It is a beautiful August day in the Northeast. The August nights are already cooler here as compared to the longest days of summer. A couple of my friends from high school have already given me updates on how they are progressing with this winter's wood supply. Last winter was an especially cold one here, and those who utilize wood for at least a portion of their heating needs realize the need for heat is not too many weeks away.

I'd like to comment on orthostatic hypotension. It is a concern for the elderly and infirm, and something that a care provider needs to understand. To simplify, orthostatic hypotension refers to a drop in blood pressure when the body changes from lying to sitting, or sitting to standing. This is usually caused from physical de-conditioning, whether a gradual onset or from a recent hospitalization. It is also caused by dehydration, and by many of the medications people take. Any that warn against driving or operating heavy machinery while taking are likely offenders. In case you think that this is just confined to the old and infirm, orthostatic hypotension was an issue for the Astronauts upon their return from space, the result of prolonged weightlessness, no gravitational effect upon the body’s circulatory system, in space vehicles and space station.

Here's what happens. The body circulatory system's reaction to positional changes slows down as these changes occur less frequently, or are depressed by medications. So, Mom, Dad, Aunt Ruth, or whomever has been lying in bed or sitting in a chair, and has to get up. When in bed, it is frequently at night to go to the bathroom. This is the time that most falls occur in the elderly population. Several things need to happen rather quickly when a person first changes position to vertical from horizontal or to standing from sitting. The heart needs to pump more blood, initially by increasing its output (stroke volume) and then by speeding up. At the same time, the vascular system, particularly in the legs, needs to respond to shunt blood flow as necessary to boost blood pressure to the upper body. Normally this process is instantaneous. In those with orthostatic hypotension, these changes are delayed. The person may feel dizzy or lightheaded for several seconds or longer, but this is not a given. Many times the reaction can be delayed for several minutes, sometimes longer. As the journey to whatever his/her destination progresses, the carotid artery sensors in the neck sense inadequate blood pressure for the brain to function properly, and solves the problem by returning the person to horizontal; they “pass out” or “faint” and fall.

What is best way to deal with this? Repetitive sitting to standing, remaining standing for about a minute, then returning to sitting for a couple of minutes sharpens the body's ability to adjust. Exercise, even at a very modest level, helps. In the event that symptoms persist, several unsure or stumbling steps when first walking, is an indication that orthostatic hypotension is occurring. Sometimes the person will become unresponsive or exhibit a glazed look in their eyes. Have them sit or preferably lie back down.

If no improvement is noted, it is time for a health professional to measure blood pressure changes lying to sitting to standing. A drop of 20 mmHg (systolic) or greater upon standing validates this diagnosis. A review of medications being taken would be wise.

Mom experienced this two years ago, when she arose quickly to respond to a knock on her door and fell, fracturing her forearm. Fortunately, she was able to rehab quickly and return to living in her apartment. Her medications are minimal and she is now practicing a regular schedule of moving from sitting to standing, so this is no longer an issue for her.

Playing cards is also not an issue for her. Once again “I lost rummy to mummy”, but salvaged my dignity with a win in cribbage.

Here's hoping yours' was a good day! Richard

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