Not my doctor filter: I passed out the bus yesterday and when I came to my pulse was hanging out at 48. What could be going on?
January 26, 2010 11:17 AM   Subscribe

Not my doctor filter: I passed out the bus yesterday and when I came to my pulse was hanging out at 48. What could be going on?

Yesterday I had a normal morning, got dressed, ate some oatmeal, and headed to work on the bus. I was standing up when all of a sudden I felt hot and achy and the world started fading to black. I mumbled to the bus driver that I felt ill (I thought I might vomit) and he stopped the bus, and carried me off where I lost consciousness in his arms. They called the ambulance and after about 15-30 min I felt pretty normal again, although drenched in sweat and slightly shocked. The medics told me my pulse was between 48-50 the whole time they were with me. This has never happened to me before. When they took me to the ER I waited 5 hours to see a doctor and eventually left because they told me it would be at least a few more hours (oh Canada).

My pulse is generally low, resting at around 65
I am borderline hypothyroid at 3.2
I am having a tonsillectomy tomorrow and I am nervous

I know you're not my doctor, but I don't have a family doctor (Canada), besides going to a walk in clinic, so any thoughts would be appreciated on why you think this might have happened!
posted by gillianr to Health & Fitness (26 answers total) 1 user marked this as a favorite
You're going in for (an admittely minor) surgery without clearing this up? Rethink that. You need to schedule an appointment with a physician as soon as possible and take it from there.
posted by Inspector.Gadget at 11:21 AM on January 26, 2010 [4 favorites]

Call Dr. Tonsillectomy and tell him/her what happened. Then do what they tell you to do.
posted by A Terrible Llama at 11:22 AM on January 26, 2010 [4 favorites]

I was standing up when all of a sudden I felt hot and achy and the world started fading to black.

You have a blood pressure issue, or something causing a blood pressure issue. See a doctor prior to the surgery.
posted by Cool Papa Bell at 11:23 AM on January 26, 2010 [2 favorites]

You had better contact the doctor who's supposed to do your tonsillectomy; if it's hypothyroidism or another serious problem that caused your pulse to drop so low, then perhaps the tonsillectomy will need to be postponed until the issue is resolved. Otherwise, your recovery could be seriously compromised.

Not everyone is 'borderline' hypothyroid with a TSH level of 3.2. I'd be close to a myxedemic coma at that point, myself.
posted by Ery at 11:24 AM on January 26, 2010 [1 favorite]

Vasovagal episode ? What , if any medications are you on ?
posted by Agamenticus at 11:29 AM on January 26, 2010 [1 favorite]

Following up on the "syncope" link -- a friend of mine went through a period of fainting spells in high school, and after much doctor probing eventually came to the conclusion that he was simply not breathing enough. Literally, he was breathing too shallowly sometimes, and starving his brain of oxygen. They taught him some simple deep breathing exercises and suggested he do them when he wasn't otherwise occupied, and the fainting went away completely.

So see a doctor. But that's something no one even though of for a long time, and turned out to be the problem.
posted by rusty at 11:30 AM on January 26, 2010

First thing: let your surgeon know NOW that you fainted. This is relevant.

IANAD, but it's my understanding that people with low blood pressure (hypotension) may be prone to fainting. You know what your usual pulse is, but is your resting blood pressure below 90/60? (Not everyone with a blood pressure below that cutoff is prone to fainting, but it's a guideline.)

When you faint, your pulse slows. That's just part of fainting.

However, although it's possible that unusual stress brought this on, you should see a doctor in a non-emergency environment to assess whether you have another medical condition contributing to this. As much as it sucked for you to wait so long at the ER, you were low on the triage list because you had a single episode of fainting, had recovered, and were not in immediate distress or danger.

The "Canada" stuff: besides the fact that people wait in ERs in other countries, too, don't be too quick to assume that a walk-in clinic is your only option in Montreal. I made the same assumption up until 2006 in Toronto, after years of using walk-in clinics because "everybody" said it was hard to find a doctor in this city. When I finally looked at a provincial directory, I got a family doctor within a day. You may not have an easy directory to use as I did (and which is no longer available in this province), but while you can get good care at a walk-in, don't give up on trying to find a family doctor, even with the reported shortages. Have you already tried this map?
posted by maudlin at 11:42 AM on January 26, 2010 [1 favorite]

Thanks for the responses so far. I'm on no medication, and I did contact my ENT surgeon (his secretary) after it happened, and I was told "I will put a note on the chart but ask to speak to the anesthetist at time of surgery".
posted by gillianr at 11:43 AM on January 26, 2010

Point of clarification: Tonsillectomy is not a minor surgery.

I wouldn't do it without getting this episode throughly checked out.
This scenario could also be a sign of a conduction problem in your heart.
You need work up for this incident before having surgery.
posted by SLC Mom at 11:54 AM on January 26, 2010

While reading your description of what happened I was reminded of a similar episode a former coworker experienced. He was subsequently diagnosed with thryoid problems and was told that was the cause of the dizzy spell. Ongoing medication was prescribed and he did very well afterwards. Absolutely explain this to the anestheologist and surgeon tomorrow. This is not normal and you definitely need to get this checked out ASAP. Best of luck to you.
posted by Daddy-O at 11:56 AM on January 26, 2010

Same thing happens to me, generally when I think about internal medical stuff.

You have a blood pressure issue...


Consult your doctor and make sure you make everyone who is involved in your surgery aware of this. Keep repeating it.
posted by jeffamaphone at 11:58 AM on January 26, 2010

This is not a talk to the anesthetist issue. This is a full stop issue.
posted by arimathea at 12:06 PM on January 26, 2010

Get checked out before the surgery. I am hypothyroid too, and on medication. My pulse and blood pressure are still low, but I can function these days. I have also fainted a couple of times. As far as problems go, this isn't a bad one to have and is fixable.

I had surgery one time, and met with the anesthesiologist way prior to the surgery--like days before. The one thing they told me was to take my thyroid medication the day of the surgery.
posted by chocolatetiara at 12:08 PM on January 26, 2010

Call the anesthesiologist today. Tell the anesthesiologist what you told us and tell him you're on his case load for tomorrow morning. No gas passer wants someone with unresolved blood pressure issues on the table. It would be one thing if this was emergency surgery, but this is a scheduled non-emergency procedure. Your BP/fainting issue should be resolved first.

Also, as a society we've gotten completely confused about minor surgery vs. outpatient surgery vs. routine surgery. A tonsillectomy is routine, but not minor. Once you need general anesthesia you're out of minor surgery territory.
posted by 26.2 at 12:22 PM on January 26, 2010

Thanks everyone, I don't think I realized how serious this is. I don't exactly have the direct line to my anesthesiologist, but I did talk to the secretary again, and I forwarded her my story above. She said it's likely now my surgery will be cancelled, but she can't get a hold of anyone today, so I'll have to go in and see them in person so they can decide. Unfortunately I'm going back to my home town for this, and I have booked two weeks off work. But better safe....
posted by gillianr at 12:25 PM on January 26, 2010

[IANAD] Maudlin made a good point about "the 'Canada' stuff" above", but here's another point along those lines: in Canada, as in most places, you will often need to self-advocate in the medical system. Call your anesthesiologist today. Trust me, s/he both wants and needs to hear this from you today, not tomorrow.
posted by onshi at 12:27 PM on January 26, 2010

Also, OP, brace yourself for some guff from your ENT (et al.) about not sticking it out in the ER queue yesterday to get to the bottom of things. But like you said, better safe than sorry.
posted by onshi at 12:30 PM on January 26, 2010

IANAD. However, I do recommend getting your potassium level checked. I went through a recent period of episodes of near-syncope (never actually passed out, but felt like I was about to) and my potassium turned out to be really low, which was an easy fix (big honkin' potassium supplements) but could have ended up pretty serious if it hadn't been caught.
posted by chez shoes at 12:33 PM on January 26, 2010

"Fainted a few days ago, low pulse, no explanation" will or should set any anesthesiologist off. The last thing that they want to deal with is someone whose pulse and blood pressure are going to unexpectedly drop while under.
posted by a robot made out of meat at 1:04 PM on January 26, 2010

My first blood pressure spike was almost the exact same except I didn't get all the way to fainting. That was high blood pressure though. I've had similar things happen when I'm really sick.
posted by geek anachronism at 1:53 PM on January 26, 2010

Had things similar back when I was a teen. Low blood pressure + anorexia = eletrolyte imbalance. Good times in deed.

Good luck.
posted by stormpooper at 1:55 PM on January 26, 2010

Coming in to emphasize what Ery said: Not everyone is 'borderline' hypothyroid with a TSH level of 3.2. I would be going to an endocrinologist and seeing about getting on some thyroid medication if I were you. Definitely postpone that surgery.
posted by gudrun at 1:59 PM on January 26, 2010

This may or may not be worth cancelling the surgery for, but your anesthesiologist will definitely want to know more about it. I do not know how scheduling works in Canadian ORs compared to US ORs, but talking to the anesthesiologist today might not be practical for a number of reasons (including the fact that the schedule might not be finalized until the morning of surgery). If it was indeed a vasovagal eipisode those are pretty common and might not be worth delaying surgery for; but depending on a lot of other factors it may be worth looking into in more detail before surgery. I would suggest showing up early on the day of surgery and when you sign in let the receptionist know you would like to talk to your anesthesiologist as soon as possible prior to surgery. Feel free to memail me if you want to know more; anesthesia is my area of expertise.
posted by TedW at 2:02 PM on January 26, 2010

This has happened to me several times in various degrees of severity for the last fifteen years (interestingly, a number of the episodes have involved public transportation). I've been to emergency rooms and had board tests and EKGs and no explanation has ever been found other than low blood pressure and/or low blood sugar. I have also successfully undergone anesthesia, but never very close to a fainting spell.

The bad news is that this is something you're going to have to monitor. What do you remember from right before you fainted? It's happened frequently enough to me that I can now identify the symptoms ranging from "I should get off the train at the next stop" to "Ok, I have to sit down right away" to "I need to yell for help because I'm about to hit the floor". I get very sweaty, have shallow breathing, palms get clammy, ears start ringing, green and black spots begin obscuring my vision and then I start doing something very strange--once I was walking like a penguin, once I was trying to unlock my car door with my fingers). By the time the spots appear, it's no holds barred, I'm going to faint.

I have learned to pay attention to my body, to stand a certain way that makes it less likely that my knees will lock (this pools blood at your feet and can cause lightheadedness), I don't drink orange juice in the morning, ever (this has a weird correlation with fainting for me and two other people I know--better safe than sorry), I alert close friends and boyfriends that I tend to faint and what to do if it happens around them. I always, always tell my doctors about these episodes whether or not I wind up going to them or to the emergency room.

The good news is that it's sporadic, and once I learned to identify the symptoms in the correct order, I've been able to prevent full loss of consciousness for almost two years. It's a totally manageable "condition" for lack of a better phrase.
posted by peanut_mcgillicuty at 7:27 PM on January 26, 2010

Thanks for the opinions everyone. I did exactly as you suggested, TedW, and showed up to the hospital early to speak with my anesthesiologist. After some frank discussion and a review of my pre op blood tests, he felt comfortable going ahead with the surgery. I am now at home recovering, but will be following up back home with your suggestions, on finding a doctor, and getting things checked out.
posted by gillianr at 12:13 PM on January 28, 2010

Glad to hear things went well!
posted by TedW at 2:50 AM on January 29, 2010

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