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Dr. Andrew Rynne

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My 19 year old son who is a Freshman in

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Dr. Antoneta Zotaj

General & Family Physician

Practicing since :2004

Answered : 1743 Questions

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Posted on Mon, 7 Jan 2019 in Medicines and Side Effects
Question: My 19 year old son who is a Freshman in college was just standing in line for dinner on campus in dining room. All of a sudden he says in a text to me: '' So I don't know what just happened. My vision just went in and out of focus. My head suddenly feels like it's going to explode. And I got really dizzy and nearly passed out. I was just standing in line for food. Here is some background information on Jonathan: He told me that he had gotten 7-8 hours of sleep the night before ( last night). He had eaten earlier today and had fluids. This has not happened to him before. In addition he is in the severe obese range ( BMI APPROXIMATELY 36 OR 37). His liver enzymes are elevated and he has early stage of fatty liver disease. Because of his obesity and liver problem, he has started to go to Kaiser weight management monthly for past 2 months .he started phentermine one half tablet per day and lost 9 pounds first month. He has stopped taking the phentermine without doctor's awareness for over a week ( and was not taking the phentermine before that on a regular basis). He said that he felt like he was going to fall over and that his head was hurting ( dull ache ) especially when he moved around. In addition, XXXXXXX started on fluoxetine for depression last XXXXXXX but he has also stopped taking that for the last month ( cold turkey ) because he suspected that it wasn't doing anything. He says he did not notice any changes since he took himself off of the fluoxetine. After this episode in the dining room, he ate his dinner and seemed to be doing ok. Thank you so much for reading about my son, XXXXXXX and I would appreciate your medical judgment on these symptoms which happened tonight.
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Answered by Dr. Antoneta Zotaj 2 hours later
Brief Answer:
It seems he had a vasovagal syncope related symptoms. Details below.

Detailed Answer:
Hello,

Thank you for the detailed information related to your son's issue.
By what you explain very likely your son had a vasovagal syncope. This is the most common cause of fainting in healthy adults.

May happen from different activities but also from prolonged standing. Prolonged standing, because of gravity, causes the blood to pool in the veins of the legs reducing the pressure or blood flow in the brain.This causes the patient to feel chances in vision, pressure in the head and neck and shoulder, the heart might beat faster and breathing might seem more difficult, and the patient might get the feeling like he is going to faint. Fainting can happen if the patient does not sit or lay down, which helps increase the blood flow in the brain.

This is generally not serious, can happen to anyone, and does not need any investigation or treatment. Unfortunately this is unpredictable. who gets it and when and trigger factors may be stress, not eating or drinking well and many times no clear triggering factors are noticed.

He needs to move his legs when he stands long in quest to help blood being pumped up from the legs to the body and if this is not helping he needs to sit with his head bended forward (a little under the level of the heart).
If the episodes don't improve with sitting or laying then this would be a reason to sick medical advice.

I hope I answered to your questions. Let me know if I can assist you further.

Kind regards,

Antoneta Zotaj
General and Family Physician
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Antoneta Zotaj 2 days later
Thank you Dr Zotaj for your thoughtful and detailed diagnosis of what my son, XXXXXXX
experienced the other evening in his college dining room. I thought you would be interested to know that I took XXXXXXX to his doctor the next day to have him evaluated.
His doctor, who is very good, also had the same diagnosis as you did: fainting! She explained what can bring this on, just as you did. She also described how to prevent fainting ,also the same as you did. So now I know you are a very astute doctor who correctly diagnosed XXXXXXX from reading my description alone, without the benefit of a physical exam ( which his doctor did have!).

I am very grateful for your expert and thorough diagnosis! I had just signed up with "Ask A Doctor'' and so you were my first doctor that I have been to. Thank you again for your excellent report. I will use this service again in the future for timely and knowledgable medical advice. Also, I'm relieved that Jonathan's diagnosis was vasovagal syncope.... and now I know the correct medical terminology for "fainting"!
doctor
Answered by Dr. Antoneta Zotaj 1 hour later
Brief Answer:
It is a pleasure

Detailed Answer:
Hello,

It is a pleasure to be able to help you. I am glad that XXXXXXX has nothing serious and he is doing well. Thank you for letting me know how things went.

Feel free to let us know of any concerns or questions you might have.

Kind regards,

Antoneta Zotaj,
General and Family Physician
Above answer was peer-reviewed by : Dr. Yogesh D
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