When Things Fall Apart

I’ve achieved a new personal record as we runners like to say.  I now have a small collection of little amber pill jars; 3 actually.  That’s the most I’ve ever had at one time.  My previous personal best in pill jar collecting was two and it usually came after oral surgery; antibiotics and the ever popular Vicodin. 

I’ve always resisted medication (Well except for my younger days when I dabbled in, uh, recreational medications).  I’ve seen people close to me dependent on meds; tranquilizers and pain pills; too many little amber jars in the house.  And I’m highly suspicious of the drug industry and their products.  A look at the side effects and you wonder if the cure is worth the costs.  Depending on the medication the list of side effects reads like something you would need to, uh, well, take medication for; shaking, dizziness, problems with various and sundry organs, depression, suicidal thoughts, erections that last 4 hours (the jury is out on whether or not this is a bad thing), blurred vision, nausea, cloven hooves and the sprouting of German Shepherd ears.  And finally I should admit that when I look down at the little 7 day pill reminder it leers back at me mockingly with the reminder that I’m not bulletproof; and as an ancient acupuncturist said to me through a toothless grin, I'm "old." Not really though.  I'm only 59.  I'm just older than I was. Aren't we all?

I stopped debating with the doctor about meds a couple of weeks ago when I was at the emergency room for another atrial fibrillation attack.  I was still groggy from sedation after having my heart zapped with a few volts to get it back in rhythm when my cardiologist stopped by for a visit.  Red faced with exasperation, he wagged a finger in my direction and announced to me, my wife and most everyone in the entire ER that I would be taking meds to keep my heart from wigging out every now and then.   And I would be taking them forever; "Capiche?"  Sure, I capiche; why not? 

So one of my meds is 50 mg of Flecainide twice a day to prevent any onset.  A physician friend damned this drug with faint praise, telling me it’s a good medicine “when it works.”  I offered in return that just about everything is good when it works; refrigerators, cars, airliners, co-workers and Congress among them; and if you don’t mind can we keep a positive spin on this. 

In the midst of his fulminations my doctor tossed a stack of papers on my lap explaining in detail my condition.  A few days later I took that stack of papers and perused them in the reading room (the quaint little name my dad called the bathroom as he would grab the front page and amble down the hall).  What I learned was sobering.  It seems that the episodes of irregular heart rate that I thought would come and go without medication and then more or less leave me in peace with medication will certainly progress from occasional to persistent to one that is chronic, permanent and ongoing; meds or not.  Appropriate that I was sitting on the toilet when I was reading this because it’s definitely the shits.  There is no timeline to all of this and at a certain point I’ll be a candidate for a procedure called ablation which essentially cooks the heart’s offending circuitry.

In the grand scheme of things this isn’t as serious a condition as many folks deal with.  The worst that can happen is during my heart’s jitterbugging I could throw a clot into my brain, get a stroke and die.  Now I will allow, that's kind of a bad thing.  I'm trusting that the doctor is better at forecasting than the weatherman since he assures me that this likely won’t happen with me.  This is because I have something called a CHADS score of zero; this is like golf – lowest score wins.  I asked the doctor if a CHADS score was anything like a hanging chad.  He wasn’t amused – I guess he voted for Gore in 2000.

Things break down and we suddenly learn all of these new terms that we never would have thought mattered; CHADS, sinus rhythm, ablation, cardioversion.  When I was 25 those were the things that other people worried about; hell, when I was 50.  For some, medical terminology and new habits become stark reality at those younger ages.  From that perspective I've been lucky.  And truth be told I'm so much luckier than my wife who has faced cancer three times and for her trouble has three surgical scars and one less kidney to show for it. And of course she is luckier than the next person who is luckier than the other person.  It goes on and on but our own issues are the ones that matter to us at the time; and there's nothing wrong in that.  So after trying to negotiate with reality, which is a no win discussion and fighting with my doctor over accepting this condition and giving in to medications I've finally come around and am grudgingly getting used to it.

I’ve even managed to get somewhat used to the sensation of an a fib attack.  I no longer feel creeped out by that strange feeling that my heart is squirming inside my chest like a little rodent trying to escape; sort of like that critter that popped out of the fellow’s stomach in Alien.  What does bother me is the trip to the emergency room and all that goes with it, ending with a lost day and a burn on my chest from the electric shock that restarted my heart.

This has made running something of an adventure because it’s not recommended that you run or do any exercise when your heart is in an irregular rhythm.  So if I’m out on a run and I have an attack I go to the other two pills in my arsenal.  I take one tablet of something called Metoprolol that’s supposed to counteract the side effect of the other which is a 200 mg megadose of Flecainide that may raise my heart rate to a dangerous level.  The hell of all of this is that I don’t know if the meds work or not until I have an attack, in which case I know that my daily dose doesn’t work.  Then I take my megadose and if it just sits there and does nothing (you know, like Congress) then I know the medicine is, for me anyway, a fraud (like Congress).  And so I begin each run with a little "please no a fib" incantation and head out with a fair amount of nerves.  I suppose 15 minutes in I forget about it all.

Looking at it philosophically it's just one of those life changes that never occurs to us when we’re in our vibrant twenties.  I never saw this coming because this was me – “Hey look, I run; I swim; I bike; I go to the gym; I’m fit and you’re not.  Oh and yes I’m also smug about it.”  Or at least I was until reality set in.  I know a lot of fit folks who wear that same fit smugness on their sweat jacket sleeves.  Reality hits us all at some point no matter how strong we are.

I’ve been admonished by friends who’ve told me I’m a geezer and need to stop running, cycling and swimming.  Really?  And then what?  Toddle around the park and feed the ducks?  Hell to the no!  No I never saw a cardiac problem coming.  Of course neither did Jim Fixx as one friend reminded me.  Fixx, who wrote a bestseller about running, dropped dead of a heart attack after taking a run.  It turned out that he had advanced arteriosclerosis.

The parts are getting worn and aren't working as well as they once did and sooner or later I suppose that I will have to tone down the activity – but now isn’t the time.  It's not as if I'm going to be taking undo risks.  After all, I have a wife I adore, two children and three wonderful grandchildren.  And lets not forget my dog.  Then again, I may not stop running and cycling until they pry my cold, dead hands off the handlebars and plant me in marble town,wearing my sweats and running shoes.   As Robert Duvall said in The Great Santini: “Beats dying of piles.”