Dear Doctor,
I am a man 47 years old. I have a problem with fainting but just only maybe not more than one second, when i have to focus/ concentrate like when singing, driving a car with more than 70 km per hour speed, or during discussion with high concentration. My problem have happenned since around 20 years ago until now.

I went to ENT doctor specialist in 1994 in Jakarta, Indonesia and he identified the root caue was Fess and Synus problem. Then in 1994, the mentioned ENT doctor operated my synus, septum and fess. Unfortunately, this operatios was not successfull as one whole of my nose in the right became narrowed and i can only breath with one whole of my nose ie. left whole for around 9 months until another ENT doctor specialist operated my septum to get it fixed. However, my problem is still exist, even my septum, synus, fess have been fixed by ENT doctor specialist twice.

In Dec 2012, i performed a medical check-up, one of them is doing treadmill. Based on the doctor observation doctor concluded "Positive Ischaemic Response" in the medical check up report and required me to consult with cardiolog doctor, but until now i haven't made it.

Then in January 2013, i went to Penang to see ENT doctor specialist and he did radio frequency in my nose, but after doing that, my problem above still exists.

Then last month in 14 September 2013, i went to Singapore Mount Elizabeth Hospital ENT doctor specialist to observe my septum, nose etc by endoscopy. He confirmed that my above mentioned problem (ie. fainting in very very short time) was NOT caused by my nose, septum etc surround ENT.

In 25 September 2013, i went to GP doctor in Sydney. Based on his recommendation, i took some blood test, Holter ECG test and Carotic Doppler ultrasound.
Below is the results of the test:
1. Blood test results ( all are during Fasting) ( the rest of results are OK, within normal):
HbA1c (IFCC) 73 mmol/mol (normal 20 - 42)
HbA1c 8.9 % ( normal 4.0 - 6.0)
Gamma GT 86 U/ L ( normal should be 5 - 50)
Cholesterol 7.9 mmol/L ( normal 3.9 - 5.5)
Triglycerides 1.8 mmol/ L (normal 0.5 - 1.7)
HDL cholesterol 1.3 mmol.L (normal 0.8 - 1.5)
LDL cholesterol 5.8 mmol/L (normal 1.7 - 3.5)
Glucosa 10.3 mmol/L (normal 3.6 - 6.0)

2. Results of Holter ECG report:
Recording from 24 Sep 2013 00:09:03 PM
Duration 23 hours 56 mins
Comment:
Rare single ventricular ectopics 1 or so total.
Rare single atrial ectopics 15 or so total.
plus 1 paroxysmal supraventricular tachycardia run to peak rate of 122 per minute for up to 5 beats.
No pauses.
Otherwise Sinus Rhythm 50 to 148 per minute
With an average rate of 82 per minute
No symptoms reported.

3. Rsult of Carotid Doppler Ultrasound
Clinical history: fainted and is hypertensive (my blood pressure during test was 148, 85, but usually 120, 80)
Findings:
Intimal thickening is seen in the carotid system on the right side but not on the left. The peak systolic velocitis are not raised, the waveforms are normal and any stenosis on the right side is less than 15% and not significant haemodynamically. The left side is normal. The vertebral blood flow is antegrade and satisfactory.

Please note that i am a diabetic melitus (DM) since 2003 and always under treatment, but my blood sugar normally still high around 180 mg/dL fasting, 300 mg/dL for 2 hours after eating. Normally, my cholesterol also high but i did not consume any cholesterol pils. For DM, I normally consumed Januvia 100 mg in the morning and 500/2.5 Glucovance in the evening.

My questions are:
1. is my problem (like fainting or black out in very very short time) due to reduced blood circulation to my brain?
2. What is "Positive Ischaemic Response"? Should i go to cardiolog doctor as per medical check-up doctor suggested?
3. I heard that there is new therapy like "brain wash". Do i need to do this in order my blood circulation to my brain better?
4. May i have your doctor recommendation what should i do?

Thank you very much.

Kind regards,

Soegiono