DEAR DR. DONOHUE: I am an athletic 24-year-old. For eight years I have been passing out. I have warning signs such as blurry vision and my hearing fades and my body is tingly. My friend saw me black out, and she says my eyes rolled back and I fell. She said I was shaking for 45 seconds. When I woke, I felt fine, as if nothing had happened. These spells used to happen twice a year; now they’re happening five or six times a year. When we were young, my friends played a passing-out game where they would cut off my air supply until I passed out. Do you think that might be causing my symptoms? I had an EEG done, and the results were negative. – J.T.

ANSWER:
What you call passing out, let’s call fainting. The medical word is “syncope” (SING-uh-pea). It’s a fleeting loss of consciousness due to a temporary interruption of blood flow to the brain. Falling to the ground restores brain circulation, and the spell ends.

It happens in a variety of situations – a too-warm room, high emotional state, hunger or standing immobile. Warning signs are lightheadedness, dizziness, a feeling of warmth, sweating, nausea and blurred vision. Blood vessels have dilated, and blood pools in the lower body. In these situations, the heart should speed up. It doesn’t. It slows. Circulation to the brain fails, and the person slumps to the ground. Sometimes brief shaking of the arms and legs takes place.

One or two faints are not worrisome. An increased number of fainting spells is. A long list of possible causes must be considered. Seizures are one of them. Even with a normal EEG, you need other tests to be certain these spells are not seizures. With seizures, people often lose bladder control and usually wake up groggy. Neither happens to you, which is reassuring. Abnormal heartbeats are another cause of seizures, and you should be checked for heart trouble. Your dangerous childhood game has not caused your present problem.

Your spells sound like innocent faints to me, but I don’t want you to brush them off until you have had a thorough going-over.

When you get the warning signs of a faint, immediately lie flat on the ground. The horizontal position keeps blood flowing to the brain.

DEAR DR. DONOHUE: My mother-in-law thaws frozen meat on the kitchen counter before she cooks it. She leaves cooked meat dishes out for up to 48 hours. Before she serves it again, she bakes or cooks it on the stove to “kill any bacteria.” I have explained to her that I have difficulty eating food thawed outside the refrigerator and left out after it’s been cooked. Please inform me of guidelines. – E.S.

ANSWER:
All food has some bacteria on it. We don’t get sick because their numbers are relatively few. However, if bacteria are allowed to multiply, the food can makes us quite sick.

Frozen foods should be thawed in the refrigerator. If your mother-in-law has a microwave oven that has a setting to thaw foods, she can use that.

Food should be eaten as quickly as possible after it has been prepared or cooked. No food should be left at room temperature for more than two hours, preferably for shorter times.

Your mother-in-law’s protocol of recooking or rebaking food that’s been left out is a bit helpful, but not helpful enough to kill all bacteria whose population has greatly increased.

DEAR DR. DONOHUE: I am a retiree who gets mail solicitations from charitable organizations that provide doctors to less-fortunate people around the world whose children are born with a cleft lip or palate, or both. I wonder if the condition is inherited. Will these kids whose clefts have been repaired have children with the same problem? – R.S.

ANSWER:
Clefts in the lip or palate occur when structures that migrated from the sides of the face fail to meet and fuse in the center of it. Genetic factors are involved, but not in every case. Nor do parents who have had a cleft automatically have children with clefts. Their children are at an increased risk, but are not destined to have the same problem.

DEAR DR. DONOHUE: Several times, I have read about a Baker’s cyst in your column. I’d like your readers to know about my experience with such a cyst. For years, my doctor told me that the swelling behind my knee was a Baker’s cyst and that he could inject it for me. I put it off because it wasn’t causing any pain and I don’t like needles. I’m glad I did. It turns out my cyst was an aneurysm. If the doctor had injected it, I would have been in big trouble. Just thought others should know about this. – W.H.

ANSWER:
A Baker’s cyst is a behind-the-knee swelling, and it’s a common condition. Often it’s painful, and often it interferes with knee bending. It’s a swollen bursa. Bursas are flat discs, about the size of a dime, that reduce friction when tendons rub against bone. When inflamed, bursas swell. A Baker’s cyst usually indicates that there is trouble in the knee joint, like arthritis or a cartilage tear.

The knee and this bursa are connected by a tunnel with a one-way valve. Fluid from the knee enters the tunnel, then the bursa. The valve closes, and fluid stays in the bursa. If rest and anti-inflammatory medicine don’t relieve the swelling, a cortisone injection is often the next step.

Your swelling, an aneurysm, is a bulge from a weak spot in an artery wall. Needling such a bulge can cause a hemorrhage. Sometimes doctors listen for blood flowing in behind-the-knee bulges, and if they can detect the sound of flowing blood, they know they’re not dealing with a Baker’s cyst. A blood clot in a vein in the same area also can be mistaken for a Baker’s cyst.

Your story is something that fills every doctor with terror and something that all people with a Baker’s cyst should keep in mind. Thanks for telling it to us.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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