DEAR DR. ROACH: I went to get a tattoo on the outer area of my hand, but upon doing it, I got dizzy and fainted. I am someone who has low blood pressure. I still want to finish the tattoo, so what can I take or do so that I don’t pass out? -- M.Y.

ANSWER: I certainly would recommend that you lie down. Make sure you have had plenty of fluid and salt (and no alcohol) ahead of time. Stress-reduction techniques, such as breathing exercises or muscle contraction and relaxation during the tattoo placement, may help. Distraction techniques also can be helpful: talking or shouting during the procedure may help (talk to the tattoo artist about your issue ahead of time). Smiling or coughing during the procedure has helped some people, too.

I received advice from people who fainted during blood draws, and that advice may be helpful for you. One reader had success by using an ice pack on his head and a second on the back of his neck: He said that 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 I would consider is a lidocaine patch to the hand prior to tattooing. The hand has a lot of nerve endings, and relieving pain might help prevent you from passing out. Very 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 very hesitant to use one.

DEAR DR. ROACH: I was wondering if you could explain Crohn’s disease and its treatment. -- L.F.

ANSWER: I can give only the outline: Crohn’s disease is a complex disease affecting multiple 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 sometimes can be bloody).

However, 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 also may involve other organs: Eye, skin and joints all may be affected, confusing the picture. Although usually, people have some bowel symptoms such as diarrhea. 

   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 in a center with expertise in this condition, and I have seen very severe cases. I also have 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 may treat overgrowth or a microperforation of the bowel) and nonabsorbable steroids (like budesonide). Severe Crohn’s disease absolutely requires an expert, and often it is treated by anti-immune-system drugs and biological therapies such as infliximab (Remicade).

   More information is available at the Crohn’s and Colitis Foundation at www.ccfa.org.