orthostatic hypotension

   People with PD who have orthostatic hypotension are not always diagnosed which can limit there abilities if left untreated. Here is an individual with PD who is coming to physical therapy for the 1st time to address her PD and is scheduled to undergo DBS(deep brain stimulation) surgery in the near future. It was the patient who requested physical therapy. She was feeling down because over the course of a year she was trying to increase her walking endurance however because of extreme fatigue and legs feeling like they were going to buckle, her walking endurance worsened. She was unable to stand for more than a minute before needing to sit. When asked if she had blood pressure problems, she denied any problems. When asked if she ever had her blood pressure taken while standing or after standing for a few minutes the answer was no. She reportedly drinks a lot – about a gallon of water a day. Her sitting blood pressure was 98/54 Heart rate 60. Initial standing 78/52 heart rate 64. After 3 minutes her blood pressure did rebound somewhat but the systolic was still below the initial sitting blood pressure. She was advised to see a nutritionist since I thought her fluid intake seemed excessive and could potentially act as a diuretic – but wasn’t sure. She contacted her neurologist and communicated the blood pressure readings. She took her blood pressure at home everytime she was symptomatic with systolic readings typically in the 70’s. The neurologist started her on florinef. The nutritionist calculated her recommended fluid intake which was less than the gallon she had been drinking. With these adjustments she is now walking on average 8,000 steps a day. her systolic is in the 120’s