Lately I’ve been reading up on vasovagal syncope, largely in response to either a) a bad take by a cardiologist or b) a bad bit of listening by a patient. In essence, a feller came away from a cardiology appointment at which his doc told him VVS is perfectly normal and nothing to worry about. As a guy who just dropped his very kind but not very helpful primary care physician, I suspect I know how that miscommunication went down.

At bottom, VVS is pretty common, and it’s also self-correcting; the faint-and-fall outcome is the body’s way of getting more blood to the noggin. My guess is that the feller heard his doc but misunderstood.

The tricksy bit of business with VVS, which I was diagnosed with earlier this year, is that it is the body behaves more or less as it should: the vagus nerve responds to some stressful stimulus (via the sympathetic nervous system) by overreacting (via the parasympathetic nervous system) and flooding the body with the chemicals it needs to calm down. It overshoots the mark, alas, which yields a hard drop in blood pressure and, in many cases, a drop to the floor. The test they perform to confirm the diagnosis is called the tilt-table test, which is more or less what it sounds like. They let you relax for a spell, then strap you to a table and tilt the body slightly past vertical, so it would fall over were it not for the straps. In my case it yielded a brief fainting spell when my blood pressure dropped down to 2 mm Hg.

The tough part for me is that I tend to associate stressful discomfort with growth, which obliges me to be as granular as I can be. The spells of VVS I recall very well have a predictable course: I get tunnel vision, which often yields to a feeling of lightheadedness; then I flush very warm for a bit, and then I’ll drop if I haven’t taken any measures to avoid doing so. Most of the disasters folks report seem to happen while they are still figuring out what’s going on. I took a couple falls in the early going, which yielded a dinged-up elbow and a bit of analytic paranoia.

I’m now in an era of active meta-analysis, which is not the fun-fest they make it out to be in the brochures. It means I’m now spending a lot of time reassessing the stuff that gets me worked up. I might have mentioned before that I’m not a big fan of grocery shopping, for instance, though I do most of the shopping here at the Abbey. Back before Target decided to consign itself to the scrap heap, I would shop at the local store right when it opened around 8:00 on Tuesday. That meant that I was in and out in 30 minutes or so, since the aisles were empty. These days I shop at our local Meijer at around eleven o’clock on Tuesdays, and it tends to hit a bunch of little stress triggers that add up. The building is a little warmish, and the aisles are full of folks with a nominal understanding of spatial relations. I can almost feel the stress building up if I don’t talk myself down and pay attention to the fact that my eyes are scanning as they should. I usually calm down when I realize that no tunnel vision is happening, though I might feel too warm and a little honked off.

Granularity seems to be the key, especially since VVS is neurocardiogenic. The tough part for me, at the level of meta-analysis, is that I have a tendency to expose myself to discomfort on purpose in order to move my own existential goalposts. As the Meijer example might imply, I find certain kind of social engagement stressful. I don’t like having to engage with anyone at the grocery store to begin with, so the fact that I often need to say “Excuse me” so I can get by some jackass who has blocked an aisle with his cart is a significant annoyance to me. I’m learning to monitor/process it better, but it usually means wading into unpleasant environments with plenty of triggering stressors when I’m already a little worn down. I rather suspect my cortisol levels are through the roof most of the time, so on a day like today, when my visit to the gym was curiously complicated by folks devoid of situational awareness (the ROTC guy who decided to do planks and completely obstruct one of the major thoroughfares, for instance, or the kid in the Dragonball Z shirt who decided to station himself right in front of the water fountain as he fiddled with his phone), I have to remember that it’s a me issue but also a real thing with real effects.

It helps that I’m a teacher who came to terms long ago with the understanding that learning is, alas, a major source of discomfort. Admitting that I suck at something, or that I’m an ignorant baboon, is never easy. But ambling headfirst into the stress mines is something I can still manage, and I learn a little more about my system tolerances every time out.