May 3, 2017

My Chronic Problem with "Orthostatic Hypotension" + My New issue with Hyponatremia = the Worst Time I've Had with My Parkinson's

What follows is the text of an email I sent to my internist, my neurologist, and the doctor I see about blood pressure. The note describes two setbacks from last last week. These incidents illustrate why I've been having the toughest times yet dealing with Parkinson's disease (PD). 

The culprits? Orthostatic hypotension and hyponatremia.

Here's that email:


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These two conditions -- orthostatic hypotension and hyponatremia -- are increasingly impacting the quality of my life. They are major threats to my physical well-being. Witness these two incidents that happened last week.

1) Wednesday Lunch
I'd been looking forward to this lunch with a treasured friend who will celebrate her 88th birthday in July, two months after mine. I was thoroughly enjoying our reminiscing, but toward the end of the lunch I sensed that my blood pressure was dropping and that I was about to have an attack of orthostatic hypotension. 

Sure enough, I ended up of having to get one of the waiters to hold me up as I tried to use my walker to get to my friend's car. On the drive home, I called my part-time caregiver so he could meet us at the house. He had to pick me up and carry me inside.

I have been having these so-called orthostatic hypotension attacks with increasing frequency and severity for the past year or so. The diuretic blood pressure medication prescribed when I was in Sibley's Renaissance rehab center seems to have triggered even more attacks.

Also compounding my current malaise is the newly diagnosed hyponatremia. The low level of sodium was first noted in the blood work done in Dr. Marcus's office just before I fell and fractured my hip.

Since this hyponatremia seemed to coincide with starting a new medication for my incontinence, I initially thought it was a side effect of the new pill. But low sodium readings have continued for over two months now, so I no longer think it's a side effect of the drug I stopped taking back in January.

Studies have shown that hyponatremia increases the risk of falls, and my experience confirms that connection. I've had Parkinson's for ten years. But before this hyponatremia condition, I'd had very few falls I'd attribute to my PD.

For about a week before the hip-fracture fall, I'd been feeling a deterioration in my sense of balance, no doubt as a result of the drop in sodium. This sensation has continued. I feel that the unusually severe attack of the so-called orthostatic hypotension (OH) on Wednesday was attributable to hyponatremia.

I've referred to these attacks as "so-called" orthostatic hypotension. From what I've read, OH describes low blood pressure episodes that occur when you stand up from sitting or lying down.

When my attacks began over five years ago, a change in position was often involved. But today, the incidents occur without my changing position. On Wednesday, we'd been sitting at the table for over an hour when the attack began.

2) Thursday 911 Call 
On Thursday morning, I was having a conversation with my housemate Nimesh when he noticed that I had tuned out. We had a similar incident recently.

On both occasions, I became unresponsive to his questions. I was aware of what was going on and what he was saying, but I was unable to respond.

Both times, he wanted to call 911. I talked him out of it the first time, but not again. These two recent events raised concerns about a possible stroke.

By the time the EMTs arrived, I was fully responsive. They did a few tests and asked a few questions, but saw no need for me to go to the hospital.

While debating whether to call 911, my housemate and I continued to take my blood pressure. Here are the readings over a 15-minute period: 
  • 67/34
  • 59/34
  • 67/38 
  • 64/39
As with the orthostatic hypotension incident at the Wednesday lunch, low blood pressure seems to be the culprit this time.

The best way I've found to deal with low blood pressure is to take a very small amount of 5-HTP, the serotonin-boosting supplement I've used for years to help combat insomnia, constipation and depression. Unfortunately, it also has a side effect in my case: elevated blood pressure.

As a result, I've stopped taking the 5-HTP on a regular basis. But when I'm now faced with the danger of fainting or falling due to a rapid drop in my blood pressure, I've been experimenting with taking a very small amount of 5-HTP to see if it might counter the dangerous blood pressure drops. So far, it's been working.

It may not be the perfect remedy. But I don't know of anything else that could be so speedily effective.

I'm writing this email on Sunday afternoon, after the Wednesday lunch and the Thursday 911 call. I've been trying to reduce my fluid intake, and I've been taking one or two salt pills a day.

I had a fall this morning. Even so, I'm beginning to feel that progress is being made on restoring my sense of balance.

I'll call Dr. Grady's office in the morning to see if I can get a new blood test for sodium. I'd also be interested in any suggestions.

I will see that Dr. Herzfeld gets a copy of this email.

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4 comments:

Ralph Goin said...





Ralph Goin said...

Paul,

I want to congratulate you on how you are dealing with your P D.
It looks like you might have created a new way of fighting P.D. If you find out your doctor verifies that, he should see to it that you get the credit, which would be appropriate for you. Keep up the good fight!

Ralph Goin

maegan@healthline.com said...

Hi John,

Healthline would like to congratulate you on making our list of the Best Parkinson's Disease Blogs of 2017!

Our editors carefully selected the most up-to-date, informative, and inspiring blogs that aim to uplift their readers through education and personal stories. We’re glad to have you on the list!

We’ve created a badge that you can embed on your site to let your readers know about your win. The embed code is at the link below.

Winners list: http://www.healthline.com/health/parkinsons/best-blogs-of-the-year
Badge to embed: http://www.healthline.com/health/parkinsons/best-blogs-badge-2015

If you have any questions or need help embedding the badge, feel free to be in touch. Congratulations and keep up the great blogging!

Warmly,
Maegan

--
Maegan Jones | Content Coordinator
Healthline
Your most trusted ally in pursuit of health and well-being

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