No Need To Panic Attack

(Author’s Note: This is Part I of a three part series on anxiety, or panic attacks, and a bum ticker. Meaning my heart decided to get in the mix with everything else that was going wrong in my life. 30 years that ended with my death at one of the best cardiac hospitals in the world. But I don’t want to spoil the ending.)

I start another day following a somewhat restless night. It finally rained last night and into this morning. It’s been a hot dry summer, not fit for much outdoor activity even.

Right now I’m lying in bed in the middle of a panic attack, one of those days when intense worry is eating me alive. There must be something wrong, at least that’s what part of my mind is telling me. I’m too hung up at this moment to take stock or inventory. I’m just worrying. Feel giddy, tense, ready to jump off the ceiling.  

I check my heart, fingers on wrist. I haven’t done this in a long time. Fast, but in sinus rhythm.  Good. Then it’s really anxiety this time and not my heart. I’ve done this a million times before, trying to decide if it’s plain old fashioned anxiety or my heart has gone into atrial fibrillation again. I can deal with panic attacks and anxiety.

In 1987 I was diagnosed with anxiety disorder in the form of panic attacks, at least according to the ER doc in California. I had driven myself to the local hospital as I was pretty certain I was having a heart attack. My heart was racing in my chest and throat, unable to take a deep breath.

After registering at the front desk and waiting 20 minutes, I was hooked up to take an EKG so they could see what was going on. By that time I had actually felt a little better, calmer but tired. I had a higher than normal pulse, but everything else checked out fine. The resident had asked a bunch of questions about health and recent happenings that might be stressful.   

I told him this has been happening for a couple of weeks. I then rambled on about how I had cheated on my wife with my secretary, told them both I was an effing idiot, and was wondering what the hell I was going to do now.  He chuckled, despite knowing the story to be true.

“So who’d you end up with?” The doctor smiled as he asked.

“What’s that?” I asked.

“Which woman?”

“Well, neither,” I replied. “ I have my clothes and guitar in my back seat and sleep in the front, parked in an almond grove outside Rosedale. The migrant workers are my wake up call.”

“Oh my god, I can fully feel your pain, and speaking from experience a year or two from now and everything will get better” half chuckling as he said it. Nice guy, must have been in the same spot. I knew he was politely saying I’m in a world of shit, but kept it professional. 

“Since we didn’t see anything on the EKG I’m pretty certain you’ve developed a case of anxiety, and experienced a panic attack of sorts.”

“I’ll give you a prescription for lorazepam” he continued. “A simple relaxant to take the edge off when the attacks get really bad. Just put one or two under your tongue, and sit back and breathe slow and deep. It should help, but take only when absolutely needed, the drug can be quite addictive.”

That was that. My current lifestyle, or lack thereof, had put me in panic mode in my early 30’s. Great. The first of many more to come. Or so I always thought, which you’ll understand shortly. The symptoms were the same each time, heart racing and trouble breathing. Even after I was promoted by my company shortly thereafter, moving across the country with my wife and kids in tow.  A valiant but failed attempt by my bosses to try and save my marriage.  

Another story.  Too many twists to unravel here. Another day,  another story perhaps. 

Every time I relocated, or every time I changed doctors, the story of the first panic attack and the prescription for lorazepam was retold, and never questioned. Each doctor refilled the script for a dozen pills, my security blanket.   I carried a half dozen sublingual lorazepam at all times, and when I ran out a quick call got me a dozen more.  It was the first medication I had on a continual basis, albeit not daily.  

I only used lorazepam 3 – 4 times a year, until I developed this condition called an esophageal spasm. This started up in the mid-90’s when my life had taken a bad turn, out of control. One of the first issues I developed healthwise.  

I learned the body has several sphincters, a set of muscles throughout the intestinal tract that pinch open or closed.  It is  like a set of valves that make sure things flow in an orderly fashion.  Of course when you hear the word sphincter your mind immediately goes to your butt. So I use the word esophageal spasm. Who wants to have cramps in the other one, but I bet it happens. 

This muscle in particular is at the top of my stomach, at the base of the esophagus. For reasons unknown to anyone, mine likes to contract or cramp.   At times so severely it feels like someone has stabbed me with an ice pick. Once  the pain starts it keeps intensifying to where, if I can’t get it under control, it means a trip to the emergency room. Been there, done that.   

I found out that acetaminophen, known by the brand name Tylenol, would also trigger the spasm. Not always, maybe 30% of the time. Nowadays I avoid the drug completely, which makes it a bit more difficult in controlling pain. 

I can feel it coming on, that tightening in one small spot, right at the base of my sternum. The pain can go from zero to ten in a matter of minutes. If I react in time I can get it to calm down, loosen it up so to speak.

That’s where the lorazepam came in handy. I say that in the past tense because I haven’t used it in years now. Since the drug is a general relaxant, I would pop two under my tongue once the esophageal spasm started.  They wouldn’t stop it by themselves, and I learned through trial and error that if I drank copious amounts of water and placed ice packs on the spot I could somehow manage to get it to ease up.

I had to make it to the kitchen to perform this “cure” routine. Mrs. K would stand by and watch as I would bend over double with the pain, half cussing, half crying. Waiting for my signal to call 911 or wait it out.

So there I was for twenty years, suffering from anxiety and panic attacks, with the occasional spasm thrown in for good measures. Lorazepam helped at least, but was far from the answer. There’s a lot that happened in those 2 decades that need to be written, the 90’s my darkest time, the lowest a person should have to get.

Move forward to 2008. I am sitting in my family doctor’s waiting room, a simple checkup and another discussion on starting hormone replacement therapy and truly starting to transition. Plus getting a refill of my medication, which I had just ran out of. I’m nervous.  I’m not surprised that I was experiencing a little anxiety in a doctor’s office. 

I’d been seeing Dr. Y since moving up north, she was really close to my new home and turned out to be a lovely person. Real talkative, and friendly. We chatted for a minute when she asked me to take off my shirt so she could check my lungs and heart out.  

She put her fingers to my wrist, the stethoscope to her ears, and in short order said “I’m calling an ambulance. You’re having a heart attack.”

“Nah doc, just another panic attack, it happens a lot lately.” I replied, blowing it off as nothing.

“This is no panic attack, your heart is beating abnormally.  Races, stops, then races again. It’s the stopping part that really bothers me.”

I answered her, “If this is the same as before it will go away in a few minutes.  Part of the reason I’m here is I ran out of lorazepam.”

“Put your shirt on but don’t bother with the buttons and come with me.”

We went down the hall to the corner office.   It has been converted to the clinic’s own lab, complete with a single nasty lab tech that I’d dealt with before. That was one benefit of the clinic she shared with 2 other doctors, you could get your blood work done, plus the lab technician was trained to run some of the more basic tests. EKG being one.

“I need you to stop what you’re doing and run an EKG on Kyd. “the doctor said to the lab tech. I’m going to stand here and watch.” My shirt came off, my pant legs were rolled up and I laid down while she attached all the contacts, six or eight in total. The tech started the EKG and we all watched as the first few waves came across the computer screen.

I knew something wasn’t right. The wave pattern was broken.

“You’re in A-fib. Atrial fibrillation.” The doctor spoke, breaking the tension. “Meaning your heart is in an abnormal rhythm. I still think you need to go to the hospital.“   

“Can we just wait a few minutes?” I asked. “This always happens and only lasts for a half hour at most. I really hate going to the hospital.” The big fear, hospitals.  If you really want to see a panic attack send me there.  Flashback to the horror of what happened. No thanks.  

“Okay, ten minutes.” She replied.  “But lie there and keep still, we’re just going to keep you hooked up.”

To the lab tech she said “keep him there and run a separate EKG every two minutes, and I want print outs of each. I’ll be right back.”

I was diagnosed as having atrial fibrillation. Later found to be specifically in the P wave, or that first trigger that takes place in the right atria. Simply put, there’s  a little node in the top of your right atria that miraculously fires a tiny electric charge through the atria to a receiving nodule of nerves which starts the first contraction. The four chambers of the heart, and the whole thing runs on that one little spark. Not that different from a car engine.

My internal “spark” was missing the target, and would keep sending rapid fire signals until it finally hit its mark. That was the abnormal P wave.

The doctor came back into the lab and sure enough, I was now in sinus rhythm, the spark was making contact on the first go round. I felt the heart beat slow down, but like every time before I felt like I’d been in a small battle. Calm prevailed, but now I was tired.  Ready for a nap.

“Okay, I spoke to my colleagues and here’s an appointment for you tomorrow at a cardiologist office. He was kind enough to squeeze you in. You better be there.”

That began my decades-long journey with cardiologists, Holter monitors, neurologists, and tread mills. Each specialist adds his own dose of medication or two. Or three. All of a sudden I found myself in 2008 on a dozen meds, but still feeling bad, and suffering whatever these attacks were. A-fib or anxiety, or both.  Neither was a joy ride.

So the question arose. Had I really been having panic attacks since 1987 or was it just episodes of A-fib? Did it not show up on that very first episode 20 years back because it had already subsided? Who the hell knows. 

So I faced a nearly ten year struggle where A-fib persisted, growing in frequency,  intensity and duration. Worse and worse….until it finally killed me.  Twice.

But that’s another story.