Big law with a heart condition? Forum

[Anonymous User]

About six months ago I found out I have a heart rate/blood pressure issue that requires me to be on a pretty high dosage of beta-blockers. While I can function ok for the most part, I have a lot less energy than I used to and it's becoming harder for me to stay focused during the day. I've had to almost cut out caffeine completely. You can imagine how this could make things difficult for a biglaw attorney.

I'm a SA at a smallish regional office of a biglaw firm, and my office has kind of been taking it easy on me in terms of workload. While I've gotten a decent mixture of assignments, they haven't been too difficult for the most part. The problem is, I've been taking WAY too long to complete them. For an assignment that would take one of the young associates 2 hours, I'm spending an entire day. I really just can't focus. I'm convinced the only reason this hasn't landed me in trouble yet is because I'm the first SA this office has had in several years. They don't really have anyone else to compare me to, aside from the younger associates (but there are only a few of them).

Even if I'm able to do well enough to come out of this with an offer, I'm scared that I won't last long as an associate if things don't change. Any advice?

[eandy]

Are you zoning out or getting distracted?

[keg411]

First, it tends to take SA's longer to to assignments anyway. Just because you're not doing things as fast as the regular young associates doesn't mean anything about you.

Second, you'll get used to the no-caffeine thing. I get super jittery from coffee and anything highly caffeinated, so I just cut it completely. You really don't need it to function. Just try getting extra sleep.

If you really think it's the medication, consider talking to your doctor. He/She may adjust the dosage or switch the medication if it's really having that much of an effect on you.

[Anonymous User]

Are you zoning out or getting distracted?

Zoning out I suppose. I'll go through hours at a time where I have to re-read everything three or four times before it sinks in. There's been a few times where I've gone into a partner's office to discuss the assignment I just finished working on and will completely blank when asked a simple question.

Another way this has manifested itself is that I get really tired pretty early at night. I've been going to bed around 10:00 most nights and waking up at 7:00.

[sunynp]

You need to talk to your doctor about biglaw hours. I think that you may not be able to handle the hours, even though you can do the work. That isn't something to be ashamed of, lots of people can't handle biglaw hours.

Your health has to come first. How are you going to function if you have to work all night or work three days in a row with little sleep? I think that has to be dangerous for your health.

Also - are you sure you aren't depressed? Maybe having a heart condition is also playing with your mental health.

Please go and talk this over with your doctor. You need better advice than we can give you.

[Anonymous User]

First, it tends to take SA's longer to to assignments anyway. Just because you're not doing things as fast as the regular young associates doesn't mean anything about you.

Second, you'll get used to the no-caffeine thing. I get super jittery from coffee and anything highly caffeinated, so I just cut it completely. You really don't need it to function. Just try getting extra sleep.

If you really think it's the medication, consider talking to your doctor. He/She may adjust the dosage or switch the medication if it's really having that much of an effect on you.

I know that I'm not expected to be as fast as the attorneys, but that's because they expect me to speed up as time goes on. While I'm sure I'll eventually become more efficient at researching and writing just like everyone else, my fear is that eventually regardless of how good my westlaw skills are, my lack of focus is going to hurt me.

I have spoken to my doctor about changing the dosage of the medication. He actually wanted the dosage a bit higher than it is now, but when I explained that I can't afford to be a zombie all day, he agreed to lower it to where it is now. I definitely plan on discussing it with him again during my next visit though.

[dixiecupdrinking]

You need to talk to your doctor about biglaw hours. I think that you may not be able to handle the hours, even though you can do the work. That isn't something to be ashamed of, lots of people can't handle biglaw hours.

Your health has to come first. How are you going to function if you have to work all night or work three days in a row with little sleep? I think that has to be dangerous for your health.

Also - are you sure you aren't depressed? Maybe having a heart condition is also playing with your mental health.

Please go and talk this over with your doctor. You need better advice than we can give you.

I agree with this but I'd also encourage you (OP) to relax a bit. Maybe you aren't in trouble because you're the only SA -- or maybe because you're the only SA you don't have a sense of what kind of expectations for yourself are reasonable this summer.

[Anonymous User]

You need to talk to your doctor about biglaw hours. I think that you may not be able to handle the hours, even though you can do the work. That isn't something to be ashamed of, lots of people can't handle biglaw hours.

Your health has to come first. How are you going to function if you have to work all night or work three days in a row with little sleep? I think that has to be dangerous for your health.

Also - are you sure you aren't depressed? Maybe having a heart condition is also playing with your mental health.

Please go and talk this over with your doctor. You need better advice than we can give you.

I'm definitely not depressed. I realize I kinda came across that way in my post, but despite my concerns about this, I'm a pretty happy-go-lucky kinda guy.

I appreciate your concerns though. My health is certainly my first priority. Complicating things is the fact that I'll be pretty deep in debt when I graduate. I have no idea how I would repay my loans without at least pursuing this biglaw job at least for a while. But I definitely will talk to my cardiologist about this during my check up next month.

[dixiecupdrinking]

You need to talk to your doctor about biglaw hours. I think that you may not be able to handle the hours, even though you can do the work. That isn't something to be ashamed of, lots of people can't handle biglaw hours.

Your health has to come first. How are you going to function if you have to work all night or work three days in a row with little sleep? I think that has to be dangerous for your health.

Also - are you sure you aren't depressed? Maybe having a heart condition is also playing with your mental health.

Please go and talk this over with your doctor. You need better advice than we can give you.

I'm definitely not depressed. I realize I kinda came across that way in my post, but despite my concerns about this, I'm a pretty happy-go-lucky kinda guy.

I appreciate your concerns though. My health is certainly my first priority. Complicating things is the fact that I'll be pretty deep in debt when I graduate. I have no idea how I would repay my loans without at least pursuing this biglaw job at least for a while. But I definitely will talk to my cardiologist about this during my check up next month.

I mean, if/when you get an offer to come back permanently, you can bring this up with your firm. They might be demanding but they don't want to kill you... nor do they likely want to fire you for reasons relating to a disability. And the answer might be as simple as putting in less face time in the office but working from home when you need to after you get some rest in the early evening. I think you'll be able to make this work; the worst thing you could do in the long run is not bring it up and put on a brave face, though.

[roaringeagle]

I'm really sorry to hear about your medical problem. I know that they can be crippling at first. However, as your treatment becomes more complete you will feel stronger and have your concentration back. I would definitely take significant time this year to go to specialists (I can help you if you live in the DC Area) and I have heard the very best heart doctors are at Barnes Jewish Hospital (WashU Hospital). I know a girl who was having trouble in relationships due to a weak heart, now she is happily married and able to have children thanks to her traveling to St Louis to get surgery there. The beta blockers themselves are no picnic.

From Wikipedia:

Adverse drug reactions (ADRs) associated with the use of beta blockers include: nausea, diarrhea, bronchospasm, dyspnea, cold extremities, exacerbation of Raynaud's syndrome, bradycardia, hypotension, heart failure, heart block, fatigue, dizziness, alopecia (hair loss), abnormal vision, hallucinations, insomnia, nightmares, sexual dysfunction, erectile dysfunction and/or alteration of glucose and lipid metabolism. Mixed α1/β-antagonist therapy is also commonly associated with orthostatic hypotension. Carvedilol therapy is commonly associated with edema.[22] Due to the high penetration across the blood–brain barrier, lipophilic beta blockers, such as propranolol and metoprolol, are more likely than other, less lipophilic, beta blockers to cause sleep disturbances, such as insomnia and vivid dreams and nightmares.[23]
Adverse effects associated with β2-adrenergic receptor antagonist activity (bronchospasm, peripheral vasoconstriction, alteration of glucose and lipid metabolism) are less common with β1-selective (often termed "cardioselective") agents, however receptor selectivity diminishes at higher doses. Beta blockade, especially of the beta-1 receptor at the macula densa, inhibits renin release, thus decreasing the release of aldosterone. This causes hyponatremia and hyperkalemia.
Hypoglycemia can occur with beta blockade because β2-adrenoceptors normally stimulate hepatic glycogen breakdown (glycogenolysis) and pancreatic release of glucagon, which work together to increase plasma glucose. Therefore, blocking β2-adrenoceptors lowers plasma glucose. β1-blockers have fewer metabolic side effects in diabetic patients; however, the tachycardia which serves as a warning sign for insulin-induced hypoglycemia may be masked. Therefore, beta blockers are to be used cautiously in diabetics. [24]
A 2007 study revealed diuretics and beta blockers used for hypertension increase a patient's risk of developing diabetes, while ACE inhibitors and angiotensin II receptor antagonists (angiotensin receptor blockers) actually decrease the risk of diabetes.[25] Clinical guidelines in Great Britain, but not in the United States, call for avoiding diuretics and beta blockers as first-line treatment of hypertension due to the risk of diabetes.[26]
Beta blockers must not be used in the treatment of cocaine, amphetamine, or other alpha-adrenergic stimulant overdose. The blockade of only beta receptors increases hypertension, reduces coronary blood flow, left ventricular function, and cardiac output and tissue perfusion by means of leaving the alpha-adrenergic system stimulation unopposed.[27] The appropriate antihypertensive drugs to administer during hypertensive crisis resulting from stimulant abuse are vasodilators such as nitroglycerin, diuretics such as furosemide and alpha blockers such as phentolamine.[28]


Hypoglycemia or low blood sugar is a killer, both to health and concentration. Have your blood sugar checked over the course of a day. I had a close friend who got seizures from hypoglycemia and was misdiagnosed for a long time.

PM if you have any questions

[Anonymous User]

About six months ago I found out I have a heart rate/blood pressure issue that requires me to be on a pretty high dosage of beta-blockers. While I can function ok for the most part, I have a lot less energy than I used to and it's becoming harder for me to stay focused during the day. I've had to almost cut out caffeine completely. You can imagine how this could make things difficult for a biglaw attorney.

I'm a SA at a smallish regional office of a biglaw firm, and my office has kind of been taking it easy on me in terms of workload. While I've gotten a decent mixture of assignments, they haven't been too difficult for the most part. The problem is, I've been taking WAY too long to complete them. For an assignment that would take one of the young associates 2 hours, I'm spending an entire day. I really just can't focus. I'm convinced the only reason this hasn't landed me in trouble yet is because I'm the first SA this office has had in several years. They don't really have anyone else to compare me to, aside from the younger associates (but there are only a few of them).

Even if I'm able to do well enough to come out of this with an offer, I'm scared that I won't last long as an associate if things don't change. Any advice?

You should speak with your healthcare providers. It is quite possible that the same goals of rate control and/or blood pressure reduction can be achieved either without beta blockers or with a lower dose of beta blockers and an additional agent. If you are not tolerating beta blockers in your current dosage, then your healthcare provider needs to address that.

[Anonymous User]

I'm really sorry to hear about your medical problem. I know that they can be crippling at first. However, as your treatment becomes more complete you will feel stronger and have your concentration back. I would definitely take significant time this year to go to specialists (I can help you if you live in the DC Area) and I have heard the very best heart doctors are at Barnes Jewish Hospital (WashU Hospital). I know a girl who was having trouble in relationships due to a weak heart, now she is happily married and able to have children thanks to her traveling to St Louis to get surgery there. The beta blockers themselves are no picnic.

From Wikipedia:

Adverse drug reactions (ADRs) associated with the use of beta blockers include: nausea, diarrhea, bronchospasm, dyspnea, cold extremities, exacerbation of Raynaud's syndrome, bradycardia, hypotension, heart failure, heart block, fatigue, dizziness, alopecia (hair loss), abnormal vision, hallucinations, insomnia, nightmares, sexual dysfunction, erectile dysfunction and/or alteration of glucose and lipid metabolism. Mixed α1/β-antagonist therapy is also commonly associated with orthostatic hypotension. Carvedilol therapy is commonly associated with edema.[22] Due to the high penetration across the blood–brain barrier, lipophilic beta blockers, such as propranolol and metoprolol, are more likely than other, less lipophilic, beta blockers to cause sleep disturbances, such as insomnia and vivid dreams and nightmares.[23]
Adverse effects associated with β2-adrenergic receptor antagonist activity (bronchospasm, peripheral vasoconstriction, alteration of glucose and lipid metabolism) are less common with β1-selective (often termed "cardioselective") agents, however receptor selectivity diminishes at higher doses. Beta blockade, especially of the beta-1 receptor at the macula densa, inhibits renin release, thus decreasing the release of aldosterone. This causes hyponatremia and hyperkalemia.
Hypoglycemia can occur with beta blockade because β2-adrenoceptors normally stimulate hepatic glycogen breakdown (glycogenolysis) and pancreatic release of glucagon, which work together to increase plasma glucose. Therefore, blocking β2-adrenoceptors lowers plasma glucose. β1-blockers have fewer metabolic side effects in diabetic patients; however, the tachycardia which serves as a warning sign for insulin-induced hypoglycemia may be masked. Therefore, beta blockers are to be used cautiously in diabetics. [24]
A 2007 study revealed diuretics and beta blockers used for hypertension increase a patient's risk of developing diabetes, while ACE inhibitors and angiotensin II receptor antagonists (angiotensin receptor blockers) actually decrease the risk of diabetes.[25] Clinical guidelines in Great Britain, but not in the United States, call for avoiding diuretics and beta blockers as first-line treatment of hypertension due to the risk of diabetes.[26]
Beta blockers must not be used in the treatment of cocaine, amphetamine, or other alpha-adrenergic stimulant overdose. The blockade of only beta receptors increases hypertension, reduces coronary blood flow, left ventricular function, and cardiac output and tissue perfusion by means of leaving the alpha-adrenergic system stimulation unopposed.[27] The appropriate antihypertensive drugs to administer during hypertensive crisis resulting from stimulant abuse are vasodilators such as nitroglycerin, diuretics such as furosemide and alpha blockers such as phentolamine.[28]


Hypoglycemia or low blood sugar is a killer, both to health and concentration. Have your blood sugar checked over the course of a day. I had a close friend who got seizures from hypoglycemia and was misdiagnosed for a long time.

PM if you have any questions

To be fair, most modern beta blockers are Beta-1 selection (i.e., cardioselective)... massive Beta 2 blockades were much more a problem with the earlier beta blockers (e.g., propranolol).

[CanadianWolf]

This is a health/medical issue. OP, tell your doctor about the drug's effects on you. Maybe altering the dosage is possible once your condition is under control. Maybe another combination of medication is possible; maybe alternative treatment is available, etc. Don't be afraid to communicate often with your physician.

[Anonymous User]

Definitely speak with your doctor and be firm about it.
I developed high blood pressure during 2L year (there's a history of severe heart disease in my family.) Had to work hard to get the drugs at the right levels (yes, I felt sluggish sometimes, light headed others.) Regular exercise and changing my eating/drinking habits helped tremendously. Good luck, man.

[CanadianWolf]

Sometimes higher than necessary doses are prescribed to get a condition under control as well as to address possible malpractice concerns if a condition is not mitigated. With managed healthcare, you--the patient--need to take charge & make appointments with your healthcare provider. Don't be shy about seeing your physician as frequently as your condition mandates. Don't be afraid to call & speak with a PA or RN. You need constant contact as long as the medication is giving you adverse or even uncomfortable reactions/side-effects. Only your doctor can help.

[Anonymous User]

As someone who has a heart condition, which has required multiple open-heart surgeries and switching medications regularly, I can say that it takes your body a substantial amount of time to get used to the new medication. I have been on beta-blockers before and they are no fun. You do have a lot less energy to function; however, there are other options out there besides beta-blockers. Talk to your doctor about it. In the mean time, take an aspirin. I know it may sound like a stupid fix but it's helped me a lot.

I can't see how this would be a reason why you shouldn't go into biglaw. Either your body will get used to the medication or you and your dr will figure out a better medication. Take the offer if you get it. Good luck!