# Big Yawn -> Nearly passed out



## Bill Mattocks

OK, not to worry, I'm OK.  And I'm due for a physical anyway, so I'll be making an appointment with my doctor and I'll be sure to ask him when I go.

However...

Last night in the dojo, I had a sudden urge to yawn, even though I was not tired or bored.  I yawned, a big huge yawn, and as I did, I felt myself start to black out.  I managed to control it and I was fine, for for a second I was pretty sure I was about to hit the floor.  I've passed out before in my life, so I know what it feels like - the black spots in front of your eyes, tingle in the fingertips, hearing recedes as if everyone was suddenly far away...then you hit the deck.  This was just like that; except that I didn't actually pass out.

For what it's worth, this was very early in the evening; we had not even started our warmup calisthenics yet.  I had been in the dojo for about a hour previously, helping out with the kid's class.  I noticed I was sweating profusely, although it was not hot in the dojo like it sometimes is; it has been raining like crazy here though the last several days, so the humidity was like soup.  So I figured I was sweating due to that and didn't worry about it.  I didn't feel thirsty but I made myself drink some water anyway, since I was sweating so much.

When kids' class was over, we got ready for the evening adult class and while standing in line waiting to begin, that's when it happened.

Afterwards, I took it easy during calisthenics at first; we were doing some spinning back kicks which I pretty much suck at in the best of times, and I stopped because I was getting dizzy; I actually thought I was going to throw up (but didn't).  Then we did some straight up hard-core exercising; one of our Senseis is into a new exercise routine called 'Insanity' (from the P90X people) and we ran some drills from that in the dojo.  It was killer, but I kept up and only felt out of breath, which was totally understandable given my level of conditioning.

The rest of the evening was fine, but overall I felt kind of puny.  Came home, had dinner, went to bed, all was fine this morning.

But I have never yawned and nearly passed out from it before.  What's up with that?  Anybody ever have anything similar happen?


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## elder999

Yawning is activated by an excess of CO2. Excessive yawning, or yawning associated with syncope (passing out) coupled with your other symptoms indicates something cardiovascular-hypertension?-or possibly associated with some medications (again, if you have high BP, these medications can have these side effects).  I'm just an EMT with his own medical history, though-you're right to see a doctor, soon. In any case, though, it sounds like a "_welcome to your fifties, Bill, do you still feel like celebrating, and just when are you going to get that AARP card_" moment.:lfao: For what it's worth, I had textbook BP: 112/65, right up to about 2 weeks after my 50th, and WHAM!


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## Carol

My totally non-medical opinion....it sounds like the yawn may have triggered a mild vasovagal response (if you pass out from blood draws as I do...that's a vasovagal response).  Considering the vagus nerve is in the neck and head, this may have been from physics alone.  

Probably nothing to worry about.  However, fainting (or nearly fainting) can be a warning sign of deeper trouble, so definitely get it checked out.  If it is a sign of a deeper issue, those issues are easier to fix when caught early on.


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## elder999

Carol said:


> My totally non-medical opinion....it sounds like the yawn may have triggered a mild vasovagal response (if you pass out from blood draws as I do...that's a vasovagal response). Considering the vagus nerve is in the neck and head, this may have been from physics alone.
> 
> Probably nothing to worry about. However, fainting (or nearly fainting) can be a warning sign of deeper trouble, so definitely get it checked out. If it is a sign of a deeper issue, those issues are easier to fix when caught early on.



Yeah, I considered that, but with his diaphoresis (sweating), I'm leaning towards the cardiovascular.


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## Bill Mattocks

Thanks, guys!  I am all hopped up on coffee at the moment (I wasn't last night, promise) so I can't take my BP at the moment, but I do have a cuff.  My BP used to be borderline high before I started karate, then it got much much better.  I will check it tomorrow morning, though.  It was fine at my last doctor's visit about 4 months ago.  As you know, I do have diabetes.  And interestingly, I do sometimes pass out during blood draws.  Not often; generally if they're taking a lot, like before surgery.  I get my blood drawn all the time for my blood glucose checks at the doctors (and check my own every day of course) and I don't pass out.  Only if they take a lot.

The whole thing was very strange though...  And yeah, Jeff, welcome to my 50's.  I also have to get my first colonoscopy when I see the doctor.  I'm *so* looking forward to it (not).

EDIT: And I wasn't on any medication except my usual 500 mg Metformin, which I had taken in the morning, so about 12 hours previously.  Nothing else.


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## Cyriacus

Consider this: Have you ever stood up after sitting down, and felt a bit light headed?

Similar Logic, caused by the way you Breathe, sometimes.
Among other things.

Also a Non-Medical Opinion.


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## Bill Mattocks

Cyriacus said:


> Consider this: Have you ever stood up after sitting down, and felt a bit light headed?



No, I can't say that I have.



> Similar Logic, caused by the way you Breathe, sometimes.
> Among other things.
> 
> Also a Non-Medical Opinion.



Thanks!  As far as I know, I was breathing normally.


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## Dirty Dog

Bill, since you're a diabetic, I like to think you checked your sugar when this happened. Hypoglycemia in a diabetic can cause a whole slew of neurologic symptoms, up to and including a full blown stroke, complete with focal motor deficits.

More likely, however, is that your extra-large yawn caused the TMJ to slip a little and tickle the vagus nerve. The vagus nerve (cranial nerve X) enervates many organs, and is made up of about 80% sensory nerves. Among other things, it's the nerve that controls the diaphragm (which, along with the intercostals means it controls breathing - and since it leaves the brain above the spine, it's what allows some c-spine injured people to breathe, a little). It's also the nerve that controls the stomache. When you strike the solar plexus, stimulating this nerve causes the diaphragm to spasm (knocking the wind out) and also causes the stomache to spasm (knocking the lunch out). 

Another major function is that of heart rate and blood pressure. Your yawn, if it stimulates the vagus nerve, causes your heart rate and blood pressure to drop. If they drop enough, so will you. This is the root cause of vasovagal syncope. Since you do faint sometimes during blood draws, you would appear to be prone to the vasovagal response. 

Certainly, since you're now Officially Old, it's worth getting checked, including an EKG and possibly a stress test. But I suspect ultimately this was a benign event.



Cyriacus said:


> Consider this: Have you ever stood up after sitting down, and felt a bit light headed?
> 
> Similar Logic, caused by the way you Breathe, sometimes.
> Among other things.
> 
> Also a Non-Medical Opinion.



Actually, what you're describing is transient orthostatic hypotension, an entirely different phenomenon. That's essentially a delay between the need for higher cardiac output and the delivery of same.


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## Steve

My non-medical opinion is that a ghost passed through you, causing your body to react to the ectoplasm commingling with your blood.  That can affect your red blood cells, literally sucking the oxygen out of your blood as the spirit from beyond drains your life force.  You're lucky.  If the ghost lingers overly long you could die or, even worse, risk demonic possession.

In other words, I'm glad to see that you're going to see an actual doctor because no matter how good we sound, nobody here really knows jack about your specific situation. 

Feel better, buddy.  Hope it's nothing serious.


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## Bill Mattocks

stevebjj said:


> My non-medical opinion is that a ghost passed through you, causing your body to react to the ectoplasm commingling with your blood.  That can affect your red blood cells, literally sucking the oxygen out of your blood as the spirit from beyond drains your life force.  You're lucky.  If the ghost lingers overly long you could die or, even worse, risk demonic possession.



I'll bet that's what it was!  You are amazing, doctor! :uhyeah:



> In other words, I'm glad to see that you're going to see an actual doctor because no matter how good we sound, nobody here really knows jack about your specific situation.



Yes, I got over that "I'm a manly man who don't need no stinkin' doctor" thing when I got diabetes.  I'm no hypochondriac, but I pay attention and seek professional advice.  I was just asking in case anyone here has run into anything similar.



> Feel better, buddy.  Hope it's nothing serious.



Thanks!  I actually feel fine; It was just last night.  No problems today.  I'm still going to see the doctor for my physical and I'm still going to bring it up, though.


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## Bill Mattocks

Dirty Dog said:


> Bill, since you're a diabetic, I like to think you checked your sugar when this happened. Hypoglycemia in a diabetic can cause a whole slew of neurologic symptoms, up to and including a full blown stroke, complete with focal motor deficits.



Thanks!  Uh, no, I didn't have my blood kit with me last night (my bad).  I have never 'gone low' and I'm a Type II diabetic who just takes 500 mg Metformin twice a day, not insulin.   But that's good advice, I should pack my kit with me when I go to the dojo.  I did briefly consider that my blood sugar might be low.  Is profuse sweating part of that too?  I was sweating like crazy and yet it wasn't that hot in the dojo.  I do sweat a lot during exercise, but we weren't even exercising yet, and this was excessive even for me.


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## Dirty Dog

Bill Mattocks said:


> Thanks! Uh, no, I didn't have my blood kit with me last night (my bad). I have never 'gone low' and I'm a Type II diabetic who just takes 500 mg Metformin twice a day, not insulin. But that's good advice, I should pack my kit with me when I go to the dojo. I did briefly consider that my blood sugar might be low. Is profuse sweating part of that too? I was sweating like crazy and yet it wasn't that hot in the dojo. I do sweat a lot during exercise, but we weren't even exercising yet, and this was excessive even for me.



Yes, I saw the metformin mentioned above. And a pretty low dose too, which is good.
Early symptoms of hypoglycemia would include feeling dizzy, shakey, sweating, or even just feeling jittery or nervous. Left uncorrected, it progresses and as the sugar drops you start to experience blurred vision, muscle tremors, lethargy, and confusion. Eventually the tremors can turn into an actual seizure, and then you pass out. By this time, your sugar is low enough that brain damage is a possibility.
They should have drilled this into you when you were diagnosed. High sugar is far more common, especially in the Type II diabetic, but it's actually (in the short term) far less dangerous than low.

All diabetics should try to get in the habit of keeping their kit with them, and not just testing supplies. Toss in some form of quick sugar too. Tubes of glucose paste are good, a candy bar is also good (but slightly slower) and hard candies, while sugary, take the longest to actually affect your sugar. 

If/when you have to hit the sugar to get yours back up, you need to follow it with something that will stay with you a bit longer, like a sandwich or something with some carbs in it.

I hope I'm just reminding you of things your PCP told you when you were diagnosed. 

You may have been mildly hypoglycemic at the time, and it's also possible (but less likely, from your description of events), and far more likely that it was a vasovagal episode.


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## Bill Mattocks

Dirty Dog said:


> Yes, I saw the metformin mentioned above. And a pretty low dose too, which is good.
> Early symptoms of hypoglycemia would include feeling dizzy, shakey, sweating, or even just feeling jittery or nervous. Left uncorrected, it progresses and as the sugar drops you start to experience blurred vision, muscle tremors, lethargy, and confusion. Eventually the tremors can turn into an actual seizure, and then you pass out. By this time, your sugar is low enough that brain damage is a possibility.
> They should have drilled this into you when you were diagnosed. High sugar is far more common, especially in the Type II diabetic, but it's actually (in the short term) far less dangerous than low.



Yes, they did drill it into me!  It's just that I've never tested myself below 70, and in fact I almost never get below 100.  So although there have been some times in the past couple years when I wondered to myself if whatever I was feeling (tired, lightheaded, dizzy, etc) might have been 'going low', when I tested myself, I never was.   So I guess I got lazy about carrying my kit around with me.  Consider the situation remedied!



> All diabetics should try to get in the habit of keeping their kit with them, and not just testing supplies. Toss in some form of quick sugar too. Tubes of glucose paste are good, a candy bar is also good (but slightly slower) and hard candies, while sugary, take the longest to actually affect your sugar.



I was told that orange juice was a good way to pop my sugar up in a hurry; and there's a convenience store built into the mini-mall that our dojo is located in.



> If/when you have to hit the sugar to get yours back up, you need to follow it with something that will stay with you a bit longer, like a sandwich or something with some carbs in it.



I'm in the habit of eating some saltine crackers with water just before leaving for dojo, to keep the carbs up.



> I hope I'm just reminding you of things your PCP told you when you were diagnosed.



Yeah, I had to go to classes and everything.



> You may have been mildly hypoglycemic at the time, and it's also possible (but less likely, from your description of events), and far more likely that it was a vasovagal episode.



Thanks for the info!  I'm due for my checkup - I only get 6 months of Metformin at a time, then have to get blood work done to get a renewal.  I had my last blood work 5 months ago, almost due anyway.  My A1C after being diagnosed was 13.7.  Since then, I've dropped to 6 and 6.5.  My weight is starting to creep up again, though.  I lost 50 pounds initially due to symptoms when I was undiagnosed.


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## Steve

Bill Mattocks said:


> I'm in the habit of eating some saltine crackers with water just before leaving for dojo, to keep the carbs up.
> .


Pretzels are great, too.


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## Bill Mattocks

stevebjj said:


> Pretzels are great, too.



I'll have to try that; I like pretzels!  I also like Ritz crackers if I'm out of saltines.  I have just noticed that after a long night at the dojo, I'm gassed before the end sometimes.  So a quick snack of mostly carbs seems to prime the pump and get me through the night.  I eat dinner (and take my 2nd dose of Metformin) when I get home.


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## Dirty Dog

Bill Mattocks said:


> Yes, they did drill it into me! It's just that I've never tested myself below 70, and in fact I almost never get below 100. So although there have been some times in the past couple years when I wondered to myself if whatever I was feeling (tired, lightheaded, dizzy, etc) might have been 'going low', when I tested myself, I never was. So I guess I got lazy about carrying my kit around with me. Consider the situation remedied!



Bear in mind that "low" is a relative term. While we claim that 60-100 (or 70-100, depending on which scale you use) is "normal", what it really is, is average. I've known plenty of diabetics to show symptoms of hypoglycemia when their measured sugar was technically normal. When you measure normal, but show symptoms, it's just called "relative hypoglycemia" and treated the same. 



Bill Mattocks said:


> I was told that orange juice was a good way to pop my sugar up in a hurry; and there's a convenience store built into the mini-mall that our dojo is located in.



That's absolutely true, and the only reason I didn't mention it was because I was limiting myself to things that could be kept in your kit all the time. Faster than any food is a shot of glucagon. Or start an IV and drop in an amp of D50. The first is possible, and something that particularly brittle diabetics are trained to do. But probably overkill for you. The second is not something you're likely to be doing for yourself. 



Bill Mattocks said:


> I'm in the habit of eating some saltine crackers with water just before leaving for dojo, to keep the carbs up.



Good plan. 

Get a handle on the weight, if you can. You don't need to add risk factors if you can avoid it.


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## HammockRider

Hey Bill, as a fellow type II diabetic I have to say good job with the A1c of 6! I think the National Association of Endocrinologists recommends you keep it at 6.5 or lower. You oughta write down your observations on how or if diabetes effects your training sometime. I and I'm sure others would find it interesting.


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## Bill Mattocks

Dirty Dog said:


> Get a handle on the weight, if you can. You don't need to add risk factors if you can avoid it.



Next you'll be telling me that 5' 10" and 260 is a bad thing.    Hey, I gave up the booze, the sugar and soda drinks, what's a guy gotta do? Hehehehe.


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## Bill Mattocks

HammockRider said:


> Hey Bill, as a fellow type II diabetic I have to say good job with the A1c of 6! I think the National Association of Endocrinologists recommends you keep it at 6.5 or lower. You oughta write down your observations on how or if diabetes effects your training sometime. I and I'm sure others would find it interesting.



Well, I'll tell you one thing; you've got to *keep your dojomates and your sensei informed* of your medical condition and what they can or should do if you should start spewing nonsense or foaming at the mouth, or falling over or whatever; you might not be able to give instructions or even talk if you get zapped whilst working out.  And although I don't wear 'jewelry' on the dojo floor, a medical ID alert bracelet or necklace is a good thing to have on you.  If an EMT comes in and finds you on the floor, _"I am a Type II Diabetic"_ is good info for him or her to have, along with your doctor's information.

We lost a dojo member recently.  I'm not going to say what caused it because I do not know, but suffice to say he was a Type II Diabetic, had reportedly not been taking his meds for a long time due to being unemployed, and he had a heart attack and died; I am told his blood sugar was over 800 when he was admitted.  He left a wife and children and a grieving mother.


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## WC_lun

I have experienced something similiar to what you describe when my blood pressure bottomed out.  The sweating andyawning are classic symptoms of that, but they are also symptoms of other things.  So seeing the doc is the best bet.


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## JohnEdward

Yea, it's called age.


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## Cyriacus

Dirty Dog said:


> Bill, since you're a diabetic, I like to think you checked your sugar when this happened. Hypoglycemia in a diabetic can cause a whole slew of neurologic symptoms, up to and including a full blown stroke, complete with focal motor deficits.
> 
> More likely, however, is that your extra-large yawn caused the TMJ to slip a little and tickle the vagus nerve. The vagus nerve (cranial nerve X) enervates many organs, and is made up of about 80% sensory nerves. Among other things, it's the nerve that controls the diaphragm (which, along with the intercostals means it controls breathing - and since it leaves the brain above the spine, it's what allows some c-spine injured people to breathe, a little). It's also the nerve that controls the stomache. When you strike the solar plexus, stimulating this nerve causes the diaphragm to spasm (knocking the wind out) and also causes the stomache to spasm (knocking the lunch out).
> 
> Another major function is that of heart rate and blood pressure. Your yawn, if it stimulates the vagus nerve, causes your heart rate and blood pressure to drop. If they drop enough, so will you. This is the root cause of vasovagal syncope. Since you do faint sometimes during blood draws, you would appear to be prone to the vasovagal response.
> 
> Certainly, since you're now Officially Old, it's worth getting checked, including an EKG and possibly a stress test. But I suspect ultimately this was a benign event.
> 
> 
> 
> Actually, what you're describing is transient orthostatic hypotension, an entirely different phenomenon. That's essentially a delay between the need for higher cardiac output and the delivery of same.



Brilliant! Now I have another Swig of... Slightly Useless, but Extremely Interesting Medical Facts  To go with the Rest


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