Behind The Mystery: Neurogenic Orthostatic Hypotension (nOH)

Behind The Mystery: Neurogenic Orthostatic Hypotension (nOH)

August 28, 2019 1 By Bertrand Dibbert


[music]
– I was, tried finding my way down
to the stairs one evening when I,
and uh, I have suddenly felt myself uh,
just falling off the stairs and down to the uh, the
uh, bottom level of the house. – Today on behind the mystery,
we’re talking to Keith, his wife Linda,
and how they’re living with neurogenic orthostatic
hypotension, or NOH. Never heard of it? Well let’s start
with the basics. N, neurogenic,
associated with the nervous system. O, orthostatic,
related to standing up. H, hypotension, abnormally
low blood pressure. In the studio this
morning to help us understand this
condition, is neurologist Dr. Stuart Isaacson. Good morning, Doctor. – Good morning. – Thank you so much
for being here. We’re gonna hear from Keith and
his wife Linda in just a bit, but first, let’s talk
about what is NOH? I’ve never heard of it. – Well, NOH as you
just pointed out, is neurogenic
orthostatic hypotension. And it’s a condition
that’s not very common, but occurs in people who have
Parkinson’s disease and some related
conditions called multiple system atrophy. And the problem with
NOH is, usually, when we stand up, we
release a chemical, a chemical called
norepinephrine. And this causes the blood
vessels to constrict, and the heart to beat faster,
so blood pressure comes up and we don’t
feel like the blood pressure’s dropping. We don’t have feelings
of lightheadedness or dizziness. Many people with Parkinson’s
disease, probably about one in five have
symptoms from NOH, and when they stand
up, not enough norepinephrine is
released and the blood pressure goes down and down,
and they begin to develop lightheadedness
and dizziness and they might even pass out. – [Olga] So in terms
of how many people are affected, it’s one in five. – One in five will
have symptoms. These may be provoked
by dehydration or not feeling well
or taking medication that may lower blood pressure. And then when symptoms come out,
we have to pay attention to the symptoms. And one way we do
this is we have people check their
blood pressure. They can check it
in the visit when they come to our office,
they can check it at home, often after
breakfast might be a time of day when
it’s the lowest. They can keep a diary
of how it changes around mealtime
or after meals or when they’re lying
in bed at night. And we find that
blood pressure drops, we always look for
a key point which is at the heart rate. Usually when blood
pressure falls and someone feels lightheaded,
the heart rate goes up and up and up. But in neurogenic
orthostatic hypotension, in NOH, the heart
rate doesn’t change much at all. And that’s really a key
for a doctor or nurse to make the diagnosis of NOH. – We recently spent
the day with Keith, who has Parkinson’s,
and his wife Linda. His diagnosis of NOH
came several years into the onset of Parkinson’s. Let’s hear more. – Do you want some more coffee? – Sure. – A little bit of fruit? – [Olga Voiceover] It
was ten years after his Parkinson’s diagnosis
that Keith and his wife Linda noticed
signs and symptoms of what would eventually
be diagnosed as NOH. Episodes were sporadic. – [Linda] You know,
kinda stumbling as after being in a car ride or going up
a set of steps, why, you know, why all of a sudden
would you be dizzy? – That was the time
when we thought it was just a, just
a periodic event. That there was, was
happening every now and then. – [Linda] The NOH
diagnosis was a little bit more difficult
because initially, I just thought it
was the other shoe that fell off with Parkinson’s. He’d had a couple falls,
not just down the, the steps, but a couple
general falls like, does this mean this
is what happens with Parkinson’s? And we’d been educated
enough to know that everybody is different. So we were also very fortunate
that our general practitioner and our move-in specialist
spoke to each other. So between the two
of them came up with, okay, we’ve got some blood
pressure issues here. – [Olga Voiceover]
Keith, a former pilot and self-described
gym rat has learned to manage his NOH symptoms. He makes sure to
drink more water along with other
lifestyle changes as recommended by his doctor. – The enemy is impatience. At sometimes you’re
in a situation where you don’t know how severe your,
your episode’s gonna be. And so I uh, I have
a routine where I get up and I give
the blood a chance to kinda, and the blood
pressure to equalize and I’ve been able
to avoid any uh, any mishaps just following
a simple set of rules. – [Olga Voiceover] They
keep a blood pressure log and communicate
regularly with their healthcare team. – [Linda] Communication
with your doctor is extremely important. – [Olga Voiceover]
College sweethearts, the Halls have always
been an on-the-go family. They’re taking
steps to help ensure they continue to
stay active even with Keith’s
Parkinson’s and NOH. – When Keith’s first
initial diagnosis, to me, it wasn’t devastating. I’m always taken aback
when people say that. So to us, it was
just part of what our journey was going to be. It might be tiring,
but I think to have things move smoothly,
and you do have to think about everything. So if you are traveling
or you’re going out, you make sure that
you, you know, have your snacks and your water
and your glasses and it’s just part
of who we are and what we’re doing. – [Olga Voiceover]
And they’re committed to spreading awareness. – I think the best thing is to,
is to look into what your local resources are. Support groups can be wonderful,
but they also can not be for everyone. Finding classes that you
can either do together or finding your own
thing that you can do. – Now Doctor, while you’re
not Keith’s physician, can you relate this
to how your experience has been with your patients? – Well, I think
what we heard from Keith and his wife
are that these symptoms come on very gradually. It’s hard to sometimes recognize
that they’re new symptoms. He’s had symptoms of Parkinson’s
for several years where he’s had trouble maybe
arising from a chair and walking and
having good balance and movement and now
different symptoms may occur that could
be confused with the mobility problems
of Parkinson’s. So it’s important
when you have any types of symptoms standing,
or after a meal, to bring those up
at a visit with a doctor or nurse and talk about
how the symptoms may be different and
may be early symptoms of NOH. – Now Doctor, once
properly diagnosed, are there ways to
manage NOH symptoms? – [Stuart] When they stand up,
they should do it gradually. Sit at the side of the bed
for a couple of minutes. Then stand up, and
before they walk, wait a couple of minutes. Sometimes squeezing
the calf muscles or the gluteal muscles
can help maintain blood pressure when
they stand up as well. Some of our patients wear
compression stockings, usually up to the
waist, so it can really push the
blood back from the stomach and also the legs. We tell our patients to
remain well-hydrated. To really concentrate
on drinking a lot of water and other fluids. And adding salt to their diet. Especially drinking
those fluids in the morning hours when
blood pressure is lower. Some of our patients elevate the
head of the bed when they sleep. And when they
don’t work, we have medications that
can help as well. Our patients always
have to talk with their doctors and nurses to
make sure that whatever they’re anticipating
to do to try to treat this problem is done
with medical guidance. – It’s a manageable
energy where you can modify the, the
response that you have to the NOH by being patient
you can live with it and you can do well with it. – So Doctor, to
summarize everything, what are the key things
we need to remember here? – Well, I think it’s
important to realize that it’s, NOH is very
common in Parkinson’s. Even more common in
multiple system atrophy and so whenever
you have symptoms that occur when you stand up,
always think that it could be a symptom
of NOH and bring it up at your next visit
with your doctor or nurse and to make
the diagnosis, the blood pressure has
to be checked seated, and also standing
with the heart rate to make that diagnosis. Because the diagnosis
has to be made so we can use
effective management to try to improve the symptoms
and not have people doing less and less
activity, becoming isolated, becoming depressed,
not going out and going about their day
because the blood pressure’s too low. – Doctor, thank you
so much for your time and all the information
you’ve given us today. – Thank you. – And if you’d like
more information on NOH, you can go to this
website, NOHmatters.com, or just check out our
website, thebalancingact.com. [upbeat music]