Why Did Eating Make Her Faint?
Tuesday, August 4, 2009
Although he had never seen a case like it in his career, cardiologist David Lomnitz felt certain he knew why his new patient kept blacking out when she ate.
At the time of her first appointment in September 2004, Martha Bryce, then a 36-year-old health-care consultant, was feeling desperate. Four years earlier she had been given a diagnosis of epilepsy, and had taken medication to prevent seizures. But doctors had been unable to explain the frequent swooning episodes that occurred when she started to eat, forcing her to put her head down on the table in an intermittently successful attempt to avoid passing out.
Doctors seemed unconcerned and told her the episodes might be a symptom of her seizure disorder. Bryce, a registered nurse, wasn't so sure.
But after a frightening incident drove home the potential danger of the baffling condition, she made an appointment with Lomnitz, now assistant chief of cardiology at Norwalk Hospital in Norwalk, Conn. "Her story rang a bell for me," he said.
His hunch about her condition, triggered by cases he heard about during his training years earlier, would upend her diagnosis and radically alter her treatment.
The first sign something was wrong was dramatic.
While on a business trip to Las Vegas in January 2000, Bryce, who lives in Ridgefield, Conn., decided to visit the Hoover Dam before catching a red-eye flight home.
Standing at an overlook preparing to photograph the concrete behemoth, Bryce recalled, "all of a sudden I felt a way I'd never felt before." She fainted and, after regaining consciousness, learned she had suffered a grand mal seizure during which she had bitten her tongue.
"I actually closed the dam down because they needed to get emergency services in," Bryce said. She spent the next four days undergoing a complete work-up at a Las Vegas hospital. Doctors ruled out a brain tumor, drug reaction and other problems. An avid exerciser in excellent health, Bryce couldn't imagine what might be wrong.
Back home, a neurologist conducted additional tests but found nothing, either. He told her she might be among the 11 percent of people who suffer a single seizure for reasons that are never determined. To be safe, he prescribed anti-seizure medication and told her not to drive for six months.
Within a week, a disturbing new problem surfaced. While eating, Bryce would feel faint and sometimes briefly pass out. The episodes never occurred when she drank, only when she consumed solid food. At first intermittent, they soon became a daily occurrence, especially at breakfast.
Her neurologist told her the episodes were unrelated to the seizure and advised her not to skip breakfast. After four seizure-free months, he weaned her off the medication and told her there was no reason to come back unless she had another seizure.