Dysrhythmic AF
I’ve been walking a lot lately. I walked 14 miles about a week and a half ago, 11 the other day, and 12 today. It’s Training for Shikoku all over again, but this time I’m not preparing for an adventure, I’m just trying to get back in the game. No matter what shenanigans my heart might be up to, it seems to tolerate a good walking pace. Sometimes I listen to music, sometimes to a podcast or an audio book, and if I time it right I might catch part of a ball game. But the walks I enjoy the most are the ones where I just allow myself to be entertained by the internal circus that is constantly performing inside my head. Jugglers, lion tamers, tightrope walkers, elephants on their hind legs, clowns on stilts. Often the circus performs anyway, even while I’m wearing earbuds and someone is trying to read his book to me. Two miles later I realize that he is finished with Chapter 3, and I haven’t heard a word. As if my ears aren’t even connected to my brain.
I’ve also been meditating lately. I exercise regularly, I don’t smoke, I keep my weight down, I’ve cut down on caffeine...meditation is all that’s left that doesn’t require taking another pill. Deepak Bhatt, a cardiologist at Harvard Medical School says, “Meditation can be a useful part of cardiovascular risk reduction.” Sign me up, and ditch the Lipitor. I wish I could say that I’ve achieved enlightenment, but quieting a circus is as hard as it sounds.
I started taking Pradaxa, my new blood thinner, the day after my birthday. I didn’t absolutely have to. “Six of one, half a dozen of the other,” my doctor said. I didn’t think that was the right expression for this context, but I think I understood what he meant. I have documented occurrences of AF (atrial fibrillation), which means that I have an elevated risk of stroke. But except for the AF, I have a very low risk of having a stroke. Will the medicine really prevent me from stroking out, or will taking it unnecessarily cause me to bleed to death after some sort of freak accident? Six of one, half dozen of the other.
In the end, I was swayed, irrationally, by Ann’s family history. My father had a life-altering stroke, but by that time his body was already riddled with cancer. Ann’s father had a stroke at a relatively young age, and it changed him into a different person. She and her brother even refer to him as Dad One and Dad Two. Dad One was intelligent and articulate, and despite some significant flaws, he was someone that they evidently had a lot of respect for. I never met Dad One. Dad Two was limited in his repertoire, repetitive, and verbally annoying. He had very little impulse control, became proficient at purchasing big, expensive things on credit, and was ultimately forced to be dragged through the process of declaring bankruptcy. Still, when he died, he was surrounded by his big, expensive things, and it was never quite clear if the stroke had caused an impairment in judgement, or resulted in a shrewd ability to manipulate the loopholes of capitalism for his own benefit. Anyway, I decided to do everything possible to prevent Ann from having to endure such a trauma again. Also, I didn’t want to become the annoying old man that nobody wanted to sit next to at Thanksgiving. So I started taking the pills. I’ll be extra careful around sharp objects.
Shorty after, I heard from the surgeon’s “scheduler.” My ablation was set for August 13th. I’d been waiting so long to get this thing scheduled; when it finally happened, I thought I’d be overwhelmed with relief. The opposite was true. As I started to do the math, I was overtaken with anxiety. August 13th means that I’ll have been on blood thinners for a full three months before the procedure, and another 3 months minimum afterward. That adds up to almost all of 2018. My odds of success are estimated at 50-70%. That means that my odds of failure are 30-50 %. Practically a coin flip. So then what? Another long wait for another ablation, and another six months on blood thinners? Or just blood thinners, maybe for the rest of my life? Or a more invasive surgical procedure? To say that these are the issues I’m wrestling with would be inaccurate. I have no control over any of this. What I’m wrestling with is acceptance.
I often wear a heart monitor when I work out. The sensor straps around my chest, and it talks to my fitness watch, a Garmin Vivoactive. The watch was given to me for my retirement by a group of friends. For years, we’d gotten together once a week or so during our lunch break. We offered each other a combination of loving support and brutal honesty, as each of us was confronted with earth-shattering life challenges: breakups and divorces, tragic deaths of loved ones, illnesses, rejections, alienations, financial woes, and the like. We called ourselves Mantopia. I rarely see any of these men any more. I don’t even know if they still have Mantopia meetings. But I think about them every day when I put on my watch.
I use the heart monitor as a safeguard when I work out. I am convinced that a high heart rate can lead to dysrhythmic AF. I set 140 beats per minute as an arbitrary upper limit. Anything more than that, I slow down or stop. Despite this strategy, I still trigger an AF episode once in a while. It happened the other day. I jogged for twenty minutes on a treadmill: nothing over 130, even over simulated hills. I did a few sets of bodyweight exercises: still around 130. I got back on the treadmill, and after a minute or so my HR jumped to 155. I got off of the treadmill, walked around a little, and my heart still raced. I walked out of the gym to my car, and sat in the driver’s seat. My HR continued to climb...159, 160, 161. I stared at the numbers on my watch, and tried to will them down, taking deep breaths and focusing on calm. I took a meditative stance...162, 163. Finally, I gave up. I had things to do. I started the car and drove away. As I turned from the parking lot into the street, I glanced at my watch. My HR had plunged to 79 bpm. It happened the instant that I stopped trying to make it happen.
I was a teacher for over thirty years. If you count the years during which I helped my mentally handicapped little sister, and others like her, cope with the world, it was more like fifty or sixty altogether. I think I was pretty good at it. Now I’m learning to let go of that. That’s the choice you make when you retire.
I was a coach. I coached athletes, and I coached teachers. I think I was really good at that. I may even try to do it again someday. But for now, I’m learning to let go.
I was a parent. Ok, technically I’m still a parent. But I no longer make decisions for my kids, I’m no longer responsible for their choices or their actions. I don’t know how good I was at it (one of my kids pretends that I don't even exist), and I know I made a lot of mistakes, but I did the best I could. I didn’t choose to retire from parenting, but that’s life, and I’m learning to let go.
I was an athlete. I wasn’t going to the Olympics or anything, but I did okay for a guy my age. I have an internal drive that allowed me to push myself further than most people would. I liked testing my limits. I’m not sure that was always healthy, but it was a choice. Heart surgery took that choice away from me. I’m learning to let it go.
Overnight, it seems, I’m not the person I once was. Sometimes, on a bad day, I’m not sure what’s left. On a better day, I see this moment in my life as an opportunity to reinvent myself. Either way, where I go from here, I believe, depends on how well I learn to let go. I’ll just have to try harder. Or learn to stop trying.