Atrial Fibrilation? Really? How weird

[douglas]

I have recently been having some rather unnerving health problems and would like to know if anyone else has experienced anything similar and/or has any thoughts on the matter. Sorry for the rather lengthy post, it's just that it is all a bit complicated.

Here's some background: 39 years old; smoked 1 pack/day camel lights for 20 years; quit analogs completely and started vaping 1 1/2 years ago (Nov '09). Cut down from initial 18-24mg to 11mg after 2-3 months (~2.5ml PV/VG liquid/day). I'm a huge fan/believer of vaping and very happy not to be smoking analogs anymore, and have seen immediate and dramatic improvements in health, lifestyle, and overall happiness!

However, and here's where things get strange/complicated. About 7-8 months ago, I had a 'spontaneous pnuemothorax' (100% lung collapse) in the left lung, accompanied by tachycardia (rapid-heart rate). Tachycardia is of course a normal side-effect of this as your heart is trying to pump twice as much oxygen from your 1 functioning lung. Went to emergency room, got lung re-inflated with a one-way air valve poked through my rib cage; 1-2 somewhat painful weeks later with some r&r — problem solved.

Forward 6 months. Since then, been having episodes of increased/irregular heart rate. Mild and infrequent at first and progressively getting stronger and more frequent within the last month or so. Most recent episodes have been almost daily with 160-190 pulse lasting between 20 min to 1 hour or more! Disconcerting to say the least. Went to get it checked out; was given an event monitor to wear; monitored/recorded several events; was diagnosed with atrial flutter/fibrillation; put on drugs to control heart-rate/rhythm with mild mixed success. If the drugs don't work or if it does not resolve itself, one option is to get a 'catheter ablation procedure' (relatively safe surgical procedure where they heat/scar small areas of tissue within the heart to disrupt electrical pathways that are causing the abnormal rhythm). Ouch... I don't care how 'safe'... that doesn't sound great.

So, basically, this sucks. I'm relatively young (39), otherwise completely healthy, fit (don't exercise much but not out-of-shape or overweight at all), normal everything (blood pressure/blood tests/cholesterol/chemical balance), eat well (some coffee and alcohol but not abusive by any means). Which leads me to wonder what might be contributing to this or am I just genetically susceptible? Naturally it has led me to question everything I do, including vaping. And I have of course specifically questioned my doctors about my PV use, and they seem to unanimously think that it is NOT a contributing factor. hmmm.... ok. Nor do they think that the aFib is in any way related to the tachycardia, except in that it may have triggered an otherwise existing condition.

Doctor's approach seems to be: give me drugs (with potentially long-term damaging side-effects) or invasive surgery. Not great options. Naturally, I would like to try everything I can first to avoid either of these 'solutions'. I could maybe quit everything (caffeine, nic, low-stress, more exercise, vegetables, etc) and live an extra-super healthy lifestyle, however, that doesn't sound too fun (or realistic).

So here's my dilemma... 2.5mL of 11mg is not a lot of nic in comparison to what many/most others on this and other forums are using. And I haven't read any accounts like this anywhere in relation to vaping. Is it even remotely possible that I am getting nicotine poisoning from such a low concentration? I really doubt it. But to put it to the test ... I have ordered some 8mg and 0mg liquid to see if maybe cutting back or eliminating nic helps (if it's related at all, which it probably isn't). If that doesn't work maybe quiting vaping altogether for a few (difficult) days as a test to see if its related to PG/VG (which it probably isn't). Or maybe trying VG vs PG juice (although had no problems for the first 11 months so don't know why I would now). Could even try analogs again (yuk) to see if that helps... lol. A bit at a loss on how to proceed.

As a side-note, I have to say that I hate to even suggest that there is any correlation in that I am a huge fan/believer in PVs, but at the same time I need to take everything into account, including diet, lifestyle, genetics, alignment of the planets, et al. More so, I hate the fact that this is one of my first posts here, because I am a huge fan, not only of vaping but of this forum as well, and could easily post hundreds more to praise the joys and benefits, and have even had success getting many others off the analogs (even people that thought they were hopeless causes).

Any advice or thoughts or accounts would be greatly appreciated. Thanks.

 

[CES]

And I have of course specifically questioned my doctors about my PV use, and they seem to unanimously think that it is NOT a contributing factor. hmmm.... ok. Nor do they think that the aFib is in any way related to the tachycardia, except in that it may have triggered an otherwise existing condition.


So here's my dilemma... 2.5mL of 11mg is not a lot of nic in comparison to what many/most others on this and other forums are using. And I haven't read any accounts like this anywhere in relation to vaping. Is it even remotely possible that I am getting nicotine poisoning from such a low concentration? I really doubt it. But to put it to the test ... I have ordered some 8mg and 0mg liquid to see if maybe cutting back or eliminating nic helps (if it's related at all, which it probably isn't). If that doesn't work maybe quiting vaping altogether for a few (difficult) days as a test to see if its related to PG/VG (which it probably isn't). Or maybe trying VG vs PG juice (although had no problems for the first 11 months so don't know why I would now). Could even try analogs again (yuk) to see if that helps... lol. A bit at a loss on how to proceed.

I'm sorry to hear about your health issues. I find it interesting that the docs don't think that it's connected to PV use or nicotine use. Please don't try smoking again- I can't imagine that could possibly be better.

Since you're still concerned and still having problems, and want to avoid nasty drugs and surgery, cutting your nic levels sounds like a reasonable way to proceed. Since nicotine is a vasoconstrictor there is the potential for effects on the heart. However, if you're not getting the nausea and headaches that usually accompany too much nic, I suspect that nicotine isn't the culprit.

Experimenting with only PG or only Vg sound like reasonable options, the problem is, that if the heart symptoms are fairly random you may not get much more clarity with the PG/VG tests. Since your doctors are aware of your vaping and your concerns with it- perhaps you'd be able to work with them to determine the best way to specifically test whether vaping is involved.

Good luck and i hope you find a simple, easily treatable cause!

 

[sheryder]

Sorry for your health issue Douglas. Hope it gets resolved soon. Great common sense way to proceed IMO also. Eliminate the cause if possible and if not possible, treat it as advised. I vote NO to starting smoking also-bad effects from that would surely outweigh ANY possible positive effect. Good luck and keep us posted.

 

[StormFinch]

I second CES and Sheryder's posts with a mild 'what are you thinking'? Cigarettes are just going to increase the carbon monoxide levels in your body and make it really hard on your heart and lungs. In fact, the 20 years of smoking pre-ecig may well have been the original culprit in this chain of events.

I've lived with a mitral valve prolapse for most of my life and my resting heart rate off meds can be as high as 120 bpm, so I sort of know where you're coming from. It's better off cigarettes and on e-cigs, and no different than when I managed cold turkey for a while, so I tend to agree with your doctors. You can try to cut your nic down, go to decaf, and avoid as much sugar/white flour as possible to see what effects it has, but this may just be one of those things you're going to have to chalk up to living life and have it treated. You could also get the opinion of a good holistic practitioner, but keep in mind that the heart is not something you want to play around with too much.

Whatever you decide to do, I wish you the best possible outcome.

 

[mwa102464]

Is it possible this is from the long term use of cigarettes then once you started vaping the Nic you where using sped up the process of what was going to happen sooner or later anyways as long as you continued using Nic. I have to agree that cutting your Nic to 0 would be the very first choice and way to go here and see if this stops all the bad issues with the high pulse rate and heart racing, just cut the Nic all together and run the 0mg it cant hurt to try this, however if me I would stop everything for a while until you regain your health back to where you have no issues at all just to protect yourself totally so nothing else happens or gets worst, nothing wrong with going healthy for a while on the body with all you have going on here, it's your wisest choice in my opinion, I'm no Dr but clearing out everything would be my first choice and regain your health FIRST !!!

 

[db13berry]

For me, someone who is 38 years old, with similar heart problems, would get the meds and/or procedure done and cut out the nicotine. I, too have no problems with blood pressure, cholesterol, triglycerides, etc. I am normal weight, but I do have the tachycardia, which has greatly improved by stopping smoking and keeping my nicotine level between 0mg and 10mg at around 3mls a day (mostly 0mg). I only have one caffeinated beverage a day. I do have a family history of heart problems and both of my parent dieing at a young age from heart disease. I also take medications for cholesterol and a beta blocker as a precautionary measure. My brother, who has never smoked, does the same.

My father was a smoker. He had his first heart attack at 38 and his second at 42, which was massive and fatal. This was the early eighties. Doctors couldn't fix things then like they can now. My mother, who never had any health issues or a single chest pain or irregular heart beat in her life, suddenly became severely short of breath, was taken to the ER, tests run, discovered blockages, had triple bypass surgery done, and died 3 days after the surgery. She was 58.

I believe your issues are related to your history of smoking and potentially family history (?). You are just now reaching the age for these problems to rear their ugly head. If I were you, I would lower your nic as much as possible (or stop completely if possible. Anxiety can be just as bad on the body), stop any caffeine, get a second opinion from another doctor if you need to to ease your mind, and follow what your doctors recommend. The heart is not something you want to delay treatment with. Good Luck to you and please update us.

 

[Sly9377]

I have recently been having some rather unnerving health problems and would like to know if anyone else has experienced anything similar and/or has any thoughts on the matter. Sorry for the rather lengthy post, it's just that it is all a bit complicated.

Here's some background: 39 years old; smoked 1 pack/day camel lights for 20 years; quit analogs completely and started vaping 1 1/2 years ago (Nov '09). Cut down from initial 18-24mg to 11mg after 2-3 months (~2.5ml PV/VG liquid/day). I'm a huge fan/believer of vaping and very happy not to be smoking analogs anymore, and have seen immediate and dramatic improvements in health, lifestyle, and overall happiness!

However, and here's where things get strange/complicated. About 7-8 months ago, I had a 'spontaneous pnuemothorax' (100% lung collapse) in the left lung, accompanied by tachycardia (rapid-heart rate). Tachycardia is of course a normal side-effect of this as your heart is trying to pump twice as much oxygen from your 1 functioning lung. Went to emergency room, got lung re-inflated with a one-way air valve poked through my rib cage; 1-2 somewhat painful weeks later with some r&r — problem solved.

Forward 6 months. Since then, been having episodes of increased/irregular heart rate. Mild and infrequent at first and progressively getting stronger and more frequent within the last month or so. Most recent episodes have been almost daily with 160-190 pulse lasting between 20 min to 1 hour or more! Disconcerting to say the least. Went to get it checked out; was given an event monitor to wear; monitored/recorded several events; was diagnosed with atrial flutter/fibrillation; put on drugs to control heart-rate/rhythm with mild mixed success. If the drugs don't work or if it does not resolve itself, one option is to get a 'catheter ablation procedure' (relatively safe surgical procedure where they heat/scar small areas of tissue within the heart to disrupt electrical pathways that are causing the abnormal rhythm). Ouch... I don't care how 'safe'... that doesn't sound great.
So, basically, this sucks. I'm relatively young (39), otherwise completely healthy, fit (don't exercise much but not out-of-shape or overweight at all), normal everything (blood pressure/blood tests/cholesterol/chemical balance), eat well (some coffee and alcohol but not abusive by any means). Which leads me to wonder what might be contributing to this or am I just genetically susceptible? Naturally it has led me to question everything I do, including vaping. And I have of course specifically questioned my doctors about my PV use, and they seem to unanimously think that it is NOT a contributing factor. hmmm.... ok. Nor do they think that the aFib is in any way related to the tachycardia, except in that it may have triggered an otherwise existing condition.

Doctor's approach seems to be: give me drugs (with potentially long-term damaging side-effects) or invasive surgery. Not great options. Naturally, I would like to try everything I can first to avoid either of these 'solutions'. I could maybe quit everything (caffeine, nic, low-stress, more exercise, vegetables, etc) and live an extra-super healthy lifestyle, however, that doesn't sound too fun (or realistic).

So here's my dilemma... 2.5mL of 11mg is not a lot of nic in comparison to what many/most others on this and other forums are using. And I haven't read any accounts like this anywhere in relation to vaping. Is it even remotely possible that I am getting nicotine poisoning from such a low concentration? I really doubt it. But to put it to the test ... I have ordered some 8mg and 0mg liquid to see if maybe cutting back or eliminating nic helps (if it's related at all, which it probably isn't). If that doesn't work maybe quiting vaping altogether for a few (difficult) days as a test to see if its related to PG/VG (which it probably isn't). Or maybe trying VG vs PG juice (although had no problems for the first 11 months so don't know why I would now). Could even try analogs again (yuk) to see if that helps... lol. A bit at a loss on how to proceed.

As a side-note, I have to say that I hate to even suggest that there is any correlation in that I am a huge fan/believer in PVs, but at the same time I need to take everything into account, including diet, lifestyle, genetics, alignment of the planets, et al. More so, I hate the fact that this is one of my first posts here, because I am a huge fan, not only of vaping but of this forum as well, and could easily post hundreds more to praise the joys and benefits, and have even had success getting many others off the analogs (even people that thought they were hopeless causes).

Any advice or thoughts or accounts would be greatly appreciated. Thanks.

I have actually had this procedure done twice. I was born with an extra nerve bundle in my heart that they had to get rid of. They were able to remove part of it (it is located on the main nerve bundle in my heart) and I take medicine as well and have not had an even lasting more than 10-12 seconds in over 17 years

 

[douglas]

Since you're still concerned and still having problems, and want to avoid nasty drugs and surgery, cutting your nic levels sounds like a reasonable way to proceed. Since nicotine is a vasoconstrictor there is the potential for effects on the heart. However, if you're not getting the nausea and headaches that usually accompany too much nic, I suspect that nicotine isn't the culprit.

Thank you for the kind words. I do remember from my smoking days and early vaping days what it felt like to have too much nicotine. The first thing you feel is the nausea more so than anything else. This definitely isn't that, which is why I suspect that nic overdose is not the culprit. However, nic still may be a contributing factor. From what I have been told, normal 'sinus rhythm' (normal heart rhythm) promotes normal 'sinus rhythm' and tachy promotes more tachy — the whole thing has a kind of positive feedback loop. So it's very possible that I am just extremely susceptible to any triggers atm (i.e. stress, caffeine, nicotene, dehydration, etc.) and a small dose of any of these things in combo can trigger an event.

I will never go back to smoking! So don't worry. Was more of a joke than anything. However, at this point I would feel totally safe doing a test with cigarettes to eliminate vaping nicotine vs. smoking nicotine. If the smoking proved successful the conclusion would be to stop both—certainly NOT to go back to smoking. Smoking just does not appeal to me anymore in the least.

I guess what I'm trying to figure out systematically is which, of the few pleasures I have, do I need to eliminate and how much, what am I willing to sacrifice, or is all of this a mute point and I must simply accept the fact and get a procedure done.

 

[douglas]

For me, someone who is 38 years old, with similar heart problems, would get the meds and/or procedure done and cut out the nicotine. I, too have no problems with blood pressure, cholesterol, triglycerides, etc. I am normal weight, but I do have the tachycardia, which has greatly improved by stopping smoking and keeping my nicotine level between 0mg and 10mg at around 3mls a day (mostly 0mg). I only have one caffeinated beverage a day. I do have a family history of heart problems and both of my parent dieing at a young age from heart disease. I also take medications for cholesterol and a beta blocker as a precautionary measure. My brother, who has never smoked, does the same.

Thank you for your account. I'm not the only one? I would find that comforting, except that I would never wish this on anyone—so for that, I do wish I were the only one. I'm sorry to hear about your health issues and parents—wow.. that's terrible... so young. I am, however, glad to see that you have managed to find somewhat of a balance between some simple pleasures and your health conditions. Btw... what medication are you taking for the tachy? Is that the beta blocker? Just curious. They have me on some designer drug called multaq (I think its rather new + $5/pill... ouch... and not very effective to boot). I think I may request to try a different drug (in consult with my doctor of course). Thanks again ... I will keep you informed.

You are just now reaching the age for these problems to rear their ugly head.

What?! you mean I'm getting old. O... great!

 

[douglas]

I have actually had this procedure done twice. I was born with an extra nerve bundle in my heart that they had to get rid of. They were able to remove part of it (it is located on the main nerve bundle in my heart) and I take medicine as well and have not had an even lasting more than 10-12 seconds in over 17 years

Thanks for the account. Great to hear that your ablation procedure was effective and without incident, and that you have it under control. It's all very scary, isn't it? I assume you are a vaper as well? Curious what concentration and quantity you consume? And what, if any effects you notice, if at all?

 

[douglas]

... nothing wrong with going healthy for a while on the body with all you have going on here, it's your wisest choice in my opinion, I'm no Dr but clearing out everything would be my first choice and regain your health FIRST !!!

I don't think you need to be a doctor to make such a fine recommendation I'm certainly leaning that way myself. Always a bit more difficult in practice than in theory however. Just trying to figure out what and how much I'm willing to sacrifice, before resigning myself to what may be a simple fact. Thanks for the advice.

 

[douglas]

I second CES and Sheryder's posts with a mild 'what are you thinking'? Cigarettes are just going to increase the carbon monoxide levels in your body and make it really hard on your heart and lungs. In fact, the 20 years of smoking pre-ecig may well have been the original culprit in this chain of events.

I've lived with a mitral valve prolapse for most of my life and my resting heart rate off meds can be as high as 120 bpm, so I sort of know where you're coming from. It's better off cigarettes and on e-cigs, and no different than when I managed cold turkey for a while, so I tend to agree with your doctors. You can try to cut your nic down, go to decaf, and avoid as much sugar/white flour as possible to see what effects it has, but this may just be one of those things you're going to have to chalk up to living life and have it treated. You could also get the opinion of a good holistic practitioner, but keep in mind that the heart is not something you want to play around with too much.

Whatever you decide to do, I wish you the best possible outcome.

Thank you. One of my best friends and former roommates is actually a highly regarded LaC/TCM practitioner (Traditional Chinese Medical Doctor) and I have been consulting with him. However, I am a bit weary of trying both western drugs and eastern herbal therapies in concert, as I know that many of the herbs are very powerful, and may have interactions. As a an example, one of the warnings on the drug I'm taking is not to consume with Grapefruit Juice.... what?!... that is just too weird... and how the hell do they know that anyway? lol

And not to worry—not going back the smoking route! Done with that. Thanks again.

 

[douglas]

Sorry for your health issue Douglas. Hope it gets resolved soon. Great common sense way to proceed IMO also. Eliminate the cause if possible and if not possible, treat it as advised. I vote NO to starting smoking also-bad effects from that would surely outweigh ANY possible positive effect. Good luck and keep us posted.

Will do... Thanks. The problem with conducting any kind of test, however, is that I would also probably need to stop taking my medication, and the medication stays in the body for a few days (meaning lengthy test cycles)... Although, in that my medication is only partially effective, maybe not... lol... idk... luckily my doctors think I am at very low risk of having any complications (i.e. stroke, heart failure, etc.) and can endure tachy without much risk, so testing out different scenarios is relatively safe.

 

[db13berry]

Thank you for your account. I'm not the only one? I would find that comforting, except that I would never wish this on anyone—so for that, I do wish I were the only one. I'm sorry to hear about your health issues and parents—wow.. that's terrible... so young. I am, however, glad to see that you have managed to find somewhat of a balance between some simple pleasures and your health conditions. Btw... what medication are you taking for the tachy? Is that the beta blocker? Just curious. They have me on some designer drug called multaq (I think its rather new + $5/pill... ouch... and not very effective to boot). I think I may request to try a different drug (in consult with my doctor of course). Thanks again ... I will keep you informed.



What?! you mean I'm getting old. O... great!

No, you are not the only one......and I would never wish it on anyone either.
I have managed to find a good balance. I hope to be able to completely cut out the nicotine completely. Due to it's vasoconstricting effects, I don't need it. I don't want to be a raging .... hole either though. Haha. So, slowly, I lower my nic levels.

Yes, the beta blocker is for the tachycardia. It mildly lowers blood pressure too, which I have only had one instance of a spiked BP in my life. That instance came about when I was upset and chain smoking cigarettes. I keep a check on my BP often to make sure it doesnt get too low. The med keeps my heart rate at a normal rate. I'm a nurse, so it's easy to check my own blood pressure and everything.


Yes sir, we aren't old yet, but we sure are getting there. Quick!

Edit: The medication I take has been on the market for years and years and years. Its actually one of the first beta blockers ever produced. And it is also used to help treat stage fright (Anxiety).
Multaq is Dronedarone. I'm sure you have researched it.

 

[Tracy68]

I think you already knew the answer Douglas when you first posted.
Sucks to have to give up the nicotine but it really needs to be done (tried at least) so you can have peace of mind and completely rule it out.
I feel for you!
I've got a history of palpitations and ectopic heartbeats and it's NOT nice to have to live with either of those. I "know" it was smoking (heavily) that set my heart a thumping. I just seem to be one of those people who is extremely sensitive to stimulants of any kind. I can't even eat too much chocolate without it giving me the jitters. (Now that sucks!)
I'm on a minuscule dose of betablocker at the moment which I'll probably drop over time because for me (luckily) it seems that vaping is really helping to stop the overexcited heart thing.

I'm curious though....what causes spontaneous pnuemothorax ? Gosh, how frightening that must have been!
Did they give you any reason as to what caused it?

 

[videvinci]

http://www.e-cigarette-forum.com/fo.../150204-heart-rate-arterial-fibrillation.html

 

[douglas]

I think you already knew the answer Douglas when you first posted.
Sucks to have to give up the nicotine but it really needs to be done (tried at least) so you can have peace of mind and completely rule it out.
I feel for you!
I've got a history of palpitations and ectopic heartbeats and it's NOT nice to have to live with either of those. I "know" it was smoking (heavily) that set my heart a thumping. I just seem to be one of those people who is extremely sensitive to stimulants of any kind. I can't even eat too much chocolate without it giving me the jitters. (Now that sucks!)
I'm on a minuscule dose of betablocker at the moment which I'll probably drop over time because for me (luckily) it seems that vaping is really helping to stop the overexcited heart thing.

I'm curious though....what causes spontaneous pnuemothorax ? Gosh, how frightening that must have been!
Did they give you any reason as to what caused it?

Thanks for the account and kind words. It's interesting to hear that vaping has helped your overexcited heart. One thing that I've been curious about is the level of absorption of nicotine from smoking vs vaping. I've read all kinds of conflicting information everywhere. Some say much less, others think much more. Hard to decipher fact from conjecture.

Re. pneumothorax: Yes. It was a bit scary. I'm told I took it rather well though. Apparently there are two basic classifications, 'primary' and 'secondary'. The difference being whether it was the result of impact or other injury (secondary) or whether it just happened (primary). Mine was primary—just happened. They don't really know the cause for sure. However, they suspect that it was the result of 'blebs' or 'bullie', which are like small air pockets or bubbles that can develop in or around the lungs. If one of these air pockets break it can essentially 'leak' air into the pleural cavity (space between the lungs and the chest wall) which is normally held together with a thin connective layer of tissue (and negative air pressure?). Many people may have 'blebs' and 'bullie' but may never experience pnuemothorax, if they don't break or if the person has an otherwise strong connective layer. Being tall and/or having a low BMI (body mass index) can also cause the connective tissue layer to be a bit thinner (and thus more prone) than someone that has a little meat on them. So apparently it is not unheard of with tall thin males in there 20-30s to experience this. I sort of fit that profile (6'1"-165lb). What causes the blebs and bullie, on the other hand, is a totally different question. They don't really know. Just a lot of circumstantial evidence. None particularly related to smoking, but it probably doesn't help either.

 

[douglas]

http://www.e-cigarette-forum.com/fo.../150204-heart-rate-arterial-fibrillation.html

Thanks for the link. I read through the thread. Sorry to hear about your issues. Wow... that's terrible.

Interesting that they have classified your case as a kind of 'heart attack' whereas they are classifying mine as more of an 'electrical issue' (paroxysmal atrial flutter and fibrillation to be technical). Is that perhaps because of the 'elevated enzymes' and the 1-time occurrence? Have the symptoms subsided since lowering your nic dose?

 

[Tracy68]

Douglas I am totally convinced, in my own case that I am getting FAR less nicotine than I was before.
My heart has always been very quick to tell me when it's received too much stimulant. Just one glass of wine for example and immediately I feel the rate increase and more often than not a few extra beats thrown in for good measure.
Before a day of heavy smoking would be guaranteed to end in an uncomfortable night of ectopics and sometimes palpitations.
Maybe I just suck at vaping (scuse the pun) or maybe there is a lot more that we don't know about as far as all those other chemicals in tobacco cigarettes that drastically enhance the absorption process of nicotine.
I'm actually surprised that you are having this problem now and yet didn't when you were smoking?

 

[douglas]

I'm actually surprised that you are having this problem now and yet didn't when you were smoking?

Well... could be that the pnuemo kicked it into gear... and now I'm just more susceptible to it. After all I didn't have any issues for nearly 12 months prior—happily vaping (much more so even than I do now). What I'm hoping is that if I can keep it under control for a period of time using drugs or whatever, that I can ween myself out of the cycle. In the meantime I think it would be best to try figure out what the triggers are and try and minimize them as much as possible.