After a few episodes of passing out on airplanes and spending far too much on hospital stays, my doctors agreed that we should try to do something about it.

At the end of the last episode, they started talking about vasovagal syncope. Google tells me that “vasovagal” means “relating to or denoting a temporary fall in blood pressure, with pallor, fainting, sweating, and nausea, caused by overactivity of the vagus nerve, especially as a result of stress” and “syncope” means “temporary loss of consciousness caused by a fall in blood pressure”.

I’d already known that I’d passed out and I’d also known that my blood pressure had dropped like a stone when I’d passed out. All that I’d gotten for my $50k was a fancier way of saying that I’d passed out. (OK, they did confirm that I wasn’t having a heart attack but seriously…!)

Once they had the words “vasovagal syncope” to play with, they found a way to test it. The test was called a “Tilt Table Test”. I was surprised by the absence of Greek or Latin words but I went for it.

The steps for the tilt table test were:

1. Deprive the patient of food and water for 8 hours.
   (I suspect that this was to minimize the cleanup if the patient tosses his cookies during the test.)
2. Strap the patient to a table so that he doesn’t fall and bump his noggin if/when he passes out.
3. Tilt the table so that the patient is pretty much standing.
   (70 degrees or so)
4. If the patient doesn’t pass out after 20 minutes, give him some nitroglycerin.
5. If the patient doesn’t pass out after another 10 minutes, give him some more nitroglycerin.
6. If the patient still doesn’t pass out, then he’s got some other problem.

I didn’t pass out during the first 20 minutes. I expected that, because just standing isn’t my problem. They then gave me the first dose of nitroglycerin.

I felt nothing after a few minutes and asked how long it would take for the nitroglycerin to kick in. The nurse said it should take a few minutes still.

Then it hit me. “I feel really nauseous and really anxious.” (It was scaring the stuff out of me.) Followed by “It’s getting really dark now.”

They lowered the table back to horizontal and asked if I was back with them. Then they called Pam back to the room and announced that I’d passed out and they knew how to treat my problem.

When Pam mentioned the shaking that I do when I’m out, the nurse said that the shaking is pretty scary looking and that’s why they don’t allow family members to witness the test. The family members tend to flip out when they see the patient flopping around.

As they talked to Pam, I realized that there was a gap between putting the table back to horizontal and asking me if I was back with them. I guess that I was actually out for a bit.

The point of all this was to record all sorts of data as I passed out. The data told them that my ticker kept on thumping normally through the whole thing but my blood pressure plummeted. It was so low that it was literally off the scale. In this case, the systolic reading was less than 60.

This means that it wasn’t vasovagal syncope. With vasovagal syncope, the ticker rate plummets but the blood pressure just blips a bit.

The nurse practitioner said that passing out with a normal ticker and plummeting blood pressure was a known condition and that they knew how to treat it. I asked if this condition had a name. She said “Yes, orthostatic hypotension.” I was reminded of a favorite quote:

“Baptizing a thing doesn’t explain it.”
– Roger Zelazny

Google says “Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position.” I guess they named it before they found it happening in other situations like exercising too hard or reducing air pressure.

The likely suspects in my case are dehydration and blood pressure meds. They’re going to look at fiddling with my diet, reviewing my blood pressure meds, maybe get me some compression socks. (Chicks dig those).

The upshot of all this is that, whatever the cause, my ticker isn’t part of the problem. If I never pass out again, it’ll be too soon.