Well, everyone, this is the blog post I’ve been hoping I would be able to write. For the first time in about 10 years, I got through a vaccination without fainting.
It’s hard to fully express the significance of this. For years, the vasovagal response and my seemingly ingrained phobia of needles have been combining forces to make injections a living hell for me. Each time we tried something new – lying down, desensitization therapy, etc. But on Thursday August 20th, 2015 we proved I could make it through without all the trauma of fainting and its aftermath.
I’ve mentioned in previous posts that I would be getting a meningitis booster. All summer I’ve been hoping and practicing and seeing my therapist, holding on to the possibility that the applied tension technique, plus whatever else we could do to draw blood to my head, would keep me from passing out. And the good news is, yes, it did.
You can read about the vasovagal reflex in detail in this post, but the short explanation is that it’s an automatic response, completely unrelated to someone’s state of mind, that causes a drop in blood pressure and a traumatic seizure-like fainting episode. This was the main crux of my problem; I’d gotten to the point where I could handle the dread that the phobia brought on, but I couldn’t stand the idea of passing out again. The appointment made my summer a somewhat stressful one, and every once in a while I would feel crippled with dread or panic, but the ending was ultimately a happy one.
I want to describe everything I did, in detail, before and during the appointment, in the hope that this might help other people overcome their phobias and vasovagal responses.
I used a two-pronged approach. The first prong was emotional, meant to deal with the phobia. While I knew that this wouldn’t stop me from passing out, it would help me stay in control of the panic and stress so I could focus on the second prong, the physical techniques to actually fight my body and keep me conscious through the procedure.
A Few Months Before
Almost as soon as I got home for the summer, I started seeing my therapist, C. She helped me build my confidence, deal with the meltdowns I had a couple times this summer, and make a plan to maximize my success. The meetings with C kept me on track and gave me a chance to vent all my fears and frustrations and come out renewed. They also helped me with decision-making about what would be most beneficial leading up to and during the appointment.
I met with my doctor about halfway through the summer to talk about good techniques to prevent the vasovagal response. My doctor’s main recommendation was isometric counterpressure, or “applied tension.” You can get a good concept of the technique with this video, but I will describe it here. When doing applied tension, you cross your legs, clasp your hands in front of your chest and pull as hard as you can, tensing all the big muscles of your body – abs, glutes, thighs, etc. You can do this sitting up or lying down (I would recommend lying down), and hold it as long as you can. I practiced this technique regularly in the month or so leading up to my appointment, which helped me strengthen my body so I could hold it longer and tighter.
My therapist encouraged me to practice desensitization as well during the summer. This was more difficult for me, because I knew that no matter how desensitized I was to syringes and clinics, it wouldn’t stop me passing out. However, I would still recommend it as a good way to get control over your emotions. The less fear automatically produced by your phobia, the more focused and in control you will be during the appointment.
After fighting my stress for a few weeks and trying to feel “relaxed” about the appointment, I concluded I wouldn’t be able to be totally calm if I knew I might faint after the procedure. So instead of trying to make myself relaxed and content, I channeled my energy into having a “warrior” attitude of determination. I wanted to go into the appointment resolved to put up my best fight and beat the vasovagal reflex. I did power poses, visualized myself going through the appointment composed and self-assured, and sang Roar by Katy Perry around the house. This shift in attitude really helped – if I couldn’t expect myself to feel serene and at peace, I could at least be tough and determined.
The Week of the Appointment
My mom made the appointment two weeks in advance, and gave specific instructions for the doctor and nurse. This is something I highly recommend: have a speech to give to any medical professional doing your needle procedure, so the appointment can go as smoothly as possible. Mine goes something like this: “I have a severe needle phobia and a high risk of passing out after the injection/blood draw/etc. When I come in, please do not talk about the injection more than you absolutely have to. Do not bring the syringe into the room until it’s time to give me the injection. I would like to request numbing cream for the skin if you have it. When you give me the injection, don’t say, ‘Here it comes,’ ‘Get ready,’ or anything like that. I will be using techniques to help with my emotional state and prevent the fainting. I would like to have the room booked for at least an hour in case I do pass out and need to recover. Please just let me do my thing and make the injection as quick and straightforward as possible.” This can make a big difference – I’ve had a lot of nurses try to be helpful but actually just heighten my stress. If they know what you need, everything will be much easier.
About a week before the appointment, I visited the clinic where I would be getting my vaccination to desensitize myself to the environment as much as I could. My mom and I sat in the parking lot for a while, then moved into the waiting room. I sat in a chair and did deep breathing while my mom asked the receptionist if we could go into a room. Eventually a nurse came out and called my name (that was a bit of a shock). We spent some time in the exam room, practiced applied tension on the table, and then I went home. Managing to get all the way onto the table was a big boost for me.
A few days before appointment I had another session with C to regroup. Not a lot of new discussion happened – mostly we just reaffirmed the plan. That same day we bought compression stockings from a local medical supplies store. Compression stockings are usually worn by the elderly to reduce swelling, but we wanted to use them to prevent the dilation of blood vessels in my legs and squeeze the blood upwards. I bought the ones that go all the way up my thighs, and also bought tube sleeves for my arms, though I ended up not wearing them because I am sensitive about my arms, especially during a medical appointment.
My vaccination was at 4:00 that Thursday. We had chosen late afternoon so if it went south, I could come home and sleep it off. I worked from 8:30 to about 11:30, just to keep busy so I wouldn’t be thinking constantly about the upcoming appointment. When I came home, I ate lunch, did progressive muscle relaxation, and then about an hour before the appointment put on my compression stockings.
I wore headphones through the whole thing, starting with the car ride. My music of choice was “Flying With Mother” from the How To Train Your Dragon 2 soundtrack. (I also played “Together We Map the World” and “Valka’s Dragon Sanctuary” in case you were wondering.) The music got me to the clinic and into the waiting room no problem, which was surprising. If you think music would be helpful, I would recommend choosing a song that is relaxing and happy, or that brings back good memories and associations. Music that you can move to in some way can keep your muscles from locking up with tension.
In the waiting room, the panic started to set in. I think it was triggered by the door opening and closing; every time it did, I was expecting my name to be called. My mom held my hand, and I turned the music up full blast. When my name was finally called, I made it back to the exam room on pure adrenaline. I let my mom answer most of the nurse’s questions. This is another time when music comes in handy – turn it up, and pull an earphone out only when you have to. It’ll prevent you from hearing any unhelpful comments the nurse might make.
They put on the numbing cream (this did nothing for me but it was a good idea) and the physician’s assistant came to check in with us and answer questions. We wanted him present during the procedure to make sure I stayed on the table if I passed out. Waiting for the numbing cream to set in took a long while, so in the meantime I got in position for the applied tension. I turned around so my legs were on the headrest, raised almost vertical. My head was on the tray that slides out from the other end of the table, bringing it below the edge of the cushion.
Finally the physician’s assistant and the nurse came in with the vaccine. I let my right arm lay loose (injections in relaxed muscle hurt less than tense muscle) and pulled on my mom’s hand with my left. I closed my eyes, turned my music way up, and started the applied tension.
This is where you have to take complete control. Don’t be afraid to be bossy. Do what you need to do. I felt the injection, and when I thought I was feeling the band-aid I asked, “Is it done?” The nurse said yes and I told my mom to let go so I could pull with both arms. The physician’s assistant kept an eye on the time and my mom coached me to keep holding the tension.
If my body tried to pass out, I didn’t feel it. I held the position for several minutes, then relaxed briefly and started again. As the minutes rolled by and I didn’t feel anything, I started tensing just my arms or just my legs. After about ten minutes the physician’s assistant left to see another patient. Gradually over the course of half an hour, I lowered my legs and then raised my head. I did the tension whenever I felt something strange, and finally I stood up and went home.
For me, this felt like a miracle. I don’t know what did the trick – the compression stockings, the elevated legs, or the applied tension, but I would recommend all three to maximize your chance of success. I’ve read in a few places that applied tension prevents or delays the vasovagal response, so taking your time to sit up and leave is important. But the two pronged approach – emotional and physical – is what worked for me, and I hope that each time I will feel a little less stressed and scared, because now I know I can get through an injection safely and calmly.
I sincerely hope that this post will help other people overcome this frustrating and complicated issue. Even if my personal process doesn’t work for you, perhaps with a little tweaking you can find a solution. I am overjoyed to be able to write this saying I succeeded, and at least for the time being I can put my phobia behind me. I know needle procedures will still be stressful, and a lot more trouble for me than for most people, but at least they will no longer be traumatic, and that’s what counts.
My experience isn’t the only experience. Helpful comments are welcome.