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Thread: EXTREME drop in blood pressure

  1. #11
    I usually drink some orange juice in the morning, I find that it helps bring my BP up and gets me going. My normal BP is around 80/40ish. I only have problems in the morning with low(er) BP.
    Learn from the mistakes of others. You won't live long enough to make all of them yourself.

  2. #12
    Senior Member patd's Avatar
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    Bp

    I've delt with this for 3 yrs now. Making sure not to run low on food seems to regulate the hypotension. Pat

  3. #13
    Quote Originally Posted by Jesse's Mom
    I have posted this before and had a few responses. After Jesse eats a meal, and more so lately, his blood pressure drops so low that he can hardly see and just alot of white light. Yesterday he had an extreme episode where he had to pull over in the truck until he felt better but I still insisted on going to the clinic. Ten minutes after he told me he felt better, the nurse said his BP was 68 over 40. Today was the same thing. It seems to be getting worse. Weather in Texas didnt seem to have the same effect as the Minnesota weather, if that is what someone might offer as an idea. Could this just be "his" problem with SCI or could it be something hiding that we need to address?
    Jesse's Mom,

    Hypotension is a problem in many people with cervical spinal cord injury. Initially, as most people here know, during the weeks and months after injury, their blood pressures are unstable. They also have several types of hypotension:
    • Orthostatic hypotension. This is low blood pressure associated with standing. This results from a combination of low sympathetic activity, altered baroreflex function, lack of skeletal muscle pumping activity, cardiovascular deconditioning, and altered salt and water balance.
    • Chronic hypotension. Blood pressure is low. This may result from adrenal insufficiency.
    • Postprandial hypotention. Many people with cervical spinal cord injuries have a problem with postprandial hypotension (low blood pressure after eating). The cause is not well understood.
    • Drug-related hypotension. Several medications may reduce blood pressure in people. Of course, this could include medication that people take for AD, including ACE (angiotensin inhibiting enzyme) inhibitors. Incidentally, I have seen reports that viagra lowers blood pressure in some people with spinal cord injury.

    Because it seems to be getting worse in Jesse, I am a little concerned that there may be a precipitating cause. If I were his doctor, I would order the following tests to make sure that his hormonal and insulin status is okay.
    • Adrenal insufficiency. This would be tested by getting cortisol levels and ACTH levels after a meal.
    • Glucose tolerance. This would be tested by obtaining glucose levels are different times after a meal.
    • Blood pressure monitoring to rule out orthostatic hypotention.

    A drug called midodrine may increase exercise performance and blood pressure in people with spinal cord injury Nieshoff, et al. (2004). I include abstracts of several recent articles on the subject as background reading.

    Wise.

    References
    1. Gondim FA, Lopes AC, Jr., Oliveira GR, Rodrigues CL, Leal PR, Santos AA and Rola FH (2004). Cardiovascular control after spinal cord injury. Curr Vasc Pharmacol 2: 71-9. Spinal cord injury (SCI) leads to profound haemodynamic changes. Constant outflows from the central autonomic pattern generators modulate the activity of the spinal sympathetic neurons. Sudden loss of communication between these centers and the sympathetic neurons in the intermediolateral thoracic and lumbar spinal cord leads to spinal shock. After high SCI, experimental data demonstrated a brief hypertensive peak followed by bradycardia with escape arrhythmias and marked hypotension. Total peripheral resistance and cardiac output decrease, while central venous pressure remains unchanged. The initial hypertensive peak is thought to result from direct sympathetic stimulation during SCI and its presence is anaesthetic agent dependent. Hypotension improves within days in most animal species because of reasons not totally understood, which may include synaptic reorganization or hyper responsiveness of alpha receptors. No convincing data has demonstrated that the deafferented spinal cord can generate significant basal sympathetic activity. However, with the spinal shock resolution, the deafferented spinal cord (in lesions above T6) will generate life-threatening hypertensive bouts with compensatory bradycardia, known as autonomic hyperreflexia (AH) after stimuli such as pain or bladder/colonic distension. AH results from the lack of supraspinal control of the sympathetic neurons and altered neurotransmission (e.g. glutamatergic) within the spinal cord. Despite significant progress in recent years, further research is necessary to fully understand the spectrum of haemodynamic changes after SCI. Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceara, CP 3157, Rua Coronel Nunes de Melo, 1127 Fortaleza, Ceara Brazil. gondimfranc@yahoo.com http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15320835
    2. Nieshoff EC, Birk TJ, Birk CA, Hinderer SR and Yavuzer G (2004). Double-blinded, placebo-controlled trial of midodrine for exercise performance enhancement in tetraplegia: a pilot study. J Spinal Cord Med 27: 219-25. BACKGROUND/OBJECTIVE: Spinal cord injury (SCI) impairs cardiovascular autonomic responses to exercise and, depending on the level of injury, may result in hypotension and pathologic fatigue with exertion. Other clinical populations with sympathetic regulatory dysfunction, but without skeletal muscle paralysis, exhibit similar signs and symptoms. Their ability to engage in physical activity improves with elevation of blood pressure through pharmacologic treatment: Midodrine, an oral alpha-sympathomimetic agent, has been shown to be safe and efficacious for this purpose. Use of this medication in individuals with SCI merits investigation. METHODS: Double-blind, placebo-controlled, randomized, crossover, within-subjects protocol. Four participants with chronic, motor-complete injuries from C6 to C8 underwent 4 peak exercise tests (PXT) using a wheelchair ergometer, following administration of midodrine, 5 mg, 10 mg, and placebo, in random order. Heart rate, blood pressure, oxygen consumption (VO2), and perceived exertion were measured. RESULTS: Treatment with midodrine, 10 mg, was associated with elevated systolic blood pressure during peak exercise in 3 participants. Two participants showed a concurrent decrease in perceived exertion and increase in VO2. No adverse effects of midodrine were evident. CONCLUSION: Midodrine enhances exercise performance in some individuals with SCI, similar to other clinical populations with cardiovascular autonomic dysfunction. Rehabilitation Institute of Michigan, Detroit, Michigan, USA. enieshof@dmc.org http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15478524
    3. Tolbert G and Tuck ML (2004). Ambulatory blood pressure monitoring in persons with chronic spinal cord injury. J Spinal Cord Med 27: 476-80. BACKGROUND: Hypertension alone or in the presence of autonomic dysreflexia (AD) may be underdiagnosed and consequently mismanaged in people with chronic spinal cord injury (SCI). Blood pressure (BP) derangements caused by AD are characterized by labile BP, in addition to episodic hypertension. Consequently, random BP readings often prove insufficient, which makes traditional outpatient evaluation and management suboptimal. Because elevated BP is common to essential hypertension (EH) and AD, distinction between the 2 entities proves challenging. The distinction is imperative because the treatments differ. Conventional BP monitoring in the office may miss labile BP patterns and episodic BP elevations. Ambulatory BP monitoring (ABPM) is used in the general population to improve the diagnosis and management of hypertension. ABPM provides the average BP level, circadian rhythm, and short-term BP variability. There is a paucity of ABPM studies in persons with SCI. OBJECTIVE: To explore the role of ABPM in individuals with SCI. METHODS: This study is a case description and detailed analysis of the use of ambulatory blood pressure monitoring (ABPM) in 3 persons with chronic SCI. RESULTS: Three cases were identified in which the diagnosis of autonomic dysreflexia, exaggerated blood pressure variability and disruption of circadian blood pressure pattern was delayed using conventional blood pressure evaluation. ABPM aided in diagnosis by providing the average blood pressure level, circadian rhythm and short-term BP variability. CONCLUSION: Because conventional office BP monitoring may miss labile BP patterns and episodic BP elevations, it is limited in the SCI population. ABPM may improve the outpatient management of blood pressure abnormalities in individuals with chronic SCI by clarifying mechanisms and patterns of BP in this patient population. VA Greater Los Angeles Healthcare System, Sepulveda, California, USA. gtolbert1@yahoo.com http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15648803
    4. Wecht JM, Radulovic M, Weir JP, Lessey J, Spungen AM and Bauman WA (2005). Partial angiotensin-converting enzyme inhibition during acute orthostatic stress in persons with tetraplegia. J Spinal Cord Med 28: 103-8. INTRODUCTION: Individuals with tetraplegia rely on the renin-angiotensin system for orthostatic blood pressure control. OBJECTIVES: To determine the effect of partial angiotensin-converting enzyme (ACE) inhibition on heart rate (HR), active plasma renin (PR), and mean arterial blood pressure (MAP) during acute orthostasis in subjects with tetraplegia (n = 7) and nondisabled persons (n = 8). METHODS: Subjects were instructed to avoid caffeine and alcohol for 24 hours before testing and to report to the laboratory between 10 AM and 1 PM. Progressive head-up tilt (15 degrees, 25 degrees, 35 degrees, and 45 degrees) was performed on 2 separate days; Day 1: without ACE inhibition; Day 2: after intravenous (IV) infusion of enalaprilat (0.625 mg). RESULTS: HR was reduced during orthostasis in the tetraplegia compared with the nondisabled group (P < 0.0001), and was unaffected by ACE inhibition in either group. PR was not increased with orthostasis in either group, but was increased after ACE inhibition in both groups (P < 0.001). MAP was not affected by orthostasis in either group, but was reduced with ACE inhibition in both groups (P < 0.01). In the tetraplegia group, MAP was initially reduced after ACE inhibition, but was maintained thereafter with increasing angles of tilt, and no subject complained of symptomatic orthostatic hypotension. CONCLUSION: Subjects with tetraplegia were tolerant of an acute bout of orthostatic stress after partial ACE inhibition. This may have clinical relevance because of the increased prevalence of type 2 diabetes mellitus in this population and the use of ACE inhibitors for the treatment of progressive renal and cardiovascular disease. Spinal Cord Damage Research Center, Veterans Affairs Medical Center, Bronx, New York 10468, USA. jill.wecht@med.va.gov http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15889697
    5. Chao CY and Cheing GL (2005). The effects of lower-extremity functional electric stimulation on the orthostatic responses of people with tetraplegia. Arch Phys Med Rehabil 86: 1427-33. OBJECTIVE: To determine whether application of functional electric stimulation (FES) to lower-limb muscles during postural tilting improves orthostatic tolerance in people with tetraplegia. DESIGN: A crossover design. SETTING: A rehabilitation hospital. PARTICIPANTS: Sixteen acute and chronic subjects with tetraplegia (15 men, 1 woman) with complete motor function loss at the C3-7 levels were recruited. Time since injury ranged from 2 to 324 months (mean, 118.9+/-104.2 mo). INTERVENTION: Subjects were tested on a progressive head-up tilting maneuver with and without the application of FES at 0 degrees , 15 degrees , 30 degrees , 45 degrees , 60 degrees , 75 degrees , and 90 degrees continuously for up to 1 hour. FES was administered to 4 muscle groups including the quadriceps, hamstrings, tibialis anterior, and gastrocnemius muscles bilaterally at an intensity that provided a strong, visible, and palpable contraction. This was to produce a muscle pumping mechanism during the tilting maneuver. MAIN OUTCOME MEASURES: Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, perceived presyncope score, and the overall duration of orthostatic tolerance, that is, the time that subjects could tolerate the tilting maneuver without developing severe hypotension or other intolerance symptoms. RESULTS: When the tilt angle was increased, the subjects' SBP and DBP tended to decrease, whereas the heart rate tended to increase in both testing conditions. Adding FES to tilting significantly attenuated the drop in SBP by 3.7+/-1.1 mmHg (P = .005), the drop in DBP by 2.3+/-0.9 mmHg (P = .018), and the increase in heart rate by 1.0+/-0.5 beats/min (P = .039) for every 15 degrees increment in the angle of the tilt. FES increased the overall mean standing time by 14.3+/-3.9 min (P = .003). CONCLUSIONS: An FES-induced leg muscle contraction is an effective adjunct treatment to delay orthostatic hypotension caused by tilting; it allows people with tetraplegia to stand up more frequently and for longer durations. Physiotherapy Department, MacLehose Medical Rehabilitation centre, Hong Kong, China. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16003676
    6. Krassioukov A and Claydon VE (2006). The clinical problems in cardiovascular control following spinal cord injury: an overview. Prog Brain Res 152: 223-9. On a daily basis, individuals with cervical and upper thoracic spinal cord injury face the challenge of managing their unstable blood pressure, which frequently results in persistent hypotension and/or episodes of uncontrolled hypertension. This chapter will focus on the clinical issues related to abnormal cardiovascular control in individuals with spinal cord injury, which include neurogenic shock, autonomic dysreflexia and orthostatic hypotension. Blood pressure control depends upon tonic activation of sympathetic preganglionic neurons by descending input from the supraspinal structures (Calaresu and Yardley, 1988). Following spinal cord injury, these pathways are disrupted, and thus spinal circuits are solely responsible for the generation of sympathetic activity (Osborn et al., 1989; Maiorov et al., 1997). This results in a variety of cardiovascular abnormalities that have been well documented in human studies, as well as in animal models (Osborn et al., 1990; Mathias and Frankel, 1992a, b; Krassioukov and Weaver, 1995; Maiorov et al., 1997, 1998; Teasell et al., 2000). However, the recognition and management of these cardiovascular dysfunctions following spinal cord injury represent challenging clinical issues. Moreover, cardiovascular disorders in the acute and chronic stages of spinal cord injury are among the most common causes of death in individuals with spinal cord injury (DeVivo et al., 1999). International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC V6T 1Z4, Canada. krassioukov@icord.org http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16198703
    7. Mathias CJ (2006). Orthostatic hypotension and paroxysmal hypertension in humans with high spinal cord injury. Prog Brain Res 152: 231-43. The spinal cord is essential for normal autonomic nervous system regulation of the cardiovascular system as the preganglionic neurons controlling the heart and blood vessels originate in the thoracolumbar spinal segments. The site and extent of a spinal cord injury determine the degree of autonomic involvement in cardiovascular dysfunction after the injury. After complete cervical cord lesions the entire sympathetic outflow is separated from cerebral control; this may cause orthostatic hypotension. Commonly after traumatic injuries to the spinal cord, one or more segments are totally destroyed. However, the distal portion of the spinal cord often retains function and activation of spinal cord reflexes working independently of the brain can result in paroxysmal hypertension. This chapter will focus on orthostatic hypotension and paroxysmal hypertension in cord-injured people with lesions affecting the cervical and upper thoracic spinal cord. Conditions promoting these abnormalities in blood pressure will be elaborated. Possible mechanisms for the hypo- and hypertension will be discussed, as will strategies for managing these problems. Neurovascular Medicine Unit, Faculty of Medicine, Imperial College London at St Mary's Hospital, London W2 1NY, UK. c.mathias@imperial.ac.uk http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16198704
    8. Garcia-Bravo AM, Suarez-Hernandez D, Ruiz-Fernandez MA, Silva Gonzalez O, Barbara-Bataller E and Mendez Suarez JL (2006). Determination of changes in blood pressure during administration of sildenafil (Viagra) in patients with spinal cord injury and erectile dysfunction. Spinal Cord 44: 301-8. STUDY DESIGN: Prospective, open-label, comparative study, to assess the effects of sildenafil on blood pressure in a population of patients with spinal cord injury (SCI). OBJECTIVES: To determine the effect of sildenafil on blood pressure in patients with erectile dysfunction secondary to SCI by comparing changes in blood pressure in SCI patients with a neurologic level below T5 versus higher levels. To establish a relationship between the potential hypotensive effect and protective muscle spasm against blood pressure reduction. To assess the effects of age, complexity and duration of SCI on changes in blood pressure. To record any adverse effects occurring during the study. SETTING: Spinal Cord Injury Unit, Insular University Hospital of Gran Canaria, Canary Islands, Spain. SUBJECTS: In total, 22 male SCI patients aged 18 years or older with a history of SCI greater than 3 months in duration. METHODS: Patients with erectile dysfunction secondary to SCI were included in the study, without excluding patients with a neurologic level above 75 or asymptomatic low blood pressure. Patients with specific contraindications for use of the drug were excluded. A personal history was obtained, and the level of injury (ASIA/IMSOP scales of international standards), impairment grade (ASIA impairment scale), spasticity grade (modified Ashworth scale) and baseline sitting and supine blood pressure values were determined. A single dose of 50 mg of sildenafil was administered, and patients remained sitting at 45 degrees . Blood pressure was monitored every 10 min for 4 h and whenever the patient reported symptoms. Any relevant signs and symptoms manifested during the study period were also recorded. Analysis of the changes in blood pressure values was performed using a paired t-test in each group of patients according to neurologic level and spasticity grade. RESULTS: A decrease in blood pressure was observed in all patients, although patients with a level of injury at T5 or above and those with a complete SCI showed a less intense decrease (P<0.05). The spasticity grade of the patients was protective against the fall in blood pressure, as it was less significant in patients with grade 3 (P>0.1) than in those with grade 0. Adverse effects were few and transient. None were related to hypotension. CONCLUSION: Sildenafil caused a decrease in blood pressure in SCI patients with a neurologic level of injury above T5 and complete injuries (grade A), but did not have clinical implications in the patients studied. A higher spasticity grade tends to protect the patient from the fall in blood pressure. Age and duration of injury do not appear to influence this decrease. Spinal Cord Injury Unit, Insular University Hospital of Gran Canaria, Canary Islands, Spain. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16249788
    9. Claydon VE, Steeves JD and Krassioukov A (2006). Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology. Spinal Cord 44: 341-51. Motor and sensory deficits are well-known consequences of spinal cord injury (SCI). During the last decade, a significant number of experimental and clinical studies have focused on the investigation of autonomic dysfunction and cardiovascular control following SCI. Numerous clinical reports have suggested that unstable blood pressure control in individuals with SCI could be responsible for their increased cardiovascular mortality. The aim of this review is to outline the incidence and pathophysiological mechanisms underlying the orthostatic hypotension that commonly occurs following SCI. We describe the clinical abnormalities of blood pressure control following SCI, with particular emphasis upon orthostatic hypotension. Possible mechanisms underlying orthostatic hypotension in SCI, such as changes in sympathetic activity, altered baroreflex function, the lack of skeletal muscle pumping activity, cardiovascular deconditioning and altered salt and water balance will be discussed. Possible alterations in cerebral autoregulation following SCI, and the impact of these changes upon cerebral perfusion are also examined. Finally, the management of orthostatic hypotension will be considered.Spinal Cord (2006) 44, 341-351. doi:10.1038/sj.sc.3101855; published online 22 November 2005. 1International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16304564
    10. Previnaire JG and Soler JM (2006). Micturition syncope following intermittent catheterisation in a tetraplegic patient. Spinal Cord Study design:Case report.Objective:To describe a case of severe hypotension and occasional syncope following intermittent catheterisations in a tetraplegic patient.Settingepartment of Spinal Injuries, Berck, France.Case report:A 47-year-old man presenting with C7 ASIA B tetraplegia for 9 months, developed episodes of severe hypotension and occasional syncope following intermittent catheterisations. These episodes were observed in the minutes following the catheterisations performed in the sitting position, associating hypotension and bradycardia. He was on intermittent catheterisation, had a history of bladder hyper-reflexia with some episodes of symptomatic urinary tract infections, of mild autonomic dysreflexia (headache, sweating) on high bladder distension, of mild orthostatic hypotension, and of reactional depression to the trauma, treated with fluoxetine hydrochloride (Prozac((R))).Results:The progressive removal of the fluoxetine hydrochloride (Prozac((R))) led to disappearance of the syncope 1 week later. Mild hypotension after catheterisations still persisted though, but completely disappeared a few months later after further management of bladder hyper-reflexia with botulinum-A toxin injections into the detrusor.Conclusion:In spinal cord injury patients at risk of micturition syncope, care should be taken to achieve a gradual decrease in bladder volume, to control bladder hyper-reflexia and to avoid any medications with orthostatic hypotension's side effects.Spinal Cord advance online publication, 7 February 2006; doi:10.1038/sj.sc.3101907. 1Spinal Unit, Centre Calve, Berck, France. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16462821
    11. Frisbie JH (2006). Unstable baseline blood pressure in chronic tetraplegia. Spinal Cord Study design:Case-control.Objective:Tetraplegic patients are subject to episodes of autonomic dysreflexia and postural hypotension. It is suggested that these patients sustain, in addition, unstable baseline blood pressure (BP) that is independent of symptoms and body position.Methods:BP monitoring was conducted in 10 tetraplegic patients, motor and sensory complete (American Spinal Injury Association (ASIA) A) (Group A), and five paraplegic at T8-T10 levels, ASIA A (Group B). A SpaceLabs automatically inflating pneumatic cuff recorded arm pressures at 10-30 min intervals in the daytime, sitting position and at 30 min intervals in the night-time, recumbent position. Group mean arterial pressure (MAP) and MAP standard deviation (MAP variation) for sitting and recumbent positions were compared.Results:Sitting the MAP for Group A was less than that of Group B; 87+/-9 versus 108+/-7 mmHg, P<0.01. However, MAP variability for Group A was greater than for Group B; 17+/-4 (20% of MAP) versus 13+/-2 mmHg (12% of MAP), P=0.04. In the recumbent position, the MAP for Group A was similar to that for Group B; 87+/-13 versus 97+/-7 mmHg, P=0.16. However, MAP variability for Group A remained higher than for Group B; 13+/-3 (20% of MAP) versus 8+/-2 mmHg (8% of MAP), P=0.02.Conclusion:Tetraplegic patients demonstrate unstable BP in either the sitting or recumbent position compared with low thoracic paraplegic patients.Spinal Cord advance online publication, 28 March 2006; doi:10.1038/sj.sc.3101920. [1] 1Spinal Cord Injury and Medical Services, Department of Veterans Affairs Medical Center, West Roxbury, MA, USA [2] 2Harvard Medical School, Boston, MA, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16568144
    12. Garcia-Zozaya IA (2006). Adrenal insufficiency in acute spinal cord injury. J Spinal Cord Med 29: 67-9. BACKGROUND/OBJECTIVE: A 21-year-old man with a C6 American Spinal Injury Association A spinal cord injury (SCI) developed symptomatic hypotension resistant to vasopressors and volume replacement 2 weeks after injury and was diagnosed with adrenal insufficiency by cosyntropin test. Adrenal insufficiency has been documented in chronic SCI; this case shows documented adrenal insufficiency in acute SCI. DESIGN: Case report. RESULTS: Secondary adrenal insufficiency complicated the medical and rehabilitative course of this patient with SCI. During 2 infectious episodes, this patient's dosage of hydrocortisone had to be doubled to control symptomatic hypotension, lethargy, diffuse weakness, and anorexia. CONCLUSIONS: The nonspecific symptomatology of adrenal insufficiency can be easily overlooked in patients with SCI. Low basal cortisol levels may be an important clue to this disorder. Low-dose adrenocorticotropic hormone stimulation may be more sensitive than high doses for detecting subclinical adrenal insufficiency. A high index of clinical suspicion is needed for the correct diagnosis of acute and chronic adrenal insufficiency. James A. Haley VA Hospital, Spinal Cord Injury Service (128), 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA. Inigo.Garcia-Zozaya@med.va.gov http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16572567

  4. #14
    Re adrenal insufficiency - last year my wife was moved from rehab to the ICU when her blood pressure plummetted. I (not they) discovered it was due to their misreading "1/4 of a 20 mg hydrocortisone tablet" as being "1/4 mg hydrocortisone"! So much for electronic records. Check all meds carefully yourself.
    - Richard
    Last edited by rfbdorf; 06-03-2006 at 12:02 PM.

  5. #15
    I would add to get an EKG to make sure there are no associated arrhythmias triggering the syncope. I would also make sure there is no seizure activity.

    If his heart and kidneys are OK, sometimes something simple such as a more liberal use of salt during meals and exercise can help alleviate hypotension. This might help him require a lower dose of medication, if in fact he ends up needing some.

  6. #16
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    Quote Originally Posted by Cripply
    I would add to get an EKG to make sure there are no associated arrhythmias triggering the syncope. I would also make sure there is no seizure activity.
    Hmmm, did I miss a syncope episode somewhere? I know that it can be useful sometimes to think out of the box but mostly when the obvious has been ruled out. What is being described here is almost certainly not related to any problem asking for an EKG or an EEG. I guess defensive medecine in the USA is to blame here ...

    As others said, changes in eating habits (many small meals vs few big meals), exercise or the use of some drugs (he can choose to hate them and not use them) that can raise blood pressure are the main solutions for him but a lot of us have to cope with the same problems and we use different combinations of the proposed solutions to minimize it.
    Pharmacist, C4-5 injury but functional C6 (no triceps/flexors)

  7. #17
    Quote Originally Posted by Broknwing
    Check their MSG usage....strange as it sounds the ammt of MSG they use in their ingredients can have lots of diff effects on your body. Being that you are suceptable to low BP maybe that's how it affects you.
    thanks Chelle... that blew straight over my head and never occurred to me that's the possible problem..





    Life isn't like a bowl of cherries or peaches. It's more like a jar of jalapenos--What you do today might burn your ass tomorrow.

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  8. #18
    Senior Member jukespin's Avatar
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    Arrow

    Quote Originally Posted by 2jazzyjeff
    thanks Chelle... that blew straight over my head and never occurred to me that's the possible problem..
    That's the first thing I thought of when I read your post.

    It "blew straight over your head"? Well consider what intellectual/educational level your head is at and you should gain some perspective.
    "Sometimes I just sets and thinks...
    and sometimes I just sets.
    "

    Otis Redding I think

  9. #19
    then why didn't you say something dumbass? geesh, the dimmest bulb on the block... after someone says it, you come in and say, ''i was thinking that too''.. oh my...

    my head level is prolly where yours is at, but the intellectual level...? the damned ole jury is still out... please come back...





    Life isn't like a bowl of cherries or peaches. It's more like a jar of jalapenos--What you do today might burn your ass tomorrow.

    If you ain't laughing, you ain't living, baby. Carlos Mencia

  10. #20
    Senior Member jukespin's Avatar
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    Wink Jury Shmurey.

    Quote Originally Posted by 2jazzyjeff
    then why didn't you say something dumbass? geesh, the dimmest bulb on the block... after someone says it, you come in and say, ''i was thinking that too''.. oh my...

    my head level is prolly where yours is at, but the intellectual level...? the damned ole jury is still out... please come back...
    I see two of them talking about it now...of wait a minute, it's Rus and some chick and it's the peanut gallery.
    "Sometimes I just sets and thinks...
    and sometimes I just sets.
    "

    Otis Redding I think

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