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I am not sure what happens to me is this at all, but it aways follows some unexpected sharp pain. I have experienced these fainting spells since I was a teenager (now 42) but they always seemed to occur when I am alone. Tonight for the first time I slipped on ice and hit my knee hard, and someone was there when I passed out. I could tell I was going to passout and warned my husband. He was very disturbed because he said though it was very brief, a few seconds, my arms and legs jerked as if i were having a seizure (this would explain why I have awaken from these spells with scrapped elbows) It was a typical spell for me, by the time I 'realized' I had to get up and the world started coming into focus, I was very flushed and sweaty (laying on ice) and sick to my stomache...all typical. I waited a minute and slowly picked my way to the house (no more ice skating on the frozen lawn for me) When we got inside, my husband said I looked ghostly white. One other thing, I am sure I am talking when I am 'out'...saying "I know I have to breathe I know I have to wake up", I asked my husband if he liked my pep talk to wake up, he said I wasn't talking at all, but all these years I was sure I was talking out loud, and always worried others would hear me and wonder why that woman was laying on the ground talking to herself! Am curious if this is common also. I have had maybe ten of these occurances in my life, all following me slipping, slamming finger in file cabinet or some surprising injury like that. It never really bothered me, but I didn't realize I shook when I was passed out. Maybe where ingnorance is bliss, till folly to be wise, but I too am wondering if pain can be a cause of vaso vagal. It sure is nice the way the pain goes away as long as I am 'out', if only that block could be transposed to the conscience state.