Question: I have been told that the reason that I am out of breath or collapse when I walk too far or stand too long is low blood pressure and there is no medication for it. How should I deal with it?
Mrs. V Pittock, Brighton.
Answer: A fall in blood pressure after standing or changing position – known as orthostatic hypotension – is a common problem in the elderly, affecting as many as 20 percent of people over 65.
But only about 2 percent of those affected have serious symptoms, and it seems that you are one of those.
When we get up, blood collects in leg veins, reducing the flow to the heart and lowering blood pressure.
A fall in blood pressure after standing or changing position – known as orthostatic hypotension (file image)
This is usually noticed by baroreceptors, in the arteries of the neck. These sensors cause an increase in the resistance of arteries, thanks to a change in the tension of the vessel walls. This limits the fall in blood pressure.
In people with orthostatic hypotension, however, these reflexes are affected – often as a result of aging – and therefore blood pressure remains lowered, leading to dizziness and fainting after getting up.
Aside from aging, there are some conditions that can cause orthostatic hypotension, including Parkinson’s, diabetes, Lyme disease, and vitamin B12 deficiency that interfere with the nervous system.
Various antidepressants, some medicines for high blood pressure, beta-blockers, diuretics and some sedatives and painkillers can also cause it.
After five years of recurring episodes, it is vital that you minimize their frequency. The solution lies in understanding the factors that contribute to the problem. You can prevent low blood pressure after eating by avoiding large meals, following a low-carb diet, and avoiding alcohol.
Drink plenty of water during the meal, as this will increase the volume of the blood and have to drink a full glass of water before getting out of bed.
Walking 30 minutes three times a week will ultimately improve the baroreceptor reflexes, and wearing professionally appropriate full-length elastic compression stockings throughout the day minimizes blood accumulation in the legs.
Question: I had a TURP operation that left my ejaculation retrograde. Is it possible to reverse this problem?
Mr. Rose, Cumbria.
TURP (transurethral resection of the prostate) is aimed at reducing urinary symptoms caused by enlargement of the prostate gland (benign prostatic hyperplasia), a non-cancerous age-related condition.
The prostate is under the bladder of a man. It secretes the fluid that, together with the sperm from the testicles, forms sperm (file image)
The prostate is under the bladder of a man. It secretes the fluid that, together with the sperm from the testicles, forms sperm.
It surrounds the urethra – which carries urine – where it leaves the bladder. This explains the symptoms of an enlarged prostate, such as more frequent urination, problems with starting a flow, interrupted or poor flow and dripping at the end of urination.
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Answers must be taken in a general context and always consult a doctor if you are concerned.
Drugs such as tamsulosin, which relaxes the prostate and bladder muscles, can help. Surgery under anesthesia is an option if it is not effective.
During TURP, a fine tubular instrument is inserted through the urethra to remove most of the prostate piece by piece.
Retrograde ejaculation then affects up to 70 percent of patients. Sperm, rather than ejaculating, goes back into the bladder due to anatomical changes caused by surgery and is removed via urination.
Less common side effects are erectile dysfunction, infections and bleeding, which can usually be resolved. But there is no possibility to reverse retrograde ejaculation.
In my opinion … just forgetting doctors as doctors
The plan to pay a £ 20,000 incentive to encourage young doctors to go to general practice is doomed to fail. It’s just a plaster on the manpower crisis.
Our leaders in Westminster do not understand that the current model of independent contractors – in which every GP practice is a small company, as has been the case since the birth of the NHS in 1948 – has broken.
Today’s doctors no longer want to take on the role of corporate property, with an emphasis on ownership, hiring staff, and inspections.
Their preference is for employment, perhaps along similar contractual lines as advising colleagues in hospitals.
This would give them the freedom to use the best medicine for their patients, stay up-to-date, perform their annual assessments and avoid the administrative burden.
However, the chief executive of NHS claims that the agreement between the British Medical Association trade union and NHS England to allocate these funds is a triumph.
I doubt it. Filling the mouth of doctors with gold won’t work.
Is there really no one with the ability to think outside the box and create a new system? We need one in which the new wave of doctors can both practice medicine and have a balance between work and private life.
Reduce bureaucratic hassle and stop forcing GPs to be business people, and students will knock on doors to return to general practice – without needing a golden handshake.