DEAR DR. DONOHUE: My wife’s blood pressure is normal in the morning. She’s on blood pressure medicine. What might cause her to feel dizzy when she stands up? Can anything be done about it? – P.A.

Your wife has symptoms compatible with a precipitous drop in blood pressure when rising from the seated or lying position. The name of this condition is orthostatic hypotension – “hypotension” being low blood pressure and “orthostatic” meaning the upright position.

In normal circumstances when a person rises from lying down or sitting, blood pools in the leg blood vessels. Immediately a normal body makes adjustments that keep pressure up. It constricts leg vessels so blood cannot pool in them. Without such adjustments, a drop in blood pressure shortchanges the brain of its blood supply. The result is dizziness and a wobbly feeling.

If your wife takes blood pressure medicines, they might be contributing to the dizziness she experiences upon standing. Diuretics in particular are often implicated. They keep the body’s fluid reserves on the low side, so they can predispose people to orthostatic hypotension. Your wife’s doctor (or you) can confirm this condition by taking her blood pressure while she’s seated and immediately upon standing.

If this is the cause, your wife might need a change in blood pressure medicine. She can prevent blood pooling in her legs by rising slowly and by contracting her leg muscles about 10 times before she rises. Drinking 4 ounces (120 ml) of water before rising can sometimes prevent the blood pressure drop. So can support hose and using a liberal amount of salt. All of this is contingent on her doctor’s proving the suggested diagnosis.

DEAR DR. DONOHUE: My question is about syphilis. An evil female gave me this disease about four years ago. I was treated with a shot. Recently I have burning sensations in my penis, but there is no discharge. Could I pass this monster to other women? What should I do? – J.L.

Let’s go over the syphilis story to relieve your unmerited anxiety. About three weeks after contact with an infected partner, a sore on the genitals appears. It is usually painless. It is called a chancre (SHANK-ur), and it goes away even without treatment. Four to 10 weeks after the appearance of the chancre, a copper-colored rash often breaks out. The rash is on the trunk and arms and frequently on the palms and soles. The latter sites are a pretty reliable indicator of syphilis. (Other conditions can cause such a rash, too.) Simultaneous with the rash is a feeling as though one has the flu. Other symptoms include a headache and swollen lymph nodes. All of this vanishes on its own, just as the chancre did.

The infection then enters a silent stage. Years later, untreated people can be hit with leaky heart valves, mental incapacity, difficulty walking, and the appearance of mounds of dead cells in bone, the liver and other places. Penicillin prevents all of these symptoms. Your symptom is not a syphilis symptom.

If you want proof of the success of your past treatment, have a VDRL blood test done. It should come back negative or show only low numbers. Penicillin almost always effects a cure.

Syphilis, while rarely discussed, is still with us and can still be responsible for major suffering and disability. The number of cases is only a fraction of what it was before penicillin, but that fraction is a sizable number of people.

DEAR DR. DONOHUE: When a person has diarrhea, where does all the fluid come from? I am just getting over it, and I can’t believe the amount of fluid I lost. – R.R.

Eight quarts (liters) of fluid enter the digestive tract daily. Most of that fluid is reabsorbed as undigested food passes through the tract. Diarrhea results from the shutting down of the reabsorption capability. Replenishing lost fluid is one of the chief goals in treating diarrhea.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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