atomic_fungus (atomic_fungus) wrote,

#3328: F-ing anxiety!

For the past week I've been essentially reliving the first real panic attack I had as an adult--the one that led me to starting with Paxil and Xanax.

In 2003, one fine Sunday morning when I didn't have to work, I woke up in bed...and as I woke up my heart began pounding, rather hard for someone who walked 5 miles every workday. Then it skipped a beat.

Then it skipped another one.

...and as I lay there in bed, my heart pounding and skipping beats, I frantically tried to decide whether or not I should call 911 or drive myself to the hospital or wait, this wasn't a heart attack because there was no pain and I could swallow just fine, and there was no tightness in my chest but my breathing--

Finally I remembered those times when I was a kid, on Saturday mornings, when I'd feel like I couldn't quite catch my breath. I'd be laying in my Dad's bed watching cartoons, and it felt like I had to yawn but couldn't quite manage it. That Sunday in 2003, that sensation clued me in to what was happening.

After a little while I calmed down and it stopped bothering me as much. I realized that I wasn't having a heart attack and I wasn't dying. The whole episode didn't last more than 15 or 20 minutes.

Went to see the doctor that week, on my next day off (I think it was Thursday that week) and she ran an EKG which came out completely normal. She suggested anti-anxiety medication, and I refused; but when I got home, I reconsidered it, called her back, and said, "Yeah, let's go." $50 later I took my first dose of Paxil...and slept for 15 hours.

And I felt enormously better, better than I had for years. I felt more relaxed, more patient--because I was no longer on edge all the damn time.

But the heart issue wasn't fixed, so I went back to the doctor, who sent me to a cardiologist. They strapped a monitor to me and I ended up at work with the thing tucked into the inside pocket of my scrub tunic. (They're reversable so there's a pocket on both sides. Convenient when you're wired up like a lab rat.) When I felt anything unusual I was to press a button on the thing and make a note of what I was feeling. Based on one event--a brief sensation of dizziness--that coincided with a skipped beat, they decided on further testing.

So I got a comparative perfusion scan.

What they do is sit you down in a chair and have you relax, and then inject radioactive dye into you. After about 15 minutes or so they put you into a gamma camera and scan your heart. The dye shows how well your heart is taking up glucose when you're at rest.

A few days or weeks later, they do it again...only this time, they put you on a treadmill and have you walk, then walk faster, then incline the thing, then speed it up more, until you're just about to puke, and then they inject you with the dye. As soon as you can walk again, into the gamma camera you go. The dye shows how well your heart is taking up glucose right after strenuous exercise.

The difference in the two scans tells the cardiologist how healthy your heart is: how well it's working, how efficiently it's using oxygen and glucose, how thoroughly the muscle is being oxygenated.

Result: healthy as a horse. "Your heart occasionally throws in an extra beat," the cardiologist told me with a shrug, and explained the mechanism by which this happens. "It does not raise your risk of a heart attack. We can give you beta blockers if the sensation really bothers you, but no other intervention is really warranted."

It has to do with how the left ventricle works. If I recall correctly, the actual nerve that fires the muscle is somewhere near the bottom of the ventricle, and after it fires there's a kind of cascading effect. This way the ventricle squeezes from the bottom towards the top (where the valve is) and it ensures maximum efficiency.

Inside the left ventricle, there's this line, or train, of muscle fibers. Each one "listens" to its neighbor, and when the guy below one goes off, he goes off a very brief moment later, and after that the guy above him does. A nerve impulse gets it started, 'way down at the bottom, and it works kind of like a bunch of people at a sporting event doing "the Wave".

These cells have a certain period they're willing to wait, and if that time runs out they'll go off spontaneously. Usually, when this happens, it still happens in a more-or-less orderly fashion: the cells at the bottom of the heart went off first, so they reset first and then "time out" first, and they trigger the ones above them and so on, and "the Wave" proceeds as normal.

In my case, some of the cells in the middle "time out" before the others; it's like there are some nerds in the crowd who don't quite get the concept of "the Wave" and stand up too soon.

But generally speaking, this doesn't happen to me. I've gone months without this happening, because it's not really a defect in my heart but in my head that's causing it.

It's a symptom of anxiety.

...because if I can get my mind off my heart--which is not easy to do when it's skipping beats and feeling as if it's about to leap through my sternum--the thing settles down and beats normally. Xanax puts me to sleep; but sometimes before I go to sleep I notice that Gee, my heart's finally settled down!

When I go for a walk (and when I tried jogging) the thing ticks along like a metronome--like an atomic clock.

Besides beta blockers, the other thing they can do (for particularly bad cases) is to run a catheter into the heart and burn away the defective tissue. I know a guy who's had this done--twice. It's not fun, but it's better than open-heart surgery would be. In extreme cases, a pacemaker is warranted. But I'm a long way from needing that. ESPECIALLY since the damn thing hardly bothers me most of the time.

It's just that--right now--I've got this musical that I'm in, and rehearsals aren't going too well for me, and so--well, here I am, in Anxiety Central.

So when I woke up this morning it was the same as it's been all week: I wake up feeling fine, but once I stop feeling groggy, the heart begins to pound and-and-and. *sigh* Today I decided I'd go for a walk. And as I walked, the ticker ticked along, regular as regular can be.

The real hell of it is, I know I'm not dying, but I can't convince myself I'm not dying--because it's an anxiety disorder. When I'm in the throes of a panic attack, saying, "Okay, it's just a panic attack, there's nothing actually wrong" DOESN'T WORK. Even though I know I'm having a panic attack, it doesn't fix the problem.

As bad as that is, at least it's just anxiety. One of my nieces is bipolar--I can't imagine how bad that would be.


* * *

On the plus side: when I went for my walk, I decided to wear sweats, which meant I needed to dig out my sporran (read: "fanny pack", but fanny packs are for queers) to carry wallet, keys, cell phone, etc. (I can't take a walk in this state without my cell phone. See above--I can't convinced myself that I'm not about to keel over--so I bring my cell phone along, turned on, so I can call 911 if need be. It's a security blanket for my hindbrain, nothing more, because up in my conscious mind I know I don't need it.)

So I went to put on my sporran, and it was too loose!

The last time I used it was last autumn, and I had adjusted it to be snug then. It means my waist is smaller than it was. Hooray low-carb diet!

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