Automatic nervous system is on autopilot
DEAR DR. DONOHUE: Just today my wife was diagnosed with autonomic dysfunction, or dysautonomia. We know absolutely nothing about this. Will you please expand? Could it have anything to do with her having extremely high blood pressure (220/91) one day and the next day low pressure (90/40)? — J.S.
ANSWER: Most people are unaware that they have an autonomic nervous system. If they are aware, they frequently call it the automatic nervous system. That mistake isn’t such a bad one. The autonomic nervous system works automatically, by itself. It’s on autopilot. It tries to keep blood pressure where it should be. It speeds the heart up or slows it down according to what a person happens to be doing. It does the same with breathing. It gives the brain a signal when the bladder needs emptying. “Dys” is a popular way of indicating that something is on the blink. The signs and symptoms of autonomic dysfunction are many and varied, and only now is medicine becoming more and more attuned to them.
Blood pressure fluctuation from high to low is one of the signs that the autonomic nervous system isn’t functioning. Blood pressure soars when a person lies down or sits, and plummets when that person stands. Autonomic dysfunction can make people sweat profusely when sweating isn’t called for. It can interfere with sleep and the regulation of body heat. It might lead to dizziness.
A number of illnesses are classified under “autonomic dysfunction.” One is multiple system atrophy, which combines the features of autonomic dysfunction with some of the signs and symptoms of Parkinson’s disease.
You’re wondering how it’s treated. A single treatment isn’t available, but a combination of medicines often can correct symptoms.
DEAR DR. DONOHUE: I have an EKG done every year. I also have worn a monitor that records heart activity for three days. Everything is fine.
When I fall asleep most nights, I wake after about 10 minutes with a rapid heartbeat, and sometimes it takes quite a time before it settles down and I can get back to sleep. I rarely have such a rapid beat at any other time of the day. Do you know what causes this, or what it might be? I am 57. — S.B.
ANSWER: If I had to make a guess, it would be paroxysmal atrial tachycardia, a sudden heart speedup for no reason. It’s usually not a serious condition, and it doesn’t indicate heart disease. If the rate is really fast or if the episode lasts for a prolonged period, then treatment would be needed.
No one can be sure unless the rhythm comes on when a doctor is present or when you are hooked up to an EKG machine. That monitor you wore for three days can be left on for longer stretches of time. Or you could have someone take you to the emergency department of a hospital if you can reach it somewhat quickly. You can’t obtain a diagnosis without such information.
The booklet on heartbeat disorders discusses their more common forms. 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 $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: In 1967, I lost more than 100 pounds and have been diligent for the past 42 years to keep it off. In 2008, I had an aortic valve replacement surgery and gave up a 60-year smoking habit. I had been doing well until four months ago, when I was diagnosed with chronic obstructive pulmonary disease. In two months I have gained 18 pounds. I am panicking. I have not changed my diet or lifestyle in any way. Could it be the medicines I take? How can I combat this? — M.G.
ANSWER: I have gone over the list of your 12 medicines with a fine-tooth comb. Weight gain isn’t listed as a side effect for any of them. You’ll have to increase your calorie burning even if you have chronic obstructive pulmonary disease. Walking is the way to achieve the calorie deficit.
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. Readers may also order health newsletters from

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