Tilt!

fw_fainting-victorian-lady1Since my teens (possibly even before that, but the facts get lost in the gauze of time) I have occasionally fallen over. Often publicly. The first time I remember was in gym class, where I turned to a classmate, said, “I feel like I’m gonna–” and did, coming to a minute later to see the faces of all three of the school’s gym teachers very close to mine, and to hear the “what happened?” of 40 15-year-old girls echoing like the cries of maddened seagulls in my ears. Since then, my public swoons have been the stuff of anecdote, like the time I fell at the top of the up escalator at a department store, and awoke to find that I was being prodded with a cane by an elderly woman who thought I was staging a protest (it was the ’70s).

I never really worried about it too much. When I was young, it seemed to be mostly associated with heroically bad cramps (or the occasional stomach bug), which was embarrassing but seemed on the outer edge of what was considered normal for us frail female sorts. I figured: if I felt rotten, best thing to do was to get down low on the ground until I passed out or the feeling went away. And I will say, your fellow citizens are generally very kindly to women who swoon. I have been in the back offices or living-rooms of strangers who decided I could not be left to lie strewn about the hallway or pavement. High embarrassment, lots of thank yous, and I’d go on with my life.

Until finally it was pointed out to me that I should really get this looked into. Here’s what happened.

One morning, when my younger daughter was still in diapers, I was getting her changed and dressed, when I had a stab of sciatica followed almost immediately by lightheadedness. I called my husband in to take over, and went off to the bathroom (the only place where Mama could get a moment to herself) to sit down for a moment until it passed. Somewhere in the sixty seconds after I sat down on the side of the tub I realized that I was really, really dizzy. I remember thinking “I’d better get down on the floor” just before the ringing gray tide swelled up around me (really, that’s the best description I can give). When I awoke I thought, for a moment, that I was in bed. I’d been having a vivid dream. Then I realized that I was on the bathroom floor. Lying in front of the door (which had stopped Danny from being able to come in and see if I required assistance). I picked myself up and realized 1) that I was bloodied (I’d bitten my lip spectacularly) and 2) broken (one of my front teeth had broken off at the gum line).

First things first: I called my dentist and got an appointment for an emergency root canal late that afternoon. Then I called my doctor, a calm sort, and explained what had happened. “Go down to the ER; my partner’s on duty. You need to have your lip sewn up.” So I followed instructions, not reckoning on the fact that few things get ER docs more excited than LOC (loss of consciousness). I kept protesting that I just needed a stitch or two, while they spoke of CAT scans and MRIs… until I said, “Well, my daughter has a diagnosis of vaso-vagal syncope….” At which point they did the ER doc equivalent of pouting, as if I had misrepresented my swoon as something interesting, sewed up my lip, and suggested that I might wanna get this checked out at some point.

Vaso-vagal syncope, as it was explained to me, is a relatively benign tendency to faint. It is often found in robustly healthy people whose systems are so finely tuned that said system mis-reads a cue, thinks that there’s a medical emergency, and cuts down blood flow to everything except the core systems–of which, it appears, the brain is not one. It is the world’s fastest episode of shock. Then, after a minute Silly Body says “Oops! My bad,” blood flow is restored, and the faint passes off, leaving the patient to deal with the embarrassment of swooning.

My doctor and I agreed that finding out what was happening was probably a good thing (and why hadn’t I ever mentioned this before? Because it mostly had seemed tangled up with gynecological issues, and…). So I was sent for a tilt table test. In a tilt table test you are strapped, Bride-of-Frankenstein-style, to a table which is then raised so that you are almost standing–thus the “tilt table” appellation. I imagine there are different protocols, but for me, they put into IVs each arm. For the first phase of the test, they piped something something into my left arm that slowed my heart rate to a crawl. Whatever it was (I remember it as adenine, but it was a long time ago) it metabolized very quickly–after about two minutes the effects were gone. But that was a horrible two minutes. I didn’t faint, but I felt… rotten. No pain, no queasiness, just awful in a way that defies description. And then it was gone.

For the second part of the test they ran a second chemical into my right arm, something that sped my heart rate waaaaay up. And that part of the test was supposed to last for about 25 minutes. “What happens if I don’t faint?” “Then you’ve passed the test, and whatever it is that’s making you faint is sinister and must be further investigated.” “Oh.” Sinister? And here I’d been ignoring it for 30 years? Fortunately, 22 minutes into the test I said “I feel like I might–” and did. At which point they lowered the table and told me I’d flunked the test and indeed, I have vaso-vagal syncope.

And there was much rejoicing. At least by me, who now had a name for what it was, and the assurance of the neurology department at NYU that I didn’t have anything really really scary to deal with.

And the recommendation on how to deal with it? If I were fainting several times a day, they could medicate me. But given that it’s only once, maybe twice a year, they didn’t want to do that. “So what do I do?” I asked.

“If you feel faint, get down on the ground.” Hell, I coulda told me that.

__________

*I suspect the 10 degrees of tilt, or whatever it is, is so that if you faint you don’t overbalance the table and fall forward.

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About Madeleine E. Robins

Madeleine Robins is the author of The Stone War, Point of Honour, Petty Treason, and The Sleeping Partner (the third Sarah Tolerance mystery, available from Plus One Press). Her Regency romances, Althea, My Dear Jenny, The Heiress Companion, Lady John, and The Spanish Marriage are now available from Book View Café. Sold for Endless Rue , an historical novel set in medieval Italy, was published in May 2013 by Forge Books

Comments

Tilt! — 14 Comments

  1. I’ve had a similar experience. I get these dizzy spells that make me need to grab a wall. The rising ringing gray tide–sort of that. A massive sort of head rush. I remember being in Indiana and being in Target and I had one so bad that I thought I was going to pass out and then wake up with Target employees poking at me. At that point, I went to a neurologist. He hooked my head up to all sorts of sensors and found nothing wrong. Not that I could make the spell happen on command. Plus there seems little rhyme or reason for it, except it does seem worse around my period.

    Anyhow, it kept happening and I went into my eye doc for a checkup and he said, oh, yeah. That’s an ocular migraine. I also get floaters and sort of blurry halos. He was surprised I’d never heard of them. Anyhow, it’s a migraine with a lot of the symptoms but no pain. They aren’t bad enough to medicate, and only come on every so often, but when they do, I grab a person or a wall and wait until it passes. Sometimes my arms and legs shake. So weird.

    • I started getting a mild version of what Diana is describing during menopause, except that while I feel light-headed, I don’t feel faint. It happened rarely then, and maybe once every couple of years now. It’s weird, but since I don’t get the headaches (thank all that’s holy), I just try to sit down somewhere until it passes.

      It appears there are all kinds of unusual physical conditions in the world. The trick seems to be figuring out which ones to worry about and which ones aren’t likely to do you any lasting harm as long as you know what to do when they come around.

  2. On another note: I went to a presentation last weekend on how to teach older people to fall taught by a fellow Aikido person who is also a nurse who does home care with frail elderly folks. I’ve wanted to be able to teach falling to those who really need to know how, but I didn’t feel like I had a grasp on how you should work with people with greater potential for injury from a bad fall. Now I do, and I’m hoping that I can get the person who gave the presentation to do some teacher training. If she does, I’ll take it and find a way to offer classes.

    She originally thought she’d have reasonably fit 50-and-60-year-olds in the class, but apparently folks in that age range still tend to think they can handle it all. Instead she got people in their 70s and 80s, so she had to modify the class somewhat.

    I’m sure you know a lot about falling from your stage combat training, but I thought I’d use your post as a plug for encouraging others to learn how to fall. We all fall, and the older we get, the bigger the dangers of injury from it.

  3. The first thing my first riding instructor taught was how to fall off the horse without killing yourself. This stood me in good stead with my horse Grey, who came to me kind of psychotic and could sunfish and crowhop simultaneously. (He ended his days happily retired and not so psychotic, also having won the state championship in dressage one year. I hasten to add that in Washington State — this would have been in the late 1960s — dressage was not very evolved.)

    I don’t know if I can do an Aikido fall anymore. I banged myself up in a hiking fall a while back and my balance is still recovering. I haven’t trained in a long time because Reasons so I don’t have anyplace to try out falling down.

    –V.

    • I’m willing to bet your instincts would come through and you would take a good back fall or some such. Those things get ingrained. And I wish my father (who taught me to ride) had taught me more about falling off a horse than “get back on it” because I spent a lot of time landing on my tailbone back in the day.

      • Ow. Getting back on is important, but getting off without getting hurt is even more important.

        Somewhere my sister has her hard hat from when she was a kitling; it has a hole in the velvet where she would have been killed if she hadn’t been wearing it.

        I have a scar under my nose (took 18 stitches to close) where I was being goofy and fell off Snofie (best horse in known universe), hit the jump, rolled back under his hooves. I remember his looking down at me as he did his best to get out of my way. Horse thought balloon: “What are you doing!? Why are you under my feet?!” Given that he was 16’3″ it’s amazing he didn’t stomp on my face. He barely clipped me. Everything that happened was entirely my fault, except for the part where Snofie didn’t stomp on my face — that was all him.

        –V.

  4. In the days when I was doing stage combat I could fall like a champ. I’m still pretty good at it (except when I have stuff in my hands, when I can forget to drop things and roll because… stuff. In my hands). When I was a younger person I used to ignore faintness, toughing it out, which meant that I fell (not, I note, “dropping” but teetering over). Since I was tested–actually, even before that–I had come to the conclusion that taking it seriously and getting down on the ground was a good thing.

    • My theory is that if you once could fall well, you have enough body memory to do most of the right things when needed. At least, that’s what I’m counting on since I very rarely fall much in Aikido classes these days.

      • I would love to have a class for falling correctly. I have a healed fracture in my wrist that still occasionally causes annoyance, because I fell down a flight of stairs and mistakenly tried to break my fall with my dominant hand.

        • It’s a natural instinct to try to break a fall by reaching out with a hand. Unfortunately, wrists are not made to take the weight of the body. So one of the things to learn about falling is to use your whole forearm. Another is to always tuck your chin when falling backwards, so you don’t hit the back of your head.

          Hmm. Seems to me we really need some falling workshops for everyone. Something to ponder here.

    • Brenda, you’d probably do fine with regular Aikido falling (unless you have some neck or back issues I don’t know about). Given the squirrels on your bike path, you should definitely learn how to do a forward roll in case you go flying over the handlebars one of these days.