appointment 2/4: blood labs

Dallas blood labs vs El Paso blood labs

I love ELP, and accept that there is precious little “sense of urgency” (as they said in teh Army) on tap here.

I can’t provide it’s a culture thing, but in Dallas your labs were scheduled 2 hours before your doctor’s appt. Here in ELP the laps are scheduled 7 days prior.

things go weird

The VA takes several tubes of blood (5?) so it takes a little while. When we were almost finished this occured over maybe 5-7 seconds:

1. my left arm started feeling weird, a kind of tingling/ache. Note that I already have numbness in the outer palm and two last fingers on that hand due to [presumed spinal compression, referred to as whatever henceforth since we really don’t know yet]; no idea if the two are related.
2. I started feeling weird, dissociated.
3. I started moving my head around to see if position helped, ending up with my head looking up at the ceiling
4. I started to fade and said (or tried to say) “I think I’m going to pass out”

I came to with the phlebotomist looking at me and telling me I passed out, so maybe I actually didn’t get those words out before going night-night. A nurse started asking me orientation questions which I answered with increasing accuracy as I finished rebooting. There were two VA police at the end of the bed.

The phleb (only member of staff that was there for the entire event) reported:

• I was out for maybe 15 seconds
• my lips were blue
• he thought I was starting to seize because of random movements in my left hand and foot. I suspect this was my “normal” level of twitchiness on my left side due to [whatever].
• he said several times that he thought I would be out much longer, based on my presentation.

The nurse called for an EMT checkout. By the time they got there I was about 90%. , which I passed.

history, or lack thereof

I have never fainted before. The closest I came was during a kidney stone event when I browned out; I could no longer stand but had enough bodily control to get down onto the floor on my own terms.

the response, and different forms of syncope

I thought the lab response was a little over-the-top (why were the cops there?) but after doing a bit of reading at the CDC and elsewhere I’m sure it looked weird. I presented the symptoms of three different forms of syncope (fainting):

• vasovagal syncope - what I think of as a normal faint. Paleness/sweatiness <- had these
• cardiac syncope - sudden onset, cyanosis <- had these
• convulsive syncope - uncontrolled movements <- had these, although they didn’t know I have it while awake also

possible factors

spitballing here

• major factors
  • a longer fast than usual; the fast was about 11 hours because of the timing (see lab results below)
  • I took my blood pressure meds before walking over to the campus
  • head position; looking at drawings I suspect tilting my head up contributed to vasovagal stress
• minor factors
  • draws were made from my left arm (at my request), which already has the numbness from [whatever]
  • stress about the blood draw. I don’t particularly like needles, not that I know anyone who does.
  • I was slightly warm from the walk over in fleece pullover
  • possible dehydration - my urine sample was darker than I’d like

recovery

I walked back to the van and napped for about 2 hours until I felt 95%. Took about 2 days before I got rid of the migraine-like “washed out” feeling.

lab results

Most numbers were normal; a few were out of the normal range

Some were high-but-unchanged from 2022

• A1C 5.8 (should be <5.7)

Some had improved

• Urine nitrogen - high in 2022, normal now
• blood glocose - high (123) in 2022, 103 normal now

Some had worsened:

• triglerides (237, should be ≤150)
• overall cholesterol (207, should be ≤200)

My diet hasn’t changed, so I attribute this to reduced physical activity because of pain from [whatever]. There are days I can barely stand up straight, although usually I just walk slower, more tenatively, and for shorter distances.

The triglycerides are probably going to earn me a spanking from the doctor. On my own I might try fish oil or niacin, but she seems keen on pharmaceutical solutions. We shall see.

I am a little concerned she may order a cardio workup, but I have to be in NE Texas shortly. If needed maybe I could do it in Dallas or wait until I return to ELP in the spring.