The medical name for these is syncope. Many of us have experienced one or more syncopal attacks, very often at school. In syncope, consciousness is disturbed or lost, not because of a paroxysmal discharge of cerebral nerve cells, but because the cerebral nerve cells are silenced by inadequate supply of oxygen through arterial blood.

When a man stands up, his brain is about 15 inches (38 cm) higher than his heart; when he lies down, the two organs are at the same level. When he stands up, therefore, the arterial pressure has to increase so that blood flow to the brain remains unchanged. Normally, this is accompained smoothly by a combination of increased heart rate and by constriction of the blood vessels in the abdomen and legs. Experience informs us of examples of a breakdown in this mechanism. The most familiar is the extreme slowing of the heart-rate produced in some sensitive people by the sight of blood or in response to pain. This cardiac slowing is mediated through the vagal nerve, and the name vasovagal attack is often given to such an episode.

The contraction of leg and thigh muscles during walking normally drives venous blood back to the heart. If venous return is insufficient because of immobility—for example, a soldier at attention on parade, or a young girl in assembly at school—then syncope may occur. Such syncope seems to be socially infectious—once a girl or soldier has slumped, others may follow in the next few minutes.

Normally blood returns to the heart from the legs smoothly through the chest and abdomen. During prolonged coughing, or straining while trying to pass a stool, the pressure within the chest is greatly increased, preventing venous return to the heart. What the heart is not getting back, it cannot put out, so this sequence of events again may result in impaired blood-flow to the brain, and syncope.

If the blood vessels in trunk and legs are pleasantly dilated in a hot bath or nice warm bed, suddenly getting up—for example, to answer the telephone—may cause syncope. This may also happen in older people, when they get out of bed at night to pass urine. The situation is more complex in this case because we know that, at the onset of urination, there is a reflex dilatation of blood vessels in the legs. This so-called ‘micturition syncope’ affects men more than women, not only because they more often have to pass urine at night (because of prostatic enlargement) but because they pass urine standing up.

Syncope may occur in association with certain diseases. For example, in diabetes the nerve fibres controlling the heart rate and the diameter of blood vessels may be diseased, and the normal adjustments to blood pressure to posture may fail to occur. There are other rare diseases of the brain in which a similar failure to control blood pressure occurs. One, which bears some similarity to Parkinson’s disease, is known as the Shy-Drager syndrome after the two American neurologists who first described it.

A much more common cause of syncope, however, is medication. Many people take tablets to control high blood pressure. One effect of some of these drugs is to cause syncope on standing up. Some antidepressants, such as imipramine (Tofranil), do the same.

How does the neurologist or paediatrician decide that his patient’s blackouts are due to syncope rather than epilepsy? Again, all depends upon the story. The first clue is the circumstances in which the blackout, occurred. If it happened at the scene of a road accident, or during a horror movie, syncope is very likely. A common story is for a man to faint while attending his wife’s delivery. Syncope virtually never occurs lying down, so if loss of consciousness happens then, a seizure is more likely. Very occasionally, vagal slowing of the heart can be so profound that syncope does happen lying down. For example, one of our patients was a woman who was so terrified of dental treatment that she lost consciousness due to syncope even if the dentist started treating her with the chair tilted back almost to the horizontal position.

The next point is the occurrence of pre-syncopal symptoms. Blood flow to the brain is reduced in syncope often for many seconds before consciousness is lost. During that time, the nervous system makes desperate attempts to constrict other blood vessels in order to elevate the central pressure. The constriction of blood vessels in the skin results in pallor, and the associated discharge of the vegetative (non-voluntary) nervous system causes nausea and sweating. The person therefore feels and looks cold, pale, and clammy.

Other points which help distinguish syncope from seizures include limpness, rather than rigidity and/or convulsions during the period of unconsciousness, and usually no incontinence during the event. Recovery of full consciousness and orientation is much more rapid after syncope than after a seizure, following which there is usually a period of confusion. Recovery after syncope often rapidly follows assumption of the horizontal position, whether the person falls, or is placed like this, so that the head is on the same level as the heart. This is nature’s safety mechanism whereby cerebral blood flow is restored. Occasionally the safety mechanism cannot operate—the position of a hand-basin or lavatory may prevent the limp body falling to the floor. Sometimes the sufferer is supported in a vertical position by well-meaning but ill-advised friends or bystanders. In these cases, cerebral blood flow may fall to such extremely low levels that incontinence, twitching, or a full-blown seizure may occur. This should be regarded as an ‘anoxic seizure’ rather than a seizure caused by epilepsy.

As an example of the difficulties that this unusual sequence of events can cause, one of us was asked to see a young nurse. Three days after a straightforward appendicectomy, she got up for the first time to go to the ward lavatory. She felt faint as she walked there, and therefore left the door ajar. She felt fainter still as she was sitting on the seat, straining to open her bowels. Before losing consciousness she called another nurse for help. This girl seeing her colleague about to tumble off the seat, held her up to prevent injury. The resulting cerebral anoxia caused an anoxic seizure. An incorrect diagnosis of epilepsy had been made, and her continued employment as a nurse was under threat.

Syncope in adolescents—usually girls—can be very troublesome, and occasionally injury occurs. Physique and life-style seem irrelevant, so the usual advice to take plenty of fresh air and exercise is probably useless. Much more important is to tell the young person to lie down at once if she feels the onset of typical pre-syncopal symptoms. Fortunately recurrent episodes are rarely troublesome for more than a year.

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Apart from meow, woof, moo, baa, oink, squeak, and heehaw, their body language says that CMO is great. In fact, we’ve never seen a failure with an animal. Absolutely never! Be it horse, dog, cat, goat, hamster, or potbellied pig, we have yet to hear of any arthritic animal that has not responded well to CMO. For more details, refer to the chapter on animals.

One health food store owner told us this funny tale. As he was telling one customer about the wonderful benefits of CMO (98% success rate with his particular clients), another customer who was overhearing the conversation butted in. He related how he had heard one of Dr. Sands’ radio interviews and consequently bought CMO for his father. But his father refused to take the capsules, or any other form treatment for that matter.

Now that family also has an old but much-loved dog who, three months earlier, had just sort of given up on things. He just laid himself down by the door and refused to budge from that spot. He ate there, he slept there, and even did all his business there, forcing a rather annoying cleanup job on the family several times a day.

Well, rather than let those costly CMO capsules go to waste, the son decided to give them to the dog. In just a few days, the man said, that dog was up on its feet again and scampering around like it had many years before. But, despite it all, the son complained, he still can’t get his father to take the capsules.

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Symptoms: poor appetite, vomiting, constipation, irritability, slow development, aggressive behavior, seizures, personality changes, clumsiness, paleness, fatigue, weakness.

Home care

Discourage your child from putting nonfood objects into his or her mouth and swallowing them.

If your home was built before 1950, have the paint and plaster tested for lead content.

Watch for changes in your child’s behavior.

Precautions

-    Check your home and yard for possible sources of lead.

-    Scraping, sanding, and other tasks involved in remodeling an older building may release lead into the air. Such a location should be avoided by infants, small children, and pregnant women until the work is completed.

-    A person who works in an occupation that involves exposure to lead should take steps to avoid bringing lead-containing dust into his or her home on work clothes.

-    Sources of lead poisoning can include artist’s pigments, exhaust from cars, soil around buildings on which lead-based paint was used, city air, and improperly glazed pottery.

Lead is a heavy and dense metal that, in the human body, acts as a poison. Microscopic particles of lead can enter the body if a person swallows something that contains lead or inhales air contaminated with lead. The metal then accumulates in the blood and in body tissues. The most serious effects of lead poisoning are on the brain and nervous system. It can also damage the digestive system and the kidneys.

Before 1950, lead was an ingredient in paint, plaster, and putty, and most cases of lead poisoning occur when a small child eats fragments of lead-based paint that have peeled off a wall or have been left in the soil around a house. Today, house paint does not contain lead, but the metal is found in many other places. Some of the sources of lead poisoning include artist’s pigments, exhaust from cars (some petrol contains lead), soil around buildings that were once painted with lead-based paint, and the air in cities where lead may be used in industry and where the exhaust from many cars is concentrated. Also, lead is found in high-acid food and drinks (for example, orange or tomato juice) that have been stored in lead-containing pottery that was not properly glazed.

Lead poisoning can cause permanent damage to the brain, especially in cases where the symptoms are severe. Such damage may not occur if the problem is quickly identified and treated. However, a child who has had lead poisoning may take as long as a year to recover completely. Lead poisoning occurs most often in children under five. It is most dangerous if the child is under two years old.

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