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Friday, April 27, 2012


Ultimately, any blog about Lyme disease must cover the entity know as POTS. This stands for postural orthostatic tachycardia syndrome. My patients first  educated me about this. Admittedly, when patients first came saying  POTS,  I thought of Potts, bone infection with tuberculosis.

When a person goes from a lying to a standing position gravity causes 25% or more of the body's blood volume to move into the lower half of the body. Receptors in blood vessels immediately send a message to the brain to correct the problem. The heart rate increases, the vessels constrict, the heart beats with more force and the blood supply is properly redistributed. The part of nervous system responsible for making thes corrections is called the autonomic nervous system. I always remember autonomic because it sound like automatic.

The autonomic nervous system has a variety of other functions. It controls things such as body temperature regulation, sweating, urinary and gastrointestinal functions and others. The generalized dysfunction of the autonomic nervous system is frequently called dysautonomia. Symptoms may include: palpitations, extreme fatigue, exercise intolerance, dizziness, fainting, shortness of breath, memory problems, difficulty concentrating, feeling hot and cold, bowel/bladder problems and intolerance of heat.

There are different forms of POTS. One type is primary and the other types are secondary. Secondary POTS is triggered by a variety of factor, Lyme is of interest here.

Occasionally POTS is due to an endocrine problem instead of dysautonomia. Here are other symptoms are reported to include: anxiety, shakiness, headaches (migraines), cold sweaty limbs and hypertension.

The overlap of Lyme and POTS symptoms is quite dramatic.

I saw a very ill young woman today: Weak  and wobbly, barely able to stand or walk. Supine her heart rate was 80. With standing  her heart rate increased to 120 -  the hallmark of the disorder.  I am comfortable making the diagnosis with this simple test in the right clinical setting.  Some doctors will only make the diagnosis with a Tilt Table test.

A variety of medications may be helpful, including: Florinef, Midrine, Ritalin, Pyridostigmine, antidepressants, clonidine and beta-blockers.

Patients should avoid heat, alcohol, dehydration, other triggers and certain medications. Reconditioning through exercise, physical therapy with emphasis on leg strengthening is an integral part of treatment.

Of course the trigger, in this case Lyme, must be treated at the same time.

The Lyme/ POTS patients are sicker and more challenging to fix. But most POTS patient improve with Lyme therapy and physical therapy.


fighting2bme said...

Are you taking new patients from other states? What is the best way to contact thou regarding the possibilities?? I mam so grateful I found your blog, truly a blessingmformyou to do!! Could I be emailed perhaps at not sure of the most appropriate way to ask. thank you doc


tritebs said...

As an adolescent whenever I was ill (a lot) whenever I sat up from laying down, I would get dizzy etc but I would also get tremendous pain in my head like being hit with an axe.
This was never investigated despite it happening many times in the doctors rooms.
Is this common?
I am not diagnosed with Lyme but have many of the fluctuating symptoms and often "POTS".
Apparently "Lyme" does not exist here in Australia despite one doctor having many patients with positive results from bloods sent to the US - I cannot afford that.

Ashley said...

Dr. Jaller, I am desperate to get an appointment with you regarding my 2008 Lyme diagnosis and recent flare ups. I called your office and told you're not accepting new patients at this time. I'm a local young woman who can't afford to see a doctor that does not accept insurance - I've been told you're the only doctor in the area who treats Lyme and accepts insurance. Could you please find a way to fit me in your busy schedule?

Brenda said...

is it possible to receive your posts by a g-mail address I would like to be added to your e-mail list. I am researching Lyme and trying to help my community in Rappahannock.
Thank you -

Mrs Fab-ulous! said...

Ashley - please remove his name. As consideration and protection of our LLMD's , their names should NEVER be posted.

I had tachycardia in July 2009, and was admitted into the ICU. I had a picc line in and they insisted none of it was related to lyme and wanted to pull my line out. I didn't let them touch me.

All the meds they gave me for the tachycardia caused my blood pressure ot plummet, so I ended up not taking anything. Once treatment for lyme progressed, the v-tach's stopped.

August said...

Good to finally find some thoughts on Lyme and POTS. The relation between the two remains a bit unclear. Will the POTS disappear once the Lyme is under control, in other words is POTS an indicator for active Lyme disease? Or does the Lyme trigger POTS which can still cause problems once Lyme has been treated properly?

Is there any relation between POTS and elevated ANA levels?


Bobbie said...

I appreciate the physicians posting on Pots! May I request a response to the post before me from August dated 11/29/2012?

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