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Dec. 19, 2021

The Boo-Boo Faint: Vasovagal Syncope

The Boo-Boo Faint: Vasovagal Syncope

While sleeping after a long night shift with Zetty, J Smiles is startled awake by the words "J come quick, Zetty has passed out!" J has a matter of seconds to determine what is happening using her foggy brain, wobbly legs and unconditional love for her mother.

J gives vivid details of the ordeal. Is Zetty having a stroke? It is late on a Saturday afternoon during Covid-19, should they go to the hospital? J leans into intuition and past caregiver experiences. Listen to this episode dripping with dramatic real life panic, solution and levity.

You will learn the basis of vasovagal syncope vs stroke. 


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J Smiles:

I was in my bed sound asleep, I mean knocked out. The caregiver on duty thrust my door open, rushes in screaming at the top of her lungs- "Jay, Jay, JAy get up quick, quick, Zetty needs you! Zetty needs you, she passed out! She won't respond!Hurry up quick, quick! Huh? What? What? That's me. It's about 4pm in the afternoon. I was comatose. Now before you judge me for being sleep that time of day, I was on shift the night before, which means 10pm to 10am, I was with Zetty, oing whatever Zetty wanted to do, which is the opposite of sleep. I had been asleep, maybe three hours. I rush by the caregiver, floating on air. I'm Flo Jo. I'm a Ferrari. I'm Sokari he says Jakari whatever Richardson, she ain't really won nothing so whatever her name is. I get to Zetty's bathroom she is fully clothed because they were about to go out of doors for her daily afternoon walk. Her butt on the bench. The bench doesn't have a back to it, it is right up against the tub. Zetty is doing some kind of piroet, swan dive, back bend, Cirque du Soleil, snow angel into the tub- mouth wide open, head dangling, arms straight out, Jesus Christ Superstar on the cross. I'm yelling Mama. Mama. Mama. Mama (smack smack smack, smack, smack, smack smack). Left, right center. Left, right center, that's Zetty's head, nothing.She gives me nothing. Lord, is my mama having a stroke? Is she having a heart attack? Is she dying? Do I call 911 What is going on? Parenting Up- caregiving adventures with comedian J. Smiles is the intense journey of unexpectedly being fully responsible for the well being of my momma. For almost a decade. I've been chipping away at the unknown, advocating for her, and pushing Alzheimer's awareness on anyone and anything with a heartbeat Spoiler Alert- I started comedy because this stuff is so heavy, be ready for the jokes. Caregiver newbies, OG's, village members trying to just prop up a caregiver you are in the right place.


Hi, This is Zetty. I hope you enjoy daughter's podcast. Is that ok?

J Smiles:

Today's episode, The BooBoo Faint, Vasovagal Syncope. Parenting Up Family, this is a prime moment when I know with every molecular, cellular, DNA ounce of anything essence in me that I was made to be her daughter. There is no way that I could have handled this event unless JG was supposed to be Zetty's child. I am not cut out for this kind of foolishness. I need you all to understand. That was any other human being, I would say to the caregiver, or any other adult- why the hell are you telling me? We'd get somebody else? I am not a doctor. I don't like bodily fluids. I don't change fish tanks. I'm not picking up dog poop. Do you hear what I'm saying? Anywho back to the chaos that is my life in the moment, I mean I am smacking Zetty any non caregiver that might have been a fly on the wall would have absolutely yelled Elder Abuse, elder abuse might have called somebody on me. I was given her the front hand the backhand, she might have got punched in the clavicle. Let me paint the picture. As I'm running down the hall and going into her bedroom, I'm yelling, Zetty Zetty Zetty Mama Mama Mama, way before I see her. When I get to her, and see that she is passed out and laying there, like a dead log in the woods I did not have a plan, I was acting on intuition. When I saw her body, my instinct was to grab her the way you would an infant when you're getting them out of a crib. So I put one hand at her neck and where the base of her skull meets. Then I put another arm up under her torso, just about where her bra connects and snaps horizontally across her back. And then I lifted her towards me, because I was straddling her thighs right around the knee area. And I'm yelling, still, not quite as loudly because I'm right there on her a face, "Zetty Mama Mama", that's when the smacking starts, but I'm going in. She's getting the open palm smack. She's getting a backhand smack. And then I had both my hands on each cheek, and I'm going oh bla bla bla bla bla like that. I'm making her face do that, except she isn't making any noise because she's not responsive. This goes on for at least 30-35 seconds before I get anything out of her. I'm wiggling her fingers. I'm pinching her cheeks. And yes, I'm freaking out. The Universe smiles on me and gives me my first it might be okay sigh, a little miracle. I get a waft of a bad odor, that's a big miracle because my sense of smell is trash. If I can smell it, it's awful. I've had four or five sinus surgeries and everything has been taken out, but I caught it. I thought, oh please, in everybody in everything in heaven and on earth let there be BM. I put an arm out right across her bust area and lean her forward the same way you would do with an infant if you were about to try to burp them. And I looked down in her pants, and I see that there is actually number two. Parenting Up Family that is the first time and we're probably about at 45 seconds now, not quite a minute. I'm guessing. That is the first time I'm thinking okay, maybe she's not dying. Maybe this isn't a stroke. Maybe it's that thing that she had three or four times earlier and two times we already had to go to the ER. I'm about to tell you about that now. So then I lean her back into the other arm, like "Zetty, Zetty, come on ma, come on ma talk to me Zetty, talk to me Zetty," t hat is the way my granddaddy always talk to any of us when we were sick. If we were in the hospital, we had the flu, we had some kind of temperature and the doctors could not get us to respond; that's the way he would come in and do it. He would move the doctors out the way and say hey, this is my grandmother's voice. Excuse me. Are you trying to trying to get J of it? Just what are you trying to do? He does. He does is trying to get them because what my granddaddy was never trying to get them what he never wanted them medical staff to do was give up on one of his children when gonna be no pulling no plug on his watch so that's the way I saw it done and where that it would come in and he was like a stay with me now. Hold on baby. Stay by daddy right here as you know he he called himself daddy to me do daddy right here baby stay right. So that's what I went into was Zetty. Mama. I'm right here is J stay with me Zetty stay with me. So I am rolling her head live right center, left right center, just like that cell phone game. Maybe at about a minute, she says Ah, that was it. But that was enough for me seeing the BM plus the Ah gave me hope. Throughout this entire process, I was feeling her forehead, feeling her neck, feeling her wrist, and knew that there was a pulse. Her temperature did not feel like 120 degrees and her eyes when I pitched the eyelid open, her pupils were pointing toward me. There's a condition call vasovagal syncope, that means in short order, an elderly person can faint when they are boobooing. Yes, y'all, they could just flat out faint for no particular reason. And a little bit later in this episode, I'm gonna get into those details, but that's what the hell can happen. And Zetty did that four or five times over the last few years, so I was able to notice the symptoms or the signs. The very first sign is there needs to be some BM even if it's just the amount of your pinky fingernail, which Zetty had in her pants. When that baby said ah ah, the first time it was as if the Mega Millions lady called out my number on the television. Even though her eyes were not open, and she had not said a whole sentence, I thought okay, she is audible and I see BM; maybe this is that crazy event like before because all I'm trying to do is avoid the paramedics in the ER. This is still doing the pandemic, but even if it wasn't a pandemic, the hospital is an awful place for anyone with dementia is especially with Alzheimer's. I stand in front of Zetty, I put my arms underneath her armpits and I'm attempting to help her get up off the bench Goodness, all Mighty. Her body looks like the blow up people in front of the used car salesman like I mean when I move left she moves right. Her knees are buckling, her head is buckling, I'm like Zetty, Zetty baby we gone fall. Zetty we gone fall, Zetty baby, please, baby, baby, please; I don't want you to fall now. I'm not laughing at this time because I'm not really sure that it is the vasovagal syncope. I'm trying to get her to the toilet to see if she can come around. Right now I'm hedging bets like I'm in the casino and I'm hoping that I hit. I'm hoping I made the right call, but I don't know yet. I have to sit her back down and go to punching her again. It's like an Alzheimer's action movie- jab, jab, uppercut, uppercut. If anybody is trying to make a movie around, somebody beating there momma up, get at me. Have the union call my people Zetty and I have already practiced and we got this thing down. I used a cold rag, put it on her neck, put it on her face then I got the second mumble, that sounded like harps. I say come on Zetty, pull through Zetty, is JG we make a great team. Still no words. Her eyes are still closed. And I have to admit, I'm wondering what they ought to do. The caregiver is steady saying behind me, do you think we should call the paramedics? Um, I'm not sure yet. I think it's the vasovagal thing because there is some number two in her panties. So go in again, I put my arms up under her armpits. I'm able to get her up. She's dragging her feet, but she is moving them. At least this time is like drab clip lock, drag club club, drag club look, we make it to the toilet. She plopped onto the toilet like a sack of bricks. She really was dead weight and her right leg weren't working, which got me super scared like man, maybe this is a stroke or maybe it's a TIA one side isn't work and I'm like Jay, are you screwing up please don't get this wrong. Isn't that such a stress that we have as family caregivers? When are we overreacting and taking our ellos to the ER or the doctor too many times we're being too dramatic. Versus when might be the time that we under reacted and brushed it off and stayed home, "Oh, I've seen this before." So that is going on in my head while I'm also trying to MMA body slam my momma into the toilet. I'm two inches taller than Zetty, but she has me by 80 pounds. Standard behavior when Zettyis on the commode is to sing, play Motown music- Last Night in The Pips, Aretha Franklin who is not Motown, The Temptations, The spinners, also not Motown, but this was such a somber moment. We didn't play any music. I'm just looking at her. I'm watching her like a hawk. She is sweating profusely. Her hair is stuck to her neck, is stuck to the sides of her cheeks. I get her pants off. I get the shoes off. She's sitting there. Now the smell is strong. Everything is starting to come out. I'm like okay, this is even better. The more the merrier. Then the caregiver tells me, "J smiles, this is very, very odd. She already had a Mount Everest size bow movement about 45 minutes ago. That's why we were getting ready to go for the walk. I can't believe there's any more in her pipes." Well, damn. Now maybe it's not the vasovagal thing because if it's not, obviously we couldn't recall now. Okay, wait, hold on, she is boobooing some more and then she opened her eyes and said huh? She heard me talking with the caregiver and said huh and I thought okay, she's starting to come around. So now this is even better than a random audible grunt she's engaging in the conversation, huh, while looking in my direction that might as well be a perfect score on the SATs. is sponsored by circleof, a new family caregiving app when we're caring for our ellos sometimes we're not sure what to ask for. Circleof makes it easy to surround herself with support from your community. It's thoughtfully designed with and for the caregiver and it's totally free on the App Store and Google Play. Check out www.circleof.com/download for more info. As we sat there, I recall that hydration is a very big deal with the vasovagal syncope if that's what it is and I'm still moving on that theory. I asked the caregiver to go get Pedialyte within 10-12 minutes, Zetty drinks 16 ounces of Pedialyte, you must know that would usually take an hour and a half to two hours to get her to consume a volume of that magnitude. My poor Mama was exhausted and thirsty. I was rubbing her brow just with my hand, kissing her forehead, telling her I loved her. I love you, Zetty. I love you. I love you so much, you're doing a great job. Thank you so much. given her a sip of the pure light. Within 20 minutes, her eyes were bright that Zetty bright white eye. The twinkle was back. She was smiling. When I said I love you. She looked at me and said I love you. I do. I do I love you. The caregiver looked at me and said she's back. I was like, oh, thank heavens, thank goodness, oh wee, that had taken about 25 minutes; that entire ordeal. Is she dying? Having a stroke or having a heart attack? Oh no. It's just the booboo faint. We kept her on the throne another 10 minutes or so just to let as much as possible release as well as give her a chance to catch a breath, let her body rejuvenate let the pedialyte sink in, let her legs get some energy. So it's still just maybe 5pm, but I decided she's about to lay down, that is enough for the day. Now I'm still in my pajamas. The whole day that I had planned, I was going to sleep a few more hours, get some work done, write some jokes, do some podcasting, do some emails, maybe go on a date. Ah hell no, this 25 minutes of Zettying has now taken me out for the remainder of the day. I high fived the caregiver and I said we bout to get this one right here in the bed nice and clean, let her lay down, and you and I can go down here and toast on something adult. Zetty walked to her bed gingerly but totally on her own. She seemed stable. It appeared that the storm had passed, but I was shook, 17 Oles,15 seas in case shook and I also wasn't exactly confident that I made the right decision. So I'm keeping one eye on her very closely, at any minute, I still might need to call 911 I walk out for a few minutes, gather myself, go look in the mirror, have a little bit of a cry. Go back into Zetty's room, maybe about 10 minutes has passed give her a little kiss, "Hey mama, baby how you doing?" Rubbing her face, rubbing her cheeks being tender; she just almost maybe you know. This one kicks back at me, "Hey, JG what to know good?" All googoo eyes smiling with (clicking noise). I was like don't you (clicking noise) me when I know so well is you not about to be coming at me with all this positive, you doing great energy like you didn't just almost die a little bit. I mean, you kind of almost checked out of here for a second like not even an hour ago lady. What you gone do is act sick the rest of the day. You about to close your little eyes and be frail and fragile the rest of this day. The same way if I got sick when I was in elementary school and had to call you off your job, and you told me now when I get home, don't you think you're gonna be running around his house playing, you're gonna be sick and stay in the bed, you better act sick the rest of this day it's five o'clock. You better look sick and act sickthe rest of this night Zetty, all of that was in my head. Instead I said, Well, what I know good is you and I am so grateful to know you. Your love sustains me. I turned around, walked out of the room, down the steps, out of doors, and screamed. Where is the Remy Martin 1738? Lady, you bout to make me bathe in this stuff. As the day progressed, I did check Zetty's blood pressure, her temperature and her pulse because I have all of that equipment at the house and everything was in normal limits. As I alluded to earlier, this was not the first time Zetty had a vasovagal episode. Be clear. I knew what to look for and was relatively calm. And I'm stressing relatively only because we had gone through this at least four times previously. Now, all the other times I was not at home when it went down. Can you imagine the pure panic on the caregivers shoulders when Zetty did this fainting stuff on their shifts? It was absolutely devastating. The very first time was the most dramatic and the most jarring because none of us had ever heard of it. Zetty was sitting on the toilet and she was not having any kind of pain. They were dancing and singing well dancing, toilet dancing, which is just tapping her feet and smacking her legs. Zetty loves to play the drums on her thighs with her hands is hilarious. I wish I could take a video of it without decimating her privacy, but what the caregiver told me was Zetty was sitting there singing her songs and literally in less than a minute the caregiver walked out of the toilet area to get Zetty's juice, walked back in, and Zetty's face was ashin and her head was down such that her chin was touching her chest, her mouth was twisted, she was drooling, and her arms were slumped down by the sides and her palms were face up. Zetty was not responding at all. Her fingers were blue and her toes were blue. Zetty was sweating profusely and she felt cold. I was in the city, she called me, she said, What should I do? I said, "What the hell should you do? Call 911! She said, "Oh, I didn't know if this had happened before." Hell no this hasn't happened before. If it had happened before, I would have told you, "hey, you know what, just in case this happens. there is a purple unicorn pill up under Zetty's bed and you should give it to her." Now, I didn't say this to the caregiver. But in my mind, I was thinking, this is a very special set of circumstances. This feels along the line of needing an epi- pen, or an insulin pen. Why the hell wouldn't I have explained this type of event to you, caregiver lady, I digress. I simply said, "Thank you so much for calling. You're doing a great job. Please call 911 and I'm on my way. I'm not sure which one of us will get there first. You stay right by Zetty's side." I got to the house in less than 20 minutes, I beat the ambulance. Zetty was alert when I arrived, but she was extremely slow. She was not speaking in full sentences. She looked very cloudy, like her eyes were gray, her fingers and her toes were still purple. She was still sweating. If I said hey, Mama, she didn't say anything back, but if I pinched her or smacked her, she would go hmm. So when the paramedics came, they just started taking her vital signs and asking how long had she presented the symptoms? But the paramedics agreed that she needed to go to the hospital. It was no question, nobody asked anything about vasovagal syncope. At the hospital, they ran the full battery of test. At the ER I made sure to tell them that Zetty was sitting on the toilet just fine and in less than a minute all of this happen. They were wonderful. They didn't give me any pushback. They ran all of the tests. They ran the EKGs the MRIs, all the scans. The chest, her head, Arteries ,totteries They even paid particular interest to that he shot. Remember, she has the VP shunt in her brain to regulate the fluid for the non hydrocephalus. And I told them I said, Look, I know my mom and dad aren't I informed the nurse tech sponging Zetty down, prepping related, but he died of a massive heart attack. I'm kind of sensitive, need to check all of that too. I can't lose her, her to go home, "Sweetie baby we are not leaving until someone in the way I lost him, please and thank you. The test took three a white coat with their name monogrammed on it can tell me days. "Good news J smiles, all results are positive. Your why she slicked fainted and kind of died for a few seconds. I'll mother is healthy. She's ready to go home." No to hell she's wait and the TV caught the Steve Harvey's Family Feud too, shoot not. She turned Blue's Clues blue, she not ready to go hom something went wrong and we ain't leaving. Y'all we had a honey we have plenty of time. Don't you know the next morning, lie down protests. I said listen I'm from Montgomery, Alabama. We the cardiologist was available to speak with me and had some will sit down, march, stand up, or lie in his bed until somebody answers, look at that. The Jolly ginger giant walks in. Thank gives me an explanation. Something happened, you can't just tell me what it wasn't. I want to know what it was. We're goodness, his disposition was just as rosy as his cheeks. I not going home under the pretense of she's healthy when I needed it. It had been a tough, tough, tough road. He said, hey, saw my mama's head bobbin like it was one of the those things who should I talk to the mom or the daughter? I can't even tell that deficient people used to see when they can caught the bass. which one is which. Ummm I will tell the jokes, you tell me what's wrong with the person in the bed? Who cares how we're related? I didn't say that. He says well, Jay Ihave good news, we have bad news. Parenting Up Family, why do doctors do that? I don't understand. We have had enough stress. I've been here long enough. It took me lightweight acting a fool just to get to talk to you, sir. Tell me. "J. Smiles, we have two findings. This is not the shoe department at Nordstroms. Jase. I call that approach the medical fumble, foul on the play doc. Well, they don't know what they talking about and they're not quite sure that's when they come with that- good news, bad news. Give me the scientific facts and sound like you went to medical school. Thank you. Anywho jolly ginger said "Jay, I ruled out everything catastrophic, it was not a stroke or a heart attack. We believe it was this fairly common yet not life threatening condition called vasovagal syncope. I though huh, what is vaginal symphony, what the hell does this have to do with the orchestra, that was in my inside brain. I thought give me your damn coat you really don't know what you're talking about? He could see the confusion on my face. He said "let me spell it. Let me write it out." I said good job, thank you. We both smiled. Then he went on to say I really believe that's what it is because you said your mother was sitting on the toilet. I said yep, she was. He said this condition happens when seniors are trying to have a bowel movement. They strain and they fight. I said But doc she wasn't straining. I wasn't there but the caregiver said she had just been singing. She didn't do the teeth grind though. I don't want to get too graphic but we all know the noise you can make or face you can make or fist ball and you can do when you really trying to get a tough turd out. None of that was happening. And it wasn't even a lot of bowel movement that came out when the release occurred. He said I know that's what makes this condition so mysterious and intriguing. What??? This is not unsolved mystery, sir. I need to understand when in fact, my mama is dying or not, I don't need to be wondering. Okay, so what are the symptoms or the signs? How can I avoid this? Oh, that's the thing so you can avoid uh record scratch. Wrong answer. Y'all, I wanted to chop this man down like a tree. So you're admitting to me that it can look like a stroke, sound like a stroke, feel like a stroke, but it ain't a stroke. We cannot avoid it., but it can happen at any time; miss me with that. Oh, yeah and by the way, for good measure it doesn't matter the size of the bowel movement. It could be a little bit or a big one. It could be soft. It could be hard. It could be very loose. It could be diarrhea. It could be a teaspoon. It could be a gallon. Really, this sounds like Congress, Parliament, the Lords of Commons, the political people who we elect that gridlock and don't get stuff done. Scary and unavoidable, okay, taxes. "Aaahhh". I said "Doc, listen, you got to give me something. Perhaps there's no defining characteristics. You don't know why it happens and you cannot correct it, but you got to give me some guideposts or something. It's just the two of us." Shout out to Bill Withers. And I am in a panic, please don't send me out here with the information you just told me. Which sounds like go out there and be ready to be scared for the rest of your life every time your mama gets to the crapper. It was like herding cats trying to pin this guy down, but I did get us something. You know, I'm always fighting for y'all. Do not let your ello get constipated, that's the great takeaway. How do you do that J smiles? keep them hydrated and having a proper amount of fiber. The amount of hydration and fiber, you should get that from your ello's primary care physician because that's based upon their weight and the other medications they're taking for that he or she needs a minimum of 50 ounces of liquid maximum of 70 ounces. And we know the grams of the fiber. For the most part, she gets fruit and oatmeal and then she's covered. Check this out, constipation is tricky too. Constipation is not only the absence of anything coming out of the rectum. Your ello can actually be passing something and still be constipated. They could have diarrhea or they could have soft stool or have a small amount of bowel movement coming out and be constipated as hell, isn't that a mess? Talk to their primary care physician to get more information. Zetty has been constipated several times even though she was having at least one or bowel movement per day. The mayoclinic.org gave a few examples of how to supplement

the fiber for your ello:

benefit fiber, Metamucil, Cituracell and fiber choice. The last one is chewable, they encourage you to employ green vegetables in fruit as much as possible. After Zetty's first time in the hospital, I thought I had a pretty good understanding of vasovagal syncope. I talked to Zetty's primary care physician, her neurologist, her neurosurgeon, and several other medical people I know to get a good cross reference. But the next couple of times that it occurred, I wasn't home and it wasn't the same caregiver. What kind of luck, right? So imagine, for each caregiver, it was completely new to them. (Picture this) So here's Zetty on the toilet, totally looking regular singing, smacking her thighs, doing her drum beat thing. They walk out the room for less than a minute they come back it appears that she's had a stroke. purple, blue fingertips, drooling. nonresponsive sweating; absolute traumatic visual stimulation! Every time they call me not one time did they call 911 first. Each time I was in the city, the second time it occurred I did attempt to talk the caregiver through. "Okay, this has happened once before and there's this thing called vasovagal syncope." Y'all she wasn't trying to hear it and I don't blame her. She was like, "What, should I call 911? What do you think it looks like? She may be having a stroke." And I was like, wait, I know it looks like it, but there's this thing. Now, I only knew about the thing for like five little bitty minutes and I was trying to describe it while I'm driving back to the house. And she could smell my fear and my ignorance because I'm a novice. And I'm saying well is she boobooing? Well can you smack her, smack her a little bit put a wet rag on her face and knock around a little bit. She's a what? I'm sure she thought I had lost all my marbles. Anywho a few minutes into that conversation, I came to my senses and said "My apologies, I am very sorry that I even started down that line of statement. Call 911 Honey, you are right call 911 I am on my way. If they get there before me, call me back. And I will walk them through her social security number and whatever they want to know." And it pretty much happened that way. The third time that he had the event- family if you're the primary caregiver and you're the one responsible for your ello you have all of the legal rights to make the decision about their bills, about their medical health, where they live, what they eat then you should probably make the call. Those two times we got to the hospital, I told them about the previous instance where it had been diagnosed as the vasovagal syncope, but I asked hey, please still run all the tests. I'm just letting you know what this was. But they did an ultrasound of her stomach and her intestines and they were able to see some constipation, so then they went on about loosening her bowels to get her to go and it was a lot in there. So boom we were able to go home in maybe like one day, a day and a half in each instance. Thank goodness finally, I was home this last time and able to make a eyeball, good decision. I think this is the vasovagal syncope. The caregiver who was here actually was the one who was with Zetty for the very first episode. And I bet you'll never believe it was still so jarring and so scary she didn't remember. That's how closely this looks to a stroke. Multiple times while it was happening, she said, Jay, are you sure you don't want to call 911? I said no, I think remember how it was that thing where Zetty was, it was the bm thing. She said, Oh, oh you're right. You're right. I forgot about that. When someone that you're caring for and that you love, and all of that is caregivers become lovefest Zetty protectors tt's hard to remember, options like this wacky syndrome, vasovagal syncope. And syncope is spelled s y n cope, like synchronized coping, that is the last thing that is happening with the family and the caregivers. Synchronized coping ain't happening with none of us. We are not coping very well and what we are not is in lockstep because it is a circus. I suggest you become familiar with it, maybe try to find a video, talk to anybody on your care team or your medical team so that you don't get caught with your pants down. It will take you out! The snuggle up. Number one- vasovagal syncope looks just like a stroke. The old adage if it looks like a duck walks like a duck quacks like a duck, it's a duck; does not work here. Make yourself very aware of how it presents. A telltale sign is do you smell or see any bowel movement, any amount? And it doesn't matter if you're ello visibly strain the strain may have been internal. Number two- constipation is the invisible enemy. Hydration and fiber intake are our friends. Speak with your medical team to determine what are the proper proportions for your ello on a daily basis. Number three- when in doubt, call 911. If you're not totally sure, call your doctor, anytime of the day or night. There is somebody at that office who will guide you. Number four- Parenting Up has a live internet talk show. You can come grab a spot and talk to me on video. Ask questions, share your story, and join the community of caregivers worldwide as we lock arms and get through this thing together. It's on gtevokal.com, Mondays at 7pm Eastern in the United States. We keep the Parenting Up caregiving content coming on YouTube, Facebook, and Instagram. As well go to www .jsmilescomedy.com and sign up for parenting of newsletters. That's it for now, thank you for listening. Please subscribe for continuous caregiving tips, tricks, trends, and truths. Pretty please with sugar on top share and review it too. I'm a comedian, Alzheimer's is heavy, but we ain't got to be.