Randy Cassingham's Blog

So, there was no free edition on Friday, August 22. There were definitely reasons for that, and at first I decided I wasn't going to say all the reasons why. But after thinking about it, and recovering from the problem I'm about to tell you about, I decided I owed you an explanation.

I was in a pretty bad mood on Friday. I didn't feel well, and there were no advertisers, who pay the freight to send out 109,000 e-mails. Usually when that happens, I just pay it myself, but last week there were few upgrades, so I was not feeling very flush. And because I wasn't feeling well, I was grumpy. "No support? Then forget it!" I thought to myself.

I went out to dinner with my wife. Even though I was grumpy, we had a nice time. She was quite surprised I had blown off the week's issue; she had never seen me do that before. She's a good wife, though: she saw I was grumpy and didn't push it.

But when we got home, I wanted to go to bed -- about three hours earlier than usual. "What's wrong?" she asked. She had asked that before, but her tone of voice communicated she wanted a real answer. I held out my arm and said, "feel my pulse."

Like me, she's an EMT. She felt my pulse, and I saw her eyebrow go up.

I sometimes suffer from non-perfusing PVCs. In layman's terms, a "pre-ventricular contraction" is a heart rhythm abnormality; when the heart muscle is irritated, usually due to excessive stress, it can trigger a premature contraction of the left ventricle, the main pumping chamber of the heart. The ventricle is definitely not where the normal heart pacemaker is. When it fires off way too early, that beat of the heart is ineffective; no blood is pumped, so it's "non-perfusing". You can definitely feel it in someone's pulse; it's a missed beat. It can be startling.

This is nothing new for me; I get PVCs all the time, including during a cardiac stress test I had a few years ago that confirmed I had a healthy heart. I typically have a few, then they go away. It's nothing to be concerned about at all. Most people have them from time to time.

But this time, for me, they weren't going away, and they were frequent.

Many people who have PVCs can feel them in their chest; they're called "palpitations". After hours of this, they were really starting to irritate me. They don't actually hurt, but they're ...well... irritating after awhile.

Kit checked my blood oxygen level; it was fine. She checked my blood pressure; it was fine. She checked my pulse again; it was ...concerning; I normally have a strong, regular pulse.

She begged me to let her call a paramedic. In our house, "calling paramedics" isn't the same as "calling 911"; she didn't summon an ambulance, she called my volunteer job boss, the county's chief paramedic, at home. But he was out of state, speaking at a medical conference. So Kit called his deputy at home. By this time it was close to 10:00 p.m. Kit just wanted her to check me out to ensure I wasn't dying. I knew that already, but a wife likes a second opinion on these things.

So the assistant chief agreed to meet us at the ambulance station, which is 20 minutes away. By the time we arrived everything was set up; I lay down on the gurney and she did a 12-lead EKG on me. It showed what I expected: a fine, healthy heart rhythm -- punctuated by frequent PVCs:

This tracing shows just 10 seconds, and there were three PVCs (shown by the arrows). That's "frequent" to be sure. "Lead 1" (upper left) gives you the idea that it really is a missed beat; there's no spike there. The other "leads" show the electrical disturbance of the ectopic beats. When you see it on the heart monitor, there's no wondering what it is!

By then, it was going on about six hours. The acute treatment: a beta blocker to calm my irritated heart, and a good night's sleep. It took a couple of hours for the drug to really take effect, and by the time I got home and settled into bed, I indeed got a good night's sleep. I took it easy all day Saturday, too.

It wasn't a "heart attack" or anything to really worry about. It's a long-term and common problem that was apparently exacerbated by excessive stress, which certainly can be something to worry about. Long term, I need to de-stress and get more exercise.

What stress? Well, it was no picnic to deal with the recent Yahoo debacle and the threat to my business. (I didn't mention that I got a bunch of mail accusing me of being a spammer -- heck, if some yahoo said I was a spammer, then surely I must be! No matter that I'm actually a very vocal anti-spammer and have been for more than 10 years; no matter that spammers don't list their names, addresses, and phone numbers on their web sites -- I do. Etc. But I digress.)

I've also got my recently launched video series, my recently re-launched True Stella Awards newsletter, Jumbo Joke, Cranky Customer, Groxx and more -- and I run most of it myself. And there have been a lot of ambulance calls I've run on this summer, including last week being first-in for an unconscious 16-month-old near my house. Yep: I've been pushing pretty hard lately.

What this is not is an end to True -- that's what I do for a living. I've mostly already given up work on Cranky Customer. I've got some volunteers to help with Groxx (thanks, folks!), and others helping with the Bonzer Sites write-ups (thanks too!) My new format for the Stella Awards is pretty easy, and I've already said I won't be doing it weekly. And the tourists will be heading home soon, so the ambulance calls will slow down. So mostly, not counting a little crisis with Yahoo here and there, I'm doing OK.

But, that said, I may cancel the free edition of True from time to time if there are no advertisers to pay for it -- I'm going to stop paying for it out of my pocket unless there were a lot of Premium upgrades that week to ease the cash flow. "Free" I don't mind; it's the "at Randy's sole expense" part that needs to stop. So there's only one way to be sure you get True every week: get a Premium upgrade, since those will continue uninterrupted.

For those who can't afford an upgrade, I understand, and I'm sorry. But if you can't afford $24/year, maybe you'll understand that I can't afford over $100 a week to send it to you. If there's a sponsor or advertiser, I'll be happy to send it out. But from here on out, the only way to be sure you get True every week is to upgrade.

Meanwhile, I'll be figuring out what else I can have my assistant do. I'll be taking more time off, answering less e-mail (but I'll still read it all). And I'll be paying even more attention to my wife. Thanks for your support, sweetie!

August 27 Update: Diagnosed

When I saw my physician Monday to follow this up, he pondered what the real cause might be. I've been stressed and tired plenty of times without having heart arrhythmias; what's different now? He of course asked about recent changes (diet, exercise, medications, anything?), but there were none. He wanted blood to check my electrolytes -- substances in the blood that help electrical conduction.

Bingo! The results came back that I had hyperkalemia (hyper = too much, kal = K = potassium, emia = related to the blood) -- excessive potassium in my blood. Potassium is absolutely required for proper nerve and muscle function, but too much can cause cardiac irritability -- my symptom exactly. It wasn't so much that it was causing changes to every heartbeat, which can be seen on the EKG, but enough that it -- plus the increased stress I've been under -- is the apparent cause of the premature contractions. There are drugs that can lower potassium in a hurry if it's a big problem, but mine isn't that bad.

I think (and hope!) I have figured out what might be causing it -- the PVCs kept coming back. At first I thought it was a new nutritional supplement a few months ago, but discontinuing it didn't help. I did some more research on hyperkalemia and I think I have a handle on what's causing it. I'll update this again in a few days. I'm still planning to work on de-stressing my life, though!

Mystery Solved

It wasn't the dietary supplement I thought it was -- it was another one. I discontinued it on a Thursday, felt significantly better Thursday night, and by Friday September 12 was all better (and symptoms haven't returned). The supplement? Pure vitamin C (powder, that I was mixing into juice daily). It is perhaps not as "pure" as advertised. I'm going to see if I can get a chemical analysis to see if it's contaminated with something.

Boy, do I feel a lot better! But I'm still going to work on de-stressing a bit.