Dear Dr. Roach: My dad is 91 and in good health. In September, he had an episode in which his body stiffened and he fell. The paramedics came, and he was taken to the hospital, where they did an EKG, bloodwork, X-rays and a CAT scan. Every test was fine.
Last night he was sitting at a table playing cards, and fell from his chair. They picked him up, and he was stiff. He was taken to the same hospital, and all tests were fine. The doctors think this is a 鈥渟yncopal episode鈥� and his blood pressure is low.
Dad takes Norvasc for blood pressure; an antidepressant, Remeron, at very low dose; and Flomax for his prostate. He is out for only a minute or so, and recovers quickly. I am worried about it being a ministroke or a seizure. B.J.
The language of medicine still includes many Latin and Greek words that are seldom used in ordinary conversation. 鈥淪yncope鈥� is an example of a Latin word from a Greek root, meaning to 鈥渃ut off.鈥� It鈥檚 the word we use for a brief loss of consciousness, such as a simple faint. Fainting has many causes, and in young people it鈥檚 most commonly caused by a neurologic reflex called a vasovagal episode (鈥渧aso鈥� for 鈥渂lood vessels,鈥� and 鈥渧agal鈥� for the vagus nerve, which sends messages from the brain to the heart and many other internal organs).
Many triggers can cause this reflex, which causes a slowed heart rate and dilated blood vessels, which combine to temporarily reduce blood flow to the brain. Most people feel nauseated or lightheaded before the episode, and learn to sit or lay down rapidly to avoid passing out. The stiffness noted twice in your father can be part of vasovagal syncope.
The blood vessels and nerves of a 91-year-old, even a healthy one, just aren鈥檛 the same as a 20-year-old. Although it is possible this is just a simple faint, I am concerned about all of his medications. Amlodipine (Norvasc) dilates blood vessels in order to lower the blood pressure, and makes fainting more likely. Mirtazapine (Remeron) has been known to cause muscle stiffness and syncope. Even tamsulosin (Flomax) occasionally causes lightheadedness, especially upon standing.
From what you have said, I agree with his doctors that it鈥檚 more likely he has vasovagal syncope, possibly made worse by his medications, than stroke or seizures. The CAT scan is a good test for stroke, especially 48 hours after the event. A seizure is a possibility, but it鈥檚 less likely. His doctors should consider whether he needs medication changes.
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Dear Dr. Roach: I heard recently that eating nuts reduces the risk of pancreatic cancer. Is it true? Anon.
The data are solid that all kinds of nuts not only reduce heart disease risk, but also cancer risk, including pancreatic cancer. A recent study in the New England Journal of Medicine showed a reduction in all cancers. I wouldn鈥檛 eat nuts just to reduce pancreatic cancer risk, but it鈥檚 a good way to improve overall health. Nuts have healthy fats, proteins and micronutrients that may be responsible for the lowered risk of disease. Nuts also make you feel full and less likely to eat snacks that are less healthy.
