I'm Wondering If Pots Is A Mechanical Issue

[sue1234]

I have and do go over every possible thing that could contribute to POTS. I guess I figure that if I don't think it through, no doctor is EVER going to devote the time I do to it!

Anyway, I have asked a doctor before if it could be a mechanical issues--that is, related to a physical problem. He said that was an interesting theory(and he's a POTS specialist!), and as usual, I forgot about it for a few months. Now that I am back visiting my gi doctor and going over my gi issues, I know I have a hiatal hernia(10 years). But when I read what symptoms HH people have, it is similar to me, such as getting SOB with walking and with lying flat.

Anyway(again), when you look at the anatomy of the stomach and a hiatal hernia, it can protrude up through the diaphragm exactly where the vagus nerve AND the aorta go! I can imagine the sliding hernia stimulating the vagus nerve. AND, I can imagine the hernia pressing on the aorta, causing the blood in the body "pooling" and having a hard time getting back up into the chest. I guess what I am saying, is the body's blood flow would be "blocked". And think to how alot of us complain after a largish meal, we feel abdominal pooling and more POTSY. It's possible the full, herniated stomach is just blocking more of the blood flow, and of course, stimulating the vagus nerve.

I found a drawing of the structures that go through a hernia, but my limited computer abilities won't let me paste the drawing that I had found and copied. Sorry.

Can we discuss this? People with hiatal hernias chime in?

[Maisie87]

Wow.. very interesting. I have a hiatal hernia as well!

I remember trying to describe to my doctor (pre-POTS diagnosis) that I feel like my blood supply is cut off after I eat. I was asking him if it's possible that my abdomenal artery is compromised by something pressing on it.

He of course, just laughed it off and dismissed my naive 22 yr old theory. ..

What you are saying seems to make sense. At least in some POTS patients if not all.

Looking forward to read others' posts on this. Thanks for posting!

bon' apettit

Maisie

[sue1234]

Thanks, Maisie, for posting. I hope we have alot of discussion on this. I THINK I am now able to post a link to that drawing:

http://www.nature.com/gimo/contents/pt1/fi.../gimo48_F1.html

Yay! It worked. It will show all of the anatomical structures that do through the diaphragm from the abdomen into the chest area.

I have issues(faster HR, incr. b/p, and SOB) with standing AND sitting very upright. I feel best in a slightly reclining position.

[MomtoGiuliana]

I think this is an interesting theory, and have recently wondered if I have a hiatal hernia b/c of some symptoms.

I think one thing that has been established is that POTS is definitely caused by multiple mechanisms. Perhaps this could be another one to add to the list of possible causes, or an aggravator anyway.

[Tachy Phlegming]

1. People with these (many of these) symptoms on this board are often not diagnosed with hiatal hernia. So either the symptoms are the same for hiatal hernia and these symptoms or doctors routinely misdiagnose hiatal hernia in dysautnomia patients. Giving our professional friends the benefit of the doubt, it should be the former explanation.

2. Nonetheless, it appears that a lot of people on this board are in fact diagnosed with (hiatal) hernias at some point.

a. Doctors will tell you that hiatal hernias (like the "anxiety" from which they say you suffer, and every other symptom you have) are really common. Here's a statistic for the population at large.

http://www.wrongdiagnosis.com/h/hiatal_hernia/stats.htm

b. We don't have access to the incidence of hiatal hernia in dysautonomia patients but a good way to get a statistical feel for this in your head is by searching it here and also going to another disease forum and checking the number of hits you get in a search for hiatal hernia; patients routinely report all of their health woes. I think the incidence is probably pretty low on other fora.

3. Given 1 and 2, my thought is that what causes someone with dysuatonomia to get a hernia also causes him/her to have defective blood vessels or is otherwise connected to dysautonomia. (And not that everyone on here is walking around with undiagnosed hernias).

Do the people on this board with a hernia diagnosis also have an EDS diagnosis? Have they been tested for EDS?

[juliegee]

I think both Sue & Tachy are on to something. There does seem to be a disproportionate number of people here with hiatal hernias- I'm one of them. You could do a poll here & see if the numbers look statistically significant.

Tachy's right... There's a lot of intermingling processes at play. Many of us have underlying connective tissue disorders that allowed the hernia to happen in the first place, which in turn contributes to/causes the POTS. I would imagine that the weakened connective tissue itself also contributes to the POTS. Our blood vessels, veins, arteries, etc. are all more lax, less toned, and do a poor job at venous return which in turn contributes to/causes the POTS.

I don't think that a hiatal hernia is going to be the magic causal factor. When you look at the bigger picture, you have to ask...what caused the hiatal hernia in the first place? I've had other hernias, inguinal....all indicative of a connective tissue disorder.

Interesting idea. I definitely wonder how I'd feel if the hiatal hernia was repaired. Can they even be repaired? Like most of you here, I was told mine was "nothing to worry about- an incidental finding "

Julie

[kayjay]

Just wanted to chime in... I don't have one. I have had everything checked at hopkins and nih. I don't know if it matters that my problems started when I was expecting.

[sue1234]

Yea, I know that it definitely wouldn't be the answer to everybody's reason why they might have dys. I realize some have EDS as their causative factor. I don't have EDS, although I've never been tested. I just assume so, as I have NEVER been limber my whole life. When other kids could do cart wheels, back bends, etc., I couldn't, as my joints are so NOT limber.

And, not everyone with a HH has POTS. But, it could be a factor for some POTS people. I will definitely bring this up at my next gi appt. I went to the gi wanting to be tested for celiac(will find out Dec. 1 at appt.), and now am still thinking that my bloating that I tell every doctor makes me short of breath, might actually be my herniated stomach pushing on my lungs. That tiny opening was only made so big to allow the few things through. So, I am picturing my stomach compressing on essential structures. It would kind of make sense, as I was just diagnosed with diastolic dysfunction(one of those many catch-all terms when they can't explain something!), and I could see the compression underneath the heart area not allowing a relaxation of the vessels leading into/out of the heart. I can ACTUALLY visualize this happening!

[Tachy Phlegming]

You might want to look a lot more on the EDS sites.

When I first read about it on here, I said to myself -- no way. I had an idea about what the disease was and could never do a backbend to save myself (cartwheels were another matter, as were headstands and diving board flips).

But then I saw a lot of other little things EDS patients (some of the _{types) have which I have and always thought were super normal, had absolutely nothing to do with any disease but were just a little quirky.}

_{Again, it takes a lot of time to believe you might have it -- but you might want to look on a lot of sites if you're otherwise not planning to check it out.}

_{(And if you find anything which makes you think you could possibly have it, you might want to be really careful about telling anyone apart from a specialist or a very trusted doctor. People will think you are off your rocker for noticing these small common things which don't make you seem ill and for associating it with a health condition. )}

[erik]

I don't have a hernia, but I do play one on TV, so I will proceed in italics here:

Could pressure from this hernia thing (or disruption of the related cavity) also create a simple disruption of baroreflex sensing?

[juliegee]

Yea, I know that it definitely wouldn't be the answer to everybody's reason why they might have dys. I realize some have EDS as their causative factor. I don't have EDS, although I've never been tested. I just assume so, as I have NEVER been limber my whole life. When other kids could do cart wheels, back bends, etc., I couldn't, as my joints are so NOT limber.

I don't have EDS either. I've actually had the genetic blood test for type IV. That being said, my doctors definitely believe I (and my family) have an (as yet unnamed) underlying connective tissue disorder. In addition to hernias, we get aortic aneurysms, carotid dissections, etc. Our parts blow, stretch, and expand....but NO DX. I think this may be true for many of us. We may have underlying connective tissue disorders and NOT even know it. Just a thought....

[ana_22]

interesting theory!!!