All of us in our life at some point in time will get a wake up call, whether that be an injury, illness or a phone call about someone we care about. For me, that wake up call came on January 19 of 2019.
That was the day my wife Amy took me to the emergency room after suffering an episode of prolonged vomiting with some mild dizziness. It was the same emergency room in Rockville, Maryland, where I and three partners had started our first ER group. By 2019, I had been traveling for work across the country as part of my role as a regional president for US Acute Care Solutions and was feeling perfectly well. But that evening, I experienced intense nausea and vomiting which would not stop followed by some mild symptoms of what could only be described as vertigo.
When we got to the emergency department, one of our most experienced clinicians examined me. She ordered a CAT scan, MRI, and lab work, and gave me multiple medications in order to stop my vomiting. I was also seen by a stroke neurologist since there was a concern that the symptoms could be related to a stroke. The final diagnosis on discharge less than 24 hours later was peripheral vertigo—which is basically dizziness due to a non-serious cause.
On further review, however, the MRI showed that I had a slight defect in an area of my brain called the cerebellum, which sits at the base of your brain and controls balance as well as (specific to my case) the vomiting center. I had indeed had a small stroke which essentially resolved within 24 hours. A repeat MRI demonstrated no evidence of the defect several weeks later.
Over the next several weeks, I had a significant workup looking for the cause of this odd finding in a very healthy and very active 54-year-old man. Doctors determined that I likely had a small blood clot in my pelvis due to my frequent air travel which broke off and crossed something called a patent foramen ovale or PFO. The PFO is a connection between the right and left sides of your heart that allows blood to bypass your lungs when you are a fetus. This opening, along with several others, usually closes at birth, allowing blood to only go through your lungs to be oxygenated prior to being pumped to the rest of your body. But in 20 percent of people—including in me, it turned out—the opening does not completely close. The medical term for my event was a paradoxical embolus. In layman’s terms: a blood clot that normally would have been trapped in my lungs and probably not even noticed was able to get through the PFO to my brain. The size of this blood clot was minuscule, because if it was any larger it would’ve caused significant and lasting neurologic deficits. The phrase there but for the grace of God go I does cross my mind.
I had lived a healthy lifestyle, ate right (mostly), moved often (triathlons), tried to get enough sleep, and used prayer for mental resilience. Nevertheless, I was confronted with the proverbial 2x4 across the side of my head. While that might’ve been enough of a teachable moment for most people, even that wasn’t quite enough for me. In May of that same year, I underwent a cardiac procedure by a gifted pediatric cardiologist to close the PFO in my heart. It’s the modern day version of placing a plug across the small opening to stop the leak from the right side to the left side of my heart. Twenty-four hours later, I was home. A few days after that, I was back on the road for my job helping to lead 800 people providing care to two million patients as part of US Acute Care Solutions.
Yet as I reflected on this series of events, I had also been wondering what were to be my next steps, both in my career and in my life. In contemplating my ‘Second Act,’ it became apparent to me that I wanted to spend my time blending the best of conventional medicine with a more holistic approach. There was only one problem. I had never learned, in a formal way, about disciplines such as nutrition, mind-body connection, the emerging science of the microbiome and the true principles underlying longevity especially as we age. For me, that meant going back to school to complete a two-year fellowship in integrative medicine. It was one of the best professional decisions I have ever made.
During these last two years as I completed the fellowship, I also learned more about myself using the same process I do with my patients. I learned that I have something called the MTHFR C677T genetic variant (common in a large minority of the population) which means that I am unable to efficiently process certain B vitamins, such as folate. This puts me at risk for other things, including elevated homocysteine (a risk factor for inflammation). I now take methylated B vitamins as one of my essential supplements. I also focus my personal efforts on overall wellness and taking the time to do things like meditation and journaling as well as adjusting my movement as I’ve aged into my 50s. All part of the comprehensive longevity plan that I discuss with my patients.
So why am I writing this article 2 ½ years after I suffered a stroke? I reflected on that over the last several weeks. I think it’s important for most people to know that all of us, no matter how well we live our lives, will, at some point, be faced with moments where you have to take stock and step back.
It would be easy to say that this was the single event that caused me to make my decision to change jobs and learn more about integrative medicine. That simply wouldn’t be true, however, as it was a combination of timing, watching my wife Amy go through her own journey with celiac disease, seeing my Dad develop and eventually die from dementia, as well as thinking about what the next steps were in my life.
Finally, and most importantly, realizing that we all have a finite time on this earth and how we spend that time should be contemplated and acted on with intention. As I continue with my Second Act, my hope is it is long and filled with wonder helping others how to live their best life. It’s actually something to which we should all look forward.