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Sophie OH Mike, 54, Male, early stage of PD, at home, care by family…

- - - - Yeah, the other day I was trying to get out of bed and go for a walk to get some fresh air, but as soon as I got up, I felt dizzy, and a minute later, it got worse, so I have to sit back down to feel better. But yeah, I couldn’t go out for fresh air.
        
        I am sorry that you couldn’t go out for fresh air. Would you mind if I ask a little more questions regarding your dizziness?
        
        Sure, go ahead.
        
        I do understand that you feel dizzy upon standing, do you also have difficulty breathing when standing?
        
        A little bit
        
        Okay, and do you have vision disturbances when standing?
        
        No
        
        Do you ever experience neck pain or aching when standing?
        
        Not much
        
        What happened? Could you tell me more about it?
        
        Yeah, it's just have been a problem for me for a while now. I am scared of falling but I can't control that if I am dizzy. So, I am just worried.
        
        Oh, I am sorry to hear that.
    - - She's alright. She is at work right now.
        
        That's good to hear.
- - - - (Take patient's BP/HR after 5 minutes supine, and after 1 and 3 minutes of standing) (comparing to patient's history of BP/HR)
        
        Alright, Mike, you could have experienced what is called orthostatic hypotension. We still need to do more testing to diagnose, would you mind answering more questions for me?
        
        No, not at all.
        
        Thank you. I want to know about your diet? Do you like to eat a lot of carbohydrates, like breads, rice, and pasta?
        
        Oh yeah, those are my favorites. And I eat a lot of food in general
        
        Okay, I hate to break it to you, but Mike, eating high in carb is not good for you in these circumstances. But it does not mean you have to cut carb out of your diet.
        
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        If you could try to eat less carbs, that would be great since eating too much carbs will increase your likelihood of experiencing orthostatic hypotension.
        .
        
        How about salt in your diet, do you usually like to eat salty food?
        
        Not at all, I was trying to cut the sodium intake. I heard it’s good for me.
        
        Well, in these circumstances, I suggest you increase sodium intake.
        
        if you could add about 1 -2 teaspoons of salt per day, that will actually be good for your health.
        
        May I ask, do you drink a lot of water?
        
        Not really, I know that I should drink more water, but I do not have the habit of drinking water.
        
        I would suggest you drink about 2- 2.5 L per day.
        
        Throughout the day, make sure to drink a good amount of water to stay hydrated.
        
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        How about alcohol, caffeine, and sugary beverages? Do you like to drink theses beverages?
        
        Oh yeah, I love caffeine, and especially sodas. I also drink alcohol before bed to help me to sleep better.
        
        Yeah, Mike, I am sorry, but maybe we should try to cut back on the caffeine, sodas, and alcohol.
        
        They all have diuretic effects, and will make your body lose fluid quickly, especially if you drink alcohol before bed, when you wake up in the next morning, you could experience orthostatic hypotension. At least, try to avoid or reserve the drinks in the evening.
        
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        That’s it for my questions, now, I just have some general information for you.
        I will give you compression waist-high stockings to try on later. If you can not tolerate this, we could also try elastic abdominal binder.
        
        And also, I recommend you to do 20 - 30 minutes of exercise daily according to your current abilities and with a goal of non-sustained bedrest during the day. And throughout the day, try to avoid bed rest whenever possible.
        
        And you could sleep with the head of the bed raised 30-45 degrees. So it will be easier for you when you get up in the morning.
        
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