What happens when the doctor starts having symptoms?

It was the Saturday after Thanksgiving. My wife and I decided to go have a nice dinner, so we splurged and took the kids out to a nice restaurant. In total I had three alcoholic drinks that night (my wife drove, but I was not tipsy or inebriated).

Once at home, as we were getting our kids ready for bed, I began having palpitations. Every few seconds I felt my heart jump. I could feel the short pause before the next beat. It would catch my breath.

I've never had palpitations before, at least not like this. Maybe two or three times in my whole life I had felt a single abnormal beat, but never more than that. This time, the palpitations seemed incessant.

Ten minutes in, and they still were not abating. I went and drank 2 large glasses of water to no avail. Every 5-10 seconds my heart skipped. I used my iWatch and checked my heart rhythm (modern technology is great, and as an Electrophysiologist I had to have a watch that could do a simple ECG) and found that I was having frequent premature atrial contractions (PACs).

After an hour, it was bedtime. Interestingly, when I got into bed, lying down, the palpitations seemed to improve, and I was able to get to sleep without issue.

The next morning, I awoke, and I had hoped that the palpitations were gone. They weren't. Right after my first cup of coffee, the palpitations set in again. Again, they seemed to go on for a long time. They did not stay all day, but they popped up repeatedly throughout the day, with seemingly no rhyme or reason. Sometimes, if they were persistent enough, I would have the sensation I needed to cough (a well-documented symptoms sometimes exhibited with PACs).

By Monday, the third day, I started to wonder whether these PACs were going to stay with me forever. While I know they are benign, and the overall burden of them was low enough that I did not need treatment, they were nonetheless very bothersome for me. Many people with PACs have no idea of them, and in fact, most of us probably have a few and never know it; but I could seemingly feel EVERY. SINGLE. ONE!!!

Monday night, I realized that something needed to change. It was time to do what I tell my own patients who suffer from PACs and similar rhythm issues who do not yet warrant medical or procedural intervention.

I did a moderate work out. I drank more water. I went to bed earlier than usual and got more sleep. And finally, on Tuesday morning I avoided my usual 4-shot Café Americano.

This all seemed to help. Most of Tuesday I had almost no palpitations, and when I did, they seemed much less frequent. I was still nervous about it, but the worst seemed behind me. For the next few days, I was more attentive to my own health. I relaxed more. I ate a bit healthier and avoided any alcohol and minimized caffeine (I found that my caffeine withdrawal headache needed about a third of a regular small coffee to keep the monster away).

Looking back, I suspect that my few days of PACs were due to multiple contributing factors. The Thanksgiving weekend meant more food. Alcohol consumption likely also contributed, even though at no time did I drink excessively. With a long holiday weekend, I also stayed up later and slept poorly.

While I suspect that I will have palpitations again, I can hope that it will be a long time before that happens. I do certainly have a better understanding of some of the symptoms my own patients experience. I do also have personal experience now that sometimes conservative interventions (hydration, sleep, caffeine and alcohol avoidance, stress reduction, exercise, and weight reduction) can have a dramatic and rapid impact on these rhythms and their associated symptoms. I appreciate even more now that while I can do a lot to try to improve someone's rhythm, they must have an active role in improving their physical health. Indeed, while medications and procedures can do a lot, they likely pale in comparison to the impact of losing weight, sleeping well, staying hydrated, quitting smoking and excess alcohol, and exercising routinely.