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Allergies and the skipzies.


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I know many of us believe there are many different triggers for our ectopics/PVCs/skipzies/whatever you want to call them, but has there ever been a mechanism discovered that connects them to allergies. 

It's warmed up this week in the north east and increased allergies have come with the weather change. My nose starts running and I'm sneezing the moment I get out of bed. But I also can feel more "mucousy" (if that's a real term) in my throat and all the way down the esophagus. It sure isn't my only trigger for more skipped beats, but it certainly coincides with an increase in them. I'm pretty certain there's something going on with mucus production here and maybe it's the same mechanism that messes with your heartbeat when we eat, but has anyone ever figured out a link here? 

Do allergies mess with mucous production and/or can they make hypovolemia worse? 

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Hi @MTRJ75 - I always suffer from POTS when I get allergies, and yes - I too get an increase in palpitations ( and more ) when my allergies are active. This is related to histamine being a vasodilator - it will naturally worsen our symptoms, and since the vasodilation causes the ANS to react to it it makes the heart more irritable - as in tachycardia and PVC's. I even get triggered by insect bites!!! Daily Loratadine has helped me immensely with allergies!!!!

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5 hours ago, MTRJ75 said:

I know many of us believe there are many different triggers for our ectopics/PVCs/skipzies/whatever you want to call them, but has there ever been a mechanism discovered that connects them to allergies. 

Or perhaps something you are taking to combat allergies? Decongestants can do this (ones like sudafed). Strangely, I discovered after much trial that fish oil capsules give me palps. I checked in on an Afib forum and some others also reported this. 

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1 hour ago, Pistol said:

Hi @MTRJ75 - I always suffer from POTS when I get allergies, and yes - I too get an increase in palpitations ( and more ) when my allergies are active. This is related to histamine being a vasodilator - it will naturally worsen our symptoms, and since the vasodilation causes the ANS to react to it it makes the heart more irritable - as in tachycardia and PVC's. I even get triggered by insect bites!!! Daily Loratadine has helped me immensely with allergies!!!!

Yes. Makes complete sense. 

39 minutes ago, Sushi said:

Or perhaps something you are taking to combat allergies? Decongestants can do this (ones like sudafed). Strangely, I discovered after much trial that fish oil capsules give me palps. I checked in on an Afib forum and some others also reported this. 

Nothing I've ever taken to combat allergies has ever worked and I'm hesitant to take anything that dries me out, so that's not it. Fish oil. Huh. Wouldn't expect that at all. 

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I'm in the middle of a fun little event right now. 

No allergies today. In fact, I thougth I was having a pretty good day. 

Had finished eating about a half hour before. Was sitting on the couch, reading when I started feeling a bit shaky in the chest. Then a few skips. Then I realized that my heart was racing too (115-130 sitting, around 140-150 standing). Then came the vomiting. Was hoping it was just an acid reflux type thing (though I'm usually able to tell if that's the case), but the skipping and speeding continued with a feeling like something was stuck in my chest. 

You forget how scary these cardiac POTS events are when you stop having them consistently. But when you go into your first skipping pattern in months lasting more than a few minutes, it doesn't matter what you tell yourself. 

Lying down, I'm just getting a skip every minute or two, but they're coming in bunches when I try to sit up now. God, it's so terrible for those of us who have to deal with this and I know many of you have it worse than me and I'm lucky enough to even experience periods of relief. And that only makes it that much worse when they start up in full force again. 

That pure dread feeling may be worse than the actual attacks themselves. 

End of rant. 

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9 hours ago, MTRJ75 said:

That pure dread feeling may be worse than the actual attacks themselves

I am so sorry @MTRJ75 that you are going through this. I was the same way before I found proper treatment, and I know how scary it is. My cardiologist explained to me that the PVC's happen when the sympathetic NS kicks in too strong and dumps adrenaline. This IS the Fight-and-Flight response and a feeling of doom or extreme nervousness is a part of it, as well as anxiety over our symptoms and what they might lead to. Due to meds, IV fluids and limiting triggers I rarely experience this anymore except for in a flare, but when it hits me it still is very scary. Keep trying to find the right medication combination and know that it CAN get better!!!!!

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You know @Pistol even though I know all these things (and re-reading them helps) and I can keep telling myself exactly what it is AND I'll use techniques like EFT during the attacks....and it still never helps in the moment (or hours). And even after the worst of it is gone physically, the mental effects last a day or two further. Thank you for the kind words. 

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Think I made a big mistake today. Been clearing my throat/esophagus all morning from congestion. Felt like so much mucus in my chest that I could feel the skips coming on and was getting a big one every time I took a deep breath. Then I made the mistake of eating (bacon and eggs). This only exacerbated the mucus problem and skipping. This feeling in my chest is awful right now. It's almost like I can feel the lack of blood flow with the ectopics building up a few seconds before they happen. Then I'm belching and coughing my brains out. It affects everything now (breathing, heartbeat, digestive), but I wouldn't even care much about the rest of it if the d*** skips would just stop. Hoping some Mucinex gets the job done. 

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On 11/5/2020 at 7:33 PM, Pistol said:

Hi @MTRJ75 - I always suffer from POTS when I get allergies, and yes - I too get an increase in palpitations ( and more ) when my allergies are active. This is related to histamine being a vasodilator - it will naturally worsen our symptoms, and since the vasodilation causes the ANS to react to it it makes the heart more irritable - as in tachycardia and PVC's. I even get triggered by insect bites!!! Daily Loratadine has helped me immensely with allergies!!!!

I want to say again that this has been a very helpful response. I've come back to it several times over the last few weeks with ongoing issues. 

The keywords/phrases: histamine, vasodilator, "makes the heart more irritable" have helped bring me back to my senses from the auto-fight or flight response my body and mind are having frequently. 

I know the more I have to clear my throat, the more skips I have that day. Just as frustrating, I feel I can only sometimes minimize them by sitting perfectly still for long periods of time and this is not what we want to do. 

I tried to vacuum a single room today for Thanksgiving and expected the back pain and muscle soreness, but the chest tremors this brought on and the movement sent me to skip city again. The inability to move around without causing chest tremors and/or skips seems to be of greater concern to me than when I can feel the gas bubbled in my throat/esophagus preceding them just while sitting still. 

I'm going to assume that any kind of physical activity or movement with the histamine higher in my system will cause increased adrenaline (and of course the reaction to each skip causes even more adrenaline), which in turn causes the symptoms mentioned to worsen? Having had a clean cardiac MRI just 11 months ago, does this assumption seem reasonable to anyone? 

(On another note, the burning, buzzing, shaking agony in my muscles AFTER sitting back down when said physical activity is concluded seems like something different I'll have to take up with neuro again.)

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4 hours ago, MTRJ75 said:

I'm going to assume that any kind of physical activity or movement with the histamine higher in my system will cause increased adrenaline (and of course the reaction to each skip causes even more adrenaline), which in turn causes the symptoms mentioned to worsen? Having had a clean cardiac MRI just 11 months ago, does this assumption seem reasonable to anyone? 

This is a very complicated subject. From what has been explained to me is that inappropriate vasodilation OR vasoconstriction is a response by the disordered ANS and can lead to elevated adrenaline ( norepinephrine ) if the sympathetic NS overcompensates for the changes. That means we can develop many symptoms of the Fight-or-Flight response, including the typical PVC's and tachycardia. Anxiety ( or excitement ) are part of this, however since we often feel out-of-control during these episodes we certainly commonly develop anxiety in response to these symptoms ( rather than as cause of the symptoms ) and this of course would increase the adrenaline level more ... 

As you see there is so much going on that it can be very confusing for us to exactly pinpoint what happens why, when and how. I used to get quite worked up when in a hyperadrenergic flare, but I have learned that staying calm and not get worked up over every symptom helps. 

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3 hours ago, Pistol said:

This is a very complicated subject. From what has been explained to me is that inappropriate vasodilation OR vasoconstriction is a response by the disordered ANS and can lead to elevated adrenaline ( norepinephrine ) if the sympathetic NS overcompensates for the changes. That means we can develop many symptoms of the Fight-or-Flight response, including the typical PVC's and tachycardia. Anxiety ( or excitement ) are part of this, however since we often feel out-of-control during these episodes we certainly commonly develop anxiety in response to these symptoms ( rather than as cause of the symptoms ) and this of course would increase the adrenaline level more ... 

As you see there is so much going on that it can be very confusing for us to exactly pinpoint what happens why, when and how. I used to get quite worked up when in a hyperadrenergic flare, but I have learned that staying calm and not get worked up over every symptom helps. 

Bolded part so hard to get anyone to understand. 

Okay, then maybe a different question in the meantime. If I can't currently control what happens to my body, how do I learn to better control my reactions to it? 

I can prepare myself for these things all day with rational reasoning about how I should respond, but it never seems to work that way. 

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7 hours ago, MTRJ75 said:

If I can't currently control what happens to my body, how do I learn to better control my reactions to it

Unfortunately the answer is : you simply can't. If we could than POTS etc would not even be an issue - we simply would go to a psychologist or learn stress relief strategies and be on our merry way. Our symptoms are not under our control - that is why they call it the AUTONOMIC NS. The trick to overcoming this is to counteract the faulty chainreaction somewhere - and this is most commonly done with medication. 

For example: if you suffer from vasodilation then a med to dilate your vessels can help. Vice versa if your body responds with vasoconstriction. If you have brainfog or fatigue Modafinil can help, for cognitive issues Stimulants may help. If you have too much circulating adrenaline you can try to avoid triggers all day long - you won't be able to stop it from happening. So that is when you address each symptoms and try to treat it with meds to prevent the faulty mechanism to start. With me this is accomplished with both meds and - most importantly - regular IV fluids. This has helped me so much that as long as I avoid being upright for too long and avoid other triggers I have only few symptoms. The palpitations completely stopped even before the IV fluids, simply with the combination of Beta blocker and calcium channel blocker ( a vasodilator ). 

It is unfortunately but the home remedy for POTS has yet to be discovered. It is nothing you can will away or control with your mind. I see one of the most renowned autonomic specialists in the world and even he had to experiment for years to find the right treatment for me, so IMO seeing an experienced specialist and being patient with trying new meds is crucial if you want to find proper treatment. 

I had to kiss a lot of frogs before I found my prince!

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I have to admit, that's not the most encouraging response considering most of the things you mention I've either already tried unsuccessfully, are impractical (freqeuent IV fluids) or unavailable to me (top specialists). 

I can't tell whether I'm constricting or dilating or maybe both? We tried a vasoconstrictor about two years ago and it increased my PVC burden terribly. But if histamine is vasodilating and increases skipping, why would a vasoconstrictor also increase them? Unless I'm mis-understanding (brain fog is bad tonight). 

Did it to myself again today trying to clean again. My mother wanted me to go to the ER, which is saying something because she's seen me in bad shape before, but I couldn't even explain what I was feeling. The best I could do is like that feeling when you get up too quick, except this was all over my body and not going away after a minute or two. Or even an hour or two. 

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7 hours ago, MTRJ75 said:

But if histamine is vasodilating and increases skipping, why would a vasoconstrictor also increase them?

We are all highly medication-sensitive and any med that interrupts the faulty mechanism can potentially trigger another one - hence the known frustration with trying to treat dysautonomia. And often it is not simply ONE med that makes a difference but rather a combination of them. 

 

7 hours ago, MTRJ75 said:

Did it to myself again today trying to clean again

I used to do the same frequently, and in the long run trying to power through and ignoring my limits caused POTS to get much more severe for me. Even after becoming fully disabled I still overdid it frequently, simply by thinking "I just want to finish this one thing ..." and then woke up on the floor. What I have learned is to completely avoid doing things when I want to do them but rather planning my day around them. For example: If I know I have to do a taxing chore ( like mopping the floor or going to a doctors visit ) then I hydrate and rest the day before and avoid any triggers. Then the day that I want to do the chore I start early ( mornings are my best times but others do better in the afternoon ) and do only what I can and rest as soon as I feel ANY symptom coming on, be that palpitations, chest pain, weakness etc. I have found that lying is much better than sitting in order to calm the symptoms, so I lie down for a while, until I feel good enough to do some more. 

The secret, my friend, is that we MUST listen to our bodies, and not fight them. The only way I have found to be able to function despite POTS is by being in tune with my symptoms and react to them as soon as they start. Using willpower or trying to tell my brain what to do has not ever been effective for me - to the contrary: trying to control my symptoms has made me worse. 

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On a certain level, I understand all this @Pistolbut figure the arguing if I don't get it done may be worse than the consequences if I just try to do it. I usually have my opening mid-afternoon until dinner sometimes, and thought I had one yesterday, but apparently did not. Then the problem becomes that I'm too wound up to lay down, but sitting doesn't help much. It's just an awful, unexplainable all over feeling that I don't know how the human body can frequently survive and only someone else who experiences it could understand.

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I've had severe POTS for 17 years and I do understand exactly where you're coming from - that awful feeling where your whole body is screaming at you that something awful is about to happen and however much you rationalise that you are safe and there is no danger your body just doesn't believe that.  I have to say that I agree completely with @Pistol - the more you push it, the longer and worse that feeling will last.  After awful advice from several GPs, I continued to work and actually increased the amount of exercise I was doing which left me bedbound for a couple of years.  Once I started to listen to my body and live within my limits the feeling happened less and for shorter periods of time.  Find a routine and stick to it for a couple of months - it is easier to figure out your baseline tolerance for activity when you are doing the same thing every day.  If you are having a good day don't be tempted to do more because you will inevitably overdo it and need 2 or 3 days to recover.  Once you are comfortable with what you can do, you may be able to increase activity slowly once you are not wasting energy recovering from overdoing it.  I do nothing spontaneously; I plan everything that is not in my normal routine with military precision!  For example, if I am going out somewhere, I rest more the day before and drink extra water.  I go at a time that suits me best ( for me that's between 11am and 3pm) and I make sure I am going somewhere within my limits of walking and with easy access to a bathroom - I'll phone and ask if I'm not sure.  Once I've been out, I rest for the rest of the day and take it easy for the next few days until I feel I'm back to "normal".  I can only manage one outing in the month so I have to plan and prioritise what that will be. 

Have you tried breathing exercises and mindfulness and meditation?  None of them will get rid of POTS but when I'm having that awful feeling I try to do square breathing for at least 10 minutes - breathe in for 4 , hold for 4, breathe out for 4, hold for 4. Focusing on something else helps me ignore that feeling of doom!

I think that the only thing that really helps you adjust to having POTS is time.  I haven't had a good result from any meds; I did really well on Midodrine for about 3 months before it started to make my blood pressure dangerously high and I had to stop it and no other meds have helped me.  I have learnt that I feel better when I try to accept my limitations and work within them rather than wasting energy fighting my body all the time.  I have hEDS which causes my veins to be too stretchy and as there's no cure for hEDS, I think I am probably stuck with POTS for the rest of my life.  I could get really depressed about that, but I'd rather make the most of what I am able to do - it's not what I imagined my life would be like but at least I am alive!  That's not to say I don't have days where I wish I hadn't been born, but I try not to dwell on them.  Try to be kinder to yourself - if you are constantly trying to control something that is outside your control, you will keep thinking you have failed whereas by trying to achieve the impossible you are just setting yourself up for failure.  

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17 years...God bless you. I don't see how I could mentally or physically last that long. I just don't have the means either. 

Everything you say is completely rational of course, but I find planning things or trying to keep a routine becomes incredibly frustrating because this condition always knocks me out of it. I actually may be better with spontaneous and never actually planning on getting anything done. I already have to carve out several hours around showers. 

Meditation and breathing exercises seem to have the opposite effect on me. The former just makes me incredibly exhausted and achy and the latter just seems to make my heart pound harder. 

It seems as though things are tolerable if I stay very still and don't eat much. I was a little anti-social for the family Zoom portion of Thanksgiving tonight, but that's their problem. Just putting some food away tonight (took 5 minutes) feels like, well, I can't actually describe the after-effects because there simply aren't words to describe what was going on in my body after I sat back down. Or if there are words, at least I don't know them. 

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