Dear Dr. Roach: I went to get a tattoo on my hand, but got dizzy and fainted. I have low blood pressure. I want to finish the tattoo, so what can I take or do so that I don’t pass out?
M.Y.
I certainly would recommend that you lie down. Make sure you have had plenty of fluid and salt (and no alcohol). Stress-reduction techniques, such as breathing exercises or muscle contraction and relaxation during the tattoo placement, may help.
Distraction techniques can be helpful — talking or shouting during the procedure may help (talk to the tattoo artist about your problem ahead of time). Smiling or coughing during the procedure has helped some people.
I received advice from people who fainted during blood draws, and that advice may be helpful for you. One reader used an ice pack on his head and a second on the back of his neck. He is so focused on his freezing neck and forehead that he can’t think about anything else.
You asked about taking something. One thing to consider is a lidocaine patch on the hand prior to tattooing. The hand has a lot of nerve endings, and relieving pain might help prevent you from passing out. Occasionally, I have recommended a fast-acting sedative for people who can’t tolerate the procedure any other way. This might help people who are very anxious, but since many sedatives lower blood pressure, you should be hesitant to use one.
Dear Dr. Roach: I was wondering if you could explain Crohn’s disease and its treatment.
L.F.
Crohn’s disease is a complex disease affecting several organ systems, but the primary site of disease is the gastrointestinal tract. The effects of Crohn’s disease can be felt anywhere in the GI system — from the lip to the anus — but it is most common in the terminal ileum (that is, the end of the small intestine) and in the colon.
Crohn’s disease is an inflammatory bowel disease. Its most common symptoms are abdominal pain and cramping, and changes in bowel movements, especially diarrhea (which can be bloody). Other symptoms can be more subtle — fatigue, fever and weight loss may be the only symptoms. In children, failure to gain weight is a common presenting symptom.
Crohn’s may also involve other organs, and the eyes, skin and joints can all be affected, confusing the picture.
Nobody knows what causes Crohn’s. Disorders of the immune response and interactions with gut bacteria are the leading hypotheses, and there is evidence for both.
The diagnosis is made by review of endoscopy (including colonoscopy) or imaging studies, and often is confirmed by biopsy. I trained at a centre with expertise in this condition and I have seen very severe cases. I have also seen people who were misdiagnosed, often because the pathology was misread.
Treatment for mild cases may include anti-inflammatory agents (such as sulfasalazine), antibiotics (which can treat overgrowth or a microperforation of the bowel) and nonabsorbable steroids (such as budesonide). Severe Crohn’s disease requires an expert, and often it is treated by anti-immune-system drugs and biological therapies such as infliximab (Remicade).
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
