Question: I am a 67-year-old individual with a resting heart rate of 70 beats per minute (bpm). However, when I stand up and walk, my heart rate increases to over 100 bpm, and I experience breathlessness and dizziness. On one occasion, it reached a high of 160 bpm after only walking 100m. Interestingly, when I rest, my heart rate returns to 70 bpm. I underwent a 24-hour ECG, but the results were inconclusive. Can you provide any insight? – Amy Bickerstaff, Preston, Lancashire.
Answer: It is possible that you are experiencing postural orthostatic tachycardia syndrome (POTS), a condition that affects heart rate upon transitioning from a seated to standing position. Ordinarily, standing causes blood to accumulate in the abdomen and legs, prompting the body to increase heart rate to restore blood flow back to the heart. However, in individuals with POTS, this response is exaggerated. POTS is more prevalent in women, although the exact reasons for this disparity remain unknown. Various factors can contribute to POTS, including decreased blood volume (associated with vomiting or diarrhea) and neuropathy (nerve damage). It has also been observed that COVID-19 may lead to POTS, although the relationship is still unclear. One key diagnostic indicator is if your heart rate and blood pressure remain elevated for at least 10 minutes after standing. It is recommended that you discuss these symptoms with your GP. Treatments for POTS typically involve graduated exercise plans and increased fluid and salt intake to boost blood volume.
Question: I have been using senna for years to alleviate my constipation. Is it safe to continue long-term usage? – Janine Morris, via email.
Answer: Senna has been traditionally used for treating constipation for centuries. This plant, found in warm climates, contains compounds in its leaves and fruit that stimulate the movement of the colon. Senna is available over the counter in tablet or liquid form, and stronger versions can be prescribed. Before turning to senna, it is advisable to try other strategies, such as increasing fiber intake, drinking more water, exercising, and exploring alternative types of laxatives. Bulk-forming laxatives like Fybogel and osmotic laxatives like macrogol can be viable options. However, if macrogol causes leaks, it may not be suitable for you. It is important to note that senna should only be used short-term (no more than a week) without a prescription, as long-term usage can lead to adverse effects. These include exacerbating constipation, as the bowel muscle can become reliant on the stimulation from senna. Additionally, long-term use of senna can result in excessive loss of essential electrolytes like potassium, which are crucial for maintaining proper fluid levels within cells. This can further lead to loss of muscle tone in the gut. Any change in bowel habits, particularly the onset of constipation in individuals who previously had regular bowel movements, should be investigated by a healthcare professional. However, since your GP is aware of your long-standing constipation issue, is informed about your senna usage, and regularly monitors your blood tests for any electrolyte imbalances, the concerns associated with prolonged senna usage can be addressed. While it may not be an ideal situation, it is currently the best option available.
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