Unexplained blackouts.

[FulhamFC]

I have recently experienced an unexplained loss of consciousness on 2 seperate occasions. I am currently undergoing testing, and I am awaiting diagnosis. Obviously I am going to make my DAME aware of this. Has anyone had experience with this themselves, or known someone who has? What are the possible causes?

I am a class 1 holder, and obviously now have serious concerns about maintaining it. Any info or advice would be greatly appreciated.

[rubberstamp]

I had one of these in 2009 whilst in Holland and woke up in an ambulance, after extensive and inconclusive testing the CAA still require me to undergo even further testing at personal expense before they will consider renewing my class 2 medical and even if these further tests are negative I will have to fly with a safety pilot for an unknown period of time.

Personally its not worth it for a pplh so my helicopter flying days are over.

I know one other Class 1 medical holder who experienced something similair again with negative test results and that was the end of his flying career so I hope that you fare better.

[Daysleeper]

A friend of mine had 2 episodes of "fainting" in fairly quick succession about 5 ish years ago and has not had any since. The bad news is class 1 suspended and still not returned. Not even an Op Multi-pilot Limitation.

Sorry it's not better news. I think it's the "unexplained" element that has the CAA spooked.

[DX Wombat]

Fulham, I'm really sorry to hear about your problem but I fear I am going to compound it. As you have had these episodes you should also not drive a vehicle. I know that is probably a real nuisance for you, but sadly it is also the law. You must also notify the DVLA. I hope the cause is determined very soon and that it turns out to be something treatable which will eventually allow you to fly and drive again.

[FulhamFC]

Thankyou all for your help. I'm quietly hopefull that there is a logical reason for these episodes that is not medical threatening, but this is sounding increasingly unlikely! Cheers.

[SpringHeeledJack]

Just a thought, might you be having panic attacks ? The latter parts of an attack , after the elevated heart rate and sickening fear, can be momentary 'loss' of consciousness due to hyperventilation

hyperventilation (pathology) -- Britannica Online Encyclopedia (http://www.britannica.com/EBchecked/topic/279777/hyperventilation).

The thing is with PA is that they arrive out of the blue and as a direct result of some shock or trauma that the person has experienced recently, or even in the distant past.

[FulhamFC]

Thankyou Jack, this would be the simplest explanation, and as such was the first cause to be explored, and subsequently ruled out. Both of my episodes were brought on by standing up too quickly,sorry, I think I left that out of my first post.

[Tarq57]

Sounds like G-LOC. Can be bought about by sustained high-G, or a smaller amount of sudden G.
Is your blood pressure low?
How long was the loss of consciousness? Are we talking seconds or minutes?

[FulhamFC]

My blood pressure has always been on the low side, but has never been a cause for concern. It's difficult to know exactly how long I was out for, however, the second episode wouldn't have been helped by the hard bump on the head I received when I fell over. Hopefully all will be revealed this week. Thanks again for your input.

[Tarq57]

All the best for a successful resolution/explanation.

[Pitts_special_driver]

Hi all and FullhamPC,

first of all to say I AM NOT a doctor, but in my daytime I work s a Hypnotherapist, having taking specialisations in stress, pain and fear reduction and I have extensive experience in helping pilots as well as myself in many issues that medically the doctors have lifted their hands up and there is nothing on the medical tests that appears out of the ordinary...or the doctors come to the conclusion that the issue is psychosomatic..I am also a PPL and aerobatic pilot with few hundred aerobatic hours...end of introduction..

So, everything I say, is applicable AFTER or in PARALLEL with all the appropriate medical tests and examinations. If the medical tests cannot offer any explanations then there are other routes that can be followed.

To cut the long story short, you may have heard stories about pilots drop dead in the cockpit (happened to Greece a month ago to an airline Captain still on the ground during the checks), or very fit footballers that drop dead in the pitch..these were fit people with no medical history and no heart problems..The coroner though, finds that they died from heart attack..

To find out why this happens, a test was devised called HRV test (Heart Rate Variability Test). This test is used to measure the effects of stress on the body (i.e. stress affects the Autonomous Nervous System (ANS) that controls most of the 'automatic' functions such as breathing, the moving of blood through the heart , e.t.c.

The ANS is divided into Sympathetic (adrenaline state - go, go, go state as I call it) and the Parasympathetic (the system that return us back to a relaxed state). The Sympathetic and the Parasympathetic have to be in Balance (most of the time) for our body to be ok. If they are not, the body is in a stressed state. The test shows if they are in balance, but also shows how random the time between the heart beats is - the variability (HRV). The more random they are the better condition we are in. This is measured by an ECG machine like the one we use to pass our ECG test, but the software used measures also the HRV and the frequencies of the Sympathetic and Parasympathetic.

This test is approved by the Cardiological societies of Europe and US and if can be done every few weeks, we can keep tabs on ourselves. It is a test that we can do every so often to see how well our body is on top of our annual check-up. If the HRV reading is too low over three consecutive reading, it is recommended that we go to do a check up. This test could have also detected if there was a condition for concern that a simple ECG could not detect. My own experience shown that stress, or the lack of it, is the major that pushes the HRV value up or down.

Google HRV test and read more about it. I am now living in Greece and I am unable to help you out with it (unless you want to pop to Athens for a coffee)..but we can find somebody in the UK if you are interested.

Something else about the fainting. There is something that we need to keep in mind at all times. The relationship between blood sugar and how and what we eat.

When we eat, blood sugar goes up. We feel good. After 2-3 hours the blood sugar drops low again and we need to eat something to get the blood sugar high again. In extreme cases if we keep the blood sugar very low we can faint, particularly if we have a history of low blood sugar (or we can 'establish' a fear or phobia of something bad that happened to us when the blood sugar was low (i.e. we are low in blood sugar, we have an accident in the car, a fear of going out may be established in the subconscious mind).So, eat well too.

All in all, what I would like to say is, please look at the stress factor and your eating habit. Both play a very big part in our well being.

We are like a barel that is half full. Then our body can fight infection, can resist to stress without becoming ill.

Add more stress and the barell gets full. Add more stress and will make it overflow. Just sit in a draft and it becomes a cold, you don't eat very well and you faint...as an example...

I had a guy here two days ago that has arrhythmia (Doing medical tests at the same time) and came to do the HRV test. When he was plugged in, the Heart Rate was jumping all over the place...from 77 to 140, to 65 then back up. After a while, I asked him to think of something relaxing. He thought about his holidays. Within seconds the heart rate stabilised to about 77 to 79..to within three beats...where before it was jumping all over the place..he thought of everyday chores...heart rate started jumping again..we did the test twice, with identical results.

Moral of the story. Before you go to your doctor, or go for your medical, find your own way of relaxing (it can be 7-8 minutes of deep breathing every day thinking of something nice for you. Then keep reasonably fit and eat 3 meals a day every 3-4 hours and a health snack in between). Do this for couple of months and you may find that your body starting to find it's own balance.

Just food for thought(forgive the pun)...and to start a discussion...

[SpringHeeledJack]

Both of my episodes were brought on by standing up too quickly

Are you tall ? Apparently it is relatively common for tall people to experience slight (light-headedness/momentary blackout 1 sec) when standing up after having been sitting and lying down for a time. This can be affected by environmental conditions and low BP. Someone I know takes a couple of deep breaths before rising and that seems to sort things out.

[FulhamFC]

I wish! At 5ft 7, i'm more on the "vertically challenged" side. Thanks again for your advice.

[aviate1138]

Without any medical qualifications but having suffered similar but slightly different symptoms I would suggest you could have a check for Paroxysmal Atrial Fibrillation. It appears and disappears in an irregular fashion. Also a brain scan to check all is OK with the grey matter might be worth a go.

[vfrrider481]

FulhamFC,

Firstly may I extend my heartfelt sympathies for your predicament.

Having lost my Class 1 intially due to 2 "episodes" which were then diagnosed, I am only too familiar with some aspects of the CAA and also the medical profession.

The key issue is not a class 1, it is your personal health and I can attest that health is taken for granted until it all goes wrong.

The neurological system is a fiendishly complicated one and the workings of the brain are something we still understand very little about. For every form of collapse there is either some fault within the brain (can be ailment/illness or a mental reaction as a safeguard due to trauma or stress) or some fault within the supply system be it low blood pressure, hypoxia or even low blood sugar levels. The key issue here is that the correct medical tests need to be carried out because without them the hypothesis can be as traumatic as the ailment.

I use the word ailment because quite simply it is not normal for an otherwise healthy individual to fall unconcious as a result of standing up.

I would refrain from seeking a cause through the internet because you'll find answers from ear infection or low blood pressure through the full spectrum to some really nasty stuff I would not care to mention. None of this will provide the reassurance or answers which you will need as I am quite sure the CAA doesn't use wikipedia for it's medical decision making.

I can however advise the following:

Get a confirmed diagnosis (if at all humanly possible)

This is for two main reasons. Firstly the CAA will not give back a class 1 to anyone who has had 2 or more instances of unconciousness if the cause is not explained. Their satisfaction that you are safe in a cockpit is a risk assessment of the probability of incapacitation. This is where the CAA and some healthcare professionals may differ. If all of the necessary scans are done but inconclusive and you have no further episodes, your GP may be happy that it's nothing serious even though they aren't quite sure what may have gone on. As examples, a transient ischemic attack (more commonly called a mini stroke) is often something where little or no evidence shows on a scan some time after the event whereas transient global amnesia is a known condition which is only diagnosed through direct observation of symptoms or the patients account as it does not show on scans at all! I very strongly suspect CAA will not re-issue a class 1 for something undiagnosed.

The second reason is piece of mind. In my case, medically it all went t1ts up big time, but I am much better equipped to cope through knowing what is going on than through ignorance.

In such circumstances, the internet is not your source of answers nor is it your friend. A lot of information on it is factually inaccurate, and likewise there are over 400 listed causes of unconciousness on one medical website! Granted some are common and some less so but the point is that it can't be second guessed.

This is a difficult time for which I can empathise, however the best thing about pprune is the available support from wellwishers which is quite staggering at times.

Hope all goes well and keep us updated, kind regards,


Ps I am not a doctor, but my experiences have opened my eyes somewhat.

[StillStanding]

Same happened to me. Got up quickly, ran upstairs, few seconds later found myself on the floor with a dented head.

Tests involved measuring blood pressure lying down, then standing up and re-measuring. Seems the prescription for blood pressure lowering had been overdone.

I'm just a GA pilot, so no consequences for employment.

[DX Wombat]

vfrrider - that must be the best ever post which I have seen on here written by a non-medically qualified person. :D :D :D :D :D It is sensitive, sensible and factual; an altogether excellent post. :ok:

[FulhamFC]

I agree. The time and effort that you guys have gone to in order to share your experience and advice with a complete stranger, is nothing less than magnificent. Thankyou all for your help, I have everything crossed for a positive outcome, but having had TWO of these nasties, i'm not holding my breath.

A good week to you all. :ok:

[TenAndie]

If you have only ever experienced the blackouts when standing up quickly and you have low blood pressure then the two will almost certainly be linked. If you are telling this to your AME then make sure you stress that you have low blood pressure which is probably the cause.

Low blood pressure is good in most cases as it means you are fit and healthy and your heart doesnt need to work as hard, however it can be bad and reveal underlying health problems. I would suggest checking your blood pressure as it has probably gone very low which would cause most to blackout when standing up. Maybe speak to your GP about ways to increase your BP before going to see your AME. Many things can cause it....

[homonculus]

As has been said, this realy needs diagnosis by doctor not diagnosis by internet

BUT

Young adults can have vasovagals where the heart slows down. In my youth it was 'fashionable' to deliberately cause loss of consciousness by a valsalva manouvre where you grunt against a closed mouth - same as strainingf if you are constipated.

you can also feel faint if you suddently stand up from a hot bath due to low blood pressure

And you may have a low blood sugar after binge drinking.

Apart from these 'normal' events all loss of consciousness is abnormal be it from arrythmias, fits, or low blood sugar (rare tumours unless you are diabetic and having a hypo but then you wouldnt be on pprune!)

So sadly it isnt normal in most cases, needs investigating, and may recur so you cant fly or drive. However, in practice we normally find out the cause of determine it is 'normal'

[BarbiesBoyfriend]

Search for a thread 'Conked out'.

[NacelleStrake]

I've experienced several episodes over the last two years. My 'triggers' include standing up too quickly and sipping fluids and choking on it. This apparently led to a vaso-vagal episode. The first time it happened I was sat down and passed out after fluid seemingly went down the wrong way and the second time I managed to get up from the computer and, while 'out of it,' walked five yards into the kitchen where I eventually collapsed and put my two upper front teeth through my top lip.
My tilt-table test was negative but my manometry test showed that the pressure readings in my esophagus were all over the place.
Do you have any difficulty swallowing food & liquids? Or, Dysphagia, as it's termed.

[NacelleStrake]

Search 'Conked out?' Comes back to your post........?

[Mimpe]

Fulham, I am medical .

Get onto it quickly with the smartest doctor you can find if you want to keep your class1 . Strictly speaking you shouldn't be flying right now at all.

The good news is that after aggressive investigation, many of the potential causes of your problem are quite minor, but you have to go about proving this with quite high powered medical input.

For a start you eill have to have a few major diseases ruled out that CAA will have to know you font have such as WPW, thyroid disease, epilepsy, slow heart rate,mineralocorticoid deficiency and so on. You will need to have 24 hour ecg tests, and a tilt test arranged by a cardiologist

Most likely you have a slow neurological response to low blood pressure and need to run at a higherblood pressure. This can be achieved by a combination of higher salt intake, venous compression, or even the addition of a bp raising hormone. You need theexperts to have a go at you asap. Your career is important to you.

[BWBI]

FulhamFC,

I suffered a TIA ( mini stroke ) in April 2009 when I lost my speech whilst on the telephone at work. Thanks to a relatively new clot busting drug administered at Morriston Hospital Swansea my speech slowly returned over a couple of hours, all be it remains slurred to this day.

My AME told me I would never fly again and the CAA withdrew my class 2 medical ( All be it suggesting I should try for a NPPL ) The DVLA suspended my licence for 6 months, I was advised to retire from a job I really enjoyed and things were looking pretty black!

However I continued to fly my Annexe 2 Aircraft with an Instructor to negate the need for a medical. My doctor ( a lady ) was fully supportive of my continued flying activities and after 6 months signed the medical declaration for a class 1 NPPL medical and I then flew solo or with a safety Pilot particularly if I wanted to go somewhere where the radio work was likely to be intense. My insurance co ( Haywards ) were happy for my insurance to continue as before with no limitations.

The CAA Medical people were also very supportive from the "word go" which surprised me no end!

After a further six months of remaining medically incident free my Doctor signed the medical Declaration for a NPPL class 2 medical to be renewed in 4 years time when I reach 65 years . The only stipulation was that I had to pass a Treadmill test ( strange world when you consider I was on yearly medicals with all the heart tests on the JAR class2 medical pre stroke! )

Since resuming flying I have flown in the region of 150 hours and regularly take my non flying partner with me, likewise friends and family who know my medical history. I limit my flying now to places I am familiar with in particular due to the radio work as I am concious of my slight speech problem but this has never presented any problems to any ATC or A/G unit.

Lessons learnt! Flying can be your sanity and challenge to get back to normality again. It helped with my speech therapy in so much as I practised continually all the radio work with my therapist over several months and it was far better than practising using NHS material!

Like VFR has said in his extremely helpful earlier Post the Internet is not necessarily your friend, Your friends are your Doctor and Health Care specialists who you badly need on your side!

Never say never especially if your AME says so! He also told me I would never get a Doctor to sign my NPPL medical! As my Doctor said I probably present less of a risk to the general public flying a light aircraft than driving up the motorway at 80 mph or being a person with a non diagnosed medical condition which is not controlled by medication.

If flying is important to you keep flying with an Instructor ASAP, it costs a bit more but keeps you in the air and proves to your Doctor and others that matter, including yourself!! that you can still do it safely!

Best of luck and I hope you eventually gain a diagnosis which keeps you up in the sky.