The perspective of a private specialty _Lapp
http://www.ourfm-cfidsworld.org/html/dr__lapp_lecture.html
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This is not the entire document/lecture, but rather the portion of it that deals with Neurally Mediated Hypotension (NMH) and Dr. Lapp's recommended treatment. Dr. Charles W. Lapp Hunter-Hopkins Center Telephone: 704-543-9602 Website: www.drlapp.net Email: drlapp@drlapp.net
THE TREATMENT OF CHRONIC
FATIGUE SYNDROME (CFS) Dr. Charles W. Lapp
Introduction: Dr. Lapp was nominated outstanding man of the year by the Jaycees, outstanding doctor of the year in Raleigh, and he was elected Duke University’s clinical professor of the year in 1986. He is really one of our champions and has worked long and hard in the CFS arena and we are very grateful. He has written many articles and spoken to medical staffs, hospital staffs, and support groups all around the country. He is also co-chairman of the clinical affairs committee for the American Association for CFS and a medical advisor to the CFIDS Association of America. Most importantly, he treats CFS patients. So, he knows about us, understands us, and he really knows his stuff, which is great. He’s going to share some of that stuff that he knows with us today. We are very grateful. Won’t you welcome Dr. Charles Lapp. Here is the portion of Dr. Lapp’s lecture that deals with Neurally Mediated Hypotension… "With all that in mind, let’s talk about some newer things here. Would you believe that there is a treatment currently available, that has withstood the test of peer review, that is available to every physician, and just about every physician knows about it. It is safe and easy to take and works in up to 50% of cases. What I’m talking about is salt and water, volume expansion. I know you have all heard about the studies at Johns Hopkins. We’ve also been doing the same studies for three and half years and have published several papers on it. You may know that somewhere between 70 and 90% of patients with CFS and FM have low blood pressure and what we call neurally mediated hypotension. When a normal person stands up, when I’m sitting or lying and I stand up, gravity pulls blood down to my legs. My heart senses it and sends a signal to the brain that the blood pressure is dropping. The brain sends a signal back to the heart to beat faster, to beat stronger. That brings my blood pressure back up and I do fine. When patients with CFS stand up, the blood pressure goes down, the signal is picked up by the heart that the blood pressure is falling. There’s a false signal that goes to the brain. The signal goes to the brain but, for some reason, when the signal comes back, you release more adrenaline. Epinephrine is the technical term for it. That actually causes the blood pressure to drop and the heart rate to drop. You actually get worse and may faint dead away. About 50% faint dead away and about 50% just get sick as the dickens. It is an easy problem to fix. What we have to do is raise the overall blood pressure. That will help. To do that, drink a lot of water, 64 oz, or eight glasses a day. Take extra salt, generally starting with 2-6 grams of salt a day. Two grams of salt is roughly a teaspoon of salt, so it is a lot of salt. If that doesn’t do it, then we add a hormone called fludrocortisone or Florinef that works only on the kidneys. Fludrocortisone will cause your body to retain more of the salt and the water, so it helps to build the blood pressure. That combination works in about 50% of the patients that we tried it with. Sometimes adding a beta blocker like Atenolol will help or another type of adrenergic blocker called Norpace will even make it work better. So that is an area that can be looked into, particularly if you have a history of feeling faint when you stand for a period of time. The question I usually ask is if you stand in church for prayer or to sing a song, do you find that you get weak and faintly, or when you stand in the shower. If the answer is yes to those, then there is a pretty good chance you have neurally mediated hypotension. At the least, you should add salt and water to your diet. Be careful about blood pressure though. If you have normal or high blood pressure, check it at least weekly to make sure you are not getting it too high."
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