POTS

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.