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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6553
Experience:  14 years as clinician in the field of Family Practice
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Today I went for a brisk walk. During the walk I noticed a

Customer Question

Today I went for a brisk walk. During the walk I noticed a post with a square top next to a picnic bench. I stopped and started to stare at it then as I started to walk away from it I turned my head to the right. My heart was beating fast and I am wondering if the exercise from walking and the anxiety caused the heart any harm?
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD : Hello!
Customer:

Hi Dr Bray

Anthony Bray MD : The exercise induced rise in heart rate would be GOOD for your heartvhealth
Customer:

I got scared when I felt it beating fast as I was turning my head to look at the post as I moved away from it

Anthony Bray MD : ....heart health....
Anthony Bray MD : The anxiety induced elevation in heart rate while not good for heart health exactly would be neutral to your heart health>>> not good but no harm either...
Anthony Bray MD : Hi again>>> I realize that the bump up on your heart rate may cause you worry but even through these episodes you are OK. And your heart is fine....
Anthony Bray MD : I realize that the anxiety and the sensation of your heart beating faster or harder will make you feel alarmed but even with these sensations your heart health is fine...
Customer:

the point that I got scared was when I was moving away from the pole and it was going out of my view

Anthony Bray MD : I hope that this information helps.... Let me know if you have further concerns and questions .. I will be happy to get back with you !!
Customer:

the point that I got scared was when I was moving away from the pole and it was going out of my view

Customer:

So even if the pole goes out of view while my heart is beating fast the heart is still safe?

Anthony Bray MD : OK... I understand .... You frequently feel a strong sense of concern or fear with regard to your heart relating to looking away from some object ...you should KNOW that these fears are not based in reality in terms of what we would be concerned of medically ....
Anthony Bray MD : Your worry of the heart is excessive and unfounded.... This the nature of the OCD however.... Not specifically the fears that you currently have but rather OCD would be similar in nature to others that have this disorder ....
Anthony Bray MD : i think that the better understanding that you have of your condition that this should help to alleviate your fear and help you to better cope with the feelings that you have to deal with !!
Anthony Bray MD : i hope that this is helpful for you!! Let me know if you have other questions or concerns....take care!!
Anthony Bray MD : Anthony Bray MD
Anthony Bray MD : Yes >> even when your heart is pounding or racing you are still fine... Try to keep your calm through these episodes... That would be of much help to you to keep calm and especially if you should develop the strength to reject your fears>>>
Anthony Bray MD : I hope that this helps !! Let me know if you have more questions>>> Take care!!
Customer:

Thank you Dr Bray sorry for the pause was talking with neighbor

Anthony Bray MD : Hello agin!!
Anthony Bray MD : That's fine. >> no worries!! I am not online continuously either... Don't worry at all !!
Anthony Bray MD : Take Care!!
Customer:

Dr Bray I think I made a break through with the staring

Customer:

in one of the work rooms I was facing the wall with a table top fan and a wall clock and to exit the room I have to turn to my right to leave the room. Once the staring started I took in three deep breaths, smiled, then forced a laugh, then said this does not harm my heart looked ahead once then turned to my right and walked out of the back room. However I did this a few times. So again this is safe from the heart and no connection between vision and heart function?

Anthony Bray MD : Hello again,
Anthony Bray MD : Yes, let me reassure you that there is no connection between your vision and your heart!
Anthony Bray MD : You will cause no harm by the staring at an object or looking away from it...
Anthony Bray MD : You want to keep up your efforts to brush aside these obsessive thoughts as best you can!!
Anthony Bray MD : I am glad to hear that you feel some forward progress in dealing with this issue!
Anthony Bray MD : Let me know if I may be of further assistance to you!!
Anthony Bray MD : Take care,
Anthony Bray MD : Anthony Bray MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6553
Experience: 14 years as clinician in the field of Family Practice
Anthony Bray, MD and 4 other Health Specialists are ready to help you
Customer: replied 1 year ago.

Hello Dr Bray my anxiety got the best of me today unfortunately. It started this morning with me obsessing over turning on and off the light switch in my hallway then it went to hyperfocusing on the clock on the microwave. Again the fears that by doing these motions harm would come to my heart. At work I kept focusing on plastic box with its size label on it and squeezing my left hand to feel my pulse beat. In the washroom I kept focusing on outlet plug next to mirror and kept looking at my reflection then the plug back and forth like an idiot. I tried using the skills but they did not seem to kick in as good as they did yesterday. I should not ask this again but with the stress of these actions is my heart still safe from the activity since I know heart functions are separate from visual? sorry to unload all this today

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes as you know the visual aspect of you neurologically is NOT related to the control of the heart... Your heart can not be harmed by your looking at any object or by looking away...

OCD will be typical to have a person such as yourself with ups and downs with regard to symptoms. You are not alone in this regard. Don't despair or get discouraged but try to relax and do the best that you can.

The goal of treatment is for you to be able to have a more normal enjoyable and functional life. We don't beat up on you for having setbacks and do not want you to best up on yourself !! That is not the point of treatment at all of course! I hope that your anxiety condition improves and that you will steadily be less affected by the obsessive thoughts and actions.

Hang in there !! Let me know if you have further questions! Take care!

Anthony Bray MD
Customer: replied 1 year ago.

Thank you Dr Bray it was a rough day for these anxiety thoughts. Even if the thoughts say that the heart would not work right if looking or moving away from either the clock or boxes from fixation there is no way the heart is harmed even by these OCD thoughts that seem to persist false information? My blood pressure is around 124/76 but my pulse tends to be around 100 to 110. In the evening it drops to the 90s.

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Your heart is not harmed by the OCD thoughts/ behaviors. You are impacted by false fears with regard to your heart. You should KNOW now that your heart is fine and not affected by the OCD / staring/ looking at objects or looking away/ fears/ none of these !! You are plagued with the OCD. And the recurrent fears with regard to your heart -- these are false in nature as you know...

Hang in there and stay grounded by the facts that you know. You have have your intellect to control the emotional false fears of heart problems.

I hope this helps! Let me know if I may be if further help to you! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.

Hello Dr Bray


Today was a little better but I was wondering if you could give me some advice to stop the hyperfocusing staring before they get worse. I have been using some CBT methods like counting to four then moving away but then my heart starts racing and usually the method to get out of the staring mode goes into a repeatitive mode that is hard to break. Is it safe to move away quickly if I find myself standing still and fixating on an object like that box containing plastic bags or in a room where something catches my eye like the brand on the tv set. I have started to just take a deep breath when that happens and move quickly forward without looking back like getting out of my car. I am really trying to convince myself that the heart has no connection to these behaviors and I am really trying hard its just programming my brain so that it knows the heart is safe. Can there be something else I can do from a medical standpoint to prove to myself that the heart is safe? I have had normal cholesterol, calcium coronary study, ekgs, stress test all within the past six months and all came back normal. Is there anything I missed?

Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

CERTAINLY >> you are welcome to use WHATEVER technique works best for you!!

 

If you can take a deep breath times one and move on then do that!!

 

If it works for you to count to three or four and then move then that would be fine as well.

 

There are a number of possible techniques that may be helpful for you. You do whatever works for you though>> don't worry about technique A > B > or C so much as whatever works for you!!

 

Your heart is FINE!! You are young and healthy!! The OCD tells you that you need to worry about the heart but every other piece of information goes against this, right??

 

So on an intellectual level you KNOW that you can't trust your own feelings in this regard>> your FEELINGS are always telling you to worry about your heart but you KNOW in your mind that this feeling is false>>

 

I know that this is a struggle and frustrating but hang in there!!

 

Your heart is not the problem and intellectually you know this is true... it is a battle between a strong complex feeling vs logic...

 

I hope this helps. Let me know if you have further questions. Take Care>>

 

Anthony Bray MD

Customer: replied 1 year ago.

Thank you Dr Bray so even with the heart racing from the anxiety it is still okay? My blood pressure medicine now is 100mg Losartan and I have been on it for close to a month. Would also the less amount of time I look at something help the anxiety diminish if I find myself staring?

Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

Yes >> even though your anxiety may cause your heart to race this does not harm the heart >> it is still OK>>

 

The less that you are able to stare then yes this would help with the anxiety ... ( Also the worse your anxiety the worse your compulsions will be ...)

 

I hope this helps. Let me know if you have further questions... Take Care,

 

Anthony Bray MD

Customer: replied 1 year ago.

Hello Dr Bray unfortunately my morning started out like hell with anxiety but I pushed onward and around noon I took one ativan. Not to sound like this is a miracle pill but the hyperfocusing stopped and the thoughts about harming the heart lessened greatly. I think I need to add this pill to my regiment every day until I can get the compulsions under control.


I need to ask though I had the fear of going into my local comic book shop for fear of hyperfocusing. I said to myself in the car nothing can harm my heart and I got out and talked with some people in line about Iron Man 3 and the sales girl. However I did look a little at this picture of a comedian on the front of the cash register where it says absolutely no checks. To make sure I did not stare at that picture on the register I moved a little quicker to the opposite side of the counter where it goes out of view and was able to carry on a small conversation. My question regarding those quick movements are safe for the heart as well even though it feels like heart may beat a little faster like a quick sensation in the upper chest like if you move quickly. I did not feel out of breath or panting but I did not look back at the register and exited store normally. Did I do right by not looking back at that picture? again I told myself heart and vision have no connection

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes >> the quick movements will not harm your heart! You did well not to become entranced in looking at the sign , YES...

Keep up the effort to stay out of becoming stuck in these thoughts/rituals/routines>> try to relax.. it is ANXIETY that is the ROOT of trouble for you that perpetuates the OCD...

I hope this is helpful for you !! Let me know if you have further questions !! Take Care !

Anthony Bray MD
Customer: replied 1 year ago.

Hello Dr Bray today I had some bumps with ocd staring at objects however I kept telling myself that the heart has no connection to the vision function. Can I also tell myself no matter how I look at something like a card on a rack at a store and move away slowly or quickly it has no affect on the heart? Sorry to keep asking this question but is there something else I can tell myself scientifically where I know the heart is safe from moving away from objects being stared at or in my case to avoid hyperfocusing and staring? today I just moved away quickly after short look at painting and artist name as well as cards on a shelf in the store I also moved quickly away am I doing the right thing?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Right, as you KNOW you can't hurt your heart by any staring or thoughts !! Your heart is safe!! You will not harm your heart by looking ( or not looking ) at anything. The vision does not impact the heart!! Your heart is fine. Your heart is perfectly safe.

You are doing well to try and minimize the hyper focusing and staring at objects...you are doing better to try and move on...you are making progress .... Keep up the effort and do your best!!

I hope this helps! Let me know if you have further questions or concerns! I will be happy to get back with you! Best regards ,

Anthony Bray MD
Customer: replied 1 year ago.

I was out shopping with my friend and only stared for a bit at a hair braclet tag that said so and the o was ironically shaped like a heart. Again I did stare a little at it and could still notice it from a distance from the checkout. My question is out of all the tags and items why would my eyes be attracted to stare at something like that? Also my blood pressure medicine Losartan is 100 mg and I feel like I lack energy after I take it in the morning. Could it be too high? Also even when you force yourself not to really look at the object again it is harmless?

Expert:  Anthony Bray, MD replied 1 year ago.

Hello again!

 

I suspect that with your preoccupation about your heart that it would be only natural that a heart shaped item would attract your attention.. that does not really surprise me at all...

 

The BP medicine Losartan is an excellent choice I think. It is usually without much at all in the way if side effects. Certainly if your BP on AVERAGE were too low then the dose may need to be adjusted back... Your AVERAGE BP should be in the range of 110 to 135 / 60 to 85... If it it runs lower than this then notify your doctor of this...

 

Do you feel that you lack energy all day or just in the AM? There are many potential reasons for feeling tired and the very first thing to examine is whether it is just a normal aspect of life versus a symptom of some underlying problem. In other words we all feel tired but there may be a certain point at which the fatigue is ABNORMAL and may indicate a problem such as illness ( hypothyroidism, anemia, B-12 deficiency, insomnia, sleep disorders, etc, etc...) OR could be a potential side effect>> Losartan AS WELL AS ALL BP MEDS will list fatigue and dizziness as possible side effects.. I would suggest that you check on your BP first to see if PERHAPS low BP readings may correspond with you feeling tired. It is possible but also possible that you may feel tired for other reasons...

 

 

In response to your other question >> YES >> It is harmless when you force yourself NOT to look at something. The looking or staring at or looking away from or forcing yourself not to stare at >> none of these actions or behaviors has the least impact on the health of your heart!! You heart is safe and healthy and fine!

 

I hope this helps! Let me know if you have further questions! Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.

Hello Dr Bray


Today I had a bad time. When I was getting ready this morning I lifted my left foot off the ground quickly then placed it down quickly on ground while my heart was beating fast. Next thing I know throughout the day the phobia of my left foot being on the ground has affected my heart negatively somehow so is this completely false again? I am having a hard time convincing myself when I set my left foot firmly down on ground it is okay. Does the heart function completely separately from this kind of action I am embarassed to ask but maybe if I know scientifically that will stop the obsessing of the left foot placed on the ground? Thank you again Dr Bray

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

This fear that you have remains FALSE >> YES !! Stop obsessing ( I know that this is so much easier said than done...) over your heart !! Your heart is fine and healthy and NOT affected by your foot position or movements either!!

You are super sensitive to your heart beat. Your fear takes over easily and you get fearful and the adrenalin flows>> this causes you to feel your pulse pounding but that is all. Your heart is fine despite these scary feelings and experiences.

Logically you KNOW this >> you need to use your logic to quell the unreasonable fears.. This is a developed skill.. Hang in there and keep working on this skill>>

I hope this helps you! Let me know if you have further questions. I will be happy to get back with you!

Take care !! Anthony Bray MD
Customer: replied 1 year ago.

Thank you Dr Bray so even if I feel extra pressure on my feet there is no scientific connection to the heart function and how we set our feet on the ground I know this is my ocd anxiety acting up bad. Could you explain to me how the heart is separate from this action in a nutshell? Sorry to ask again having a very hard time tonight forgetting this.

Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

No that is fine>> don't worry about asking me questions >> that is quite alright!!

 

Your heart is its own entity basically. It may be influenced by your anxiety and thus may beat faster. This actually has ABSOLUTELY NOTHING to do with your FEET however.. Your anxiety may translate into increased sympathetic nerve impulse and increased adrenalin release and these may cause the heart to beat faster and harder for a short period of time BUT this does no harm to your heart.

 

Your heart has its own electrical system and it may be influenced by nerve signals or chemical signals but there is no direct connection between the heart and either your vision or your feet. No direct connection at all!! But it is important for you to realize that even though your nervous system has influence to your heart your heart keeps on beating irregardless of this influence... Your heart will maintain its own minimum rate regardless of your nervous system signals.

 

The temporary racing that you may feel if you are in a state of fear does NOT HARM the HEART!!

 

You get stuck in these vicious cycles that seem to perpetuate your state of fear. That is the OCD >> try your best to RECOGNIZE what is going on and to use your LOGIC to QUELL the sense of FEAR!!

 

I hope that this helps. Let me know if you have further questions. I will be happy to get back with you!

 

Best Regards,

 

Anthony Bray MD

Customer: replied 1 year ago.

Thanks Dr Bray I think I am paying too much attention to my feet on the ground and my heart rate but there is no connection as you explained. So the fast heart rate is due to the anxiety and not the fact that my feet are firmly placed on the ground? Any way I can forget about this obsession?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Right >> your feet have nothing to do with your heart !! Yes you may forget this obsession!! I hope that you can!

Your heart rate may of course respond to your anxiety or fear and may of course increase if you exert yourself and exercise. These are normal responses that EVERYONE has. Your heart does not really care how your feet are placed on the ground!!

I hope this helps! Let me know if you have further questions or ongoing concerns! Best Regards,

Anthony Bray MD
Customer: replied 1 year ago.

Thank you Dr Bray to try and shake this obsession off I did some foot lifts four on each foot raising it off then setting it down on the ground each time. However I made the mistake of squeezing my left hand to feel my pulse which was beating fast but that is just from the adrenaline?


Also I don't know if this is my anxiety again but it seems like I have extra sensitivity in my feet when they are on the ground either sitting or standing is this normal or am I over analyzing this foot sensation obsession? Again heart is functioning separately as always and I should try to not keep squeezing my left hand to feel pulse?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

You are over-analyzing your feet sensations.

Try to quit checking your pulse... it will do fine without your attention!! You will be more functional the LESS that you manage to pay attention to these things ( pulse rate and feet sensations)

Your OCD leads you to worry > still know that you are best off to reduce your sense of worries as much as you can...

Yes your heart functions separately. You do not have need to check your heart or worry about it... this checking and rechecking ONLY serves to aggravate your OCD. It is a vicious cycle and you need to do your best to relax and get away from the obsessions and worries...

I hope this helps you! Let me know if you have further concerns.. Take Care!!

Anthony Bray MD
Customer: replied 1 year ago.

Any method I can use to forget about the foot sensations and worrying about the heart since there is no connection? It still does not want to let go today and I appreciate your help Dr Bray

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well the OCD driven worries are not easy to control as you know. There is no magic wand so to speak. You are familiar with techniques to try and remind yourself of the logical and sensible conclusion such that you have nothing really to worry about with regard to your vision, staring, looking away from any object, feet sensations or foot positions having any negative impact on your heart. Your heart is safe.

As we discussed before I would include the technique of keeping a small object in your pocket. The object such as a smooth stone or other object of your choice would serve as the ribbon tied to your finger as a simple reminder >>>this reminder object would symbolize to you to that your heart is healthy and fine and that your fears are not founded!!

I would reinforce your understanding that your heart is in fact healthy by setting aside a few minutes each AM and PM with the purpose of reinforcing to yourself the idea that your heart is healthy by meditation on this specific idea. You may write down some key statements and read back over these with each meditation.

These statements could be for example #1 my heart is in good health. #2 my worries and fears of the heart being harmed by my actions are just false ideas # XXXXX need to stop worrying about my looking at objects #4 my feet position has nothing to do with my heart # XXXXX I don't need to check my pulse because I know that it is ok!

The above are a few examples of hopefully helpful reminders to yourself. The repetition of the ideas over and over with time should strengthen your mind to accept the logical argument and hopefully help to repress the dominating emotional responses if fear that are a part of the OCD...you may certainly phrase a few statements to best convince yourself that you need not worry as you are driven to do.. The repetition of positive and logical ideas may help you to be better defend against the irrational but powerful fears that plague you!

Your therapist and the CBT should be helpful for you as well....

Medication for anxiety is usually helpful in the control of OCD but not a cure-all either. The best results usually comes from a combination of medication, therapy and CBT. Multiple techniques and aids are need to have best effect.

I hope that this helps! Let me know if you have further questions. I will be happy to get back with you! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.

Thank you Dr Bray so I need to stop over analyzing my feet sensations and that will help as well? Also what is your opinion on acupuncture to relieve anxiety and ocd?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

Yes you will do well to stop over- analyzing your feet and move on. Fluid movement through life's events without the consuming/ distracting/ excess worries of your OCD is what you need!?

I do not have direct experience with acupuncture. From my training in Western medicine and not Eastern i have to admit that I remain skeptical to the claims of benefits with acupuncture. ( from my knowledge of human physiology the technique dies not make much sense to me...) I am the first to admit that I do not know everything of course and since acupuncture us really outside my training and experience I may not be the best person to ask about this... For myself I would not seek acupuncture as a treatment course but I would be interested to review articles on the subject....I do not claim yo be the final word on acupuncture >> you may benefit in this to get several opinions pro and con...

I hope this helps! Let me know if you have further questions. I will be happy to get back with you!

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.

Thank you Dr Bray in order to shake this foot thing off I stood in front of a mirror and took turns lifting each foot up and down four times in a row and saying this does not harm my heart. Is this okay to do to shake the phobia?


Also here is the article on acupuncture I found earlier regarding GAD


http://www.acupuncture.com/newsletters/m_july10/anxiety.htm

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I checked out the article that you listed above... Still western me since theory of mechanism of disease and Chinese theory are dramatically different. From my position I am a natural skeptic of benefit from acupuncture --- I suspect that it probably does have a beneficial placebo effect....many treatments for varied conditions may have about a 20% improvement from placebo effect...

So I leave it to you to consider if you want to try acupuncture but I can' in good conscious recommend it. If you pursue this course of treatment then I would be I interested in your experience with it...

I hope this helps! Let me know if you have further questions and I will be happy to get back with you! Best regards,

Anthony Bray MD

Customer: replied 1 year ago.

Hi Dr Bray sorry to bother you again with this foot issue but still having a hard time. It seems when I am sitting I tend to lift up one or both feet at the same time then set them down on the ground. While I am doing this ritual I am squeezing my left hand to feel my pulse. Again I am sorry to ask this but no matter how many times you raise or set your feet either with or without shoes on the ground and feeling your pulse in your left hand there is no connection to this affecting the heart whatsoever? I think I feel my pulse change while I lift my feet up and set them down and I fear setting them down to quickly will affect the pulse so this is false thinking again? Also no matter if its a hard or soft surface this has no bearing at all as well? thank you Dr Bray

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,Well there are two possible ways in which these actions might affect your pulse rate. Any exertion or exercise will increase your heart rate- of course! Also anxiety can stimulate some rise in your pulse rate! As we have discussed such effects are normal and harmless. You therefore worry for no good reason!!Further your feet position have no relation to your heart health! None whatsoever!! So your worries in this regard are not founded in reality.Any movement that you may make with your body from walking, jogging, sit-ups or waving your hand will constitute a degree of exercise and your heart rate does naturally respond to exercise. This is normal and not a reason to worry!You are certainly better off to NOT even check your pulse in response to your feet position! This is pointless to do that. It only serves to give more power and momentum to your OCD. That is the last thing that you need to do!I hope this is helpful for you! Let me know if you have further questions or concerns. Take care!Anthony Bray MD
Customer: replied 1 year ago.

Hi Dr Bray


Sorry to ask again but this situation with my feet just will not let up I even tried the CBT techniques. I did limit myself to squeezing my left hand to check my pulse rate when lifting and lowering my feet. Basically what my anxiety tells me if I lower my feet on the ground in a sitting position how much sensation should I really be paying attention to and again it still goes back to the heart worry which is unconnected as you explained.


Is there a way I can trick my brain into thinking that feeling my feet set on the ground with shoes on or off makes no difference to the heart function? When I tend to worry or internally analyze my heart rate goes up a bit about this. I know I beat the staring at the feet before and I know there is something I can do to let the brain know that the feet on the ground whether it be setting down flat or upwards by the heels that it is safe? Thank you again Dr Bray

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

OK let's look at this situation logically.... You have gone your entire life with your feet on the ground in different positions --flat on the ground , toes up, toes down , heel down and so forth. You have had shoes on and shoes off... All your life this has made no difference to the function of your heart. If you feel that your feet control your heart then sit down and write a paper to explain why this is!! Go ahead and waste your time in this exercise in futility. Write down in paper exactly how this seems to be if any possible logic to you. Why would your feet affect the health if your heart?

The idea that I am trying to express here is for you to reverse the process. Instead if you trying to reassure yourself if the lack of connection between the heart and the feet--- try to justify this idea...is this not self evident as to the ridiculous nature of your worry? It is silly!! Your fear is driven by OCD and the resultant illogical anxiety and fear associated with it. I am not telling you anything that you do not already know.

Use your reason to reject the absurdity of your fears.... I know it is easier said than done but YOU HAVE TO DO THIS!!


I hope this is helpful for you! Let me know if you have further questions or concerns and I will be happy to get back with you! I am not trying to be rude or insulting to you but I am hoping to have a positive impact in helping you deal with this problem!!

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.

Hi Dr Bray no I agree with you this is really crazy thinking that the feet affect the heart and I need to reinforce the fact that this makes no logical sense because there is no connection with the heart and the placing of the feet. When I have my feet positioned on the ground and the OCD thought arises can I just tell myself that this is silly just like the issue with looking at the feet was same principle and no connection?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Yes try to reinforce your logical side in which you KNOW that your feet have no connection with your heart function or health. The OCD is producing these repeat emotion based thought cycles. Do try the same techniques as with the vision fears to quell the disruptive repeat fears with regard to worrying about your feet adversely affecting your heart! You might try another object to symbolize the reassuring truth that your heart is not harmed by your feet position. A short message printed out on an index card to reassure yourself might be helpful for you. There are several methods such as this that may be helpful for you.

I hope this helps! Let me know if you have further concerns or questions! Take care!

Anthony Bray MD

Customer: replied 1 year ago.

Thank you Dr Bray my bp was 118/82 and pulse of 64 at the doctors office but when I got home it was 123/76 with a pulse of 120. I did have anxiety looking at building in front of my car before turning away and walking to my condo also I had similar experience before doctors office looking at poles before walking away. Is the vision function still separate from heart function and could the anxiety have raised the pulse that high?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes the rise in pulse was probably due to anxiety. Keep in mind that your pulse also elevates in response to even mild exertion. So standing and walking around even will make the pulse rate go up. This is perfectly NORMAL however and no reason for concern..

AS always your vision does not have direct effect on your heart. Your vision can in no way harm your heart. The rise in pulse may be associated with anxiety or exercise but even so this is a normal and completely harmless effect.

I hope that this helps! Let me know if you have further questions! Take Care,

Anthony Bray MD
Customer: replied 1 year ago.

Thank you Dr Bray so the rise to 120 pulse was nothing to fear? My doctor didn't think I needed a beta blocker because it may have more bad adverse affects such as tiredness and fatigue and he also thinks the fast pulse rate is due to my anxiety. Regarding the staring at poles or building I did my best to turn away and not look back so as not to feed into the staring ritual. Am I doing right by moving away quickly when this happens as well?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Well I don't know enough specifics of your tachycardia to tell you if the beta blocker is needed. It is the RESTING pulse that would be the more significant however.. As I recall you have been on a beta blocker and this might be needed for you >> ??? I think there has been a question as to the diagnosis of this though , right??

Your resting pulse ( with > ten minutes sitting still and more if recovering from exercise >> your pulse should be 60 to 100 as normal...)

Your vision and your feet do not have anything specifically to do with your heart rate however!! These are not factors that would affect your heart function at all!!

Now anxiety can be a factor to raise your heart rate >> fear and panic attacks in particular may cause the heart to race.. this would not itself be detrimental to your heart function either though..

Also even mild exertion or exercise would cause your heart to beat faster but here again this is NORMAL physiology and nothing to be worried about in itself..

If you have an irregular heart rhythm or racing for no reason then you may need a beta blocker... It would benefit to help in such a judgment if I could review your EKG tracings or holter monitor results.. As it stands I can not really make such a judgment call on your behalf...trust what your doctor and cardiologist have to say on the matter is the best that I may advise you in this regard!!

I hope that this helps! Let me know if you have other questions or concerns.. Take Care,

Anthony Bray MD
Customer: replied 1 year ago.

I talked to my psychiatrist about the foot thing and he also said it is physiologically impossible for placing feet on the ground having any affect on the heart. My problem is I over feel the sensation of my feet on the ground and is there a way to stop doing that? Like you mentioned maybe I should make up an index card or piece of paper that says this is nonsense and feet and heart have no connection on the card?

Expert:  Anthony Bray, MD replied 1 year ago.

Hello!

 

It is a matter of where you place your attention. Try to distract your attention to more positive things>> I realize that this is easier said than done..

 

I do think that having reminders for yourself as to the harmless nature of the feet sensations and the visual should be helpful aids for you!

 

You may benefit to put up a picture or pictures of scenes that you find relaxing or reassuring. This might be pics of family, a pet or a nature scene for example. Perhaps you could place such items in strategic places at home and/or work that would have a positive influence and the content of your thinking...

 

 

I hope this is helpful for you!! Take Care!!

 

Anthony Bray MD

Customer: replied 1 year ago.

Hi Dr Bray this morning I became nervous about closing the door to hard because I thought it would affect my heart but I know this is not scientifically possible so I did not spend a lot of time on it. Also I noticed that before I pulled in my parking spot in my condo lot I start worrying about walking away from my car towards the entrance of the building but actually there is no reason to worry however my heart does beat a little faster from the worrying of possibly going into a staring mode however I did my best not to look and just keep on walking forward. My pulse has been running a little faster since after my doctor appointments yesterday between 110-120 and wondering if I should get it checked out at immediate care tonight but yesterday my doctor and student doctor both listened and examined my heart carefully and my pulse at that time in the morning was only 64 and the pressure was 118/82. Is anxiety playing a role in the high pulse rate again?

Customer: replied 1 year ago.

Hi Dr Bray this morning I became nervous about closing the door to hard because I thought it would affect my heart but I know this is not scientifically possible so I did not spend a lot of time on it. Also I noticed that before I pulled in my parking spot in my condo lot I start worrying about walking away from my car towards the entrance of the building but actually there is no reason to worry however my heart does beat a little faster from the worrying of possibly going into a staring mode however I did my best not to look and just keep on walking forward. My pulse has been running a little faster since after my doctor appointments yesterday between 110-120 and wondering if I should get it checked out at immediate care tonight but yesterday my doctor and student doctor both listened and examined my heart carefully and my pulse at that time in the morning was only 64 and the pressure was 118/82. Is anxiety playing a role in the high pulse rate again?

Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

 

Your anxiety may play a role with your rise in the heart rate > Yes to that >> this does not harm you however...

 

Your exertion with even standing and a short walk will cause the heart rate to go up but this is NORMAL PHYSIOLOGY >>nothing to worry about..

 

I don't think that you need to see anyone else this PM about your heart... you just saw your doctor yesterday and you were fine.. I think that this would be unnecessary and detrimental to you to go back to ER tonight for example. I think it would be detrimental from the standpoint of reinforcing your fears and anxiety which is the last thing that you need!!

 

I repeat and reassure you that your heart is not adversely affected by you closing a door hard, or staring or by your feet position or other OCD behaviors...

 

 

I hope this is helpful for you! Best regards,

 

Anthony Bray MD

Customer: replied 1 year ago.
I was in the waiting area at CVS and was looking at the spaces between the ceiling tiles one I stared at for a little bit then stopped staring. Was it safe to not continue to stare and this has no connection to the heart functions at all? Also this morning I became too sensitive to my feet placement on the ground in the shower. Is the foot position also separate from heart as we discussed and should I just try to ignore foot position?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again !

YES >> you should try to ignore the feet position. You should try to ignore objects rather than staring...Neither your feet or your eyes have any impact on the function or health if your heart!! YOU KNOW THIS!! Keep and work to reinforce your reminder and reassurance aids in this regard.

Your emotions are continually being "played" by your OCD. These leads to the false fears as you know. Your heart function is fine. You need to control the fear, anxiety, OCD and move fluidly and happily through your life... Perhaps write a succinct reassurance message on an index card and fold it and keep it in your wallet. Keep a symbolic reminder such as a small smooth stone or other in your pocket ( like the ribbon on the finger) let this symbol be a reminder of your heart being healthy and unaffected by vision or feet--- I know we have discussed these techniques but perhaps the reminder will help some.

The idea of reinforcing is important here in particular to your condition I think! OCD involves the involuntary repetition of worrying ideas that interfere with the normal function of your life. To combat this we have you repeat the positive and reassuring answers to the false worries... As you recognize the troubling patterns of thought and practice your techniques learned in CBT the better you should be able to cope and move forward.

I hope this is helpful for you! Let me know if you have further concerns or questions. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
I will try more of the reinforcement methods more I promise. Just one concern about the feet setting position on the ground. Basically when are feet are resting on the ground it is normal for us to feel them in that way and its not normal to try and feel the pulse since that has no relevance to how we place our feet on the ground? That probably what is causing me to falsely think there is a connection the heart when there is not one with foot and heart functions?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!!

It is normal to minimally notice sensations from your feet at all. You know they are there but for the average person the feet do not typically draw much attention at all unless they hurt if course. It is quite abnormal to check your pulse in response to your feet's position. Your pulse is going to have natural variations but this is not going to be specific to foot position---not at all!! Exercise , exertion, or anxiety with the adrenalin factor may indeed alter your pulse rate but the heart "does not care" if your feet are on the floor or ceiling....so to speak.... The position or pressure on the feet specifically has no relation to your heart function at all!!

So perhaps the deeper that your mind is able to accept this fact that the feet have no bearing on your heart function then perhaps the OCD feelings will loosen their grip on you !!

I hope this helps!! Let me know if you have further concerns!! Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Hi Dr Bray today was a little better as far as managing anxiety. However at the end of the day at work when there was a rush my OCD kicked in as far as staring at upper ceiling of walk in cooler at these plastic circular covers about the size of a quarter. There is one on each side of the entrance of the door. I stood in the middle of the cooler did my three deep breathes, smiled, laughed then said this has no connection with my heart. Although my heart was beating fast from moving I tried hard to ignore the circles. I had to walk up to the door then back up and look at them before I walked past them and exited the cooler. However I did limit the amount of time spent on this and I even told myself I am not benefitting by staring at these unless they are falling off and need to be put back over the screw they are covering on the wall. So even when the heart is beating fast and I stop the staring and keep on moving forward there is still no connection to vision and the heart functions? I even told myself hearts works separate from what I am looking at here. Is this a step in the right direction as far as handling the OCD staring obsessions? At least I know they trigger when I am under stress.
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

You seem to be improving in recognizing your OCD and gaining control so that is very good!

Yes as you know your vision has nothing to do with your heart function.

Even when the pulse quickens this may be caused by activity or by anxiety but these responses are normal and nothing for you to worry about.

Keep up the hard work with your coping mechanisms and the control of your OCD will get better with time.

Take care and let me know if you have further questions!

Anthony Bray MD
Customer: replied 1 year ago.
Thank you Dr Bray so even if the thoughts tell me that some harm will come if I do not keep looking back at the circles on the wall I did right by moving forward and not looking back up at them several times because the vision and heart functions separately? The thoughts can be really hard to fight but I fought them back today the best I could without having to go back and look up multiple times but I did look back a couple times to ease the anxiety.
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Yes you do right to recognize and reject the false OCD fears. You know that the vision has nothing to do with your heart function. You do well to reject the false fears brought on by the OCD. Keep up your efforts to identify the OCD thoughts and reject them!! This will continue to pay benefits for you!!

So hang in there and keep up the hard work . It is a gradual process in dealing with the OCD.

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.
Thank you Dr Bray so even if I did repeat the walking up to the door then walked backwards to look at circles a couple times that was still harmless and nothing to worry physically about because its just from the staring anxiety and has no connection to how the heart functions?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes-- these actions are still harmless. They have no bearing on the health of your heart. Try to relax and know that your heart is fine!

Take Care!

Anthony Bray MD
Customer: replied 1 year ago.
Good morning Doctor last night I was sitting on the couch eating pizza and watching a commercial where I focused on the bottle being advertised. My heart was beating a little faster from an herbal drink and eating the not so healthy pizza. If you feel your heart beating a little faster is that normal in this case. Watching the commercial with the bottle on the screen could not have done anything aside from maybe raise the anxiety a little? Should I not worry if the heart beat a little stronger and if it did beat noticably once a little stronger could that just been from digesting process?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Your vision had nothing to do with you feeling your pulse faster or more strongly and it is not a cause...

Anxiety , activity and yes more active digestion may be factors in the pulse picking up speed or intensity.

This feeling is not a need for you to worry!

I hope this helps. Let me know if you have further questions!!

Best regards!!

Anthony Bray MD
Customer: replied 1 year ago.
Even setting objects down repeatedly does no harm as well?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

You KNOW the answer to this ... Of course these are not harmful to you or your heart function. Your OCD repeat behaviors have no adverse effects on your physical health.

I hope this helps. Let me know if you have further questions! Take Care!

Anthony Bray MD
Customer: replied 1 year ago.
In the movie theater I felt hesitant to lean my head back in the seat because my OCD acted up making me think that by leaning my head back against the seat would affect my heart beating? I am so sorry I keep having these thoughts. Also in regards to setting down silverware knife utensils there is absolutely no correlation to the heart function again?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

Right as your logical side knows... The leaning of the head back would not bother or hurt your heart! Neither would utensils have any negative impact on your heart ... Keep trying to reinforce your positive and reassuring messages to yourself and this should help.

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Hi Dr Bray I forgot to mention when I was walking out of show I was paying attention to exit signs above the doors. Sorry to ask this but if you walk past them while continuing looking at them then it goes out of view that has no affect on the heart as well because heart and visual functions separate? I just had an anxiety feeling when I passed the exit sign in particular that way so nothing to worry about?
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Right the exit signs were no reason for you to worry. They have no impact on your heart function.

Take care,

Anthony Bray MD
Customer: replied 1 year ago.
Today at work I kept staring at a piece of scotch tape holding a sign on the window on the right middle side. I kept trying to break my concentration of this particular piece of tape but kept looking at it throughout the afternoon. I tried distracting myself from it but it kept passing in my vision. I finally looked at it once more before I turned and exited the room. Again vision and the heart functions are completely separate and there is no harm to my heart for pulling myself away from looking at this piece of tape that I kept fixating from my OCD? My psychiatrist has added 10 mg of Prozac to my medicine regime as well to help with OCD.
Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes >> you KNOW that your vision is not adverse to your heart's function. The looking at the tape nor pulling away your attention from this would not hurt your heart in any way...

I hope that the Prozac plus other meds helps you! Keep up the metal exercises to control the OCD> Best of luck to you!!

Anthony Bray MD
Customer: replied 1 year ago.

last few days have been hell dealing with anxiey OCD. Again even the holding of the steering wheel in the car a couple times however I stopped that after a couple times does no effect to the heart function even if the heart is beating fast? Also the staring at the water cooler knobs at my work and the piece of tape on the sign on the window were hard to break. Finally I just looked at tape and knobs on water cooler then walked away and tomorrow I am going to ignore them. I know the anxiety feeds off the staring OCD but why does it always have to be something that tends to be so hard to break free from looking at? Again this has no effect on the heart even though my anxiety is telling me this? I am so sorry to sound repetitive but I just have become exhausted trying to fight off these OCD habits the last couple days

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Right these worries and OCD events have adverse effects have no effect on your heart! Your anxiety might increase your pulse some but this is harmless to your heart. Keep using your reminders to reinforce this information to yourself--- hopefully this will help. The OCD Iis of course an anxiety disorder itself .... So the OCD and other anxiety symptoms will hopefully benefit from your treatment.

I hope this is helpful for you! Take care,

Anthony Bray MD
Customer: replied 1 year ago.

Thank you Dr Bray so even clutching the steering wheel with my hand then releasing it once then moving away not to repeat the action again is safe for the heart because the heart is functioning separately from the action of grabbing?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes --- this is harmless to the heart .

Take care,

Anthony Bray MD
Customer: replied 1 year ago.

Hi Dr Bray tonight I had a problem staring out of my condo entrance door into the parking lot for several minutes. My fear was if I turned away too quickly that would somehow affect my heart in a negative way but I know this cannot happen because heart and vision are separate functions? However I feel like my heart is still pounding before I turn away and go up the stairs again this is normal body reaction?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

Your vision has nothing to do with your heart-- that is correct. Your OCD has everything to do with you carrying unnecessary fear--fear will cause increased adrenalin and this may quicken your pulse rate.... Still this response is no reason to worry. Fear causes your heart to beat faster as it does with every person!! This fear reaction does not mean that there is any harm or danger to your heart...so keep on tract to try your best to deal with your OCD!! Know that your heart is fine and normal and the fear responses are not any legitimate reason for you to worry about your heart though!!

I hope that this helps ! Let me know if you have further questions and I will be happy to get back with you!! Take care!

Anthony Bray MD
P
Customer: replied 1 year ago.

Thanks Dr Bray even though as I was sitting at my computer and I felt my heart beat harder and a thought of grabbing my heart popped in my head that anxiety thought cannot change anything with the heart beating?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

No your fear will not hurt your heart. You may FEEL that it might but that is all just a feeling and not the reality of the situation. Bottom line is that your heart is fine--- everyday you have fear with regard to your heart but it is only your OCD!! Keep working to bring the fear and s curry disorder under control! Hang in there!

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.

Thank you Dr Bray so just to clarify when I do break away from staring say through the door and I turn away and go up the stairs that is harmless to the heart as well even if it is beating fast from the anxiety?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

Yes it is safe to break away from the staring! Your anxiety may make your heart beat faster but this is harmless to your heart. As with exercising it is a part of your herat's NORMAL response!

Take care!

Anthony Bray MD
Customer: replied 1 year ago.

Thank you Dr Bray if I may can I ask what is the best way for me to break away from staring at something or in the case earlier out the door through the window? It seems like my eyes are mesmorized and I find it hard to move away from situation. Any suggestions on how to break the staring habit? I did googles searches online and could not find any help on how to break staring habits

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I think that the key is for you to find the best technique for you! You might try upon recognizing an OCD staring episode to close your eyes and repeat on your thoughts a key helpful word or phrase ( example >> close eyes and tell yourself silently " I will control this. I'm fine and my heart is good. I do not need to stare right now...") then change your direction and focus. This is just an example... There are many possible variations. The key is that you A) recognize the problem B) correct the staring behavior C) maintain your sense of calm and get beyond the fear D) finally redirect your energy into a good productive direction...

This is how I would try to break down the problem and organize the solution. There are many ways that you can think of this process but the basics are going to be similar in nature I would say.

I hope that this is helpful for you! Take care! Let me know if you have further questions and I will be happy to get back with you!

Best regards ,

Anthony Bray MD
Customer: replied 1 year ago.

I have been having very bad anxiety last few days. Is the heart safe if you walk out of a room after looking at either a clock or the brand name on the tv by hyperfocusing on them? My heart feels like it races when that happens that does not mean I am having heart trouble and is vision still separate from heart functions in these cases as well?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

Yes your heart is fine! Your heart is in no way harmed by the events that you describe. Also the heart's function is separate from your vision.

I'm sorry to hear that your anxiety has been worse. I hope that you feel better soon!

Best regards,

Anthony Bray MD
Customer: replied 1 year ago.

In follow up to my fast heart pulse of 112 the clinic doctor today asked if I should have a CT scan of the lung with contrast to rule out a pulmonary embolism but found it highly unlikely. Do you think I should still get one? Also when I walked out of the exam room I looked back in to look at the wire wall hanging was that safe to do?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello!

I doubt that you have a pulmonary embolism. A blood test >> D- dimer can be used to screen for abnormal clotting . Blood clots to the lungs would be associated with some abnormal risk factor .... It is a consideration as a cause of elevated pulse rate but your pattern has been longstanding and so I really doubt that this would be a likely finding ...

As for you looking at the wire that is of no danger to you at all.

I would advise that you proceed with the tests that your doctor has ordered. I think that this chest CT will be negative though. It helps to rule out a possible cause if your chronically elevated pulse rate. Are you still taking a beta blocker or did you stop that?

Let me know on that issue. Best regards,

Anthony Bray MD
Customer: replied 1 year ago.

Thank you Dr Bray my primary doctor decided I do not need the chest CT scan and thinks this may be heart burn or gerd associated with the cough. He does not seem too concerned with the elevated pulse rate nor does my psychiatrist who thinks I should keep taking the Abilify with the Remeron. I asked my doctor about the beta blocker but he decided not to and I am currently just taking Benicar HTC 20 mg. I am still puzzled on what to do? Does it seem like my Doctor is avoiding me regarding the high pulse situation?


I also am having a problem standing in kitchen work staring at sink window then when I move away I think it is going to affect something badly is this is harmless anxiety again and no connection to heart?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again!

I think that your doctor probably does not have a clear diagnosis as to your high pulse rate. I would think that a beta blocker would be helpful for you as it may have benefit toward certain anxiety related symptoms. I suspect that your anxiety may be tied to the high pulse rate.

Still you do not need worry about your vision or staring at certain focal points as this does not affect your heart.

I hope this helps. I would request that you start a new question thread soon as this one is getting pretty long. Thank you and best regards,

Anthony Bray MD
Customer: replied 1 year ago.

Hi Dr Bray I promise to close this thread after this with a rating and start a new one. I appreciate your patience and not giving up on me. My doctor put me on 40 mg of proponatate I think its called to treat gerd and ulcers which could be causing my chronic cough which seems to arise after I eat. My OCD was very bad yesterday and today and involved picking up the wooden handle of a knife and setting it down then retouching the handle with the fear it was affecting my heart beating somehow which is false of course? I think you are right my high pulse rate causes my anxiety to flare up in the knife situation and even staring at something. So no matter how many times I picked up the handle or set it down or touched it cannot affect the heart aside from anxiety making it beat faster? Sorry to ask again but these thoughts were terrible. I also wondered if looking at people on tv screen moving a certain way could affect the heart but I keep telling myself vision and heart are not connected and two separate systems. My psychiatrist increased the Abilify to 10mg along with Remeron 45 mg. I stopped the Prozac 10 mg because it was just too much during the day. With these recent touching and staring rituals should I just keep telling myself heart is safe and keep moving away from them as my psychologist counselor says? Thanks again

Expert:  Anthony Bray, MD replied 1 year ago.

Hello again,

 

First of all with your OCD and the fears that you have with regard to your heart and high pulse rate >> that is true that your vision does not affect your heart. The repeat actions and rituals do not affect the heart. Retouching the knife handle could not affect your heart. These thoughts may affect your anxiety and the anxiety may make your heart beat faster >> that is true but this does not harm the heart at all!! We normally respond to anxiety or activity/exercise with a rise in our pulse rate >> that is part of our normal physiology. This is not harmful in any way to you however!! So TRY to relax with regard to these false and unnecessary fears!! (I now that this easier to say than for you to really let go of these fears..)

 

 

Now with regard to your reflux >> it may be that reflux might be a cause of your cough. Keep in mind that medicine for reflux reduces the stomach acid and this may help some symptoms but if you have high reflux that causes you to cough this may still occur. You may need to observe reflux precautions in order to reduce the cough effect >> WAIT 1.5 hours after you eat before you lie down !! ELEVATE the head of your bed on blocks under the head side bedposts 4 to 6 inches. These steps should help!!

 

 

I hope this information is helpful for you! Let me know if you have further questions! Best Regards,

 

Anthony Bray MD

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