Bush back at work after fainting briefly

AP Medical WriterWASHINGTON (AP) -- President Bush was doing well and back at work Monday after fainting briefly in the White House residence while choking down a pretzel a day earlier.

"I feel great," Bush told reporters on the White House lawn as he prepared to board a helicopter for a two-day trip to the Midwest and Louisiana.

"My mother always said, 'When you're eating pretzels, chew before you swallow,"' Bush said. "Always listen to your mother."

White House spokesman Ari Fleischer said the president had been checked by his physician, Dr. Richard Tubb, Monday and his vital signs were normal.

"I hit the deck and I woke up and there was Barney and Spot showing a lot of concern," Bush said in recounting that he had passed out while watching a football game on television. Barney and Spot are his dogs.

"My glasses cut the side of my face," Bush said, pointing to an abrasion on his upper left cheek.

Tubb said in a telephone interview Sunday that Bush quickly recovered from the episode, apparently brought on by swallowing a pretzel awkwardly which triggered a temporary decrease in heart rate. He said the president had been feeling under the weather over the weekend.

Bush, 55, suffered an abrasion on his left cheek the size of a half dollar and a bruise on his lower lip from falling onto the floor from a couch.

The president fainted while alone in a room at the White House residence, watching the Baltimore-Miami National Football League playoff game on television and eating pretzels.

"He said it (the pretzel) didn't seem to go down right," Tubb said in a telephone interview. "The next thing he knew, he was on the floor."

A nurse on duty at the White House was summoned at 5:40 p.m. EST. Tubb was paged eight minutes later. Bush, under his own power, used an elevator to go downstairs to the doctor's office for a complete exam.

Tubb said Bush believes he was out only for a few seconds because when he awoke, his two dogs were sitting in the same position they were when he lost consciousness.

"But the dogs were looking at him funny," Fleischer added.

Tubb, an Air Force colonel, examined Bush, including monitoring his heart, and found nothing abnormal.

But Bush has a rigorous exercise regime that keeps both his blood pressure and heart rate at low levels -- a healthy plus that in this case appeared to be a factor in the fainting spell.

The pretzel-caused coughing apparently stimulated a nerve that further slowed Bush's heart rate, Tubb said.

In medical terms, it's called vasovagal syncope. The body sends a signal to the heart via the vagus nerve, slowing heart rate enough that the person briefly loses consciousness.

It's very common. Fear, even intestinal cramps, can cause vasovagal fainting.

"It's thought that pretty much everybody has one simple faint in their life. We see folks every day that have had a vasovagal reaction," said Dr. David Skibbie of Inova Fairfax Hospital in suburban Virginia. "It's alarming, but if everything checks out it's fine and they can go home without any concerns about their future health."

A vasovagal episode isn't the only possibility, Skibbie said. Somewhat less common is cough syncope, where a coughing episode -- similar to what Bush reportedly had -- can increase pressure in the chest enough to momentarily lower blood pressure. It, too, is benign.

Ironically, people in good physical shape actually are more prone to such types of fainting, because their blood pressure and heart rate already is so low, he noted.

It is the first health scare for Bush as president.

But Tubb insisted it did not appear related to stress of extra work brought on by Bush's duties as commander in chief and the war in Afghanistan.

One possible additional factor, Tubb said, was that Bush had acknowledged feeling under the weather this weekend, as if he were coming down with a head cold. He continued his daily exercises nonetheless.

------EDITOR'S NOTE: AP White House Correspondent Ron Fournier contributed to this story.