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Top 10 Tips to Manage Orthostatic Intolerance On Your Own
Many persons with CFS experience problems with upright posture that accompany various forms of orthostatic intolerance (OI) – dizziness, feeling faint, muddled thinking, increased fatigue after standing, nausea and profuse sweating. These symptoms can be provoked or made worse in warm temperatures, so we offer tips to cope during the summer months – and year ‘round – if they’re a problem for you.
During the summer it’s important for everyone to drink plenty of fluids and avoid getting overheated. But people with postural problems will find that making a very conscious effort to drink water all through the day will help ward off dizziness and headache that are triggered by even mild dehydration. Some experts suggest drinking two liters of water a day to provide proper hydration. Gatorade and other sports drinks may provide added benefits, but be careful about the high sugar content and extra calories they contain.
Don’t fear salt!
Salt plays an important role in helping retain fluids in the blood vessels and maintain blood pressure. For decades we’ve been told to restrict salt intake, but this recommendation is really intended for people who have high blood pressure or who already eat a high-salt diet. So shake on the salt! Some people with very low blood pressure report that adding healthy high sodium foods like tomato juice or salt tablets to their diets provide a noticeable improvement in OI symptoms.
Feet up by day; head up by night
Whenever you can during the day, elevate your feet to help blood return from your extremities and back to your heart and brain. At night, it’s actually best to elevate the head of your bed slightly – just 10-15 degrees. This position helps the body retain fluid, rather than losing fluid into the urine.
Anytime you have to stand still, whether it’s at the kitchen sink or in line at the post office, fidget. Flex your leg muscles and shift your weight to help keep blood from pooling in your legs. Even when standing in an elevator, these small movements can help your body to adjust to sudden elevation changes that can worsen symptoms.
From hose, that is. Waist-high compression stockings or support hose can help push blood from the legs back into the torso. There are a variety of options available (even for men) at medical supply stores and online. Compression stockings are fitted to you and may require a prescription; they also have to be used correctly to provide results. Lighter weight support hose are easier (and less expensive) to obtain but may not provide as much relief. You may find it takes some experimentation to make them work for you.
Avoid large meals, especially at night. The digestive process requires added blood flow, drawing fluids away from other body functions (like thinking and moving large muscle groups). Instead, eat smaller meals throughout the day. Also avoid consuming alcohol because it causes dilation of the veins. (Most people with CFS and/or OI find they can’t tolerate alcohol anyway.)
Stay out of warm environments as much as possible. If you have to go out, make trips early in the day or after sundown. Seek shade when parking your car or attending outdoor events -- even a few degrees can help avoid the extra fluid lost to heat and sun exposure. Avoid saunas, greenhouses and other intentionally warm indoor environments, too.
Try a bath
Showering often provokes symptoms because of the combined effects of standing still and the warm environment. Bathing can actually provide a therapeutically effective way to accomplish personal hygiene, especially if you use cooler water and can submerge to shoulder level with knees slightly bent and arms at your sides. This posture and the pressure of the water around you improve blood pressure and lymphatic flow, and have some beneficial effects on dilation of vessels in the skin, too.
For a couple weeks, make notes about everyday activities and your symptoms to uncover patterns that might exist. You may find that you’re standing for longer periods in the superstore and that a smaller market is better. Sitting on the (shady) “away” sidelines at your daughter’s soccer match may allow you to stay longer than when you sit on the (sunny) “home” bleachers. Eating half a sandwich mid-morning and the second half mid-afternoon may help avoid the afternoon slump that’s made worse when blood flow diverts to digest a larger meal.
Look out for overlap
OI expert Dr. Peter Rowe points out in a 2002 article, “An underappreciated aspect of management is the need for effective control of other comorbid conditions that may independently contribute to orthostatic intolerance, including allergies, asthma, dysmenorrhea, migraine headaches, movement dysfunctions (especially those associated with hypermobility), anxiety and depression.” Some of these conditions are amenable to the same kinds of medications as OI, so there may be some two-for-one benefits possible. Also be aware of medication side effects that can make any overlapping conditions worse.
Like CFS itself, managing OI generally requires a combination of pharmacological and non-pharmacological therapies. Remember that even small changes can have positive effects over time, especially if they become routine.