My husband regularly falls severely and comes out of nowhere because of his low blood pressure. He has only been told to drink more water, take salt and wear compression stockings – and there are long waiting lists to see NHS specialists in our area.
I am constantly tense, especially at night when he has to go to the toilet. It seems like high blood pressure is getting attention, but what about low blood pressure?
Pat Lister, Whitley Bay.
The condition you describe is orthostatic hypotension, where blood pressure drops after standing or changing position. It is a common problem among the elderly, affecting as many as 20 percent of those over the age of 65.
But only 2 percent of those affected experience serious symptoms — dizziness, blurred vision, and falls, for example — and it seems your husband is among that group.
If you understand exactly what’s going on, you may be able to minimize the problems for your man.
When we stand up, blood naturally pools in the veins of our legs due to gravity, which in turn reduces the flow to the heart and causes a drop in blood pressure.
The condition you describe is orthostatic hypotension, where blood pressure drops after standing or changing position. File image
This drop is usually noticed by receptors in the arteries of the neck that are part of our autonomic nervous system (which controls functions such as breathing that we have no conscious control over). In turn, these receptors send signals to the brain, triggering a series of changes to quickly return blood pressure to a normal range.
In people with orthostatic hypotension, these reflexes are compromised – often due to aging or conditions such as Parkinson’s or diabetes that impair the nervous system – and so blood pressure remains lowered, leading to dizziness after standing up.
Certain medications, including several antidepressants, some high blood pressure medications, beta-blockers, diuretics, and some sedatives can also cause it.
First, it’s critical for your husband to identify the factors that could be contributing to his orthostatic hypotension.
When medications are prescribed to treat other existing health conditions, the choice of how to manage the orthostatic hypotension can be a balanced decision. I suggest you see your GP to see if your husband would benefit from a review of any medications, with the aim of minimizing symptoms if they are contributing.
When we stand up, blood naturally pools in the veins of our legs due to gravity, which in turn reduces the flow to the heart and causes a drop in blood pressure. File image
He’s already been told that being well hydrated is important. This is especially relevant during meals, because after a meal, blood pressure tends to drop slightly and fluids will increase blood volume. You can also lower low blood pressure after eating by avoiding large meals, eating a low-carb diet, and avoiding alcohol.
A referral to a specialist physiotherapist may also help, as they may suggest a supervised exercise regimen. For example, walking for 30 minutes three times a week can, over time, improve the baroreceptor reflexes that keep your blood pressure stable.
Wearing professionally fitted full-length elastic compression stockings throughout the day will also minimize the amount of blood pooling in the legs. Your GP is well placed to give advice.
I am 72 and healthy, but lately I have been experiencing a stabbing pain in my right knee every few days when I walk, sit or lie in bed.
Although the pain lasts only ten to twenty seconds, it is very painful. What could be the cause?
Peter Schwemlein, Taunton.
From your description of the pain it sounds like you have what is called a loose body in the knee joint.
These are fragments of cartilage – the ‘shock absorber’ that protects our joints from wear and tear – that have become detached from the bulk of the cartilage at some point, either as a result of minor injury or osteoarthritis in the joints. joint.
From your description of the pain it sounds like you have what is called a loose body in the knee joint. File image
Usually the fragments remain free floating, but they can get stuck in the knee joint and cause acute pain. I suspect you need to see an orthopedic specialist, who will arrange an MRI scan.
If a loose body is identified as the problem, the solution is a keyhole procedure known as an arthroscopy, in which a probe with a small camera on the end is inserted into the joint to see what’s going on and to see all the remove offensive material. This is usually done under general anesthesia.
I think… Letby: Why doctors need more control
Can you imagine how the parents of the babies killed or injured by nurse Lucy Letby must feel knowing that the doctors have expressed their concerns about her – but that not only have they been ignored by management, but that the doctors even apologized to the murderous nurse?
Several doctors noted a much higher than usual death rate in the neonatal ward at Countess of Chester Hospital and called for an investigation into why, say, the same nurse – Letby – was always on duty for every unexpected death.
Can you imagine how the parents of the babies killed or injured by nurse Lucy Letby (pictured) must feel knowing doctors expressed their concerns about her?
Not only did management refuse to suspend the nurse, she was even able to file a formal complaint. In the hospital’s complaint inquiry, the questioning of Letby’s reputation was deemed ‘unacceptable’.
Doctors used to be the most important figures in the hospital hierarchy, but that was before the arrival of the manager. Now they are just cogs in a larger machine.
If management had given more weight to doctors’ views, lives probably would have been saved. I can’t help feeling that giving doctors more control, or even more respect, would be a big improvement over the current system.
Write to Dr. Scurr
Write to dr. Scurr of Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail.co.uk
Dr. Scurr cannot engage in personal correspondence. Answers should be taken in a general context. In case of health problems, consult your own doctor.