Readers Wednesday

Hello All! Just thought I would give you the chance to ask questions or make comments. How is everybody doing? Heart palpitations worse or better right now? Have any tips or suggestions on how you are dealing? Let's talk.

Pervasiveness: Part 3 of 5

Permanence is about time. Pervasiveness is about space. When you get heart palpitations are you able to forget about them once they pass? Or do you get depressed for the rest of the day or start worrying about the next time you might get them? Some people can put their troubles neatly in a box and go about their lives even when one apect of it--their health, for example, is suffering. Others bleed all over everything. They catastrophize. There have been times, when I have had heart palpitations that I can barely muster enough strength to get out of bed. The depression becomes so heavy it effects my entire life. I no longer want to exercise, spend time with my loved ones, leave my house, or go to my job. I just want to wallow in self-pity and curse my bad luck. I believe the key to accepting heart palpitations is to accept that not only will they last forever (permanence) but that I can still go on with my life and do the things I want and need to do. I may have to pause and relax or deep breathe when they are occurring, but once they are finished, I should be able to bounce back and get back into the game of life. Today, I had a fun but busy morning hanging out with extended family. I felt very sleepy after lunch but wasn't able to take a nap until after my in-laws had left. I got some pretty scary heart palpitations and when I went to lay down I could feel I was in bigeminy. I freaked out at first but I was able to calm done and fall asleep. A few years a go, that episode would have caused me to be depressed for the rest of the day. It would have caused me a lot of anticipatory anxiety for the next couple days. But today, after I woke up, I felt good. I acknowledged that the heart palpitations were temporary due to fatigue. I was able to get up and go on with my day. I even went to the mall. Today, I did not let my PVC episode bleed into the rest of my life.

We interrupt this program...

for the BEST article on heart palpitations that I've ever read!!! No kidding. I'm so excited to share this letter from a real medical doctor. It's long but well worth it!!! (My favorite part? The comparison of PVCs to an awkward dance.)

Thank you to www.pvcgroup.webs.com for sharing it!

To Those Concerned With Heart Palpitations
(Letter from MD)

I want to start by talking about a very special part of the human anatomy that does not seem to appear in the collective messages I've reviewed; The VAGUS nerve. The vagus nerve, also referred to as the 10th cranial nerve, is appropriately termed a "mixed" nerve. It provides a sort of two-way communication of nerve impulses back and forth between the brain and the pharnyx,larynx, esophagus, stomach and associated abdominal viscera(basically, your throat, windpipe, your tummy and guts), the heart, lungs and several more complex but irrelevant body organs or functions. The vagus nerve is the longest and most complex of the cranial nerves in the body.



The key point here is to make note that this nerve involves the "heart," the "lungs" and basically the whole digestive system of your tummy and intestines. Now let's pair that with some real specific and limited physiology about the heart and its rhythm.

We also need to bring clarity to some of the medical jargon being talked about by many of you in your messages. The term PVC, or Premature Ventricular Contraction, is just one of many arrythmias and not necessarily isolated to what many term as "palpitations." When we speak of palpitations, what we really mean is the presence of "ectopic" beats(heartbeats where there should not normally be)and the precise induction of these beats is felt by us as dancing of our heart or a flutter sensation in our chest, the prominence or intensity of which is determined by the precise moment of the extrabeats in proximity to the most recent beat and the upcoming beat or contraction of the heart ventricles or atria. Think of it in relation to your memory of your worst date, where the guy you're with has no rhythm whatsoever but wants to impress you with all the right moves and clumsily tries to introduce his own dance-step into your otherwise smoothly flowing and natural pace with the music.Depending upon his rather untimely entry, he can cause awkwardness that either simply causes you to quickly pause and regain your rhythm or literally trip you repeatedly until you're forced to leave the dancefloor. Well, the same holds true for the heart in our example. The extra beat, or palpitation might come at a point that's subtle, or it might be at a point where the heart stumbles repeatedly until normal sinus rhythm is regained. Now let's get to "why" palpitations occur.

The heart has a natural pacemaker called the sinoatrial node among several less distinct and similar pacers, which is stimulated by guess which nerve? You guessed it; The VAGUS nerve.

The vagus nerve helps regulate the heart in comparison to other functions taking place with other areas and is doing its job right now in each and every one of us. In fact, the variability of your heart rate during inspiration and expiration of your lungs is an effect of the vagus nerve. We've all noticed that when we take a breath in, our heart tends to beat just a little faster and when we breath out, a little slower. It's an entirely normal bodily function and is connected to the need by the body's system to respond to the environment.

Now that we kind of have a little medical background under our belts, let's take one of the complaints by many of you regarding the proximity or timely appearance of palpatations and indigestion. Remember that we said the vagus nerve is linked to both the tummy, the throat and the heart. Let's assume that we've eaten meal and it's caused us to experience some gastrointestinal discomfort, or in other words, gas. The irregular presence and activity by your tummy and intestines stimulates, more appropriately irritates, the vagus nerve which sends a rather inappropriate signal back along the pathway to guess where? That's right! The heart. Move to the head of the class. The heart is busy pacing away regularly and is relatively unconcerned with all the food you poured into your tummy, when all of a sudden in comes a signal from the vagus nerve because it has been inappropriately stimulated and tells the heart to beat. Well, just like our bad date example, the signal to beat is rather untimely and awkward but the heart has to accept it and respond. The result is extra beats that make the heart feel like it is stumbling. The degree to which it stumbles oftentimes depends upon the extent to which the vagus nerve is irritated and the relative state of indigestion present as the causitive agent.

There is most often no pain assoicated with this occurrence because it is not the result of a lack of blood or oxygen that creates the palpatation, but rather just a simple additional electrical impulse or series of impulses. Pericardial pain, or pain adjacent to the heart, can sometimes accompany palpatations or exist exclusive of any arrythmia, but is not necessarily considered pathologic or harmful to us. Remember that we're dealing with inappropriate electrical impulses and muscle tissue other than the heart that is partially innervated by the vagus nerve and can respond inappropriately, causing a jabbing or shooting pain than many describe as a "catch" in their chest. We'll talk more about chest pain in a bit.

Let's discuss the sensation that some of you described as a warm flushing sensation of your face and perhaps other body areas that accompanies the palpitations. Recall our anatomy lesson. The vagus nerve stimulates many areas of the body in response to our environment or internal conditions caused by the outside environment, ie. a meal that produces indigestion. The vagus nerve provides all of us with a stable process called vagal tone. This tone or stability keeps us in a state of balance so to speak with our environment. In response to environmental cues or situations, that tone or stability changes to prepare for what may be required. You've probably all seen a guy that makes your heart "skip a beat." Ever wonder why that phrase ever came about? Think for a moment. If you've ever been emotionally overcome, your heart races or feels like it pounds in your chest, we begin sweating, our blood pressure rises, we feel nervous and at some point our face is overcome by a warm flushing sensation that we attribute to nervousness or embarrassment. Well, guess what nerve plays a very big role in that entire process?
Right Again!!! The VAGUS nerve.

The above scenario would be a case of increased vagal tone. Well, if there's an increase, there's likely to be a case of decreased vagal tone as well. Indeed there is. decreased vagal tone can make us weak, nauseated, tremble, and even faint. It happens in cases of being excessively startled or frightened. Other conditions, such as diabetes can cause decreased vagal tone, but for our purposes we'll stick to conditions that by what I've read from all of you are non-disease provoking conditions, with the exception of one individual with Mitral Valve Prolapse but we'll touch on that in a bit.

Anyway, the point is that our body doesn't always accurately recognize proper environmental cues and the vagus nerve doesn't always know when and how to act. In other words, it misbehaves once in a while as a result of inappropriate stimulation. All sorts of things make the vagus nerve act out, including stress, anxiety, depression, illness and even ideopathic causes(origin or cause is unknown). In fact, there is work going on right now using electrical vagus nerve stimulation to treat depression, anxiety and even seizures.

And here's a little extra for those who cough when experiencing a palpitation. Recall your anatomy lesson again. Remember we said the vagus nerve stimulate the pharnyx, larynx, bronchi and esophagus. Well, what do you know. Those are exactly the processes involved in the cough reflex. So when the vagus nerve inappropriately stimulates the heart and causes a palpitation it also stimulates in some cases the cough reflex. How about that!

So we begin to see that the cause for palpitations and the palpitation itself is not a life-threatening occurrence at all. It concerns us for several reasons. First, it has to do with our heart and hey, that's the thing that keeps us alive basically. Big concern! Secondly, we've been bombarded by all the medical revelations and awareness about heart disease. But a case for heart disease does not make for every condition the heart demonstrates, especially palpitations. If you've ever had a cramp in your hand from typing too much, it probably never gave you pause to think you might not make it, so to speak. You reason in your mind that the cramp is caused by repetition fatigue and you need to take a break, massage your hand and rest momentarily. Well, palpitations can be considered sort of a cramp and nothing more. Under stress and other factors we talked about, the vagus nerve gets irritated or fatigued and acts out. Just because the heart is affected, doesn't mean that you've got heart disease or vascular problems that are looming. They're annoying,
worrisome and even frightening, but knowing where they come from and why will help go a long way in knowing that they are non-injurous and if we respond appropriately, will subside and we can go about our lives with far less worry.

Let's touch on anxiety for a moment. Anxiety, and depression too, can definitely cause a state of dysfunction in many areas of our body. Many patients who have these disorders are exhausted from constantly presenting themselves to the medical community with real and valid symptoms of pain, fatigue, bowel problems, vision problems, tinnitus or ringing in the ears, difficulty swallowing, excessive saliva, dry mouth, sore or sensitive tongue, and many many more troublesome circumstances only to have repeated tests all return normal. How can that possibly be?!! It's there, we feel it, we experience it, we hate it. Why doesn't the test confirm that it's there? How frustrating is that????

Well, here's some news that should make you feel a bit less frustrated and even comfort you. Most all tests are based upon the algorithmic, or sequential processing, of certain symptoms and signs that are all conclusive of various disease and illness. When someone with anxiety, depression or other condition that has somatic features (felt physically)undergoes these tests, the components that underlie the actual diseases which have similar symptoms simply does not add up and no presence of the actual disease is evident. So it's a case of false identity, sort of like having a biopsy of a mole that turns out to be benign. Looks like cancer, but is not cancer. Well, that same thing can happen to us with regard to all sorts of disorders and diseases. They look similar in presentation, but one reveals true disease and the other a nonpathologic condition or illness. So the next time your doctor tells you he can't find anything wrong, be glad for that much at least. Many people get far worse news!

So with regard to depression and anxiety, these conditions impart disturbance upon body functions. I suppose you're already guessing that the vagus nerve is not exempt from those circumstances and you're exactly right. So when you have an episode of anxiety, rest easy when you have a palpitation or two, or three or even four. The vagus nerve is irritated and needs a break or to reset. No problem whatsoever and you needn't worry any longer that a palpitation is sure indication of worse things to come. Nothing else happens. Just an extra heartbeat or two where there should not normally be. What a relief!!!!!

And the caveat I promised to the one individual with Mitral Valve Prolapse, your heart condition, while not necessarily life-threatening at all, does predispose you to panic disorder which I'm sure you are probably already aware.

Okay, so now we know what these palpitations are and what causes them. What the heck do we do about th'em? Well, there are several techniques that can help. Firstly, let me say that if a run of palpitations makes you feel faint or weak, don't panic and try to make it somewhere less embarrassing. Be safe and think smart. Squat to your knees or sit down until the feeling subsides. No sense in cracking open your skull by trying to make a mad dash for privacy. Anyone can feel faint and people in your company will always rally to your aid more often than not. So relax. The conditions will quickly pass and you'll be back to yourself in a jiffy.

Secondly, if you sense indigestion and gas, discomfort and bloating when the palpitations are present, try merely changing positions which often causes the distention to realign from its offending position proximal to the vagus nerve.

If you're pregnant, well indigestion or gestation. It doesn't matter. What's important to realize is that both conditions represent a temporary rearrangement and limited space downstairs. That means proximity or closeness to the nerve receptors of the VAGUS nerve and you're going to get palpitations when conditions are right.

As for the palpitations themselves, taking slow, deep breaths repeatedly will typically cause the palpitations to cease. Recall your anatomy lesson. The vagus nerve stimulates the lungs as well as the heart, so this purposeful stimulating of intention-breathing will often interrupt the irritation signal.

If you're experiencing tachycardia(racing heart), then if a fountain or bathroom is nearby, apply cold water from your hands to your face and while holding your hands against your face, press gently, repeat GENTLY, on your eyes. This will invoke what is termed the "dive reflex" and will cause your heart rate to decrease in most cases. Regardless, tachycardia, like palpitations is not harmful in of itself, just a bit unnerving.

The key in all cases is to do your best to remain calm and rational. Know from our little lesson what it actually taking place and that you'll be fine.

Finally, we'll save a lot of space here by simply stating that with regard to any of the conditions either described or that you're experiencing, do not substitute a support group for responsible notification of your symptoms to your personal primary care doctor. We live in an age where medicine is oftentimes scoffed at by many who fail to realize the benefits they expect. Yes, it's true that medicine is not a perfect science, but neither are human beings. It is difficult at best to create perfection from imperfection. But even so, we all must give recognition that many thousands of people are being cured of certain cancers that just a decade ago would have meant their demise. Simple penicillin saves hundreds of thousands in third world countries that would otherwise perish from infection.

So don't become discouraged that medicine doesn't find something wrong with you. Feel blessed that they don't have less encouraging news for you. I exist in an occupational environment where disease and illness is very concentrated. It is of great joy and optimism that I can walk from conditions such as those to the sanctuary of my private life and know that I'll return tomorrow.

You too, all of you, need to be thankful that your condition is benign and that you have the power of influence over its effects.

So kick up your heel, give a shout, grab the keys and your husband's credit cards with the highest limit and PREPARE TO SHOP! Those pesky palpitations are but a mere nuisance and you have the rest of your life to live, so get busy and do the voodoo that you do best!

best regards and good health. Feel free to write if you care to and I'll do my best to answer, but no promises.

and this is for all the attorneys circling overhead who strive for a willing plaintiff, or even an unwilling one.

THIS COMMUNICATION REPRESENTS OPINION BASED UPON MEDICAL FACTS AND IS IN NO WAY INTENDED TO REPLACE OR SUPPLANT THE NEED FOR PERSONS TO DIRECT THEIR MEDICAL NEEDS AND INQUIRY TO THEIR PERSONAL FAMILY DOCTOR REGARDING THEIR HEALTH.

Permanence: Part 2 of 5

People who give up easily believe the causes of the bad events that happen to them are permanent: The bad events will persist, will always be there to affect their lives. People who resist helplessness believe the causes of bad events are temporary.

In 1965, Seligman and some of his colleagues set up an triadic experiment for creating an animal model of helplessness. The first dog was given escapable shock: By pushing a panel with its nose, the dog could turn off the shock. The second dog was given inescapable shock: Nothing the dog could do would cease the shock. And the third dog was given no shocks at all. All 3 dogs were then placed in an experimental shuttlebox. All three were given shocks but they could easily escape the shocks by hopping over the low barrier dividing one side of the box from the other. Within seconds the dog that had been taught to control shocks discovered that he could jump over the barrier and escape. The dog that earlier had received no shocks discovered the same thing. But the dog that had found nothing it did mattered made no effort to escape, even though he could easily see over the low barrier to the shockless zone of the shuttlebox. Pathetically, the dog gave up and lay down, though it was regularly shocked by the box. It never found out that the shock could be escaped by merely jumping to the other side.

What do all these depressing animal experiments have to do with me and my heart palpitations? Well, sometimes I feel like I'm the dog that has learned that no matter what I do, I will be permanently "shocked" by heart palpitations. In fact, sometimes when I get them bad, I literally feel like someone is zapping at my heart and making it go into arrhythmia. At this point I feel helpless and start to whimper. I get anxious and even more depressed that I'm so powerless. I feel like the permanence of having to forever deal with heart palpitations and the anxiety that comes with it is just too much for me to bear. Even though I know that there are things that can help alleviate them, sometimes I'm just too depressed to even try again.

But there is hope. Once I believe that heart palpitations are never permanent, that they will come and go in my life like the passing of the wind, that the future of medicine and technology will someday discover a cure for heart arrhythmia, that I have the choice to take care of myself and reduce my stress levels, that I can trust my doctors and their benign diagnosis, and that I'm in the hands of a loving God, THEN they will only bother me temporarily. They'll still bother me, but they will go away. I will learn to leap over the barrier from depression to life.

Learned Optimism : Part 1 of 5

For the most part, I have come to accept the occasional heart palpitations. However, when I have a lot of stress, illness, or hormonal fluctuations and my heart goes into arrhythmia, I sometimes get very depressed. Usually, I get down because of the chronic nature of my condition. To think that there is no cure, and that I could suffer with them for the rest of my life, is uber depressing. To not always have the energy to do or accomplish things in my life for fear of stress and its effect is also depressing. I was feeling pretty low after the holidays when I told my mom how devastating it is when you feel like there's no real hope and you'll be living with misbeats forever. Her response is one I had heard her tell me before. "Ali," she says, "doctors are always coming up with new medicines, procedures, cures. I'm confident that you will find some sort of relief in your lifetime." "But mom," I protest, "if doctors are always saying that I'm fine, why would anyone be working on a cure for some benign pvcs?" And she replied, "They're bothersome to enough people. I'm sure they're working on something to alleviate them in the future."

Now I have no idea how sound her research hopes may be, but one thing is for sure. When it comes to my health, my mom is an optimist. And I'm the pessimist. I recently stumbled across the book "Learned Optimism" by Martin E. Seligman. His book is full of research on why individuals get depressed and how pessimists can in fact learn to be optimists. But not through mindless devices like whistling a happy tune or mouthing platitudes, but by learning a new set of cognitive skills. I will discuss the how to change part in the last of my series.

Whenever something good or bad happens to us, we react in our explanatory style. So whether we give up easily, believe we are deserving or become hopeless all have to do with our view of our place in the world. Seligman argues that there are 3 crucial dimensions to our explanatory style: permanence, pervasiveness, and personalization. I will discuss each of these in detail because I believe they are key to wading through the waters of a chronic condition.

Reflections

I've always thought New Years Day is a totally overrated holiday. Since I now have a small child who's an early riser, staying up until Midnight just to say "Happy New Years" does not sound like my idea of fun. But even before that, I was disillusioned with New Years. I'm sure as a young girl I came up with resolutions for the new year like 1) study more 2) hit my sister less 3) be nicer to my mom. And I'm sure I always failed...like within 24 hours. And I know I'm not alone. Studies show that two-thirds of New Year's resolutions are kaput by St. Patrick's Day. So after failing and failing at keeping my resolutions, the past few years I haven't even bothered to make them in the first place.

So today instead of setting myself up for inevitable failure, I thought I would take a few moments to reflect on 2010 and dream about 2011.

Reflections of 2010:

1) Making my health a priority. Exercising regularly this Spring and Summer including jogging, swimming, yoga, and weight lifting.

2) Blogging (semi) regularly

3) Learning to accept that I need more sleep than most people and trying not to ignore that fact. I napped during the day when my child napped.

4) Making a lot of authentic relationships with other moms at my church and in my neighborhood. I'm so grateful to have such an amazing group of friends in my life.

5) Treating myself to Girls Night watching "The Bachelor" and sipping Mexican martinis.

6) Rejoining the church choir. It's been nice to worship God in this way. I had some performance anxiety in the beginning, but I worked through my irrational fears.

7) Taking the Marriage Course at my church last Spring did wonders for helping my spouse and I to communicate more effectively. And the 4 course dinners and childcare were amazing!

8) Remodeling our kitchen was a pain but it will be well worth it. Thank you my dear sweet Jake for all your help and patience. And thank you to my parents for opening up their home to us for 3 weeks while it was being worked on.

Dreaming of 2011:

1) Make my health a priority. Exercising not just in the Spring and Summer, but also in the Fall and Winter.

2) Remember to take a multi-vitamin every day!

3) Find a therapist. (It's been a couple years now since my last therapist retired. I'm hoping I can find one that I can occasionally see if my panic/heart palpitations flare up.)

4) Read the bible (a lot more regularly).

5) Cook healthy meals for my family. I'm hoping my new kitchen will help. Maybe start a vegetable garden?

7) Do less

8) Love more (and that includes myself)

Postscript: I did make it up until Midnight last night. We had to cancel our plans with friends because my husband got sick, but I did ring in the new year with my sister and her boyfriend. And by "ring in" I mean I got out of the bathroom in my pajamas to give them both a pathetic hug. But I made it, and I'm ready for 2011.