I'm Thinking Vasodepressor Syncope

Hillary Clinton leaving the 9-11 memorial service:

When you try to roll to Chili's with the squad after Gameday still shitfaced. pic.twitter.com/Pd3AQcJksH

— Old Row (@OldRowOfficial) September 11, 2016

There she was, standing in one place for quite a while while feeling poorly, being supported by one or more colleagues (? secret service agents?), when she tries to "walk" and stumbles toward the ground.

This just doesn't smack of an abrupt cardiac arrhythmia (usually there's no warning there), but rather hypotension. Perhaps a simple faint. Perhaps a side effect of medications. Whatever it was, there wasn't enough blood pressure to remain vertical unassisted.

Other thoughts? (Please be respectful).

-Wes

The Cost of Fainting

What it will cost after you faint in a public space? Kirk Nielsen, of Miller-McCune.com, explains:

"I was afraid, I thought I might be dying, I was thinking about my deductible. The number '$2,500' flashed through my mind. Or was that my maximum 'out of pocket'?

I knew for sure that I was enrolled in a $129-per-month emergency and hospitalization plan with Blue Cross Blue Shield of Florida. Like everyone, I'd heard that a trip to an emergency room could cost several grand.

'I can't afford that,' I muttered.

'Now isn't the time to worry about money,' my sister responded, slightly scolding.

Then my eyes rolled upward into my skull as I blacked out again, my chin dropping to the top of my chest and the rest of me still just sitting there."

How much did the workup "cost?" How much did the insurer pay? How much did the patient end up paying for the ambulance ride and the care he received?

Read on.

-Wes

Should Doctors Report Patients with Blackouts?

Today's Chicago Tribune leads its North Chicagoland Extra section with this headline: "Grieving father seeks legislation: Daughter killed in crash caused by driver who ignored doctor's warning on blackouts." The story describes the efforts by Attorney Maurice Grimes to advocate for legislation to require doctors to report all patients with blackouts (syncope) to state officials, who could then revoke their drivers licenses. You see Mr. Grimes lost his lovely 27-year old daughter after she was involved in a head-on collision with a 30-year old man who had experienced blackouts before and was advised not to drive by his doctor. The man was convicted of reckless homicide, sentenced to three years in prison, and released after 5 months and remains on parole.

Both lives, forever changed.

But Mr. Grimes, a Chicago lawyer, remains convinced that "it was murder" and is proposing legislation requiring physicians to report all patients with syncope to state officials.

These cases always tug on emotional heartstrings, and I do not blame Mr. Grimes for pursuing what he feels is the right course of action, but it might be helpful to review our experience with such legislation's effectiveness again. After all, there is a considerable body of research in this area in people with defibrillators and pacemakers, not to mention epilepsy. in fact, I have reviewed these issues before. Even more recently, the TOVA (Triggers of Ventricular Arrhythmias) trial, demonstrated that people with defibrillators had an especially low incidence of arrhythmias resulting in car accidents: 1 episode per 25,116 person-hours spent driving.

While I appreciate the Grimes family's desire to "make something useful" come from their daughter's death, that desire must be balanced with the individual's need for mobility and access to education, employment, health maintenance, and personal enrichment opportunities that, ultimately in our society, are highly dependent on the automobile. Being unable to drive puts limitations on the individual, which results in both emotional stress and loss of economic status.

For this reason, and the other reasons stated in the original Tribune article (especially the difficulty enforcing such legislation), I can only hope that Mr. Grime's proposal never sees the light of day.

-Wes