👂 Why A Second Opinion Always Matters
Or even a third, in this healthcare system.
Buckle up, today’s newsletter is a wild one.
Special thanks to my wife for allowing me to tell her story.
Today’s newsletter won’t follow the usual structure. Hopefully, you guys don’t mind!
I’m very reliant on the U.S. Healthcare system.
By that, I mean I trust that the doctors performing my physicals, cardiorespiratory tests, and blood work know what they’re doing.
Maybe there's too much trust there.
But as a hypochondriac and the son of two respiratory therapists, I’m constantly being vigilant about the health markers I can track.
This past winter, though, I started to change my beliefs about the medical system, its many actors (emphasis on acting), and whether or not they always have our best interests in mind.
Vasovagal Reactions: A Saga
My 31st birthday consisted of snowboarding in Killington, Vermont.
Three days of my wife and I trying to learn how to toe-turn, since we always did the “falling leaf” technique on our rides down the slopes.
“I want to snowboard for real,” she said.
So we tried. We fell. A lot.
We also had a ton of fun, a ton of hot chocolate, and a ton of laughs.
But I wasn’t seeing something that my wife kept warning me about.
A few falls on her tailbone in the first couple of days had hesitant about trying any hard routes.
“I’m good on that,” she’d say, despite my egging her on to do more.
When I’d finally mastered the turns, I chose to ride down a few blues. She passed, ending her third day early and saying she wasn’t feeling well.
I didn’t think much of her state until I took a hard tumble.
Even though I felt like I’d mastered the board after seven years, I took the long way down a blue slope on the mountain and hit a big lip of snow, which sent me flying onto my tailbone, whiplashing my head into not-the-softest snow, and somersaulting around.
“Oh, that’s what she was feeling,” I thought.
But she’d been feeling it way more amplified than that.
Then I thought back to previous weeks and knew why she wasn’t feeling up to finishing the day on the slopes.
Just two weeks before that, she woke up in the middle of the night with a splitting headache.
After alerting me at 2 AM that she “was feeling like she was going to pass out,” I woke up to find her limp a second later. She passed out for a whole 20 seconds in bed. It was like she fell back asleep instantly.
When she woke up, she took Advil, and we waited until her headache faded before we could both fall asleep again. It was the most frightening thing since her anxiety-attack reaction to her mom catching COVID in 2020.
She hadn’t revealed the full nature of her discomfort during my birthday trip, but she was constantly at risk of having vasovagal reactions since that episode at 2 am.
Why was this happening?
It took us too long to figure out.
After our trip, all of March was more light-headedness, tingly feet, and nausea. It was frightening, but I didn’t show much emotion so as not to scare her.
At first, I figured she’d pinched a nerve from falling during our snowboard trip, but trying to guess this weird ailment was a fool’s errand.
It took us a surprise trip to the emergency room in mid-March to get a primary care doctor in to see her.
That Monday before the ER, she woke up again with a splitting migraine, and I took her blood pressure at 2 am to check her vitals.
85/53.
I’d never seen a blood pressure reading that low.
“Is that normal?” she asked, a bit panicked.
It’s not good, but you’ll be okay,” I said with some semblance of calm in my voice. Thankfully, that worked, but I was a wreck in my head thinking about that number.
Two days went by of her simply not feeling 100%.
Both days, she worked from home until she decided to tough it out and hit the office on Wednesday.
I get a phone call that day at 5 pm, just before my last client of the day, that she nearly fainted at work and has to go to the ER.
I’d never called an Uber faster.
I got to midtown, drove her to New York Presbyterian, dropped off our dog at home, and then drove back to the hospital, where we sat for 6 hours.
4 different tests. No answers.
Her primary care doctor finally saw us the following week and confirmed at least one thing we somewhat already knew: she was having vasovagal reactions.
But we didn’t know why.
An echocardiogram showed no heart irregularities.
A negative CT scan of her head showed no issues with her brain.
Vasovagal reactions are triggered by low blood flow to the brain and nervous system shock, but we couldn’t figure out what was causing that.
Two doctors in the past had called it “too much caffeine,” and “bad stress regulation,” but those were bullshit, cop-out answers.
We needed more.
Why A Second Opinion Is Priceless
Her primary care doctor referred us to yet another cardiologist, where I worried about the same old song-and-dance.
“Lay off the coffee, get to sleep on time, and consider a beta-blocker” was what I was expecting.
No.
We found out something that was in some ways a MASSIVE relief and in some ways incredibly horrifying.
At the cardiologist's the following week, she sat down by herself with him.
The Doctor was beginning his Par-Q, general intake questions, before putting her through tests.
“Any family history of disease?”
“No.”
“Any medications?”
“Just spironolactone for acne.”
“Spironolactone?”
“Yes, my dermatologist prescribed it. I have a non-hormonal IUD, and it helps regulate my progesterone.”
“How long have you been on it?”
“Five years.”
“Five years…?”
Spironolactone, her cardiologist said, is not a five-year prescription.
Nor is its main function acne control.
Google will tell you it is a diuretic.
What her cardiologist told her left her jaw on the floor.
“Spironolactone shouldn’t be used for more than six months. We prescribe this to patients with high blood pressure and a risk of cardiac events. It is not something you should be on for long, and definitely not something you should be exercising or running intensely while taking.”
Suddenly, the vasovagal reactions made sense.
When February hit, my wife started her training block for the New York City Half Marathon, which she had to sit out for fear of passing out.
It was the right choice, according to this doctor.
She doesn’t have high blood pressure. She’s never been at risk for cardiac events. She didn’t need a diuretic.
Spironolactone was making her dangerously hypotensive, limiting her kidneys’ ability to produce red blood cells for her to sustain exercise, causing her to feel dizzy and nearly faint regularly, and dehydrating her.
Why the fainting had only surfaced now, after five years of taking the medication, is still a mystery to us.
But the drug was wrongly prescribed by her shitty dermatologist who, in my opinion, cared more about cashing out on a refilled prescription than caring for my wife’s skin.
What RFK Has Right About Health
I understand RFK Jr. gets a lot of hate for his health policies. None of them are particularly appealing, but he’s on to something with reducing fluoride intake and removing artificial coloring.
If nothing else, his own policy of researching on his own — albeit somewhat misguided in that he’s not so thorough — shows us that we need to do more of our own research and come to critically thought-out conclusions about what to put in our bodies before just mindlessly trusting the system.
Researching on your own should involve careful searching for confirming evidence, fact-checking the things your provider told you, and looking for the most up-to-date data on whatever you’re considering.
In my wife’s case, she took spironolactone because she was convinced it was the only way to fix her acne.
There wasn’t a second question about what else she could do to fix it or why her dermatologist chose spironolactone.
That’s not totally her fault, either.
In her dermatologists’ defense, its sometimes prescribed as such — just not for five fucking years.
The lack of power or authority we currently feel when our health is in question puts us in extremely vulnerable positions for medical professionals.
Their job is to help us, but our job is also to help ourselves.
That’s what this episode taught us.
We don’t have to blindly take a prescription or do something just because a doctor said it will work.
Much of medical research is the result of hypotheses and trial and error — if we consistently put ourselves at the mercy of people who can profit from writing prescriptions, well, I doubt the prescriptions stop getting written for moral reasons…
Maybe that’s a cynical take.
But I hope this is a reminder to advocate for yourself and stay vigilant about what mainstream health is saying to do.