Your ballroom days are over, baby
Night is drawing near
Shadows of the evening crawl across the years…
— from “Five to One” by Jim Morrison
A month ago today, I took my second ride in an ambulance. No sirens, no racing through the streets. In fact, it seemed like an incredibly slow ride. The only thing that was racing was my heart, somewhere in the 130s as I recall. Maybe higher. I don’t remember a lot of details of the ride — I was trying my best to stay calm and trust that the EMTs were doing what they needed to do to stabilize me. But I was scared as hell.
As it turns out, I have paroxysmal atrial fibrillation (AF). Paroxysmal means that the AF spontaneously resolves on its own, as mine did during my hospital stay (with the help of some rate-control drugs). But as I learned from my cardiologist, people rarely have just a single episode of AF. As he put it, my next episode could be next week or next year, but he was all but certain that my AF will return.
Naturally, I have been doing a lot of reading about AF in the days since my scare. One of the most informative articles I found was Diagnosis and Treatment of Atrial Fibrillation by Gutierrez and Blanchard in American Family Physician. It spelled things out for me in extensive but readable detail. The basic treatment strategy is this: (a) assume the patient will return to AF at some point; (b) but note that rhythm-control drugs have side-effects and have limited effectiveness; (c) therefore, prefer to use rate-control drugs to keep the heart from racing and injuring itself during future AF events; and (d) use anti-coagulants to keep clots from forming in the atrium (and going to the brain) if-and-when AF recurs.
I was already taking a beta-blocker, which is a blood-pressure and heart-rate control drug (the doctor tripled my dose). But I am now also taking a so-called blood-thinner, which does not thin the blood per se but instead interferes with clotting. I was sent home with a prescription for Xarelto (once a day) but have since switched to Eliquis (twice a day) since there is less side-effect bleeding with Eliquis.* I read the research.
I am confident that my new cardiologist (not from our local hospital) now has me on the right course but he is still a bit mystified. You see, AF is my second heart-related problem. It exists (paroxysmally, for now) alongside my left bundle-branch block (LBBB) which is a type of heart-muscle signal-conduction failure. In essence, the left side of my heart does not get its own dedicated signal; instead, it has to “borrow” its signal from the right side. My LBBB was discovered in the aftermath of my first ambulance ride, two decades ago — but who knows how long I had it before then. What mystifies my new cardiologist is that I have been “walking around” with LBBB all these years and my heart is not in worse shape, to paraphrase his remarks during our visit.
It took me aback when he told me that — blood instantly rushed to the top of my head. If I may explain: After my LBBB diagnosis, it took me a good while to shake off the notion that I might suddenly drop dead. I wandered through a two-year-long panic-infused funk. So now, my cardiologist telling me not only that my AF will get worse but that my LBBB should have been worse was a one-two punch of cold sober. It stirred up some of the old panic-funk, which I have been trying to keep at bay since the visit.
The cardiologist has ordered a cardiac MRI to help resolve the mystery. I hope this will not deliver a third punch. We will find out more in a few weeks.
Meanwhile, I mourn the loss of some familiar friends. I can no longer take ibuprofen for headaches or sore muscles because of the bleeding risk. I can no longer eat grapefruit or cranberries because they interfere with metabolism of the anti-coagulant. I have had to virtually eliminate caffeine and alcohol, as both of these may trigger new episodes of AF. Goodbye happy-hour martinis, hello carefully-measured splash of bitters to add flavor to some club soda. That’s the way it is, as Walter Cronkite used to say.
• • • •
I did debate whether to write and post this. In the end, I decided it had therapeutic value if nothing else. I know many others have more painful stories to tell, and this one stands somewhere way back in the line. I’m sure I will have a different perspective on all of this next week, next month and next year, but right now I’m just laying low, feeling an odd mix of carefulness, thankfulness and loss.
Thank you, Sue. Bear with me.
* Inexplicably, the hospital cardiologist sent me home with Xarelto, despite the fact that other doctors I saw in the hospital expressed their preference for Eliquis, as did my new cardiologist and my primary physician. The hospital cardiologist apparently decided that my taking one pill a day (Xarelto), instead of two (Eliquis), was well worth the higher risk of internal bleeding. Was I involved in the decision or informed of the risks before I was discharged? Of course not.