10: Stress and Echo

I was incredibly nervous on the day of the stress test and echo. For one, I couldn't eat anything, nor could I take any medications. Not taking my meds is what made me the most nervous. I knew I could go a while without taking Glucophage and just take them later that day with food. Vitamins were no concern. But I was very nervous about not taking the Eliquis, especially the Cardizem. I was worried about what my heart might do without them in my system for a few hours.

The morning of the tests was the longest I had gone without taking Cardizem since July. I had been on the drug since the ER visit and hadn't missed a dose once. So, naturally, my blood pressure and pulse were all elevated that morning of the tests.

Although my anxiety had come down some the weeks leading up, this was a different kind than what I had been experiencing. I legitimately was worried I might have a panic attack at the cardiologist. Leslie accompanied me that morning and even drove just so my anxiety would be a little lower. It still didn't do much for my pulse or blood pressure.

I went back for the tests and got an IV site started for the stress test. They took my blood pressure, which was 140s/90s, but I didn't know my heart rate yet. When I went in for the stress test, they connected me to the leads to prepare to walk on the treadmill. After the tech hooked up all my leads, I saw my heart rate -121 beats per minute. The tech said, "Well if we don't get your heart rate down, we may not be doing this test. Have a seat." I thought, please cancel it! I did not want to do the test. I was so nervous something bad might happen. But I sat down, tried to relax for a few minutes, and even asked God to help me calm down.

Eventually, my heart rate came down to 99. By comparison, in May 2022, my heart rate was 76 before that stress test. I had no real concerns about the test then. For this stress test, I needed to reach the goal of 148 beats per minute. I had reached about 141 beats per minute a few times, walking in August, going up hills and such. Nothing happened bad then, so I thought, I can do this. So, I got on the treadmill, and the test began.

One issue with stress tests, they start you off incredibly slow. I know why they do this: to ensure there are no complications for the person doing the test. But, seriously, it was so slow I thought I might actually walk off the front of the treadmill before I reached the target heart rate. I was used to walking much faster than this. The tech eventually asked me to loosen my grip on the handle because I was going completely to white knuckles holding on to it. That wasn't helping with some of the readings coming up. With that pace, I only got my heart rate up into the 130s, but now she was increasing the elevation and speed. 

The funny part of this test was that I was getting frustrated with myself for not already getting my heart rate up to 148. The tech asked if I had been taking anything to lower my heart rate, and I told her yes, the Cardizem. Of course, I hadn't taken it that morning yet, so it must have been residual effects from the drug, making it take a little longer to reach the goal. Finally, after speeding up the treadmill and elevating it, I reached the goal of 148, and the test was concluded. It only took about 5 minutes, but it was about 3 minutes longer than the year before. If you're reading that, you know that's not bad in either case. I wasn't even breathing hard afterward.

From there, the testing was easy. You lie down for the echo so they can use an ultrasound to visualize the heart's internal structures and record the sounds present. The perfusion test has you lying down on your back with your arms over your head to determine if there is any indication of blockages within the arteries of your heart. In both cases, they can't tell you anything to let you know.

The tests' results would not be shared until November 1 in a follow-up visit. Now, it would be a wait-and-see deal, which can be just as agonizing as leading up to the tests themselves because you don't know anything. But some things came out of that test that helped me. For one, I had no issues with my heart during it or after. I felt good and got to the goal very quickly. I wasn't the least bit fatigued. All of these things said to me there's no blockage. I had even asked one of my relatives who I knew had a blockage once what it felt like. They told me a burning sensation was present, and thus far, I had no effect like that. I felt great, actually.

One thing that helped was receiving the perfusion test results that day. With the perfusion results, they can publish those electronically rather than scanning them in like they do with the echo. When those results came up, it said: Normal perfusion LVEF 59%.

Normal perfusion! That means no blockages were present, and my coronary arteries were good. LVEF means Left Ventricular Ejection Fraction, which is the percentage of your heart's ability to pump blood out of the left ventricle and into the rest of the body. Typically this ranges from 55-75 for a healthy EF. In 2022, my EF was 66%, but on July 14, the day after Afib, my EF was 50-55%, or low normal. Now, 3 months later, my EF was back up to 59%. I wasn't quite where I had been the year before, but I was back up, which is also a very good thing.

All signs pointed to good results in the follow-up visit, and I was so relieved. I was counting my blessings. It would still be nerve-wracking the day of the follow-up, but I believed only good things could come from it. I would have to wait until then to hear the echo results and know how my cardiologist felt about my heart.

Until then, it was time to enjoy the rest of October and the Fall Break to come. 

Tune in for the next segment, 10: Happy Halloween.

10: PTSD

 

Credit for photo: vecteezy

The ghosts of past trauma, in the middle of Spooky Season, in October. Appropriate somehow.

When you think of post-traumatic stress disorder (PTSD), what comes to mind? For me, I think of military personnel whose nervous system has been pushed beyond the limit it can take, where they relive the agony of battle. Many military personnel for generations have experienced this under different names. George Carlin once referred to it as shell shock. Carlin brought this up during a comedy skit in a more serious tone, talking about the softness of language and how the more political terminology seemed to diminish the conditions military service personnel sometimes experienced.

But in today's world, because of people like Carlin and other political activists calling attention to PTSD more, the condition is taken more seriously, especially after the film American Sniper. The film showed the effects of PTSD on Chris Kyle, played by Bradley Cooper. The point was not only to show what happened in his life, ultimately leading to his untimely death but also to show how serious PTSD can be and how it goes well beyond even military personnel.

PTSD is a condition that can happen to anyone, and in a mild way, it happened to me.

I didn't expect to hear those letters when I met with my primary care provider in mid-October. Mainly because I was deluding myself. The day before my appointment, I considered canceling it because I thought I would be fine without talking about it. But I was wrong. During a walk that afternoon, I could feel the tension building up in my chest. Eventually, I felt like my heart jumped in my chest, which scared me. I went inside and reported the symptoms on my monitor, but when the cardiologist called me back, they said my heart rate was normal sinus rhythm. There was no issue. I was freaking out again, although this time, I was handling better.

That was when I knew I needed to talk to someone. I was going to continue upsetting myself day after day and week after week until I wouldn't be able to function if I didn't try something. So, the day before my stress test and echocardiogram, I went to my provider.

During the visit, the tears flowed. Crying is a good thing for you healthwise. It releases that tension and helps you to begin to cope with the truth of situations happening. Right from the start of the conversation, my provider said I had a mild form of PTSD because I just kept reliving the experience of July 13. My stress would increase dramatically if my heart did anything I deemed unusual. This happened with a full-blown panic attack on Labor Day. High anxiety was present leading up to the loop monitor insertion. My blood pressure going up in late September freaked me out again, with another panic attack. PTSD can actually cause a type of panic attack all its own. It can occur from flashbacks like a military service person might experience, but emotions and memories can all contribute to causing one as well. Despite not having any Afib for months, the memories of that day haunted me, and it was a traumatic event that made us change everything we were doing that day and beyond.

When she said that, I broke down more about everything that had been bothering me since before Covid caused the Afib. My stress had been through the roof for the six months prior, worrying bout finances, things at work, and how things were going with my family, particularly with my daughter Abby. We argued a lot over the years. Even more, since she turned 10 years old. I hated myself for allowing those interactions to happen, and I wanted to do something to try and help myself and my family. I needed to do something because all the Afib had done was reveal how strong my anxiety truly was at that point.

For that reason, my provider started me on Lexapro, a Selective Serotonin Reuptake Inhibitor (SSRI). SSRIs generally are used for depression and anxiety. I knew if my anxiety kept going unchecked without anything, it would ultimately lead to depression. I wasn't there yet, but it was going that way. I knew it was, and I accepted it. I would try anything to help me feel more like me again. But it went beyond just an SSRI.

I was already starting to adapt my mindset before the visit. Changes in behavior are essential, not just medication. The medication helps, but you have to adjust your body and mind to what is happening to you. Just like I had with my diet and exercise when I learned about the A1c of 10. In fact, I had lost about 5 pounds the day I went to see my provider since making changes to my diet in September to try and help myself. That was a very good thing to do for me and my mindset, too. There's never anything wrong with helping yourself and doing self-care. Now, I would spend weeks trying to regulate myself a bit better. But on this day, I had to think about only one thing: the upcoming stress test and echo. They would be the following day, and my anxiety was high because I was so nervous about what the results might be.

Tune in next time for the next segment, 10: Stress and Echo.

10: Count Your Blessings

 

It's been a little bit since I mentioned having dreams. The last time I had a wakeful moment discerning a voice was in August 2023 with the "It's time" statement. By October, though, it was more of a dream.

The vivid dreams stopped in March 2021, but this one was different. It was a vivid voice inside the dream, making me aware of something important.

One night in October, as I lay comfortably in bed, I heard a voice talking to me directly about my situation. There was no question I was still highly anxious about the Afib since July. I was set to meet with my Primary Care Provider about things I could do for stress and would soon have the stress test and echo completed, but that was still over a week away when the dream occurred.

The voice sounded like a man's but said something that I had heard my mother try to tell me multiple times during the previous three months.

"The medications are helping your heart. Count your blessings."

After hearing this statement, I woke up immediately. I had this amazing sense of peace when I woke up like I hadn't felt in previous weeks or months. It was revitalizing. Count your blessings. That's the best phrase that could have happened during this time. But also suggesting my medications were helping was a huge piece, too. I had believed the medications were helping, but I kept worrying, what if they don't anymore? Those negative thoughts can be so pervasive. Nothing indicated that the medications were not working or wouldn't continue to work at that point in time. My heart was being regulated. The meds were also helping my blood pressure, and I didn't have to take Hydralazine anymore. On this day, my anxiety plummeted and carried me on through the remainder of that week.

Count your blessings. That one phrase helped to reshape my mindset even more. Ever since that day, if negative thoughts crept in, I would remind myself to count my blessings. That's one phrase I'll keep doing from now until the end of time. Scripture has something to say about counting your blessings.

"And God is able to bless you abundantly, so that in all things at all times, having all you need, you will abound in every good work"-2 Corinthians 9:8

My mom had tried to help me see this verse and other things for years leading up to that day. I would come home and complain about things quite a bit. I would get so angry about things, many of which were out of my control. I would worry about things that the added stress did no good. In fact, I was convinced my stress leading up to July 13 contributed to the Afib as much as Covid. No matter how hard I tried, I just couldn't let things go. My anxiety was beyond belief, even before Afib, and I feel it is no surprise that a physical problem manifested.

I had Covid before, after all, and did not get Afib. My stress was significantly worse by July 2023.

My mom's favorite way to remind me to count my blessings was a song she learned when she was younger:

Count your blessings, name them one by one;

Count your blessings, see what God hath done;

Count your blessings, name them one by one;

Count your many blessings, see what God hath done.

See the rest of the lyrics here.

That's the best song in the whole wide world. God has blessed me immeasurably, which is why I used the image in this post today. My greatest blessing is my family and the happiness we share. I can never forget that and will never forget that.

After this day, my spirits were high, and I felt confident about the upcoming tests and visits. I felt I would be okay, but as you can imagine, my anxiety still was trying to creep in from time to time. That's when I visited my Primary Care Provider and shared with her some of the things I felt were contributing to my concerns. They let me know the root cause of my concerns.

Tune in for the next segment, 10: PTSD.

10: October Acceptance

Ah, October is one of my favorite months of the year. It's such a favorite that I named a character in my book The Civilization Loop after the month, the nefarious Willis October. You can go here to see more about my books. You'll also see the eyes of October.

But October is my second favorite month, behind a tie for December (Christmas) and March (my birth month). Halloween, however, is my favorite holiday, right up there with Christmas. From the graphic you can see with this entry, I look for the positive attributes of Halloween that make me love it so much. It's not about the occult or dark, evil spirits. It's about the camaraderie, togetherness, and fun. Scary stuff can be fun, particularly when you know it is not real. There are far more terrifying things real human beings do each and every day that make Halloween pale in comparison.

With October starting up, that already put me in a better mindset. But also, I was starting to take a better perspective on things. I watched a video as part of the RN PREP training we have students doing that was all about perspective. It spoke about how we respond to things, our reactions and how we can let our emotions get the better of us. The video also spoke about ways to react better and allow for resilience to build. I had to learn resilience, where Afib was concerned and how that affected my mindset.

From that day, October 3rd, I felt things progressing in a more positive direction. I was still stressed, but I didn't feel unwell anymore, especially like I had the week before. I was going to see my primary care provider about something to help with stress. My cardiologist was now going to do a stress test and echocardiogram to see where my heart is currently. But I started doing some things for myself to try and help, too. Much of the change centered around diet changes.

Because of some of the concerns I had with Afib, I started reading up on diet modifications you could make. Now, I was actively in Afib, but I felt it couldn't hurt to change some things up anyway. For one, in June 2023, when I went to my cardiologist, I weighed in that day at 219 lbs. A few weeks later, I was up to 221 lbs. I was slowly creeping back up to the range where my weight had been when I first went to my primary care provider about my high A1c.

None of this was good, and even my cardiologist suggested that it would be good for me to get my weight down lower to help with things about my heart. So, after the incident on Labor Day, I switched my diet pieces to some of the things I had done initially when I had an A1c of 10.

Firstly, I cut out all the sweets. No ice cream, no candy, no nothing in that category. I started doing this right after the issues on Labor Day. I also cut down on items like popcorn, pizza, and other fatty foods. I ate more grilled chicken vegetables and bought Smart Ones meals at the grocery store. Part of the reason I did this is I noticed that my Potassium levels were on the low side. It was in the expected range of 3.5-5, but sometimes it was 3.7 or even 3.6 when assessed. On the day I had Afib, my Potassium level dipped to 3.3 momentarily. I began feeling like a lower Potassium was not helping my situation, particularly if a blockage was present. So, I began eating foods with Potassium in them.

We all know that bananas are a good source of Potassium, but I don't eat fruit. Part of the reason I don't is the sugars in some fruits can drive up blood sugars. So, I looked for other sources. Broccoli is a great source of Potassium. Suddenly, I developed a liking for Broccoli like I never had before. Just ask my in-laws how much I used to love Broccoli (very sarcastic now). Broccoli actually led to one of the first arguments Leslie and I had, believe it or not. But now, I love it.

Also, green vegetables are good sources, beans, Salmon, chicken, spinach, the list goes on and on. The other piece with these items, they are healthier most of the time. Of course, too much of a good thing can be bad, but I knew if I ate more grilled things and less fried, as well as things containing potassium because they were better for me, then even if I had a blockage, this change would help.

I was also continuing to walk at least 30 minutes a day. I didn't try to push it like I had on Labor Day. A minimum of 30 minutes is substantial. All of these changes were good things for me to pursue, particularly considering the issues recently with my heart. A heart-healthy diet was something my cardiologist wanted me to look at anyway.

When I began making these changes, my weight was 214 lbs, so it had already come down a bit because of stress and other factors. But these changes, beginning in September and continuing into October, would only help me and not hinder me.

I was accepting that I needed to make changes. I was getting myself right with God, and now I needed to get myself right with me. Fortunately, another waking sleep moment would help me see that my changes were helping me more than I knew.

Tune in for the next segment, 10: Count Your Blessings.

 

10: Wake Me Up When September Ends, Part 3

"It's always darkest before the dawn."

After the loop monitor insertion, things began to ease off some. My anxiety came down quite a bit. I was feeling a little more like myself but still guarded. My blood sugars were still good. As I said, I felt like I was moving in the right direction.

Then, Tuesday, September 26 came.

The day started fine, but I walked to the hospital around lunchtime to get some food. That's when I had an odd feeling in the center of my body. The sensation was centered between my heart and stomach, and it felt like it was more toward my stomach, but I couldn't tell. What it felt like was weakness.

It was persistent and was present the entire time I walked to and from the hospital. I ate something to see if that would help, then laid down on my office floor for a few minutes. That seemed to help, and then my stomach got upset. I had to use the bathroom two times within an hour, and then my stomach felt sour. I wasn't sure if it was something I had eaten or if perhaps I was getting a stomach bug, but it just felt bad. So, I went to the store to buy some Tums to help alleviate the situation. Back in August, taking some Tums helped me once after eating something I knew I shouldn't have. The Tums also helped again, somewhat, but I still felt off.

The sensation I felt was gone, but I generally felt bad. That was when I decided to go home early that day, ensuring my lab instructors were in a good place. I drove home, still not feeling completely good, and when I reached home, I really didn't feel well.

All of a sudden, this pressure started building up in my chest. I hadn't felt something like that before, even with the Afib. Leslie and Abby had gone shopping, and I was home with Charlie. I decide to go lie in bed, trying to rest some. That's when I checked my blood pressure.

Before this day, my blood pressure had averaged 120s/80s or 130s/80s, not a real concern. But when I checked it around 5 PM that day, it was 168/98 with a pulse of 70. I was shocked. I immediately checked my other arm's blood pressure, which was up, along with my pulse. Then I started to freak out. 

My legs began shaking. I didn't know what was happening. My heart rate was going way up, so I took another Cardizem. I thought the Afib was returning. I was in complete meltdown mode and did the only thing I knew to do: I called my Cardiologist. Since it was after hours, I had to speak with whoever was on call. It was the same person I would see the next day for my loop recorder follow-up. I told them what was happening and all the symptoms I felt. The only thing they could suggest at that moment was for me to go to the ER to have an EKG done and see what might be going on, as they didn't have access at that time to the loop recorder monitor. All I could think was, here I am, headed to the ER again for the second time in a month.

My in-laws were home and helped drive me to the hospital, where my mom and Leslie joined us. I was so stressed out being there again. My blood pressure only came down some, with my heart rate bounding around, but it was never in Afib. I was lying there on the stretcher in the ER, and that's when I had a disturbing thought.

Am I just a burden now? Maybe they would all be better off if I wasn't here.

For an instant, I believed I was a burden on everyone. My anxiety was becoming overwhelming. My fear of Afib pushed me to the brink of unhealthy thoughts and considerations. Those are really unbelievable thoughts. I had many blessings to be thankful for, but I was letting this situation control me despite knowing I needed to not do that, to give it to God. That's when you know you are powerless to stop it. At that moment, I knew I needed some help.

The 12 Steps Program for alcohol addiction tells you that you can recover until that person admits they have a problem. Well, I admitted it by the time I got home that night. I had a problem, and I needed to fix it. Mentally, my problem was escalating and starting to cause physical reactions.

This can also be termed Post Traumatic Stress Disorder (PTSD). The episode of Afib had pushed me to a dark place. Dark thoughts were creeping in, and even the unthinkable was being considered. I had to do something about it. I didn't believe I had a problem for a while during these previous months, but my anxiety had taken on a life of its own. When I went for my loop recorder follow-up, I truly believe my cardiologist was more concerned about my mental well-being than my heart that day. The loop recorder showed nothing. My blood pressure being up was born out of anxiety, fear, and really things unrelated to my heart. Now, my EKG did show some mild ST depression in the anterior lead and some T inversion in the lateral lead. These are not necessarily bad things but could have indicated a potential blocked artery. But, those EKG changes could have also meant electrolyte imbalances or even high stress and anxiety. So, to determine what was happening, they wanted to repeat my stress test and echocardiogram that I had done the previous year. Leslie and I were relieved because we thought more testing was needed.

I asked my cardiologist if they thought I needed something for stress or anxiety, and they answered yes. Either an SSRI or even a Benzodiazepine potentially, so I set an appointment with my primary care provider that day.

For the rest of that week, my stress was still very high. My cardiologist did provide me with some hydralazine for high blood pressure to help until the two tests, just as needed. I took one to take the edge off, and it seemed to help. My blood pressure was fine for the days following, but my anxiety was all over the place. 

At one point that Saturday, I was anxious about being home with no other adults. Once my parents came over to visit, that anxiety came down some. But it was still incredibly high. I was anxious about eating certain foods, fearing it would raise my blood pressure too much. I was fearful of doing things that would get my heart rate up. I was afraid to drive for fear something would happen to my heart and I would kill my whole family in a car accident. I was becoming extremely irrational. 

That Sunday night, my blood pressure went up again. My stomach was just churning all week and causing me issues. I truly believed I had some sort of stomach bug that played a factor, and my cardiologist did wonder if something I ate upset it contributing, but my anxiety was the bigger issue. But as I lay in the bed with my family, I heard whimpering beside me. 

It was Leslie, crying herself to sleep. She was worried sick about me and what was happening to me. I remember laying there thinking, "This can't keep going on. Something has got to give. Someway somehow, it has got to get better. I can't keep doing this to my family, to those I love."

I asked Jesus to help me in any way possible. And He did.

The next day, I had some meetings, and my anxiety was extremely high for those things, making it higher than usual. I had to take another hydralazine to help with the blood pressure. But following that meeting, I talked with a friend who started helping me. They shared some of the concerns they have had in life and what they have had to endure. It started helping me put things in perspective better. Almost immediately, my stomach stopped churning. My blood pressure came down. I could focus again, and I was feeling some better. Maybe it was a stomach bug. Maybe it was just my anxiety. Maybe it was both, but it had eased off. I had put everything in perspective now, and things felt different.

September was finally over, and the dawn of October was starting well for me on this Monday afternoon. Something was telling me, things are going to be ok. I just needed to accept it.

Tune in for the next segment, 10: October Acceptance.