Preparing for Autonomic Disorder Testing: Caffeine, Medicines and the Symptom Diary

The appointment letter arrives with a page of instructions, and one line stops you cold: no coffee. For someone whose mornings only start after two cups, that request lands harder than the mention of electrodes or a table that tips upright. You start wondering what else in an ordinary day might quietly change the numbers your neurologist is trying to read.

That instinct is exactly right. Autonomic testing measures reflexes so sensitive that a latte, a decongestant or an anxious sprint from the parking lot can shift them. Preparing for autonomic testing is less about bravery and more about arriving as your everyday self, so the machines record your nervous system rather than your breakfast.

This guide walks through what the tests do, why caffeine and certain medicines matter, how to keep a symptom diary your care team will actually use, and which signs should prompt a call before the test date ever arrives.

What is autonomic testing and what does it actually measure?

The autonomic nervous system is the part of your wiring that runs in the background: heart rate, blood pressure, sweating, digestion, pupil size and bladder control, all adjusted without a conscious thought. When it misfires, the result is dysautonomia, a broad label for any disorder of that automatic system, as the National Institute of Neurological Disorders and Stroke describes it.

Autonomic testing is a set of short, non-invasive maneuvers that provoke those reflexes on purpose and record how the body answers. Stand up quickly and healthy vessels tighten within seconds to keep blood flowing to the brain. Breathe slowly and deeply and the heart rate should swing up and down with each breath. Bear down as if lifting something heavy and blood pressure dips, then rebounds in a predictable curve. Warm a patch of skin with a small electrical current carrying a sweat-inducing chemical and the local sweat glands should respond.

Each of these responses can be measured, timed and compared with reference ranges for your age. The heart and blood pressure tests probe the pathways that use the neurotransmitter acetylcholine and the vessel-tightening pathways that use norepinephrine. The sweat tests examine the smallest nerve fibers, the ones standard nerve conduction studies cannot see.

Why does this matter for preparation? Because the tests are looking for differences of a few heartbeats per minute or a few millimeters of mercury in blood pressure. Anything that nudges those baselines, such as caffeine, dehydration, a large meal, a hot bath or a medicine that acts on the same receptors, can blur the picture. The laboratory is not being fussy when it hands you a rule sheet; it is protecting the one thing the test cannot do twice cheaply: your undisturbed baseline.

What should I expect during autonomic testing?

Most autonomic laboratories run a battery of four or five tests in one visit. The Mayo Clinic notes that a tilt table study alone can take up to about 90 minutes when both phases are done, and a full battery often fills a morning, so plan for a longer visit than a blood draw.

You will lie on a padded table while a technologist places sticky electrodes on your chest for a continuous heart tracing and fits a cuff, usually on a finger or the upper arm, that tracks blood pressure with every beat. For the sweat test, small capsules are taped to a forearm, leg and foot. The chemical inside causes a mild warming or tingling for a few minutes; most people describe it as odd rather than painful.

Then the coached parts begin. You breathe in time with a light or a voice for about a minute. You blow into a small tube against resistance for about fifteen seconds, several times, while the screen watches your pressure fall and recover. Finally the table tilts you toward upright, held by straps at the chest and knees, and you stay there while the team watches the numbers. Mayo Clinic describes this upright phase as lasting anywhere from 5 to 45 minutes depending on the protocol and how you respond.

You may feel lightheaded, warm, sweaty or nauseated during the tilt. That is often the very response the team hopes to capture, and they can lower you flat within seconds. Speak up the moment something feels wrong; the technologist would rather stop early with a recorded event than push through and miss it.

Afterward you will rest lying down until you feel steady, then walk out. Results are usually interpreted by a neurologist and discussed at a follow-up rather than handed over on the spot.

Preparing for autonomic testing: why caffeine changes the numbers

Caffeine is a stimulant that blocks adenosine receptors, the brakes your brain uses to signal rest, and it also nudges the release of adrenaline. The practical result is a faster resting heart rate, a small rise in blood pressure and vessels that behave slightly differently when you stand. For a person having a routine check-up that hardly matters. For a tilt study designed to catch a heart rate rise of 30 beats per minute within 10 minutes of standing, the threshold Johns Hopkins Medicine lists for postural orthostatic tachycardia syndrome, a morning coffee could push a borderline result over the line, or mask a real one by tightening vessels that would otherwise have failed.

Caffeine also lingers longer than the buzz. Its effects on heart rhythm can persist for several hours after the last cup, which is why laboratories tend to ask for abstinence starting the evening before rather than just at breakfast. Your own instruction sheet will give the exact window; when instructions differ, the lab’s version wins.

Watch for the hidden sources. Tea, cola, energy drinks, chocolate, some pain relievers and many pre-workout powders all carry caffeine, and decaffeinated coffee still contains a small amount. Nicotine and alcohol are usually on the same list for the same reason: both act on heart rate and blood vessel tone.

If you drink coffee daily, stopping abruptly can bring a withdrawal headache and grogginess. Some people taper over a few days before the test so the morning itself is uneventful; others simply accept one rough morning. Either approach is fine as long as the test-day window is respected. Do not swap in a different stimulant to cope. Mention any withdrawal headache to the technologist, because a pounding head can itself raise blood pressure and is worth a note in the record.

What medications should I stop taking before an autonomic test?

The honest answer is: none, unless the prescribing clinician or the testing team has told you to, in writing, with a date. Several medicines do change autonomic readings, and laboratories routinely review your list before the visit. But whether a pause is safe depends on why you take the drug, and that judgement belongs to your treating team, never to a magazine article.

It helps to understand the mechanisms behind the common requests. Beta-blockers slow the heart and blunt its rise on standing, so they can hide the pattern a tilt test is hunting for. Medicines with anticholinergic effects, a group that includes some older antihistamines, bladder relaxants, tricyclic antidepressants and certain sleep aids, dampen sweating and can make sweat-gland tests read falsely low. Drugs prescribed to raise blood pressure in dysautonomia, such as the vasoconstrictor midodrine or the fluid-retaining steroid fludrocortisone, do their job so well that they can conceal the drop the test is designed to measure. Decongestants, stimulants for attention disorders and diuretics all move heart rate, pressure or fluid volume in ways that matter.

How far ahead a medicine is paused depends on how long it stays active in the body, which varies from hours to days between drug classes. Some medicines, particularly those for heart rhythm, seizures, mood or blood clots, should never be interrupted for a diagnostic test, and the lab will simply note them and interpret around them.

Your job is narrower and very useful: bring a complete list, including supplements, over-the-counter products and anything taken only occasionally, with the time of your last dose of each on test day. If you were asked to hold something and forgot, say so before the electrodes go on. A test run with full information is far more valuable than one hiding an unspoken tablet.

Who is usually sent for autonomic testing, and who is asked to wait?

Referral typically follows a story that does not fit neatly elsewhere. Someone faints repeatedly with a normal heart tracing. A person with long-standing diabetes has dizziness on standing that cannot be pinned on blood sugar. A younger adult has a racing heart every time they rise from a chair, months after a viral illness. Others arrive with a mix of bowel, bladder, sweating and blood pressure symptoms that suggest a wider nerve problem. MedlinePlus lists diabetes, alcohol use disorder, certain autoimmune conditions and some degenerative brain diseases among the recognized causes of autonomic neuropathy, and testing helps sort where an individual sits within that range.

The tests also serve as a baseline. When a clinician suspects small-fiber neuropathy, a disorder of the thin pain and sweat nerves, sweat testing can document damage before larger nerves show anything. Repeating the battery a year or two later can show whether the condition is stable or progressing.

Some people are asked to wait. Acute illness, fever or vomiting in the preceding days shifts fluid balance and heart rate enough to make results unreliable, so labs commonly reschedule. Pregnancy changes blood volume and vessel tone substantially, and the tilt component in particular is often deferred. Recent heart attack, unstable angina, severe aortic narrowing or an uncontrolled heart rhythm disorder can make a provoked blood pressure drop unsafe, and the referring cardiologist or neurologist will weigh that risk first. Open skin infections at the sweat test sites, or a pacemaker in some protocols, may alter which components are run.

Children can have autonomic testing, usually with age-adjusted reference ranges and a shorter protocol. Preparation for a child is about explaining the tilting table honestly, arranging a familiar adult in the room and choosing loose comfortable clothes; nothing more complicated is expected of a family.

What are the signs that your autonomic nervous system is failing?

People search this question hoping for a definitive list, and the truthful reply is that autonomic symptoms are common, non-specific and shared with dozens of unrelated conditions. Feeling dizzy on standing, sweating too much or too little, digestive sluggishness, bladder changes and unexplained fatigue can each appear in autonomic failure, but they also turn up with dehydration, thyroid disease, anemia, medication side effects and ordinary deconditioning. That overlap is precisely why formal testing exists.

What clinicians weigh is pattern rather than any single symptom. The Mayo Clinic describes autonomic neuropathy as tending to affect several systems at once: blood pressure regulation alongside digestion, sweating alongside sexual function, pupil responses alongside heart rate. A symptom that is reproducible, that follows a trigger such as standing, heat or a meal, and that has persisted for weeks or months carries more diagnostic weight than a bad afternoon.

Orthostatic hypotension, meaning blood pressure that drops meaningfully within a few minutes of standing, is the most measurable of these clues, and it can often be checked in an ordinary clinic before any specialized test is booked. A heart rate that climbs steeply on standing without a pressure drop points toward a different pattern, the one Johns Hopkins describes in postural orthostatic tachycardia syndrome.

The reason this article refuses to hand you a scoring checklist is practical. Self-grading symptoms tends to raise anxiety without changing the next step, which is the same for everyone: describe what happens, when it happens and what you were doing, then let a clinician decide which tests fit. That description is where the symptom diary in the next section earns its place. It converts a vague sense that something is wrong into timestamps, triggers and durations a neurologist can compare against the tracing on the day.

How to keep a symptom diary before autonomic testing

A good symptom diary does one thing brilliantly: it lets the neurologist line up what you feel in daily life against what the laboratory recorded in a single controlled hour. The test captures one morning; your diary captures the other twenty-nine days.

Start as soon as the referral is made, and keep it simple enough that you will still be filling it in on day twelve. For each episode, note the time, what you were doing in the two minutes before it began, how long it lasted, what you did to recover and how you felt afterward. Add what you had eaten or drunk in the previous few hours, including caffeine and alcohol, because meals and stimulants are frequent triggers. Record the room temperature or weather if heat seems to matter. If you own a home blood pressure cuff or a wearable that logs heart rate, a lying-then-standing reading during a spell is gold, but never chase a reading if you feel faint; sit down first.

Equally useful are the good days. A run of quiet days after better sleep or more fluids tells the team something about mechanism. So does a pattern tied to the menstrual cycle, to shift work or to a particular medicine time.

Keep it to a page or two of plain notes or a simple table on your phone. What the team does not need is a novel of adjectives. Numbers, times and triggers beat descriptions of how frightening it felt, though one line about the impact on work, driving or caring for children is valuable, since that shapes urgency.

Bring the diary on test day and hand it over at the start. Some laboratories ask you to rate symptoms on a simple scale during the tilt itself; having thought about your typical spells beforehand makes those ratings far more accurate.

Which autonomic test does what, and what interferes with each

Not every laboratory runs the same battery, and the instruction sheet you receive reflects the specific components ordered for you. The table below summarizes the tests most often bundled together, the reflex each one probes and the everyday factors most likely to distort the reading. Use it to understand the reasoning behind your instructions, not to replace them.

Test	What it measures	What commonly interferes
Heart rate response to deep breathing	How much the heart rate swings with slow breaths, a marker of vagus nerve function	Caffeine, anxiety, shallow or irregular breathing, medicines that slow the heart
Valsalva maneuver	Blood pressure fall and rebound while bearing down, testing vessel-tightening reflexes	Poor technique, recent large meal, dehydration, vasoconstrictor medicines
Tilt table test	Heart rate and blood pressure while moving from lying to upright and holding it	Caffeine, low fluid intake, heat, beta-blockers, blood pressure medicines, prolonged bed rest
Sweat gland test (QSART)	Local sweat output from small nerve fibers in the skin	Skin lotions or oils, anticholinergic medicines, some antihistamines, recent sunburn at the site
Thermoregulatory sweat test	Whole-body sweat pattern in a warm chamber, mapping areas that fail to sweat	Antiperspirants, skin products, dehydration, medicines that suppress sweating

Two patterns stand out. Caffeine and hydration touch almost every row, which is why they head the preparation list for nearly everyone. Skin products appear only in the sweat rows, yet they are the item people most often forget. A single morning application of moisturizer on the forearm can block the capsule from reading properly and force a repeat. Shower with plain soap, skip lotion, oil and antiperspirant on the day, and wear short sleeves or clothing that rolls up easily so the sites can be reached without undressing fully.

Tilt table test preparation: the 48 hours before your appointment

Two days out, read the instruction sheet again and flag anything unclear. Laboratories are used to phone calls about specific medicines, and a quick check now avoids a wasted trip. Confirm whether a friend or family member should come; many labs recommend a companion because you may feel washed out after a positive tilt, and driving yourself home immediately afterward is often discouraged.

The day before, drink water normally rather than loading up. Over-hydration can suppress a real blood pressure drop just as dehydration can exaggerate one; the aim is your usual self. Avoid a heavy alcohol evening, a long hot bath and a strenuous new workout, each of which shifts fluid balance for hours. Start your caffeine abstinence at whatever point the lab specified, and get to bed at a normal time. A short night raises resting heart rate and makes the deep-breathing test harder to perform well.

On the morning itself, follow the eating instructions exactly. Mayo Clinic advises that patients may be asked not to eat or drink for about two hours or more before a tilt table test; some labs allow a light early breakfast and water, others do not. Take medicines as instructed, with only the sips of water permitted. Shower with plain soap and skip every skin product. Dress in loose, layered clothing with a top that rolls above the elbow, and bring warm socks, because lying still under electrodes can feel chilly.

Pack the essentials: your full medicine list with last-dose times, the symptom diary, reading glasses, a snack and a drink for after the test, and any home blood pressure or heart rate logs. Arrive early enough to sit quietly for ten minutes before you are called. Walking briskly from a distant parking lot and being wired up while still breathless is a small, avoidable way to start the recording on the wrong foot.

What are the risks of autonomic testing?

Autonomic testing is among the lower-risk investigations in neurology, because it involves no needles, no radiation and no sedation. The maneuvers deliberately provoke symptoms, however, and it is fair to know what that can feel like.

The most common event is feeling faint or actually fainting during the tilt. Mayo Clinic notes that this is a recognized and expected outcome for some patients, and the table is designed for it: you are secured with straps, the team watches continuously, and returning you to flat takes seconds. Blood pressure and heart rate almost always recover promptly once horizontal. Nausea, sweating, palpitations, tremor, tunnel vision and a headache in the hours afterward are also reported and typically settle with rest and fluids.

The sweat tests can leave small red marks or mild irritation where the capsules sat, which fade over hours to a day or two. The deep breathing and bearing-down maneuvers can cause brief lightheadedness. Rarely, a slow heart rhythm during a faint lasts longer than expected, which is one reason laboratories keep resuscitation equipment on hand even though it is very seldom needed.

People at higher risk from a provoked blood pressure drop, including those with severe coronary disease, significant narrowing of the aortic valve or a recent stroke, are usually screened out or tested with a modified protocol. Tell the lab about any of these conditions in advance if they are not obviously in your record.

Alternatives depend on the question being asked. A supervised lying-and-standing blood pressure check in a clinic, a prolonged wearable heart monitor, or an active stand test done without the table can each answer parts of the puzzle with less provocation. None replaces the full battery when small-fiber damage or the shape of the reflex curve is the issue, which is why the referring clinician chooses the combination rather than defaulting to everything.

What do the days and weeks after autonomic testing usually look like?

The hours right after the visit are often the hardest part. A positive tilt can leave people drained for the rest of the day, with a lingering headache and a woolly, jet-lagged feeling. Fluids, a normal meal, avoiding heat and lying down when needed usually see that pass by the next morning. If you were asked to hold a medicine, restart it exactly when the prescribing clinician said, not when you feel better and not when a friend suggests.

Results typically go to the ordering neurologist for interpretation, and a discussion follows at a scheduled appointment or through a written letter. Timelines vary between services, so ask at the visit when and how you should expect to hear. The report will describe each component as normal, borderline or abnormal, and may summarize a pattern: for instance, a heart rate rise consistent with postural tachycardia, a blood pressure fall consistent with orthostatic hypotension, or reduced sweating in a pattern suggesting small-fiber involvement.

An abnormal result is a starting point, not a verdict. It is common for the team to order further blood tests, a heart monitor, nerve studies or imaging to look for a cause, because dysautonomia is a description of what the nerves are doing rather than why. A normal result is also informative; it can steer attention toward other explanations for the symptoms and spare you treatments that would not have helped.

Where a diagnosis is made, management plans in guidelines emphasize fluid and salt intake tailored by the clinician, compression garments, graded physical conditioning and adjusting triggers such as heat and prolonged standing, with medicines reserved for people who need them. Which of these applies to you, and in what order, is a conversation for the follow-up visit. Keep the symptom diary running through this period; it becomes the measure of whether any plan is working.

What people often get wrong about autonomic testing

The first myth is that a bad result on the day means the test failed. Fainting on the tilt table is not a failure; it is a recorded event, often the most useful minute of the whole session. The team wanted to see what your body does when challenged, and it obliged.

The second is that the tests are painful or invasive. There are no needles and no anesthetic. The sweat capsules tingle, the table tilts, and you breathe into a tube. Most discomfort comes from the symptoms the tests provoke rather than from the equipment.

Third, many people assume that stopping their own medicines beforehand will produce a cleaner result and impress the team. It does the opposite. Unplanned interruptions of beta-blockers, blood pressure medicines or antidepressants can cause rebound effects that are themselves dangerous and that contaminate the reading. The only medicine changes that help are the ones the prescribing clinician has agreed in advance.

Fourth, the idea that drinking as much water as possible on the morning will help you pass. There is no passing. Over-hydration can hide a genuine problem and lead to months of chasing the wrong explanation. Arrive as your usual self.

Fifth, a normal result is often read as being told nothing is wrong. Autonomic testing samples specific reflexes on one morning. A normal battery narrows the search and points elsewhere; it does not deny that you feel unwell, and clinicians know that.

Finally, people expect a diagnosis before they leave the room. Interpretation requires comparing every trace against age-matched norms and against your history, and that is done afterward. Asking when you will hear, rather than what the technologist saw, gets a far more useful answer.

Questions to ask your care team before and after the test

A short list of questions, asked before the appointment, does more for preparation than any amount of online reading, because the answers are specific to you. Consider raising these with the referring clinician or the laboratory when you confirm the booking.

• Which components are ordered for me, and roughly how long should I allow for the visit?
• Which of my medicines, supplements and over-the-counter products, if any, should be paused, from exactly when, and who is authorizing that pause?
• How long before the test should I stop caffeine, alcohol and nicotine, and can I drink water on the morning?
• Should I eat a light breakfast, or arrive fasting, and for how many hours?
• Is it safe for me to drive home, or should someone come with me?
• I have a condition or device (for example a pacemaker, heart valve narrowing, pregnancy or a recent infection); does that change the protocol?
• What should I record in my symptom diary, and would home blood pressure or heart rate readings be helpful?

After the test, a second set of questions keeps the momentum going.

• When and how will I receive the results, and who will explain them?
• If a medicine was held, when precisely should I restart it?
• What would an abnormal result lead to next, and what would a normal result mean for my symptoms?
• Are there triggers I should avoid or activities I should limit while I wait?

Write the answers down or bring someone to take notes. Autonomic symptoms often include brain fog, and remembering a verbal instruction about medicine timing after a tiring tilt is harder than it sounds. A written plan you can photograph and share with your pharmacist removes that risk entirely.

When to call your doctor

Most of the sensations around autonomic testing are expected and pass within a day. A few are not, and they should prompt a call whether they arise in the lead-up, on the day or afterward.

Before the test, contact the referring clinician or the laboratory if you develop a fever, vomiting or diarrhea in the preceding days, since the test may need rescheduling, or if you have started, stopped or changed any medicine since the referral. If you have been asked to pause a medicine and notice a marked change in heart rate, blood pressure, mood or seizure control, do not wait for the appointment; call the prescriber the same day.

Seek urgent care, by calling emergency services if necessary, for any of the following at any time: chest pain or pressure, sudden shortness of breath, a faint that leads to injury or one that occurs while sitting or lying down, a heart rate that stays very fast or very slow for more than a few minutes at rest, confusion, slurred speech, weakness on one side of the body, a seizure, or fainting accompanied by a new irregular pulse. These may signal a heart rhythm problem or stroke rather than dysautonomia, and MedlinePlus and Mayo Clinic both list them among the situations that need immediate assessment.

In the days after testing, call if a headache is severe or unlike your usual ones, if lightheadedness is much worse than before, if the sweat test sites become hot, swollen or weeping, or if you cannot keep fluids down. Call too if you are unsure when to restart a held medicine; a two-minute phone call to the prescriber or pharmacist is always the safer choice.

Every decision about medicines, further testing and treatment rests with your treating team. This guide is here to help you prepare well and describe your symptoms clearly, not to replace that conversation.

Frequently asked questions

Autonomic function test: what to expect on the day?

Expect a morning of lying on a padded table with chest electrodes and a blood pressure cuff while a technologist coaches you through timed breathing, a bearing-down maneuver, small sweat capsules on your arm and leg, and a tilt toward upright. You may feel lightheaded or faint during the tilt; that is monitored and often expected. Results are interpreted afterward by a neurologist rather than given immediately.

What should I eat before a tilt table test?

Follow your laboratory’s written instructions, because protocols differ. Mayo Clinic notes patients may be asked not to eat or drink for two hours or more before a tilt table test, while some labs permit a light early breakfast and water. Avoid a heavy meal, alcohol and caffeine within the window you were given, and bring a snack and a drink for afterward.

What medications should I stop taking before an autonomic test?

None on your own. Some medicines, including beta-blockers, anticholinergic drugs and blood-pressure-raising treatments, can blunt or mask the reflexes measured, so labs review your list in advance. Whether a pause is safe depends on why you take the drug, and that decision belongs to the prescribing clinician or testing team, in writing, with a clear restart date.

How long before autonomic testing should I stop caffeine?

Use the window on your appointment sheet; laboratories commonly ask patients to avoid caffeine, alcohol and nicotine from the evening before and through the morning of testing, because their effects on heart rate and vessel tone outlast the noticeable buzz. Remember hidden sources such as tea, cola, chocolate, energy drinks and some pain relievers. Tapering over a few days can soften a withdrawal headache.

What are the signs that your autonomic nervous system is failing?

There is no reliable self-check, because dizziness on standing, sweating changes, digestive sluggishness, bladder symptoms and fatigue overlap with many unrelated conditions. Clinicians look for a pattern affecting several body systems, reproducible triggers such as standing or heat, and persistence over weeks. Describing when symptoms occur and what precedes them, in a diary, is more useful than grading yourself against a list.

What are the risks of autonomic testing?

Risks are low because there are no needles, radiation or sedation. The most common event is feeling faint or fainting during the tilt, which Mayo Clinic describes as an expected outcome for some patients; the strapped table is lowered within seconds and recovery is usually prompt. Nausea, headache, fatigue and mild skin redness at sweat test sites can follow and typically settle within a day.

Is dysautonomia testing painful?

Not usually. The sweat capsules produce a warm tingling for a few minutes, the electrodes are sticky patches, and the breathing and bearing-down maneuvers are effortful rather than painful. Discomfort mostly comes from the symptoms the tests provoke, such as lightheadedness or nausea on the tilt table. Tell the technologist as soon as anything feels wrong; stopping early with a recorded event is still a useful result.

Can I drive home after a tilt table test?

Ask your laboratory beforehand, because many recommend bringing a companion. A positive tilt can leave people washed out, headachy and lightheaded for hours, which is not a safe state for driving. Even with a normal result, an early start without caffeine and a long visit can be tiring. Arranging a lift removes the worry and lets you rest immediately afterward.

What should I write in a symptom diary before autonomic testing?

Record the time each spell starts, what you were doing in the two minutes before, how long it lasted, what helped, and what you had eaten or drunk beforehand, including caffeine. Note heat, sleep and menstrual cycle if they seem to matter, and add any home blood pressure or heart rate readings taken safely while seated. Include good days too; they reveal mechanism.

Does a normal autonomic test mean nothing is wrong?

No. A normal battery means the specific reflexes sampled on one morning fell within the expected range for your age, which narrows the search and steers your clinician toward other explanations. It does not dismiss your symptoms. Discuss at follow-up what the result rules out, what further tests might be considered, and whether repeat testing would ever be useful.

References

• Cleveland Clinic: Dysautonomia
• NIH National Institute of Neurological Disorders and Stroke: Dysautonomia
• MedlinePlus: Autonomic neuropathy

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.