Dizziness While Descending - WTF?!

On Saturday I climbed Madison (Randolph Path, Brookside, Watson Path). A good strenuous climb in just under book-time. Ate and drank at regular intervals along the way. Feeling good. Descended to the hut and sat down to rest a spell. After a while I had a brief dizzy spell and my eyesight partly blacked out for a few seconds. What's going on? Then on down Valley Way, stopping occasionally to park my butt on a rock and wait for my buddy to catch up. Two more short episodes of dizziness/blackout. Only happened when I was sedentary, not while I was moving. Made it down safely.

I'm in pretty good shape for my age (71) and I get a lot of exercise. Blood pressure's good (120/80). Cholesterol is excellent (155).

Anybody else out there have had this experience or know why it might happen? I will go see my doctor about it, but I thought I'd see if anyone here could shed some light on this disturbing phenomenon.

Bob, "postural hypotension" is pretty common in trained endurance athletes. (Sorry, you are one.) This is the "head rush when standing"--your cardiovascular system is so well-tuned that it backs way off when you're sitting down, and standing up the heart doesn't always kick the gear back up fast enough to maintain the pressure necessary to send blood to your head instead of falling down into your legs.

Related is falling over after crossing the finish line...when you've been working the legs and the blood vessels in them have expanded to support it, but the action of the legs is pumping the blood through and back into the body. Your soleus muscle is sometimes called the "second heart." If you then stop working so hard with the legs, the blood may pool there. If you were having issues early on the descent, or shortly after getting to the hut, this may be part of the issue.

There may also be something about your head position or eye position when descending that's triggering some sort of nausea. If you haven't had an eye exam lately, maybe check that. If you're wearing bifocals hiking, maybe consider a backup pair of monofocals?

I think there are some rather benign explanations, but you should get to the doctor fairly directly to make sure they're the right explanations, and communicate in as much detail as you can what you were doing in the half-hour or so leading up to each episode, as well as immediately before. Write it down now while it's fresh.

Hi Bob, I'm no doctor, but I am a health writer and editor, so I am intrigued. I can think of a couple of things.

I wouldn't be surprised if you had a bit of dehydration -- it can happen on hot strenuous days, even when you drink a lot of water. Your blood pressure may have dropped a bit, causing the symptoms: http://www.heart.org/HEARTORG/Condi...ure/Low-Blood-Pressure_UCM_301785_Article.jsp

I've had vision changes (aura) for years that are symptoms of migraine without the actual headache, so that may be a possibility too: http://www.americanmigrainefoundation.org/migraine-and-aura/

Not to be alarmist, but very worst case is TIA (mini stroke), so I would definitely call your doctor and see if s/he thinks you need to get checked out. Strokes can happen to anyone, regardless of age, so rest assured I would be telling anyone to get it checked out.

If you do have any of those symptoms again, I would call your doc ASAP. You really can't be too careful. http://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/basics/symptoms/con-20021291

Of course, you get what you pay for on the internet! See your doc!

Bob Kittredge said:

On Saturday I climbed Madison (Randolph Path, Brookside, Watson Path). A good strenuous climb in just under book-time. Ate and drank at regular intervals along the way. Feeling good. Descended to the hut and sat down to rest a spell. After a while I had a brief dizzy spell and my eyesight partly blacked out for a few seconds. What's going on? Then on down Valley Way, stopping occasionally to park my butt on a rock and wait for my buddy to catch up. Two more short episodes of dizziness/blackout. Only happened when I was sedentary, not while I was moving. Made it down safely.

I'm in pretty good shape for my age (71) and I get a lot of exercise. Blood pressure's good (120/80). Cholesterol is excellent (155).

Anybody else out there have had this experience or know why it might happen? I will go see my doctor about it, but I thought I'd see if anyone here could shed some light on this disturbing phenomenon.

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I've never personally experienced anything like that, and I'm sorry to hear that you have - that sounds scary. I think the general disclaimer of 'talk to you doctor' will apply here, as those symptoms could be caused by a number of problems. Hope things are OK.

It's happened to me on days where it can easily be attributed to dehydration and/or heat exhaustion. Twice that I can think of.

Tim

Thanks, guys. I'll be seeing my doctor this afternoon. I'll let you know what he says.

I must say, I'm impressed by Jniehof's postural hypotension call, but nonetheless am going to put a fiver down for glucose deficiency. Just for the heck of it. Regardless, I hope it's something innocuous.

I would just look it up on WebMD.

http://www.webmd.com/

When I was in Nepal I had a "grid in gray" of hatch marks in my vision. A day later a major headache began, which I thought was HACE. My eye doctor said it more likely was a migraine, the hatch marks being a silent marker with no pain. The other thing I was thinking was sinus pressure. I get allergic reactions to something in the woods and mountains, especially in spring and late summer. For me, the sensation begins as what I've called "head hiccups" (I have nicknames for everything) and even blinking my eyes, or thinking about blinking them can cause them. It will be interesting to learn what your physician thinks.

This is actually a really frequent problem especially in older hikers so I thought I'd spend a few bytes responding. Thinking physiologically (disclaimer- I am a health care professional but only for my job!) it's fairly simple: Your brain, as organs go, is actually pretty dumb. (the kidney and liver are far smarter and versatile, one reason we can transplant them but not brains). Your brain needs oxygen and glucose, otherwise it misbehaves. Your blood brings both of those.

1. Oxygen problem:
a) you aren't getting enough oxygen in your blood (lung issue), or
b) your oxygenated blood isn't getting to the places it's supposed to get to (blood vessel or heart issue).

2. Glucose problem:
a) your blood doesn't have enough in it. This one is really simple: Unless you are taking insulin, you just don't have enough sugar in your blood. So eat and drink well. You did this, so probably isn't this one.
b) see 1b) above, substituting "glucose" for "oxygen".

So unless you are at high altitude, or have lung problems, and assuming you are eating and drinking OK, it boils down to 1b) blood ain't going to where it's needed.
So what's going on?
1. You might be having a stroke (unlikely, unless you also have other symptoms, and it wouldn't go away with rest)
2. You might have blockages in blood vessels going to your brain (somewhat more likely), really a less acute version of #1
3. You might have postural hypotension (really common, great work jniehof), heat exhaustion (lowers blood pressure), or dehydration (also lowers blood pressure).
4. You might have a heart rhythm problem (also somewhat more likely). Ask your hiking buddy (IMHO hiking with someone greatly increases your margin of safety as you get older- PM me if you want more detail about why I say this) to take your pulse and see if it seems irregular or too slow or too fast.
5. All kinds of really rare stuff I won't go into.

So, as others have said, great to see your doctor. Ruling out a heart rhythm problem or a blood vessel blockage would be very reassuring.

Hmmm. Just got back from seeing the doc. (He's in his 60s and an avid cyclist, by the way.) But he's baffled. He's ordered up a cardiac event monitor for me that I can hook up at the start of my next hike. If anything untoward happens, it'll give him a few minutes of EKG to examine.

I do find it curious that this happens when I have stopped moving.

Bob Kittredge said:

I do find it curious that this happens when I have stopped moving.

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jniehof said:

Related is falling over after crossing the finish line...when you've been working the legs and the blood vessels in them have expanded to support it, but the action of the legs is pumping the blood through and back into the body. Your soleus muscle is sometimes called the "second heart." If you then stop working so hard with the legs, the blood may pool there. If you were having issues early on the descent, or shortly after getting to the hut, this may be part of the issue.

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Perhaps this is the reason. It shows up when you stop.

Great responses here.

I am not in the medical profession. When I saw your post before reading responses, my initial thought was low blood pressure. Be well Bob; I imagine you'll find out it's something simple.

Hey, good on you and your doc for not taking any chances. Still, I believe it highly likely that the workups will come back normal.

I think it's simple fainting, wherein your veins dilate a bit more than appropriate, in turn reducing blood pressure and the amount of oxygen getting to the brain. It's happened to me a number of times, though to date not on the trail -- instead in very innocuous situations. Ironically (and fortuitously), most of my episodes have been while standing in the doctor's office while there for whatever completely unrelated reason or other. It can also happen to me after zipping (not particularly fast or aggressively) up a flight of stairs following a period of inactivity. Relaxing and collecting myself for a moment has always solved the problem.

Check out this WebMD excerpt below, esp the last paragraph.

Alex

What Causes Fainting?

Fainting may have a variety of causes. A simple episode, also called a vasovagal attack or neurally-mediated syncope, is the most common type of fainting spell. It is most common in children and young adults. A vasovagal attack happens because blood pressure drops, reducing circulation to the brain and causing loss of consciousness. Typically an attack occurs while standing and is frequently preceded by a sensation of warmth, nausea, lightheadedness and visual "grayout." If the syncope is prolonged, it can trigger a seizure.

You may suffer from a simple fainting spell due to anxiety, fear, pain, intense emotional stress, hunger, or use of alcohol or drugs. Most people who suffer from simple fainting have no underlying heart or neurological (nerve or brain ) problem.

Some people have a problem with the way their body regulates their blood pressure, particularly when they move too quickly from a lying or sitting position to a standing position. This condition is called postural hypotension and may be severe enough to cause fainting. This type of fainting is more common in the elderly, people who recently had a lengthy illness that kept them in bed and people who have poor muscle tone.

Great discussion. So I was thinking: Medicine to lower one's blood pressure is a multizillion-dollar industry in the US, and many of us who are out of shape and/or overweight need it. Could it be there is a tiny subpopulation of people with weird habits (I'll call them hikers, for the sake of argument ) who actually needs medicine to raise blood pressure? Are some of us in too good shape? Discuss.

At the peak of my bicycle racing fitness, at a time when I was 15 years younger, my resting heart rate was 45-47 BPM. That tended to freak out people who might measure it. IIRC, Miguel Indurain, 5-time TdF winner, was said to have a RHR in the low 30s - so efficient was his CV system that 32 BPM at rest was enough.

Tim

I came down with vertigo last summer, not fun. Inner ear problem. Hope you don't have that.

Bob Kittredge said:

...Anybody else out there had this experience or know why it might happen? I will go see my doctor about it, but I thought I'd see if anyone here could shed some light on this disturbing phenomenon.

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Your doctor is not apt to pick up a heart rhythm problem with testing. Just happens when it happens. Not usually with eye problems associated, but would otherwise fit as a possibility. I've had it happen once hiking (we're assuming that because I have also had the problem on two other occasions [separated by 20 years!] where it was clinically measured). The suggestion to read your pulse as it happens (if it happens again) is excellent. There is an app that measures both pulse and regularity. I don't own a smart phone but my doctor suggests I get one and carry it and his prescribed blood thinner with me on backpacking trips in case it happens again on the trail and not I'm not able to get immediate care.

Will said:

Your doctor is not apt to pick up a heart rhythm problem with testing.

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In the peak of my running days, I had an irregular heartbeat in the form of PVCs (premature ventricular contractions) They occurred only at rest, but were a bit scary. I wore a Halter monitor for 24 hours to record heart activity, including during g a 10-mile run. Diagnosis was benign with stress as the cause.

You might want to consider having a bi-lateral carotid artery ultrasound. It can discover issues in the artery that simple listening cannot. These scan are relatively cheap ($150) and can be had outside hospital environments and without a doctor's order. Here's a typical outfit that does them.

Having said that, I also wonder if dehydration might be an issue. Before buying a 3-litre hydration bladder, I was chronically dehydrated while hiking, summer and winter. Dizziness and "spaciness" were my symptoms. I just never opened my Nalgene bottles frequently enough to stay ahead of dehydration, esp when sweating heavily in summer. Having a sippy hose available made all the difference for me.

Every time I read about one of us "senior" hikers keeling over on the trail I get sweaty palms. At our age (I'm 68), the best defense is a good offense. Training sensibly, taking care of the machine, and getting proactive health care will, I hope, keep us going for a few more miles.

Oh yes, and some good luck.
cb

ChrisB said:

Dizziness and "spaciness" were my symptoms. I just never opened my Nalgene bottles frequently enough to stay ahead of dehydration, esp when sweating heavily in summer.

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While I'm neither a doctor, nor a nurse, nor did I sleep at a Holiday Inn Express, dizziness combined with spaciness sounds more like a blood glucose bonk to me.

bikehikeskifish said:

It's happened to me on days where it can easily be attributed to dehydration and/or heat exhaustion. Twice that I can think of.

Tim

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I'm no doctor either, but I'll agree with that. Being slightly dehydrated reduces blood volume and being too warm dilates capillaries and increases heart rate to move heat to the skin. Stop and your heart rate will drop which reduces blood flow to the brain.

https://en.wikipedia.org/wiki/Heat_syncope

https://myhealth.alberta.ca/health/pages/conditions.aspx?hwid=not245139&