From: Patti Schmidt Date sent: Sun, 27 Aug 2000 Exact Procedures for Bell/Streeten Orthostatic Many people on the various lists have been talking about the test Drs. Bell & Streeten use to find out if a patient is orthostatically intolerant (in other words, has NMH) right in their offices. These are the proper procedures, right from Dr. David Bell, MD. ___________________________________ The proceedure is very simple. 1. Patients should be tested late morning or early afternoon with no unusual activity prior. Large meals and large volumes of fluid prior to testing should be avoided. 2. Normal medications should be taken the day of the test. Medications which affect circulating volume should be stopped at least two weeks prior to testing as they will affect the results. Examples are Florinef, diuretics, blood pressure medications, large salt loads. Tricyclics and SSRI medications are acceptable if not for research studies. 3. Blood pressure should be taken with manual sphygmomanometer every three to five minutes, along with pulse. If available, a dynamap or other accurate BP device can be used. Step 1. Patient lying down comfortably for 10 minutes. Pulse and BP at onset, 5 min and 10 min; observations on symptoms. Step 2. Patient stands without moving or leaning on any object for 30 min or as long as tolerated. If patient pre-syncopal, the test is terminated. Right arm is resting on table at mid chest (heart) level with BP cuff in place. P and BP taken every 5 minutes, and spontaneous symptoms recorded as well as observations (ie, yawning, feet mottled or bluish, etc) If symptoms become more severe P and BP every 3 minutes. It is important to note that this test is very difficult for some persons with CFS and an opportunity to rest for an hour after is offered. Intravenous saline is very helpful to aid recovery. Next, we'll ask Dr. Bell for a list of the normal ranges for the five different abnormalities which occur. Date sent: Wed, 6 Sep 2000 Dr. David Bell was kind enough to give us the proper procedures for his orthostatic intolerance test. He also sent this list of normal ranges for the five different abnormalities which occur in the test. His response to the email from the man who's heart had stopped during the test is below the list of ranges. Thanks, ~~ Patti ~~ ------------------ Many people on the various lists have been talking about the test Drs. Bell & Streeten use to find out if a patient is orthostatically intolerant (in other words, has NMH). We've sent out the proper procedures for that test previously. Dr. Bell has also sent a list of normal ranges for the five different abnormalities which occur in the test. They're from Dr. David Streeten's book Orthostatic Disorders of the Circulation. The normal ranges are: Normal sBP: recumbent: 100-142; Standing (4 min) : 94-141; Orthostatic change: -19 to +11 Normal dBP: recumbent: 55-90; Standing : 61-97; Orthostatic change: -9 to +22 Normal P: recumbent: 54-96; Standing : 62-108; Orthostatic change: -6 to +27 Orthostatic systolic hypotension: fall in systolic blood pressure of 20 mmHg or more Orthostatic diastolic hypotension: fall in diastolic BP of 10 mm Hg or more. Orthostatic diastolic hypertension: rise in diastolic BP to 98 mm Hg or higher Orthostatic narrowing of pulse pressure: reduction in pulse pressure to 18 mm Hg or lower. Orthostatic postural tachycardia: increase in heart rate of 28 bpm or to greater than 110 b/min. In regards to the email from the man who's heart had reportedly stopped during the test, Dr. Bell said: "I would completely agree that orthostatic testing should be done in a physician's office with the appropriate equipment for complications. In my office no one has had any serious cardiac abnormalities such as you have described, but we do not continue the test past the point where the patient is pre-syncopal. And it is important to remember that this test (the in-office orthostatic testing) merely replicates the physiology of a person standing in line at the grocery store. This is one of the advantages of this test over the tilt table. The second reason for doing this test in a physician's office was also stated: the results will not be trusted or believed unless recorded by medical personnel. By doing the test at home, the results are meaningless for purposes such as establishing disability. It is also unnecessary - every person with CFS knows what will happen to them if they stand quietly for fifteen to thirty minutes, they have already experienced it."