![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 35. Go back in thread:
Posted by Racer on October 24, 2000, at 22:11:13
In reply to Re: Fainting, posted by medlib on October 24, 2000, at 20:53:16
> Hope your internist is a good diagnostician and is able to pinpoint what's wrong quickly. If she orders blood work, having it done fasting (yeah, I know it's a pain) and including a CBC would rule out anemia or blood sugar problems as possible causes. Please keep us posted.
Actually, this wouldn't necessarily rule out glycemic trouble. My problems only became apparent with a four hour GTT, fasting glucose didn't show much of anything at all. The GTT did show strange results, though it was some years later that the full extent of the problem became clear. (It took a carefully controlled diet and exercise program, and faithful recording of food/exercise/blood sugar readings on a good glucometer to show everything that was happening.)
Regardless, I'm with you on sending noa good wishes.
Posted by medlib on October 25, 2000, at 2:34:12
In reply to Re: Fainting, posted by Racer on October 24, 2000, at 22:11:13
> > Hope your internist is a good diagnostician and is able to pinpoint what's wrong quickly. If she orders blood work, having it done fasting (yeah, I know it's a pain) and including a CBC would rule out anemia or blood sugar problems as possible causes. Please keep us posted.
>
> Actually, this wouldn't necessarily rule out glycemic trouble. My problems only became apparent with a four hour GTT, fasting glucose didn't show much of anything at all. The GTT did show strange results, though it was some years later that the full extent of the problem became clear. (It took a carefully controlled diet and exercise program, and faithful recording of food/exercise/blood sugar readings on a good glucometer to show everything that was happening.)
>
> Regardless, I'm with you on sending noa good wishes.
Racer--You're right, of course. That comment was a last minute (clearly, not-thought-out) afterthought, and I shouldn't have been so glib, or so general. I was thinking more of frank diabetes than of hypoglycemia or other less clear-cut blood sugar abnormalities. For someone who passed out in the 4th hour of a 6 hour GTT at age 13 (and had 2 hypoglycemic kids), it's a puzzling error, to say the least.
Thanks for the heads up!---medlib
Posted by Noa on October 25, 2000, at 13:58:25
In reply to Re: Fainting » Racer, posted by medlib on October 25, 2000, at 2:34:12
Thanks, everyone.
I just came from the doctor. After checking me out for concussion, etc., they had a mini-conference of nurses and docs in the hallway, to figure out why I fainted. They decided it is most likely a vasovagal faint from the big yawn, stretch. They advised for now to chill my yawns out a bit, not to bend my neck back or press down if sitting, while yawning, and no huge yawn/stretch combos. But that if it continues, they will send me to a neurologist for eval.
My heart and breath and blood pressure all checked out ok, and my neck arteries sound good, they say.
I just looked up vasovagal syncope on pubmed and apparently, it is quite common. There is a diagnostic procedure called the Head UpTilt Test (HUTT) but I haven't found a good description of what it is. I imagine it involves tilting the head up and back, which puts pressure on the neck, and vasovagal nerve. Does anyone here know more about it?
I feel fine today, just a bit of a headache, and a tender minor lump on the side of the head, plus one sore spot on my shoulder.
Funny thing, when the nurse practicioner came back in to talk to me after the "mini conference", she started yawning a lot! When I said I think I had infected her, she told me that while the bunch of docs and nurses were discussing this in the hall, they all started yawning all of a sudden!
Posted by dove on October 25, 2000, at 14:10:55
In reply to Fainting, posted by noa on October 24, 2000, at 7:22:58
I haven't read all the responses to you Noa, I'll do that as soon as I'm done. I have *lots* of experience with greying-out and completely blacking-out! So, I take a few of the same meds as you do, I too have fainted due to severe anemia, I have fainted and afterwards tested positive for hypoglycemia, as well as the occasional positive TSH test(I think that's the name? Positive for "temporary" hypothyroidism -you're the pro on that one Noa!).
The combo of my new p-doc forgetting to straighten out my Serzone prescription at my new pharmacy has left me with a mere 300 mgs for since yesterday. Last night this resulted in a massive blinding headache, an extremely queasy feeling, and kind of "out-of-it" sort of thing. I sat around not really doing anything, not reading, just staring off into space. I had the same thing happen for the last 1 1/2 hours, started exactly when I would normally have taken my serzone. Kind of came out of it a little bit ago and saw your message (to which I'm now replying!).
Adderall, I'm taking 40 mgs and have never had a black-out or faint that appeared connected to this med in any way. I've taken Adderall alone, w/ prozac, wellbutrin, amitriptyline, serzone, neurontin, and in a multitude of combinations with those meds, and not once has the Adderall proven to be the problem. Of course, this unfortunately only really applies to me and not necessarily to your situation.
My uneducated guess would be the missed Serzone and Cytomel, with compounding factors such as fatigue (or trying to wake up your body/brain--lack of oxygen--that's the whole purpose of yawning in the first place), and no glucose stabilizing food fueling your brain/body (like protein?). Did you sleep well last night, your apnea still being taken care of?
I am inordinately vulnerable to fainting when I haven't eaten, haven't slept, haven't taken certain meds (Serzone, Neurontin being the biggies at this point),and haven't totally woken up yet, or am getting hit with a second wave of fatigue. I would encourage you to get your thyroid levels checked soon, that might give you some clues. All my prayers and thoughts are with you ((((Noa))))
dove
P.S. I'm sorry Noa, I just noticed that you posted this yesterday! So please read my tone as not so direly urgent :-) You still have my thoughts and prayers, although belatedly.
Posted by dove on October 25, 2000, at 14:15:41
In reply to Re: Fainting » noa, posted by Racer on October 24, 2000, at 18:44:15
I just remembered that one of our psycho-babblers fainted last winter I think? Was it Adam? Sick with the flu and fainted while taking a shower. And his girlfriend found him and he was all beat-up by the evil shower. Was that Adam?
dove
This is all just to let you know that you're not alone Noa. Hope you're feeling better today!!!
Posted by dove on October 25, 2000, at 14:45:44
In reply to Re: Fainting, posted by Noa on October 25, 2000, at 13:58:25
One more little item to add--now that I've read all the responses and know undoubtedly that I must try to read all the responses before impulsively responding to a message--as to prevent blatant reoccurring redundancy.
Now, my dad is hypoglycemic and gets extremely suicidal when his blood sugar decides to take a dive. Until he began an extremely strict diet (sort of like those high protein diets I keep reading about), his moods swung so wide and far that my mother *left* him on a number of occasions, totally convinced that he was truly insane. His hypoglycemia affected every aspect of his life, and only now is he finally stabilizing mood wise.
So... I was thinking that it might be a great idea to get some hypoglycemia info together for that "Links" page on egroups. Such expertise Psycho-babble already has, and I'd hate to see that precious knowledge lost. Anyone interested in doing something like that?
And maybe create a multi-crossing category like "Fainting" or "Black-outs" that would present different characteristics and their implied meaning.
For example: Graying-out while stretching and yawning is more characteristic of "whatever that vaso something was". Adding to the base of layman/working knowledge for recognizing some of these characteristics and when/where to go for help.
Or this might be all to discombobulated and we should just go with straight-forward links to hypoglycemia and depression?
dove (babbling and rambling...)
Posted by dove on October 25, 2000, at 14:48:52
In reply to Fainting, posted by noa on October 24, 2000, at 7:22:58
Do I appear hypo-manic to anyone wading through all my posts? I apologize Noa for dragging your message so completely off course, I think the Neurontin is working a little *too* good.
dove (yet again!)
Posted by Noa on October 25, 2000, at 15:16:48
In reply to Re: Fainting, posted by dove on October 25, 2000, at 14:15:41
Dove, you have a good memory. I remember about the fainting in the shower, and yes, I think it might have been Adam. He seemed to think it was a combo of the flu, easily fluctuating blood pressure due to MAOIs, and the hot water. While I was searching on pubmed today, I did notice a couple of articles on hot bath water as raising the risk of fainting.
Dove, I don't mind the thread detouring. I think my needs were already met.
I asked the various docs, nurses, etc. whether a threshold phenomenon could be part of this vasovagal syncope--ie, things like hypoglycemia (it was 6 am, I hadn't eaten anything yet, but had eaten a whole bunch of very sweet stuff right before going to bed the night before), anemia, medications, etc.--could they lower the threshold for a vasovagal reaction. They didn't seem to think so.
Posted by Noa on October 25, 2000, at 16:38:44
In reply to Re: Fainting, posted by Noa on October 25, 2000, at 15:16:48
I did some more reading online and it turns out the head tilt test involves lying on a table, and then they tilt it from horizontal to either 60 or 80 degrees vertical, and measure heartrate, bp, etc. Some people faint during the procedure, which confirms the v-v syncope dx.
I don't know. I don't think I would faint in that test. I usually have no problem going from sit to stand or lying in bed to standing, although as a teen, I used to "grey out" sometimes.
But I still thing the v-v response makes sense in explaining why I fainted--I think it was the yawn.
Posted by medlib on October 25, 2000, at 17:30:58
In reply to Re: Fainting--Head Tilt Test, posted by Noa on October 25, 2000, at 16:38:44
Noa--
The tilt table test is more demanding than it sounds like. By slow, they mean over a period of 25-45 minutes. I've seen quite a number pass out on it. Many people unconsciously hyperextend or "lock" their knees when reclining/standing in one place for a while--which cuts off venous blood return from the lower legs. This alone often is enough to cause blackout (aka the "Palace Guard Syndrome"). But, IMHO, there's no reason to take a test if nothing is to be done with the results.
Regardless, it's great that you have a presumed dx. If something similar happens again, head between the knees position helps some (if there's time).
Well wishes---medlib
P.S. I yawned through this whole post, as well as the one last night. It's hopelessly contagious!
> I did some more reading online and it turns out the head tilt test involves lying on a table, and then they tilt it from horizontal to either 60 or 80 degrees vertical, and measure heartrate, bp, etc. Some people faint during the procedure, which confirms the v-v syncope dx.
>
> I don't know. I don't think I would faint in that test. I usually have no problem going from sit to stand or lying in bed to standing, although as a teen, I used to "grey out" sometimes.
>
> But I still thing the v-v response makes sense in explaining why I fainted--I think it was the yawn.
Posted by noa on October 26, 2000, at 7:04:58
In reply to Re: Fainting--Head Tilt Test » Noa, posted by medlib on October 25, 2000, at 17:30:58
Thanks, medlib. and LOL about the yawn.
Posted by Greg on October 26, 2000, at 12:46:03
In reply to Re: Fainting--Head Tilt Test, posted by noa on October 26, 2000, at 7:04:58
Noa,
This sounds very simplistic in nature, but I was wondering if they checked you for a possible inner ear problem? I sustained an injury to my left ear as a child and only have about half my hearing in that ear now. When I do things that require me to bend over I periodically get dizzy to the point of passing out. The docs say it's due to the inner ear problem. It just dawned on me that this might be an issue with you.
Just random "babbling".
Greg
> Thanks, medlib. and LOL about the yawn.
Posted by noa on October 26, 2000, at 13:46:19
In reply to Re: Fainting--Head Tilt Test » noa, posted by Greg on October 26, 2000, at 12:46:03
Not simplistic at all, but I had no dizziness before fainting. I have had inner ear infections which cause loss of balance, dizziness and nausea. This was different--it really does fit the vasovagal response thing pretty well.
Posted by danf on October 26, 2000, at 14:42:44
In reply to Re: Hypoglycemia, posted by dove on October 25, 2000, at 14:45:44
some help with vasovagal stuff.
vaso vagal faints are by definition, neurogenic in nature.
some stimulus causes the heart rate to slow down & bp falls. In some, part of the event is mediated by peripheral dilation of the extremities so that blood pools in the extremities & does not go back to the heart quick enough to be pumped out.
Not enough blood goes to the brain & we faint. a short warning of a few seconds is present. While not impossible, one will usually not faint if lying down as adequate blood returns to the heart to keep some perfusion (blood flow) to the brain.
after the BP / HR control 'escapes' from the slow HR, the BP & HR both go 'high' for a short while ( few minutes). this sequence is easy to see if another person is present to monitor BP & HR.
IT can be induced if some one has a sensitive carotid sinus ( 'sensitive carotid sinus syndrome' ) in the neck & is wearing a tight collar for instance, or has the neck massaged.
a mechanism present in some people is putting the head under water ( a variation of the 'diving reflex' ). A deep yawn may trigger a variation of this same reflex pathway.
An interesting sister reflex, is initiation of a sneeze when a bright light is shined in the eyes, or by walking from a shaded room to bright sunlight.
It is unknown why some people have these reflexes activated in a powerful way at times. All people have the reflexes, but they are rarely triggered in such a powerful way. Perhaps some neurologic meds have an influence.
Anything which causes peripheral dilation may cause blood to pool in the extremities & possible fainting. A hot shower or bath are examples. some meds, like aldomet, partially paralize the bodys ability to respond to postural changes.
However these other mechanisms are not vasovagal, by definition.
Posted by laural on October 26, 2000, at 15:50:46
In reply to Fainting, posted by noa on October 24, 2000, at 7:22:58
i don't have time to read this thread but i grey out a lot too. its because i have low blood pressure. i was severely hypoglycemic in high school due to my anorexia i guess and tey gave me these pills that would help but they lowered my blood pressure even more and i could barely do anything, had to do it very slow or else down i'd go. maybe your meds cause low blood pressure-- laural
Posted by SLS on October 26, 2000, at 19:36:19
In reply to Re: Hypoglycemia, posted by dove on October 25, 2000, at 14:45:44
> For example: Graying-out while stretching and yawning is more characteristic of "whatever that vaso something was".> Or this might be all to discombobulated and we should just go with straight-forward links to hypoglycemia and depression?
> dove (babbling and rambling...)
Dear Dove,You are so cute. Whenever I read your stuff, I can't help but to think how appropriate your "handle" is here.
Oh yeah, your smart too.
:-)
- Scott
Posted by noa on October 27, 2000, at 6:36:39
In reply to Re: vasovagal fainting, posted by danf on October 26, 2000, at 14:42:44
Thanks for all the info, Danf.
Do you know if anything can lower a threshold for getting this vasovagal reaction from something like yawning? For example--hypoglycemia, anemia, certain medications?
My doc seemed to think not, but I wondered if you had any thoughts on this.
Posted by noa on October 27, 2000, at 6:38:17
In reply to Re: vasovagal fainting, posted by danf on October 26, 2000, at 14:42:44
BTW, I read that vasovagal fainting when standing from a lying or sitting position is fairly common in adolescents because of elasticity in blood vessels in the extremities. I did get the greying out from standing up, as a teen, too.
Posted by danf on October 27, 2000, at 11:11:38
In reply to Re: vasovagal fainting, posted by noa on October 27, 2000, at 6:36:39
It is an interesting question.
anaemia & hypoglycemia lower the threshold for fainting, but the mechanism is usually not vasovagal.
For anaemia to have a significant effect, it must be severe & this tends to be a positional /change of position effect where blood flow rates are high from the anaemia & do not compensate. AS in, peripheral vessela are dilated & one stands up & faints... 'orthostatic fainting'
hypoglycemia is similar but is driven by glucose supply to the brain. As blood glucose falls, neurologic function starts to fail, this includes all levels, conscious & autonomic plus the body pumps out adrenaline to keep blood glucose levels up ( the jittery feeling some people get that warns them the glucose level is falling ). Then as glucose stores are used, glucose levels quickly fall & fainting occurs.
Then for meds. since vasovagal is triggered by a cholinergic episode ( heart slowing), any med that increases cholinergic tone has the theoritical potential to lower the threshold for vasovagal fainting ( gagging & retching increases this tone, by the way).
most SSRIs & ADs fall into this catagory. However, they do not in practice, seem to have this side effect.
Many other meds may have fainting as a side effect. beta blockers, High BP meds of all classes, Heart meds, angina meds, etc... however most of these cause fainting by affecting BP control, or peripheral resistance, etc, not by affecting vagal tone.
I know when I started celexa, that I yawned like crazy for a couple of weeks. I also coughed & gagged. there was some light-headed-ness with the coughing /gagging, but never a full faint.
I think it is possible for an AD med to lower the VV threshold, but unless it happenes more than once it will be difficult to trace the cause. Most would consider this to be an idiosyncratic reaction, if present.
Posted by noa on October 27, 2000, at 16:11:55
In reply to Re: vasovagal fainting, posted by danf on October 27, 2000, at 11:11:38
> It is an interesting question.
>
> anaemia & hypoglycemia lower the threshold for fainting, but the mechanism is usually not vasovagal.
>
> For anaemia to have a significant effect, it must be severe & this tends to be a positional /change of position effect where blood flow rates are high from the anaemia & do not compensate. AS in, peripheral vessela are dilated & one stands up & faints... 'orthostatic fainting'
>
> hypoglycemia is similar but is driven by glucose supply to the brain. As blood glucose falls, neurologic function starts to fail, this includes all levels, conscious & autonomic plus the body pumps out adrenaline to keep blood glucose levels up ( the jittery feeling some people get that warns them the glucose level is falling ). Then as glucose stores are used, glucose levels quickly fall & fainting occurs.
>
> Then for meds. since vasovagal is triggered by a cholinergic episode ( heart slowing), any med that increases cholinergic tone has the theoritical potential to lower the threshold for vasovagal fainting ( gagging & retching increases this tone, by the way).
>
> most SSRIs & ADs fall into this catagory. However, they do not in practice, seem to have this side effect.
>
> Many other meds may have fainting as a side effect. beta blockers, High BP meds of all classes, Heart meds, angina meds, etc... however most of these cause fainting by affecting BP control, or peripheral resistance, etc, not by affecting vagal tone.
>
> I know when I started celexa, that I yawned like crazy for a couple of weeks. I also coughed & gagged. there was some light-headed-ness with the coughing /gagging, but never a full faint.
>
> I think it is possible for an AD med to lower the VV threshold, but unless it happenes more than once it will be difficult to trace the cause. Most would consider this to be an idiosyncratic reaction, if present.
Posted by Bugster2k on January 12, 2001, at 12:07:25
In reply to Re: vasovagal fainting--thanks (np) » danf, posted by noa on October 27, 2000, at 16:11:55
I beleive that I have Vasovagal syncope.
The first time I started coughing and fainted
was in the summer of 1994. It comes and goes
and seems to get worse in cold weather.
Throughout the spring and summer, this
may have happened once or twice. Living in
the northeast, this has been a pretty winter
so far. The worst I have had it this winter,
I passed out about 7 times during 1 eight hour
shift at work. It only happens when I cough,
and tessilon pearls, doesn't help that much.> > It is an interesting question.
> >
> > anaemia & hypoglycemia lower the threshold for fainting, but the mechanism is usually not vasovagal.
> >
> > For anaemia to have a significant effect, it must be severe & this tends to be a positional /change of position effect where blood flow rates are high from the anaemia & do not compensate. AS in, peripheral vessela are dilated & one stands up & faints... 'orthostatic fainting'
> >
> > hypoglycemia is similar but is driven by glucose supply to the brain. As blood glucose falls, neurologic function starts to fail, this includes all levels, conscious & autonomic plus the body pumps out adrenaline to keep blood glucose levels up ( the jittery feeling some people get that warns them the glucose level is falling ). Then as glucose stores are used, glucose levels quickly fall & fainting occurs.
> >
> > Then for meds. since vasovagal is triggered by a cholinergic episode ( heart slowing), any med that increases cholinergic tone has the theoritical potential to lower the threshold for vasovagal fainting ( gagging & retching increases this tone, by the way).
> >
> > most SSRIs & ADs fall into this catagory. However, they do not in practice, seem to have this side effect.
> >
> > Many other meds may have fainting as a side effect. beta blockers, High BP meds of all classes, Heart meds, angina meds, etc... however most of these cause fainting by affecting BP control, or peripheral resistance, etc, not by affecting vagal tone.
> >
> > I know when I started celexa, that I yawned like crazy for a couple of weeks. I also coughed & gagged. there was some light-headed-ness with the coughing /gagging, but never a full faint.
> >
> > I think it is possible for an AD med to lower the VV threshold, but unless it happenes more than once it will be difficult to trace the cause. Most would consider this to be an idiosyncratic reaction, if present.
Posted by Noa on January 15, 2001, at 11:30:57
In reply to Re: vasovagal fainting--thanks (np), posted by Bugster2k on January 12, 2001, at 12:07:25
WOW--that is a lot of fainting--it could be very dangerous, don't you think?
As for my fainting--after that one episode, I have not fainted again. And, it seems that since beginning exercise, my circulation must already have improved somewhat, because I don't find myself having to be so vigilant about "gray outs" when I yawn and stretch--they seem to be less pronounced.
Posted by danf on January 16, 2001, at 9:02:08
In reply to Re: vasovagal fainting--thanks (np), posted by Noa on January 15, 2001, at 11:30:57
> WOW--that is a lot of fainting--it could be very dangerous, don't you think?
Noa.. what did you do... convert the Yawns to BIG O's ?? lol
Posted by Bugster2k on January 16, 2001, at 17:56:03
In reply to Re: vasovagal fainting--thanks (np), posted by danf on January 16, 2001, at 9:02:08
Since I went back to the docs, and started taking tessilon pearls again, it has slowed down alot though.
> > WOW--that is a lot of fainting--it could be very dangerous, don't you think?
>
> Noa.. what did you do... convert the Yawns to BIG O's ?? lol
Posted by danf on January 17, 2001, at 9:09:17
In reply to Re: vasovagal fainting--thanks (np), posted by Bugster2k on January 16, 2001, at 17:56:03
> Since I went back to the docs, and started taking tessilon pearls again, it has slowed down alot though.
Do you think it is because you cough less ???
Opiates also affect reflexes & neural pathways... which is part of the addiction potential...
The Tessilon perls should only be a short term solution.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.