Why Did the Yellow Wiggle Fall Down?

 

If you have (or have had) a toddler, you know who The Wiggles are.

For those of you who don’t, The Wiggles are a children’s music group formed in Sydney, Australia in 1991. The original members, which included Anthony Field, Phillip Wilcher, Murray Cook, Greg Page and Jeff Fatt, are known as much for their color-coded clothing as their kid-friendly rock songs.

Greg Page, the Wiggle in the yellow shirt, retired in 2006 because of a mysterious medical ailment which caused him to faint and lose feeling in his limbs.

After extensive medical detective work, a diagnosis was finally made: Orthostatic Intolerance, a cardiovascular problem which can be treated with medication and lifestyle changes. Page was ecstatic:

Just knowing that what I had had a name, and it wasn’t terminal, and it could be treated was wonderful. I feel like I’m getting a second chance.”

And now, Page is doing much better, so much so that he is rejoining the group, and going back on tour.

His physician, Dr. Susan Corcoran told People:

Simple measures have been effective in helping his condition, but he’ll need to be careful with the rigors of the tour.

 So, What is Orthostatic Intolerance?

Orthostatic Intolerance (OI), sometimes called orthostatic hypotension, refers to a group of conditions in which symptoms worsen with standing (or sitting upright) and are made better by laying down.

Normally, when you stand up, gravity causes blood to pool in your legs. The loss of almost 3 cups (700 ml) of blood from your upper body can lead to a drop in blood pressure, decreased blood to your brain and can cause you to pass out.

However, the body has a safeguard which prevents this from happening. The autonomic nervous system is the part of your nervous system that controls involuntary actions, such as the beating of your heart and the widening or narrowing of your blood vessels. Reflex actions of the autonomic nervous system immediately cause the blood vessels in your legs to constrict when you stand, preventing a large drop in blood pressure.

The Autonomic Nervous System

For people who suffer from OI, their bodies seem to lack this reflex safeguard.

Many healthy people occasionally suffer from acute orthostatic hypotension, which can be triggered by upright posture for long periods of time, a warm environment, an emotionally stressful event  or too little fluid and salt intake. A classic example of acute OI is a soldier who faints after standing rigidly at attention for an extended period of time.

Those with chronic OI have symptoms nearly every day. These symptoms can include:

  • Lightheadedness
  • Headache
  • Fatigue
  • Altered vision (blurred vision, “white outs,” black outs)
  • Weakness
  • Difficulty breathing or swallowing
  • Tremulousness
  • Sweating
  • Anxiety
  • Heart palpitations, as the heart races to compensate for the falling blood pressure
  • Exercise intolerance

It is estimated that over 500,000 people in the U.S. are affected by orthostatic intolerance. OI affects more women four time more often than men who are usually under the age of 35.

Interestingly, up to 97% of those who have chronic fatigue syndrome are thought to have some form of OI.

How is OI Diagnosed and Treated?

OI is notoriously difficult to diagnose.  Many patients have gone undiagnosed or misdiagnosed and either untreated or treated for other disorders.

Current tests for OI include the Tilt table test, “autonomic assessment” and “vascular integrity.”

The first line of treatment is typically lifestyle interventions:

  • Increase fluids and salt (drinking more than eight cups of fluids each day)
  • Tilt the head of the bed up slightly
  • Wear compression garments (such as support hose, girdles or abdominal binders)
  • Learn to avoid and cope with things that can make OI worse (such as standing in long lines, being in warm environments and eating large, heavy meals)

Medications can be used to treat more severe cases.

For more information: click here to go to the Resounding Health Casebook on the topic.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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