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.
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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.
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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
Be Kind and Feel Better,