Last March, I had my routine annual physical, and my blood pressure had been creeping up over the prior couple of years, so that was something that I wanted to ask about. The last time I had it checked, six months before that, it was 140/95. That day, it again was 140/95, but more importantly, my resting pulse was 118, which was something new. My doctor; who was a new doctor for me because I had just moved back to PA months before, asked me a few questions about whether I felt my heart racing, or if I ever felt short of breath, or tired, and I answered no to all of those things. When the rest of my physical was complete, she said she was going to order a sleep study to check for Sleep Apnea, a blood test to check for any thyroid issues, and to start me on a beta-blocker; specifically Metoprolol Succinate, mainly to lower my pulse but also to lower my blood pressure as a side benefit.
I went out and bought one of those automatic blood pressure monitors, and for the first two weeks, everything seemed fine. My pulse dropped to 76 and my blood pressure dropped to 125/85 fairly consistently. But one night, on a Thursday night, as I was lying down to fall asleep, my heart started beating erratically; I could feel it inside of my chest beating without any kind of rhythm. It wasn't beating very hard, or pounding, and there wasn't any chest pain. I didn't feel any shortness of breath; just that my heart beating all over the place. So I sat and waited to see if it was going to go away. Fifteen minutes, then thirty, then forty-five, and no changes. After an hour, I finally decided that I should go to the ER; so I grabbed my keys, wallet, phone, and phone charger (priorities) since I lived only two blocks away, I drove over, walked in, and told the check-in desk that my heart was beating erratically.
The ER folks put my into a bed, hooked my up with an IV and a blood pressure monitor, and a finger pulse reader. The ER doctor walked away for a couple of minutes, and when he came back in and looked at the monitor, he said "yep, you're in A-Fib", which of course is Atrial Fibrillation. He then informed me that: 1) I wasn't going anywhere that night except to be admitted to a room, 2) he was going to add a heart rhythm medication to my IV bag, and 3) he was going to give me a shot in my stomach that was going to burn for a couple of hours. The shot was a blood thinner, and he explained that it was necessary because, when the heart is in A-Fib, the heart doesn't pump blood as efficiently as normal, so it may sit and pool in different areas of my body; without the blood thinners, the pooling pool could form clots, and in his words, "we don't want this to turn into a stroke or anything like that."So...I'm normally a calm and collected guy...and I tried to act like it at that moment...and maybe I did...but inside, that really kinda knocked me down a peg or two. I then debated whether I should call my parents then, or in the morning, and I (wisely) decided to call them then. My dad came over and ended up sticking around the entire time I was in the ER until I was admitted...which ended up being three hours, from 12:30AM until 3:30AM, to sit there and think about it, in the ER bed, with my heart flopping around all over the place.
At 3:30AM, I was finally wheeled up to a regular room.
The hospital I went to is the same hospital where my mom was a Nurse for 35 years, where my dad was a Lab Tech for 20 years, and where I was a Radiology Dept Courier (wheels patients to and from the Radiology Dept) in the summer of '93. The Nurse assigned to my room was someone that worked with my mom. They reloaded my IV bag with additional heart rhythm meds (since my heart was still flopping) and I was still hooked up with the finger pulse reader. I was also given a blood pressure cuff that took my blood pressure every five or ten minutes, I think...I don't remember, and finally, a EKG monitor with all of those sticky electrode thingys (that's a technical term, of course). Somehow, with all of that, I was able to sleep from 4:30AM until 6:30AM.
At 8:00AM, the nurse came in to take my breakfast order - from the low sodium menu. At 8:10AM, the Cardiologist Physicians Assistant came in to ask me a few questions, and to inform me that I couldn't eat breakfast as they were still waiting for my heart to snap back into a normal rhythm. At 8:20AM, I had to call my boss to tell her that I was sitting in the hospital, and that I wouldn't be logging into work...which was a surprisingly hard phone call to make. It was hard because I hate to cause people to worry, but there was no avoiding it.
At 9:00AM, the PA came back in, and gave me a different heart rhythm medication, and a different blood thinner. At 9:10AM, the Cardiologist came in, and asked me a whole ton of questions to try to determine why this was happening. Had this happened before? No. Had I been feeling chest pains at any point overnight or before? No. Does my family have a history of heart disease? No. Did I have high cholesterol? No. The only thing that changed...was the recent addition of the beta-blocker. He then informed me that they were going to wait an hour to see if my heart snapped back into rhythm, and if it didn't, they were going to potentially perform an Electrical Cardioversion, in which they put me under and try to shock my heart back into rhythm.
So...then I started watching the clock...9:30...9:45...and then right after 10:00, the Nurse and the PA both walked in and said "you're back in rhythm." I hadn't realized that yes, in fact, my heart was no longer flopping around, and I was indeed back in rhythm. Not too long after, the Cardiologist came back and said he wanted to perform the normal gauntlet of heart tests just to see if there was any physical cause of this A-Fib episode. So...within an hour, it was off to...the Radiology Department...and several of my former co-workers who I hadn't seen in 25 years...which was a nice reunion with me wearing that drafty backless gown. My reunion consisted of an Echocardiogram ("...we're going to turn down the lights and rub a soft warm jelly all over you and listen to the sweet music of your heart", which is exactly what the tech said), and then a Nuclear Stress Test ("we're going to dump some nuclear waste from Limerick (Nuclear Power Plant) into your blood, then we're going to have you pretend you're running for your life on a treadmill", which is exactly what that tech said), and then a chest X-Ray "for old times's sake." I was told that if all of the tests came back OK, then I could be discharged.
At 3:30PM, I was told that all of the tests came back just fine, so they were going to start the discharge process, but that could take a few hours, was there anything I wanted? I said I wanted my original breakfast order and to watch the rest to Maury to take my mind off of things.
So what caused it? The cardiologist said that sometimes, A-Fib episodes can be a one-time thing, and to take comfort in the fact that all of my tests came back showing that I had a very strong heart with no issues or abnormalities or anything like that. We scheduled a follow-up with him for two months, and a follow-up with my primary doctor in two weeks. I was given a prescription for the second heart rhythm medication I was given, with the instructions that if I entered another A-Fib episode again, as long as I wasn't having shortness of breath, or dizziness, or chest pains, I was to wait an hour to see if they went away on their own. If not, I was to take those four pills, and wait another hour. If my heart doesn't snap back into rhythm after that hour, I should then head to the nearest ER. And with that, I was discharged, on Friday evening at 5:30PM.
I had a pretty quick decision to make; on Sunday, I was scheduled to take my monthly week-long trip to Rochester for work. I had to decide whether I thought it was a good idea to do so or not. I wasn't given any restrictions, or any warnings, so I made a decision that if I didn't go, that would be a decision made out of fear, and I wasn't about to start living in fear of a what-if; and so I decided to take the trip as normal and keep it moving.
That week worked out fine.
The week after worked out fine.
My primary doctor follow-up went fine, but she suggested increasing my dose of the beta blocker, thinking that my A-Fib episode was caused by my heart trying to get used to the meds and that the dose wasn't high enough. But in reading online about Metoprolol Succinate, one of the listed side effects is A-Fib. So to be honest, I wasn't too sure about increasing the dose versus maybe changing meds. But I filled the script anyway.
Before I took the increased dose; two days after that appointment, on a Sunday, my brother and I painted my parents' garage on a 90-degree day, and that evening, I started having steady light palpitations, but without chest pains, or shortness of breath, or dizziness. These were different from the A-Fib episode, as my heart was in a regular rhythm this time. So...online I go, and several articles pointed towards dehydration as a cause of palpitations, and after a couple of hours, they went away. But at that point, I was too freaked out to make any changes to my meds, so I called my primary doctor, and she agreed that I shouldn't increase the dose, or stop taking the meds, until I talked to my Cardiologist. And I ended up being fine again for a couple of weeks. All that time, I had been walking once or twice a day, 30 to 45 minutes each time, and I never had any issues doing physical activity.
THEN (no, this isn't over, yet)...two weeks later on a Thursday, I was driving to Pittsburgh on my way to visit friends before heading up to Rochester for my normal monthly trip, and I ended up driving through a pretty intense thunderstorm in the mountains west of Somerset. As the storm ended, I started another round of palpitations, the same as the painting "episode". And same as before, these lasted about a couple of hours. I chalked those up to the stress of driving on the narrow PA Turnpike in a raging downpour.
That theory proved wrong when I had another round of palpitations again Friday night relaxing, Saturday night relaxing, Sunday afternoon driving on a sunny day to Rochester, and Monday, and finally in Tuesday, I called my primary doctor to mention all of this, and she referred me to my Cardiologist follow-up, which at that point was three weeks away. She reminded me of my test results, and asked me if at any time I had had chest pains or shortness of breath or dizziness, of which the answer to all of that was no...
...which left the next three weeks to be an exercise in blind faith. Faith that everything that I was being told was right, faith that if something more serious were to occur, that I would notice it soon enough, and react correctly, and that everything would end up being ok. Which...is VERY hard to do.
And that pattern continued for the most part for those three weeks...fine in the morning, palpitations in the afternoon or evening lasting two or three hours, and then fine after that. It was so consistent that I actually started to get used to it. When I finally had my Cardiologist follow-up, he reiterated what my primary doctor said; he felt that it was my heart reacting to the meds and not having a high enough dose, so that I should increase my dose and see what that does; and if that didn't change anything positively, then we would re-evaluate and take different steps. I was told to keep in mind, again, the fact that all of my heart tests were fine, and that he wasn't seeing any issues that concerned him.
And so, finally, to end this story, I increased my dose, and within two days, I stopped getting palpitations, and everything has been fine ever since. I jokingly say that my heart liked moving fast and fought for two months to keep doing so. My pulse is still down around 76, and my blood pressure is at 118/65. I have had two cardiologist follow-ups since then (last August and yesterday), each time with EKGs, and all is well.
In my next post: the Sleep Apnea side of the story.
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In hindsight and moving forward:
First, there is something to be said in finding medical professionals that you trust, and who are willing to sit and listen and explain things. I didn't go into that aspect above in depth, but everyone that was part of my care that day in the hospital, and in the various appointments afterwards, have been truly wonderful even during the unknowns that occurred, and I realized something along those lines: the medical profession, in the end, really is all just guesswork; educated guesswork, even highly educated guesswork, but still guesswork, and I think that sometimes gets lost. The body is going to do what it's going to do, and the study of medicine and anatomy and diseases and disorders is all about following trends and probablilites and scientific theories...and there are always exceptions to those. In the end in my case, my doctors were following the trends and keeping a close eye to make sure that there weren't any extreme exceptions; and though it was a nerve-wracking two months, in the end, it was only two months, and I am better off now than I was at the beginning of this. I think sometimes people think that doctors should know what is occurring and what will occur, without exception. And to be sure, there are some doctors who come across that way, and that is dangerous indeed. In my case, my doctors never once gave me definitive statements; they explained several options, and they explained what their preferred options were, and why, and that to me is very important to look for out of your medical professionals.
But more than that: in looking back, I don't think my ER visit was life-and-death, but hearing the words "prevent a stroke or something else" really jolted me. It's another, but much more personal reminder, of how life does not come with a guarantee. You really never know when "your time is up" and none of us are even guaranteed a warning. Wasted time is lost time, time you can't get back. The whole "you never know" cliche is yes, a cliche, but it's real. And to me, nothing is worse than having regrets over wasted time.
I bolded above my conscious decision to not live in fear, and it's also related to the comment above that I made referring to blind faith. Even though that first decision I faced at that time was over something as meaningless as a business trip, I faced the same type of decision in mid-June. I had a planned a father-son trip to New York City for Father's Day; this was going to be our second overnight trip together, and it was only 3 weeks after my increased dose of meds. I did have a string of thoughts come across my mind as to whether it was a good idea for me to be travelling with just my 10-year old son; and what if I did have another palpitation episode, or another A-Fib episode, and what if I had to find an ER in NYC at 10 at night; what was he going to do? How traumatic would it be for him to have to ride in an ambulance with his father in this large city, alone? I hesitated in planning the trip, honestly, but in the end, I took the trip, and everything ended up fine; it turned out to be a fun and memorable trip for both of us. But sometimes, and probably more times than we do, you just have to push past the fear, whatever fear it is, and have faith that you are going to get through whatever it is you are wanting to accomplish, and that you are going to be able to handle any trial that comes your way; because there will be trials. And this isn't a commentary on doing anything reckless; for each decision I made in this area came with a lot of research and information gathering, but nothing is ever 100% guaranteed or predictable. There comes a time where all the preparations have been made, and it's time to take that next step.
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"You can spend minutes, hours, days, weeks, or even months over-analyzing a situation; trying to put the pieces together, justifying what could’ve, would’ve happened…or you can just leave the pieces on the floor and move the f--- on." - 2Pac
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