Tips for Fight or Flight Episodes

Hi all. The past few months, I have been using AI as a tool to learn more about botulism and all of the ways it can disrupt the autonomic nervous system.

As many of you know, this disruption can lead to the dreaded fight/flight episodes, heart palpitations, and/or "air hunger" sensations, even though our oxygen saturations are normal, and hospital testing tells us we're "fine".

I had AI put together a short post (and I read through and edited as needed) about things that can help calm the autonomic nervous system when you find yourself in these episodes.

FIRST: read this if you’re in the middle of an episode

What you are feeling is real. It is not imagined, not weakness, and not you “losing control.”

This is a body-driven autonomic episode, not an emotional panic attack.

You are not in danger because you’re afraid.

You feel afraid because your nervous system is misfiring.

These episodes do pass - even when they feel endless.

What these episodes usually feel like

People commonly describe:

• Sudden shortness of breath or air hunger

• Rapid breathing (sometimes very fast)

• Chest heaviness or pressure

• Internal adrenaline surges

• Shaking or internal vibration

• A sense of doom without any preceding worrying thoughts

• Episodes lasting minutes to hours, coming and going

  
  

Often:

• Oxygen levels are normal

• ER tests look “fine”

• You’re told it’s anxiety- even though you weren't worried about anything except for these awful symptoms.

  
  

What is actually happening (simple explanation)

Your autonomic nervous system—the part that controls breathing, heart rate, and survival reflexes—has lost its normal balance.

• The “alarm system” (sympathetic) turns on

• The “calming brake” (parasympathetic / vagus nerve) doesn’t turn it off properly

So your body declares an emergency without a real threat.

This is why:

• There’s no fearful preceding thought

• Reassurance doesn’t immediately help

• The episode feels mechanical and relentless

  
  

What helps DURING an episode

1. Change the environment

• Dim the lights

• Reduce noise

• Sit or lie in a supported position in bed or on a coach

• Avoid heat (no hot showers during episodes)

• Play very soft, gentle and repetitive music if desired, like nighttime lullabies

Your nervous system needs low stimulation, not encouragement to “push through.”

2. Gentle breathing (only if it helps)

The goal is not to “calm down.” The goal is to stabilize CO₂, not oxygen.

Try:

• Breathing through your nose if possible

• Letting the exhale be slightly longer than the inhale

• Keeping breaths soft, not deep or forced

  
  

If breathing exercises make symptoms worse:

• Stop

• That does not mean you failed

• It means your system is too unstable for active breathing techniques right now

  
  

3. Hydration matters more than you think

• Sip fluids regularly

• Add electrolytes or salt if tolerated (unless your doctor says not to)

• Dehydration worsens autonomic instability

Even mild dehydration can intensify episodes.

4. Do less than you think you should

During flares:

• Avoid exertion “to test yourself”

• Avoid stimulants (caffeine, decongestants)

• Avoid arguing with your body

Rest is protective, not weakness.

When the ER is appropriate

Go to the ER if you have:

• New or worsening trouble swallowing

• Slurred speech or inability to speak clearly

• Blue lips or fingertips

• Fainting or near-fainting

• Inability to urinate for many hours

• Sustained very rapid breathing with exhaustion

Even if they say “everything looks normal,” documentation matters.

How to describe this at the ER

Instead of saying:

“I’m having panic attacks”

Try:

• “I’m having episodes of air hunger and rapid breathing, but my oxygen stays normal.”

• “This feels like autonomic dysfunction, not anxiety.”

• “I had a known neurotoxin exposure and now have dysautonomia-type symptoms.”

• “I’m not afraid- I feel a body-level emergency response.”

This language shifts how you’re perceived.

Medications: an honest note

Some people find low-dose medications help take the edge off episodes by calming brainstem overactivity- not because this is psychological.

• This is individual

• What helps one person may not help another

• Nothing “fixes” the underlying issue immediately

• Please see our post on things to consider avoiding, to see what others have reported a worsening of effects with.

• Please read our Recovering from Botulism PDF to see a complete list of practices and supplements that have helped other botulism victims work through these symptoms

  
  

You are not weak for needing support.

What to avoid (important)

• Being told to “push through”

• Overexertion during flares

• Blaming yourself

• Assuming this means you’re unsafe or “broken”

• Letting anyone convince you this is “just anxiety”

This is physiology, not mindset.

The recalibration phase: what to expect

For the vast majority of people, the nervous system will slowly recalibrate.

Healing often looks like:

• Waves of improvement and setbacks

• Symptoms that come back briefly

• Long stretches of “almost normal”

• Gradual shortening of episodes over time

Setbacks do not mean you’re back at square one.

The most important thing to remember

These episodes feel terrifying because of how the body is wired, not because you are in danger. Your nervous system is injured- not failing you.

You are not imagining this. You are not alone. And this does not define your future.

If you are reading this for someone else

What helps most is:

• Believing them

• Staying calm

• Reducing stimulation

• Not arguing with their experience

• Reminding them the episode will pass

Validation reduces suffering- even when medicine can’t stop the episode immediately.