The Perils of Standing: Treating Orthostatic Intolerance in
Chronic Fatigue Syndrome (ME/CFS)
Standing up is a largely unconscious activity for most people. For some people,
however, this simple act can be fraught with peril; causing their heart to pound
and their blood pressure to drop and leaving them dizzy, nauseous and fatigued.
It turns out that standing is not simple not all. Just the act of rising
requires that a complex set of interactions involving the nervous system, blood
vessels, muscle and heart work smoothly to keep the blood from draining from out
of our upper body into our lower body.
Orthostatic intolerance is a relatively new and evolving field and different
forms of OI are being uncovered. Some people exhibit immediate drops in blood
pressure upon standing (dysautonomia induced OI) for others it takes more time
(vasovagal faint), instead of low blood pressure some people experience
increased heart rates (postural tachycardia syndrome (POTS)) and a recently
discovered group has problems with carbon dioxide elimination (POSH).
Orthostatic Intolerance
Drugs
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Do I Have Orthostatic Intolerance? Tilt table tests (if
done correctly) can identify different forms of orthostatic intolerance but
they’re not fool proof. One rather telling study found that most of the ME/CFS
patients that seemed to ‘pass’ their tilt table tests still experienced
worsening symptoms during one.
For those wishing to try their own ‘tilt table’ test. Dr. Bell provides one that
can be done at home. In the end, though, the symptoms are the key. For some
people the answer regarding whether they have OI is painfully obvious; standing
immediately brings on dizziness, heart pounding, fatigue, difficulty
concentrating and more.
Dig Deeper: A
Simple Test for Orthostatic Intolerance by Dr. David Bell
For others with less dramatic symptoms the issue is a bit more clouded. A yes
answer to any of the following questions suggests you could have some form of
orthostatic intolerance.
- Do your symptoms tend to worsen when you stand up or have to stand still for a
period of time?
- Are you a squirmer when you're standing in line?
- Do you feel like you think better when you're in a seated position?
- Does bringing one leg up when you’re sitting for some reason just feel better?
- Are you typically exhausted after meals?
- Do warm showers bother you?
- Does warm weather bother you?
Treating Orthostatic Intolerance in Chronic Fatigue Syndrome
(ME/CFS)
Orthostatic Intolerance and Chronic Fatigue Syndrome (ME/DFS): the Research