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My Visit With Dr. Watkins

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So, I had an appointment with Dr. Phillip Watkins of the MVP & Autonomic Center in Birmingham, AL last week. For starters, it was an absolute RELIEF to speak with a physician who didn't look at me funny and understood exactly how all of my symptoms were related. I was very impressed with Dr. Watkins and the time that he spent with me.

They started me off with an Echo-cardiogram...pretty standard, except they also like to perform some imaging in the sitting position, presumably to capture things when the HR is really going. Next was the tilt-table...I was pretty surprised with this test, as I wasn't all that uncomfortable in the upright position, and my HR didn't really spike too much. Perhaps the Florinef was skewing the results, in addition to the fluids that I drank earlier in the morning. So, the tilt-table was unremarkable. Finally, the stress-test...I made it 14 minutes before quitting...and my HR was up around 170 BPM or so.

After those tests...I finally met with Dr. Watkins to discuss the results. Notably, he had a framed letter from Dr. Grubb on one of his side tables. We talked quite a bit about family history, historical symptoms (like IBS), etc. He eventually asked me if anyone had ever mentioned "dyautonomia" to me...to which I replied "that's why I'm here to see you.". After some more back and forth...and a physical exam...he prescribed the following:

* 150min aerobic exercise/week

* Lot's of fluids

* No caffeine

* Beta blocker (Atenolol for me)

* Clonazepam

* Lexapro

I started everything last week...and the beta-blocker has really dropped my HR (resting around 55bpm...as low as 44bpm at night in bed). I was a little worried about my BP dropping off the table, but it seems to be doing okay (110-120/65-80). I still have a bunch of troublesome symptoms (fatigue, GI stuff, hot flashes, lightheaded), but I'm hoping things will improve over the next week or so. Dr. Watkins sounded pretty confident that this protocol would "fix me up", so only time will tell. He did mention that I might experience an exacerbation of existing symptoms or some new symptoms as things start to work.

To be honest, I'm a little confused how the prescribed protocol all works...but I'm still new to all of this stuff, so I'm going to follow it to a T. He sounded very confident in his diagnosis and protocol, but I really wish I understood the science behind it all.

Regardless, I was very impressed with Dr. Watkins and would highly recommend him to anyone else.

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I am thrilled that you found someone! I wish we had even half that here in Georgia!

This is just my take on how this stuff works:

* 150min aerobic exercise/week---reduces any deconditioning and increases blood volume

* Lot's of fluids---again, increases blood volume

* No caffeine---cuts out any sympathetic stimulation and diuretic action of caffeine

* Beta blocker (Atenolol for me)---reduces sympathetic overstimulation and brings HR into a comfortable range

* Clonazepam---again, reduces sympathetic overstimulation and exerts some not yet understood action on the central nervous system

* Lexapro---good for the general malaise and stinky mood that all this ______ generates, as well as helps with neurotransmitters (?)

I really hope that this helps you. I know how hard you've looked to find someone locally. Keep us posted.

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"They started me off with an Echo-cardiogram...pretty standard, except they also like to perform some imaging in the sitting position, presumably to capture things when the HR is really going."

I was just thinking about this today.. wondering if an echo could be done in different positions to see what the heart actually does in our case - if anything abnormal would be captured. Doesn't sound like he said? Sounds like an overall very good visit though. It must have been so nice to have a real conversation with a Dr who gets it. Hope the protocol works. :)

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I've been on Clonazepam before...pretty easy to come off since it has such a long half-life. Per firewatcher, I believe he prescribed it to "calm" an over-stimulated nervous system. He also mentioned that I was probably getting very poor restorative sleep...so it will help with that as well (taking .5mg at bedtime).

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