Shyness/anxiety Vs. Pots

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Hello all,

I've always been a naturally shy person, and things like public speaking tend to make me nervous. But it's something I've been able to overcome more or less in my adulthood, and now I'm a teacher, so I've gotten fairly used to speaking in front of a large group of adults. Although I wouldn't consider myself a wildly outgoing or charismatic person, I feel like I can be at a social function and be social "enough," without turning red or getting too flustered or anything.

However, every once in a while I will have a very extreme reaction to situations that usually only make me mildly nervous. For example, today at a staff meeting, I spoke up and shared some information with a group of about 20 people. I volunteered to speak; I felt perfectly comfortable when I started to speak. But then all of a sudden, my heart was pounding so fast and so hard I could hardly hear anything else, and my voice started shaking so badly I could hardly control it and I sounded all weird and warbly like I was really upset. My whole body trembled, and my hands and legs shook so badly I felt really embarrassed. It seemed like the sort of reaction I might have if I had true social phobia; but I've spoken to this same group of people countless times at other staff meetings and never had this reaction before. Maybe had a momentary increase in hr, but nothing that I ever really noticed.

This kind of reaction - wild heart pounding, with full-body trembling that I can't control - has happened at other seemingly odd times. Sometimes when I'm driving in bad traffic, or if I'm running late for something. It's often in situations that might make me a little nervous or tense, but it's just such an EXTREME reaction to the amount of nervousness that I feel. It's like most of the time I barely notice what might be considered "anxiety," and then out of the blue for no real reason I'll have what looks more like an anxiety attack. I've had panic attacks before when I was a teenager and this feels nothing like that - this feels much more physical, and I am always very clear-headed when this happens, and surprised at how my body reacts.

Is it possible that this could be related to adrenaline and POTS? I've always attributed it to "just being shy," but when I think about it, it doesn't happen all the time, and it has happened more now, in my adult life, and it never happened when I was younger and more shy.

[firewatcher]

Boy, I could have written this one too, except I don't need to be talking to anyone for it to happen! I think it just your body OVER-reacting. I've noticed that when I get mad, excited for some reason or just plain stand up this can happen. Not always, but often. My Beta-blocker is wonderful to control it, but it won't in extreme situations: I was rear-ended at a red light and started shaking uncontrollably for 30 minutes. I think anxiety is an unreasonable fear response, not a purely physical one; if you were suddenly fearful, or had feelings of dread or "impending doom" WITH the physical, that would be anxiety. I think this is where psychiatrists and doctors get confused with us, we have the PHYSICAL symptoms of anxiety, but not the emotional reactions (although the physical reactions CAN be pretty scary! Especially if your heart is beating really fast!) One of the POTS doctors did a study and found that POTS patients actually have LESS anxiety than the general population! [i think that article is posted on the homepage links.]

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thanks firewatcher!

The more I've thought about this the more I've been thinking this is related to ans stuff. It's like a situation will sometimes tip off a normal amount of stress or anxiety -- and then all of a sudden my body goes completely haywire. Since a lot of the time I seem to react normally to the same exact situations, it makes me think this isn't just "being shy."

Yesterday, when I had the strong reaction, I was having a very symptomatic day anyway. I hadn't had enough sleep, and in the am I was having unusually bad tachycardias -- I suspect my increased POTS symptoms and my body's strange reaction to a little bit of stress were related.

I will look up that article!

[janiedelite]

I can totally relate! Last month I was with my mom at her carcinoid syndrome support group. It's normal for everyone to share their "story" but it makes my mom nervous which causes carcinoid flushes. So she asked me to speak for her. I know most of these people, and this wasn't a high stress situation, but after a minute of talking I found my hands shaking so that I had to hide them under the table. My heart was pounding, face flushing, and I was having a hard time keeping my breath even between sentences. After I was done speaking my mom knew something was wrong, but I just excused myself to the bathroom, knees knocking and all.

Almost any type of prolonged speaking (more than 5 minutes, even on the phone) will set off some degree of this reaction in me. I've been at my primary care doc's for a routine visit and by the end of the visit, I'm applying cool cloths on my face and neck and she's checked my temp which often goes up one or two degrees since the beginning of the visit, just because of the minimal stress/talking during the visit.

My elevated norepinephrine levels at Mayo just confirmed for me that this is a mainly physiological reaction. Unfortunately, I feel so tired after one of these adrenaline rushes. I'm sure you guys can relate. I am not an anxious person! But knowing my tendency toward these surges tends to make me anxious, unfortunately!

[EarthMother]

Speaking can often be a trigger for me as well. And as Thankful said even on the phone. I suspect I don't breathe as well when I am talking or worse yet having to stand and talk at the same time. And I use to be amazing at giving stand up lectures. I am funny and love to engage my audience. But there is simply no way I could do that now. Towards the end of my career I would frequently flair at committee meetings. Folks came to see that as just part of my style. My hands would shake, my heart would be pounding and I would be peeling off layers of my "business attire" just to manage the internal inferno.

What's even more strange is that sometimes it wouldn't happen at all. I mean there could be a really "heated discussion" at a board meeting and my body would be perfectly calm. There just wasn't any rhyme or reason. Still isn't for me. I can have a huge flair now in the middle of a Zazen sit. And I can say with confidence it isn't a panic attack. I have had panic attacks since I was in my early 20's and they feel much different than whatever this ANS imbalance seems to be.

Good luck on your healing journey.

~EM

[firewatcher]

I also get this quite often when I read to my kids, or try to sing. I think it is some sort of sustained chest pressure response, stinks though!

[turtlefairy5]

I've always been shy/socially anxious, but I've noticed only the last few years or so that I get completely hot-faced and turn noticeably red when I try to talk in a group, or even when I say something randomly embarrassing to one person. I wasn't always like that with the extreme blushing, and the blushing only make me more anxious, which makes me turn more red. urggggh.

I'm not sure if it's related to POTS or not, except that it has been occuring, it seems, only in the past few years.

[ramakentesh]

Ive never been shy but sometimes with POTS I find that i have an excaggerated response to certain stressful situations - whether they are arguments at work or watching a scary movie.

POTS is typified by an excessive sympathetic nervous system response to standing. Or in some patients its elevated all the time - whether its mediated by excessive epinephrine, norepinephrine or controversially, angiotensin II. This means that if you encounter something that would normally stressful, you will react to it worse than previously and it may also bring on your symptoms.

This seems to fit with the idea that POTS in some patients is caused by faulty norepinephrine reuptake - your body secretes it in stress and cant get rid of it because its transporter is malfunctioning. WHen i was tested I had very little NET but its unclear whether this is a cause or consequence of POTS.

[carinara]

I can totally relate as well. Speaking always makes me feel dizzy and symptomatic. I love to talk to friends on the phone, i also need to talk at work but i get symptoms almost all the time.

I found out that it helps when i dont speak with a loud voice!.

Playing my flute is impossible. when i do these things it feels a little bit like the valsalca maneuver test. (or blowing up a balloon).

I experienced, that as soon as my body feels some tension, it doesnt matter if it?s possitive or negative. My ANS goes mad. This is one thing that really bothers me, because i love discussing things and talking about interesting subjects. But i can never do that without getting lightheaded and dizzy and then i just listen to the others instead of saying much myself anymore. Inside i feel i have so much to say, but my body just goes mad.

I guess that our bodys are so sensitive, that even the adrenalin that gets set off when we are excited is often tooooo much for us to handle.

But i cant stay in a meditation mood 24 hours a day?????????

Well i guess iam learning to be a better listener now

[valliali]

i can relate EXACTLY to what you are saying, only, i have always been a very loud and social person, never afraid to talk to anyone, so i chalk up this drastic change to physiological causes and not merely shyness. and i suspect the same in you. my body just overreacts. anything that stimulates me causes the same symptoms all of you experience - rapid pounding heart, flushing, hot, trembling, can't breathe. it's horrible. soooooo horrible. pots made me a completely different person from the one i was. i was fearless, a leader, and pots made me terrified of people and social situations because of my reaction.

i do believe that this reaction was in part due to psychological triggers, like being afraid of the symptom. but, the way my body reacted to this fear was out of control, definitely not normal.

and like many of you, i am NOT an anxious person and never was. ever.

in fact, the social situations reaction was one of my first symptoms. and it floooooored me because i one day went from super outgoing to having panic attacks when someone asked me a question.

i am, recently, getting much better. i attribute it to propranolol. i feel like it has given me my true personality back. it has helped my facial flushing a great deal, which has helped me rid thoughts while talking to someone of my fear of turning red. it's also just calmed the adrenaline down. i truly feel like it is the only thing that has given me my life back in the last two years. i feel more like myself personality wise than ever before.

but i still have reactions like this for no good reason.

once, i tested super low for normetanephrines, the metabolite of norepinephrine. this could mean that i was not metabolizing NE, which means more of it was being released into the blood stream. however, i not too long ago had my plasma NE levels tested, and they were normal. so i am not sure of this connection yet, and i have posted about the low normetanephrine levels before, but no one else seems to have had that result.

[ramakentesh]

Actually I got tested for a different metabolite of NE - DHGB i think it was - during my tilt and supine and it was found to be low in me and all POTS patients tested. I also had a vein biospy that showed that 5 of 6 POTS patients had nearly no NET or NE transporter.

Interesting when you consider that a recent study demonstrated that an antioxidant in olive leaves causes an increase in NET expression.

[valliali]

that is interesting!! is the net deficiency from genetics, or is it a change that occurs b/c of pots??? like, can it ever go back to normal???? i am interested in getting the other metabolites checked.

what is the study about olive leaves?? how does one get the leaves??

i am not sure why my normetanephrines are low. the enzyme that breaks down ne, the comt enzyme, may be at fault.

[jesse1919]

I get these sort of surges too. When I got a pocket pair in Texas Holdem my heart would go nuts and I'd feel lightheaded. I'd talk to my heart "dude relax there's $2 in the pot". POTS seems alot like anxiety but it's your autonomic reaction, not an abnormal psychological state. Your body's reaction to stress is exaggerated.

[EarthMother]

I get these sort of surges too. When I got a pocket pair in Texas Holdem my heart would go nuts and I'd feel lightheaded. I'd talk to my heart "dude relax there's $2 in the pot". POTS seems alot like anxiety but it's your autonomic reaction, not an abnormal psychological state. Your body's reaction to stress is exaggerated.

That's SO FUNNY! I had pocket rockets in a round of Poker Palace on Facebook last week and it pretty much did me in!! And that's not even real money!!! At times I can't play at all because my ANS is way too hair trigger sensitive. So glad to know I'm not the only one.