I fainted for the first time. Thud.
July 24, 2016 11:47 AM   Subscribe

Help me figure out what to to next, and how to stay upright in the future!

A week and a half ago, I fainted for the first time in my 31 years. Context: I was traveling in Portugal (I live in the US). I'd been there about a week. On this day, I had spent a little bit of time in the sun, the temp was probably around 90 degrees, I hadn't eaten much during the day, I was on my period, probably still jet lagged, and I'd had several beers on an empty stomach (I know; lesson learned!) Shortly before I passed out, I'd eaten a big place of super-carby fettuccine alfredo. I was at a restaurant with maybe 25 other people; I had several moments of sharp cramps, felt very nauseous, felt very hot, vision got fuzzy, and I had to put my head down (I felt like I couldn't keep it up). The next thing I remember is coming to (very shortly after) under the table, with my boyfriend looking down at me and saying my name over and over, and others peering at me under the tablecloth. I felt a sense of relief after fainting. The waiter had me put my feet up on my chair while I was lying on the floor; they brought me port wine and sugar water to get my blood pressure back up.

About a week later, a similar thing happened, but without the actual fainting, and my period was done by then. Several hours in the sun, a bit of sangria and paella, and I felt very nauseous, had to rest my head on my boyfriend, felt lightheaded and hot. My friends gave me some Alka Seltzer for my stomach and I quickly began to feel better.

I would love to never feel like this again.

Other factors: I've had two period-related episodes in the last two years that have been very bad. Incredibly painful cramps (I can't stay still during them; basically I'm writhing around on the bed), feeling lightheaded and nauseous, and very sweaty/clammy. The cramps come in waves. As soon as it seems like a bad episode is on the verge, I take 3 ibuprofen and wait for the gaps between the cramps to get longer. The whole thing lasts about an hour and it's big, painful production. I just want to sleep afterwards.

I think I have pretty low blood pressure generally. I feel like my reading are usually 100 over something below 80. Oftentimes when I stand up I get lightheaded or my vision goes black for a second or two.

I'm not on birth control. I haven't been on any for about a year.

I'm on a steroid for asthma. I've been on various asthma steroids for years and years.

Over the last year or so I've noticed occasional heart palpitations. I went in and got an EKG and everything looked great. I haven't noticed them so much recently. The doctor I saw did not seem worried at all, considering my age and general health.

I often feel like I have a long list of health issues and I don't know where to start in terms of solving them. I don't have a GP at the moment but am looking for one.

If you were me, would you see a gyno first thing? Where should I start? I'd really like to not ever feel this crappy again.
posted by sucre to Health & Fitness (22 answers total) 2 users marked this as a favorite
You MUST wear a hat in the hot sun. If my bare head isn't covered, I'll pass out in five minutes.
Our health concerns may not overlap, but please, please wear a hat!
posted by BostonTerrier at 11:56 AM on July 24, 2016 [5 favorites]

It sounds like symptoms for heat stroke -- which may be exasperated by having your period. Stay hydrated - with water or sports drink, limit sun exposure or cover extremities, and cool off indoors when you first have symptoms.
posted by DoubleLune at 11:59 AM on July 24, 2016 [6 favorites]

I am not your med student, but I would go to an internist and get worked up just in case, because even if you were "just" dehydrated, most people don't faint when they're dehydrated. Take care of yourself!
posted by 8603 at 12:00 PM on July 24, 2016 [8 favorites]

I would start with a GP. You can certainly share your concerns about your periods with a GP, too, but fainting is definitely within the purview of a GP.

In the meantime, just anecdotally, my blood pressure tends to run low too and I have to be pretty disciplined about hydration, salt, and food, especially in the heat. I tend to salt my food pretty heavily (I have to hold back if I'm cooking for anyone else) and have been known to eat a palmful of salt or a gulp of pickle juice on a hot day. These tips should not replace a visit to the GP but may keep you more comfortable until you go.
posted by telegraph at 12:00 PM on July 24, 2016

P.S., sorry: Just go back to whomever it was that did the EKG. I'd start there.
posted by 8603 at 12:06 PM on July 24, 2016 [3 favorites]

Include other electrolytes (salts) besides just table salt, like magnesium (e.g., brazil nuts) and potassium (avocadoes).
posted by aniola at 12:06 PM on July 24, 2016 [3 favorites]

I would recommend talking to your doctor, of course. You might (if insurance allows) just go straight to your GYN, get your yearly physical with bloodwork, and also talk about possible endometriosis issues (which can leave you additionally dehydrated if you are having bowel hypermobility or diarrhea) given the level of cramping you suffer.

One of the thing that sucks about heat stroke is that you are extra susceptible to heat stroke in the days/weeks afterwards.

You may just be reaching an age where you know you have to be more mindful of hydration and electrolytes in the heat.
posted by Lyn Never at 12:09 PM on July 24, 2016

It sounds like a perfect storm of reasons to get heat stroke:
*Jet lagged (tired),
*Dehydrated (airplanes have notoriously dry air),
*The 90-degree-plus ambient heat,
*Your period (more dehydration from fluid loss, plus possibly lowered blood pressure and low iron count),
*Alcohol on an empty stomach, plus
*Several hours out in the sun.....

All of that equals, yeah, fainting from heat stroke. Definitely talk to your doctor, but also keep in mind drinking water (not beer or other alcohol!) when you're dehydrated; and either keep out of the sun (walk in shady areas, under trees or on the shady side of the street), wear a hat and/or carry an umbrella/parasol for portable shade.
posted by easily confused at 12:38 PM on July 24, 2016 [2 favorites]

This type of thing, including the heart palpitations, used to happen to me when I was anemic.

The heat stroke seems most likely, and of course, get a doctor and try what they say, but please also get some blood tests. I was so anemic for so long I started thinking it was normal, so now I go around warning people about that.
posted by ernielundquist at 12:51 PM on July 24, 2016

I am not a doctor.

This sounds VERY much like an episode I experienced once, for which I ended up in the emergency room. It was diagnosed as "vasovagal syncope". Look it up (e.g., here). It isn't dangerous, has symptoms exactly as you described, and can be caused by a number of common things (including heat exposure).

Of course, you should visit your GP to discuss your particular case.
posted by Halo in reverse at 1:02 PM on July 24, 2016 [3 favorites]

i nearly passed out at the gym a couple of months back. went to see a general doctor (literal translation - i guess GP) and she poked me around and asked for a bunch of tests at various specialists (everything worked out fine in the end).

anyway, in retrospect that worked well - the GP coordinated everything and had the big picture. individual specialists reported back and the GP then responded to those results with more requests. but i live where medical care is relatively cheap.
posted by andrewcooke at 1:12 PM on July 24, 2016

If you have low blood pressure - coffee, a little more salt (dont go nuts), licorice are all good to get it up a bit
posted by speakeasy at 2:19 PM on July 24, 2016

I'm a former fainter. My blood pressure also has always been low and I used to have truly awful menstrual cramps. Re fainting, I have to beware of getting very hot, and I also went clunk when my ears were pierced, so I am careful when I am giving blood samples or donating blood or getting a tattoo.

Besides being aware of your risks -- and you now know that heat, alcohol, and lotsa carb loading are that for you -- be aware of how it all felt when it started. Next time you feel that woozy dizziness, sit if you aren't already, bend over at the waist, and put your head between your knees. Stay in that position until the wooziness passes. Then drink water and cool off.

For the menstrual cramps, try a pain reliever like motrin with caffeine as soon as they start, lie down, and listen to something musical you find peaceful. That routine used to make a huge difference for me. Don't sweat the low blood pressure unless your doctor sounds an alarm. And re the steroids and the heart palpitations, I'd chat with your doctor about whether you should have concerns.
posted by bearwife at 2:33 PM on July 24, 2016 [1 favorite]

I agree that your GP would be a good start, and that it sounds like a vasovagal response which is something that happens to me from time to time. My 'triggers' seem to be heat, low blood sugar (not eating), low blood pressure (standing for too long), dehydration, and pain (eg period pain). Each of these things on their own is not usually a problem but in combination can cause light headedness, dizziness and fainting.

In my case I just have to be careful to avoid triggers - stay out of the heat if possible, stay hydrated, don't stand up for too long. If I feel dizzy, I sit down, head between my knees and wiggle my toes and feet to keep the blood moving.
posted by Shal at 2:41 PM on July 24, 2016

This happened to me when I was a teenager. It could have been heat related or blood pressure related, I guess. For me it was blood sugar. I went to an internist who discovered I had hypoglycemia. It's easily controllable (in my case) by diet. Just knowing the signs, I can definitely feel it coming on and do something about it when I've been lazy about eating right.
posted by ctmf at 2:43 PM on July 24, 2016

Sounds like postprandial hypotension, if both episodes were associated with eating a meal? Here's an article about it with some tips to help prevent it. The heat and dehydration probably didn't help.
posted by castlebravo at 3:49 PM on July 24, 2016

(((not your doctor)))

given the sweaty skin, that sounds more like heat exhaustion, than the more dangerous heat stroke (dry skin)

but as others have said, definitely get checked out and yeah EEG + EKG wouldn't hurt. it could be some sort of pre-syncope condition (of which there are several kinds, some electrical, some cardiovascular, and others) - I've got one of those, and only actually fainted once, 5 years ago. (after that, I learned to identify the particular triggers for me and avoid them (mostly postural, i.e. some very specific orthostatic and orthodynamic behaviors, plus some other things. and also learned to be constantly aware and looking for the beginnings of the particular feeling that would tell me to watch out. sit down a few minutes, drink some cold water, that's what works for me.))
posted by dorian at 5:38 PM on July 24, 2016

See the doc, but just know that I am also a fainter, with low pressure, and eating super super carby stuff totally does this to me at times. I am sure there's a reason for this (blood sugar something or other) but practically speaking, make sure you have enough protein in your diet.
posted by Countess Sandwich at 7:20 PM on July 24, 2016

I've had a lot of what you mention (blacking out when standing, period-related episodes like you describe) and also low blood pressure, though I've only actually fainted once. I'm also 31F and not on BC, so twinsies! Of pain and ickiness! Yay...?

So, in my experience, here are three things you might consider looking into:

1. Vasovagal syncope, as Shal mentioned above. The one time I fainted, I was running and stepped weird and I tore a ligament in my ankle. It was much like you described - nauseous, hot, tunnel vision, and then falling over (except not all the way over because my now-husband caught me in his arms before I fell. Swoon - literally!). I felt way better when I woke back up a minute or so later. I happened to be wearing a heart rate monitor at the time, and my heart rate apparently got super slow, and then went back to normal. The doc at the hospital, when we went a few days later for my massively swollen ankle, said that meant definitively that it was vasovagal and not some other kind of fainting, and therefore didn't require an EKG, etc. Cool! I know now that my triggers (mostly pain) mean fainting might happen, so when I feel woozy, I get on the ground so I don't, you know, topple over. Just in case my husband is at work and can't catch me that time :)

2. Specifically for your period-related episodes, what my doctor calls "prostaglandin attacks." Essentially, when I first get my period, I have too many prostaglandins floating around, which makes my uterus contract more than it needs to, and can also make my intestines spasm. So I get diarrhea and nausea and super intense cramping (like you, writhing around or pacing, because the pain is too intense to stay still), which can itself lead to vasovagal symptoms like dizziness, blacking out, feeling super hot, etc. I often get super pale and take off all my clothes and lay on the bathroom floor (which I would never do under normal circumstances) and sweat profusely (which I also usually don't do). Like you say, mine lasts for about an hour, during which I'm totally miserable, and then I'm totally fine. For this, my GP suggested preemptive ibuprofen (ibuprofen is an anti-prostaglandin as well as a pain reliever), which I've found to be amazingly helpful. I track my cycles and take 2-3 ibuprofen the night before my period is supposed to start (or even earlier if I start to get cramps). I do it then and not the day I start bleeding because of an unfortunate early morning episode where it woke me up and I tried to take ibuprofen in time but ended up just throwing it up instead. If I'm good about doing this, I don't get these episodes at all anymore. It's awesome. I highly recommend it.

3. Anemia or iron deficiency. Anemia can make you pass out or feel icky, and it can be worse when you're on your period or just after. Even iron deficiency without anemia can make you feel some of this stuff potentially, including heart palpitations. I suggest asking your GP for both a hemoglobin/hematocrit test (part of a CBC, tests for current anemia) and a ferritin test (a separate test that checks iron stores), especially if your periods are heavy or you're a vegetarian. I was never anemic but had super low ferritin, and didn't know that until a med student finally suggested we test that, just for kicks. More iron has helped me with lots of my symptoms. Yay iron!

Hope you feel better soon!
posted by bananacabana at 9:11 PM on July 24, 2016

Seconding other electrolytes. I always have to have extra before and right after my period, or I get horrifying cramps, fever, and muscle aches. A friend is the same, only she gets flu-like symptoms.
posted by Ms. Moonlight at 3:20 AM on July 25, 2016

I came in to suggest pre-emptive ibuprofen for the period pain too. The second day of my period used often to feature episodes of the kind of pain you describe, leaving me writhing on the bed crying. Following a suggestion on a mailing list, I started taking regular doses of ibuprofen beginning a day or two before the period was due, and that turned out to help massively, reducing the pain from unbearable to merely unpleasant.
posted by ManyLeggedCreature at 1:27 PM on July 26, 2016

I am so grateful for all of you who chimed in here. I was feeling pretty anxious about this, but being aware of triggers and seeing a doc are two things I can actively do right now.

Bananacabana, oh my gosh- I do the same get-naked-and-lie-on-the-bathroom-floor thing! You know it's bad when that happens!

(I don't think it was heat stroke, as that seems to be much more serious than what I experienced; my body temp definitely wasn't 104; I'm guessing heat exhaustion is more likely. And I was wearing a big hat every day- so glad I had that thing!)

A serious big thanks to everyone. I love you, AskMefi.
posted by sucre at 9:29 PM on July 26, 2016

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