Medical Anxiety - teen - ideas or recommendations?

[lavenderblue]

My daughter has Medical Anxiety that has actually gotten better in some aspects after her hospitalization for her ED in 2020, but other times, like today, it still rears its ugly head. She use to run and hide whenever she had to get immunizations and don't even get me started on the drama that was her oral surgery a few years ago. 

Anyway, the current issue is that she has a severely infected toenail. We went to the Pediatrician last week and they gave us an oral antibx as well as an antibx cream for her toe. Problem is, it isn't getting better. We went to the Podatrist today and he want to remove part of her nail and she pretty much freaked out at the thought of getting the injections to numb her toe and downright refused. He has her doing a Betadine soak 4x day for the next two weeks, but if it doesn't get better, he said that she really needs to get it removed. How can I help her through this? Any suggestions? Because I am completely stumped. The only thing I can think of is to find a doctor who will do it under a twilight sleep type of thing like she had for her oral sx, but I don't even know if that is a thing. 

[mrsukyankee]

Therapy - CBT for phobias. I had a needle phobia and had to go through it as I was in charge of a blood drive. It works as long as you are willing to face a bit of discomfort. And it makes things much better. I now give blood. Seriously the only thing that truly works for life is CBT with this.

[devonpow]

DS2 did cognitive behavioral therapy for his fear of needles/getting shots (and some other anxieties). It really worked well for him.

[raleighnc]

I would start on CBT as soon as possible, but DD1 also has propranolol (and used to have Xanax, but it didn't work as well for her - she has a lot of the physical anxiety symptoms that amplify her anxiety - sweating, crying, nausea, lightheadedness). But otherwise, you might have to pursue treatment by someone who has the facilities to do sedation or general anesthesia. Our pedi dentist contracts with a mobile anesthesia practice that goes to a variety of practices.

[joy]

Is it possible for her father to take her to the nail appointment if it needs to be removed? Or another adult that you trust?

One parent often becomes “safe” and the child knows that parent will be empathetic with them. So the child gets upset easier and the parent gets upset and together both spiral downward.

A different adult doesn’t allow that spiral to happen so the child makes it through, sees they CAN do it, and feels good about themselves after the appointment. The safe parent will be waiting to celebrate their accomplishment.

It’s not “leaving them at a critical moment,” either. This is a toenail removal - rather low stakes in the great scheme of medical interventions. It’s scary and unknown for the child but also a great opportunity to face fears and come out the other side seeing they did it.

I am speaking as a child who had tremendous anxiety, as well.

[nicolewi]

First of all, can they seriously give her like Valium, or some other calming medication or sedation prior to the procedure under the circumstances?

Second, my daughter is anxious in general, not specifically medical, but she randomly got a breast abscess, and had to have it surgically drained. She was absolutely freaking out, but we were already at the Children’s Hospital complex and doing it that same day, so at least she didn’t have additional days in which to worry. They had their awesome child life Person come and talk her through the entire procedure with like a photo book of what each room would look like, how long it would take, exactly what to expect at each step. It really did seem to help her out. Maybe you can do a similar thing with a toenail?? Like at 10 AM we will give you some medication. It’ll make you feel a little bit more calm. At 11 we take you to the doctors office. The whole procedure only last five minutes. Then you’ll rest there for 15 more minutes in the waiting area. And then we’ll go out for breakfast. Or Sephora. Or whatever it is.

[nicolewi]

And obviously therapy would be great for the longer-term, but that’s not gonna help you deal with this particular situation bc this needs to be dealt with right away.

[sonrisa]

Both my kids have medical anxiety about shots and blood draws, One ran and hid in a remote hospital janitorial closet before last year’s covid/flu shots (ah, the impulsivity of ADHD). The only thing that has sometimes helped is I bring lidocaine to put on the area where the shot is going and numb it ahead of time. But that has been hit or miss.

[karinothing]

I had to have a biopsy on my toe and the numbing shots were excruciating. So I can't judge her for being afraid. I agree with some medication to deal with the anxiety and maybe see if there id anything available to help with the pain of the injection

[raleighnc]

Oh yeah! I forgot about what we do for shots. The Pedi prescribed EMLA cream to apply 1-3 hours before the injection. We do it 2 hours before. We also have a shot blocker (little prickly pad that supposedly confuses the nerves) and a Buzzy Bee that is an ice pack that also buzzes and also supposedly confuses the nerves. This is on top of the oral meds and therapy, lol.

[livinitup]

Is she at an age where she can participate in medical decisions and problem solving? My DD’s medical anxiety would escalate if she “had” to do anything and her participation became more alarmed and exclusively “no”. Which makes sense. The tough thing about medical interventions is that there is usually only a sliver of room for the patient to “choose”. Is she at an age where she can understand her options and you have time to let her decide the course to decrease anxiety and/or agree to the shots and surgery? Can she make calls, appointments, etc?

ETA: I also agree with being deliberate at picking the adult person who can support her. DD and I can get locked a lot faster and a lot longer than my H. She gets irrationally annoyed at me in ways and to a severity that does not happen with H. In fact, H did all of her podiatry appointments, including the shots, etc.

[SusanBAnthony]

My 16 year old has now had this done 3 times. 🤦‍♀️ face palm because in his case its self induced.

By the 3rd one he was a pro and was complemented for not freaking the f out. Apparently most teenagers freak out about it. So your daughter is not alone and they are somewhat used to dealing with it if you can get her through the door.

We've had the best luck with medical anxiety at children's hospitals/clinics. They are good at explaining things, calming kids/teens down, and making sure it isnt painful.

[heygrey]

I don't have advice for the anxiety part, but I have had infected toenails several times starting as a teenager. Apparently the edges of my toenails are weird and prone to issues that were exacerbated from sports. There were conversations about removing my toenail or burning the edges to stop regrowth which was a big no thank you to teenage me.

For healing them, I did a soak 2-3 times a day, trimmed the nail as short as I could (easier after a soak), poured peroxide over the nail a few times after soaking it (over a sink or bucket), and put an antibiotic ointment on it. One time it was a particularly stubborn infection and my mom read that filing the centre of the nail quite thin will make the nail draw up out of the edges and relieve the infection. It worked. Idk if any of this is helpful because it sounds like you've tried a lot, but I can commiserate with her pain. It is awful.

[k3am]

We have this *exact* scenario with DD. I have no advise. They gave her enough Xanax for a grown adult and it wasn’t enough. It will get bad enough she needs antibiotics, soaking multiple times a day, cotton under the nail, etc and eventually improve… only to be in the same position within 6 months. It’s annoying.

[lavenderblue]

Thank you everyone!

Before we even got to the Podiatrist, she was already on an oral antibx as well as an antibx cream for the toe, so I was worried that cutting the nail would be our only option, but the doctor is having us do a Betadine soak 3-4 times a day and we're finally starting to see improvement.

If we do end up having to cut the nail, I will look and see if our local Pediatric hospital has some options. Unfortunately having another parent take her is not an option as she does not have any contact with her Dad.

[circa1978]

I'm glad she's getting better! For me, medical anxiety (and my ED and OCD and GAD) are about control, and my lack of control. It may be helpful for her to do some cognitive behavioral therapy, if she hasn't already. There will be lots of times when twilight sleep is not available, but benzodiazepines (my current one of choice is Klonopin) are pretty much a must for me in most medical situations.