DEAR DR. DONOHUE: My doctor said I have orthostatic hypotension. Is there a cure for it? – B.M.

ANSWER: “Orthostatic” means the erect position – standing up; hypotension is low blood pressure. Orthostatic hypotension, therefore, is a drop in blood pressure upon standing.

Blood pressure changes constantly from minute to minute, depending on what a person is doing. Taking care of raising and lowering it appropriately falls into the province of the autonomic nervous system – nerves over which we have little to no control and that operate on automatic pilot.

When a person rises from the lying or sitting position, blood fills the veins in the lower part of the body. That takes blood out of circulation, so to speak. The result is a drop in blood pressure. If the drop is not remedied quickly, the brain suffers a blood deficit, and a person feels woozy and is on the verge of fainting. A faint can occur.

Ordinarily the autonomic nervous system raises blood pressure when a person rises. However, with age, the autonomic nervous system loses some of its vigor, and it doesn’t perform well. Orthostatic hypotension results.

The first order of business is to look for things that can put the autonomic nervous system on the blink. Diabetes, Parkinson’s disease and neuropathies (nerve disturbances) are conditions that can throw the autonomic nervous system off kilter.

If such conditions cannot be found, then people can do things that prevent precipitous blood pressure drops. Boosting the amount of salt in the diet is one – if salt is not contraindicated, as it is for those with high blood pressure. Wearing elastic stockings can keep blood from pooling in the legs and lowering blood pressure. Drinking two 8-ounce glasses of water provides, after two minutes, a modest rise in blood pressure that lasts for two hours – a preventive step for one who knows he or she is subject to spells of orthostatic hypotension.

DEAR DR. DONOHUE: Is pulse rate the same as your heart rate? My pulse rate is 42 to 48. Is this too low for a 70-year-old man? What is the normal range? – J.S.

ANSWER: Pulse rate and heart rate are the same. If you put your hand over your heart, you can feel the heartbeat. Count how many times it happens in a minute, and that’s your heart rate. If you put a finger on the artery on the thumb side of the wrist, you can feel it pulsate. Count those pulsations for a minute, and that is your pulse rate. Your heart rate and pulse rate will be the same.

The normal heart rate/pulse rate is 60 to 100 beats a minute. Less than 50 is bradycardia. If such a low rate causes dizziness or fainting spells, it needs immediate attention, and a pacemaker is the usual treatment. If it doesn’t cause symptoms, it needs regular doctor observation because it can herald future problems.

The booklet on heartbeat irregularities takes the mystery out of abnormal heartbeats and rhythms. Readers can order a copy by writing: Dr. Donohue, No. 107, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have friends who take Celebrex, and they say it can cause bad side effects for your kidneys. Please tell me something about it and if it is good to take. – A.C.

ANSWER: Celebrex is a drug for arthritis. It’s an NSAID, a nonsteroidal anti-inflammatory drug. That means it fights inflammation without being a cortisone drug. Cortisone drugs are steroids, and they are the most powerful inflammation-fighters available.

There are 20 NSAID drugs. Familiar names include Advil, Aleve and Motrin. One drawback of NSAIDs is their tendency to irritate the stomach. Celebrex was synthesized to lessen stomach irritation. It does so, but it is not completely free of such an effect.

Celebrex and many other NSAIDs can lead to kidney injury, but it seldom occurs and can usually be reversed by stopping the medicine. I would not hesitate to use Celebrex if I needed it.

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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