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Thread: passing out

  1. #1

    passing out

    C7 quadriplegic for 31 years. I get frequent orthostatic hypotension, exclusively in the morning when I get in the shower chair. I will rest in bed after breakfast (eaten in bed), head elevated, a while before getting up, wear a binder, started taking 1 g of salt with my breakfast, yet it still occurs. Once up, most times it will pass and I will lean forward on some of pillows. But other times it progresses to actual passing out for a minute or so, which gets some caregivers nervous.

    I would say actual passing out occurs maybe once, possibly and rarely twice per year. I can't find my past records for this to know the exact frequency, though all of my caregivers have experienced it.

    Some caregivers have gotten frightened and called the police/ambulance and by the time they arrive in the okay, though for the next few hours I usually feel queasy. I deny transport to the hospital since I do not think it warrants it, as all they would do is perhaps give me IV fluids and let me go after a couple of hours. I do not think it warrants an admission to start searching for an alternative reason.

    What shall I tell my caregivers to do when it occurs, which is currently to stay close physically, keep me stable from falling forward with their body if necessary and let it transpire, get me back down in bed as soon as safely possible or call 911?

    It scares some of them out since the manifestations of losing consciousness briefly can be frightening to see, such as eyes rolling, going pale, different breathing pattern, etc.

    It's too bad there isn't a quick acting medication to increase your blood pressure, such as an inhaler, as I can always feel it coming on.


  2. #2
    Senior Member
    Join Date
    Apr 2016
    Cincinnati, Ohio, USA
    This could be from a combination of meds or dehydration. As SCIs, literally every drug they give us is contraindicated for every other drug they give us.

    Baclofen, gabapentin, lyrica, valium, codeine, etc. all have warnings about each of the others.

    So we get used to being a class of patient that violates these warnings.

    My recent brush along these lines was last week as part of my Lyrica withdrawal issue. Dr. prescribed me nortryptaline to help with the withdrawal symptoms, but didn't tell me not to take it with Valium. Like all my other drugs they are contraindicated and, in this case, it mattered. I didn't pass out, but I got fuzzy peripheral vision and immediately tilted in space to get my knees up. I spent most of the rest of the day like that to keep my BP from tanking.

    It might not have been strictly nortryptaline + valium because I also take oxybutynin (next Botox is Wed) and baclofen so it could have been the combination of all of them. Removing the valium made the BP issues go away.
    T3 complete since Sept 2015.

  3. #3

    Spinal fusion?

    Did you have a spinal fusion to stabilize your neck when you got injured?

    "We must overcome difficulties rather than being overcome by difficulties."

  4. #4
    Senior Member Prerun's Avatar
    Join Date
    Jan 2009
    Oconto Falls, WI
    Eating will certainly trigger Orthostatic Hypotension. After eating, your body tends to rush blood to aid in digestion. A drop in blood pressure occurs and it can take awhile for your blood pressure to normalize. Concentrating on fluids can help.

  5. #5
    Yes, I am fused at several levels in my cervical region. I eat either no carb or complex carb breakfasts, even diluting my OJ about three times the volume of water to lower the sugar, drinking about half a liter with breakfast.

    I do take baclofen, tizanidine, gabapentin, and Ambien (the night before). Midrodrine is used for the treatment of orthostatic hypotension. I wonder if it can be used just in the morning only.

    For instance today, I was 90's/60's in bed with head up after breakfast/1 g salt/pneumatic compression garments on lower legs to push blood up for a half-hour. Immediately after being lifted into the chair I dropped down to 70's/50's; still a bit lower minutes later.

    Close to two hours later, when my bowel care was completed and I was all showered up it finally had a decent 100/70.

    Can only is what my BP must've been when I passed out, possibly 50's/30's.

  6. #6
    When I was first injured 3 years ago I took the blood pressure medicine in the morning to help raise it.
    I think I passed out once but many times felt like I was going to.

    Do you have a chair that will allow you to recline backwards almost to a lying down position to help bring your BP up if it starts to dip?

    Obviously our situations are going to be different, but I found the more I was able to get up, standing, at first with a tilt table and then with a standing frame, the more my blood pressure would regulate over time.

    It is still quite low but I do not feel negative effects any longer.

  7. #7
    Quote Originally Posted by crags View Post
    ....Midrodrine is used for the treatment of orthostatic hypotension. I wonder if it can be used just in the morning only.....
    For years I took midodren once a day with breakfast. If I didn't, I was likely to have a light headed event within a few hours, usually when I was driving. I also could take midodren before using the standing frame. It seemed to provide benefit (higher BP) very quickly. I don't need it anymore. I'm not sure why but it may be related to the chemo drugs I took over the last year for treatment of leukemia.

  8. #8
    Quote Originally Posted by titanium4motion View Post
    Did you have a spinal fusion to stabilize your neck when you got injured?
    Does that affect blood pressure??

    I get pretty hypotensive but I've never passed out. That seems scary. I hate the feeling though. I'm around high 80s, low 90s in the morning too. Sitting up for 30 minutes is barely enough for me to stabilize my BP, especially after waking up in the morning. 45-60 min is manageable for me. I've got to sit as close to a 90 degree angle in bed with my head up and legs straight, not elevated. And I try to eat salty food and drink lots of fluid before I get into the shower chair. Slim Jim worked really well for me cuz it's basically a stick of salt.

    In addition to tilting back, is there a way to keep your legs elevated in the shower chair?

  9. #9
    Senior Member
    Join Date
    Aug 2001
    Melbourne, FL USA
    You described my environment for 38 years and have found the drug call midronine or ProAmatine and it helps me control my blood pressure. Have gone down as low as 40/28.

    Eating, bright lights, water, my bowel program, there are many things that will crash my blood pressure from its already low baseline.

  10. #10
    It appears that Proamatine is perhaps the brand name for midodrine, is this correct? For those that take either, what dosage and frequency do you use?

    I am going to speak to my physician about trying the lowest dose, 2.5 mg, once per day in the morning. I rarely if ever have a problem once my morning routine is complete and I am in the chair for the day. In any event, should I get a bit lightheaded, I do have a power chair with full tilt and recline which I regularly use for pressure relief anyway.

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