Living with Vasovagal Syncope

 

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Does anyone ever wake up in an instance to see their vision in an array of tiny black pixels formulating in obscure random patterns? Or a sick crumbling feeling in their stomach accompanied by an impending tingling wave of nausea moving up their chests with a ringing in your ear and you lose your balance?

If so, you’re in luck because well, you’re not alone.

For the past 15 years I’ve experienced a health condition called Vasovagal Syncope which is basically getting dizzy more than often or fainting. Now I have had this condition long enough that I know the different stages and how severe my symptoms are at the time. My symptoms can range from just a quick dizzy spell and be back to normal all the way to fainting for 5+ minutes and every thing in between.

I’ve adjusted my life to help control my Vasovagal Syncope. For example, when I workout, I cannot do real squats. I must do sumo squats (legs apart) so that way, I have enough balance and lower my chances of fainting. I must carry a water bottle every where I go.

Vasovagal syncope is a fancy medical way of saying that a person had a change in their body that caused them to faint. The change is not caused by a disease or disorder – instead, it happens because of an extreme feeling like shock, fear, or pain. It also happens in certain other situations (e.g., seeing blood). People with vasovagal syncope often describe sweating, feeling dizzy or nauseous, or having clammy hands or skin before they faint. They will usually regain consciousness after lying flat for a few minutes. A doctor will ask you about the situation surrounding your loss of consciousness to identify vasovagal syncope. Treatment usually involves avoiding the type of situation that caused the fainting spell – if this is not possible, there are other behavioural and medical treatments that a doctor could prescribe for you.

The first fainting spell I got was when I was 6 at a toy department store with my parents. A toy box fell on my hand and left a cut on my fingers. It was a moment of intense panic and I slowly find myself collapsing on the ground with my lips as pale as paper. My parents held me down in the car measuring my pulse. It was intense for a child my age, and I thought I was going to die.

When you have a syncopal episode, you have something akin to a very vivid dream, and when you regain consciousness, you can’t remember it apart from the fact that you thought you were dreaming. (Perhaps, that was the leading factor that got me interested in stuff like astral projection, out of body experiences, etc.)

The second time that happened was also the first time I got my menstrual period. I was in a train and I felt like I was losing a lot of blood. I passed out and terrified every passenger in the cabin. Thankfully, to the kindness of strangers and train coordinators, they helped me out with water and a kind lady with paramedic license massaged my temples.

At least once a year, a pattern of thoughts turns into a series of chemical reactions, and I lose consciousness, crash into something, have rapid muscle spasms that look for all the world like an epileptic seizure, and then I lie limp and unresponsive for a while with dangerously low blood pressure, a weak, sluggish heartbeat, and a thready pulse. A series of heart palpitations ensues. It scares the hell out of everyone. As for me, I’ve done it so many times and under so many circumstances that it’s mostly just humiliating. I have a refrain for these post-faint moments, and I’m usually saying it as I come to: “I’m sorry, I’m sorry, I’m sorry.”

Sometimes what I am thinking causes me to freak out so badly that my vagus nerve is triggered and all the blood leaves my brain, with the effect that short portions are edited out of my life.

It was definitely terrifying to experience this from time to time, but the interesting fact is that is biologically justified. Specific triggers induce an overactive “fight or flight” response that then leads to vasovagal syncope. It’s different for everyone. Some people experience it when they hear particularly shocking or overwhelming news. Others pass out at the sight of blood, or at graphic descriptions of injuries, or in situations in which they themselves are superficially injured or are undergoing a procedure involving needles.

Distress signals from the brain cause a wave of adrenaline to crash through the body, which in turn kicks the heart into high gear, narrows the blood vessels, raises blood pressure, and floods the heart and lungs with blood. These are the body’s “oh shit!” responses, developed over the ages to prepare humans to recognise and flee from predators or fight for their lives. A true state of panic, however, one where the brain and body react as though the threat were genuinely lethal, can only be sustained for so long.

In people with a history of vasovagal syncope, the “fight or flight” response seems especially prone to overheating and then triggering a response from the body’s emergency pressure valve, the vagus nerve. From its privileged position close to the brain, this nerve sends up a message authorizing the release of massive amounts of the neurotransmitter acetylcholine, adrenaline’s opposite. Blood volume plunges and pools in the legs, leaving the brain with too little circulation to keep functioning. Musculoskeletal control is lost and the body collapses.

It is the brain’s last-ditch effort to reclaim the blood it needs—if the heart is suddenly too weak or slow to pump blood upwards, the body must be brought down.

And here the response usually ends. Sometimes it even looks graceful, more accurately fitting the word “swoon”—wrist to forehead, a gentle crumbling perhaps brought on by a too-tight corset. There were even special couches for this purpose in the Victorian age, “fainting sofas,” on which one could elegantly recline while smelling salts were held beneath the nose. But in an even smaller subset of the already small percentage of the population prone to vasovagal syncope, an exclusive club to which I and a few members of the population belong, the fun continues with a sudden, violent stiffness in the limbs or uncontrolled shaking that resembles, but is not, a seizure.

In other words, anyone without a spear in the Paleolithic Era learned pretty quickly how to tell when things were going south for their side in a conflict. Better, if the raid is heading more towards a massacre, to go ahead and appear dead. Keep in mind that humans at this point were pre-verbal, and had no means of communicating through sounds or symbols.

A convincing appearance of death was truly the only way of saying, “Fuck, please stop stabbing me.”

I find it fascinating that a non-lethal trigger, something as tiny as a needle’s prick, the sight of someone else’s blood, a convincing or elaborate description of gore, or even a strong emotion, can cause an uncontrolled, if brief, shut down of the brain and the superficial appearance of death in the body. The situation is not “fight or flight,” not a confrontation between predator and prey, but my imagination, my emotions, my mental pictures of split bones, pierced veins, and swelling, empty tooth sockets that have convinced my brain that the stakes are life and death. The stress of lost control plays a huge part as well, the knowledge that whether or not I approve, painful and invasive things either must be done or have already happened to my body.

In a case of a syncope episode, it is important to not freak out. I’ve complied some effective ways of managing it, to protect yourself from your environment. These are from my personal experiences. I am in no way a certified cardiologist, but I have been recently diagnosed and I really hope they could come in handy one day.

Self-Management tips for Vasovagal Syncope

1. If you are able to be aware of the oncoming signs, sitting down, lying down, would be an immediate response. There’s the old head between the knees method. But avoiding them completely, well, the only thing to do would be to avoid what causes it, and sometimes we just don’t know what the trigger is.

But once you do learn then treating the symptom as something to avoid if you can, and generally taking things slower and easier to allow the body time to adjust.

2. It is important to lie down flat immediately when you sense heart palpitations and loss of vision because you never know what can happen if you fall and knock your head, breaking your skull, neck or spine which can cause instant death.

3. Lying down helps to regulate your blood flow instead of gushing it down to your lower body, delaying the flow to your brain which needs it most for oxygen.

4. It is also especially helpful to drink water as taking gulps helps to regulate breathing and take in long timed breaths.

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All in all, it is not a lethal condition, but something biologically engrained. Perhaps, that adds as a relief knowing that is something just to be aware and cautioned about, and not to fear any onset potential health threats. I, and some others, just have a more sensitive nerve, which sometimes malfunctions and starts a fight with my brain, all for the better of my safety.

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The Most Accessible Form of Therapy: Meditation

 

I remember as a child about a good twelve years ago, I would be awaken by the sounds of my mother unwrapping a huge piece of velcro to reveal the yoga mat. We would have breakfast and head to the community park for yoga lessons.

I wasn’t particularly fond of that. The constant stretching, balancing on my clumsy feet and distraction by the swarm of morning cyclists and chatter certainly did not amuse me.

However, my favourite part of it all was the meditation session at the end of each lesson. They always boost me up at the beginning of the day with energy and a refreshing mind and somehow, magically, able to steer me away from external noise.

Battling with ongoing anxiety throughout adolescence and after getting tired of flipping through self help articles online, I came across an old CD my mother had in one of the drawers under the TV.

I remembered it very clearly. Twelve years ago on the last day of the class before he leaves for India, the yoga master gave it to my mom and told her to always remember and practise mindful meditation on her own.

Of course, my mother and everyone else neglected it as everyone was living amid the material comforts of city living and the demanding pressures of academic and career pursuits.

As the years go by and in the final year of college, I was immensely beaten up by stress, depression and raging anxiety. Internship was difficult and each day was a struggle to pull through. It was also the period I first noticed and realised the gentle and profound teachings of the Buddha.

At that time, along with my unhealthy emotional wellbeing, a natural curiosity about the nature of the mind had awakened in me a healthy appetite for intellectual and mental nourishment.

It is therefore not surprising that I was immediately attracted to the philosophical and psychological genius of the Buddha and attempted to reconnect with my faith. What I at that time accepted intellectually of Buddhism led me, in due course, to the practice of meditation, which is the central axis of Buddhist spiritual life.

Starting Something Is Never Easy!

I began meditating with fifteen minutes of mindfulness of breathing each day. I didn’t and couldn’t get the hang of it for the first three months. During the first few weeks of practice, I was overwhelmed by the barrage of thoughts, images, emotions, and even sounds or voices, that were constantly “swimming” in my mind.

This was not evident to me until I had to make repeated attempts to focus attention on a single object (breathing). I started to become aware of how unaware I had always been of these ubiquitous mental states and contents. The constant flow of images and inner sounds would so often occupy the entire field of consciousness that it was extremely difficult to pay concentrated attention to breathing.

Each day, following my mindfulness of breathing, I would proceed to the practice of loving-kindness meditation. This involved extending loving thoughts and feelings to myself and others without undue thinking and emotional involvement.

My initial attempts brought the feeling that the whole procedure was rather contrived and artificial. I had felt, at the time, that the practice was not very different from the psychological technique of auto-suggestion and therefore was suspect. Nevertheless, I decided to temporarily suspend my skepticism and critical appraisal of the practice so as to give it a fair trial.

Another difficulty I encountered in the course of this practice was constant emotional involvement in the images I had evoked, whether of a loved one or of a disliked one, often resulting in a whole train of discursive thinking connected with the images. At such times I would forget the aim of the practice and become completely immersed in my personal mental melodramas. It usually took me some time to notice that I had wandered. This recognition had the effect of automatically re-establishing the practice.

By the end of the first two months, I was feeling increasingly doubtful about the value of this practice. The sense of its artificiality came to me with greater intensity than before. I persisted nevertheless. By the fourth month of practice, I found myself more able to stay with the practice without being sidetracked.

As time went on, I started to get better at meditating. I noticed in month three and month four that I felt less rushed than I normally do. Initial difficulty during practice is especially normal, but never give up! I had just as much to do each day, of course, but I felt less anxiety about the time I needed, and my ability to accomplish all the tasks I needed to get done.

It’s as if I had more confidence and greater compassion for the life around me and developed a more clear direction throughout my mental headspace, greatly benefiting the daily tasks I do and taking care of my needs.

What happens without meditation is that there’s a section of our brains that’s sometimes called the Me Center (it’s technically the medial prefrontal cortex). This is the part that processes information relating to ourselves and our experiences. Normally, the neural pathways from the bodily sensation and fear centers of the brain to the Me Center are really strong. When you experience a scary or upsetting sensation, it triggers a strong reaction in your Me Center, making you feel scared and under attack.

When we meditate, we weaken this neural connection. This means that we don’t react as strongly to sensations that might have once lit up our Me Centers. As we weaken this connection, we simultaneously strengthen the connection between what’s known as our Assessment Center (the part of our brains known for reasoning) and our bodily sensation and fear centers. So when we experience scary or upsetting sensations, we can more easily look at them rationally.

One of the obvious benefits of meditation is relaxation. And I’m sure science would agree that the more relaxed you are, the easier it is to fall asleep. I think your body understands that you have made an attempt to lower your rhythm and decrease your stress and so better (and easier) sleep may be your body’s way of rewarding you which is greatly helpful in cutting down my caffeine and recurring sleep delay due to stress and anxiety.

But Meditation Is A ‘Buddhist’ Thing To Do! I am not Buddhist and definitely not becoming one!

A misconception is that you have to be Buddhist to try meditation. That’s not true! Even though I was born and raised Buddhist, anyone can try meditation and it does not have to be along the sounds of Buddhist chants. You could play any form of relaxing music ( I love the sounds of nature and rain!) and there are loads of them on Youtube. Psychologists worldwide(and supported by American Pyschological Association) often suggest meditation as part of therapy and strongly recommend it over medication as a healthier alternative.

Diligent and sustained practice of mindfulness of breathing and loving-kindness meditation is a fruitful and spiritually fulfilling endeavour that results in an enhanced state of awareness and a transformation of unwholesome mental patterns in one’s daily life.

Meditation practice isn’t about trying to throw ourselves away and become something better, it’s about befriending who we are. – Ani Pema Chodron

A Fun Way To Get Started

One of the best (free!) apps I’ve come across to help you get started with meditation is called Headspace. Invented by former Buddhist monk Andy Puddicombe, this is meditation geared towards busy people like you and me. It is a cute and beautifully designed app that guides you through 10 minutes of simple meditation every day. You don’t have to do anything—just sit down and turn on the app and let Andy’s calm voice (his voice is truly amazing–the app is worth trying just for that!) explain how to approach meditation. I strongly suggest everyone to try it!

 

Keep calm and stay well.