Have You Ever Been Compared To Pavlov's Dogs?

[ajw4790]

Have you ever been compared to Pavlov's dogs?

I can now say I have, although I would have much rather have not been compared to a dog, especially Pavlov's! And, yes, this occurred at my recent trip to the institution I have been discussing in my other recent post. It was not made by a doctor (MD), but by an exercise physiologist that regularly treats POTS/dysautonomia patients. I have to say that I took great offense to the whole thing. Not only because of the behavioral conditioning part of the analogy, but because he also jumped to a conclusion and did not have all my testing information! His nice little analogy DIDN'T even apply to me!

So, what is this nice little thought process???

According to him, he tells his patients that many times patients like myself are much like Pavlov's dogs. The dogs salivate when the bell rings, even when the meat powder is removed. So, according to him patients like myself can have symptoms of low blood pressure without actually having low blood pressure, because we are reacting to a stimulus that provided low pressure previously. So, in other words we are behaviorly conditioned to have this response (dizziness etc.), even when there is actually no low blood pressure occurring. So, then we would have to recondition ourselves to not have this response...

I mean REALLY???

BUT, the kicker is that I did not have a declining BP response during my stress test (which is what he was looking at), BUT I did have a sharp decrease in BP on the TTT. So, I DO experience low BP. So, I had to explain it to him... and that there are many types of lightheaded/dizziness. The type I experienced on the stress test was much different than the TTT.

I see so many holes in this thought process that it seriously irritates me? Not to mention, at least to me, I find this quite offensive!

Have you ever been told anything similar??? What do you think of comparing our symptoms to behavioral conditioning???

Is there any merit to this thought process???

[firewatcher]

"an exercise physiologist that regularly treats POTS/dysautonomia patients."

I sure hope not! Does this "learned expert" actually believe this of ALL his patients?! That we're "conditioned" to respond this way? Can you seek another professional to see, citing difference of opinion? What does your referring physician say of this "opinion?" I would definitely bring it up with whomever recommended this physiologist. Honestly, most dogs (at least pets) are treated better than we are! If my dog wasn't acting right or limping, I'd take it to the vet!

I'm sorry you had to deal with that.

[Kitsakatsa]

He's talking about forming neuropathways in response to stimuli- and extending it to situational physiology. He's suggesting that you have formed a neuro connection to a symptomatic feeling. He's not only suggesting that the symptomatic feeling does not tie to an actual acute or chronic disorder, but that you have received some reward for having a symptom (ie, meat powder).

His logic suggests that it is instead he himself who is similar Pavlov's dog and that faced with a problem he is not intellectual capable of handling, he reacts with a cheap answer and is rewarded with a confused, red faced, or exiting patient.

I was in your shoes very recently and I did not go back to that doctor. I can't waste time and energy with those who increase drama in my life.

Either go back in charging, or walk away but don't let him put you in that box.

Kits

[Poohbear]

I'm sorry that you had a bad experience and felt invalidated by this physician!!

I can understand part of what he may have been talking about (although I appreciate your not liking his analogy).

If you think about this a little bit in terms of people who have panic attacks that may be another way to explain it so that people can understand. For example, let say you are in an elevator and you suddenly feel your heart race. You DO have a physical problem in that moment but your thoughts can exaccerbate the situation. You may think, "Oh no I'm about to die" and your brain may make the connection to all of this taking place in the elevator. Thus, the next time you go to get on an elevator, even if your heart wasn't racing, you start to panic (and then your heart may race).

There are many people on this board who started out having "only" medical symptoms but then when spells happened in public or unexpectedly the fears crept in and then they end up dealing with panic attacks on top of the initial medical problem. There are some people on this board who have dealt with agoraphobia because of the medical problem.

I'm not saying this is YOUR case and maybe this guy did a poor job of explaining it to you and/or maybe he didn't do enough to validate all of your issues but I can see where what he was trying to explain could (and does) apply to some patients.

It can get very complex for some patients because a "POTS crisis" can increase the epi, norepi, adrenalin etc. in the body; those are also some of the same catecholamines that are at work in panic attack. Your body does not know the difference and that is where the mind comes in. I do think there is a lot to be said for the 'self talk' that people can use in the middle of an autonomic crisis and just like anything else.....some people don't need training in those methods and some people do.

It sounds like this guy definately did not listen to you which is angering for sure but I do see the point he was trying to make.

[lieze]

I kind of get what he's saying but not sure he said it right.

My mom's doctor explained something similar to her regarding her diabetes.

I guess what happens is these are all normal processes our body tells us to eat when our blood sugar gets low. To sit down before we fall down when our bp drops?

I guess the longer you go along with a disease process? if that is the right word your brain can start to send out false messages. In other words my mom's brain is sent out the message to eat your sugar is getting low at a different set point now after so many years of being diabetic so it is a false message she is getting.

She was able to confirm that what he was saying was true.

The problem is how do we know when a message is false and when we should listen to that message. I have gotten the message before now when I am fine. For example felt depleted of oxygen but had the equipment right there took my pulse ox and it was 100% as soon as I saw that number I felt instant relief and actually started feeling okay right away. I used the feedback system also when I wore my heart monitor I loved being able to keep tabs on my heart rate.

If I felt symptomatic but my heart rate was only 90 I realized I was okay I had a way to go yet.

But if I was increasing jumping up to 110 on up then I would slow down.

I am realizing I have no idea what my heart is doing until I take the actual pulse.

Also the bp there have been times I have felt like absolute crap granted I don't have an actual reading from the moment that started but when I take my vitals I am fine.

Also when hooked up to equipment in ER I would feel the wave go through with no change in vitals many times.

So in my case it seems my body is sending false messages. My problem is I don't know when to listen. The instant I know I'm okay I start to feel okay.

Also taking a Xanax tends to relieve many of those sensations which makes me think that's all they are to begin with are weird bodily sensations.

Now I have to admit at the same time I am no where ready to go run a marathon, or do anything very strenuous. I get nervous looking at a flight of stairs or taking a trip to Walmart.

But I do see that there is something going on here I just can't figure it out.

I'm not sure if what that doctor is referring to or not though-sorry.

lieze

[poppetkazutaka]

Sounds like my dad when he told me, "I'm not saying you're making it up, I'm saying your reading this information on the internet and then you're feeling the symptoms as if you really had them."

"That would be BECAUSE I really have them and THEN I look them up."

[erik]

I am male. I have Pavlovian responses on a minute to minute basis. How does a momentary whiff of a perfume an ex girlfriend used to wear result in autonomic responses such as increased salivation, increased heart & respiratory rates, piloerection (that's goosebumps, folks), cognitive distraction, et. al.???

I think the trainer guy here is overstating things, but that isn't uncommon when people are offering a full regime and using "motivational attitude". It is the operative construct of any "therapy". Details don't even have to be entirely accurate, and also things don't necessarily have an inherent condescension. You can actually get POTS from simple deconditioning and a spiral of results... even being horizontal too long lowers aldosterone (cascading to hypovolemia)... putting road blocks up to recovery. So it seems the advertised approach could well be successful for a subset of folks. Any promises in this regard are overstatement or simplification or just erroneous, but it isn't the worst thing ever. If you don't like the regime, just say no. As a consumer, you can shop around in one way or another.

Even when there are specific damages (neuropathy or other damage) one can try to make use of whatever adaptation the body is able to muster. Maximizing whatever compensations are available seems wise. Even embracing a flawed or incomplete context can be useful... even relaxing... since reality and uncertainty wear one out.

[juliegee]

Dr. Peter Rowe at Hopkins, my son's doctor, offered a different explanation. My son experienced symptoms (lightheadedness, nausea, anxiety) about 25 mins prior to his BP dropping to an immeasurable level during his TTT. Dr. Rowe says that the brain intuitively KNOWS when the BP is about to drop out. Symptoms begin at that point even though they can't be corroborated by an irregular BP. When you are experiencing symptoms THAT is the time when you should force fluids, lie down and elevate feet. If my son doesn't, he will faint & barf like he did on the TTT.

My son has NO reward for his behavior. I can't imagine what that would be.

I love Kits and Jennifer's answers. YES- dogs are treated much better than we are- sad .

Julie