Standing for long periods

When I must stand for more than 20 minutes or so, I become nauseated and soon start to black out.  The problem is relieved by sitting but returns when I stand again for a short while.  It happens regardless of the activity that requires me to stand.  For example, doing dishes is particularly hard because not only am I standing, but I am working with my arms extended.  I sit whenever possible while cooking, such as when chopping.  This has gone on for years.

I need to solve this problem, because I sing in a professional choir and it is disruptive for me to sit during performances when the rest of the choir is standing, and I may be asked to resign.  This doesn't seem to be a problem for other singers.

I don't know even what area of medicine might address this problem.  Is circulation the issue, and does it have a solution?    I have very lttle endurance.  It does not vary with weight, which has generally been normal.  My heart rhythms are fine.  I have been on Synthroid for 20 years, and my thyroid function tests are normal.  I have a diagnosis of Chronic Fatigue Syndrome, but it doesn't help me solve this rather urgent performance problem.  Any suggestions?  I need help!

[Kevin Pho, MD]

One consideration would be orthostatic hypotension.  Causes for this are many, but one consideration would be chronic autonomic failure.  This usually leads to a drop in blood pressure when standing, leading to the symptoms you describe.

Tilt-table testing is normally the test to evaluate this.  Tilt table testing typically reproduces the clinical symptoms in association with a heart rate increase 30 beats/min or a maximum heart rate 120 beats/min within the first 10 minutes.

If this is the case, there are medications used to treat this - including mineralcorticoids as well as alpha-1 adrenergic agonists.  You may want to discuss these options with your personal physician.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
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