I Stand Up and Faint

I said these words to 27 different doctors before cardiologist Dr. David Cannom diagnosed me with something called dysautonomia.

“Dys”autonomia is “dys”function of something called the autonomic nervous system (ANS).

The autonomic nervous system regulates everything that’s “automatic” for you, like blood pressure, heart rate, breathing, and food digestion. That’s the easiest way I use to explain it, and here it is in all its sympathetic and parasympathetic functions:


Screen Shot 2017-05-23 at 3.21.01 PM

See the left bottom, 4th word up: “vasoconstriction?” That means that a blood vessel goes from being big to being little. The vessel constricts in size, squeezing on itself. Blood vessels vasoconstrictor to give blood supply to another area, or when an extremity is cold.

The opposite of vasoconstriction is “vasodilation.” Blood vessels get bigger when blood supply is needed. In general, blood vessels vasodilate to increase blood supply to use big muscles, for blushing, or for carrying or taking away nutrients or waste, respectively. The process of either vasoconstriction or vasodilation is called, “vasoreactivity.” If you eat, vasodilation to the stomach occurs; if you swim, vasodilation to the leg muscles happens.


5 Situations Requiring Vasoreactivity

  1. Eating. When you eat, vasodilation to the gut occurs, to break down food into tiny molecular parts.
  2. Swimming. When you jump in a swimming pool, the blood vessels  in the stomach vasoconstrict to halt food digestion. That’s because the leg muscles need energy, so they vasodilate to keep you floating.
  3. Blushing. When your face turns pink from blushing, that’s because of vasodilation to the skin. You can also feel hot, for more complicated reasons, and that’s an idea of what a ‘hot flash’ during menopause can feel like. It’s rather uncomfortable.
  4. Standing. Are you understanding? Here’s the crucial part: When you stand, the leg veins squeeze or vasocontrict to divert blood up to your brain, so you don’t pass out or faint when you start walking. You don’t even have to think about it, because your autonomic nervous system is just peachy.
  5. Dysautonomia. When a person with dysautonomia stands, the leg veins do not squeeze or vasoconstrict. Therefore, blood pools in the feet and it’s like a sinking ship as the brain starts to pass out, seeing everything gray at first, in a “gray-out.” Soon, the gray-out leads to fainting, or syncope. Patients with dysautonomia live with pre-syncope or syncope (pre-fainting or fainting) as a lifestyle. That’s why they always lay in bed – to stay sideways.

There are many different types of dysautonomias; the simplest one is orthostatic hypotension, denoting people who get dizzy whenever they stand. A more extreme type is  Postural Orthostatic Tachycardia Syndrome, or POTS, which requires the heart rate and blood pressure to reach more extreme measures when standing. Here’s a fact about people with POTS, or POTSIES, that I can vouch as being true:


As with many invisible illnesses, dysautonomia and POTS are not “rare.” They are frequently misdiagnosed, undiagnosed, or completely unrecognized.

To increase awareness, dysautonomia is associated with the color blue. I find that many organizations and images depict an outstretched hand.

I’m not sure why this is so, but I can tell you that when you pass out, it’s a sickening and sinking feeling, so perhaps an automatic body response is to reach out for help. That’s why The Rebel Patient has outstretched hands.

Literally, we extend our hands out and reach for help.

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You can help increase awareness of invisible illnesses like dysautonomia.

You can sponsor research, volunteer, or help a sick or elder friend.

Perhaps easiest: Just Share this article to increase awareness!

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Additional Articles by Dr. Margaret Aranda

Organic Orange Blueberry Scones

Organic Blueberry Buttermilk Muffins

Organic Paleo Muffins

Organic Carrot Cake

Diabetes & Obesity

How are you Aging?

10 Complications of Diabetes

10 Health Benefits of the Low-Glycemic Diet

Chronic Metabolic Syndrome is Killing US

What does ‘Iatrogenic’ Mean?

What is a Diagnosis?

7 Ways that Chronic Pain Changes the Brain

What Matters to You: Patient Advocacy

From Dr. Forrest Tennant: Hyperalgesia: No Reason to Stop or Reduce Opioids

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Read Dr Margaret Aranda’s Memoirs:

Age 1: A Baby in the Sky for Father’s Day

Age 2: The Making of a Woman Intensivist

Age 3: In the Blink of a Car

Age 4: Respond, Don’t React

Age 5: A Baby on the Edge

Age 6: Glistening in the Moonlight

Age 7: The Pigeon Boy, The Suction Bush and The Darkness

Age 8: Selling Cupcakes

Age 9: Sitting on the Edge of a Cave

Age 10: Mr Bubble Strikes Again

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3 thoughts on “I Stand Up and Faint

Add yours

  1. Is vasovagal syncope a symptom of dysautonomia? I starting fainting when I was 12, usually when I first woke up in the morning. It got so bad that I missed a week of school, and ended up lying on the bathroom floor one day because I passed out in the bathroom, and then was unable to even sit up without pre-syncope. My dad had to come home from work and help my mom get me to the couch. My Dr said it was probably due to cold virus I had just gotten over, or an ear infection that accompanied the cold, then decided it was puberty… Finally he put me on a heart monitor for 24 hrs, which recorded an instance in which I had fainted, and sent me to a cardiologist at the children’s hospital in Portland. He diagnosed me with vasovagal syncope.
    I remember getting dizzy and seeing “fuzzy lights” when I would stand up as a child. Around 20 I jumped out of bed to get ready for work, and felt that horrible heavy-hearted feeling, an indication I was about to pass out. I remember trying to lower myself to the floor then I remember coming to and realizing I should call work and let them know I’d be late.
    I worked on the spinal cord injury rehabilitation unit of the hospital, and my co-worker said, “oh honey, that sounds like orthostatic hypotension! I’ll call someone to come in for you and we’ll check up on you.” I was a CNA 2, and knew about orthostatic hypotension, and knew that my BP was typically in the lower range (but my pulse is always a bit high) I just didn’t think that was the cause of my tendency to faint. They tried to do a tilt table test at the ER, but had no tilt table, so they gave me fluids and sent me on my way. My blood sugar is always below 70, and they weren’t concerned. That issue was adressed after I had a 3hr glucose tolerance test months later and ended up with a critical lab result on my last draw. I also have a B12 and ferretin deficiency, and pass out when I have blood drawn, even if I’m lying down.
    I know about autonomic dysreflexia, common with spinal cord injuries, but I just read about disautonomia on Twitter.


    1. Dear Livi, that is quite a history. It sounds like you could meet the definition of ‘orthostatic hypotension’ several times in your life. Most people with dysautonomia get the diagnosis from a cardiologist who specializes in this field. Have you seen a cardiologist and do you have a diagnosis? So proud that you are an ePatient finding great internet information – you qualify to be well suited to Stanford Medicine-X program and are encouraged to Follow their Tweets @StanfordMedX, too. A bunch of us Tweet nearly every day, and you can find us @themdphdisin and @TheRebelPatient. My new book, The Rebel Patient, launches on Tuesday 😉 and hopefully it will have much more information for your quest. Do hope you have seen a good cardiologist by now.


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