A Long-Awaited Victory

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.

The 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. 

Vasovagal Syncope: The War with My Body

When you think of fainting, you probably think of ladies in period costume swooning because their corsets are too tight. You might also think of someone blacking out after too much physical strain, or because they stood up too fast. But there is a lesser-known type of fainting that commonly goes hand-in-hand with needle phobia, and it is a very different experience.

Vasovagal syncope, also known as the vasovagal reflex or vasovagal response, is an automatic response to a certain trigger, frequently a blood/injection procedure. It involves a sudden drop in blood pressure (caused by a slowed heart rate and the blood vessels in the legs dilating so blood pools in the lower half of the body) that results in loss of consciousness, and often in convulsions. Most people, myself included, find this experience traumatic and dread needle procedures all the more because of it.

I first experienced vasovagal syncope when I was four years old. Surprisingly, it was not in response to an injection – I saw a row of staples down my grandmother’s knee during a followup appointment after her knee surgery. Since then, it has been triggered by injections and once by a badly infected ear piercing. I have not gone through an injection without passing out since I was seven or eight years old.

For those of you who want to understand vasovagal syncope better, I want to describe exactly what it feels like. If you suffer from needle phobia or have experienced the vasovagal reflex before, you may find the following paragraph distressing, but it may be good to read so you know you’re not alone.

I pass out about 10-20 seconds after the injection. When I’ve had two in a row, my blood pressure didn’t drop until after the last one was over. I see lights and my head swims, so I can give the nurse a warning before I’m out. When I’m unconscious, sometimes I dream. I’ve dreamt I was being chased, or that I got through the injection and went home. It usually lasts 30 seconds to a minute, but it’s gotten longer every time. All of my muscles seize up, my eyes roll back in my head, and the last time I passed out I was convulsing so much I almost rolled off the table. Waking up is the worst part. I forget where I am, and experience a strange time distortion which makes me very confused when my mom and the nurse tell me I fainted. The room actually spins, so it takes me a while to be able to reorient myself and adds to my panic. Once the room stops spinning, I experience all the repercussions of the episode. I always feel nauseous, although I haven’t thrown up yet. It takes me 10-15 minutes to regain my color. I always wet myself, so my mom has started bringing a change of pants and underwear to my appointments. On top of my disorientation and exhaustion, the disappointment and emotional trauma of the episode is always the worst just when I wake up, and I usually want to cry. I stay in the room for almost an hour until I’ve recovered enough to walk. I go home, maybe eat a tiny meal, take a shower, and go to bed. The syncope exhausts me so much that I can’t do anything else.

I couldn’t tell you whether the phobia or the syncope came first, and I think it’s different for everyone. I would say that at this point, I am more afraid of fainting than I am of needles, but it wasn’t always that way. My phobia and the syncope certainly exacerbate each other, but I don’t know how they worked together in my mind to create the problems I’m facing now.

When I went through desensitization therapy, I believed it would cure my syncope. Since I had a phobia of needles, we just assumed the intense anxiety I experienced during needle procedures was the cause. If I wasn’t anxious, the vasovagal response wouldn’t be triggered. So I practiced the desensitization and went into the appointment confident, calm, and relaxed. I listened to calming music on headphones, closed my eyes, and went to my “happy place.” I sincerely believed I wouldn’t faint. But about ten seconds after the injection, I was out, and it was as bad as ever.

That last procedure has led me to conclude that the vasovagal reflex has no correlation to my state of mind. I thought that being relaxed and minimizing my anxiety would prevent it, but I’ve been forced to look for a new method, and I’ve been amazed at how little medical and mental health professionals seem to know about this phenomenon. My therapist truly believed that desensitization could prevent the syncope. A nurse once told me that if I lay down it was impossible to pass out (this was proven false). My doctor did not have a ready solution for me until the last time I went in for a consultation (after years of dealing with it). So it’s been a long war with my body and a process of trial and error.

It is important to understand that you cannot expect someone who suffers from vasovagal syncope to be able to “will” themselves to not pass out. I have absolutely no mental control over my syncope. However, there is one technique I’m working on now that I intend to try at my next appointment.

It’s called “applied tension.” It involves crossing your legs, pulling on your hands, and clenching all the muscles you can. The idea is that by clenching the big muscles of your body, you stop the blood from rushing out of your head when the blood pressure drops, and by crossing your legs, you squeeze the dilated blood vessels. The research I’ve read reports a high success rate (over 90%), but if you are trying to solve your vasovagal syncope, I encourage you to do more research yourself and talk to your doctor about it. I’ve been practicing this technique almost daily, and it’s the best hope I’ve got. I will be receiving an injection in mid-to-late August and I will be posting more before and after. I will be sure to detail what I did to prevent the syncope, and what the results were.

There is no nice and neat solution to vasovagal syncope. My best advice is to have a plan. Make sure the doctor and nurse know your risk of passing out. Talk to your doctor about ways to minimize your chance of fainting. Make sure that all other factors are taken care of so you can focus your energy on getting through the procedure.

Know that you’re not alone. Vasovagal syncope is more common than you think, especially for people with needle phobia. Do some research, or have someone else do it if it causes too much anxiety. Most importantly, don’t give up! Try something new every time, until you find something that works for you.

Update: On August 20th, 2015 I finally got through an appointment without fainting. I used compression stockings along with the applied tension technique described above. You can read the details and my recommendations in this post.

My experience isn’t the only experience. Helpful comments are welcome.