9/27/25 – from Raquel
Hello friends and colleagues. I have some difficult news to share: I am now in Heart Failure (class III). The technical diagnosis is Heart Failure with Preserved Ejection Fraction (HFpEF). The underlying causes appear to be an unfortunate combination of Metabolic Syndrome (related to psychiatric medications that I took previously) and Familial Hypercholesterolemia (genetic disorder related to lipid metabolism).
I am getting comprehensive care at this time. My treatment is overseen by the Advanced Heart Failure Center at UCSF. My medical team includes Primary Care, Cardiology, Endocrinology, Lipidology, and Palliative Care. I am also applying to participate in a clinical trial for a new medication at Stanford.
You may know that I have been struggling with a variety of medical symptoms for the past five years, which were mostly misattributed to menopause and/or depression. So I was both shocked but also not surprised by this change in my status. I am happy to report that I am still lucid and somewhat mobile, although I get tired easily. Friends tell me that I look and sound the same as I did a few weeks ago. For now, I enjoy visiting with my close friends, going on outings with others as my health permits, taking short walks, and watching movies.
I am also in the process of retiring from my career as a Ketamine Consultant. It has brought me a great deal of joy to serve in this way. I feel a lot of sadness about this change.
My friends and I have started a Kudoboard for me. We would like to invite all of my friends, colleagues, and students to make a post there. A short video message would be great, or you could post a photo of yourself (or you and me together) with a text message. You are welcome to speak to whatever you like. I would love to be reminded of how we met, the adventures that we had together, or how my teachings influenced your work. This is a lovely moment to reflect on my career and relationships.
Please bookmark this page and check back in the future. My friends and I are planning to post occasional updates here.
10/23/25 – from Raquel
Some folks have asked if they could receive an alert when there is an update to this page? I’m not able to coordinate that at this time, but there an easy solution: Visualping. It is a simple and free tool that will automatically detect updates to this page and send you an email.
10/24/25 – from Raquel
Folks have asked how I feel physically? I feel crummy, like an engine with no gas, running on fumes. My limbs often feel light. I am very aware of my heartbeat. Thankfully I am not experiencing any pain at that this time. Mostly I just feel extremely tired. Note that looks can be deceiving… friends tell me that I look and sound pretty good right now. But that part that is invisible to others is when I crash after taking clothes out of the dryer or having a shower. Sometimes I am too tired to stand at the stove and fry an egg. The intensity of fatigue is hard to describe.
Folks have asked how I feel psychologically and spiritually? I’m feeling everything all at once: sadness (grief), anger (rage), fear (terror), gratitude, acceptance, then repeat. When I first received a life-threatening diagnosis, it was a largely dissociative experience; everything felt unreal for the first couple of weeks, or I was coming in and out of this reality. Now things are settling down, and I feel more calm and less frantic on the inside. I’m just trying to surf the big waves of emotions as they arise.
Folks have asked about the prognosis? That is unknowable at this time. My medical team is still trying to adjust and optimize my medication regimen. I am currently planning for multiple scenarios, including living a bit longer, having a catastrophic medical event, and dying.
11/01/25 – from Raquel
My docs suspect that I have severe functional anemia (a/k/a “anemia of chronic disease” or “inflammatory anemia”), so they are getting me started on iron infusions. Let’s pray that it helps me! Functional anemia and heart failure are closely related. (Here is more technical info about the connection between these two diseases.) Functional anemia is different from iron-deficiency anemia, and it does not show up on the basic blood test for regular anemia. Functional anemia occurs when the body actually has an adequate amount of iron, but the bone marrow cannot utilize the iron effectively in making red blood cells. In other words, something is wrong with the hemoglobin, so the red blood cells cannot carry and deliver enough oxygen to the tissues, creating the symptoms of anemia. This condition is extremely under-diagnosed and under-treated. So if you know someone who has mysterious intense and debilitating fatigue, it might be useful to know about this.
11/10/25 – from Raquel
Hello friends and colleagues. Thank you very much for all of your loving messages on my Kudoboard. It really lifts my spirits to look there and see your thoughts and reflections. ❤️🧡💛
I am learning that there is a huge liminal space in between receiving a life-threatening diagnosis and death. It is characterized by endless waiting… waiting for an appointment to see a medical specialist… waiting for the insurance to approve the infusion that the doctor ordered… waiting for an appointment at the infusion center… waiting to see if the medication will work, etc. It is infernal.
I try to comfort and distract myself by making lists in my head of things to be grateful for: my friends, my career, my mentors, my kitties, my god-daughter, access to modern medical services, organic food, etc. I’m also grateful in a way for this quiet period to reflect on the life I have lived, tie up some loose ends, and make preparations for the next part of the journey of the soul.
12/08/25 – from Raquel
Right now, I am working on creating a scholarship fund to subsidize KAP for clients who need low fee or sliding scale services. I have been wanting to do this for a long time! I am looking for one or more clinic(s) and/or organization(s) to provide the services and house the fund. If your group would like to apply for this, please complete the application form by Dec 12. (Note: I am not able to accept funding requests from patients at this time.)
I am happy to report that I that I am feeling a bit better as a result of the iron infusions. It would appear that I was experiencing severe inflammatory anemia (as explained previously). Before the infusions, I could barely make it from my bed to my kitchen table by myself. Now I am slowly moving around my house again, preparing meals and answering emails.
It has been helpful to develop some new language to more clearly describe my experience. One useful semantic distinction is the difference between “depression” vs “demoralization.” I have struggled with true clinical depression for much of my life. (This is the reason that I got interested in studying ketamine in the first place.) This kind of depression has many neurological features, and it is helped by psychiatric medication(s), among other things. In contrast, demoralization refers to sadness and frustration related to the patient’s health status. Any reasonable person might have these feelings in a similar situation. It is not pathological, and psychiatric meds are neither useful nor appropriate. Instead, demoralization calls for grieving and compassion.
Another important semantic issue is understanding different kinds of “fatigue.” I am tired all the time, even though I get plenty of sleep. My doc suggested that I say “cardiac depletion” now to describe my lack of energy, to distinguish it from other kinds of tiredness.
01/17/26 – from Raquel
I recently passed the two-year anniversary of my first heart attack. On the night that it happened, I was awakened from sleep by intense pain in my face and jaw, with nausea and sweating. I was taken by ambulance to the hospital, where I had an emergency radial angioplasty that saved my life. Somehow I regained consciousness in the middle of all of this, and watched on a giant video screen as doctors placed stents into my heart.
Anyway… I did not know that I was having a heart attack while it was happening. I sensed something was terribly wrong, but my symptoms did not fit my mental image of a heart attack. Later, I learned that heart attacks often present differently in women than in men. I also learned that cardiovascular disease is the leading cause of death for women in my age group, causing more deaths than all kinds of cancer combined!
There are a couple of things that you can do now to protect yourselves and your loved ones. (1) Learn the symptoms of heart attacks in women. (2) Know your numbers; ask your doctor to order a lipid panel (blood test) for you. (3) Learn CPR (or take a refresher class) so that you can follow instructions over the phone if you see someone who is experiencing cardiac distress. The basic class takes less than one hour.