I do not often open up about my own health.
Since the age of 23, I have taken diet and exercise seriously. I come from a long lineage of cardiovascular disease and premature cardiovascular events on both sides of my family. Prevention was never abstract to me.
As I traveled and continued to learn about preventive screens and diagnostics, I realized that this information, although available, was not common knowledge, either with clients or within their respective healthcare teams.
In 2015, I launched my first community-oriented cardiovascular symposium. I brought in a progressive cardiologist and lipidologist, a clinical psychologist, and a naturopath to explore a multi-angular approach to educating and protecting our community.
A Constellation of Signals
Since I was a kid, I have dealt with a constellation of symptoms that, as a child, teenager, and early adult, did not seem related:
- Auras
- Anxiety
- Disrupted sleep (frequent awakenings)
- Consistent and impactful dizziness when standing or jumping up too fast
- Weird physiological transitions at altitude
- Worsening anxiety, bouts of tachycardia, and multiple trips to the ER
In my 30s, even with support, a strong care team, and regular aerobic conditioning and strength training, I became more prone to these anxiety attacks and odd feelings of instability.
I coordinated care, explored overlapping opinions, and for all intents and purposes, I was strong and healthy.
In retrospect, some of these signals can be consistent with intracardiac shunting, where blood moves through the heart in a way that can affect oxygen delivery during activity, or with exercise-related cardiac physiology. Many are nonspecific and can overlap with other explanations. What mattered most was that the pattern deserved a second look.
When Certainty Replaces Curiosity
I sat in with a highly-regarded cardiologist who performed an echocardiogram (a heart ultrasound that evaluates structure and function) and a carotid IMT (a screening ultrasound that looks at the thickness of the carotid artery wall).
He reviewed the results and advised that I should be on the treadmill regularly, then proceeded to describe his personal routine. This was said despite the fact that I was already training consistently, and I regularly hired outside professionals to help sidestep my own biases and blind spots, including running coaches.
Oddly, every time I started a run without easing in, I became breathless and incredibly dysregulated. Coaches and clinicians alike often leaned into the notion that the first 10 to 12 minutes of a run always feel terrible, but this felt categorically different. It felt like a gear slammed into place at the 10 to 12 minute mark and my physiology shifted immensely.
The cardiologist looked at me and said, “You do not need me, you need a therapist,” and laughed.
I sat with that.
Self-Advocacy Without Confrontation
I pondered what I would do if I were trying to support any other client. I requested a second opinion, this time through the Mass General Preventive Cardiology unit.
My appointment came and within minutes, my doctor listened to my heart with an “hmmm… uh hu… hmmmmm.”
I had a list of questions. She did not hesitate. “I see you had an echo done but it is not lining up with what I am hearing. I am going to send you for another echo.”
This one was more comprehensive. Within weeks, I received a call. “Ryan, we did find either a patent foramen ovale or an atrial septal defect. We really are not sure, and we are going to schedule you with our interventional cardiology team.”
I outlined my symptoms and they scheduled me for a cardiopulmonary exercise test (CPET) using the athlete protocol.
Adria attended every visit, co-advocated, took notes, and asked clarifying questions, because even I was becoming overwhelmed in these visits.
For context, a patent foramen ovale (PFO) or an atrial septal defect (ASD) are congenital heart findings involving a small opening between the heart’s upper chambers. These are real, structural differences that can influence how blood moves through the heart, particularly during physical exertion or changes in pressure.
When symptoms such as exercise intolerance, palpitations, dizziness, migraine with aura, or unusual physiological responses at altitude appear together, clinicians may view these findings as clinically relevant rather than incidental. They do not explain everything, but they can meaningfully change how symptoms are interpreted and why further evaluation is warranted.
In my case, the cardiology team treated this as something to take seriously. They discussed activity and travel precautions and recommended longer-term imaging follow-up to monitor structural changes over time.
What Certainty Missed
I sat back and reflected on this experience. It would have been easy to dismiss me as mentally unwell. The previous cardiologist spoke with such confidence and condescension that if I were anyone else, I might have left it at that.
Because I continually seek perspectives for my clients and those I love, I leaned in and continued to advocate for myself with Adria as my co-pilot.
We do not yet know what this next chapter will bring. But I do know one thing: it can feel incredibly lonely when you feel something is off and you are dismissed because the root cause is not obvious.
Self-advocacy does not always look like confrontation. Sometimes it looks like asking again. Sometimes it looks like finding someone willing to listen twice.
What certainty missed was curiosity. And without curiosity, a highly relevant clinical consideration never entered the conversation.
Compounding Effects of Self and Co-Advocacy
When curiosity is preserved, progress becomes possible.
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Emotional
Relief in being taken seriously. Reduced self-doubt. A steadier internal narrative. -
Social
Shared advocacy replaced isolation. Appointments became collaborative rather than adversarial. -
Intellectual
Uncertainty became navigable. Questions were allowed to exist without being dismissed.
Ryan Travis Woods
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