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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by KaraS on March 11, 2005, at 16:05:28
I've been using a lightbox steadily for about 3 weeks now. I haven't seen any benefit yet but I'm recently experiencing some symptoms and I wonder if the lightbox could be responsible. I'm experiencing a fluttering feeling in my chest - like maybe my heart is skipping a beat now and then. Very scary. It could just be anxiety or from the doxepin (even though I'm only taking 25 mg.). The other thing I'm experiencing is irritability. I have been quite depressed lately but not nearly as irritable as I am now. Is there a chance that either of these things might be caused by the lightbox? Could I be using it too much? I'm using it about an hour a day, sometimes a little more.
Thanks,
Kara
Posted by Sarah T. on March 12, 2005, at 0:20:07
In reply to Can a lightbox cause this?, posted by KaraS on March 11, 2005, at 16:05:28
Hi Kara. I'm not familiar with lightboxes causing palpitations, but I suppose it's possible. After all, if they have an antidepressant effect, then they must be affecting neurotransmission and hormones. I HAVE heard of lightboxes causing irritability in some people, particular those who might have some tendency toward hypomania. At what time of day are you using the box? Do you live in a particularly overcast part of the country? I live in a very dreary part of the country that has bad winters, so I use the lightbox a lot during the fall and winter. When I use it in the spring and summer, I use it sparingly. During the sunnier seasons, I can feel when I've had enough; during the winter, I feel as if I can't ever get enough. Are you taking anything besides doxepin? Are you taking any alternative meds or anything with lots of caffeine that might be causing the palpitations? May I ask what you were on before you started Doxepin? The reason I ask is that, several times when I've withdrawn from a stimulating medication, I've had palpitations intermittently for weeks after I terminated the drug. This occurred after stopping Ludiomil, Wellbutrin, dexedrine and adderall. The dose you're taking (25 mg) is a small dose, but I have to say that I had some intense cardiovascular responses to nearly all the tricyclics, even at small doses. At larger, more "therapeutic" doses, I had some pretty scary episodes of tachycardia. On Ludiomil they were so bad, I had to wear a Holter monitor for a while. Another possible cause of palpitations in women can be changing hormonal levels, such as lowering estrogen.
Posted by KaraS on March 12, 2005, at 2:42:59
In reply to Re: Can a lightbox cause this? » KaraS, posted by Sarah T. on March 12, 2005, at 0:20:07
Hi Sara,
>>> Hi Kara. I'm not familiar with lightboxes causing palpitations, but I suppose it's possible. After all, if they have an antidepressant effect, then they must be affecting neurotransmission and hormones. I HAVE heard of lightboxes causing irritability in some people, particular those who might have some tendency toward hypomania.
That's interesting that you've heard of light boxes causing irritability - particularly in those who are susceptible to hypomania. I may have a "soft bipolar" condition. I've never had typical hypomania but increased agitation may be the soft bipolar equivalent of that. Therefore, it might make sense that the lightbox is making me more irritable.
>>>At what time of day are you using the box? Do you live in a particularly overcast part of the country? I live in a very dreary part of the country that has bad winters, so I use the lightbox a lot during the fall and winter. When I use it in the spring and summer, I use it sparingly. During the sunnier seasons, I can feel when I've had enough; during the winter, I feel as if I can't ever get enough.
I've been using the lightbox in the late morning. I live in southern California but it's been so rainy and dreary that I thought the lightbox would be a good idea to prevent an increase in depression from the lack of sun. The weather here finally cleared up but I thought I'd continue with the lightbox since I don't get much sun anyway. I don't have enough practice with it to know when I'm getting enough. Maybe I should discontinue using it now. I haven't been able to detect any decrease in depression and so wanted to give the lightbox a full 6 week trial - but I think that maybe at this point it would be better to stop using it and see what happens.
>>>Are you taking anything besides doxepin? Are you taking any alternative meds or anything with lots of caffeine that might be causing the palpitations? May I ask what you were on before you started Doxepin? The reason I ask is that, several times when I've withdrawn from a stimulating medication, I've had palpitations intermittently for weeks after I terminated the drug. This occurred after stopping Ludiomil, Wellbutrin, dexedrine and adderall.
I am not taking anything else besides the doxepin. I'm not taking any supplements that contain caffeine or anything else very stimulating. I've been drinking very little coffee with caffeine as well. My anxiety has been too intense to take anything really stimulating. I haven't gone off of anything recently either. I decreased Effexor very slowly and went off of that completely a few months ago. I didn't seem to have any long-term problems from it.
>>>The dose you're taking (25 mg) is a small dose, but I have to say that I had some intense cardiovascular responses to nearly all the tricyclics, even at small doses. At larger, more "therapeutic" doses, I had some pretty scary episodes of tachycardia. On Ludiomil they were so bad, I had to wear a Holter monitor for a while. Another possible cause of palpitations in women can be changing hormonal levels, such as lowering estrogen.
I had tachycardia from nortriptyline and desipramine but didn't used to get that from doxepin or maprotiline. Recently I tried low-dose maprotiline again and did get tachycardia. I wore the Holter monitor for nort. too. I'd been on the low dose (25 mg.) doxepin for about a month before noticing this heart fluttering symptom. I would think that if it were the doxepin, that this side effect would have shown up sooner, but who knows.
The lowering of estrogen is a good point. I forgot that palpitations can be caused by this. That may be possible here although I thought my estrogen levels had stabilized.
Thanks for your response.
K
Posted by gardenergirl on March 12, 2005, at 7:15:30
In reply to Re: Can a lightbox cause this? » Sarah T., posted by KaraS on March 12, 2005, at 2:42:59
Hi Kara,
Try cutting down the time you spend with it. Or the intensity if you can adjust it. An hour is kind of long. I do 30 minutes a day. See if that helps, and if not, then try cutting it out altogether.Good luck.
gg
Posted by KaraS on March 12, 2005, at 14:02:18
In reply to Re: Can a lightbox cause this? » KaraS, posted by gardenergirl on March 12, 2005, at 7:15:30
> Hi Kara,
> Try cutting down the time you spend with it. Or the intensity if you can adjust it. An hour is kind of long. I do 30 minutes a day. See if that helps, and if not, then try cutting it out altogether.
>
> Good luck.
> gg
Thanks gg,
I'm so scared of this symptom that I'm going to cut it out altogether - at least for a while. It's sunny here now where I'm living so I probably don't need it anymore anyway.Do you think that the 30 minutes a day has been helpful to you? Can you really tell the difference from when you didn't use it?
K
Posted by tealady on March 12, 2005, at 16:00:09
In reply to Can a lightbox cause this?, posted by KaraS on March 11, 2005, at 16:05:28
> I've been using a lightbox steadily for about 3 weeks now. I haven't seen any benefit yet but I'm recently experiencing some symptoms and I wonder if the lightbox could be responsible. I'm experiencing a fluttering feeling in my chest - like maybe my heart is skipping a beat now and then. Very scary. It could just be anxiety or from the doxepin (even though I'm only taking 25 mg.). The other thing I'm experiencing is irritability. I have been quite depressed lately but not nearly as irritable as I am now. Is there a chance that either of these things might be caused by the lightbox? Could I be using it too much? I'm using it about an hour a day, sometimes a little more.
>
> Thanks,
> Kara
>Hi Kara,
Umm How do you know it's not the doxepin?
I've heard of lots of good reports from light box users.
I would have tried one myself in winter months but nopone over here sells them. Last year I mostly was overseas. Going to Vanuatu and the other side of the world worked well :-))except for the month left of winter /spring when I got back.It sounds maybe like lack of potassium? Could doxepin cause a potassium depletion?...I know nothing about doxepin(and don't want to know:-, but check if its a possibility. If it is, just eat a banana every day or something like that.
Not sure if any help. Let us know.Jan
Posted by KaraS on March 12, 2005, at 17:04:11
In reply to Re: Can a lightbox cause this? » KaraS, posted by tealady on March 12, 2005, at 16:00:09
> > I've been using a lightbox steadily for about 3 weeks now. I haven't seen any benefit yet but I'm recently experiencing some symptoms and I wonder if the lightbox could be responsible. I'm experiencing a fluttering feeling in my chest - like maybe my heart is skipping a beat now and then. Very scary. It could just be anxiety or from the doxepin (even though I'm only taking 25 mg.). The other thing I'm experiencing is irritability. I have been quite depressed lately but not nearly as irritable as I am now. Is there a chance that either of these things might be caused by the lightbox? Could I be using it too much? I'm using it about an hour a day, sometimes a little more.
> >
> > Thanks,
> > Kara
> >
>
> Hi Kara,
> Umm How do you know it's not the doxepin?
> I've heard of lots of good reports from light box users.
> I would have tried one myself in winter months but nopone over here sells them. Last year I mostly was overseas. Going to Vanuatu and the other side of the world worked well :-))except for the month left of winter /spring when I got back.
>
> It sounds maybe like lack of potassium? Could doxepin cause a potassium depletion?...I know nothing about doxepin(and don't want to know:-, but check if its a possibility. If it is, just eat a banana every day or something like that.
> Not sure if any help. Let us know.
>
> Jan
>
Hi Jan,I don't know that it's not the doxepin. Cardio problems are common place with tricyclic ADs. My doctor had told me that I probably wouldn't have any problems like this if I kept the dosage under 100 mg. I'm only taking 25 mg. Also, I've been on 25 mg. for at least a month now and just recently developed the symptoms. I would like to believe that it's not the doxepin since it has been working miracles in terms of my anxiety issues.
I'm stopping the lightbox for now and I'll see where that leads me. Chances are it is the doxepin or perhaps some combination of the doxepin with lightbox that is responsible for the palpitations.
In terms of the irritability, I think that is due to the lightbox. I may have a soft bipolar condition and instead of experiencing traditional hypomania, I get agitated and irritable instead. I'll see what happens since stopping the lightbox.
Potassium is a possibility. I just bought some bananas so I'll make sure to have one daily. Can't hurt!
Thanks.
Kara
Posted by Green Willow on March 12, 2005, at 18:10:15
In reply to Can a lightbox cause this?, posted by KaraS on March 11, 2005, at 16:05:28
Kara,
I developed atrial fibrillation while only on 10 mg. of doxepin, so I do know that it can cause heart problems. After discontinuing doxepin I have not had many episodes. 1 hour or more of lightbox therapy seems like too much. 45 min. - 1 hour is recommended during the first 1 - 2 weeks, and after that I think the recommended time is about 20 - 30 mins. I have heard that the light box should be used much earlier in the morning than you are using it to really be beneficial, like before the sun gets too high and when your body tempature is still low from sleeping, but I don't know any specifics on that. Recently I was using the box about 20 minutes per morning and I experienced a sort of manic feeling, which has not been so noticeable since I shortened the length of time. Now I have shortened the time to about 5 - 7 minutes, and I notice that I feel the positive effects within that time. I am interested in what will happen if you make some changes. Green Willow
> I've been using a lightbox steadily for about 3 weeks now. I haven't seen any benefit yet but I'm recently experiencing some symptoms and I wonder if the lightbox could be responsible. I'm experiencing a fluttering feeling in my chest - like maybe my heart is skipping a beat now and then. Very scary. It could just be anxiety or from the doxepin (even though I'm only taking 25 mg.). The other thing I'm experiencing is irritability. I have been quite depressed lately but not nearly as irritable as I am now. Is there a chance that either of these things might be caused by the lightbox? Could I be using it too much? I'm using it about an hour a day, sometimes a little more.
>
> Thanks,
> Kara
>
Posted by KaraS on March 12, 2005, at 18:25:03
In reply to Re: Can a lightbox cause this? » KaraS, posted by Green Willow on March 12, 2005, at 18:10:15
Hi,
Unfortunately I know it is possible for the doxepin to create this problem. I was on it for many years at that low dose in the past without problems however so I've been hoping that it isn't the cause of my current problem. In your case, it's a good thing you got off of it!If I do start the lightbox again, I would do so at max 30 mins. I've seen different amounts of time suggested but in my case 1 hour is definitely too much. I've been using the lightbox when I first wake up in the morning which has been late morning. My cycle is all screwed up. Using the lightbox at that time has cemented the problem.
I'll keep you posted on my progress (or lack thereof).
K
> Kara,
> I developed atrial fibrillation while only on 10 mg. of doxepin, so I do know that it can cause heart problems. After discontinuing doxepin I have not had many episodes. 1 hour or more of lightbox therapy seems like too much. 45 min. - 1 hour is recommended during the first 1 - 2 weeks, and after that I think the recommended time is about 20 - 30 mins. I have heard that the light box should be used much earlier in the morning than you are using it to really be beneficial, like before the sun gets too high and when your body tempature is still low from sleeping, but I don't know any specifics on that. Recently I was using the box about 20 minutes per morning and I experienced a sort of manic feeling, which has not been so noticeable since I shortened the length of time. Now I have shortened the time to about 5 - 7 minutes, and I notice that I feel the positive effects within that time. I am interested in what will happen if you make some changes. Green Willow
>
>
> > I've been using a lightbox steadily for about 3 weeks now. I haven't seen any benefit yet but I'm recently experiencing some symptoms and I wonder if the lightbox could be responsible. I'm experiencing a fluttering feeling in my chest - like maybe my heart is skipping a beat now and then. Very scary. It could just be anxiety or from the doxepin (even though I'm only taking 25 mg.). The other thing I'm experiencing is irritability. I have been quite depressed lately but not nearly as irritable as I am now. Is there a chance that either of these things might be caused by the lightbox? Could I be using it too much? I'm using it about an hour a day, sometimes a little more.
> >
> > Thanks,
> > Kara
> >
>
>
Posted by Sarah T. on March 12, 2005, at 19:55:54
In reply to Re: Can a lightbox cause this? » Sarah T., posted by KaraS on March 12, 2005, at 2:42:59
Hi Kara. Is there a pattern to the palpitations? Do they occur at around the same time(s) each day, or are they unpredictable? The reason I ask is that, when I was on TCAs (including Ludiomil which is technically a "tetracyclic"), I had the most severe cardiovascular symptoms when the blood levels of the medicines were peaking. For several TCA's, that occurred around 12 hours after I took the dose, so if I took it a few hours before bed, I'd wake up in the morning with racing heart beats. I found out from the Holter monitor that I had sinus tachycardia, so it was a "normal" rhythm, just too darn fast.
I think gardenergirl's idea about reducing the amount of time you spend in front of the light box is a good one, especially since you live in a nice, sunny place (how I envy you!). When I use my light box in the warmer months, I use it for only a few minutes. I actually use it as a make-up light, when I put on make-up, tweeze eyebrows, etc. Add to that a mirror that magnifies between 5X and 8X, and I see all my imperfections. It is most unforgiving! So, even if you don't use it as an antidepressant, the light is still multi-functional. Oh, my cat also likes to "sun herself" in front of it.
Posted by gardenergirl on March 12, 2005, at 20:20:24
In reply to Re: Can a lightbox cause this? » gardenergirl, posted by KaraS on March 12, 2005, at 14:02:18
>>
> Do you think that the 30 minutes a day has been helpful to you? Can you really tell the difference from when you didn't use it?I absolutely can tell the difference if I don't use it. I have terrible trouble getting out of bed, and I have more apathy. I actually bought a portable unit because I didn't want to miss it while I was travelling recently.
gg
Posted by gardenergirl on March 12, 2005, at 20:26:23
In reply to Re: Can a lightbox cause this? » Green Willow, posted by KaraS on March 12, 2005, at 18:25:03
I set an alarm for my lightbox. I take my first dose of Nardil and sit under the light at about 6:30 a.m. If I don't have to be up that early, sometimes I go back to sleep, but usually I am too awake. The light therapy has really helped my sleep/wake cycle get regular. I even wake up just before the alarm!
I used to need multiple snoozes and even then would ofen oversleep by hours.
gg
Posted by KaraS on March 12, 2005, at 22:08:45
In reply to Re: Can a lightbox cause this? » KaraS, posted by Sarah T. on March 12, 2005, at 19:55:54
> Hi Kara. Is there a pattern to the palpitations? Do they occur at around the same time(s) each day, or are they unpredictable? The reason I ask is that, when I was on TCAs (including Ludiomil which is technically a "tetracyclic"), I had the most severe cardiovascular symptoms when the blood levels of the medicines were peaking. For several TCA's, that occurred around 12 hours after I took the dose, so if I took it a few hours before bed, I'd wake up in the morning with racing heart beats. I found out from the Holter monitor that I had sinus tachycardia, so it was a "normal" rhythm, just too darn fast.
>
> I think gardenergirl's idea about reducing the amount of time you spend in front of the light box is a good one, especially since you live in a nice, sunny place (how I envy you!). When I use my light box in the warmer months, I use it for only a few minutes. I actually use it as a make-up light, when I put on make-up, tweeze eyebrows, etc. Add to that a mirror that magnifies between 5X and 8X, and I see all my imperfections. It is most unforgiving! So, even if you don't use it as an antidepressant, the light is still multi-functional. Oh, my cat also likes to "sun herself" in front of it.Hi,
Palpitations might not be a good word for it. It's more like it skips a beat now and then. I've had tachycardia and this isn't that. As for the timing, there doesn't seem to be any rhyme or reason to it. It just happens once in a while.I'm not going to use the lightbox at all for a while and then, if/when I do, it will be for maximum of 30 minutes (at least initially). (Wish I had experienced some effect from it by now.)
I didn't take the doxepin last night and the problem did seem to be better today. I'll probably take it tonight though. I'm afraid to take it but I'm also afraid not to.
K
Posted by KaraS on March 12, 2005, at 22:09:57
In reply to Re: Can a lightbox cause this? » KaraS, posted by gardenergirl on March 12, 2005, at 20:20:24
> >>
> > Do you think that the 30 minutes a day has been helpful to you? Can you really tell the difference from when you didn't use it?
>
> I absolutely can tell the difference if I don't use it. I have terrible trouble getting out of bed, and I have more apathy. I actually bought a portable unit because I didn't want to miss it while I was travelling recently.
> gg
>That's great. Do you remember how long after you started using it that you got the positive effects?
K
Posted by KaraS on March 12, 2005, at 22:10:29
In reply to Re: Can a lightbox cause this? » KaraS, posted by gardenergirl on March 12, 2005, at 20:26:23
> I set an alarm for my lightbox. I take my first dose of Nardil and sit under the light at about 6:30 a.m. If I don't have to be up that early, sometimes I go back to sleep, but usually I am too awake. The light therapy has really helped my sleep/wake cycle get regular. I even wake up just before the alarm!
>
> I used to need multiple snoozes and even then would ofen oversleep by hours.
>
> gg
I'm jealous.K
Posted by Sarah T. on March 13, 2005, at 0:00:17
In reply to Re: Can a lightbox cause this? » Sarah T., posted by KaraS on March 12, 2005, at 22:08:45
Hi Kara. If you stop the light box and the Doxepin at the same time, then you're changing two variables at once, and you won't know what's causing what. I just skimmed an article from the October 2002 issue of PSYCHIATRIC TIMES on seasonal affective disorder, SAD. According to the author, Raymond Lam, M.D., patients usually respond to light therapy within a week, but some patients require 2-4 weeks. He also said that some patients with bipolar disorder might switch to mania or hypomania. He cautioned that patients with Bipolar I should be on mood stabilizers if they use light therapy.
If you decide to resume Doxepin, and if, after a few days of being back on Doxepin but being away from light therapy, you find that you are still getting those skipped beats, then perhaps you could get the liquid doxepin and take less than 25 mg. Maybe you could try 22.5 or 20 mg and see whether those symptoms subside.
I hope you feel better tonight.
Posted by KaraS on March 13, 2005, at 1:15:07
In reply to Re: Can a lightbox cause this? » KaraS, posted by Sarah T. on March 13, 2005, at 0:00:17
> Hi Kara. If you stop the light box and the Doxepin at the same time, then you're changing two variables at once, and you won't know what's causing what. I just skimmed an article from the October 2002 issue of PSYCHIATRIC TIMES on seasonal affective disorder, SAD. According to the author, Raymond Lam, M.D., patients usually respond to light therapy within a week, but some patients require 2-4 weeks. He also said that some patients with bipolar disorder might switch to mania or hypomania. He cautioned that patients with Bipolar I should be on mood stabilizers if they use light therapy.
>
> If you decide to resume Doxepin, and if, after a few days of being back on Doxepin but being away from light therapy, you find that you are still getting those skipped beats, then perhaps you could get the liquid doxepin and take less than 25 mg. Maybe you could try 22.5 or 20 mg and see whether those symptoms subside.
>
> I hope you feel better tonight.Hi Sarah,
I'll probably take the doxepin tonight so it should be easier to see what was doing what. I'm hoping that it's the lightbox but there's really no scientific information to back that up. Chances are that it's the doxepin. I hope I'm wrong but I'll know soon enough.I don't know for certain that I am bipolar. My pdoc thinks it's possible. If that is the case, then the irritability from the lightbox would make sense. At some point I'll probably try a mood stabilizer. Then I could try the lightbox again and see if there's any change in my effect from it.
If I want to try a lower dosage of doxepin, then I can open up the pills and estimate dosages. I have some empty capsules at home I could use for this. We'll see.
Thanks again for your input.
Kara
Posted by tealady on March 13, 2005, at 5:52:31
In reply to Re: Can a lightbox cause this? » Sarah T., posted by KaraS on March 13, 2005, at 1:15:07
Hi Kara,
Hope you feel better soon.
As I mentioned in last post, I suspect the doxepin.
If you do experience the heartbeat irregularities again..try eating a couple of bananas and taking some magnesium as well. The magnesium helps the potassium get into the cells. Sorry to repeat..just a bit concerned and saying eat bananas doesn't quite make it sound like I am :-)
I only suspect potassium as I go low on most things from time to time, so I get to experience most things:-)
Whatever is causing it..hope you find it out soonGood luck, Jan
Posted by ed_uk on March 13, 2005, at 11:08:34
In reply to Re: Can a lightbox cause this? » KaraS, posted by Sarah T. on March 12, 2005, at 19:55:54
Hi,
>I found out from the Holter monitor that I had sinus tachycardia, so it was a "normal" rhythm, just too darn fast.
I've had sinus tachycardia for the last two years! I'm on lofepramine, a TCA. Pulse is usually about 110 at rest.
Ed.
Posted by gardenergirl on March 13, 2005, at 13:18:52
In reply to Re: Can a lightbox cause this? » gardenergirl, posted by KaraS on March 12, 2005, at 22:09:57
Hmmm, I can't remember exactly how long it took. Also, at first, if I didn't get up at 6:30, I would just use it whenever, sometimes as late as 10:30 a.m. or even in the afternoon. That was a very bad idea, and actually messed me up. So I suppose once I started using it regulary at 6:30 a.m., it probably took only about two weeks for full effect.
gg
Posted by gardenergirl on March 16, 2005, at 10:08:37
In reply to Re: Can a lightbox cause this? » KaraS, posted by gardenergirl on March 13, 2005, at 13:18:52
Posted by ed_uk on March 16, 2005, at 15:24:57
In reply to Re: Can a lightbox cause this? » KaraS, posted by gardenergirl on March 13, 2005, at 13:18:52
Hi gg!
Did you start topiramate?
Ed.
Posted by KaraS on March 16, 2005, at 19:35:58
In reply to Kara, how are you doing? (nm), posted by gardenergirl on March 16, 2005, at 10:08:37
Hi gg,
Thanks so much for asking and for your response above. I'm doing about the same. I was definitely using the lightbox too much. I haven't used it at all in a few days and I'm less irritable. I'm still having what feels like irregular heartbeats occasionally. I have a regular doctor's appointment on Monday so we'll see what s/he has to say. Chances are I'll be off of the doxepin soon. I should probably go off of it now but I'd rather take the risk than go back to that overwhelming anxiety.
How are you doing? Have you started the topomax?
K
Posted by gardenergirl on March 16, 2005, at 22:17:25
In reply to Re: Can a lightbox cause this? » gardenergirl, posted by ed_uk on March 16, 2005, at 15:24:57
Yes, I started 25 mg last Thursday. I will go to 50 mg tomorrow. Hmmm, I guess that means (according to the package) that I should take 25 in the a.m. and 25 at night. Thanks for the reminder!
gg
Posted by gardenergirl on March 16, 2005, at 22:20:18
In reply to Re: Kara, how are you doing? » gardenergirl, posted by KaraS on March 16, 2005, at 19:35:58
I did start the topamax. I haven't noticed a huge effect yet. Although I think maybe that when I eat a lot now, I feel full and a bit sick to my stomach. And I don't wake up starving for breakfast. So I can see how weight loss can happen with this. But I still get low blood sugar if I don't eat. So regardless of my appetite, I just need to eat better.
Oh yeah, and exercise. But if it helps with bingeing and does not have problematic SE's it will be worth it.
Glad your irritability is better. Hope your doc helps with the heartbeat thing. I've had that occasionally. It's not comfortable.
gg
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