Why poor blood flow could be giving you funny turns
21:41 GMT, 7 May 2012
Greg Page is used to performing. For almost two decades he has fronted The Wiggles, one of the most successful children’s entertainment groups in the world.
They’ve sold more than 23 million DVDs and 7 million CDs worldwide, as well as performed sell-out live shows. If you know a child under five, then you’ll no doubt recognise The Wiggles.
Yet for several years the Yellow Wiggle, as Greg is known because he wears a yellow jersey, had been finding it hard to put on a show. There was no single symptom he could put his finger on. He just felt slightly out of sorts, a little giddy at times and got the occasional pounding sensation in his chest. Then, during a two-month tour of the U.S. in 2006 he started to feel much worse.
Down and out: Poor blood flow can result in people just keeling over and fainting
‘On stage I would be OK but within minutes of coming off I would be too tired even to talk — and my chest would feel really heavy,’ says Greg, 40, who is married to Vanessa, 40, and is father to four children aged between eight months and nine.
‘I could feel my heart racing and got short of breath. My hands were shaking. Then I actually passed out unconscious twice in two days.’ Each time he was taken to hospital but doctors couldn’t work out what was wrong.
‘It was a pretty awful time and I was starting to feel scared,’ says Greg. In fact, he felt so unwell he flew back to his home in Sydney, quitting the band as the strain of not knowing what was wrong played heavily on him.
Months later — and after 60 different tests — doctors were able to say what was wrong with him: he was suffering from orthostatic intolerance — poor blood flow in the body.
It occurs as a result of a malfunction in the nervous system, which means when part of the body requires increased blood (for example the gut, after eating, or your legs when getting up to stand), there is a delay in adequate blood supply to the brain. Typically sufferers feel faint and some may even black out when they stand up or exert themselves.
Doctors have only been aware of the condition since the 1990s, but one leading expert believes that a ‘whole lost tribe’ of people suffer from orthostatic intolerance but don’t realise it; furthermore, she suggests many people diagnosed with chronic fatigue may in fact have orthostatic intolerance.
‘There are five litres of blood in circulation in the body and when we stand up 700ml of it drops into our legs,’ explains Julia Newton, clinical professor of ageing and medicine at Newcastle University and Newcastle Hospital NHS Trust.
The Wiggles: Greg Page wears the yellow jumper
‘Normally, to compensate for this, our heart rate has to go up slightly to keep the blood pushing up to the brain, and the blood vessels in the legs constrict to push the blood around. However, in people with orthostatic intolerance this mechanism doesn’t work quickly enough.
‘So whenever they stand up they feel faint and breathless because their blood pressure drops and their heart rate races, so not enough blood gets to the brain. Some people [like Greg] may feel breathless too — it’s the body’s way of trying to get more oxygen.
‘In those with mild symptoms, this will only last for a few seconds. However, some people have both orthostatic intolerance and another condition called vasovagal syncope [where the heartbeat suddenly slows down]; this causes problems not when getting up to stand, but on standing. They suddenly just keel over and faint.’
Another common symptom is feeling light-headed and tired after a meal, as extra blood goes to the gut, thus limiting blood supply to the brain.
‘They may also feel dreadful after exercise because all the blood is going to their muscles and not the rest of their body,’ says Professor Newton. ‘Many people feel permanently exhausted and have trouble sleeping too, possibly because your blood pressure drops naturally at night and for people with orthostatic intolerance their blood pressure drops so low that they can’t reach a deep sleep.’
(The symptoms are similar for low blood pressure, the difference is that with low blood pressure they occur whatever the patient is doing, even if just sitting still.) Orthostatic intolerance is often triggered by a virus such as glandular fever and most commonly occurs in the under-35s, possibly because they are more susceptible to viruses. Another possible trigger is surgery, as a result of the stress this puts on the body. Greg’s orthostatic intolerance could be linked to a hernia operation he had a year before his collapse.
‘However, it is four times more common in women than men and most women say that their symptoms get worse around the time of their period or the menopause, which suggests there is a hormonal link,’ adds Professor Newton.
People with auto-immune conditions where the body attacks itself, such as diabetes, are more prone to the condition and it is a recognised complication of Parkinson’s disease. Orthostatic intolerance can also cause memory problems and increase the risk of a heart attack or stroke as it reduces blood supply to the brain and heart — so early diagnosis is vital.
The simple test involves lying down for ten minutes. Patients are then asked to stand up and if their heart rate increases to more than 120 beats per minute or if their blood pressure sinks by 20mm of mercury or more, they are classed as having orthostatic intolerance.
However, often this diagnosis is hard to come by. ‘This is a new disease, so some GPs and even consultants don’t know what to look for,’ says Professor Newton.
‘Also, you need to use a blood pressure monitor on to the finger to measure each heartbeat. However, most GP surgeries and some hospitals only use blood pressure monitors that strap around the arm and have to be inflated, by which time the tell-tale drop in blood pressure might be missed.
‘Consequently many people don’t get a correct diagnosis. Some get told they have anxiety — and 30 per cent of the patients I see diagnosed with chronic fatigue, or myalgic encephalomyelitis (ME), actually have orthostatic intolerance when we diagnose them properly.
‘So if you suffer from blackouts, or light-headedness when you stand up, go to your doctor and mention orthostatic intolerance.’
'Five years ago I felt terrible and had no energy but now I feel I can handle this again'
Greg lived with his symptoms for 12 years before he was correctly diagnosed. ‘I would come off stage and my bandmates would say: “Hey look, Greg’s got the shakes again” but because it went on for that long I didn’t think anything of it,’ he says.
His diagnosis came as a relief, even though he had never heard of the condition. He’s been told it may be partly due to the fact he suffers from hyperhidrosis, or excessive sweating, which he was diagnosed with aged 34.
‘It meant I would sweat a lot even in winter — it was a major cause of embarrassment,’ he says. ‘I was losing so much fluid that it would have reduced my blood pressure and made the symptoms worse.’
There is no single cure but self-help measures include drinking two and a half litres of fluid a day to provide a good volume of blood to keep blood pressure up. ‘We check what tablets people are on, as for example blood pressure lowering medication, diuretics or anti-depressants could all make things worse,’ says Professor Newton.
‘People are also encouraged to do sharp squeezes of their leg muscles before they stand up to try and move the blood back into the circulation. If that doesn’t work, then medication such as fludrocortisone or midodrine can be prescribed — these help the body retain salt and so push blood pressure up.
Greg ensures he drinks plenty of fluids and that he does not stand up too quickly or for too long. ‘We used to do appearances at stores and things and I would be on my feet for about an hour and think I was going to pass out.
‘Now I keep shifting my weight from one foot to another to keep the blood pumping. The only medication I took was fludrocortisone. I was on it for about 18 months, which really helped.’
He now feels so in control of his condition that he’s just re-joined The Wiggles and will take part in the forthcoming tour of the UK.
‘Five years ago I felt terrible and had no energy but now I feel I can handle this again,’ he says. ‘I’m also really enjoying being with my family more now I have energy.’
Greg is keen to improve awareness of orthostatic intolerance. He says: ‘I heard from a man the other day who had been to see his doctor who said: “Ah, Yellow Wiggle syndrome”. I am so glad that I can help ensure more people know about this condition and that some good can come out of this.’
The charity STARS provides support for people with orthostatic intolerance, go to stars.org.uk.
The Wiggles tour of the UK starts on May 31, for details visit www.thewiggles.com