May Ends

It has been raining for days. And before that, it was raining for more days. On May 29, the local weather station announced that May, 2016, is the wettest May on record for central Virginia.

Today is Tuesday and it’s not raining, it’s just hot and humid, but the forecast calls for thunderstorms for tomorrow and every day until next Monday, so this afternoon I mowed the yard. The grass was a little wet, but I knew if I waited another six days to mow, I would have to hack my way through backyard jungle to get to my garage where my mower lives.

There was a time when I tried to try to keep my yard well manicured: grass cut short, sidewalk and curb edged, bushes trimmed. This year I reached my Popeye moment. To keep the city happy, I will mow 98% of my grass; the remaining hard-to-reach 2% can go crazy: grow tall, create seed heads, do anything it wants. The bushes in front of my house which, in the past I have always tried to keep neat and trim, are now shaggy, green monsters. When I look at them, my predominant feeling is not “they need trimming” but rather “they need to be cut down.”

Patches of my front lawn are dying off, leaving islands of green grass. This is the first year this has happened to my lawn, and it made me wonder, what’s up with my lawn? Why are there so many places where not just grass but weeds, too, cannot grow? Then one morning I happened to open my front window blinds in time to see my across-the-street neighbor letting her dog out of her house. My city has a leash-law, which means dogs must be kept in a fenced yard or on a leash. Nevertheless, people snub their noses at this law all the time. So the woman across the street lets her dog out, and the dog comes across the street to my yard, and it pees, and it trots back across the street and into her house. This must be a morning ritual for the dog. Lovely. No wonder my yard looks like it’s been bombed with grass-killer. I shake my head: people.

The woman who lives in the house beside my across-the-street neighbor owns cats. (Assuming it’s possible to own cats. My theory is you can’t own cats, you can only feed them.) Her cats are always in my yard. They poop in my yard, they pee in my yard. There is no leash law for cats. The city says “cats catch mice ergo, cats good.” I’ve seen her cats catch birds in my yard; I’ve seen her cats kill and eat squirrels in my yard. My front and back yards are decimated by voles – their tunnels are everywhere, and the tunnel entrances are big enough for a full-grown rattlesnake to slither through. I ask, where are the neighbor’s cats when you need them? They poop, they pee, they kill birds in my yard, but the voles destroying my yard get a free pass?! I shake my head: cats.

When half my lawn is gone, the two neighbors across the street, the one with the dog and the one with the cats, will probably complain to the city that I’m not keeping my yard up. They’ll want the city to make me do more to make my lawn pretty. People: they’ll piss on you and then get mad at you for smelling like pee.

Panic

Imagine this:

You’re walking beside a highway filled with fast-moving traffic when suddenly an oncoming automobile blows out a front tire and veers off the highway directly at you. You have a second or two to save yourself. There are a couple of ways you might conceivably respond.

Here is one way: you calmly observe the situation and think, “Okay, if that car continues on its current trajectory it is going to impact me and terminate my life. Logic tells me to jump out of its path. So I’ll do that.”

You might do that if you’re that cyborg guy in the movie Alien. But if you’re a human being, that is not what you will do. You will instantly jump, with adrenaline-fueled muscles, out of the path of the car. As the car whizzes past you, so close that it grazes your clothes, you will suddenly feel weak, your heart will be pounding, your hands will be shaking, and your legs will feel so weak you fear you will collapse. Those symptoms are the after-effects of the sudden rush of adrenaline through your body.

The near-death event produced in you what is customarily called a state of panic. Panic is your body’s way of going into emergency overdrive to save itself from an immediate, life-threatening situation. When panic strikes, your brain shuts down and your body simply reacts. You don’t think of what you’re going to do, you just do it. Our bodies evolved that response because when split-seconds count, your body doesn’t have time to wait for your brain to think things through and decide on the best course of action. The body has to react now. And because they’re not thinking, some panicked people do the wrong thing, they do the very thing they should not do, and it costs them their lives.

Maybe you’ve never experienced panic. If so, you’ve been blessed. Maybe you’ve experienced panic only a few times in your life. If so, you’re lucky.

For some unlucky people, panic strikes them hundreds or even thousands of times in their lives. It strikes them when they’re in their car, when they’re sitting in a restaurant, when they’re standing in the checkout line at the grocery store. It can strike them simply because they contemplate being in a situation where panic could strike.

I was one of those people. For me, attacks of panic started on a visit to New York City when I was about 22 years old. I vividly remember my first panic attack and I’ll remember it until I die. Having panic strike you over and over “out of the blue” is something I wouldn’t wish on my worst enemy. To say it is life-changing is an understatement. If you can’t get it under control, it closes so many doors to you. Some people become afraid to leave their home – they become house-bound.

Over the years, I tried many kinds of therapy and many medications. Nothing stopped the panic, but tranquilizers numbed me enough that I could endure the panic without fleeing the situation. But who wants to take tranquilizers every time they want to drive their car or buy a few items at the grocery store? The panic attacks were so hellish that for most of my life I simply said “No” to invitations, to social engagements, to going to all kinds of places and doing all kinds of activities. The things other people enjoyed and looked forward to doing were things I dreaded and only managed to endure.

If it sounds bad, wait – it gets worse. People who have panic attacks are ashamed of their panic. They don’t want to admit they have these attacks and try to appear as normal as possible to other people. They’ll put on a smile and act calm when their heart is pounding and they’re barely able to keep themselves composed. What they really want to do is jump up and run out of the room, or bail out of the car in the middle of a highway, or bridge, or at a red light. They want to abandon the restaurant meal they just ordered – throw some money on the table and leave. They desperately want to be anywhere else than where they are, and it takes all the willpower they can muster to remain where they are and appear normal.

Over the years, I added beta-blockers to the medications I could take for panic. If I had to go to the dentist, I would take some beta-blockers along with tranquilizers. If my job required me to speak in public, I’d take beta-blockers along with tranquilizers. They were not a cure, but they “got me through” what I had to do.

In recent years, I’ve taken a drug called an SSRI. The drug changes my brain chemistry and blocks panic attacks from occurring. It’s been a miracle drug for me, but it has negative side-effects that are also life-altering and which many people find unacceptable.

So am I cured? Yes and no. When I go into a situation that would formerly elicit a panic attack, I still get anxious. Sometimes I can even feel the very beginning of a panic attack, but then it stalls. It doesn’t progress to a full panic attack. That is certainly an improvement.

The downside is that decades of panic attacks, decades of developing avoidance behaviors, decades of automatically computing in my head the best strategy to avoid a situation likely to lead to panic – and having to do that multiple times per day, daily, weekly, monthly, yearly, for the better part of a lifetime – leaves behind something like psychological scar tissue. Bend a sapling and keep it bent; it will still grow into a tree. But the tree will grow bent, and once grown, there’s no way to make it straight. It is what it is.

Since I’m turning philosophical, l will add that for a long time, I’ve felt that this is how my life was intended to be. Every strategy I tried, with the hope of making my life different, failed, as if destined to fail, as if there were no other way it could have turned out. Like a train on tracks, I seemed unable to steer my life by one degree right or left.

I’m not saying I understand why my life was what it was, and is what it is … but only that I feel it couldn’t have been otherwise.

And I feel like the people in my life, close friends present and past, are and were destined to be in my life. Every friend who was in my life for a time, and who is in my life no more, seems, on reflection, to have been exactly the right person to have in my life at that exact time in my life. I feel they were all there for a reason. And maybe, I was in their lives for a reason.

Shakespeare wrote,

All the world's a stage,
And all the men and women merely players;
They have their exits and their entrances,
And one man in his time plays many parts …

At the risk of being a little theatrical and a tad off-topic, I understand the sense Shakespeare was trying to convey. When I was very young, I felt strongly that I had existed somewhere before my birth. At times I felt I could almost remember that place. So I had my entrance, and I played my part, and one day I’ll have my exit. Maybe then everything will make sense.

“Now we see through a glass, darkly.” So true, Paul, so true.

A-fib Adventures

When I moved to this central-Virginia city in June of 2003, I didn’t have any medical problems that I knew of. I also didn’t have a doctor. Prior to moving here, I had only gone to a doctor when I had a serious reason to go, like strep throat.

In August, 2004, I had my first episode of A-fib (atrial fibrillation). A-fib not only causes quite disagreeable symptoms, it can also cause a stroke. In fact, a person with untreated A-fib has a six percent chance of having an embolic (blood clot) stroke. That’s six percent per year: 18 percent in three years – a nearly one in five chance of stroke. Not treating A-fib is like playing Russian roulette. Treatment involves taking an anticoagulant like Coumadin, or one of the new, “novel” anticoagulants like Pradaxa, Xarelto, or Eliquis. That will lower the risk of stroke to less than 2%.

At the time, I didn’t know what A-fib was, I only knew something was very wrong in my chest. I couldn’t walk more than 50 feet without stopping to catch my breath. I drove to the ER and landed in the hospital with a resting pulse rate of 160. The docs gave me an IV drip to bring down my pulse, and my heart converted back to normal sinus rhythm the next morning. I went home with a prescription for metoprolol, an inexpensive beta-blocker, and I was fine – for a while.

In October, 2011, I had my second episode of A-fib. I landed in the hospital again, and again my heart converted back to sinus rhythm, and I went home with a second prescription: diltiazem, a calcium channel blocker.

In June, 2013, I had my third episode of A-fib. Back to the ER and into the hospital. Again, my heart responded to the meds and converted to sinus rhythm and I went home. I was on the same meds as before but was taking a stronger dose of diltiazem. When I left the hospital, my PCP told me to stop taking metoprolol. Her advice was delivered through a nurse, so I couldn’t question her about it. But I thought her advice was strange, because metoprolol was the medicine I was originally given to keep my heart stable. Nevertheless, I followed her advice and discontinued the metoprolol. Two days later the A-fib was back (fourth episode), and I was pretty sure the cause was stopping the metoprolol. So I took a pill before driving to the ER. While I was in the ER, my heart returned to sinus rhythm. The ER doctor and I agreed that stopping metoprolol was probably what triggered the A-fib and taking the pill was probably what ended it. So I kept taking it.

In March, 2014, I had my fifth episode of A-fib. This time the ER doctors said there was nothing they could do because my heart rate wasn’t high enough to justify medications. And, anyway, I was already taking the medications they likely would have wanted to give me. They wanted to admit me overnight so my cardiologist could see me first thing in the morning. And indeed, both my cardiologist and my PCP stopped by my bedside early the next morning. My PCP wrote me a prescription for an anticoagulant and told me to go home. There was nothing else they could do.

I went to the pharmacy to fill the prescription, but the drug was so expensive ($360/month) that I told them to keep it. Over the course of the day, my heart felt more and more normal, until by the end of the day it felt completely normal.

My sixth, seventh, and eighth episodes of A-fib hit me in May, June, and July, 2015. Episode six lasted 12 hours and episode seven lasted 18 hours. When episode eight hit, I decided to try an experiment. I had noticed that when I drank alcohol, just as the alcohol wore off my heart would beat strongly and very steadily for about ten minutes. So I thought, if I have a few drinks, then maybe that strong, steady heartbeat will return and terminate the A-fib. I drank three shots of vodka. Three hours later, my heart returned to sinus rhythm. Maybe I had “fixed” my heart rhythm; maybe it was coincidence.

My heart’s ninth episode of A-fib hit me in April, 2016. I didn’t go to the ER because the previous time I went there, they could do nothing for me. The earliest appointment I could get with my cardiologist was three weeks away. When I went to see him, I was still A-fibbing and he gave me medical orders and told me to go to the hospital.

At the hospital, I got an echocardiogram, a TEE (trans-esophageal echocardiogram), and a cardio-version to electrically shock my heart into a normal rhythm. That worked but only for five hours. I had a tickle in my throat that made me cough, and the cough triggered the A-fib again. I was discharged with a prescription for Eliquis and advised by my cardiologist to see him in two weeks.

When I saw my cardiologist two weeks later, he told me my heart was beating too fast – the resting rate was over 100 and just walking around would bring it up to 130 or 140. He said my heart would wear out unless the rate was brought down. I said, “Okay, but it will take years, right?” The doctor said, “No – it will be months or weeks.” Frankly, I don’t believe he is correct about the time frame, but he’s the heart doctor and I’m paying him for his advice, so I left his office with a prescription for amiodarone. It’s a drug that can have very severe side effects. After researching it online, I realize I don’t want to take it. I have to see the doctor again in six weeks, and I may ask him to switch me to digoxin. I have more research to do.

So far, my episodes of A-fib have produced medical bills totaling $146,714. Insurance has covered most of that. I am out-of-pocket $12,622 not including medications nor my most recent doctor visits. At this point, it appears medications will cost about $2,000 out-of-pocket annually. In the past year, drug prices have risen sharply, so that $2,000 could double in the next three to six months. In fact, with medicines it appears the sky’s the limit.

Some doctors say A-fib is not a disease but is the result of disease. They say A-fib is the heart’s response to risk factors such as inflammation, hypertension, diabetes, excessive drinking, smoking, sleep apnea, etc. Even growing older is a risk factor. I have metabolic syndrome and perhaps that has affected my heart.

I’ve dieted many times without success. At first the weight comes off, then the weight loss slows down, then the weight loss stops, then, even though I’m consuming the same number of calories, my weight begins increasing! At the same time, I become excessively tired and lacking in energy. It is clear what is happening: my body has decreased its metabolism – its energy usage – in order to regain its original weight. The experience is disappointing but, nevertheless, I may try another diet. I may even try some manner of exercise, but the A-fib leaves my body a little short of oxygen and works my heart harder than normal, even when I’m resting, so I don’t know about that. I’ll give it thought.

I have that end-of-the-road feeling. Like I’m on the edge of a precipice. I’m not having dark thoughts, it’s just how I feel. Maybe I’m not at the end of the road, but I feel it’s in sight.

Time will tell.

Hawking’s Voice

I was watching a show on PBS called Genius by Stephen Hawking in which Hawking, the famous English physicist and cosmologist, induces people to figure out the answers to philosophic and scientific questions like “Why are we here?” and “Where did the Universe come from?”

Hawking narrated the show. Hawking is, unfortunately, almost totally paralyzed by a slow-progressing form of ALS. He can only communicate by a single cheek muscle attached to a voice-synthesis device.

I liked the show, and I imagine its intent was to make me think about the answers to Great Questions such as, you know, “Why are we here?” and “Where did the Universe come from?”

However, what I found myself wondering about was, “Why does Hawking’s voice synthesizer sound like the voice synthesizer in the 1983 movie Wargames?”

That movie is 33 years old. Voice synthesizers have gotten so much better. Automobile GPS systems come with multiple male and female voices that sound like natural human speech. Can’t Hawking get an upgrade for his voice unit?

Sure he can but, as it turns out, he likes the voice and identifies with it. And so do the rest of us. When we hear that robotic, American-accented Wargames voice, we know immediately who is behind the voice: a British genius named Stephen.

Cell Phone Zombies

I heard this on the news tonight: cell phone radiation has been associated with cancer – in rats. Frankly, I think rats should stay off the damn phone. Then they wouldn’t have problems with cell phone cancer.

This news item raises many questions. How in the world do they teach a rat to dial a cell phone, let alone convince it to spend hours talking on the phone? And how do rats manage to hold cell phones up to their ears with their small paws? And who do the rats call on the phone? Are there lots of rats out there with phones? It wouldn’t surprise me. There are probably a number of labs studying the impact of cell phone radiation on rats, and the rats are calling each other out of boredom. “What did they feed you today? Oh, rat chow again! Yeah, I’m getting tired of it, too.” Of course, to us humans the conversation would sound like, “Squeek? Squeek squeek squeek! Squeek squeek.”

I’m pretty sure that cell phones don’t cause cancer in humans. If they did, teenagers would be dropping dead all over America. I have witnessed teenagers getting off a school bus, walking in front of the bus, walking across the street, stepping up on the curb and continuing down the sidewalk, all without ever lifting their gaze from the cell phone they are holding in front of them with both hands.

If cell phones can be made small enough – and it’s a safe bet that one day they will be – people will probably get cell phones implanted inside their brains. Then, we really will have a world filled with walking zombies.

Andee

The song of the day is Black and White Heart from the 2015 debut studio album by Canadian singer-songwriter Andee (Andrée-Anne Leclerc).

Seinabo Sey

The song of the day is 2013's Younger by Swedish-Gambian singer-songwriter Seinabo Sey. Younger was Sey’s debut single.

Trump and the Second Amendment

I read in the news that Donald Trump told members of the National Rifle Association (NRA) that if Hillary Clinton is elected President, she will abolish the U.S. Constitution’s 2nd Amendment. The Donald attributes a shocking amount of power to the U.S. president. The president certainly can’t wave a hand and say, “Begone, bothersome constitutional amendment.” So how will Clinton (if elected) abolish the 2nd Amendment?

Trump says Clinton will cleverly appoint anti-gun justices to the Supreme Court. She will somehow sneak her appointees past the Senate Judiciary Committee, and then, assuming they are approved, sneak them past the full Senate which must vote to approve her appointments. Then, presumably, those new Supreme Court justices will vote to abolish the 2nd amendment.

Except, the Supreme Court can’t do that. The Court has no authority to abolish the Constitution, nor any part of it. In fact, the main job of the Supreme Court is to see that our laws conform to the principles declared in the Constitution. The Court can rule that a law is unconstitutional, but the Court cannot rule that the Constitution itself is unconstitutional.

Trump says Clinton will curtail gun rights. If any President had the power to curtail guns in America, one would think Barack Obama would have done so by now. After all, during his terms in office he has had to address the nation after each of twelve mass shootings (to date).

The truth is: to change or abolish the 2nd Amendment, two thirds of the House and Senate must approve the changes, and three-fourths of the states must affirm the changes. That process has been used 27 times to amend the Constitution. There is another way to amend the Constitution but it’s never been used, and that is for two-thirds of the state legislatures to vote to hold a Constitutional Convention. The Convention can propose amendments, but the amendments must still be approved by three-fourths of the states. The 2nd Amendment is pretty safe. Of course, there was that time when “the People” decided to abolish alcohol in America, so anything is possible.

The Hospital Option

I got home from the hospital Thursday. Home never felt so good.

Backstory: I entered a local hospital on Tuesday with a-fib (atrial fibrillation). It wasn’t the first time I’ve been treated in the hospital for a-fib, but I think it may be the last time. Untreated a-fib can cause a clot to form in the heart, and the clot can travel to the brain and cause a stroke. Strokes are bad.

At the hospital, I had an echo-cardiogram AND a TEE (trans-esophageal echo-cardiogram) which involved running an ultrasound probe down my esophagus (gag) to look for clots in the heart's atrium, then an electric shock stopped my heart momentarily. When it restarted it was in normal sinus rhythm. That lasted five hours until I coughed and my heart went back into a-fib. That's not supposed to happen.

My cardio doc said I had 3 choices. Option One: radiofrequency ablation. In that procedure, a gadget is threaded up a vein in my leg to my heart, and the troublesome part of my heart is zapped away. It's a 3 to 5 hour procedure.

Option Two: begin taking the blood thinner warfarin. It's cheap but I would have to go to the doc's office once a week to have my blood monitored. It has lots of interactions with various foods, herbs, and other drugs. And it can make you bleed to death, or worse, cause a brain bleed which turns you into a vegetable. But not the leafy-green kind of vegetable that is good for you. No, it turns you into a bad vegetable, like okra.

Option Three: begin taking one of the newer blood thinners, like Xarelto or Eliquis. They have the great advantage of not being warfarin, but they cost an arm and a leg. Seriously, you have to give the store an arm and a leg before they will fill the prescription. You get to choose right or left.

To give myself time to think, I left the hospital with a prescription for Eliquis. I also wrangled a 30-day free trial offer from Bristol-Myers Squibb. All I had to do for the free trial was give them my name, address, email addy, and phone number, and agree to give up all my privacy rights and allow them to call me anytime day or night. How could anyone say “No” to a deal like that?

As a footnote, I will add that the hospital staff could not have been more friendly and solicitous. Even so, lying in a hospital bed with nothing more than a crappy television picture to look at all day, being stuck with needles, and carted hither and yon for various tests, was enough to make me want to cut my head off with a dull, plastic butter knife. When I mentioned that to one of the nurses, the plastic knives that had been coming on my food tray disappeared permanently. I can hear the staff now, muttering to each other, “Get rid of the plastic knives. He says he’ll cut his head off, and he’s crazy enough to do it.”