Any suggestions to manage orthostatic hypotension?

[WinnieThePoo]

My Dad has been diagnosed with PD - 4 years ago. He is on lc and that controls his tremors and relieves rigidity. When he reduced his lc recently those symptoms were significantly worse. Mostly he manages pretty well in his new home environment, but suffers increasingly with fainting / dizzy spells which have resulted in us having a wheelchair for him, since if we go out on an excursion he can get a spell within a few tens of yards of starting to walk. He can walk around the house, sometimes round a supermarket, but increasingly cant walk more than 50 metres. Prior to his PD diagnosis he was on ACE inhibitors, but those have ceased and he is on a medication to raise his blood pressure. BP no meds is about 90/65, on his medication typically sitting down 130/90. Last time I caught him in the recovery phase of a dizzy spell 72/48. He recovers quickly when sitting down - systolic back over 120 within a minute or so. Its worse getting up too quickly from a meal. Senile old goat doesn't drink enough water to my recurring frustration. Any magic pill suggestions? Anyone on Thiamin or other regimins which they find work for postural hypotension? Anyone else have it?

[johntPM]

I find water is the key. Drinking more is easier said than done: unfortunately, I have lost most of my desire to drink. If I'm going out for some time, I take a packet of crisps (for the salt) for when I feel a bit off.

John

[WinnieThePoo in reply to johntPM]

Thanks. I wonder whether Orthostatic hypotension is always this severe. It is really the only thing disabling him, and none of his medical professionals seem to address it really. Problem is, he's usually right as rain when he goes into see any of the doctors

[ddmagee1 in reply to WinnieThePoo]

Unfortunately, I’ve had a similar problem. Although, my lightheaded problem came close to fainting, it didn’t happen. The doctor did adjust my blood pressure medicine, and that does help. So, with me it’s been relatively mild. When I go to the doctor’s office, and my blood pressure is checked when I’m sitting and standing, it is the same, so my GP gave me a little lecture, that it is normal for people to have a little lightheaded problem once in a while, and, here I am, twice his age, never, ever having that problem before the diagnosis of PD. So, rather than argue, next appt. I just said, everything's fine, and left it at that. It is a terrible feeling, though, when one has these variable symptoms, and is honest with his doctor, and then one thinks the doctor either doesn't believe them, or that they are exaggerating. Oh well, that's why it's good we have this forum, to support one another, and caregivers.

[wifeofparky]

If he has a cardiologist, please discuss the issue with them. He may need a dose adjustment on his current meds or a change in the BP medication.

[wifeofparky in reply to wifeofparky]

Also to get more fluids in him, make sure he eats soups and stew-like meals that have more liquid in them. I put gravy on most of my husband's meals which made them easier to swallow plus increased his fluid intake.

[WinnieThePoo in reply to wifeofparky]

I try. Like me, he has urgent urination needs and complains "I'll be peeing every 5 minutes if I drink any more". We all nag him. But he's a stubborn old goat

[park_bear in reply to WinnieThePoo]

He is right - the problem with drinking plain water is the kidneys filter it out as soon as it raises the blood volume, because that thins out the electrolytes. The kidneys work to maintain a constant concentration of electrolytes, salt being the main one. The way to get this to work is to drink isotonic saline - water with the same salt concentration as the blood. That concentration is 9 grams per liter, about 8 grams per quart. Back when I was suffering from orthostatic hypotension I would chug a full quart of saline first thing upon arising.

He can drink this as needed in the morning, but not anywhere near bedtime. The companion to orthostatic hypotension is supine hypertension - excess blood pressure upon lying down. If you are successful in raising his daytime blood pressure you should also check in the evening when he lies down to make sure he is not suffering excess blood pressure.

[WinnieThePoo in reply to park_bear]

Thanks. I forgot to mention that as a lifelong drug pedlar (pharmaceutical rep) he has spent a lifetime taking a pill for everything and now has impaired renal function. To be fair he'd probably have been dead long ago without the medication. I'll suggest he tries a saline solution, although I have enough trouble getting him to drink regular water

[WinnieThePoo in reply to wifeofparky]

Thanks. He has seen a cardiologist - he has had a couple of jump-starts for atrial fibrilation. But its really patchy - really poor getting to see doctors in the UK (my sister takes charge of this since she lives 5 minutes from Mum and Dad). The health service here in France is so much better. Anyway, vaguely coordinated by his GP his meds have been recently reviewed and his "normal" BP is bang on the money. He just gets very dramatic episodes of "wobble" when he gets them. He's also not a great communicator, so sometimes I think he tips forward and grips his thighs due to "wobble" and sometimees due to thigh pain, but he gets light headed and doolally during these episodes.