Does Blood Pooling Tend To Be Obvious?

[Annaliese]

For those people that have blood pooling in their legs, is it obvious? Is it possible that blood is pooling in my legs but i dont know it? I dont have any discolouration or aching....

[icesktr189]

Mine is but Im not sure if it has to be. My feet and legs get really red or purplish and if I press on them, they indent and turn white. I know my stomach pools, but I dont have discoloration from it, just looks bloated or like im preggo.

[rubytuesday]

My feet usually turn purplish black when standing, when showering, if I'd been sitting a long time, or if cold. But the toes can also appear whitish. I guage my blood pooling by when my calves begin to feel tight , my ankles are harder to bend as are my toes (they may start to look like little sausages), and how bad the indentation from the seams of my waistband and seams of my jeans/socks leave on my legs.

[Alyssa]

Most of the time it's pretty obvious for me. When I'm sitting/standing my feet turn purple and swell up a little. There are other times that it isn't quite as obvious, I can feel it pooling, but I can't see it - just depends on what I'm doing.

[Clairefmartin]

I've been wondering the same thing, thanks for posting. i get pain and redness in my feet sometimes, but i feel like the blood is running away from my feet most of the time, they are white and cold and tingly. Weird :/

[Katybug]

I have just a slight color change in my thighs most of the time but there are times when I can see a dramatic change in color and I have had my legs turn so purple that it didn't seem human. I have also had some weird pooling patterns lately where it looks like my thighs are covered in spider veins. I took pics and the POTS doc says it is one of many patterns the blood pooling can make. It was kind of scary the first time I saw it because it looked like something out of a sci-fi movie. I find the color change most noticeable in the shower.

I also have abdominal pooling which I experience the same as dani, no color change...just the preggo/bloated look (not my most attractive moments.)

[Dizzysillyak]

I had pooling that showed up a few times in my legs but it didn't happen often. Mine pools in my gut after eating for sure but not sure where else it's pooling at. Interesting topic ... tc .. d

[Annaliese]

Thanks everyone or posting. Is it like the varicose vein feeling you get when you're in your late pregnancy and your legs ache, feel heavy and it feels nice to put them in cold water?

[Katybug]

My legs don't really feel any different when they pool, just have the color change. BUT, its the rest of me that feels it when it happens...I get dizzy, and brain foggy, and feel like I'm either going to lay down voluntarily or my body will lay down involuntarily, like it or not. I also will get flushing and sweats and my knees will buckle if I try to push myself and don;t lay down.

[micheller]

My feet turn purple and cold, was noticed by the tech during my TTT. I've been noticing the bloated/prego look later on during the day. If you have blood pooling in your feet, why do they get cold? You would think they would be warmer?

[rubytuesday]

My legs don't really feel any different when they pool, just have the color change. BUT, its the rest of me that feels it when it happens...I get dizzy, and brain foggy, and feel like I'm either going to lay down voluntarily or my body will lay down involuntarily, like it or not. I also will get flushing and sweats and my knees will buckle if I try to push myself and don;t lay down.

Sounds like me except that my knees don't buckle--they just collapse under me unless I get down fast. Scarey thing for me was that cardiac specialist told me that I am going to start having fewer warnings.

[Katybug]

I think its because the blood is just sitting in your legs/feet instead of circulating properly which is how it gets rewarmed at your body core. Also, because it is not being properly re-oxygenated it isn't continuing to feed the cells oxygen to continue metabolic processes that give off heat.

[Katybug]

rubytuesday,

WHy did they say you'll get less warning signs? I haven't heard that one before...that's worrying cause I count on being able to get myself in a safe position.

Katie

[ramakentesh]

Some feet and leg poolers feel warmer hands and feet rather than colder, others get filtration problems where the liquid in the plasma leaks out into surrounding tissue causing cold extremities, still others get raynauds either to compensate or because they have excessive vasoconstriction in the legs and arms rather than the opposite.

You could measure the diameter of your legs or stomach after standing for a long time as an indicator.

However, some people with POTS have a kind of delayed vasoconstriction in the hands and feet where it works but it requires larger amounts of NE than normal, and because the rest of the body is still normally sensitized to the NE you feel hyper.

Finally, all patients with POTS (pooling or otherwise) prettymuch have reduced cerebral autoregulation, meaning they feel dizzy.

[ramakentesh]

It may also be that many mistake this for blood pooling:

http://docs.google.com/viewer?pid=bl&srcid=ADGEESjxbKXO-8EJ4WjTYK5_sV4i27vKwUYRJS9uNRzX6i-IOu_5HQLd7m24LeKsvm7H1HIQLD3_nds1QORW8IhbvNYrdmd2SB5_IbpNjNMLmIF37x_4aRLk0PKveUwzVmodP6nCRkSd&q=cache%3AGOSgFvc5388J%3Aimg.medscape.com%2Fpi%2Femed%2Fckb%2Fpediatrics_cardiac%2F1331339-1331342-902155-1371936.doc%20postural%20tachycardia%20muscarinic&docid=6fce209656be6e9f92aefe43141b995a&a=bi&pagenumber=6&w=800

[ramakentesh]

Further, according to Marvin Medow, bluing or acrocyanosis does not generally occur in patients with peripheral (hand and leg) pooling:

http://docs.google.c...number=13&w=800

[Libby]

ramakentesh - neither link is working for me

I haven't read Medow's thoughts, but it's important to note that his area of expertise is pediatric POTS.

I have 'significant pooling' in my legs, according to my doc. Sometimes it feels like my legs are a water balloon that someone is filling up until right before it pops. They ache when I walk and when I touch them. But visually they swell a just tiny bit and turn a nice shade of red, my feet especially. And, like with a sunburn, if I press my finger down onto the skin it pushes the blood out of the way for a moment and leaves me with a white patch (that lasts all of a second).

They do turn blue as well, though not when they're badly pooling. My feet look dead, purple/grey and ugly. Blech. I let it happen at a follow up with my cardio once, while I was sitting on the exam table waiting for her to come in. She waited until the end of the consultation, but she went over and pressed down on my ankle (checking for edema, probably) but didn't seem concerned. I'm not in heart failure, I guess. Yay.

But yeah, if I'm not moving my legs and calf muscles, it's pretty much a guarantee that my feet will turn some color.

[handmadebyemy]

Mine is very obvious - my legs get dark purple when sitting or standing. Way worse than the picture shown in this article

;: http://www.google.com/imgres?q=pots+leg+pooling&um=1&hl=en&client=safari&sa=N&rls=en&biw=1280&bih=597&tbm=isch&tbnid=GnwWP8Sqgj1L1M:&imgrefurl=http://cogprints.org/4802/1/raj.htm&docid=jZi-kADDa81ZBM&imgurl=http://cogprints.org/4802/1/raj2.jpg&w=600&h=450&ei=cZXNTrnLLuHn0QGBoOBE&zoom=1&iact=hc&vpx=430&vpy=82&dur=5&hovh=194&hovw=259&tx=125&ty=137&sig=104097835803778222817&page=1&tbnh=134&tbnw=179&start=0&ndsp=22&ved=1t:429,r:9,s:0

[roxie]

Mine is totally obvious, dr's are always staring at it. I get it in my hands too & when I'm upright a long time I think my cheeks & nose get mottled. 

At night when I take my stockings off there's like this purple pool that sits on the top of my foot.

I just went to a knew dr who wants to go a special pelvic ultrasound bc blood can pool in your stomach too. It's called Pelvic Congestion Syndrome and it's something that can be ablated! So whoever talked about the prego look from bloating- maybe PCS is a possibility?

[RichGotsPots]

I've been wondering the same thing, thanks for posting. i get pain and redness in my feet sometimes, but i feel like the blood is running away from my feet most of the time, they are white and cold and tingly. Weird :/

Cf I have the same thing, my feet are freezing most of the time even with socks on and the room at 77 degrees. If I stand for 5+ minutes my feet are throbbing almost like pulsing and just in pain. I don't notice discoloration but then again I'm always wearing socks lol I'm doing to try to take them off when it happens now. Do you think what we have is pooling had anyone ever tested you for it?

[RichGotsPots]

Some feet and leg poolers feel warmer hands and feet rather than colder, others get filtration problems where the liquid in the plasma leaks out into surrounding tissue causing cold extremities, still others get raynauds either to compensate or because they have excessive vasoconstriction in the legs and arms rather than the opposite.

You could measure the diameter of your legs or stomach after standing for a long time as an indicator.

However, some people with POTS have a kind of delayed vasoconstriction in the hands and feet where it works but it requires larger amounts of NE than normal, and because the rest of the body is still normally sensitized to the NE you feel hyper.

Finally, all patients with POTS (pooling or otherwise) prettymuch have reduced cerebral autoregulation, meaning they feel dizzy.

I'm going to have to disagree with you, I have POTS and no dizziness. I think the ones who have the dizziness have BP issues, usually lowered or variable. No all POTS patients have this.

[anaphylaxing]

Before I was symptomatic with POTS/my whole life my legs would turn purply red in the shower, heat, or if I stood too long. Then I got sick, now I have POTS and my legs/feet hands go really pale in the shower and I notice my legs and feet going purple when I sit

[icesktr189]

RichGotsPots,

You are very lucky that you dont have dizziness! Do you ever get it? Mine has been constant for almost 5 years now :/

[chipper]

Pooling for me is red hot burning feet when warm and standing. When cold they will be purple like. Before getting better, they were cold past my knees and red-purple all the time, but worse when standing. Hands get red and hot. When they are cold the finger temperature is 70 degree { 80 is normal}.. I've been told the stomach also.

[ramakentesh]

Stewart and Medows work with patients up to the age of around 27-28 now days. Only their early work was strictly funded for pediatrics. Most of their findings are commonly referenced by other researchers now in relation to adult patient populations - including this particular finding:

Not only their work but the work of others indicates that the bluing and dusky red skin on the legs of a large subset of POTS patients may not be venous blood pooling but actually decreased blood flow to the cutaneous vasculature possibly from reduced neuronal nitric oxide activity and increased plasma filtration. This has been referenced and similar statements made in studies from a variety of other research groups including Vandebilt.

This isnt my opinion here. Im just reporting what the majority of recent studies have suggested. Nearly everything about POTS is still conjectural in terms of etiology but you might find if you do some reading that much of what patients and even some doctors accept as fact about this condition is being challenged via impressive new research. Below are some references for this and if you want and i have the time I can find more.

I should correct the statement that ALL POTS patients have dizziness. It is true that rare cases (beta1 receptor hypersensitivity and autoimmune mediated inappropriate sinus tachycardia as examples)do not exhibit dizziness.

However, I can refer you to numerous studies that demonstrate reductions in cerebral blood flow and autoregulation under orthostatic stress in POTS within most of the major subsets. Most get dizzy even when their overall blood pressure is normal (in most patients, low blood pressure is not suggestive of a diagnosis of POTS) but even with postural HYPERtension (due to cerebral vasospasm, decreased cerebral autoregulation beacuse of overall sympathetic overactivity, vasomotor nerve failure or a variety of other mechanisms not necessarily driven by basic overall blood pressure regulation). So while you have corrected me for your case, it does not apply to the vast majority of patient subsets who clearly do experience cerebral hypoperfusion.

The dizziness in POTS is often a result of redistributive changes in blood flow rather than reduced blood pressure, although the consequences are the same.

Back to the bluing...

Acrocyanosis in dependent parts of the body in POTS:

Cardiac auscultation may reveal a murmur of mitral valve prolapse, but significant mitral regurgitation is unusual. A striking physical feature of POTS is the dependant acrocyanosis that occurs in 40-50% of patients with POTS (Figure 2). These patients experience a dark red-blue discoloration of their legs, which are cold to the touch. This can extend from the feet to above the level of the knees. The reasons underlying this phenomenon are not clear. The current data suggest that the problem is not due to increased pooling in the venous capacitance vessels, but rather due to decreased blood flow in the skin^16,17.

Satish Raj, Vandebilt Autonomic Centre

http://www.ipej.org/0602/raj.htm

I can find many more.

The increased blood pooling in a subset of POTs patients in the legs can be catagorised as:

http://www.nymc.edu/...Flow%20POTS.htm

Although the patient group here is up to the age of 19 - but the findings agree with similar made by just about every researcher of a subset of POTS patients with impaired peripheral vasoconstriction and alpha1 adrenoreceptor malfunction.

This might also be of interest as well:

Stewart JM. Pooling in chronic orthostatic intolerance: arterial vasoconstrictive but not venous compliance defects. Circulation. 2002;105:2274-2281

Orthostatic intolerance is characterized by postural tachycardia syndrome (POTS) with exaggerated tachycardia, orthostatic symptoms, and "pooling" (which comprises acrocyanosis and dependent edema when upright). My colleagues and I tested the hypothesis that pooling results from increased venous compliance in POTS patients.

CONCLUSIONS:

The findings suggest that pooling in POTS is due to blunted arterial vasoconstriction, which produces passive redistribution of blood within peripheral venous capacitance beds. Venous compliance in POTS is similar to that in control subjects.

Whether you disagree or not is entirely your call but this is what THEY are saying it is Doesnt mean its definately right or that its 100% proven but im just repeating what Ive read. Cheers.