Is it always debilitating?  NMH isn't always debilitating and can even be very mild or what is considered subclinical. It can cause mild intermittant symptoms and may be only triggered by certain conditions. It can be severe and debilitating causing extreme difficulties for the person. This last category has been linked to chronic fatigue and some have been treated with medication with improvement. There are many web sites which focus on this. However I have not seen any on the milder or subclinical form of NMH. So I'll focus on it here.  How is it diagnosed? It's generally not routinely diagnosed but an abnormality can be found by doing a tilt table test. The first two phases of the test will likely be normal but on the third part of the test the blood pressure will drop to an extreme level while the heart rate may or may not change. With a normal tilt table test, the blood pressure nor the heart rate drop. There are some "normal fluxuations" but no significant drop which causes any symptoms. What symptoms will this "borderline" test produce? It will produce similar results as the "positive" test (unquestionably NMH). These include feeling weak or clammy, dizzy, darken vision, popping sounds, nausea, and feeling faint. After the test there will be a continued feeling of weakness even after eating, a strange sense that something is off balance in the body and unusual body pains upon exertion for the next day or two. What symptoms does the person normally have in day to day life? Usually not much except maybe some intermittant dizziness or feeling a little faint or weak if standing in a line for an extremely long time on a hot day or sitting in a suana or some other extremely hot place. These situations do not produce symptoms in everyone but apparently effects those with the subtle abnormality. Any extreme exersion in hot conditions or hot environments can produce symptoms. Doesn't everyone experience symptoms under extreme conditions. Maybe so but those will subclinical NMH or "borderline abnormal" results get symptoms sooner with less extreme than those with "normal" or "negative" tilt table results. When should NMH be treated? If it causes significant or troublesome symptoms. If it causes problems you should seek medical advice. What can you do to decrease minor symptoms? First make sure nothing significant is causing you problems such as any other medical problems by getting a good physical. You can reduce symptoms by simply increasing fluid intake (juice, water) and adding a little salt (if you don't have medical problems limiting salt intake). You can also do the most simple thing by limiting activities which produce symptoms and gradually build up endurance (ex if mowing the grass produces symptoms take short breaks rather than try to do the whole yard at once). Also eating a well balanced diet and getting the proper amount of sleep and rest will decrease any physical symptoms and promote health. This should decrease these minor symptoms. If symptoms are bothersome or get worse then you should consult your physician about these symptoms.  
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