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2 episodes with orthostatic hypotension
2 episodes with orthostatic hypotension
2 episodes with orthostatic hypotension
2 episodes with orthostatic hypotension
2 episodes with orthostatic hypotension
2 episodes with orthostatic hypotension
2 episodes with orthostatic hypotension
Broadcast from KSQD, Santa Cruz on 10-10-2024: Dr. Dawn announces Medicare's new list of over 200 drugs available for $2 per 30-day supply, covering a wide range of medications. She discusses a new urine test called ExoDx for prostate cancer screening, which can help avoid unnecessary biopsies in the "gray zone" of elevated PSA levels. The doctor addresses a listener's question about Klebsiella pneumoniae found in a nasal swab, explaining colonization versus infection and the risks of unnecessary antibiotic use. Dr. Dawn explores the reliability of QuantiFERON TB tests, suggesting potential false positives and the importance of retesting with different antigen tubes. She discusses orthostatic hypotension in older adults, offering practical tips like squeezing a firm ball before standing up and proper standing techniques to prevent falls. The doctor explains the importance of vitamin A for vegans, highlighting potential BCMO1 genetic variations that may affect beta-carotene conversion and recommending blood tests. Dr. Dawn addresses a question about elevated bilirubin levels post-gallbladder removal, discussing possible causes and diagnostic procedures like MRI and ERCP.
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KSQD 4-24-2024: In this week's show, we tackle several important health topics. Dr. Dawn starts by investigating "the prescribing cascade," where side effects from an initial medication necessitate additional prescriptions. This is often seen with treatments for high blood pressure and atrial fibrillation. We then explore strokes of undetermined origin. Interestingly, Dr. Dawn notes that for preventing recurrent strokes, the classic, low-cost aspirin can be just as effective as newer, more expensive alternatives. Another topic is delayed orthostatic hypotension, a condition where blood pressure drops upon standing. Dr. Dawn provides details on a simple test for diagnosis. We address a worrying trend: increasingly aggressive colon cancers are occurring in younger populations. Dr. Dawn discusses both established and novel screening tests, like the new DNA-based successor to Cologuard, emphasizing the importance of early detection. Finally, we offer a sobering reality check about vaping. Studies show a growing number of young people who begin with vaping are transitioning to traditional smoking, underscoring that vaping carries its own significant risks.
Blake wants to reduce the risk of orthostatic hypotension in a patient with low blood pressure. The physical therapist should: A. Encourage slow transitions from sitting to standing B. Have the patient perform deep breathing exercises before standing C. Recommend wearing compression stockings during sessions D. Check the chart for blood pressure reducing medications LINKS MENTIONED: Did you get this question wrong?! If you were stuck between two answers and selected the wrong one, then you need to visit www.NPTEPASS.com, to learn about the #1 solution to STOP getting stuck. Are you looking for a bundle of Coach K's Top MSK Cheatsheets? Look no further: www.nptecheatsheets.com --- Support this podcast: https://podcasters.spotify.com/pod/show/thepthustle/support
The world of Dysautonomia and all the various symptoms and conditions that fall under this broad heading, can leave people impacted by it, feeling miserable, defeated and like their world is limited due to their inability to properly function within it.Dysautonomia is an umbrella term used to described disorders related to the autonomic nervous system (ANS). The ANS serves as an automatic/unconscious control system for our brain and the nervous system making sure our body has a stable environment and all the fuel and input it needs. This beautiful system, the ANS, regulates blood pressure, heart rate, breathing, digestion, temperature control, hormone secretion and regulation, pupillary reflexes, organ function and basic survival control.As you can imagine, when any of these above areas of our body are impacted and the ANS loses is ability to properly control the specific system, the resulting Dysautonomia can be incredibly disruptive to the health of the individual.Common Symptoms to Dysautonomia are the following: LightheadednessFaintingHeat IntoleranceAbnormal Blood PressureIrregular Heart Beat (Commonly Tachycardia/Increased Heart Rate)Brain FogImproper Nutrient AbsorptionFatigueIntolerance to standing or exercise (Often Due to Orthostatic Hypotension or POTS)Photophobia (Light sensitivity)Gastrointestinal ProblemsChronic PainDizziness (Lightheadedness)Migraine and Chronic HeadachesIn this episode we are fortunate to have our friend, colleague and expert in the field of Dysautonomia on the podcast to discuss the subject and share his wealth of knowledge on how to help people impacted by it... Dr. Nathan Kaiser, DC, DACNB, FABBIR.Dr Keiser is a board certified chiropractic neurologist specializing in non-surgical, non-pharmaceutical treatment of the dysautonomia, traumatic brain injury, and movement disorders. He resides and practices in Chelsea, Michigan, just 20 minutes west of Ann Arbor.In addition to his clinical practice, Dr. Keiser serves as an Assistant Professor of Clinical Neurology for the Carrick Institute, which provides post-graduate instruction for doctors of all disciplines in the field of clinical and functional neurology. He is actively involved in ongoing research in his area of study and he regularly presents and teaches across North America and Europe. He is a true leader in the world of Dysautonomia and through his research, clinical approach years of practice in this specialized area has led to greater hope for those suffering from one of the many conditions that fall under this broad family of neurological disorders.Over 70 million people worldwide live with various forms of dysautonomia and I would estimate that this number is well below the actual number truly impacted.Concussion and Traumatic Brain Injury (TBI) are two common causes to dysautonomia but more recently we have seen an increase in post-infectious causes due to infections like COVID-19. Dysautonomia can be a part of the lingering "Long Haulers" symptoms.Common Dysautonomias:Postural Orthostatic Tachycardia Syndrome (POTS)MigrainesAnxiety and Panic Attacks (certain ones can be a result of dysautonomia)We hope you enjoy this discussion on dysautonomia and we hope it delivers information to help you or someone you know find help and answers.For more information on our guest, Dr. Keiser, please check out his instagram, @dockeiser, or his website at www.drkeiser.comFor more information about the hosts of the show and to get in contact please reach out to: www.thewellnessinstituteofdallas.com or on IG @healthwealthultimateself or @wellnessinstituteofdallas
Today, you'll learn about the psychological toll of steroid use, a very slow moving penguin-iceberg collision, and why we sometimes get dizzy when we stand up. Steroid Psychopath “Male weightlifters who use steroids are more prone to psychopathology than those who do not.” by Vladimir Hedrih. 2023. “Clustering psychopathology in male anabolic-androgenic steroid users and nonusing weightlifters.” by Marie Lindvik Jorstad, et al. 2023. “Anabolic Steroids.” Cleveland Clinic. 2023. Iceberg Crash “45-mile-long iceberg slams into penguin refuge in Antarctica, almost causing ecological disaster.” by Harry Baker. 2023. “A Brief Iceberg-Island Encounter.” by Adam Voiland. 2023. “Chinstrap Penguin.” n.a. N.d. “Chinstrap Penguin.” National Geographic. N.d. Stand Up Dizziness “Why do you get dizzy if you stand up too fast?” by Anna Gora. 2023. “Orthostatic Hypotension.” NIH. 2023. “A Brief REview on the Pathological Role of Decreased Blood Flow Affected in Retinitis Pigmentosa.” by Yi Jing Yang. 2018. Follow Curiosity Daily on your favorite podcast app to get smarter with Calli and Nate — for free! Still curious? Get exclusive science shows, nature documentaries, and more real-life entertainment on discovery+! Go to https://discoveryplus.com/curiosity to start your 7-day free trial. discovery+ is currently only available for US subscribers. Hosted on Acast. See acast.com/privacy for more information.
Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices
Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices
Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices
Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices
Vi intervjuade Madeleine Johansson, MD, PhD, Kardiolog, Lunds Universitet. Hon berättade om att i studien såg de en stor skillnad i endostatinnivån hos patienter med ortostatisk hypotension jämfört med friska individer. PP-ELI-SWE-2809
In this episode, we review the high-yield topic of Orthostatic Hypotension from the Cardiovascular section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets
Orthostatic hypotension (OH) occurs when the body has an inadequate response to postural changes and, as a result, is unable to maintain a steady blood pressure when moving from a lying to standing position. It is defined as a decrease in systolic or diastolic blood pressure that occurs within three minutes of moving from a sitting or supine position to a standing position. The parameter for OH is a decrease of 20 mmHg systolic or a decrease of 10 mmHg diastolic. In this episode you'll learn: * The physiology of orthostatic hypotension * The key difference between acute and chronic OH * How neurogenic OH differs from non-neurogenic OH * Conditions that exacerbate OH * Why drug-induced OH occurs * Medical conditions that can cause an individual to have acute or chronic OH * The complications of orthostatic hypotension * How orthostatic hypotension is diagnosed * How orthostatic hypotension is treated * Pharmacology for OH Read the article and view references here. Are you looking for an easier way to learn Med Surg? Enroll in Med Surg Solution and get lessons on 57 key topics as well as out-of-this-world study guides! If this episode helped you, please take a moment to rate and review the show! This helps others find the podcast, which helps me help even more people _____________________________________ The information, including but not limited to, audio, video, text, and graphics contained on this podcast are for educational purposes only. No content on this podcast is intended to guide nursing practice and does not supersede any individual healthcare provider's scope of practice or any nursing school curriculum. Additionally, no content on this podcast is intended to be a substitute for professional medical advice, diagnosis or treatment. Straight a Nursing is a proud member of the Airwave Media Network. Learn more about your ad choices. Visit megaphone.fm/adchoices
In this episode, Dr. Salima Brillman discusses: The what and why of nOH (neurogenic orthostatic hypotension) Treatments for nOH In the moment tricks for managing nOH episodes How to talk to your doctor about your symptoms The effect of food and lifestyle choices on nOH Click here for the accompanying blog post to this episode where you will find any mentioned links and resources, the video recording, and more.
Join Akilah Cadet and host, Harper Spero, for a special IG Live event on February 22nd at 12:30pm EST! Follow @madevisiblestories on Instagram to tune in. Akilah has been diagnosed with pericarditis, coronary artery spasms, and orthostatic hypotension, but she's still searching for a reason why she's experiencing intense and chronic pain on the left side of her body. On today's episode, we talk about how why she no longer thinks of her health journey as a temporary bump in the road, why she decided to start talking about her health with clients, and how she advocates for herself, despite the bias she encounters as a woman of color, so she can find answers. This episode previously aired on December 4th, 2018. For more information about Akilah and her journey with advocating for herself, visit our website at madevisiblestories.com/podcast This podcast aims to change the conversation around invisible illnesses and we need your help! Help support our mission by leaving a review and sharing this episode! Please note: This podcast is intended to provide information and education and is not intended to provide diagnosis, treatment, prevention, cure, or guarantee. You should consult with a licensed or registered healthcare professional about your individual condition and circumstance. Join the conversation and connect with us online! Website: madvisiblestories.com Facebook: madevisiblepodcast Instagram: @madevisiblestories LinkedIn: madevisible Lily CBD's hemp-based CBD oil offers an alternative way to nurture yourself, and can be especially beneficial for relieving anxiety and inflammation. Because Lily CBD focuses on small, single-farm harvests, more nutrients are able to make their way into each bottle. Think of it like a glass of beautiful natural wine from a small family vineyard. Visit lilycbd.com and use code madevisible at checkout for 15% off. – Podcast Editor & Strategist: @episodeready
This episode summarizes some key points from a systematic review by Logan et al( 2022) that looks at what are the current non-pharmacological interventions that can be used to treat postural drop/Orthostatic hypotension. I recommend you still go and look at the original piece of work to get the full context as well as the limitations that the study highlights for each of the treatments mentioned. link to full review - Effectiveness of non-pharmacological interventions to treat orthostatic hypotension in elderly people and people with a neurological condition: a systematic review https://journals.lww.com/jbisrir/Fulltext/2020/12000/Effectiveness_of_non_pharmacological_interventions.4.aspx Logan, Angela1,2,3; Freeman, Jennifer1,3; Pooler, Jillian4; Kent, Bridie3,5; Gunn, Hilary1; Billings, Sarah6; Cork, Emma7; Marsden, Jonathan1,3. Effectiveness of non-pharmacological interventions to treat orthostatic hypotension in elderly people and people with a neurological condition: a systematic review. JBI Evidence Synthesis 18(12):p 2556-2617, December 2020. | DOI: 10.11124/JBISRIR-D-18-00005 Make sure to check out www.rookshealth.com for more information and a deeper dive into this episode and more health and wellness topics To read more blog posts on each podcast episode check https://www.rookshealth.com/podcast/ Find out more information about this podcast and more health debunk tips on social media @Rookshealth Twitter: https://twitter.com/rookshealth Instagram: https://www.instagram.com/rookshealth/?hl=en Facebook: https://www.facebook.com/Rookshealth Pinterest: https://www.pinterest.co.uk/rookshealth/ Support the show (https://www.buymeacoffee.com/rookshealth)
This episode covers the two types of orthostatic syncope:Neurally mediated orthostatic syncope (from conditions with autonomic dysfunction)and"non-neurally mediated" orthostatic syncope which is from medications or hypovolemia.We discuss the diagnostic value and dangers of orthostatic vital signs and how to determine what type of orthostatic syncope your patient has had.This is part 3 of a 4 part series on syncope so make sure you check out episode #32 and #33. If you would like to check out the 1hr, 1 CE course, go to:www.rapidresponseandrescue.comyou can use coupon code: PODCAST22To get $22 off the cost of the course now until the end of 2022
Allan Buccola, a PT in Burlington, North Carolina, reached out to us after the podcast aired on orthostatic hypotension (episode 123) to let us know he's gone deep down the rabbit hole of orthostatic hypotension assessment and management. He's scoured the research and helped teach his coworkers more about the topic, which is more complicated than it may seem! Allan discusses the interconnectedness of the autonomic nervous system components, what to notice beyond just dizziness if you're concerned about hypotension, how to tell whether it's neurogenic or not, and more. Allan works both in acute care and outpatient while Claire leads community classes for people with Parkinson's making this conversation span the entire continuum of care. Please reach out with any questions you may have on the topic or to let us know about a topic you'd like us to discuss more on the show! Email us at info@neurocollaborative.com
New podcast host, DeLon Canterbury, interviews LIVE at the 2022 Annual Meeting with Author Elizabeth Pogge, on her Geriatric Pharmacotherapy Case Series for November on The Senior Care Pharmacist "Geriatric Pharmacotherapy Case Series: Neurogenic Orthostatic Hypotension."
Dr. Sarah Schaefer speaks with Drs. Gregoire Courtine and Jocelyne Bloch about the use of an implanted spinal cord stimulator for the treatment of orthostatic hypotension in multiple-system atrophy. Read the article.
Podcast Highlights: 00:27 Taking Breaks from Adaptogens 04:26– Serum Sodium Ranges 05:40 – U-Shape curves 08:06– Functional Ranges on blood work 09:28 – The Salt Fix 10:50 – Healthy Sodium ranges 12:01– Low Sodium 13:25– Adrenal Fatigue 15:48 – Orthostatic Hypotension 20:36– Table Salt 24:01 - Aldosterone 25:44 - Hypovolemia 28:41 – Mild Hyponatremia...... Continue Reading →
Podcast Highlights: 01:31:03 – Hypertension and polymorphisms of the Sammi people 10:12:06 – I have a MCV on my blood test of 101, what does that mean? 27:29:18 – What are your thoughts about using mushrooms as an alternative to caffeine or espressos? 30:25:19 – What’s can I put in a protein shakes for my [...]Read More »
Orthostatic Hypotension affects up to 1/3 of all people with Parkinson's and can have devastating consequences. In this episode, Anne discusses what Orthostatic Hypotension is, how it is diagnosed, and strategies for how to manage it in your daily life.
Featuring Dr. Philip Sloane, Dr. Mallory Brown This podcast will spotlight articles from the November, 2021 issue of JAMDA - the Journal of the Society for Post-Acute and Long-Term Care Medicine. Dr. Sloane is a family physician and geriatrician with a master's degree in public health. He is the Elizabeth and Oscar Goodwin distinguished professor of Family Medicine and Geriatrics at the University of North Carolina at Chapel Hill, and Co-director for the program on aging, disability, and long-term care, at the Cecil G Sheps Center for Health Services Research Dr. Brown is also a family physician and geriatrician at University of North Carolina, where she is an associate professor of family medicine and director of the residency training program. References: Shieu, B., BSN, RN; et. al., "Younger Nursing Home Residents: A Scoping Review of Their Lived Experiences, Needs, and Quality of Life", JAMDA, November/2021. Vahlberg, T.; MSc et. al., "Orthostatic Hypotension is a Risk Factor for Falls Among Older Adults: 3-Year Follow-Up", JAMDA, November/2021. Bahat, G., MD., et. al., "Hypotension in Nursing Home Residents on Antihypertensive Treatment: Is it Associated with Mortality?", JAMDA, November/2021. Bardenheier, B., PhD; et. al., "Adverse Events Following One Dose of mRNA COVID-19 Vaccination Among US Nursing Home Residents With and Without a Previous SARS-CoV-2 Infection", JAMDA, November/2021. Recorded: November 18, 2021 Available Credit 0.25 CMD-Clinical
We made it to 100! This week Pfizer seeks Emergency Use Authorization for their COVID oral antiviral; A meta-analysis found commonly prescribed drugs were linked to orthostatic hypotension; A novel treatment is approved for polycythemia vera; A new program has been cleared to allow individuals to carry out remote endoscopy procedures; And the largest to date psilocybin trial shows promise in treatment-resistant depression.
What is the causal relationship between high-level spinal cord injury, orthostatic hypotension and increased risk for cardiovascular disease? In this episode, Consulting Editor Patrick Osei-Owusu (Case Western Reserve University) interviews authors Christopher West (University of British Columbia) and Aaron Phillips (University of Calgary), along with expert Jill Wecht (James J. Peters VA Medical Center) about the new study by Hayes et al. High-level spinal cord injury can lead to orthostatic hypotension, a debilitating condition experienced by a substantial number of both cervical and high thoracic spinal cord injury (SCI) patients. Yet how this impacts the heart and cerebral vasculature is not well understood in this population. By creating a novel experimental animal model of lower body negative pressure, the authors were able to study how the brain vasculature and heart respond to an orthostatic challenge. Hayes et al. first quantified how much negative pressure was needed to replicate clinically-relevant orthostatic hypotension in rodents with SCI. The authors then introduced the lower body negative pressure technique, and measured cardiac pressure and volume responses in rodents with and without SCI. Finally, the authors imaged the mid-cerebral artery and analyzed step-wise reductions in blood pressure during lower body negative pressure to understand the relationship of pressure to flow in the cerebrovasculature in rodents with and without SCI. What did the authors find and what is the clinical significance of this novel experimental model of lower body negative pressure that allows for real-time micro-analysis in multiple organ systems? Listen to find out. Brian D. Hayes, Mary Pauline Mona Fossey, Malihe-Sadat Poormasjedi-Meibod, Erin Erskine, Jan Elaine Soriano, Berkeley Scott, Ryan Rosentreter, David J. Granville, Aaron A. Phillips, and Christopher R. West Experimental high thoracic spinal cord injury impairs the cardiac and cerebrovascular response to orthostatic challenge in rats Am J Physiol Heart Circ Physiol, published September 23, 2021. DOI: 10.1152/ajpheart.00239.2021
We're talking about something else that's going on with us! This time it's all about Orthostatic Hypotension. Are you wondering why we titled the episode this? Well, I guess you're going to have to listen to the episode to find out! There's a lot of Rachel bleeps in this episode, your favorite thing and a terrible dad joke at the end. OH WAIT - TWO dad jokes at the end. This episode is a nice little break in our DNA circuit, and next episode we will be continuing onto part 4! Thanks for listening. --- Send in a voice message: https://podcasters.spotify.com/pod/show/sciencewithmillennials/message Support this podcast: https://podcasters.spotify.com/pod/show/sciencewithmillennials/support
Dr. Satish Raj and Nasia Sheikh discuss new research findings on the hemodynamic mechanisms underlying initial orthostatic hypotension.
Dr. Satish Raj and Nasia Sheikh discuss new research findings on the hemodynamic mechanisms underlying initial orthostatic hypotension.
Guest: Daniel Claassen, MD, MS Neurogenic orthostatic hypotension (nOH) is a subset of orthostatic hypotension and is prevalent in patients with autonomic dysfunction.1,2 The cardinal symptoms of nOH include dizziness and lightheadedness,3 but frequently could include syncope, cognitive slowing, generalized weakness, coat-hanger (neck and shoulder) headache, fatigue, orthostatic dyspnea, blurred vision, and orthostatic angina.3 According to the Harris Poll conducted among nOH patients and their caregivers, the symptoms of nOH have a negative impact on activities of daily living. The symptoms are often minimized, poorly recognized/evaluated, or inadequately discussed and addressed.4 Patients with nOH may experience symptoms that can make daily tasks a challenge.1,5 The frequency and severity of symptomatic episodes can be unpredictable,6 and it is this unpredictability of events that contributes to a vicious cycle of nOH.1 In this cycle, fear of symptomatic events and falls may lead patients to reduce physical activity.1,5 References: Palma JA, Kaufmann H. Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension. Mov Disord Clin Pract. 2017;4(3):298-308. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72. Freeman R. Neurogenic orthostatic hypotension. N Engl J Med. 2008;358(6):615-624. Claassen DO, Adler ...
Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Tighter blood pressure control does not increase the likelihood of orthostatic hypotension '
Guest: Satish R. Raj, MD, MSCI Neurogenic orthostatic hypotension (nOH) is a subset of orthostatic hypotension and is prevalent in patients with autonomic dysfunction (1-3). In these patients, there is insufficient compensatory peripheral release of norepinephrine, the major neurotransmitter responsible for blood pressure maintenance, upon standing or following postural change (2,4,5). Due to this norepinephrine deficiency, there is inadequate vasoconstriction to maintain blood pressure or cerebral blood flow (1,5,6). This may lead to symptoms of nOH, which may increase the risk of falls and lead to serious consequences (7,8). Here, Dr. Satish Raj, Professor of Cardiac Sciences at the Libin Cardiovascular Institute at the University of Calgary’s Cumming School of Medicine and Medical Director of Calgary Autonomic Clinic, discusses the pathogenesis of nOH, as well as the mechanisms behind therapeutic approaches to controlling its effects. References: Palma JA, Kaufmann H. Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension. Mov Disord Clin Pract. 2017;4(3):298-308. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72. Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of ...
Among the many non-motor symptoms of Parkinson’s disease (PD) are blood pressure changes. One manifestation is neurogenic orthostatic hypotension, a condition in which blood pressure drops sharply when one moves from a reclining to a more upright position, such as standing up when getting out of bed or rising from a chair. The person may feel lightheaded, dizzy, lose balance, or, rarely, even lose consciousness. Besides being uncomfortable, the condition can be dangerous if it leads to a fall and subsequent injury. Orthostatic hypotension is common in mid- and late-stage PD, but it may also be an early sign of the disease. Fortunately, there are strategies and other measures people can do for themselves to lessen the problem, and a variety of medications may help. Other conditions and medications can also lead to the condition, and they should be investigated in addition to a connection with PD. In this podcast, neurologist Dr. Katie Longardner of the University of California San Diego discusses the problem, how it is diagnosed, what people can do to alleviate it, and some of the research she and others are conducting.
the thing about RCT is they are random and everything is equal. its why in table one of an RCT you should never see a pvalue because they are random and should be equal but in observational studies you see pvalues because it is not equal, it can’t be, its not random. In observational studies you try to account for all the confounders but you just cant ever make it equal to an RCT but lets look a look at observational data using a real world example. I will start with a question—is there an association between fluoroquinolone use and aortic aneurysm and aortic dissection (AA/AD).? You might say well in dec 2018 the FDA issued a warning recommending avoiding fluoroquinolone use in patients with AA/AD or who are at risk for these conditions But that was not the question I asked – I said “is there an association between c use and aortic aneurysm and aortic dissection (AA/AD).?” The answer is ‘it depends’—clearly seen in recent issue of JAMA Internal Medicine one paper – we willl call study number 1 titled “Association of Infections and Use of Fluoroquinolones With the Risk of Aortic Aneurysm or Aortic Dissection” found “Fluoroquinolones were not associated with an increased AA/AD risk when compared with combined amoxicillin-clavulanate or combined ampicillin-sulbactam (OR, 1.01; 95% CI, 0.82-1.24) or with extended-spectrum cephalosporins (OR, 0.88; 95% CI, 0.70-1.11) among patients with indicated infections” And another study in the same journal we will call study number 2 titled “Association of Fluoroquinolones With the Risk of Aortic Aneurysm or Aortic Dissection” found a small, risk for AA/AD when comparing fluoroquinolones with azithromycin for pneumonia, but no association when comparing fluoroquinolones with TMP/sulfa for urinary tract infection. AHHH SO WHAT DOES THIS ALL MEAN you ask!!!!! Well in the second study when they did a secondary analysis and limited the analysis to patients who had imaging studies the risk of AA/AD disappeared. Suggesting there was surveillance bias. Surveillance bias refers to the idea that “the more you look, the more you find.” When you get more test you find more things. For example hospital number 1 uses 1000 covid test a day and hospital two uses 1 covid test a day. Both hospitals see the same number of patients. Can you say that hospital one has more cases of covid?? Of course not, they just have a surviellance bias.. Similarly Also sicker patients who happen to get a flouroquinolone are also more likely to get a CT of their abd/pelvis which reveals aortic disease. An incidental findings that only comes about when you are sick and also happen to be placed on antibiotics. But lets go back to study number 1- the one that found no increaes risk of aortic disease when comparing flouroquinelones to other antibiotics—likely it is because they included only patients with what they termed indicated infections. This would suggest that likely it is not the antibiotic causing the AA/AD it is the illness! It is the confounders that cant be accounted for in any oberservational data set, AA/AD are not more common with flouroquinolones but unfortuneately sicker patients are both more likely to be prescribed fluoroquinolones and severe illness just also happens to be a risk for AA/AD So I ask you again, “is there an association between fluoroquinolone use and aortic aneurysm and aortic dissection (AA/AD).?” The full answer is it depends on the secenaro, it depeds on the bias, it depends on the cofounders. It just depends https://jamanetwork.com/journals/jamadermatology/fullarticle/2769109 Advisory Committee on Immunization Practices (ACIP) has issued an update on recommendations regarding HPV vaccination. Approx.. 33700 HPV caused cancers annually in the US One big problem with the data is only 8% of the studied participants are male—we basically are doing this in female and then translating the information to men which is not always the best, for example statins do not work in women to prevent heart attacks when you look at some group analysis, they help prevent strokes but not heart attacks, the numbers don’t always translate when you are crossing the gender barrier Few important points to this new update Catch-up vaccination is now recommended for all persons through age 26 years. Did get it as a kid, you can get it now, call me mustard cause when it comes to vaccines it is time to katchup ACIP recommends routine vaccination at age 11 or 12 years (or as early as age 9 years) for all persons.— regardless of prior or current HPV infection status.!!! ACIP continues to recommend age-based dosing schedules, with 2 doses for persons beginning HPV vaccination at ages 9 through 14 years and 3 doses for persons beginning after age 14 years or persons who are immunocompromised. https://www.acpjournals.org/doi/10.7326/M20-4298 what if I told you that intensive blood pressure control is not associated with incrase risk of orthostatic hypotension Effects of Intensive Blood Pressure Treatment on Orthostatic Hypotension A Systematic Review and Individual Participant–based Meta-analysis Annals of internal medicine Researchers examined five trials, with a total of 18466 participants and 127,000 follow up visits to examine the effects of intensive BP-lowering treatment on OH in hypertensive adults. As with all meta analysis the inclusion criteria of the studies did differ on what they call intensive therapy. But in the end intensive bp treatment lowered yes it actually LOWERed the risk for OH (OR .93 with 95% CI 0.86-0.99) I read this and I though no way does Intensive BP-lowering treatment decreases risk for OH. And the authors say ‘well long term or chronic hypertension can throw off many of your regulatory mechanisms, and so there for you throw off these mechanism with poor blood pressure and that is what causes the OH not the actual lower number, it is the uncontrolled bp’ and maybe they are right, that is for the ivory towers to decide I could not wrap my mind around this but then I stumbled upon it—OH does NOT mean falls. OH does not mean syncopal episodes. In this study OH only means a decrease of 20 mm Hg or more in systolic BP or 10 mm Hg or more in diastolic BP after changing position from seated to standing. This is again a surrogate marker- I don’t care if you number changes briefly if you feel fine The paper even says that the Data on falls and syncope was not available. The patient oriented outcome I care about was not available!! This is a headline paper that likely doesn’t say what you think that it says. THIS IS A LAB VALUE that grabs the headline and makes you think well intensive control actually leads to less falls or less syncopal episodes when in actually this paper just say intensive control just mean less changing of a bp number! WHICH makes sense— if you start at a lower number you have a lot less ability to change! Think about this for one second --One person in intensive control has a bp of 120 and they stand to a bp of 110 while the other person in the not intensive control arm has a bp of 130 and they stand up and the bp falls to 110--- both of those people standing have a bp of 110, the exact same bp!!!!! but one droped 20 points and is diagnosed with OH and the other is told they are normal. This next article falls into the quickest summary I have every given on a paper and it is in The Lancet Rheumatology. Titled How How long does a shoulder replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 10 years of follow-up ---which comes from the same authors that last year gave us How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30226-5/fulltext And the famous How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up Now use their same massive database to try and answer the question how long does a shoulder replacement last and the answer is at least 10 years for most everyone. It didn’t matter if you were having humeral hemiarthroplasties, osteoarthritis with reverse total shoulder replacement, or a rotator cuff arthropathy with reverse total shoulder replacement it appears at 10 yrs approximately 90% of shoulder replacements were doing well with sustained clinical benefit. If your patients needs a new shoulder—tell them the good news is it will likely last at least 10 yrs And that was a fast summary but lets do one more--- https://jamanetwork.com/journals/jama/fullarticle/2769724?guestAccessKey=75076244-d788-4a4f-ba64-2eee4284fd70&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=082520 Effect of Vitamin D3 Supplementation on Severe Asthma Exacerbations in Children With Asthma and Low Vitamin D LevelsThe VDKA Randomized Clinical Trial 192 children with persistent asthma and low vitamin D level ----if you gave them vit d did you improve the time to next severe asthma exacerbation , In this randomized double-blind, clinical trial were put on either placebo or vitamin D3, 4000 IU/d The most simple answer is…..no. there was no difference between placebo and vit d
Blood pressure: How Low Is Too Low? In this episode, I will tell you what blood pressure is considered too low, according to science. Everybody is different, and you should check with your doctor about your parameters. At the end of this episode, I will give you a tip that we use in the clinic to screen for dehydration.Remember, this is not medical advice, and only your doctor can tell you what you need to do for your high blood pressure. Consult your doctor or health care provider for medical advice. ****Click here to see how to use a home blood pressure monitor and log. You can purchase an Omron Blood Pressure Monitor from any big box store or pharmacy. Click here for purchase online. Visit Hypertension Resistant to Treatment's YouTube Channel for What to Eat?****Ask your doctor if you would benefit from vitamins: Vitamin C with rose hips, Zinc, D3 & K2, Magnesium or this one, B complex, Elderberry, Probiotic or this one, Melatonin, & Quercetin **** At Hypertension Resistant to Treatment podcast, website, and YouTube channel, you will get knowledge, training, resources, and support so you can take action to get good blood pressure control. Visit hypertensionresistanttotreatment.com for more detailed information. ****Hi, I'm Dr. Tonya, a clinical research scientist at the University of Alabama at Birmingham, Alabama, where I hold various positions. I spent the past decade studying hypertension, home blood pressure monitoring and tracking, medication adherence, and readiness and confidence to change lifestyle behaviors. I am an author of six first-authored publications in scientific journals. I have collaborated with colleagues on three published studies with the finding from the landmark study that influenced the new hypertension guidelines released in 2017 (Systolic Blood Pressure Intervention[SPRINT] Trial. You can read my work HERE at this link https://www.ncbi.nlm.nih.gov/pubmed/?term=TONYA+BREAUX-SHROPSHIRE, including my published studies from the landmarked Systolic Blood Pressure Intervention (SPRINT) Trial. **** I created a blog, podcast, and YouTube channel for you to learn what everybody ought to know about hypertension. Connect with me on Facebook or Twitter. If you liked this podcast, please share it with anyone who could benefit from it. **** Join me every week for more hypertensionresistattotreatment.com podcast, and hit subscribe to get upcoming episodes immediately when released. Voiceover Intro by Mr. Willie Breaux, Jr. Song: My SwagDisclaimer: This podcast is for educational purposes only and not intended to replace medical advice. I have provided this content based on my clinical and research knowledge. Consult your health care provider for medical advice and treatment and before starting any nutritional supplements or lifestyle practice.
Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I’m looking forward to sharing with you some of our community’s questions that have come in over the past few weeks… Let’s get started! Jacqueline: My 8 year old daughter is struggling with some mast cell issues. We’ve been to multiple Drs and can’t get a solid diagnosis. They diagnosed her with hyperpermeable skin and then another Dr diagnosed her with chronic idiopathic urticaria. Right now I have her on Zyrtec which has helped her to be able to eat more foods without getting itchy and also helped with her constipation. The weird symptom is if she spends a lot of time outside in the sun the next time she eats she will get itchy dry arms. It doesn’t last too long, I just put anti itch cream on and that seems to help. I’m trying to heal her but every functional test I’ve done on her, stool, OAT, and mold, have come up with issues, Bacterial overgrowth, Candida overgrowth, c diff, h pylori, blastocysts, mold toxicity, and food sensitivities. She is so sensitive to almost every supplement we’ve tried. How do I help her heal if she is so reactive? Also, how do I keep the faith that she will be better one day when we keep having set backs? Dar: Now I don't drink alcohol very often but when I do it's usually a special ocassion like a wedding or birthday party every couple of months where we probably tend to have 5 or more drinks in the night. I guess that's considered binge drinking. How had is it if it's only a few times a year. Rya: Hi there Dr. Cabral, Thank you for all that you do. After suffering for decades, I found your podcasts and have a new sense of hope.I am unfortunately, worse than ever after seeing an Functional Doctor and naturopath and I’m scared.I am a 34 year old woman... Long story short, I was on PPIs for 20 years (finally weaned this year!) 2 years ago I developed extreme vertigo, vestibular neuronitis, daily migraines and head pressure, ear itchiness, leakage, and fullness, Orthostatic hypotension, Histamine intolerance, and more. I figured out it was gluten and dairy giving me the symptoms and promptly gave them up. ALL symptoms vanished! 6 months later, the symptoms returned despite being off of gluten and dairy and I lost oral tolerance to new foods each month until I was down to only tolerating a few. I have had a GI Effects test, heavy metals, Viome, food intolerances, mold, etc. Everything comes back with very little clues and all of my doctors are at a loss. No parasites, no signs of leaky gut (confirmed by both an FMD & naturopath), no metal toxicity... some IgG intolerances (way smaller list than what I actually tolerate)... I do apparently have adrenal insufficiency and estrogen dominance, but I don’t tolerate any adrenal supplements and so far DIM / bioidentical progesterone isn’t helping.I live on a very humid & moldy island that I can’t leave for over a year, but my symptoms started WELL BEFORE we moved here and my mold test showed almost nothing. I also don’t tolerate glutathione! I only eat 100% clean, organic, non processed local food. I never “cheat” because even a tiny bit sends me into the symptom frenzy. I’ve been healing my gut and supporting my detox organs for over a year. I cook and freeze food immediately to lower histamine. DAO / anti histamine supplements don’t help much. The only exercise I tolerate now is light weights and yoga. I go to the sauna 5 days a week and meditate daily. I’m currently doing a modified version of the CBO protocol because I can’t tolerate many of the ingredients. I support my vagus nerve. Please help! I am 98 lbs and I have no idea what to do. I’ve turned from an ambitious, active, social person into a sickly, broke hermit and I fear I will never recover! I’ve spend countless time, money, and effort healing and my debilitating symptoms continue to worsen. FMDs etc just keep putting me on “standard protocols” that work for 99% of people, but I’m the 1% that needs something very customized. The worst part is that I still have NO IDEA what is causing all of these symptoms after I eat basically anything at all. All I know is that it’s connected to food and I get every single one of those (head centered) symptoms after eating. I actually don’t have GI symptoms except GERD.Side note: my younger sister developed celiacs around the same time and has very similar symptoms when consuming gluten. My mother also developed similar symptoms after going on a cruise and starting perimenopause. It must be partly epigenetics? Thank you SO MUCH!! Penelope: Hi Dr. Cabral! Thank you for all you do - I listen to your show every day and you have become my go-to for any health and lifestyle related questions. I have one of the first Apple watches created (the one without a direct cellular connecting, but has wifi and Bluetooth) and Ive become nervous about wearing it for fear that it is harming me in some way. Was hoping you could help me determine whether this fear holds weight or not. I would love to wear the watch for all the tracking benefits. Can you speak to the pros and cons of wearing these smart watch devices? Thank you so much and have a great day! Thank you for tuning into this weekend’s Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes & Resources: http://StephenCabral.com/1395 - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - - Dr. Cabral’s Most Popular Supplements: > “The Dr. Cabral Daily Protocol” (This is what Dr. Cabral does every day!) - - - > Dr. Cabral Detox (The fastest way to get well, lose weight, and feel great!) - - - > Daily Nutritional Support Shake (#1 “All-in-One recommendation in my practice) - - - > Daily Fruit & Vegetables Blend (22 organic fruit & vegetables “greens powder”) - - - > CBD Oil (Full-spectrum, 3rd part-tested & organically grown) - - - > Candida/Bacterial Overgrowth, Leaky Gut, Parasite & Speciality Supplement Packages - - - > See All Supplements: https://equilibriumnutrition.com/collections/supplements - - - Dr. Cabral’s Most Popular At-Home Lab Tests: > Hair Tissue Mineral Analysis (Test for mineral imbalances & heavy metal toxicity) - - - > Organic Acids Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Thyroid + Adrenal + Hormone Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Adrenal + Hormone Test (Run your adrenal & hormone levels) - - - > Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Omega-3 Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - > Stool Test (Use this test to uncover any bacterial, h. 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Orthostatic Hypotension --- Support this podcast: https://anchor.fm/kamesa-anota/support
Dr. Ylva Hiorth provides the main clinical messages from her study on orthostatic hypertension in Parkinson disease.
In the first segment, Dr. Jeffrey Ratliff talks with Dr. Ylva Hiorth and about their paper on a 7-year prospective population-based study on orthostatic hypotension in Parkinson disease. In the second part of the podcast, Dr. Jason Crowell talks with Nobel Prize winner Dr. Stanley B. Prusiner in the first part of a two-part interview. Disclosures can be found at Neurology.org. CME Opportunity: Listen to this week’s Neurology Podcast and earn 0.5 AMA PRA Category 1 CME Credits™ by answering the multiple-choice questions in the online Podcast quiz.
Download free study guides from Aureus Medical Staffing here: https://www.aureusmedical.com/nptestudycast.aspx
This week we discuss the disutility of orthostatic vital signs as a diagnostic tool in patients with suspected volume loss. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_140_0_Final_Cut.m4a Download Leave a Comment Tags: Cardiology, Orthostatic Hypotension Show Notes Summary: Based on the limited available evidence, it's unlikely orthostatic vital sign measurement can be used to determine which patients have volume loss and which do not. The baseline prevalence of orthostatic vital signs is common and patients will not always develop orthostatic vital signs in response to volume loss. Therefore, there will both be patients who are orthostatic by numbers without volume loss and there will be patients with volume loss who are not orthostatic by numbers. Symptoms, with the exception of inability to stand to have orthostatics performed, are not useful either. Bottom Line: Based on the low overall sensitivity of orthostatic vital sign measurements, they should not be used to influence clinical decision making. Read More REBEL EM: Orthostatic Hypotension in Volume Depletion References: Skinner JE et al. Orthostatic heart rate and blood pressure in adolescents: reference ranges. J Child Neuro 2010; 25(10): 1210-5. PMID: 20197269 Stewart JM.
This week we discuss the disutility of orthostatic vital signs as a diagnostic tool in patients with suspected volume loss. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_140_0_Final_Cut.m4a Download Leave a Comment Tags: Cardiology, Orthostatic Hypotension Show Notes Summary: Based on the limited available evidence, it’s unlikely orthostatic vital sign measurement can be used to determine which patients have volume loss and which do not. The baseline prevalence of orthostatic vital signs is common and patients will not always develop orthostatic vital signs in response to volume loss. Therefore, there will both be patients who are orthostatic by numbers without volume loss and there will be patients with volume loss who are not orthostatic by numbers. Symptoms, with the exception of inability to stand to have orthostatics performed, are not useful either. Bottom Line: Based on the low overall sensitivity of orthostatic vital sign measurements, they should not be used to influence clinical decision making. Read More REBEL EM: Orthostatic Hypotension in Volume Depletion References: Skinner JE et al. Orthostatic heart rate and blood pressure in adolescents: reference ranges. J Child Neuro 2010; 25(10): 1210-5. PMID: 20197269 Stewart JM.
Fainting spells are surprisingly common. Even among United States Marines. This week we explore the mechanisms underlying loss of consciousness in your every day patient. And your every day soldier. Produced by James E. Siegler. Music by Jason Shaw, Andy Cohen, Kai Engel, and Josh Woodward. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Freeman R. Clinical practice. Neurogenic orthostatic hypotension. The New England journal of medicine. 2008;358:615-24. Grubb BP. Neurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation. 2005;111:2997-3006. Wolters FJ, Mattace-Raso FU, Koudstaal PJ, Hofman A, Ikram MA and Heart Brain Connection Collaborative Research G. Orthostatic Hypotension and the Long-Term Risk of Dementia: A Population-Based Study. PLoS Med. 2016;13:e1002143. Sonnesyn H, Nilsen DW, Rongve A, Nore S, Ballard C, Tysnes OB and Aarsland D. High prevalence of orthostatic hypotension in mild dementia. Dement Geriatr Cogn Disord. 2009;28:307-13.
1) The Effects of Orthostatic Hypotension on Cognition in Parkinson's Disease 2) What's Trending: Carotid surgery trials3) Topic of the Month: Neuromuscular topicsThis podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the first segment, Dr. Matthew Barrett interviews Dr. Justin Centi about his paper on the effects of orthostatic hypotension on cognition in Parkinson disease. Dr. Andy Southerland is interviewing Dr. Seemant Chaturvedi for our “What's Trending” feature of the week about urgency for carotid surgery trials. In the next part of the podcast, Dr. Ted Burns interviews Dr. Michelle Mauermann about neuromuscular topics. Disclosures can be found at www.neurology.org.DISCLOSURES: Dr. Barrett has received research support from Axovant Sciences, Inc., the Virginia Center of Alzheimer's and Related Diseases, and the Department of Defense.Dr. Centi has been an employee of Commonwealth Psychology Associates LLC and Harvard Medical School/Partners Consortium in Neuropsychology; and has received research support from NIH-NINDS.Dr. Southerland serves as Podcast Deputy Editor for Neurology; receives research support from the American Heart Association-American Stroke Association National Clinical Research Program, American Academy of Neurology, American Board of Psychiatry and Neurology, Health Resources Services Administration and the NIH; has a provisional patent application titled: “Method, system and computer readable medium for improving treatment times for rapid evaluation of acute stroke via mobile telemedicine;” and gave legal expert review. Dr. Chaturvedi has been a consultant for Merck; has served on the executive committee of ACT I study and CREST 2 study; serves on the editorial boards of Neurology, the Journal of Stroke & Cerebrovascular Disease, Stroke, and NEJM Journal Watch Neurology; has received research support from Boehringer-Ingelheim, NINDS, and the FDA; and has received compensation for expert witness testimony.Dr. Burns serves as Podcast Editor for Neurology®; and has received research support for consulting activities with UCB, CSL Behring, Walgreens and Alexion Pharmaceuticals, Inc. Dr. Mauermann serves on the editorial board of Mayo Clinic Proceedings; receives publishing royalties for book Autonomic Neurology; and receives research support from Ionis Pharmaceuticals, Inc. and Alnylam Pharmaceuticals.All other participants have no disclosures.
Dr Mario Masellis and Dr. Sean Udow from the Sunnybrook Health Sciences Centre, University of Toronto, Canada, look at the potential association between orthostatic hypotension and cognitive impairment in α-synucleinopathies such as Parkinson’s disease, dementia with Lewy bodies and multiple system atrophy. Read the review published by JNNP here: http://jnnp.bmj.com/content/early/2016/09/09/jnnp-2016-314123.abstract.
In this podcast, James Cave (DTB Editor-in-Chief) and David Phizackerley (DTB Deputy Editor) discuss health checks for young people with learning disabilities and review two recently licensed drugs - one for treating orthostatic hypotension and the other for managing ADHD in children and adolescents. Read all the articles featured here: dtb.bmj.com/content/54/5.toc
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