I wanted to write with an update on my continuing issues with self-injection anxiety. I can report that after a round dozen self-injections, it does in fact seem to be getting somewhat easier, but there was really a hump I had to get over, and some specific actions that helped me get over it. In case there’s anyone just starting the self-injection saga and dealing with similar anxiety, I figured it might help if I write down the stages I’ve been through, and how I’ve worked to move past them (and if you don’t care about self-injection anxiety, skip to the last two paragraphs where I briefly recap my other ongoing pregnancy-related anxieties!):
- Stage 1: Hey, needles have never bothered me, and this is something new and interesting! I swear, I got through the first couple of injections on pure adrenaline. I was shaky and weak both during and after, but kind of on a high, and proud of myself for getting the job done. And it was a novelty. The fact that I’d have to overcome that mental barrier every day for the next 9-10 months didn’t quite hit me until…
- Stage 2: Wait, I have to do this to myself every day? Cue mental freak-out. I worked myself into a cold sweat every morning trying to do the injection. I blamed myself for being a wimp. I blamed my husband (how come he doesn’t have to deal with this?! He could at least help give me the injections!). I cried tears of anger and frustration. I tried to bully myself into doing it. I spent 10-20 minutes per day sitting in my bathroom staring at the needle poised above my belly, freaking out about all the time I was wasting being stupid. I convinced myself that there was just no way I could do this for the rest of my pregnancy.
- Stage 3: This is a legit problem that I’m going to have to deal with. I read lots of stuff on the internet. I read this Cognitive-Behavioral manual for dealing with self-injection anxiety from cover to cover and laughed as I recognized my own irrational and self-defeating thoughts sprinkled throughout. I started trying to work some of their suggestions into my morning routine (more on that below).
- Stage 4: This is easy! Ha, just kidding. I haven’t gotten there yet, and might not ever. But it’s definitely getting easier, and having piled up a bunch of successful self-injections is making me more confident that I can keep doing this for the foreseeable future. Having strategies for dealing with my anxiety makes me feel more in control of the situation and less trapped. It’s still hard, but I think I’m past the worst of the freak-out.
Here is a list of things I’ve done that have helped me get through my morning injections, mostly adapted from the manual I mentioned above:
- Reframing negative (and untrue!) self-talk. Instead of “I’ll never be able to do this for nine months!” I started telling myself “I’ve already done this 11 times, therefore I’m very confident that I can do this 12 times.” (Tomorrow will be a baker’s dozen!) Instead of “Why can’t I make myself do this? I’m wasting so much time!” I started telling myself, “I will stay calm and give myself as much time as I need to do this because it’s important to keep me and my baby healthy.” (Perhaps unsurprisingly, this has actually made the whole process go faster! I was down to only about 5 minutes of needle-staring today!)
- I now consciously relax my thigh muscles and take deep breaths from my diaphragm to fight the automatic panic responses that were setting in every time I got out the needle. This has definitely reduced my tendency to sweat. My hand still shakes a little, but hey, one thing at a time. We’re moving in the right direction, at least.
- I decided that I would continue to give myself the injections and not ask my husband to do it (even thought he offered), for a few reasons: (1) The manual discusses how short lapses can lead to longer-term relapses, where someone who could previously self-inject misses a few days or gets someone else to do it for a while and then finds it harder to re-start. (2) I want the independence of being able to do my own injections, and not being dependent on my husband’s schedule or having to re-start with the whole anxiety process when I travel for work. (3) Lovenox burns going in, and afterwards too — it’s like a bee sting, maybe worse. It helps if I go really, really slowly on the plunger, even stopping sometimes, and I’m sure I couldn’t instruct my husband on the right speed. That lack of control is just setting the situation up for failure. Having made the decision to continue to do all the injections myself feels good, and puts the kibosh on my negative mental talk about my husband (thank goodness!).
- I started doing the intermediate step of touching the needle to my (alcohol-cleansed) skin before plunging it in. I can’t really articulate why this helps, but it was on the list of steps to work towards in self-injection in the CBT manual, and for some reason it helps me. The slight poke reminds me what a needle prick feels like — unpleasant, but nothing I can’t handle. I think my brain usually blows the sensation of a needle prick way out of proportion right before I plunge in the needle, and this helps me get past that irrational panic. I also read about how it actually doesn’t matter whether you put the needle in fast or slow, and I’m finding that on some days it’s actually a little easier for me to do it slowly. I used to freak out that I was being unhygenic if I touched my skin or put the needle in partway before I put it in all the way, but now I don’t worry about it as much since I read that it’s OK. Knowledge is power, man.
I think those are the biggies! As I mentioned above, I’m definitely not to the point where this is a ho-hum part of my morning routine. This morning, even though I managed to get through the injection in record time, I had my first episode of what is probably a vasovagal response that made me worried I might faint for a moment (I felt dizzy and weak and had ringing in my ears and my vision started to fade a little). I’m a little worried that that might continue. Unfortunately it seems to be a side effect of my new-found ability to push the needle in slowly instead of quickly, and the fact that I’ve found that keeping the needle in for 10 seconds after I finish injecting seems to help minimize bruising (another tip from the internet — thanks, internet!). So we’ll see — I suspect there may be some tradeoffs involved here (e.g., deciding that bruising is better than fainting), and I’m not out of the woods yet, but I do feel that things are getting better.
Oh, and in case you’re wondering, this is far from my only source of anxiety in this pregnancy — it just happens to be the one I have found the most control over. 🙂 After seeing our baby’s heartbeat for the second time last Monday, I’ve been anxious the last couple of days that it’s stopped since then. I was worried because I’d managed to convince myself that my pregnancy symptoms had decreased. It’s frustrating, because I also remember from my first pregnancy that they do tend to come and go, so rationally I know that the odds are that everything’s fine, but I just can’t convince myself to calm down. Yesterday I was sure my breasts had stopped being sore, although when I put my laptop on my lap as I started writing this post, I noticed pain when the pillow brushed over them. Guess they’re still sore! I also felt less nauseated yesterday and today, although when I think about it I realize that being home over the weekend means that it’s easier for me to graze on little snacks whenever I start to feel queasy, and usually I feel my most nauseated right before a meal after not eating for a while, which mostly happens at work (like on Friday, when I thought I was going to vomit walking to our weekly pizza lunch for the summer students). Anyway, you get the idea — these are the sorts of thoughts that are constantly going through my head. Oh, and want another piece of evidence of my constant anxiety about this pregnancy? On Thursday I had calf pain when I got up to walk my dog in the morning. I had noticed pain in the same place for the previous ~week or so, but it was worse on Thursday. Since I had inadvertently been giving myself slightly less than the full prophylactic dose of Lovenox, I was worried that I might have a blood clot. So I called my doctor, who sent me in for a deep vein ultrasound just to be cautious, and everything was fine, other than the fact that I was embarrassed.
Guys, I’m only 8.5 weeks pregnant. I’m not sure I can stand this level of anxiety for a whole pregnancy! But hey, 9 months of anxiety is certainly better than the alternative… I’ll take it! So, I’m doing my best to calm the heck down while we wait for our last appointment with the RE on Wednesday. I’m sure I’ll feel better when I see that flickering heartbeat again… for all of five minutes. 🙂