DISCUSSIION WITH PATIENTS OF HOW TO INSTITUTE CERTAIN LIFESTYLE CHANGES IS OF PIVOTAL IMPORTANCE.
These patients experience hypovolemia with a central blood volume that is generally 10 to 20 percent below predicted. They appear unable to regulate blood volume properly. Because of this they are generally not thirsty and are unaware when the low blood volume is causinng some of these symptoms. It is mandatory to stress to the patient the importance of maintaining an adequate fluid balance, and they should be given a goal of drinking at least 64 ounces or 8 glassess, of fluid per day. In warmer weather, a good rule of thumb is to stress the importance of an ounce of fluid for each degree of Fahrenheit temperature. Also, in hot weather one of the sports drinks with appropriate electrolytes may help maintain blood volume.
Avoiding caffeine is also extrermely important, as the use of caffeine stimulates the autonomic sytem for the release of more catecholamine and therefore, more symptoms The patient should be instructed specifically to avoid not oly coffee and tea, but also colas and sweets such as chocolate that can contain caffeine. Avoiding sweets also helps alleviate the fatigue that these patients experience and avoid fluctuations in blood sugar that also can trigger more autonomic dysfunction..
A very specific exercise program should be prescribed for the patient. It is not enough to tell the patient to go out and exercise. It first should be determined what type of aerobic exercise the patient prefers, and then the frequency and duration of this exercise should be discussed. In general, the recommendations of at least 3 days per week and at least 30 minutes of sustained aerobic exercise per session is appropriate. The exercise can consist of simple walking, using a treadmill, going to an exercise class to do aerobics Zumba, Jazzercise, step aerobics, ect. In weightlifting and the use of resistance machines tends to aggravate the symptoms of the syndrome. It is also important to stress to the patient that they will get tired, but the more they exercise the more benefit they will derive from improvements in their symptoms. It is useful to teach the Borg scale of exertion. Also, using heart rate response to exercise may cause the patient to under exercise.