This morning was the worst morning yet in regard to fainting.  I don’t recall that she fainted during the trips to the commode during the night and in the morning.  When she got up, we made it through pills and her usual yogurt, juice, and today she chose a granola bar from the other regular options. 

Then the fainting began in earnest.  She fainted every time she stood up even to transfer from the dining room chair to the transfer chair.  What was most concerning to me was that after moving her in the transfer chair to her usual spot by the little table to watch television, she fainted.  She was sitting in the chair, had not gotten up and down, but was just sitting and went out cold. 

Orthostatic Hypotension is the blood vessels not constricting when a person stands up, allowing gravity to keep most of the blood in the lower part of the body, slowly reducing the blood flow to the brain.  She was just sitting down.  She had not gotten up. 

Of course, after she came out of that syncope, she insisted on standing up, and fainted every time.  I asked her if she wanted to lay down for a nap, but she was determined not to do that today. 

She decided that she wanted to get dressed.  I rolled her into the bedroom.  When she stood up, she fainted again. When she has fainted, sometimes when she comes around, her eyes shut tightly, her lips purse and she sort of twists her head to the side.  That usually means that she has shut down and can only lie down and nap.  This time I asked her again if she wanted to lie down, expecting either a yes or no answer.  She said no.  I asked if she wanted to get dressed.  She said yes.  She was determined.  I managed to get her transferred to the bed to begin the process of taking off her top to get dressed. 

She fainted again just sitting on the bed.  This time I just arranged her on the bed, covered her with the sheet and she stayed out and slept for a time.  She did not sleep quite as long as on other days, maybe an hour or hour and a half. 

When she woke up, she was better.  While she still fainted, she could stand up longer and did so more in accord with the pattern of previous days.  The rest of the day has continued the pattern of the last couple of weeks.  She was able to function.  As has been so recently, I could not really leave the room to speak of, since she continued to be in pop-up mode.  She could walk eight or ten feet, but then needed to sit down. 

The Cardiologist’s office called this morning to respond to my request about increasing the Midodrine, the medicine that raises her blood pressure to minimize the syncopes due to the Orthostatic Hypotension.  The suggestion was to increase each of the three doses in the day by 50%.  Instead of one pill, one pill, and then a half pill four hours apart, it could be increased to one and a half pills, one and a half pills and one pill four hours apart. 

Normally I would titrate the increase over a few days.  After this morning, I decided to make the full change right away.  The noon and suppertime doses have been increased.  Tomorrow morning that dose will be increased.  My hope is that this will move us back over the threshold to a more manageable pattern.  We live very close to the margins of functionality. 

We should know pretty soon if the change will take us back to the version of normal we were experiencing a couple of weeks ago.  We may have to adapt to a new normal.  We prefer the old normal to this new one that seems to be trying to emerge. 

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