Of Irregular Heart Beats and Vulnerability

Something happened last night that scared the hell out of me.

I woke up in the middle of the night and had to go to the bathroom. That, in and of itself, was not scary. As a slightly-beyond-middle-aged male, I've grown kind of accustomed to that annoying trip to the bathroom every night. But what happened once I got to the bathroom was something I'd never done before.

I fell.

When I had gotten out of bed moments earlier, I felt that rush of blood to the head one sometimes feels when getting up suddenly from a resting state. I didn't think much of it, but when I walked into the bathroom it felt like I was walking into a carnival funhouse. I lost my balance, my vision went fuzzy, and the next thing I knew I was falling. And I couldn't stop.

I ended up on the tile floor after bouncing off the bathroom vanity first, and in the process sent the bathroom scale flying. I think I screamed, too. In fact, I must have screamed, because before I knew it, my wife was in the bathroom asking me what had happened and offering her assistance.

I had fallen, and I couldn't get up.

Now, before you all start thinking to yourselves, "Damn, this guy is old," let me tell you that I believe last night's incident was the result of my having started taking a new heart medication yesterday. (Damn...I am old.)

I was diagnosed with atrial fibrillation (AFib) almost 18 years ago. After several episodes of a rapid, fluttering heartbeat--think fish flopping around in your chest--and a trip to the emergency room, doctors were finally able to figure out what was wrong with me. They put me under for 30 seconds (literally), used those cardioversion paddles you always see on TV to shock my heart back into a normal rhythm (CLEAR!!!), and all was good again. The same medication has kept my heart pretty normal ever since. But, unfortunately, sometimes meds stop working.

Almost three weeks ago, I started having AFib flare-ups with some regularity. In fact, I've probably had more flare-ups in the past three weeks than I'd had in the previous 18 years. And it kind of sucks.

For those of you who don't know, atrial fibrillation is an abnormal heart rhythm characterized by rapid, skipping, quivering beats. While my normal heart rate is around 60 beats per minute, during an AFib episode that number can go up to 125, 140, or even higher. (During hospital stays early on, I saw my heart rate rise to 300 bpm and beyond.)

The crazy heartbeat is caused by abnormal electrical signals in the heart. If you were to look at a handout in a cardiologist's office, it would probably say stuff like, "The top and bottom parts of the heart don't work together as they should"; "The heart beats very fast and irregularly"; and maybe "As a result, blood is not properly pumped to the bottom part of the heart and the rest of the body." All of this ends up causing some nasty symptoms--dizziness, light-headedness, shortness of breath, confusion, massive fatigue, chest pressure or pain, sweating, etc.--and, if not controlled, an increased risk of stroke and heart failure.

So thanks to AFib, I've had the best damn cardiologist you could ask for since the relatively young age of 36. (He's actually a "cardiac electrophysiologist," in case you want to get technical.) And yesterday I went to see him about my most recent flare-ups.

He told me he suspected that the drug I started taking 18 years ago (propafenone) had become ineffective, and gave me two options:

1.) I could try another drug (sotalol), and see how it worked for me.
2.) I could have a procedure known as a catheter ablation.

Basically, a catheter ablation involves a thin, flexible, tube with an electrode at the tip of it being inserted through a large vein in your groin and moved into your heart. The catheter is then directed to the precise location(s) in your heart that are producing the AFib. These points are then burned off by zapping them with the electrode. Fun stuff, huh?

As complicated as that procedure may sound, for someone who knows what they're doing, it's relatively simple. And the success rates are pretty high. Of course, there are the normal risks associated with someone putting you under anesthesia and burning off parts of your heart with a wire they stuck into one of your bigger veins. But, all in all, it's pretty straightforward.

To be perfectly honest, I went into my appointment yesterday ready to lobby hard for the ablation procedure. It's been a long time since AFib has kicked my ass like it has this month, and getting refamiliarized with everything the surprise flare-ups entail reminded me just how shitty the symptoms can be. Plus, I wanted nothing to do with trying any new medications. Why? Because the medications that help regulate abnormal heart rhythms come with side effects, the most annoying one being fatigue. When you slow down someone's heart with meds, they're going to be tired. Period.

After talking to my doctor for a bit, my wife and I finally asked him, "If it were you, what would you do?" His answer? Try the new medication first. Initially, I was disappointed to hear this, but his explanation made total sense. If the new meds work without making me feel awful, it's a win. And if they don't work--or if they work and make me feel miserable in the process--I can always go the ablation route.

So that's where I'm at. I took my first dose of the new medication last night, just a few hours before I ended up on the bathroom floor. I took my second dose this morning, and while I feel a little "off," at least I'm managing to stay relatively upright.

The last few weeks--especially last night--have really made me stop and realize just how vulnerable we are as human beings. Or at least how vulnerable I am. Life is a gift, there's no doubt about it. And the older I get, the more I understand that it's a gift with an expiration date.

Falling in the bathroom made me think of my dad, too.

In the months leading up to his death, my dad fell in his bathroom on two different occasions, and I was the person my mom called to come over and help him up. (I talk about one of those incidents here.) Both times, I was struck by how helpless my dad was in that moment. It was terrifying and sad. But you know what? That was me last night: sitting on the bathroom floor, in the dark, wondering what the fuck had just happened, as my wife stood over me asking how she could help. I am 32 years younger than my dad was, but still in the same scary, vulnerable position.

Sotalol and I are not off to a very good start, but I'll keep taking the new medication for the next couple of weeks and monitor how my body reacts to it. If everything goes splendidly, maybe I'll choose to continue with that course of treatment. But if there are any hiccups along the way--or any more unplanned trips to any floors--you can bet I'll be turning my abnormal heart beat over to my cardiologist and his heart zapping electrode.

"When we were children, we used to think that when we were grown-up we would no longer be vulnerable. But to grow up is to accept vulnerability....To be alive is to be vulnerable." --Madeleine L'Engle

Dr. Luis Pires: The best cardiologist on the planet and the best doctor I've
ever had.