice, all of these things. Coping skills, knowing what to do.

Lisa: So you think it’s just like a desensitization thing?

Gabe: No, I don’t think it’s a desensitization thing. I think it’s much easier to do something a second time than the first time.

Lisa: Isn’t that what desensitization is?

Gabe: No. Maybe. I think of desensitizing as you no longer care about something, I care very much. I’m not just walking past it and dismissing it. I’m actually doing something about it so that I don’t have to walk past it anymore.

Lisa: Well, it sounds like what you’re talking about is just desensitization, and as I was

reading about one of the treatments for tomophobia, the extreme fear of surgical procedures, is desensitization. Kind of an exposure based therapy. You know, start about thinking about what surgery will look like. Get to maybe look at some pictures, watch a video, go to the surgical center and tour it, stuff like that, to all help diminish this phobia. Isn’t that basically the same thing?

Gabe: I think it’s exactly the same thing as, you know, this is how I handle.

Lisa: Yeah, exactly,

Gabe: Yeah.

Lisa: This is how you would handle anxiety all the time. When you had anxiety about going to a concert or something, you would go to the arena ahead of time, get a feel for the place, scope out where the bathroom was, where the concession was, where the doors were. You’re just saying that I have less anxiety now because I’ve done it before. Meaning you know what to expect. I think a huge part of the anxiety of surgery is the unknown. Most people don’t have surgery that often. They don’t know what’s going to happen. They’re worried it’s going to be like on TV. You’ve already, again, submitted yourself to this complete lack of control. And of course, you also don’t know what your surgical outcome in the first place will be. Will you have a good outcome? Will something go wrong? Will it fix the underlying problem that you started with? All of these unknowns contribute to anxiety.

Gabe: Exactly, Lisa, I think this is an excellent example of where just because the stakes are higher doesn’t mean the approach isn’t exactly the same.

Lisa: Exactly.

Gabe: You’re right. It doesn’t matter if it’s surgery or a concert. You still have to do all of the right things leading up to it to help manage panic and anxiety disorder.

Lisa: So your coping skills are universally applicable.

Gabe: They really are.

Lisa: The first day of work, this situation, meeting a new person, you’re using the same coping skills, just applying them to different situations.

Gabe: Word.

Lisa: So you’re saying that the thing that was better this time is you knew what to expect. You’d done it once before. It wasn’t as scary because of that. But what were you saying to yourself? What did you feel?

Gabe: I felt scared, nervous, I felt anxious. I spent a lot of time with the doctor. I spent a lot of time clearing my calendar, except for this. And I got a good night’s sleep the night before. I work really hard to focus on the positive. In your example of going to a concert, it’s reasonable to think, why would somebody go through all of that effort, you know, driving there ahead of time?

Lisa: Because you wanted to see the concert.

Gabe: Yeah, because you get the concert and the concert is amazing. Why have the surgery if you’re so scared of it? Because living a long, healthy life, I’ve been through so much when it comes to mental illness, I don’t want some easily correctable issue to be the thing that took me out, especially if it’s still related to mental illness. I do see overcoming the anxiety and getting the surgery as still part of defeating mental illness. I’m on board with defeating mental illness. If I refuse to have surgery because I’m scared, then I let mental illness win and that is just not compatible with my general belief system. 

Lisa: Ok, but this was a minor, if there’s any such thing as a minor surgical procedure, outpatient, the stakes aren’t super high. This isn’t a life and death thing. Does that make a difference?

Gabe: Yeah, it makes a huge difference, right? A stitch in time saves nine.

Lisa: Ohh, especially applicable here.

Gabe: Yeah, I really think it is you’re right, it was minor, it was outpatient, I didn’t need it today. I could have easily put it off. And in fact, I had put it off for a decade, as you know.

Lisa: Yeah, you thought about doing this years ago.

Gabe: Right, and I probably should have. The older you are, the harder it is for the body to bounce back. So some of this pain that I’m feeling, I probably wouldn’t have felt as much if I had done this 10 years ago.

Lisa: Well, there’s a question, why didn’t you do it 10 years ago?

Gabe: Money,

Lisa: Oh, OK.

Gabe: Money and time.

Lisa: I don’t know if the audience realizes this, but after the gastric bypass, several years after you had the excess skin removed surgically and you had some surgical complications that got really bad.

Gabe: I did, I did,

Lisa: Yeah.

Gabe: I spent five days in the hospital.

Lisa: You almost died. It was very traumatizing. Are you sure that you didn’t put this off all this time because of that? Because that had been so difficult and so traumatic.

Gabe: It’s certainly a possibility, but I’d like to think that no, that’s not why. I live in the real world, and in order to have surgery, you’ve got to be able to be off for two, four, six weeks. And you have to be able to spend not only the money on the surgery, but make

up the lost wages for the time that you’re off. And it just wasn’t something that I could afford to do. When COVID-19 shut down the world,

Lisa: Good point.

Gabe: It opened up my calendar a lot. It also opened up the surgeon’s calendar a lot. And that did help make it a more affordable price. A lot of things did go into it. And I do wonder if I was deluding myself, was I sitting there saying, oh, it’s because I don’t have the money.

Lisa: Were these convenient excuses?

Gabe: Yeah, yes, I do not believe so, but regardless of the reason, getting something out of the way sooner is certainly better than putting it off until it becomes extraordinarily problematic.

Lisa: Well, you’ve been anticipating this for a long time. As we said, you planned this months ago and you occasionally have come around to it. Oh, I’m worried about this. Oh, this is coming up. Don’t forget about this. How has that been for you anxiety wise? Did having all that time make you more anxious? Less anxious? Would it have been better if you scheduled it for three days later? Less time to ruminate? People are worried about the after care for surgery. Who’s going to take care of them? How bad are they going to feel? Will they be able to get in and out of bed by themselves? Planning all of that ahead of time can be extremely helpful when it comes to relieving some of your anxiety, knowing that you’ve got that set and you don’t have to worry about it, even things like clearing the rugs out of your house, making your physical environment a good place to recover.

Gabe: You hit the nail on the head, Lisa. I learned as much as I possibly could about this surgery. One of the things that I learned is that I have wounds that are going to seep. I don’t mean to be TMI, I.

Lisa: That’s a little TMI, Gabe.

Gabe: I understand, but I made sure before I left the house, I had old sheets for my bed. On the couch, we put the cushions in garbage bags and put towels on top of that. We did all of these things so that when I came home, I could just sit right down. I didn’t have to stand there and wait. Also learning about the surgery through the doctor, I asked the doctor all of these questions. I got to be so clear, when it comes to anxiety, do not go on the Internet. Do not ask Dr. Google, because that will just terrify you. I asked the doctor and when the doctor told me that these are the things that I can expect, when the wounds were seeping, that did not bother me at all. I expected this. And that’s how come everything in my house is covered in plastic bags right now.

Lisa: Well, because if you didn’t know in advance, that would be really scary.

Gabe: Exactly.

Lisa: It just seems like if you have anxiety or a phobia of something that as it gets closer, your anxiety would get worse and worse and worse and worse.

Gabe: Yes, having distractions as you get closer are certainly extraordinarily helpful. It’s been a little difficult in the time of COVID-19 to have some of these distractions. It would have been ideal if I could have maybe gone on vacation during the time and then just forgotten about it, or if I could bury myself in work or if I had a lot of big projects or maybe take on something around the house or do something with my wife or do something with you. It was certainly difficult to distract my mind just because I have more free time than normal right now. And I did notice that this allowed me to ruminate on it. I have to say that the people in my life were very helpful because you all knew that I had this coming. And when I wanted to talk about it and ask questions, you all agreed to answer them 20 times. I think that there is some level of helpfulness in pulling in your support system, letting them know you’re worried and telling them what they can do for you ahead of time. Now, not everybody has a Lisa who’s been through multiple surgeries.

Lisa: But it also, again, sometimes leads me to not have very much sympathy. I often forget how big of a deal this is in other people’s lives. And I was reading about people with surgical fear, when their family and friends say things like, don’t worry, this is a minor outpatient procedure, everything will be fine. Statistically, your odds are very good,  

that they feel like in some ways that’s dismissing their concerns, acting like their concerns aren’t valid. It’s not something to worry about. Do you feel that way? If people are saying to you, this isn’t a big deal, be chill, do you feel like they’re kind of ignoring you?

Gabe: Yeah, it’s the equivalent of being told to calm down.

Lisa: It’s exactly being told to calm down.

Gabe: It’s just not helpful. I like it when people ask me what I’m worried about, I’m scared to have surgery. What are you worried about? I’m scared to have surgery. No, specifically, what are you worried about? Are you worried about the pain? Are you worried about dying? Are you worried about not being able to drive for a week? Are you worried about money? What specifically about the surgery are you worried about? I have learned that I’m not scared of dying in the surgery. Every surgery is its own, but death is not the motivator that causes my anxiety.

Lisa: Because it’s so unlikely?

Gabe: No, I don’t know why it’s not I don’t even need to delve into it, right, why bother? I am scared of the pain. I am scared of not being able to care for myself. So one of the things that I do to help my own anxiety is to address all of that. What’s my pain management plan? What are the things that I can do in my house so that I can move the easiest? Even the drive home and the scheduling. Let’s not drive home in rush hour. Let’s drive home when it’s on and on and on. Talking to my doctor and getting the pain management plan, raising up my chair so that it’s easier to get up and down, asking my wife not to sleep in bed with me because I’m afraid she’s going to kick me. Definitely not letting the dog sleep in bed with me because he will climb all over me.

Lisa: Yeah.

Gabe: Little things like this make a big difference in assuaging my anxiety. I think that so many people focus on the wrong things. They’re like, well, surgery causes me anxiety. And then they just want to talk about surgery. They want to talk about outcomes. They

want to talk about death rates. And what specifically is bothering you?

Lisa: Well, again, that’s one of your normal coping skills, trying to narrow down as far as possible to the very fine grained thing that’s worrying you, because then you can address that specific concern. That’s one of the coping skills that you learned all those years ago and have been using since for everything, not just this type of anxiety.

Gabe: Yes, it’s not lost on me that people that use coping skills for more mundane things or daily tasks don’t realize that those same coping skills are applicable to big things, to things like surgery. It really is the same.

Lisa: And we’ll be right back after these messages.

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Lisa: And we’re back talking about how to deal with the anxiety caused by medical procedures.

Lisa: OK, so you ready? Tell me when you’re ready.

Gabe: Yeah, hang on a second.

Lisa: Take your time. Get adjusted.

Lisa: Are you sure you can do this?

Gabe: Yep,

Lisa: You don’t look so good.

Gabe: I’m good.

Lisa: Again, it won’t bother me. Are you sure that you can keep going here?

Gabe: I’m good.

Lisa: You don’t look so good. You’re kind of sweaty.

Gabe: I’m OK, this is.

Lisa: Ok, I won’t be mad if you need to stop, I won’t be mad.

Gabe: I appreciate that, you know,

Lisa: Ok.

Gabe: It’s interesting, I know this isn’t for the show, but part of managing some of the anxiety, of course, is managing the expectations of those around you. I suppose that the average person is not dumb enough to try to record a show on anxiety and surgical procedures the day after

Lisa: Uh-huh. Uh-huh.

Gabe: They have a surgical procedure. But you and I, we did set up expectations, like you told me, that I could take a lot of breaks. You bring me water.

Lisa: Got you the water, yeah.

Gabe: Obviously setting expectations of what you can do. You know, some people go back to work three days a week or maybe part time or they let their children, their animals, their dogs I.

Lisa: Yeah, but some people don’t have these options. Some people have to push themselves through it.

Gabe: It is very true, and that makes it.

Lisa: You don’t have to do this.

Gabe: Well, I think I disagree with that. I mean, the show must go on. I didn’t invent that.

Lisa: Well, the show could go on tomorrow. It doesn’t have to go on right now. It could go on in an hour after you get your next pain medicine dose.

Gabe: I know. I wanted to ensure that the experience was fresh in my head, and I appreciate you going down this road with me. I have now drank water, rested for five minutes, adjusted my chair, because I can’t sit longer than 20 minutes without rubbing against a surgical scar, apparently. You know, I thought this chair was comfortable until now, but.

Lisa: Yeah, I think you might be asking an awful lot out of an office chair there.

Gabe: All right, let’s pick this back up.

Gabe: Lisa, I want to circle back to something that you said earlier when you said that you were not very sympathetic or caring toward people who had surgery.

Lisa: I’m trying, I’m trying I understand this is a big deal for you, I care about what’s important to you.

Gabe: I can only speak to my own experience, I don’t know how you have been with

anybody else in your life who has had surgery, I did not feel that in any way. You helped me up. You helped me down. You dropped me off at the surgery center. You picked me up. You sat by my bed.

Lisa: I didn’t drop you off and pick you up, I sat there the whole time. Who drops someone off for surgery?

Gabe: Well, somebody who thinks that their loved one is a burden and are burdened by them having surgery, I guess that’s what I mean. You said that you don’t have a lot of sympathy for people, but I’m not sure what you’re basing this on because you’re certainly not basing it on your actions. Your actions are perfect. You seem to be describing this idea that the people who are doing your care don’t like it. Yeah, no shit, Sherlock. Of course they don’t like it. Who the hell likes it? I don’t like being sick. The people who are taking care of me don’t like taking care of me. That’s not a shock. You seem to think that there’s some sort of like meaning in the fact that your family and friends don’t like it when you’re sick.

Lisa: It’s kind of a thought crime.

Gabe: Look, you have always been extraordinarily appropriate, extraordinarily caring, and have done everything that I have ever needed, including this. Are you kidding? When I said that I wanted to record a podcast the day after surgery, you tried to stop me. And even now you’re bringing me water. You’re asking me if I need breaks. You’re telling me that I don’t look so good. Where is all of this hostility, anger and meanness of which you describe? It seems to be that because you’re not enjoying taking care of me, you think that means you’re bad.

Lisa: I don’t think it’s bad. I’m saying that your actions don’t always match your mental process. I am very good at taking care of people who are sick or are having surgery, that kind of thing, in part because I’m experienced with it and I’m not uncomfortable. A lack of experience might be why some people seem to not give you that level of caring that you’re asking for. A lot of people don’t do well in the post-operative period because they’re uncomfortable with blood. They’re freaked out by it. They don’t know what to do. They’re afraid of doing something wrong. It’s kind of like when someone dies, you’re like,  

oh, none of my friends, even they don’t know what to say. So when people don’t know what to say, they say nothing. When people don’t know what to do, they do nothing. They’re not sure how to behave. So they just ignore it. Not the right decision. The thing that I’m trying to explain to you is my actions are not necessarily reflective of what I’m thinking. When you had the excess skin removed, you ended up in the hospital. I slept by your hospital bed for, what, five and a half days? I did not leave the hospital even once the entire time you were there, which was the right thing to do.

Gabe: That’s not true, I had to call you from the nurse’s cell phone because they tried to operate on me when you went home that one time to take a shower on day one, then you never left again.

Lisa: That’s true, that’s fair. A few hours after you were admitted, I thought, OK, I’m going to go home, do things like make sure the door is locked, feed the cats, get a change of clothes, etc., get your toothbrush, stuff like that. And I hadn’t even made it to the parking lot. I was still getting out of the parking lot in my car when you started calling in a panic saying that you needed me to come back, and I did.

Gabe: They tried to operate on me without your permission.

Lisa: I know I came back, I didn’t leave again, I stayed at the hospital the entire time. I slept next to your bed on one of those really uncomfortable chairs. And so I was trying to give as much love and care and support to you as I possibly could. Right. And to never, ever let it show how I felt. And I don’t know how you’re going to react to this, but what I was doing was stepping out into the hallway and calling my friends or family and complaining about you and saying, oh, my God, I can’t believe this guy is so freaked out about this. Why is he such a wuss? Why can’t he suck it up? Can you believe he needs me to be here 24 hours a day? This is ridiculous. Although I would like to qualify that. You should absolutely get someone to stay with you 24 hours a day, if at all possible when you’re in a hospital. But it can’t necessarily be the same person the whole time. You’re going to have to swap off.

Gabe: It’s so interesting to me, the idea that you think that I would think that you did something wrong because you were unhappy about being in the hospital for five days.

Lisa: You’re honestly not upset about that?

Gabe: Why would I be? This is are you do you know how often I vent about you?

Lisa: I was calling my mom and complaining about you every day.

Gabe: I call my mom to complain about you every day and you’re not in the hospital. Venting is healthy. Of course, you weren’t having the time of your life. I would actually be more disturbed, like and I honestly believe the listeners would be more disturbed as well. If you would have said, oh, my God, I just remember those five days as awesome. I mean, you hanging on for dear life, needing two additional surgeries, the blood transfusion, you crying, when we thought you had that infection. Nobody knowing if they could get the bleeding to stop. I mean, honestly, I look back on that week and think, wow, you know, really, there was that week that you almost died in the hospital. Then there was the cruise, then there was our honeymoon. What is wrong with you? I want you to be miserable. It is a miserable thing. Why would I expect any different?

Lisa: I am honestly surprised that you’re not upset to hear this. Would you have been upset at the time if you had overheard me?

Gabe: Yes, probably, I mean, one, I was I was on so many drugs and I was scared, I think that we do need to consider my reaction would not be.

Lisa: I know you were out of it. Looking back on it, I feel a little bit bad about how many negative thoughts I was directing your way. You weren’t used to it. You hadn’t done this before. The complications were scary. The panic disorder, it upset your regular bipolar medications, etc. In retrospect, I shouldn’t have been as annoyed with you as I was because you had valid reasons for being as upset as you were.

Gabe: I think it’s very important to point out that you weren’t annoyed with me. I’m not mad at you because you weren’t annoyed with Gabe.

Lisa: Oh, I was totally annoyed with you.

Gabe: No, you weren’t. You were annoyed that I was sick. I’m not upset because you weren’t mad at Gabe. You were mad at the things that were happening to Gabe. You were mad that I had a complication. You were mad at the unknown. You were mad at the fact that I had to get in an ambulance and be taken to a hospital. I literally passed out in the smallest room in our house and six.

Lisa: The one with the offset doors.

Gabe: I yeah, and then six firefighters had to take me out, I just. Why on Earth?

Lisa: Yeah, that was funny in retrospect, sort of.

Gabe: Listen, I am not surprised that you were angry, you handle all emotions with anger, there is nothing that you don’t handle with anger. So therefore, you were scared and worried that your husband might die and needed three surgeries in a matter of 24 hours. And that made you angry. That perfectly tracks with your personality. You keep saying, well, Gabe, I was angry at you. Really?

Lisa: At the time, I felt like I was angry at you and look.

Gabe: Of course, you felt that way.

Lisa: Looking back on it, I realize that was not fair. It wasn’t your fault; you couldn’t control some of it. But yeah, I still feel like I was angry with you.

Gabe: The reality is people die, people die all the time and their loved ones are mad at them. My father is still grieving my grandfather, who he’s angry who left. My grandfather died of cancer. This is nobody’s fault. But my father is angry about him for dying young. This is not atypical. This is how you process and experience extreme emotions. I’ve known you for 20 years. First off, I’m a little bit insulted that you think that I don’t know that you were pissed off. What other emotion do you have?

Lisa: But you just told me that you didn’t see that, that I was appropriate and caring and

loving and stuff.

Gabe: Yeah, because you were appropriate, caring, and loving and stuff. Yes, I would have been very annoyed if sitting next to my bed while I was scared at the at the at the prospect

Lisa: The unknowns.

Gabe: Of another surgery, the unknowns of not knowing what’s going to happen. And you started complaining. That would have been a wholly inappropriate. It’s just like moms and dads should not bitch about their children in front of their children. But I don’t think that parents who complain about their kids are bad parents. Do you? I mean, honestly, if you’re hanging out with your friends, and they’re like, oh, my God, my toddler won’t sleep and he’s driving me nuts. Are you like, oh, that is a bad mom and dad right there? No, you vent about your kids. Are you going to start firing everybody that vents about their boss or their job? Where does this end?

Lisa: This is very interesting, I learn so many things through this podcast, I’ve never thought about it that way.

Gabe: I want people listening to this show to know that their family members are probably scared as well. And that comes out in different ways for different people. Lisa, you may well believe that, yes, you were mad at Gabe Howard, but even you have said that was unreasonable. Gabe didn’t do anything wrong

Lisa: Some of it was, yeah.

Gabe: Well, as much as I hate to admit it, not everything is about me. Your emotions for what happened during my surgery were not about me. The only thing that I can judge you on is your actions and how you treated me. And you were perfect. Perfect.

Lisa: Thank you. I tried.

Gabe: What more can you? What nonsense, absolute nonsense that you would think

that I would be upset that you had emotions for having to sleep on that horrible chair next to a hospital bed for five and a half days. And remember when I learned that the only thing you ate for those five days were French fries? No wonder you were miserable, nothing but grease.

Lisa: Those French fries were amazing. I’ve actually thought about going back to that hospital cafeteria, but maybe it was like a situational thing, maybe they actually weren’t that good. I just thought they were. I can remember I was eating fries and you woke up and you said, oh, you’re still eating those fries? Yes. Still, these are the same ones I had earlier. This isn’t another order. No. Yeah. Still eating these fries.

Gabe: Oh.

Lisa: Ok, Gabe, we’ve talked about before the surgery. We’ve talked about how you’re doing today. Unlike other surgeries that you’ve had in the past, for this one, you were awake.

Gabe: I was the entire time.

Lisa: So what was that like? What was it like actually during the surgery or do you remember?

Gabe: It was terrifying. Of course it was, and it was also very calm,

Lisa: Because of the drugs?

Gabe: The medication absolutely helped. You know, you say you’re awake during surgery, but they still numb the area. I was still given medication to help me calm down.

Lisa: You’re awake, but you’re not exactly yourself.

Gabe: Exactly, so I do remember bits and pieces and one of the things that helped keep me really, really calm is I explained to my doctor ahead of time that I had an anxiety and panic disorder and they had a nurse that literally every minute. How are you doing,

Gabe? How are you? How do you feel? What’s going on? She just kind of chittered at me for two hours. And then the doctor started talking to me. My doctor said if he wasn’t a doctor, he would be a volunteer firefighter. I

Lisa: I have so many questions,

Gabe: There’s many questions.

Lisa: Did that actually happen? Did he actually say that or is that just what you remember being drugged up?

Gabe: Exactly. Exactly, I believe.

Lisa: What a bizarre conversation to have.

Gabe: Exactly, it was just a bizarre, meaningless conversation designed to take my mind off of what was going on. The other thing that they did for me that they told me is they covered my head. They put a surgical sheet over my head the entire time I was laying on my stomach for the surgery. And they put it over my head and I stared down at the floor the entire time. And then when they had to flip me over, they put it over my face as I stared at the ceiling. And they told me afterwards, they do that for their more anxious patients because then you can’t see anything.

Lisa: Does the average patient want to be able to see?

Gabe: Apparently.

Lisa: That’s what I would do.

Gabe: I am not capable of watching on a monitor them do the surgery. Whereas, my grandfather, for example, still tells the story of how he watched them operate on his hand on a little monitor.

Lisa: Yeah, I’ve done that.

Gabe: That sounds awful, but people like it. I don’t know.

Lisa: Do you remember when you had to have that mole removed, where was it? It was like on your arm or something and you couldn’t even look at the incision. You had to turn away?

Gabe: I don’t look when they do blood draws or when I get a flu shot or anything.

Lisa: I do, I want to see what they’re doing so I know what’s going on.

Gabe: Exactly, that is not me, I look the other way. Sometimes I hold my phone in my hand or I do a squeeze ball or I try to say the alphabet backwards because it takes so much brainpower. I do anything I can to keep my mind off what is actually happening. And that has been an extremely helpful anxiety management mechanism for me.

Lisa: Well, if it works for you, I would feel like that would increase my anxiety because then there’s more unknowns. Now you don’t know what’s happening. You don’t know what’s coming next because you’re not watching.

Gabe: Exactly, and for some people, that is probably true, and that’s why it’s not a one size fits all. You need to figure out what helps you and communicate that to the medical staff. During the time that I was in there, which about two and a half hours, because, you know, you got the set-up prep and they got to rub, you know, that that that cold, brown bronzy.

Lisa: Betadine.

Gabe: Yes. All over you. I was communicating the entire time how I felt, what I felt like. Just everything, the whole nine yards. I never stopped talking, which should surprise no one.

Lisa: When you had the excess skin removed, that was a huge worry of yours because you were remembering the anxiety with the gastric bypass. It almost seemed like it was

more worrisome to you than the actual surgery. You discussed that with the doctor, the nurse, the anesthesiologist. And I think that really did help. And it was one of the first things when the doctor came to talk to me, he said, we’ve got this under control. We are taking this worry of his seriously. You don’t need to be concerned about this, although part of it, I think why they were so worried about it and wanted to make sure is because you’re so big.

Gabe: I am. I’m a giant man, 260 pounds, six foot three, I got a six-foot wingspan

Lisa: Yeah, that and especially since you were having surgery at that outpatient surgery center, they don’t have the same capabilities as a regular hospital. So, I think there was some concern about if you did get really agitated, you would be difficult to control.

Gabe: I really think the bottom line, Lisa, is that you manage medical procedure anxiety the same way that you manage all anxiety. The biggest takeaway that I want people to hear is that you’re allowed to talk to your doctor. So many people believe that your doctor, your surgeon, whomever is performing the procedure on you is unapproachable. That is not true. You need for your own mental health, for your own anxiety, and, of course, to have the best outcome, you need to engage with your doctor and with their medical staff so that you know everything that’s going on and you can communicate. I strongly encourage you to communicate to your doctor that you have anxiety and panic. Don’t just say that you’re nervous. We have a tendency to downplay it. Right? Well, I’m a little worried. No. Look your doctor in the eyes and say, my name is Gabe Howard and I have anxiety and panic disorder and these are the things that I need in order to be safe. And here are the things that I want you to be aware of. And any additional information that you can give me so that we can work together will be extraordinarily helpful leading up to the surgery, on the day of surgery, and for my outcome. That alone is worth the price of admission for the show. Please, please memorize it. Don’t be afraid to say it. Write it on an index card. If you have to, bring your Lisa, your wife, your father, your mother.

Lisa: Oh, always bring someone with you.

Gabe: Just bring somebody with you and have them explain it. Do whatever you need to  

do to communicate that to the medical team and communicate it often, don’t be afraid to bring it up constantly. I’m not afraid to bring it up constantly. And it’s helped me so much.

Lisa: It’s interesting that all of these coping skills and all the things you do and all the techniques for anxiety are completely applicable to this situation as well. And you’re describing how you used all of them.

Gabe: It’s awesome, isn’t it?

Lisa: It is. It also sounds like the preparation, being physically prepared, having your environment ready, knowing that you can handle it financially and of course, the emotional preparation and all of this communicating with your doctor really made a big difference. And a lot of people are afraid of doctors. That is changing. There’s not near as much paternalism in medicine as there used to be. It is changing, but not fast enough. 

Gabe: And we have to do our part to ensure that it keeps changing by holding doctors accountable to answer our questions. Remember we’re the patient. Be a health care consumer. Don’t be afraid. I promise you it will turn out very, very well. Don’t you agree, Lisa?

Lisa: Absolutely, as the patient, you have all the power, the doctor does not have the control, you do. So, Gabe, here we are. Next day. How are you feeling? You got through it.

Gabe: I survived both the surgery and podcasting the day after surgery with my ex-wife.

Lisa: And the anxiety you survived the anxiety of the surgery.

Gabe: I did. I’m both ecstatic and tired and sweaty

Lisa: Yeah.

Gabe: And how do I look?

Lisa: You don’t look great, but to be fair, you did have surgery less than 24 hours ago. So, with that in mind, you’re probably looking pretty good. How do you feel?

Gabe: I feel awful, however, I’m safe. I’m good, I want you to reassure the people that I have done no long-term damage here.

Lisa: No, you’re fine, you’re fine. You had an excellent surgical outcome, everything went well, it should be smooth sailing from here.

Gabe: I’m looking forward to get back on stages as soon as I heal and, you know, the pandemic goes away.

Lisa: And COVID. Yeah.

Gabe: I also want everybody to know that by the time this airs, I’ll be like two or three weeks past surgery. I promise we won’t air it if something bad happens. So if you’re.

Lisa: Nothing bad has happened, nothing bad is going to happen. Also, depending on how fast I edit, it might be longer than that. We’ll see. But you’re doing quite well and no worries, everyone. Gabe is fine.

Gabe: Lisa, thank you so much for helping to make this happen. I know that you had better things to do than work with a podcast host who is 16 hours post OP. I really appreciate it.

Lisa: You’re welcome.

Gabe: I also want to give a huge thank you to my wife, Kendall. Not only is she super cool, but I think she would have preferred that the day after surgery, I stayed on the couch watching reruns of Family Guy. So it took her.

Lisa: It does involve quite a bit of extra work for her.

Gabe: Yeah, she did fantastic. Big, big things to my wife, Kendall Howard. Hey,

everybody, I want you to know that I wrote a very cool book. It’s called Mental Illness Is an Asshole: and Other Observations. You can get it on or you can get a signed copy directly from my website, head over to and buy Mental Illness Is an Asshole. I’ll throw in a bunch of stickers and swag, including Not Crazy stickers.

Lisa: Yeah, the Not Crazy stickers are totally the best part, and especially considering that you’re still recuperating, I’ll probably be shipping the books, so I’ll make sure there’s a bunch of them in there.

Gabe: Thank you so much, Lisa, and thank you, everybody, for listening. Here is what you can do for us. Wherever you downloaded this podcast, please subscribe also rank and review us, use your words and tell other people why they listen. We really appreciate you being here. And we will see you next week.

Lisa: Hey, that’s my line. We’ll see you next Tuesday.

Announcer: You’ve been listening to the Not Crazy Podcast from Psych Central. For free mental health resources and online support groups, visit Not Crazy’s official website is To work with Gabe, go to Want to see Gabe and me in person?  Not Crazy travels well. Have us record an episode live at your next event. E-mail for details.


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