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5 Questions For People With Pots (please Help)


avidita
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Hello everyone!

Thank you for having such a wonderful site full of resources for people who have dysautonomia and their families. It is a difficult condition to have and every little bit of support and information is heaven sent.

This post is intended as a question to anyone who has been diagnosed with having POTS to help me understand the condition a little better. Just as an overview, all my life I?ve had vestibular migraines (ones where you just feel extremely dizzy) before exams and when studying too much. Then in the beginning of ?07 after a few months on Yaz I got very dizzy in a way that wouldn?t go away no matter what I did (lay down, etc.) for 2 weeks. Had a vestibular workup, stopped the Yaz and was put on Xanax, which made me feel good. The extreme dizziness got better, but ever since I?m dizzy on a daily basis (a type of swaying/rocking sensation). This year I just couldn?t take it anymore and did complete workup: MRI, blood work, ENT test (with 3 different doctors btw), tilt table test, the works. Everything except the tilt table came back normal. Now, I have two diagnoses. The doctor who did the tilt table thinks I have POTS (because it was a positive tilt table) and all other doctors think I have anxiety. I am getting a third opinion, soon, but it would really help me understand POTS better if I got your thoughts on the following few questions if that is OK.

1. With POTS, do you think you will be able to do a long hike without making your symptoms worse? (this summer in the middle of a bad period of dizziness I went on a 4 day hike at 10,000 feet above sea level and did 10 hour trails without getting my symptoms worse)

2. With POTS, does Xanax-type medication make your symptoms get a lot better or even go away? (Xanax has been the only medication, together with Atarax, to make my symptoms get a lot better or go away, even more so than drinking lots of water)

3. With POTS, is it possible to work out 1-2 hours a day and feel fine during the workout? Does cardio or weights make you worse? (In general, when I feel bad, taking a long walk or doing elliptical makes me feel great during the work out, then I return to my usual dizziness. Very rarely do I get worse after a workout, and it is usually after weight lifting, not cardio).

4. With POTS, on days where you feel bad even when sitting or lying down, does standing up and walking around make it even worse? (for some reason I feel the worst when sitting still. To make it go away, I usually get up and walk around)

5. With POTS, do stressful events or situations make your symptoms worse? (needless to say they do for me)

Any response to the questions above will be appreciated. I want to stress again that I am seeking a third medical opinion and this is not intended to substitute medical advice. Thank you in advance for anyone who takes the time to reply!

Sincerely,

Margarita

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1. I couldn't even walk for 15 min at 10,000 with pots

2. I do take xanax and it calms me down, but it doesn't come close to making me better

3. I can only do 20 minutes of very slow exercise, after four years of pots

4. On a day when I'm not feeling well the only thing I do is lay on the couch and eat small meals

5.Stress does make my symptons worse

Maggie

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avidita- just wanted to ask whether the ENT did the caloric test? (the one where they run hot ait and cold air through your ears, or hot water and cold water?

just wanted to ask as i have the same constant dizziness and this is the only vestibular test that cam back abnormal & i had been seen by prior ENT's that had said everything was fine.

1. cant walk for more than 5 mins

2. xanax does calm my ssytem down but no where near functioning

3. Exercise makes everything worse

4. yes standing and walking make bad days worse

5. yes, most of the time

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Thank you for your reply, Maggie!

I btw want to add for anyone reading this that I am not completely insane with my exercise questions. I've done extensive POTS research and I am aware of how it affects those with the syndrome. I do have days where I am completely non-functional and just lay in bed b/c of the dizziness and nausea, my pulse is really wacky and gets high, etc. But then there are those other things and it makes me (and my doctors) confused. That's the reason I ask.

Thanks again!

Margarita

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avidita- just wanted to ask whether the ENT did the caloric test? (the one where they run hot ait and cold air through your ears, or hot water and cold water?

just wanted to ask as i have the same constant dizziness and this is the only vestibular test that cam back abnormal & i had been seen by prior ENT's that had said everything was fine.

1. cant walk for more than 5 mins

2. xanax does calm my ssytem down but no where near functioning

3. Exercise makes everything worse

4. yes standing and walking make bad days worse

5. yes, most of the time

Hi, Ana!

The ENTs did every single ENT test there is: hearing tests; eye tests; balance tests of all kinds (the one where you stand on a platform, the one where they spin you in a chair); also the caloric test with hot/cold air (which was normal, too, both times they did it). The only thing that came back abnormal was a VEMP test, but they explained that it has to do with my vestibular migraines and it doesn't explain the constant dizziness as it does not test the organic state of the vestibular system (like the caloric test does), but rather the way it processes information (sound in particular).

Thank you for your answers!

Margarita

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1. With POTS, do you think you will be able to do a long hike without making your symptoms worse?

At one point during my illness I was very in shape and if this was not pushing it for you then your body was ready for it.

2. With POTS, does Xanax-type medication make your symptoms get a lot better or even go away?

No, Xanax does not make symptoms go away. ussually makes them more pronounced.

3. With POTS, is it possible to work out 1-2 hours a day and feel fine during the workout?

Feel fine while working out. It's after that i feel horrible.

4. With POTS, on days where you feel bad even when sitting or lying down, does standing up and walking around make it even worse?

Yes, being still is difficult. Moving makes the blood move so you feel better. Although lying down is best!

5. With POTS, do stressful events or situations make your symptoms worse?

Yes!

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H

1. With POTS, do you think you will be able to do a long hike without making your symptoms worse? Sometimes- I taught for a few years with POTS- I used to bike and run on mu eliptical for long times.

2. With POTS, does Xanax-type medication make your symptoms get a lot better or even go away? Not sure Klonopin makes me FEEL better

3. With POTS, is it possible to work out 1-2 hours a day and feel fine during the workout? Does cardio or weights make you worse? A few years ago I might have - not now

4. With POTS, on days where you feel bad even when sitting or lying down, does standing up and walking around make it even worse? I feel the need to move when I have really LOW bp or if I am having an adrenal surge

5. With POTS, do stressful events or situations make your symptoms worse? yes- i overreact

YAZ caused a huge Pots flare for me. If you have hyperadergenic POTS YAZ can cause real problems.

Good luck to you.

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The reason I posted that was that the swaying and rocking sensation sounds unusual. I don't know if that is the only kind of dizziness you have ...

They wrote that most often sufferers get it after a trip. If that's the only reason you don't think you have it, it's not necessary to get it then.

Xanax is a benzodiazepine which is one of the treatments which is supposed to work for the syndrome.

http://www.mddsfoundation.org/mdds_treatment.html

And the other thing is, if you have it, motion (travel), may make your symptoms go away temporarily (and it sort of sounded like motion helps you).

http://abcnews.go.com/Health/Story?id=2817081&page=3

Not that I'm an expert and I haven't experienced what you do -- but the swaying/rocking, the motion which helps, and the drug which helps sound a little like this ...

(And sorry not to have written this out in the first post but I wanted to clarify a little more just in case it's helpful).

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1. I have had POTS for years, and I've done some daylong hikes. I did Mount Lassen with POTS, which is above 12,000 feet. This summer I did a nine-mile hike in the Tetons. So yes. Just because you can hike doesn't mean you don't have POTS.

2. Xanax does help a lot of people with their POTS symptoms. Me personally, it doesn't.

3. I walk 1/2 hour to and from work each day, and also do 30 minutes on the elliptical. It's a little harder than it used to be for me right now (I'm in a bad period right now) but I can still do it. And yes, I have POTS.

4. I'm usually fine walking around. Standing still I usually feel cruddy.

5. They can. Keep in mind that anxiety and POTS can feel a lot alike, because both can include overreactivity of the autonomic nervous system. HOWEVER, people who are "just anxious" do NOT have positive tilt-table tests. So the doctors who say it's "just anxiety" are JUST PLAIN WRONG. If I sound irritated, it's just because I was misdiagnosed for 15 years as just being a basket case when I really did have something physically wrong with me.

Hope that helps!

Amy

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I btw want to add for anyone reading this that I am not completely insane with my exercise questions. I've done extensive POTS research and I am aware of how it affects those with the syndrome.

So you have expectations of what the answers will be?

1. Hikes - My POTS waxes and wanes and sometimes it goes away completley - but even unless Im really bad I could complete that kind of Hike. For some reason I find that remaining active like on holidays Im usually ok - but cramped up in front of a computer all day long makes my symptoms worse.

I often go camping and I usually feel great but when I return to the buzy city I can go downhill. No idea why.

2. Xanax helps a little, but alcohol works for me amazingly. gets rid of nearly all my symptoms after 1/2 a light beer. Told my POTS doctor and he didnt believe me (Assumes that all orthostatic conditions are caused by inappropriate vasodilation when infact some subsets appear to be caused by excessive vasoconstriction).

3. For me I need to build slowly back into exercise when im in a bad patch or I can feel crap for days. I build up slowly - short walks, longer walks, and then short runs, pushups, sit ups. Once I get to a point I like to push through no matter how ordinary it may make me feel. This always seems to improve me quicker than stopping when I relapse. No idea why, just what works for me.

A doctor I spoke to who advocates exercise said that it may make you feel worse but does not make your condition worse - many here may disagree though! :0

Chinups can make POTS bad for me - other exercises less so.

4. Sitting: The most challenging time for a POTS or OI patient is ALWAYS quiet standing or sitting. In this state there is little movement to get the skeletal muscle pump muscles firing and as a consequence this is when orthostatic stress is at its worst. So this is no surprise. When Im POTSie im jittery so I rarely can sit still and I ALWAYS fidget to stop myself from feeling like IM going to faint.

5. Particularly in the 'hyperadrenergic' variety - stress makes things worse for a variety of reasons - increases stress hormone release which increase already high levels in plasma due to impaired reuptake in some patients, but adrenaline at lower levels can act in one vasoactive way and then when increased can actually do the opposite.

Many patients with POTs experience sympathetic overactivity. Stress can make this already overactivei system more so.

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I btw want to add for anyone reading this that I am not completely insane with my exercise questions. I've done extensive POTS research and I am aware of how it affects those with the syndrome.

So you have expectations of what the answers will be?

1. Hikes - My POTS waxes and wanes and sometimes it goes away completley - but even unless Im really bad I could complete that kind of Hike. For some reason I find that remaining active like on holidays Im usually ok - but cramped up in front of a computer all day long makes my symptoms worse.

I often go camping and I usually feel great but when I return to the buzy city I can go downhill. No idea why.

2. Xanax helps a little, but alcohol works for me amazingly. gets rid of nearly all my symptoms after 1/2 a light beer. Told my POTS doctor and he didnt believe me (Assumes that all orthostatic conditions are caused by inappropriate vasodilation when infact some subsets appear to be caused by excessive vasoconstriction).

3. For me I need to build slowly back into exercise when im in a bad patch or I can feel crap for days. I build up slowly - short walks, longer walks, and then short runs, pushups, sit ups. Once I get to a point I like to push through no matter how ordinary it may make me feel. This always seems to improve me quicker than stopping when I relapse. No idea why, just what works for me.

A doctor I spoke to who advocates exercise said that it may make you feel worse but does not make your condition worse - many here may disagree though! :0

Chinups can make POTS bad for me - other exercises less so.

4. Sitting: The most challenging time for a POTS or OI patient is ALWAYS quiet standing or sitting. In this state there is little movement to get the skeletal muscle pump muscles firing and as a consequence this is when orthostatic stress is at its worst. So this is no surprise. When Im POTSie im jittery so I rarely can sit still and I ALWAYS fidget to stop myself from feeling like IM going to faint.

5. Particularly in the 'hyperadrenergic' variety - stress makes things worse for a variety of reasons - increases stress hormone release which increase already high levels in plasma due to impaired reuptake in some patients, but adrenaline at lower levels can act in one vasoactive way and then when increased can actually do the opposite.

Many patients with POTs experience sympathetic overactivity. Stress can make this already overactivei system more so.

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1. With POTS, do you think you will be able to do a long hike without making your symptoms worse?

HIKE?? On a "good" day I can make it to the mailbox and back. I can only go to stores that have the electric carts unless we take the wheelchair.

2. With POTS, does Xanax-type medication make your symptoms get a lot better or even go away?

It doesn't make my symptoms go away, but it improves my quality of life since it calms the tachy better than anything else.

3. With POTS, is it possible to work out 1-2 hours a day and feel fine during the workout? Does cardio or weights make you worse?

Uhm.... The first day we had our elliptical I managed 15 seconds. I did get up to 1 minute - but after doing it 3 days in a row it was too much.

4. With POTS, on days where you feel bad even when sitting or lying down, does standing up and walking around make it even worse? Yes, but if I don't at least get up and stretch once in a while or change positions - I hurt. Sometimes, though, I am so exhausted I feel like even lying in bed isn't "resting" enough.

5. With POTS, do stressful events or situations make your symptoms worse? Yes

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@ramakentesh: I didn't have any expectations about the answers. Like I said, my doctors and I are at a loss at this point. However, my husband, family, and all but 2 doctors think I have anxiety and the fact that I am able to exercise is proof enough for that. They think that since I have dizziness to a point where I can't work and feel bad most of the time, it would be unthinkable for me to do a hike and have POTS at the same time. I just wanted to check if there is anything to that. I was hoping that there is a chance they could be right, given that I get worse from exerting myself mentally WAY MORE than when I exert myself physically.

@Tachy Phlegming: I am thankful to anyone who offers advice or an opinion about what possibly could be going wrong with me. I always get motion sick and if I don't drive myself, I get sick within 10-15 minutes and traveling does not make the dizziness better by a long shot. I am usually very medicated and sleep the whole way. Other than that, when the dizziness progresses when I read or when I study, etc. and then it's full blown vertigo with me spinning, etc. The website mentioned that this disorder is not associated with vertigo and my dizziness goes into vertigo mode when I am migrainating (that's what I call it :) ).

@Amy: I don't take offence with you at all. I am sick of being told I am causing this to myself and I need to stop digging for answers and get therapy or go on antidepressants. Like I explained to ramakentesh, to say the people around me don't think I have POTS will be an understatement :).

Thanks again to everyone who answered!

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@Amy: I don't take offence with you at all. I am sick of being told I am causing this to myself and I need to stop digging for answers and get therapy or go on antidepressants. Like I explained to ramakentesh, to say the people around me don't think I have POTS will be an understatement :).

Keep in mind, however, that SSRI or SNIR antidepressants help a lot of us with the symptoms of POTS. So don't automatically punch any doctor in the nose who suggests it. Just if they think it's all "anxiety." :)

Amy

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Boy - I am in the category with Dawg Tired. I would never be able to hike. I walk around the neighborhood on a good day and early in the day...otherwise I just wouldn't be be able to. I can't do anything for more than 1-2 hours so I can't imagine exercising for that length of time. I have never tried Xanax for POTS. Pain meds and Beta Blockers are the best for me so far. But mainly the beta blockers make it so I am walk around the block.

Before beta blockers I couldn't stand and dry my hair. I geet dizzy but my main complaint is feelinso sick...and mostly after activity. Although I barely ever feel completely well.

Good luck.

Erika

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Fair enough. Let your family and friends know two things. Firstly that POTS varies considerably from day to day and second and most importantly, it is prolonged STATIC postures that are often the worse - not the moving around exercising part, the sitting still or standing still at the shops are the things that cause the most difficulties.

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1. I would LOVE to do a long hike like that, but it has not been possible in my lifetime.

2. I was on Xanax for several years, with the doctor constantly increasing my dose. It never helped, and I went off it. Withdrawl is he&% !!!

3. Cardio is not an option for me right now. However, I feel much better when I work out on the weight machines. At night, I turn the TV on and sit/lay on the floor and do stretching exercises (and play with my cat). It helps!

4. When I feel horrible... REALLY horrible, the best thing for me to do is crawl in bed and sleep. Sometimes, for several days!

5. Stressful events are killers for me! I used to be an elementary teacher/principal, and every holiday vacation found me doing a crash and burn in bed to recover from the stress of getting ready for the holiday. Thanksgiving Day and Christmas with the family all coming to my house for dinner is also stressful, but I have an awesome husband who will do much of the cooking and cleaning.

Caron

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I was diagnosed with POTS through a failed tilt. The dizziness that has plagued me for years is my worst symptom. I saw a neurologist for the dizziness shortly after my POTS diagnosis because we couldn't figure out why I was still so dizzy when vitals were stable (this has long been a question of mine). He did all kinds of tests and said I have a deep seeded vestibular disease (not Meniers) that causes the vertigo sensations and the sensations like I'm being pushed/pulled etc. He said that this is a separate issue from the POTS and would not show up on any traditional tests. This was years ago. He prescribed Xanex to take to help alleviate the symptoms but I was unable to take it with all the other meds I'm on. A few years later I saw an ENT and he thought I was having silent migraines and prescribed something that would have sent my heart arrythmias into a tailspin so that didn't happen. The dizziness waxes and wanes and I have never been sure if it is truly what either of them said or if it is a dysautonomia thing - where my body is just constantly making adjustments that may not show in my heartrate or bp. Recently, the dizziness has been relentless (especially with the rainy East Coast weather) and I feel like I'm always on a boat. I can exercise some but afterwards will go through about 15 minutes or so of extreme rocking/dizziness when I stop. My cardio feels this is due to the blood vessel constriction and my body readjusting to not being upright. I have never received a definitive answer to my dizziness and it is the symptom that makes me the least able to function.....

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Hi Daisy,

I do get those push/pull sensations and I hate them. I came across a study recently for people with unexplained generalized dizziness and the participants were found to fall into these categories: dysautonomia (duh!), physical trauma to the head, anemia, anxiety or arrhythmia. The dysautonomia aside, I do believe that anxiety alone can cause that type of dizziness and given that the POTS diagnosis is making me extremely anxious all the time, I am not counting it out as part of the problem. Who said one cannot have POTS and Anxiety? The last ENT specialist I went to was very good and explained the mechanism to me like this: lets say that you have a minor flaw in your vestibular system (in my case the way it processes certain information), that causes you to get dizzy sometimes, which in turn makes you anxious. The part of the brain that is responsible for anxiousness and dizziness overlap, so one makes the other worse. If you can put numbers to it, say the vestibular problem alone is a "1" and the anxiety is a "1" as well, but together, they don't make a "2" but rather, they magnify each other and you get a "4".

By the way, I am not a doctor, but I disagree with your neurologist somewhat. If your vestibular system was not functioning properly that would have shown on a test somehow. Did they do a VEMP test on you? That was the one that was abnormal for me.

Margarita

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1. With POTS, do you think you will be able to do a long hike without making your symptoms worse?

Nope.

2. With POTS, does Xanax-type medication make your symptoms get a lot better or even go away?

No.

3. With POTS, is it possible to work out 1-2 hours a day and feel fine during the workout? Does cardio or weights make you worse?

Cardio and weights make me worse. I think I am healthy enough that I could find a workout plan that works (I just haven't done this yet) ... my doctor has recommended swimming. However, I'm not sure if I could handle a full hour of that even.

4. With POTS, on days where you feel bad even when sitting or lying down, does standing up and walking around make it even worse? Yes. My best position when I'm really sick is laying on my back with my legs propped really high up on pillows.

5. With POTS, do stressful events or situations make your symptoms worse? Sometimes.

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The last ENT specialist I went to was very good and explained the mechanism to me like this: lets say that you have a minor flaw in your vestibular system (in my case the way it processes certain information), that causes you to get dizzy sometimes, which in turn makes you anxious. The part of the brain that is responsible for anxiousness and dizziness overlap, so one makes the other worse. If you can put numbers to it, say the vestibular problem alone is a "1" and the anxiety is a "1" as well, but together, they don't make a "2" but rather, they magnify each other and you get a "4".

Or, more likely, the mechanisms of POTS themselves result in anxiety - the sympathetic nervous system is the flight or fight mechanism and its been demonstrated to be overactive in response to orthostatic stress.

Secondly, one of the chief mechanisms of POTS is possibly the impaired reuptake of norepinephrine which results in this stress hormone moving and collecting in plasma and activating beta receptors = anxiety like symptoms.

Third, when circulation to the brain becomes disordered sometimes the body releases tonnes of epinephrine to attempt to re-regulate circulatory control. It doesnt work but by god it makes you anxious.

Fourth, the brains of most POTs patients were found to have high levels of lactate - a result of reduced glucose metabolism due to hypoxia. Lactate levels have been connected with anxiety.

Five, a portion of POTS patients were found by Stewart et al to have significant postural hypocapnia - which also results in anxiety as a symptom.

Anxety and POTS go hand in hand because anxiety is an obvious result of many of POTS mechanisms.

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The last ENT specialist I went to was very good and explained the mechanism to me like this: lets say that you have a minor flaw in your vestibular system (in my case the way it processes certain information), that causes you to get dizzy sometimes, which in turn makes you anxious. The part of the brain that is responsible for anxiousness and dizziness overlap, so one makes the other worse. If you can put numbers to it, say the vestibular problem alone is a "1" and the anxiety is a "1" as well, but together, they don't make a "2" but rather, they magnify each other and you get a "4".

Or, more likely, the mechanisms of POTS themselves result in anxiety - the sympathetic nervous system is the flight or fight mechanism and its been demonstrated to be overactive in response to orthostatic stress.

Secondly, one of the chief mechanisms of POTS is possibly the impaired reuptake of norepinephrine which results in this stress hormone moving and collecting in plasma and activating beta receptors = anxiety like symptoms.

Third, when circulation to the brain becomes disordered sometimes the body releases tonnes of epinephrine to attempt to re-regulate circulatory control. It doesnt work but by god it makes you anxious.

Fourth, the brains of most POTs patients were found to have high levels of lactate - a result of reduced glucose metabolism due to hypoxia. Lactate levels have been connected with anxiety.

Five, a portion of POTS patients were found by Stewart et al to have significant postural hypocapnia - which also results in anxiety as a symptom.

Anxety and POTS go hand in hand because anxiety is an obvious result of many of POTS mechanisms.

I guess it is individualized. Whether or not it's POTS that is plaguing me, I know I have anxiety as well. I have a cognitive behavioral book that I am working myself through and I have every major type of wrong thinking, etc. So, I am sure that if I a manage to minimize that aspect of my anxiety (the one that is non-POTS related, but rather stems from my thinking patterns), I think it will make a dent in my symptoms. Just because my POTS is activating the anxiety mechanisms in my brain, doesn't mean I am not exaggerating that problem with my thinking patterns. That is my personal opinion for myself at least. Other people are different :( It helps me to think that there is something in this that is under my control somehow and not just lay back and play victim (which I am not saying anyone does, but I know I am making my anxiety worse with my thinking patterns, so I am not going to ignore that).

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>1. With POTS, do you think you will be able to do a long hike without making your symptoms worse?

How well you cope physically with extreme periods of exertion will depend on:

a. your present fitness level

b. how well you understand and control blood sugar and breathing during extended periods of exertion,

c. recent history of symptom severity,

d. recent history of stress management, particularly acute mental stress episodes/events

I've always found moderately-paced walks meditative, calming, and energizing - as long as I was careful to maintain my blood sugar levels and take regular breaks.

>2. With POTS, does Xanax-type medication make your symptoms get a lot better or even go away?

This is a GABA receptor modifier. Your positive response to a anxiolytic drug underscores the importance of GABA in dynautonomic disease.

>3. With POTS, is it possible to work out 1-2 hours a day and feel fine during the workout?

Well, again, this will depend on your fitness level. Generally speaking, the answer should be NO WAY! At about 1-1.5 hours into a workout, you're starting to seriously deplete energy reserves, and that can bring on a marked drop in blood sugar, and with it, release of epinephrine and extended release of cortisol.

> Does cardio or weights make you worse?

Will depend on your level of fitness, how you train, and most importantly, how you breath.

Dollars to donuts, many of you who lift weights do not regulate your breathing correctly. That can worsen hypoxia, an attendant problem in dysautonomia, and cause irregular BP spiking and plunging.

For me, the ticket out of POTS **** included vastly improving physical condition, slowly and with careful attention to nutritional support. However, early on in training, I would run out of energy easily, until I learned to pace my workout, and even break it up into shorter periods to get around blood sugar and blood pressure control problems.

As I put on muscle and improved aerobic performance, I found that I was finally able to improve energy storage in liver and muscle, so that I was able to perform well above expectations in as little as 6 months and outperforming expectations in about a year.

In order to learn how to work out correctly, I had to learn, and to do that, I had to join a physical fitness forum and read, read, and practice.

>4. With POTS, on days where you feel bad even when sitting or lying down, does standing up and walking around make it even worse?

Can't answer this because I don't know what you mean by 'feeling bad'. Sometimes, if I've had a really emotionally stress period and have slacked off on my exercise and diet, I will feel myself start to 'shut down' - I may feel cold and feel like I need to lie down. This is pretty rare, though.

>5. With POTS, do stressful events or situations make your symptoms worse?

Yes. Not only do stressful events make the symptoms worse, but the frequency of these events, over the course of months to years, has a direct role in sudden escalation of symptoms and their severity.

How you cope with acute and chronic stress is very important to managing dysautonomic conditions.

You can never be 'cured', but you can work towards extended remission.

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