Needing to pee while getting your blood pressure taken can get you treated with a BP-lowering drug you don’t need—causing cascading harms to your health.

Say your actual resting blood pressure is 115/70.

That’s normal blood pressure—blood circulating at a healthy rate of speed.

The urge to pee can spike that number by 15 on top and 10 on the bottom—bringing it to 130/80—Stage 1 high blood pressure.

Which you don’t happen to have.

Correct diagnosis: Three Diet Cokes during a crazy-busy morning and no time to run to the john.

Reason to “work smarter,” but not an actual medical condition.

BP Measurement Fails

Reading papers on blood pressure, I realized I have never had my blood pressure taken correctly.

The needing-to-pee problem is just one of many factors that can artificially inflate a blood pressure measurement.

Cardiologist Seamus Whelton, MD, and his colleagues created this chart showing common ways (systolic) blood pressure measurement becomes blood pressure mismeasurement.

It’s not a complete list. Other BP measurement pitfalls include:

OTC PAIN MEDS: Ibuprofen and acetaminophen boost BP by 3.7 and 4.7 points respectively.

IGLOO-ESQUE EXAM ROOMS: Cold causes blood vessels to constrict—a heat conservation measure—elevating BP by varying amounts, greatest in older people and those with high BP.

THIRST: Being thirsty is a sign of inadequate fluid levels in the body. Blood vessels constrict to adapt to the lowered levels. The slimmer the pipes, the harder your heart has to work to pump the blood around, raising BP by varying amounts.

All of These Wrong Numbers Can Really Add Up

Why High BP Matters

Blood pressure is the force it takes to circulate blood around our body—measured via the blood rush hitting the walls of our arteries.

Actual high blood pressure—“hypertension,” accurately measured—is a nefarious thing. So many disorders do us the courtesy of a prompt heads up, like with the medical yoohoo of projectile vomiting, elephantine swelling, disemboweling pain.

Not high BP.

It hides inside our arteries, furtively doing its nasty work: weakening and stiffening them and causing abrasions in the smooth lining, which allow fats and cholesterol to infiltrate and then narrow our arteries with plaque.

For years or even decades, high blood pressure is imperceptibly ruinous—until that eventual 911 moment: dropping us with a stroke or heart attack or revealing an acute need for an aftermarket kidney.

This makes it vital to regularly measure our blood pressure and address any departures from “normal” levels pronto; ideally, with lifestyle measures rather than drugs. (Covered in the upcoming Part II of this BP series.)

Getting “Healed” To Death

Your doctor’s care should not lead to a hip fracture or your head being smashed on the pavement like a pumpkin.

But that’s exactly what can happen if, due to measurement errors, you’re put on BP-lowering meds you don’t need—giving you a medication-induced disorder you did not previously have: low blood pressure, potentially in the range of 90/60—or lower.

This can sock you with:

• “Orthostatic hypotension” (aka the pumpkin-meets-pavement problem)—going woozy when standing up and maybe even blacking out and dropping like a rock. (This is a major cause of hip fractures in older patients.)

• Fatigue and brain fog. Beta blockers—drugs like propranolol, with an “olol” ending—are big perps here, reducing blood and oxygen transport to the brain and blocking norepinephrine and normal alertness.

• Messed-up kidney function. Diuretics and meds called ACE inhibitors screw with water and salt handling. This can stress the kidneys and cause electrolyte imbalances from low sodium and/or potassium.

• Polypharmacy. This only sounds like a drug-fueled orgy. It is drug-fueled. It’s a pharmaceutical pile-on—the term for being prescribed five or more meds you take regularly, often leading to even more meds to mitigate the adverse effects of the first pack.

How likely are you to be prescribed BP drugs you don’t actually need?

Well, under the revised 2017 BP guidelines, 65-72% of people whose systolic BP is 120-129 will be wrongly diagnosed—overdiagnosed with “hypertension”—report epidemiologist Katy Bell and her colleagues.

Help Yourself to a Correct BP Reading

PARTNER WITH THE PRACTITIONER: Let the nurse or other practitioner taking the reading know it’s important to you to get your blood pressure number right—and you want to work with them to do that.

SIT LIKE A KING: Back supported and both feet on the floor.

GIVE YOUR ARM A REST: Your arm should not be hanging down by your side like an orangutan but supported on a flat surface.

That surface needs to be high enough so your upper arm (and specifically, the cuff) is at heart level, just like AI-generated Annie here.

Accept no too-low substitutes. Ask for a small table to be moved into the BP-taking room.

BP CUFF SHOULD FLIRT WITH YOUR ELBOW: The bottom of the BP cuff goes just above the bend of the elbow.

MEDITATIVE, NOT MANIC: “Rest for 5 min before measurement” from the Whelton chart means “sit quietly for 5 minutes before a reading is taken,” with your arm all prepped and ready on that flat surface, like AI Annie’s.

To make this a medical reality, ask the nurse to give you five minutes so you can calm yourself enough to give them a correct reading.

Your phone? Silenced, face-down, and across the room, you doomscrolling junkie.

KNOW YOUR CUFF SIZE: If you’re a big fella, you need the husky-sized cuff.

Figure out your size before you go to the doctor, lest Nurse Nellie try to fit you with Barbie’s BP cuff.

Helpfully, the Whelton team included this size chart, with the size names in the right column—though “Adult thigh” is actually the size for “Extra-large adult.” (More on sizing at the bottom of the post.)

A Single BP Measurement is Not Enough

In blood pressure measurement, “one” is not only “the loneliest number,” but the most inaccurate, because the initial BP reading tends to be overly high.

A possible perp—right out of the medical literature? “White coat syndrome”—being freaked out at getting your blood pressure taken (due to what that could mean for your health) or just being at the doctor’s office.

Or, if you’re like me, it’s the breathless race to your appointment as the clock is about to strike like a reproachful guillotine.

Immediately following your first BP measurement, ask for a second. No need to wait three to five minutes, as has been the practice; the second reading can be taken a minute after the first. (Ideally, there would also be a third.)

If your first reading’s high, it might seem you’d stay “all het up” for the second. In fact, cardiology specialist Matthew Alexander finds that a second measurement leads to a “lower averaged BP,” better accuracy, and, the biggie: “improved cardiovascular risk prediction.”

Don’t Let Mismeasurements Become Medical Records

Whenever a BP reading is high relative to my usual blood pressure, I ask the nurse to throw it out and do a retake—noting that I have a verified medical BP measurement device at home and my normal BP is 99/62.

You don’t need a device to make the case for a retake. You could just tell the truth: “That reading seems wrong.”

That might work. But your best bet is blaming “white coat syndrome.”

It seems to bypass a nurse’s “Well, hellooo, medical princess!” defense system—probably because hearing medical jargon they recognize triggers reward circuits in the brain, both out of familiarity and professional validation: a reflection of their medical knowledge and competence.

If they bristle, persist. And remember that you have two jobs on the BP agenda:

1. Get a redo (or two if you can).

2. Insist the first reading (or any other elevated readings) be excluded, lest they be averaged in, falsely elevating the total.

Keeping that el-spike-o first number out of your chart is vital.

And not just because it’s wrong.

How a Medical Record is Like a Criminal Record

For a responsible medical practitioner, a single lab value or test number is a data point to investigate further, not a diagnosis. And then there are irresponsible practitioners. They’ll glance at a single BP test and write “Hypertension” into the “Ongoing Conditions” part of your chart—which gets you deemed diseased.

Sure, you could show evidence the number is wrong or work to bring down elevated BP to a healthy level, but what goes into your chart tends to be very hard to get removed. At best, it shape-shifts slightly.

As epidemiologist Katy Bell and her colleagues put it in the Journal of Hypertension:

Once a person is diagnosed with ‘hypertension’, they do not later become undiagnosed as a result of lower BP measurements, but rather they are said to have ‘controlled hypertension.’

This “diseased on paper” thing warps the perception of doctors who read your chart—and how they diagnose and treat you. You can explain that it’s wrong, a testing error, but doctors, medical administrators, and other medical employees tend to have a quality bias—assuming that their colleagues who’ve diagnosed you were rigorous and right.

This can lead to your getting denied drugs you need, pressured to take drugs you don’t, or coerced to get unnecessary tests that sock you with radiation or otherwise put you at risk.

You Have a Right to Medical Accuracy—and It Starts With You

The best defense against being mistakenly declared some sort of geyser of blood pressure is a body of evidence: a slew of BP readings that say otherwise.

I strongly suggest you measure your BP at home—as do all the major cardiovascular medical organizations.

Blood pressure fluctuates throughout the day. Self-measurement gives you a real-world picture of your blood pressure IRL, in your “natural habitat”—as opposed to the temporary artificial environment of your doctor’s office (the equivalent of a medical zoo).

For those who aren’t up for buying a device, you can do home measurement with a medical device your provider loans you for a day. Ask your doctor for ABPM, Ambulatory Blood Pressure Monitoring: a 24-hour detailed BP measurement.

You’ll get a BP cuff attached to a small recording device that takes readings of your blood pressure and heart rate every 20 to 30 minutes during the day and every 30 to 60 minutes at night.

ABPM beats doctor’s office BP measurement for accuracy and provides all sorts of detail the office version does not, like whether you have healthy “dipping” during sleep (10-20%).

But because ABPM is just a 24-hour snapshot, it lacks the benefits of daily or regular self-measurement. There are three biggies:

1. A collection of BP readings is a powerful counterpoint: discrediting the here-and-there inaccurate measurements at your doctor’s office.

2. You’ll see patterns—changes throughout your day and from month to month in your BP metrics during, say, exercise or sleep.

3. The numbers will tell you whether you might need to make some BP-reducing changes—and, if so, with continuing measurements, you can see the results.

(In the next post in this series, I’ll cover how to prevent and/or lower high BP—along with exposing the medical underthink driving current diagnose and treatment.)

How to Buy and Use a BP Measurement Device—and Log Your Measurements

THE DEVICE: For correct BP measurement results—and credibility with your doctor—use the American Medical Association’s ValidateBP.org site to buy a device that meets their standards for accuracy. The dabl Educational Trust has another list of validated devices.

As an alternative, you can do as my primary care doctor had me do with my Homedics device—bring it in and have a nurse test my BP on their medical-grade device and compare the results. (They were just a hair apart.)

THE CUFF: Upper arm cuffs, not wrist cuffs, are recommended. Get sizing help under the Resources pulldown at the top of ValidateBP.org.

THE “HOW-TO”: Detailed guidance on how to take your BP under the Resources pulldown at ValidateBP.org.

LOG IT: There’s even a handy log to download (see below), though many people will just take a photo of their BP monitor with their phone each time. That’s what I did.

But a combo approach is probably best: photo verification of at least one BP reading a day, plus filling out this chart to give your doctor the big picture.

CONSISTENCY: Take your BP at the same time and under the same circumstances each day.

And a request: In the comments, let me know how it goes—or how it’s gone: your experience with BP measurement and mismeasurement. And feel free to post any questions you want me to take on in future posts or the comments!

Finally, if you like my posts—which I put a lot into—please throw me a like below. Helps!

NEXT: Coming Up in Part II of this BP series:

Numbering Us Sick: High Blood Pressure Is The Wrong Problem

It’s a sign, not a diagnosis.

Doctors fixate on bringing down BP numbers with drugs—often to the detriment of patient health in those with milder levels of hypertension—while failing to lower the risks of heart attack, stroke, or premature death in these patients.

Though it’s not always possible to know the cause of high BP, even when we don’t, we can take steps to fix it—in doable, lifelong ways.

Which I lay out for you in this upcoming post!

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What you (and your doctor) need to know about the real science of menopause and perimenopause

“This is a rigorous and meticulous guide to everything related to menopause. … Alkon does a tremendous job of breaking down scientific facts for everyday readers. … Her smart, thoughtful accounts of her own experiences lend a feeling of camaraderie to the book.” —Kirkus Reviews

Doctors are not chimps.

A chimp will work for a grape—handing over a painted rock to a primatologist.

Getting doctors to change their prescribing behavior takes a bigger investment—like a 13-cent plastic pen with an Abilify logo.

In one study, a pharma rep spending just $13 on a doctor—like for a tuna sandwich and cappuccino in the hospital cafeteria—was associated with 94 days of brand loyalty: three months of the rep’s drug being prescribed instead of the generic.

It seems crazy that plastic trinkets and institutional tuna could sway doctors, but even the tiniest gift can cue our evolved drive for reciprocity and increase the prescribing of a certain brand of drug, notes George Washington University health policy professor Susan F. Wood.

“Free” drug samples likewise warp doctors’ prescribing practices, significantly increasing the doctor’s prescriptions of the promoted drug.

Your doctor likely believes they’re immune to all this pharma bribe-fluencing—too smart, with too much integrity to have their medical judgment compromised.

This is common human thinking, our cognitive cleanup job that has us believing the best about ourselves—and hey, no biggie if it doesn’t cause us to prescribe a harmful drug to the neighbor or insert a substandard medical device in a co-worker.

As for doctors believing they’re beyond this, as surgeon Jo Buyske, MD, puts it, it’s not like the drug and device industry “has a ‘goodwill’ budget to provide pens to needy physicians.”

Pharma Fakes Action

Increasingly, there were calls for government regulation of pharma’s pay-to-sway scheme.

As pharma saw it, if there had to be a guard on the henhouse, it had best be the fox.

In 2002 and again in 2009, the major industry association, the Pharmaceutical Research and Manufacturers of America (PhRMA), headed off government intervention by creating voluntary guidelines for their members.

The new rules shut down the torrent of cheap pharma swag—a sad day for committed users of Zoloft tape dispensers and GlaxoSmithKline stress balls—while retaining pricey freebie dinners for doctors, provided they include some “educational” element.

They also allowed “consulting arrangements”: doctors paid to advise other doctors on “products, therapeutic areas, and the needs of patients”—and what a surprise if those “needs” happen to dovetail with the sponsoring company’s financial interests.

These dedicated doctor-educators, like rural doctors of yore, are often forced to travel great distances—boarding long first-class flights to Hawaii to dispense their expertise at swanky resort hotel medical conferences. (All-expense-paid, natch, by the generous philanthropists of pharma.)

Cash Cows In Lab Coats

Pharma’s investments pay off—on a level few investments do, reported a 2010 NPR/Propublica investigation of the influence of drug company payments on doctors’ prescribing practices.

Drug companies spend millions buying data from pharmacies to track which doctors are frequent prescribers.

A former drug company sales rep told NPR’s Alix Spiegel that if a doctor wrote a lot of prescriptions, he’d offer him a speaking fee. Post-talk, he’d see the doctor write an additional $100,000 to $200,000 in prescriptions of his company’s drug.

“So, yeah,” he said, “it was a good return on investment.”

And then some.

The speaking fee? Just $1,500.

Of course, for a wealthy doctor, that’s pretty much pocket change—but it’s the ego burnishing that closes the deal.

Spiegel reports that every drug rep she interviewed “used the exact same phrase” to pitch a doctor on speaking, telling him he was being called on to serve as a “thought leader.” This, a doctor/speaker explained to Spiegel, suggests his opinion is respected by the medical community.

As for how he’s seen by the pharma “community,” in the words of another former drug rep: “A thought leader is defined as a physician with a large patient population who can write a lot of pharmaceutical drugs. Period.”

“How Much is That Doctor in the Window…?”

There’s a US government-run site—Open Payments (openpaymentsdata.cms.gov)—where you can look up your doctor and other practitioners to see whether they’re getting money from pharma and medical device companies.

The site lists how much they got, from which companies, and the purpose of the funding, with payment data from 2018 up to December 2024 (as I write this in December 2025).

To go back further, look up Open Payments data from 2013 to 2017 on the Archived Dataset page.

Another “show me the money" site is ProPublica’s Dollars For Doctors, but it only goes up to 2019.

I test-drove OpenPayments by randomly grabbing the name of a menopause-focused doctor-researcher who showed up with some frequency in studies I looked at while researching GOING MENOPOSTAL.

In 2019 alone, this doctor-researcher had a whopping 147 payments from pharma—for a total of $97,629.70! That total includes $13,000 in “travel and lodging,” $58,000 in speaking fees, $22,000 in consulting fees, and $3,194 in “food and beverage.”

Time to Search Closer to Home

I typed in my psychiatrist’s name. He had just three years with payments—2017, 2018, and 2019—all for unwhopping chunks of change.

In the most recent year, 2019, there was a total of $18.74 from a pharma company—for “food and beverage.”

My guess: Some pharma rep treated him to lunch—somewhere chi-chi, like the hospital cafeteria or Olive Garden—or left Krispy Kremes for the office staff when they came to see him.

I asked him about it. He had no idea what the $18.74 went for. (It’s drug companies, not doctors, that report these payments.)

“I know in 2018 I went to a Mexican restaurant to hear my old professor talk, but I told them I wasn’t eating.”

His best guess: pharma-sponsored coffee and danishes for a CME (Continuing Medical Education) course he took at the American Psychiatric Association meeting.

May your doctor be as fiscally dull as mine.

At Your Doctor’s Office: Seven Questions to Protect Yourself From Marketing-Driven Medicine

(And to figure out the basis of your doctor’s treatment decisions)

1. “Why did you choose this particular drug for me (and my condition)?”

That’s the short form of the question. To spell it out further, ask: “What studies and guidelines drove your decision?”

And “What do you hope this drug will achieve for me?”

2. “Are you prescribing the brand drug, and, if so, are there generics that would work just as well?”

This is an important question for people who have to pay entirely out-of-pocket for their drugs or who have a heavy co-pay.

However, we’re told that generic drugs are the equivalent of brand drugs. That isn’t necessarily the case. Generics are required to have the same active ingredients as the brand drug, but in an upcoming post, I’ll explain why they can be different—sometimes very dangerously different.

3. “Is this a new drug, and if so, why do you prefer it over older, more established options?”

New drugs tend to lack long-term data on safety and efficacy, and sometimes skullduggery (like unpublished findings that un-sell the drug) can take years or decades to surface. Personally, I try to avoid taking new drugs unless it’s a life-or-death or “this is all there is” situation.

4. “Are there alternative options, like lifestyle changes I could make or waiting to see if I get better on my own?”

5. “Could you tell me the potential downsides of this drug—adverse effects it could have for me, given my health metrics, age, sex, and any other factors that might matter?”

6. “Could this drug interact negatively with other medications I’m taking, foods I eat, or supplements I use?”

Bring a list of meds you’re taking.

Bring a separate list of supplements.

7. “Have you had any contact with the manufacturer of this drug, like receiving meals, drug samples, or educational materials, or giving sponsored talks?”

Though I wrote this in the most neutral language I could muster—”Have you had any CONTACT…?”—a doctor might still interpret it as, “SO, DR. SLIMECAKES, DID THEY PAY YA OFF WITH A FREE LEXUS?!”

Which is why this question is last on the list.

Dismal Medical Realism

Full disclosure: In a way, this is fantasy advice, because more often than not, doctors will not have answers to these questions.

Many—or even most—are simply scientifically and medically unequipped, due to med schools churning out class after class of doctors who are not trained in how to read and critically evaluate medical research.

Protecting our health takes a DIY approach—as much as that’s possible.

Truthfully, most people don’t have the capacity to meaningfully take the advice, “Do your own research.”

It isn’t about being smart. You can have an IQ in the nosebleed zone, but just for starters...

If you don’t read a paper and scream into the drapes, “What, were you drunk and forgot the control group?!”...

And if you haven’t read a body of research on the subject...

And if you don’t have a scientific understanding of the physiology involved...

You may miss vital facts or end up woefully misdirected.

That said, you might be all you have to protect yourself.

Your job? As I wrote previously, “Distrust—and Verify,” meaning, as much as you have the energy for it, take a skeptical approach to every element of your medical care, from diagnosis to drug prescriptions to surgeries to any medical device a doctor proposes inserting in your body.

You may end up a little off-base, especially if you fall into some bottomless conspiracy hole on Reddit, but better to find you’re needlessly worried than to find yourself in the shadow of that tall dude with the scythe.

FIND THE HARMS, LEST THE HARMS FIND YOU

Look up the “adverse” effects of the drug—or device or proposed surgery. You can start with those consumer health sites, but know that they are often incomplete or wrong—per my research for GOING MENOPOSTAL.

You might expect FDA drug labels to comprehensively and correctly list potential harms. A number I’ve checked do neither. The patient drug insert for healthy FDA-approved oral micronized progesterone, biologically the same as the progesterone made by our body, falsely accuses it of the harms of its synthetic knockoff, medroxyprogesterone acetate.

Your best bet is to look at studies on the drug to find the section on potential harms—which I’ll show you that you can do, even if you don’t have a science background.

Go to Google Scholar (easier than PubMed, but that works, too) and enter the drug name and other info that might be helpful, like the condition you have.

Jigger the years on the left to get current studies.

Try to look up research as close to your demographic and medical situation as possible; for example, typing in women, reproductive age, endometriosis, along with whatever drug or treatment is being proposed for you.

If you come up empty or close, google for alternate names for the drugs and procedures you’re looking up.

Don’t expect to understand the studies. You don’t need to. Once you get to them, just search for “adverse” (effects) and these other terms:

adverse event (AE), adverse reaction, side effect, toxicity, harm, complication

Copy/paste the adverse effects section and highlight the terms that make you go “Huh?” then stick them in AI and ask for the definitions.

Then bring your concerns to your doctor.

But what if you’re wrong about Drugumozatab giving you a third boob? Okay, you’ll be embarrassed.

That lasts, what, 32 seconds?

What if you’re right?

DANGEROUS DRUG INTERACTIONS ARE BEST DISCOVERED IN ADVANCE

Use the Drugs.com interaction list to see whether the new drug plays poorly with other drugs you’re taking.

Search using both the generic and the brand name. To find the brand name, just google the drug name and “brand name,” and then do the same for the generic.

However, even if the site reveals few interactions or seemingly unimportant ones, it’s wise to do a deeper dive. Google your drug’s name and “interactions” and/or swap in other partner words like “harms,” “risks,” and the terms in the above section.

You can google “Reddit” with your drug name and also search on Twitter—though a turbo bullshit detector and a science background are pretty vital for navigating around all the cuckoopants claims.

Also checkable at the Drugs.com link are food and (vitamin and mineral) supplement interactions, but I wouldn’t trust that site to pick these up in any comprehensive way.

Google for these—as energetically as you would if somebody were trying to poison you and you need to know the particular death potion.

How to Non-Confrontationally Confront Your Doctor

People tend to be at their angry, fearful, defensive worst when confronted on the fly and expected to provide an answer—one they don’t happen to have.

If you’ve read UNFUCKOLOGY, you know that attacks on our reputation set off our threat detection and response system—the amygdala and its physiological buddies—just like “being chased balls to the wall by a bear” attacks.

So, if you discover adverse effects that seem to apply to you, I suggest messaging your doctor with the details—relatively briefly—and asking for a phone appointment to discuss them.

This allows them time to either investigate and show you why you might be off-base—or pretend they knew the adverse effects all along and suggest another treatment.

Of course, there are doctors who will be straight-up with you. My psychiatrist is one of them.

A while back, he and I were figuring out the best sleep drug for me. I asked him about orexin receptor antagonists, which were relatively new at the time, because they didn’t seem to have the harms of benzos or the z-drugs (Ambien, aka zolpidem, Lunesta, aka eszopiclone).

He said the most beautiful thing—something like, “I don’t know anything about them.” (And then probably said he’d look into them.)

This is the kind of doctor you want.

Help Me Help You! (Please Donate.)

I need your financial support for SCIENCE MADE PRACTICAL to continue my 30-year mission of putting out rigorous, highly practical applied science.

You’ll be helping fund my deep dives into research across disciplines and the doable applied science solutions I come up with for you and all my readers.

Ways to Donate:

• PayPal (one-time—or monthly or yearly donation)

• Credit or debit card (one-time donation)

• To use another method, please email: info@amyalkon.net

Buy GOING MENOPOSTAL:

What you (and your doctor) need to know about the real science of menopause and perimenopause

“This is a rigorous and meticulous guide to everything related to menopause. … Alkon does a tremendous job of breaking down scientific facts for everyday readers. … Her smart, thoughtful accounts of her own experiences lend a feeling of camaraderie to the book.” —Kirkus Reviews

The ER has a unique mission: to keep you from dying right now.

Bleeding out? Flopping on the floor like a psychotic fish? You’re in the right place.

But if your symptoms or injuries aren’t dramatically life-threatening, they may default to cutting you loose—sending you home.

Possibly sending you home to die.

Cryptically ill: Serious conditions, vague symptoms

Bring a medical puzzle to the emergency room and you’re in trouble.

It’s the department of fierce ‘n’ fast medical heroics—not long-haul deep dives into medical complexity.

Former ER doc Rick Pescatore, D.O., tweets about some of the diagnoses he missed:

Though the pace and purpose of the ER can make even doctors of Pecatore’s caliber prone to tragic missed calls, diagnostic errors are rampant throughout medicine.

Santa, The Tooth Fairy, and Diagnostic Competence

In GOING MENOPOSTAL, I lay out three big myths we believe about our medical care—to the detriment of our health (and sometimes, our continuing “aliveness”).

Today’s catch? Diagnosis.

Myth #2: Doctors are highly trained in and skilled at diagnosis, the reasoning process to drill down to the underlying cause of a patient’s symptoms.

Reality: Dr. House ain’t home.

Diagnostic Error is Baked Into Medicine—from Med School On

Most med schools don’t teach even a single course on diagnosis “or how to avoid diagnostic error,” reports SUNY Stony Brook professor emeritus of medicine, Mark L. Graber, MD, in 2016.

We patients pay the price.

“The best estimate from autopsy studies is that there are 40,000 to 80,000 deaths a year from diagnostic error,” notes Graber (though he suspects vastly more patients are injured).

He explains that many of these errors involve doctors impulsively settling on a diagnosis because the symptoms “in front of them” happen to fit with a particular condition.

“Go no further medicine,” I call it.

A 2022 US Agency for Healthcare Research and Quality research review offers a per-ER estimate of diagnostic errors—and the resulting harm:

1 in 18 ED patients receiving an incorrect diagnosis, 1 in 50 suffering an adverse event, and 1 in 350 suffering permanent disability or death.

Heart attacks are among the most missed diagnoses.

And they are especially likely to be missed in women.

Meet Joe Plaque

Quick! Picture somebody having a heart attack.

Lemme guess: You rolled mental videotape of the “Hollywood heart attack”—some all-red-in-the-face businessman clutching his left arm and dropping like a sack of rocks.

On TV, heart attacks almost always strike men.

But over here in real life, heart attacks are the leading cause of death in women (and especially menopausal women), currently killing 1 in 5 and soon to take out 1 in 3. Strokes are not far behind, ranking as a leading cause of long-term disability in women and one of the top five causes of death.

Jenny From The Blockage

In both men and women, a heart attack starts with a blockage of blood flow to the heart, cutting off the oxygen transported in it that the heart needs to keep beating.

Kind of a big deal. A big GET THEE TO THE FUCKING EMERGENCY ROOM ASAP! deal.

Problematically, the cardiovascular disaster signs in women not only lack the dramatic intensity of the male clutch-’n’-drop, but they’re practically BEIGE.

Take the most common symptom in both men and women—chest pain. For men, the pain can be crushing—two tons of heart attack fun, like the house from the Wizard of Oz landed on a guy’s chest.

Women’s chest pain may be milder—and frankly, vague: a pressurized ache or squeezing or fullness in the chest that lasts a few minutes and then comes back.

With Hollywood Heart Attack as a cultural template, women shrug off symptoms like these as “just indigestion,” acid reflux, or stress—nothing to go to the ER over, reports nurse/scientist Cynthia Arslanian-Engoren, Ph.D.

Mama’s Mild-Mannered Myocardial Infarction

Say a woman does make her way to the ER. She’s likely to get vastly less aggressive (or even attentive) care than men—or get dismissed entirely: sent home with an Advil or a Benadryl or a scolding about wise and unwise places to order the clams.

(And no, sexism is not to blame!)

It seems many medical personnel also have the Hollywood heart attack in mind and are unaware of the comparatively bland way heart attack warning signs present in women.

• Pain or discomfort in one or both arms and/or the jaw, neck, stomach, or back

• Breaking out in a cold sweat

• Nausea and vomiting

• Shortness of breath

• Dizziness or lightheadedness—feeling on the verge of passing out

• Sudden extreme fatigue

• Indigestion

• Palpitations (fluttering feelings in the chest)

• Anxiety (unrelated to anything specific)

• Disturbed sleep: sudden difficulty falling asleep or staying asleep

Granted, these symptoms do show up in lots of “not a heart attack” situations.

But being clued in that they can point to “heart go boom” in a woman is vital, allowing us to err on the side of “Get thee to the ER!”—instead of defaulting to “it’s probably nothing” and delaying to the point there’s permanent heart damage.

We’re prone to do the latter. We humans are adorably pathetic, desperate to avoid the embarrassment we feel at being wrong—and especially theatrically wrong: wrong with screaming sirens, fire trucks, an ambulance, and a cast of firemen, paramedics, doctors, nurses, and a guy actually dying in the next bed.

Distrust—And Verify: In the ER and beyond

Avoiding the harms of diagnostic error takes a form of assertiveness I call “Defensive Patient-ing”—asking questions to suss out whether their diagnosis seems well-supported or whether their mental investigation ran the gamut from A to, uh, A.

Nine Questions

1. What is your specific diagnosis?

2. Could you walk me through your reasoning behind your diagnosis and the treatment you’re recommending?

3. Are there other conditions my symptoms might point to?

4. Are there tests would confirm or challenge this diagnosis?

5. Have you looked my lab numbers and health conditions and factored those into your diagnosis and treatment recommendation?

6. Please tell me all the risks, including less common risks, from the treatment or course of action you’re recommending.

7. Are there safer or less invasive treatments?

8. Do I need to do this now or could I wait or go without treatment?

9. Am I in any danger going home, and are there red flags that suggest I should come back fast?

Diagnostic Reasoning or Diagnostic Lazy Guess?

If a doctor can’t or won’t answer these questions—clearly and understandably—it’s a sign, and no, not that you’re stupid.

Consider that my psychiatrist explains complex neurology understandably to 5-year-olds—which takes being a doctor who truly understands complex neurology.

So, push for answers—satisfactory answers—until you get them. Which may take going to another doctor. Ask for a second opinion (your right by law and not the slightest bit rude to do).

Need time to think or call somebody you trust? Tell ‘em and take it—and refuse to be emotionally bullied into rushing.

They won’t like it. But they’ll respect you and wait for your answer.

That Voice in Your Head Deserves Your Attention

You know when something’s just not right with you—like that girl’s mother knew in Pescatore’s tweet above.

Insist on talking to other doctors or a supervisor (or a supervisor’s supervisor) until somebody agrees to check out your heart (or whatever).

While you’re doing it, give yourself props for being brave and maybe even refusing to be sent home to die.

That last bit might sound a little drama llama.

You’ll see from the story of a dear friend of mine that it’s anything but.

Wild Guess-Based Medicine

My friend and colleague, forensic psychologist Dr. Helen Smith, was 37 and in great shape—running regularly since the age of 12, working as a weight trainer at the NYU gym, and doing karate.

Suddenly, she couldn’t breathe.

“It was an awful feeling--I felt like I was smothering to death and going to pass out.”

Her husband called 911, and they told him to get her the nearest hospital.

“Despite the fact that I was short of breath and shaking like a leaf, the doctor decided I was allergic to something in the gym and gave me a shot of benadryl.”

On vacation a few weeks later, she got short of breath and could not walk. And she again went to the emergency room.

“Amazingly, while in the emergency room, a man in his thirties or forties came in with shortness of breath. He was whisked off for heart tests and his wife and two little children were there crying. I felt so sorry for them.”

She finally got doctors to do an EKG. The results suggested she’d had a heart attack—an MI, myocardial infarction, caused by a blockage of blood flow to part of the myocardium, one of the chambers of the heart.

At last! Time to save Helen’s life!

“A cardiologist came into the room, looked at the reading and shrugged, stating that many thin women in their 30's who were athletic had a similar reading. I took his word for it and left.”

She finally persuaded her regular doctor to look at her heart. He sent her for tests—and called her and told her to get to the hospital PRONTO.

She was with her dad, who raced her to the hospital.

When they got there, the orderlies told him to get in the wheelchair—figuring that he was the one with the heart about to blow.

“I would have laughed myself silly if I had not been so ill. I had tests including a heart cath that helps doctors to see inside the heart.

Later, when I was back in my room, the cardiologist came in and told me that I had suffered from a heart attack and also had a ventricular aneurysm (a ballooned out area of the heart) as a result of not resting my heart after the heart attack.

I had been told that I had panic disorder so I thought that exercise would be good.”

Eventually, they diagnosed her with what’s basically an electrical malfunction in the heart, ventricular tachycardia: an irregular heart rhythm in which the lower chamber of the heart beats dangerously fast—too fast to pump well, starving the body of oxygen (that travels in blood).

Electrical problems get electrical solutions: an implanted ICD, a defibrillator that will shock her heart back into a healthy rhythm if it goes off the rails.

I also received the life-saving drug Tikosyn, which is so potent, I had to take it for five days in the hospital to make sure I could tolerate it.

For the first time in years, I feel almost normal. I give thanks everyday for the amazing advances in heart research over the past 15 years. I know it sounds cliche, but I feel lucky just to be alive. When other people in their thirties and forties complain about their aches and pains, I just laugh--I feel lucky to get up in the morning without feeling dizzy or nearly fainting.

The Mundane Objects Of My Ongoing Tragedy

(11:50 am, Nov 7, 2025, Kaiser Permanente West Los Angeles Medical Center.)

I may never walk normally again.

That’s a tin of herring I can no longer open.

My horrifically negligent cornea surgeon did this to me. The worst thing anyone has ever done to me.

Upon completing my first corneal endothelium transplant March 10, 2025, she prescribed me a corticosteroid eye drop, prednisolone acetate, and what amounted to systemic levels of a fluoroquinolone antibiotic. (Ofloxacin and then Moxifloxacin.)

Unbeknownst to me, this drug risks tendon damage, including tendon rupture from “routine movement,” and nerve damage that takes your ability to balance and walk from you. (FDA Black Box 2008 and 2016, respectively.) And don’t forget that groovy aortic dissection!

Zero informed consent. Zero disclosure of risks. Making this prescription medical battery.

On the morning of October 4, the symptoms hit: Two terribly painful episodes of trigger finger, a disorder I did not have. The symptoms have gotten progressively worse—throughout my body. My fingers are so stiff and painful that I often can’t even type till 8:30 or 9 p.m.

On October 7, at 1:45 a.m., I notified Kaiser (via a PDF to my cornea surgeon, sent through KP’s portal) that I required referral to an “appropriate expert specialist” with fluoroquinolone expertise and diagnostic MRIs to investigate the state of my tendons so I could avoid or minimize movement of those that were damaged, torn, or at risk.

I have spent since October 4 day and night fighting Kaiser Permanente for the vital diagnostic imaging and nerve tests I need to possibly mitigate further harm. It is November 14, Friday, 2:05 a.m., as I write this.

Kaiser has violated “timely access” rules of the California Department of Managed Healthcare through much of October by not expediting the diagnostic appointment in a situation with urgent catastrophic risk. $2500 fine a day at the 96 hour point from 1:45 a.m. October 7.

I now have a torn shoulder tendon, torn biceps tendon, a torn ankle tendon, a partially detached (from the bone) ankle tendon, and the edema (swelling) around the Achilles tendons that precedes rupture. My friend Heather Heying will tell you how much fun that is. As is having prostate cancer like Scott Adams and having simply evil denials of care by Kaiser.

The Doctor Ate My Homework

I don’t miss deadlines.

But I thought about all of you who subscribed—many of you I know as my beloved column readers, blog commenters, Going Menopostal readers, and more.

I thought about Raddy from blogland, and though he’d tell me to take care of my health first. And I think that’s what a lot of you would say.

It’s been horrific. And I’ll tell the story better soon. And it’s unbelievable. And I’m really proud of myself for the ways I’ve fought to get the care Kaiser is denying me.

Fiercely, daily, “Amy Alkoning things into happening.”

And there have been some major heroes in this, including my gynecologist (the single biggest hero), gyno boss in the book, the entire West LA department of radiology, Sean who runs the lab, the neuro nurses, a janitor with a missing front tooth.

I have fought in incredible ways that no patient could, as both a medical expert and expert in delivery of care, the laws and codes surrounding that, and more. When I’ve had more sleep and gotten the last few tests I’m fighting for, I will be posting shorter posts and more frequently.

Also, I will use this to help other FW-injured patients. And I already am. As I’ve going through these battles, I regularly feel sick about other patients—who have zero capacity to muster the scientific gotchas I use. And then, a major breakthrough.

On Thursday, I figured out the nut of this—an incredible nut—that should eliminate the need for patients to do more than wave a page of words I give them at their providers. (Pro tip to KP: Don’t fuck with a woman who wakes up to FQ injury with thoughts of Knox v. Keene and other delivery of care cases flying around in her head like irate Sugar Plum Fairies!)

This has also led to a whole slew of ideas on how we can all proactively avoid medical harm, and these require no medical knowledge and are pretty exciting.

To see more on this, Twitter searches: amyalkon fluoroquinolone, amyalkon blackbox, amyalkon black box.

Warning: These are not necessarily all that coherent because this fight is so massive and hard every hour of every day, and keep staying up til 3, 4, 5 a.m. to file correctly with the Department of Managed Healthcare and write rebuttals to Kaiser.

Oh, and did I mention writing my own MRIs that my fucking hero of a gynecologist has been putting in for me? At the behest of truly wonderful gyno boss, who said he could help me.

Unfortunately, he can only order below the ovaries! So I am left to this day to fight Kaiser for the beyond urgent hand and wrist MRI—correctly written (by me)—and the urgent 3mm skin punch biopsies for small fiber neuropathy.

They keep denying these (and more) and delaying or just doing nothing about other necessary elements of diagnosis and care.

They think this is a big win for them, having not a bent clue about how wildly stupid it is to keep me hanging around when you’re hiding medical evil to sick and suffering people behind a bureaucratic veneer.

Help Me Help You! (Please Donate.)

I need your financial support for SCIENCE MADE PRACTICAL to continue my 30-year mission of putting out rigorous, highly practical applied science.

You’ll be helping fund my deep dives into research across disciplines and the doable applied science solutions I come up with for my readers.

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What you (and your doctor) need to know about the real science of menopause and perimenopause

“This is a rigorous and meticulous guide to everything related to menopause. … Alkon does a tremendous job of breaking down scientific facts for everyday readers. … Her smart, thoughtful accounts of her own experiences lend a feeling of camaraderie to the book.” —Kirkus Reviews

I AM A MEDICAL DETECTIVE. I look at people’s labs, evaluate their doctor’s diagnosis and treatment advice, and then figure out what’s really going on—and what’s scientifically warranted.

I have also become a sort of lie detector for scientifically crap claims that doctors make. In just about every conversation I have with doctors, I hear them making declarations of supposed medical fact—untethered from science and the most basic understanding of human physiology

There are doctors practicing the evidence-based medicine we’re led to believe we are getting, but they are few and far between. We don’t want to believe that, because it means we can’t trust our doctors to help us instead of harming or killing us.

But the US National Academy of Medicine reports that more than half of our medical care in the US may not be “based on or supported by adequate evidence.”

Our medical care won’t become evidence-driven overnight. We, the patients, need to understand the science so we can bring it to our doctors and ask for the evidence-driven care most are often unable to provide.

That is a major mission of this newsletter. But evidence from scientific research is only part of the story.

A doctor’s diagnosis and proposed treatment must make sense in light of human physiology—the physical and functional makeup of the human body and its parts: the workings of the human “factory.”

But doctors often lack a meaningful understanding of physiology—beyond once cramming on it to pass med school and their boards. And by understanding it, I mean both understanding physiologic function and the need to take it into account in patient diagnosis and treatment.

“Doctors ignore physiology? Come on, Alkon!”

I know that sounds unbelievable, but—to name one disturbing example—there’s my cornea surgeon, an elite practitioner, highly respected for her surgical skill.

I was grateful to have her as my corneal endothelium transplant surgeon—or as I put it, “The person sticking the X-acto in my eye.”

The corneal endothelium is basically the plumber of the eye—a one-cell-thick sheet of tissue that pumps out fluid so it won’t build up and blur your vision.

I was in need of a set of these “aftermarket parts” due to a genetic disease—Fuchs endothelial corneal dystrophy (aka FUCKFUCKFUCKYOU! dystrophy)—that causes you to progressively lose your vision, and in severe cases, go blind.

Upon diagnosing me, she mentioned that I’d need to take steroids (in eye drop form). Forever.

I expressed concern—noting that steroids eat bones and can lead to jacked-up blood pressure and blood sugar, gastro issues, and suppression of the immune system.

“These don’t have systemic effects,” she told me—perhaps believing this because they’re inserted into the eye in drop form instead of taken orally.

I immediately knew she was wrong.

Hello?! Tear Ducts, Anyone?!

There’s a hole—that little hole in the corner of your eye—that’s the opening to the drainage system that leads down to your tear duct plumbing. (It’s actually got a partner hole on top.)

Squeeze an eye drop into your eye and a bunch of it goes right down the “pipes”—into your nose and the back of your throat—and gets distributed to your body (AKA your “system,” home of those fun “systemic effects”).

You can block some of it from going down the hatch with your big clumsy thumb smushed into the corner of your eye after insertion. However, like me, you’re sure to taste the ineffectiveness of this measure when a good bit of that liquid steroid still makes its way down your nose and into your throat.

Consider that my surgeon deals with various forms of tear dysfunction, plus the eye is not exactly the Texas of the human body, so it’s not like she forgot these holes were there.

She just didn’t think to take them into account.

Staging a Scientific Intervention

My surgeon did the first transplant operation on March 10—on my right eye, because my vision was worst in that eye.

The surgery I had is called DMEK—Descemet’s Membrane Endothelial Keratoplasty— the replacement of my endothelium-in-the-shitter and its Descemet’s membrane base with donor tissue. DMEK transplants have only a 1.9% percent rejection rate, due largely to the lack of “vascularization”—veins in the tissue. No veins, no rivers of blood for immunowarriors to travel down to attack the graft.

I was scheduled for a checkup with my surgeon two weeks afterward, and I went in prepared.

I had the science on steroids in my lap but I opened on the steroid-driven drama—telling her how close I’d come to dying of a traumatic brain injury. For the first time in my 61-year-old life, I’d fainted: dropped like a rock on my bathroom floor, inches away from my head turning into a smashed pumpkin on the cast-iron tub.

There were also serious heart effects, like my resting heart rate mimicking my “being chased by wild dogs” heart rate.

I presented my case for a prescription change: citing research on the harms of prednisolone acetate and the successful retention of transplants with alternative steroids and reminding her of my strong metabolic health. Translation: Extremely low bodily inflammation, reflecting a substantially decreased need for steroids to keep post-transplant inflammation down.

I asked her to switch me from noxious prednisolone acetate, with its strong systemic effects, to Lotemax ointment, a “softer steroid” with far less systemic distribution.

But before she could answer, I brought in backup.

Gotta Destroy Your Eye to Save Your Eye

Vitally, Lotemax ointment is preservative-free—and thus free of the pernicious effects of the destructive BAK preservative in prednisolone acetate (and most eye steroids and ocular antibiotics). This horrible stuff begins eroding the corneal epithelium in a matter of days, delays wound healing, worsens the uncomfortable and unhealthy “dry eye” I already suffer, and…LEADS TO CELL SHRINKAGE AND CELL DEATH!

This is information she should know! And not because some worried nerdy patient told her, probably halfway through her career as an eye surgeon specializing in corneal disease who constantly prescribes ocular steroids (and BAK-containing antibiotics like the one she prescribed me).

But, yes, the rather consequential harms of BAK preservatives appeared to be news to her.

I have to assume this—both from her response to me and because she seems to care deeply about me and her other patients. I can’t imagine her secretly wanting to destroy the eye parts she’s saving with her surgeries. (“Hah, hah...here’s some prescription cell death to throw in your peepers!”)

Pervasive Cluelessness

My surgeon’s obliviousness about the harms of preservatives in eye drops had company. Both my optometrist and another ophthalmologic surgeon had prescribed me preservative-laced eye drugs or drops.

I messaged the latter guy, a cataract surgeon who’d prescribed OTC hypertonicity saline eye drops to help decrease the fluid buildup from Fuchs. I was in their pharmacy, about to get the drops, when I saw they had preservatives—toxic parabens that, in a mere 24 hours, lead to cell shrinkage and cell death in the glands that make the oil in tears that keeps them from evaporating.

Could he please change the scrip to preservative free?

“Is there such a thing?” he messaged me.

Me, in my head: “I’M THE PATIENT! HOW THE FUCK SHOULD I KNOW?”

I dick around on the web trying to figure this out and call Kaiser’s 24-hour pharmacy and talk to a pharmacist. Unhelpful. I dick around more on the web. Turns out, yes, there’s preservative-free hypertonicity saline ointment. I order it off Amazon and then yell into the drapes:

“COULD I PLEASE NOT BE THE FUCKING MEDICAL ‘GENIUS’ IN EVERY FUCKING AREA OF MY MEDICAL CARE?”

Of course, I’m no genius—I’m the janitor, cleaning up doctor vomit: lazy, irresponsible myth-based beliefs harmful to my eyesight and ocular health!

The Moment of Medical Reckoning

I could see my surgeon was annoyed by my meddling, and it is not just gross literary hyperbole to say this filled me with brown clouds of terror.

I needed her to do my second transplant. Having her dislike and resent me would not be a positive state of affairs.

I muttered something appeasingly guilt-infused.

She was curt. “It’s your body!”

And that was that.

She typed in the prescription change for the Lotemax ointment.

More nervous mumbling from me, “Um, BAK, uh…offloxacin…but not moxifloxacin…”

More typing. She switched me from offloxacin, the BAK-laden antibacterial drop she’d prescribed, to moxifloxacin: the preservative-free, similarly-priced generic equivalent—which I informed her, per the research, has broader-spectrum protection!

Unfortunately, it was too late to change my medical fate.

Prednisolone made me terribly ill for three whole months and part of the fourth, probably due to my bordering-on-extraordinary metabolic health: extremely low inflammation, insulin sensitivity, a “quiet” immune system, and a quiet HPA axis (the hypothalamic-pituitary-adrenal axis that potentiates healthy and necessary cortisol release).

Malpractice by Rote

I had emphasized my strong metabolic health to my surgeon, because this is essential information for doctors to factor into your care—especially in the serious eye surgery arena.

However, in her field and in much of medicine, doctors too often treat each patient as if they are EveryPatient—some mythical “average patient” who does not actually exist—rather than doing the medically responsible thing and factoring in individual metabolic health and other individual patient metrics.

Accordingly, my surgeon had prescribed me what amounted to a huge overdose of prednisolone acetate: the 8-drops-a-day dose you might use as a “rescue steroid” for someone aggressively rejecting their transplant—or a very unhealthy patient with several inflammation-jacking conditions: diabetes, Lupus, obesity, atherosclerosis, and/or other immuno-taxing diseasemates.

In contrast, the field standard is 4 drops a day. And no, that’s not because researchers did the responsible science thing and tested 1 drop against 2 drops or 4 drops against 6 and, say, found 4 to be better.

The 4-drop dose, like way too much of our medical care, is based on clinical habit!—“We do this because we’ve done this!”—though doctors prescribing it believe it to be evidence-based.

As for the Double Stuf Oreo prescribing standard my surgeon seems to have applied, she appears to believe, “If 4 drops is good...8 drops must be better!”

This is—as politely as I can put it—SCIENTIFICALLY IDIOTIC!

Cluelessness-Driven Prescribing

There is no evidence that this 8-times-daily dosing is superior—or even warranted! In fact, such a huge blast of steroids would likely increase the risk and intensity of steroid-driven systemic damage and carnage in the eye or eyes getting the drops, including progressive destruction of the optic nerve and glaucoma!

I didn’t take the 8-drop dose long enough for that to happen.

But in me, it led to the delayed and highly compromised healing of my transplant.

And worse.

While it’s just an educated guess on my part, tests I’d gotten an endocrinologist to give me pointed to harm to the normal functioning of my HPA axis, which led to a four-month stint of unpleasant, scary, and harmful effects.

I suffered tachycardia—a dangerously high heartbeat—every day: 177 bpm while sitting still on my couch. 142 while standing by the receptionist with the bunnies backboard at my surgeon’s office. Less frequently, there was bradycardia, a dangerously low heartbeat (42 or 45 bpm), popping in like a parole officer for random visits.

I was also devastatingly weak. I normally lift weights every day, and not the little pink variety. I couldn’t hold my phone up for more than 15 or 20 seconds or make it through even the short cycle of my electric toothbrush.

My brain felt like a foreign object—like a doorstop filled with dying neurons. I was cognitively flattened, suffering unrelenting brain fog and all-day mental malaise that made the slightest effort at thinking seem like too much work.

I longed to escape my bricked brain with sleep, but, as they say, “There’s no rest for the medically fucked.” Every day, I suffered the physical effects of an all-day panic attack: hours and hours of heart-pounding discomfort—like from 8 a.m. to 2 or 4 or 5 p.m.—while my mind remained coolly rational as ever.

Doom With a View

I was seriously lucky.

That probably sounds crazy.

But for starters, I knew something was terribly wrong and I knew it was almost certainly due to being overdosed with steroids.

Unlike doctors and researchers, who are forced to narrowcast—specialize in a single area—I’ve immersed myself in the science across a number of disciplines.

In addition to understanding the systemic harms of corticosteroids like prednisolone acetate, I’m versed in the mechanics of stress and how stress hormones act in the body and brain; I understand the workings of the immune system and healthy and unhealthy inflammation; and I spent a year studying cognitive neuroscience and neurobiology to think out and write UNF*CKOLOGY.

My salad bar of scientific knowledge allowed me to drill down to the likely cause of my terrible symptoms: an HPA axis freakout from the steroid overdose, with normal healthy signaling and hormone release seriously out of whack.

This, in turn, pointed me to the “What do I do now?”—steps to take to stop the harm and heal from its effects (though there was a terrifying possibility I’d experience long-term or even lifetime persistence of these symptoms).

Poring over research on Fuchs, ocular steroids, and DMEK surgery and factoring in my extremely low levels of inflammation, I carefully calculated the applied science: how to protect the gift of a transplant I’d been given without harming or ruining my lifetime health.

The Lotemax ointment I had her switch me to is gooey, so stays in the eye rather than sliding right down the “pipe” like liquid drops do, and it kept my inflammation and eye pressure at a healthily low level, without the slightest sign of transplant rejection.

I applied other scientific judiciousness that I can’t reveal here, on both the first transplant and the second. What I can disclose is that upon my second transplant, at my checkup just seven days after my surgery, I was an ocular rock star: I had zero “anterior chamber inflammation,” a simply stellar intraocular pressure (IOP) reading of 10, and my surgeon said my transplant and eye, overall, “looked terrific.”

We Should Be Patients, Not Prey

This harm I suffered can happen to any of us who are solely at the mercy of a doctor’s knowledge and beliefs—and this drives the medical and health content you’ll see in this newsletter. A good part of it will be how to avoid medical intervention through science I post on how we can be at our healthiest.

Medicine and Health

•I’ll identify the everyday unwitting malpractice of medicine by doctors in area after area of our care.

•I’ll lay out what the science actually says, note vital tests that doctors may not know to give, and explain how to get the evidence-based care we should be.

•I’ll cover compelling new findings in research as well as studies in the news that are scientifically and physiologically ludicrous.

•I’ll also debunk widely-held medical, nutritional, and Big Vitamin-serving myths—like “The Calcium Myth” that I take on in GOING MENOPOSTAL: What you (and your doctor) need to know about the real science of menopause and perimenopause.

Beyond Medicine: Love, Sex, Friendships, Healthy Conflict, and How To Be The Best You

This newsletter will also include my science-based advice on everything from your friendships and relationships to being and bringing your best self. My goal: Giving you a diving board to cannonball off into living your most productive, happy, loving, meaningful (and even fabulous!) best life

Help Me Help You. (Please Donate.)

I need your financial support for SCIENCE MADE PRACTICAL to continue my 30-year mission of putting out rigorous, highly practical applied science.

I’m living off my savings, and they’re running out.

You’ll be helping fund my deep dives into research across disciplines and the doable applied science solutions I come up with for my readers.

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Shape What I Cover Here

Please post requests in the comments. You can also send questions and advice requests privately to me at info@amyalkon.net for possible coverage here. My policy, same as in my advice column, is to keep the requester anonymous.

Finally, please consider picking up a copy of GOING MENOPOSTAL, even if you’re a dude. There’s stuff for you, too, on the most powerful and efficient ways to eat and exercise for long-term health—and really spiffy abs and other muscles! And because these tips are from me, disciplinary sainthood is not required. They’re doable by mere mortals.

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What you (and your doctor) need to know about the real science of menopause and perimenopause

“This is a rigorous and meticulous guide to everything related to menopause. … Alkon does a tremendous job of breaking down scientific facts for everyday readers. … Her smart, thoughtful accounts of her own experiences lend a feeling of camaraderie to the book.” —Kirkus Reviews