About That 36-Year-Old Woman Who Was Healthy Until Covid Gave Her Heart Failure

I have so much to say about this news story that it became this blog post.

For those who don’t want to read the entire article, the tl;dr is: Jamie Waddell, a healthy vaccinated-and-boosted 36-year-old woman, got covid-19, recovered, then got heart failure so severe they put her on a heart transplant list, then recovered from that too.

Why Didn’t The Urgent Care Clinic Test Her for Troponins?

From the article:

Two days later, she was coughing and achy and asked her doctor for a chest X-ray, which came back normal. She called off work two days and went to her local urgent care clinic. She did not test positive for COVID-19 or flu.

“My vital signs at that visit were a little off. My heart rate was a little high. I had a fever,” she recalls. “I came home and basically went to sleep.”

*facepalm*

Given that she had myocarditis, a troponin test at this point would’ve come back positive. Then the doctors would’ve known that she had a heart injury, and she needed treatment. Good treatment at this point in time would’ve slowed or perhaps stopped the progression of her heart failure, and she wouldn’t have needed such intense life support.

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Heart Metaphors Hit Different Now

Heart-based metaphors are everywhere in our language. Perhaps in all human languages (if you know of a human language where heart-related metaphors are uncommon, please let me know). Culture, combined with a lifetime of good heart health, trained me to think of this all as a flowery way of talking.

Then, my heart health scare (pericarditis) happened.

I noticed it first with pop song lyrics. Singing about heart attacks, breathlessness, how your heart hurts, when you supposedly are singing about romance… well, it weirded me out when while I was reckoning with what a heart attack would mean. This is despite never having a heart attack or shortness of breath.

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Many Doctors Care More About Their Egos Than Saving Lives

State of the Heart by Haider Warraich ends with these words:

This means that if science continues to advance, perhaps half this book will one day be proven false. Perhaps one day, a historian will cite these words snidely to reflect how ignorant we were and how far we have come since. That thought gives me a lot of joy, and the sooner we can break the untouchable idols of today, the sooner we can strip the masters of dogma, the sooner we can focus on the sum of our organs.

Being proven wrong about his scientific understanding may make Warraich joyful, but many other people in a position of power in medicine and public health would rather cause many deaths than admit mistakes.

History is full of examples. Take for example, Ignaz Semmelweis, who found evidence that washing hands before helping women give birth greatly reduced deaths.

That said, it was Dr. Semmelweis who ordered his medical students and junior physicians to wash their hands in a chlorinated lime solution until the smell of the putrid bodies they dissected in the autopsy suite was no longer detectable. Soon after instituting this protocol in 1847, the mortality rates on the doctor-dominated obstetrics service plummeted.

“In 1850, Ignaz Semmelweis saved lives with three words: wash your hands” by Dr. Howard Markel, PBS News Hour

Did other obstetricians rejoice because they had a simple method to increase the survival rate of their patients? Nope.

Unfortunately, Semmelweis’s ideas were not accepted by all of his colleagues. Indeed, many were outraged at the suggestion that they were the cause of their patients’ miserable deaths.

The same thing happened in the United States when Oliver Wendell Holmes Sr. advocated that doctors wash their hands.

These “doctors” didn’t care about evidence or saving lives. Or at least, they cared less about that than the insults about their unwashed hands’ uncleanliness. To them, it was better than more of their patients die painful deaths than that they go through the inconvenience of washing their hands.

You might also know about the story of John Snow and cholera.

Warraich describes an example prioritizing their egos over following evidence or saving lives I hadn’t heard of before.

In the early 20th century, doctors regarded high blood pressure as a good thing. Some believed it was an effect of aging with no bearing on health, others believed that the higher the blood pressure, the better.

I can say two things in defense of doctors in the very early 20th century: nobody had collected evidence that high blood pressure is dangerous, and the only method they had to reduce blood pressure was extreme salt restrictions.

Then someone gathered and published evidence that high blood pressure is deadly: life insurance companies.

In 1925, the Actuarial Society of America published a report which noted a correlation between high blood pressure and earlier death. While doctors were dismissing the need for blood pressure readings, life insurance companies pushed to have it measured and factored into their policies.

The doctors and scientists ignored this.

In various parts of the book, Warraich describes the various pressures to conform to authority and hierarchy in science and medicine. In a top-down hierarchy, you get ahead by pleasing the people of higher rank. Saving many lives might impress the people of higher status, but a more reliable means to get ahead is to flatter them and not embarrass them. It’s safe to agree with the medical authorities even when they’re wrong, but it’s risky to point out their errors.

Life insurance companies are predictive markets of human death. They bet they can collect more money from living customers than money they spend on the dead. When their bets are accurate, they make money. When their bets are inaccurate, they lose money. Given a choice between conforming to people of high status in medical and scientific hierarchies and understanding reality, they choose to understand reality.

Then the Framingham study began in 1947. It tracked the lives of people in the town of Framingham, Massachusetts to better understand human illness and health. Warraich says, “when the Framingham study was threatened with its funding being cut, life insurance companies helped bail it out, seeing how important the actuarial benefits of the study were.”

The first report published on the Framingham study showed a strong correlation between high blood pressure and heart attacks, as well as high blood pressure and strokes.

Warraich says:

The Framingham study investigators thought their job was done after they began publishing their landmark findings but quickly realized they had run into a wall—that wall was their fellow physicians. The overwhelmingly strong data they had generated failed to change the practice of either the most preeminent doctors of their time or those running mom-and-pop-style clinics in the country. And all this time, people continued to die of untreated high blood pressure by the millions—after the Second World War, every other person died in part due to hypertension. Even in the 1970s, when some medical textbooks started to recognize the importance of blood pressure, they focused on the lower number, the diastolic blood pressure, even as the Framingham investigators continued to show that it was the systolic blood pressure that mattered a lot more. Yet it wasn’t until the 1980s and 1990s, after large clinical trials proved them right, that the medical community fully embraced the findings from Framingham that had been published sequentially over many decades and had long before been supported by the life insurance companies.

(I hope to write a post about what life insurance companies say about Covid-19. Until then, the tl;dr is that life insurance companies are still uncertain about how to adjust their policies.)

To be fair to the doctors of the 1950s and 1960s, they had no way to safely reduce blood pressure other than restricting salt. The first reliable medication for reducing blood pressure was discovered in 1975—though perhaps if scientists had taken blood pressure more seriously, the medication would’ve been discovered sooner (it came from pit viper venom of all places—the viper’s bite causes victims’ blood pressure to drop so low they faint, but a small dose of a chemical in the venom only causes a small decrease in blood pressure).

Today, we have Dr. Anthony Leonardi. Do I believe Dr. Leonardi is 100% correct? No, because scientists are rarely 100% correct. Dr. Leonardi himself would probably admit that he can make mistakes. However, he has predicted the course of the covid-19 pandemic more accurately than the ‘experts’ who claimed that an infection would grant lasting immunity, then claimed that the first generation vaccines would end the pandemic, then claimed hybrid immunity would end the pandemic. In predictions about the future of the covid-19, I think Leonardi is more likely to be right than the WHO or the CDC.

Contemplating this history gives me another perspective on the healthcare workers of today who refuse to wear masks, even around vulnerable patients indoors.

Or maybe, the healthcare workers who refuse to mask even when their patients beg them too has given me a new perspective on the obstetricians in the mid-19th century who, even after encountering Semmelweis’ evidence that handwashing saves lives, continued to touch women in childbirth with unwashed hands.

I Shouldn’t Have Heart Disease. Why Me?

Before the weirdness in my chest began, it never occurred to me that I could have heart disease. Sure, in the vague future perhaps, but not anytime soon. I’m physically active, eat a lot of fruits and vegetables, I don’t eat animal fats, I’m a woman under the age of 40.

(I eat a lot of coconut fat and, until recently, plenty of sodium too, but I have reformed my sodium-eating ways, and I’m not sure coconut fat is a problem, I’m a good girl now).

My chest sensations made me seek more information, which led me to the books The Exquisite Machine by Sian Harding and State of the Heart by Haider Warraich.

Both books confirm that heart disease can happen to anyone with a heart.

Yes, I’m at ‘lower risk’ than many other people. It’s just that—lower risk. Not zero risk.

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If I Don’t Have Heart Damage, Why Does My Left Chest Ache?

This week, I got a troponin test.

Troponins are a type of protein only heart cells make. When heart cells die, they leak troponins into the blood, where they persist until kidneys remove them.

Every living heart loses at least a few cells per day, so there’s always at least a trace of troponins in the blood. Only three things can cause troponin levels in the blood to rise: a) running a marathon or an equivalent feat of physical effort (there is so much going on in the muscles that the kidneys temporarily can’t clear troponins, this isn’t a problem) b) something wrong in the kidneys (rare, but it can happen), or c) a ton of heart cells have died.

Mass heart cell death is by far the most common cause of a ‘positive’ troponin test (i.e. higher than normal levels of troponin). Heart attacks always cause troponin levels in the blood to shoot up. Myocarditis also always causes troponin levels to go up. Most heart diseases cause troponin levels to go up. It is the best biomarker to determine whether something is wrong with the heart.

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Sliding Into Low-Sodium Life (and Why Many People Don’t)

I switched to a low-sodium diet smoothly, but only because of my advantages. For most people, it’s much harder. Which means fewer people do it. Which means some people who’d otherwise live, die.

Higher sodium leads to higher blood pressure, lower sodium leads to lower blood pressure. People whose blood pressure is too low benefit from consuming more salt, but in the United States in the early 21st century, high blood pressure is more common. Way more common.

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The ‘Virtue’ of Avoiding Exercise

Due to the problem in my left chest I described last week, I’m avoiding unnecessary physical activity.

Well, not quite. I’m ‘cheating’ a little with physical activity, which isn’t strictly necessary.

(I’m lucky that I don’t depend on physical labor to pay my bills.)

I live in a culture in which ‘exercise’ is a ‘virtue’ as long as it’s not for low-prestige jobs. (Meanwhile, the physical work, for example, people who pick crops on farms, is devalued, though we eat the literal fruits of their labor). People reinforce the message that getting more exercise is virtuous, whereas not exercising is a weakness we often fall into due to our relatable flaws. We conflate health with morality, and getting more exercise is ‘healthy.’

It’s weird to be in a situation where avoiding exercise is what’s best for my physical health. That slipping in some exercise just for pleasure feels like ‘cheating.’

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I’m Pissed at the Medical System for Not Taking Covid Safety Seriously

A few weeks ago, I started having an odd sensation in my left chest, around my heart. It’s so mild the word ‘pain’ seems like overkill. I dismissed as just something weird at first, but I kept noticing it. Mild as it is, it’s not how my chest is supposed to feel.

What pushed me to act was remembering what happened to my uncle. When he felt something weird in his chest, he considered not doing anything about it, but he went to an urgent care clinic just in case. That choice saved his life.

I dug myself out of denial and did some reading on the internet. Based on my symptoms and my body, myocarditis seems like the most likely diagnosis. If this is myocarditis, odds are it will go away without treatment. There’s a tiny chance it will kill me.

I talked to a doctor. Upon hearing a description of my symptoms, he said, “you should go to a cardiologist.” He was the first to bring up the word ‘myocarditis’ in that conversation, not me, which confirms that it’s a likely diagnosis. He thinks that whatever I have is probably nothing and will resolve itself, but I should go to a cardiologist for peace of mind—and perhaps it’s not ‘nothing.’

Going to a cardiologist for a physical exam is a good idea, I agree.

Ah, but here’s the rub: viral infections are the most common cause of myocarditis. Including Covid-19.

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Let’s Talk About Nxde

What I miss most about the hot springs of Japan and Taiwan was the social permission to be nude in semi-public without turning it into a major affair.

Some spas in San Francisco have public baths which allow nudity, but they are more expensive, and it’s dressed up as a special treat, rather than someone you can do as casually as visiting a restaurant. Spas are supposed to help you relax, and in a way they do, but… I felt I could let myself go a bit more at hot springs in East Asia.

I’ve also been to a hot spring in California which permits nudity. I only exposed my legs. For some reason, in that culture, I felt less comfortable exposing myself. It wasn’t that there were men there—I’ve been to mixed-gender hot springs in Japan and gone nude. Shared etiquette and staff govern Japanese onsen. That California wild hot spring had no staff, and I didn’t know what the locals’ established rules were.

Sometimes, in my dreams, I go walking in the street half-nude and don’t realize it until I’m far from home. What do those dreams mean? Your guess is as good as mine.

I need to know that others around me will accept my nudity and that we all share rules which protect us all. When I feel that safe, it’s freeing to not need clothes around other people.

That brings us to (G)I-DLE’s new song, “Nxde.”

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My Stomach Returned to Taiwan

One irony of the pandemic is that my lungs are healthier than ever. As far as I know, I haven’t had a single respiratory infection for over two years. That’s unprecedented.

By paying more attention to my nose than before, I figured out that I have low-level chronic hay fever. Xylitol-saline nasal spray is cheap and increases airflow. Wearing masks which screen out nasal irritants might help too.

Then there’s my stomach.

When I lived in Taiwan, I had stomach bugs about twice a year. I accepted them as an unpleasant fact of life. After I returned to the United States, stomach trouble happened much less often. Since the covid-19 pandemic started, I’ve been catching stomach bugs about as often as I did in Taiwan.

I wonder why.

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