Blood Pressure Drops When He Stands Up

DEAR DR. ROACH: Will you write about orthostatic hypotension? I’ve been told I have this disorder. I’m a retired 86-year-old man in fairly good medical shape. I want to regain my regular activities.

My regular doctor put me on labetalol. I think he is researching this a bit himself. This apparently is not a frequent problem. I have found articles about it on the internet, but the medical language is not easy to understand. — R.T.F.

ANSWER: “Orthostatic hypotension” literally means “low blood pressure on standing upright.” It is a symptom, not a diagnosis. There are many medical conditions that can lead to the symptom of orthostatic hypotension, but many people, especially those over 65, have no discernable cause that can be found.

On standing, the blood pools in our veins, and the heart and blood vessels need to rapidly adjust to prevent blood pressure from falling too much. Even a brief drop in blood pressure can lead to a sensation of lightheadedness, and to fainting if it is more severe and prolonged. Normally, blood pressure drops about five points, but the body compensates by increasing heart rate and by constricting blood vessels.

As we get older, our body’s ability to adapt to rapid changes in position can diminish. Medications, especially beta blockers and antidepressants, interfere with the body’s coping mechanisms. So I am surprised that your doctor is trying labetalol, since it is both a beta and alpha blocker, and it is one of the most notorious causes of orthostatic hypotension. But it can be difficult in older people with high blood pressure to find a medicine that doesn’t make orthostatic hypotension worse.

Some general advice may be of benefit. First, don’t try to get up too quickly. If lying down, sit up for a few minutes before trying to stand, to give your body time to adapt. If your doctor says it’s OK, increase salt and water intake.

In your case, it might be worth finding someone, like a hypertension expert or a cardiologist, with more expertise in managing orthostatic hypotension. I assure you it is far more common than you might think. 

                                      • • •

DEAR DR. ROACH: I have been experiencing shortness of breath whenever I vacation and walk in the mountains. I was a smoker, but I quit 31 years ago. My doctor sent me for the lung capacity breathing test, and I passed with flying colors. The technician said my number was one of the highest she has seen. This concerns me. Why is it happening? — N.L.

ANSWER: I have two concerns. The first is that lung capacity is a measure of just what it sounds like — how big the lungs are. When the technician says it’s among the biggest she’s seen, I worry that it’s too big. An elevated lung capacity can go along with emphysema, which can be related to distant smoking or can be due to a condition called alpha-1 antitrypsin deficiency. Emphysema can be diagnosed by other components of pulmonary function tests, particularly a test called the DLCO, and confirmed by X-ray or CT.

However, breathing problems also might indicate heart problems and anemia, so you might need another visit. On the other hand, there is less oxygen in the thin mountain air, so some degree of shortness of breath might not be abnormal.

                                      • • •

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 ToYourGoodHealth@med.cornell.edu. 

© 2019 North America Synd., Inc.
All Rights Reserved

As I turned on the news last week and saw a family of four from Ohio had died from carbon monoxide poisoning, I couldn’t help but get upset by this tragic loss that could have been avoided. Carbon Monoxide is called the silent killer for a reason. It is a odorless, colorless and tasteless gas that if undetected can make you very ill and/or kill you. 

Many people make sure they have working smoke alarms in their homes. Some remember that they should also have fire extinguishers readily available. However, many homeowners and renters forget about carbon monoxide alarms. CO alarms can be purchased at just about every local corner store or online. Here are some tips regarding CO alarms in your home.

A carbon monoxide alarm should be located on each level of your home in a centrally located spot. One should be located outside of sleeping areas just like smoke alarms. Make sure to follow manufacturer’s recommendations on where to best install the CO alarm. CO alarms have an expiration date and should be replaced every 10 years. Change the batteries every six months like you do for your smoke alarms and test your CO alarms once a month. If your CO alarm sounds, immediately go outside to fresh air and call 911. 

Never start your vehicle in the garage and leave it running in there. Pull the vehicle outside while it warms up. Have your appliances serviced on a regular basis by a professional to ensure they are in good working order. If you do need to have an appliance fixed or installed, use a qualified technician to do the work. During and after a snowstorm make sure all exhaust vents for your stove, dryer, furnace and fireplace are free from snow. And never use a gas or charcoal grill inside an enclosed structure. 

Following these tips will help ensure you are not the next news headline. If you have any questions or concerns I can be reached at 563-589-4195 or at Dpaulson@cityofdubuque.org

Living Better with Chronic 
​Respiratory Diseases

Pulmonary rehabilitation can make life better for many people with chronic respiratory diseases.

(NAPS)—Here’s news that should help many people with chronic respiratory diseases such as COPD breathe easier: Pulmonary rehabilitation is a proven treatment that improves quality of life.

The Problem

“People with COPD and other chronic respiratory diseases are often limited in many daily activities,” said Carolyn L. Rochester, M.D., professor of medicine, pulmonary critical care and sleep medicine at Yale School of Medicine and past chair of the American Thoracic Society Assembly on Pulmonary Rehabilitation. “Some may not be able to even walk from one side of their home to the other, prepare a meal or wash their own hair.”

Chronic lower respiratory diseases such as COPD are the third-leading disease-related cause of death in the U.S., just behind heart disease and cancer. Unfortunately, many people with COPD and other chronic respiratory diseases may not know about available treatments.

According to an eye-opening survey by Wakefield Research commissioned by the American Thoracic Society, the world’s leading medical association dedicated to advancing pulmonary, critical care and sleep medicine, 62 percent of people diagnosed with a chronic respiratory disease have not heard of pulmonary rehabilitation—a proven treatment that is usually covered by Medicare and private insurance. 

Pulmonary Rehabilitation Can Help

A comprehensive six- to 12-week program, pulmonary rehabilitation includes supervised exercise, education and support. Research shows that pulmonary rehabilitation enhances overall quality of life, reducing symptoms and improving physical and emotional function. However, it is significantly underused. 

Explained Chris Garvey, FNP, MSN, MPA, MAACVPR of the University of California, San Francisco Pulmonary Rehabilitation and Sleep Disorders, “Pulmonary rehab works by strengthening the muscles to ease the burden on the lungs. It provides a safe environment to learn how to manage breathing, allowing patients to not only feel better, but to do more in their lives, including many activities they may have been avoiding because of their symptoms.” 

The survey also revealed that 40 percent of patients diagnosed with these diseases are unaware of how deadly their condition is. Respondents ranked stroke, diabetes and Alzheimer’s over chronic respiratory diseases as leading causes of death. In fact, 28 percent of respondents did not rank chronic respiratory diseases in the top three at all.

In contrast with the lack of knowledge about pulmonary rehabilitation, the majority of patients with a chronic pulmonary disorder have heard of oxygen therapy (70 percent) as well as medicinal interventions, including long-acting or maintenance inhalers (61 percent), short-acting or rescue inhalers (52 percent), and inhaled or oral steroids (52 percent) as treatments for their disease.

Many patients, the survey discovered, who have heard of pulmonary rehabilitation do not pursue the treatment or fail to complete the treatment. Of the 38 percent of respondents who had heard of pulmonary rehabilitation, only 29 percent completed the program. 

Live Better

The American Thoracic Society partnered with the Gawlicki Family Foundation to create livebetter.org, a dedicated website about pulmonary rehabilitation, which includes a directory of programs that is continually updated based on feedback from the pulmonary rehabilitation community.

Learn More

​If you or someone you know is suffering with COPD or another chronic respiratory disease, talk with your health care provider. Visit livebetter.org for more facts about pulmonary rehabilitation and to find a nearby program.

Be Kind and Feel Better,
​Research Shows

Kindness means being friendly, generous and considerate. The definition focuses on what an individual can do to make someone else feel better. However, Iowa State research shows that thinking kind thoughts about others can improve your own mood.

Douglas Gentile, professor of psychology, senior lecturer Dawn Sweet and graduate student Lanmiao tested the benefits of three different techniques intended to reduce anxiety and increase happiness or well-being. They found that simply wishing others well for 12 minutes could improve a person’s mood. 

“We asked students to walk around campus and either wish for others to be happy, to consider how they might be similar and connected, or to think about how they might be better off than others. Any of these could possibly make people feel happier, but there were clear differences,” Gentile said. 

“Wishing others well reduced anxiety and increased happiness and feelings of social connection. Considering how connected we all are increased feelings of connection, but had no effect on happiness or anxiety. Thinking about how we might be better off than others had no benefits at all,” Gentile said.

The Iowa State study recently was published in the Journal of Happiness Studies.

We can practice kindness in many ways — with our children, other family members, our friends and other people with whom we interact each day. Here are some examples:

• Practice simple manners. Saying please and thank you are easy ways to teach young children the beginnings of kindness.

• Send short notes to others. Leaving short notes of affirmation at random can be done quickly and create opportunities for connecting with others when they least expect it. Younger children can decorate a note, while early writers can practice their language skills. 

• Offer random acts of kindness. Doing random, unexpected, small acts for others can bring children into an action that teaches social skills and connects positive feelings to their emotional development. Simple things, like sharing or helping, show children how to be kind. 

Gentile noted that this study didn’t require people to do anything other than to think how they wish for others to be happy; so it can be done without requiring any actions or even for the other person to know about it.

Gentile was instrumental in launching ISU Extension and Outreach’s Science of Parenting. In 2011 Science of Parenting began with audio podcasts and a blog, and has grown to a one-stop, online source for trustworthy research on popular parenting topics. 

We combine current research with a dose of reality for parenting success. Visit the Science of Parenting website from ISU Extension and Outreach for access to current research and information.

• “If you have a flannel-backed vinyl tablecloth that gets a tear, don’t throw it out. You can cut it into rectangles to line a shelf. Use a thin bead of glue at the edges to keep them down, and it makes a nice liner. You can even use squares between pans as a scuff guard.” — T.A. in Ohio

• Washcloths with tags on them can be hung from an “S” hook on a towel bar. You can fit several, and they’ll still dry as long as you hang them from the tag. 

• Sewing machine tip from C.K. in Texas: “After you oil your machine, use a folded over paper towel to put a few stitches through. It will absorb any excess oil that is on the machine’s surface or needle.”

• Use a used fabric softener sheet to collect cat hair from areas where Kitty likes to nap — the back of the couch, fabric-covered chairs, etc. This also works on curtains that are regularly rubbed up against. Make sure you use a sheet that has already gone through the laundry.

• “Idea for an old, unpaired sock: Insert a tennis ball and tie closed, then give to a dog as a toy.” — R. in Oregon. (Here’s another: Fill with clean, uncooked white rice and knot closed. Heat in the microwave for a hot pack to use on aching muscles.)

• Use an old toothbrush to clean out your combs or small brushes. Spray the comb with alcohol and then use the toothbrush to scrub it clean. 

• O.L. writes: “Never store bread in the refrigerator. The cold will turn it stale, dry and tasteless, and it also will soak up odors from the fridge. Use a breadbox to keep moisture from escaping. In a pinch, you can store bread in a microwave.”

• “A skunk spray is a smell you will not forget, and if your dog gets a full dose, you’d better wash it off right away, or it’ll linger FOREVER. Here’s one good method, but it will likely need repeating a few times. First rinse off your dog and especially his face and around his eyes. Then generously lather him up with dog shampoo. Rinse and rough dry with a junk towel, then absolutely soak him with canned tomato juice. Keep him still and don’t let him shake for 20 minutes, then repeat the wash.” — T.D. in Alabama

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628 Virginia Drive,
Orlando, FL 32803.

​© 2019 King Features Synd., Inc.

Trattoria-Style Shrimp Fettuccine

Classic and quite simple to prepare, this shrimp and pasta dish can be served on its own thanks to the bag of fresh spinach that gets incorporated at the last minute.

• 12 ounces fettuccine or spaghetti
• 2 tablespoons olive oil
• 1 medium (6- to 8-ounce) onion, chopped
• 2 cloves garlic, thinly sliced
• 1/2 cup dry white wine
• 1 bottle (8-ounce) clam juice
• Salt
• 1 pound shelled and deveined large shrimp, with tail part of shell left on if you like
• 1 bag (5- to 6-ounce) baby spinach
• 1/3 cup (loosely packed) fresh parsley leaves, chopped

1. Heat large covered saucepot of salted water to boiling on high. Add pasta and cook as label directs.

2. Meanwhile, in 12-inch skillet, heat oil on medium until hot. Add onion and garlic, and cook 10 minutes or until golden and tender, stirring often. Add wine; increase heat to medium-high and cook 1 minute. Stir in clam juice and 1/2 teaspoon salt; heat to boiling. Stir
in shrimp, and cook 2 to 3 minutes or until shrimp turn opaque throughout.

3. Drain pasta and add to skillet with spinach and parsley; toss to coat. Serves 6.

• Each serving: About 350 calories, 7g total fat (1g saturated), 115mg cholesterol, 515mg sodium, 46g total carbohydrate, 4g dietary fiber, 24g protein.

​For thousands of triple-tested recipes, visit our Web site at www.goodhousekeeping.com/recipefinder/.

© 2019 Hearst Communications, Inc.
All rights reserved

Hamburger Salad Sandwiches

Sometimes the best flavors come from the most unexpected combinations. Don’t turn your nose up at this unusual sandwich before giving it a try.


1 pound extra-lean ground sirloin or turkey breast
1/2 cup chopped onion
1/4 teaspoon dried minced garlic
1/2 cup fat-free mayonnaise
1/4 cup dill pickle relish
2 tablespoons prepared yellow mustard
1/8 teaspoon black pepper
1 cup peeled and chopped fresh red tomatoes
6 lettuce leaves
6 small hamburger buns


1. In a large skillet sprayed with butter-flavored cooking spray, brown meat and onion. Stir in garlic. Place skillet on a wire rack and allow to
cool completely.

2. Stir in mayonnaise, pickle relish, mustard and black pepper. Add tomatoes. Mix gently to combine.

3. For each sandwich, place a lettuce leaf on bottom of a bun, spoon about 1/2 cup meat mixture over lettuce, and arrange bun top over meat mixture. Serves 6.

• Each serving equals: 225 calories, 7g fat, 16g protein, 24g carb., 545mg sodium, 2g fiber; Diabetic Exchanges: 2 Meat, 1 1/2 Vegetable, 1 Starch.

​© 2019 King Features Syndicate, Inc.

Small Changes Can Mean Big Differences In Blood Pressure Control

A growing number of people are becoming aware of the risks of having high blood pressure and the need to make changes to reduce the chances of a heart attack or stroke.

(NAPS)—Almost half of the U.S. adult population has high blood pressure—that’s any reading at or above 130 for the top number or 80 for the bottom number.

If you find yourself among them, it may be wise to consider four lifestyle evaluation questions:

1.    How often do you eat fruits and vegetables?

2.    How much salt do you take in?

3.    Are you at least moderately active for half an hour a day?

4.    Are you at a healthy weight for your height?

What To Do

If your assessment reveals room for improvement, Michael Hochman, M.D., MPH, a Los Angeles physician and professor at the Keck School of Medicine at the University of Southern California, has an encouraging message for you: “Know this: Small changes can make big differences. You don’t have to overhaul everything you do and eat. Tracking your blood pressure between health care visits lets you easily stay on top of your health. In 10 minutes or less, you can check your numbers. If you are learning for the first time that your blood pressure is creeping upward, small changes in your lifestyle—a bit more physical activity, a few more fruits and vegetables—could mean the difference between low vs. high risk for heart disease or stroke.”

Here are some hints to help you make those small changes:

•    15–20 minutes of moderate aerobic activity per day can reduce the top number in your blood pressure reading, called systolic pressure, by 5 to 8 mmHg

•    Reducing sodium intake by 1,500 mg (3/4 of a teaspoon) per day can result in lowering systolic pressure 5 to 6 mmHg

•    A 10-pound weight loss could lower systolic blood pressure by 5 mmHg.

Little-Known BP Raisers

If you do have high BP, consult your health care provider or pharmacist about the safety of your over-the-counter medicines.

Some OTC pain relievers, known as nonsteroidal anti-inflammatory drugs, or NSAIDs—such as naproxen and ibuprofen—may raise blood pressure. Acetaminophen may be a better choice for pain. Drugstore cold and flu medicines that contain decongestants can also raise blood pressure. To avoid these BP raisers, read medication labels and discuss alternative pain, fever or cold medicine with your doctor. A quick guide to BP raisers is at heart.org/BPtools.

Take It Home

Monitoring at home can help confirm a diagnosis and determine how well your lifestyle changes and medications are working to reduce your blood pressure.

​The American Heart Association’s efforts to improve healthy choices related to living with high blood pressure are proudly supported by Tylenol.

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