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Information Resources

DINET has always been grounded by the principle of support.  In alignment with our mission of support, we believe Black Lives Matter and support organizations, movements and people working to reduce racism, discrimination, prejudice, violence and systemic injustice in our country and throughout the world.
And, as an organization that believes wholeheartedly in advancing healthcare for our members who live with dysautonomia, we must acknowledge that we have not done a good job recognizing the inequities in healthcare experienced by Black Americans day in and day out, including those who live with dysautonomia. 
We are sorry to our Black members, brothers, and sisters for not joining the conversation sooner.  We are listening.  We will keep educating ourselves.  And, as we continue to work toward our goal of a more equitable healthcare system, we will be conscientious about recognizing the particular healthcare inequities faced by Black Americans. 
DINET Board of Directors and Administrators
*Thanks to Chelsea Goldstein for the compilation of resources and research contained in this article.
Below is a list of resources we are using to further our education on racial disparities in healthcare:
Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington
Communities in Action: Pathways to Health Equity by the National Academies of Science, Engineering, and Medicine
Rare Diseases and African Americans by Black Health Matters
The Overlooked History of Black Disabled People by Vilissa Thompson
Understanding and Addressing Racial Disparities in Healthcare by David Williams and Toni Rucker
African American Health by the CDC
The Burdens of Race and History on Black People’s Health 400 Years After Jamestown by Stephen B. Thomas and Erica Casper
The Tuskegee Timeline by the CDC
Race, History, and the Science of Health Inequities by Sandro Galea

COVID-19 & Racial Disparities:
COVID-19 United States Breakdown by Black Ladies in Public Health 
Racism and Inequality in the Face of COVID-19: Viruses Don’t Discriminate, But We Do a webinar moderated by Jamila Taylor
Coronavirus in African Americans and Other People of Color by Sherita Hill Golden
Spotlight on COVID-19 and Health Disparities: Opportunities to Achieve Better Understanding and Equality for Vulnerable Populations by Eliseo J. Pérez-Stable
COVID-19 and Racial/Ethnic Disparities by Monica Webb Hooper, Anna María Nápoles, and Eliseo J. Pérez-Stable
Organizations that work toward health equity:
Society for the Analysis of African American Public Health Issues 
Black Ladies in Public Health 
National Institute on Minority Health and Health Disparities 
Healthy African American Families 
Black Women’s Health Imperative 

COVID-19 Research: study conducted by Dr. Blitshteyn for Neurologists treating a variety of dysautonomia disorders.  Also, patient research conducted the Rare Disease Network for people living  with rare diseases, whether you have had any exposure to COVID or not.  Visit our Recruitment Studies page for info on both studies.
Statement from Dr. Peter Rowe, Director of Children's Center CFS Clinic, John Hopkins Univ. School of Medicine on COVID-19 and CFS and OI
Dysautonomia and Coronavirus - an article by Dr. Blitshteyn, one of DINET's medical advisers. 
COVID-19 Part 2 - Article by Dr. Blitshteyn, Director and Founder of the Dysautonomia Clinic.  This article tells you what to do now.
From DINET:  We live with chronic illness - tips for COVID-19 isolation  then join the forum to weigh in with your tips - POTS is like cabin fever
Important information you need to know about face masks
From the Global Genes and the Rare Disease Network
Government Updates
World Health Organization: Rolling Updates on COVID-19 World Health Organization: COVID-19 Online Courses Centers for Disease Control & Prevention: Guidelines for people at High Risk Centers for Medicare and Medicaid Services: Current Emergencies Centers for Medicare and Medicaid Services: Coronavirus (COVID-19) Partner Toolkit Cambridge Rare Disease: Current UK NHS & Government Information & Guidance City of Little Rock: Experiencing symptoms related to COVID-19? City of Little Rock: ¿Tiene síntomas relacionados con COVID-19? (Spanish) Food & Drug Administration:COVID-19 What’s New and Fast Facts National Institutes of Health: COVID-19 Updates World Health Organization: Coronavirus Information Centers for Disease Control & Prevention: Coronavirus Information Center U.S. Government: State Health Department Directory Coronavirus (COVID-19) Education & Information
Día de la Mujer Latina: Dispelling the Myths and Rumors of the New Coronavirus Disease (Webinar) Día de la Mujer Latina: Disipando los Mitos y Rumores del Nuevo Coronavirus (Webinario) GRIN2B Foundation: Flip Book Social Story SCN2A Australia: Podcast on COVID and Epilepsy Coronavirus Support Network: FAQ (English) Coronavirus Support Network: FAQ (Spanish) Coronavirus Support Network: FAQ (Portuguese) National Health Council: COVID-9 Preparedness for people with chronic disease (Webinar) Association of Community Cancer Centers: COVID-19 Resource Center American Society of Clinical Oncology: Coronavirus Resources American Academy of Neurology: COVID-19 Neurology Resource American Thoracic Society: Public Health Information Sheet American Thoracic Society: COVID-19 FAQ Financial Assistance 
Laughing at My Nightmare: COVID-19 Resource Relief Arkansas Community Foundation: Arkansas COVID Relief Fund Virtual Networking
Ehlers-Danios Society: Virtual Chat Rooms Twitter QA: #spooniechat Our Odyssey: Online Meetups The Mighty: Come Hang with the Mighty Events Support Services
Robert Wood Johnson Foundation Culture of Health Leaders: Coronavirus Support Network Global Healthy Living Foundation: COVID-19 Support Program for Chronic Disease Patients and Their Families Cancer Support Community: What Cancer Patients, Survivors, and Caregivers Need to Know About the Coronavirus Mental Health
Centers for Disease Control & Prevention: Managing Stress and Anxiety During COVID-19 Happy: Online Mental Health Support Talking to Kids
Kids Health, Nemours: How to Talk to Your Kids About COVID-9 KinderCare: Talking to Children About Coronavirus At Home Teaching Resources
District Administration: Free K-12 Resources We Are Teachers: 130+ Amazing Online Learning Resources Diagnosis, Treatments & Vaccines
Milken Institute, FasterCures: COVID-19 Treatment and Vaccine U.S. Food & Drug Administration: Clinical Trial Guidance Mindray: COVID-19 Clinical Diagnostics Webinar Episode 1 Mindray: COVID-19 Clinical Diagnostics Webinar Episode 2 Mindray: COVID-19 Clinical Diagnostics Webinar Episode 3 Mindray: COVID-19 Experts Dialogues Coverage & Benefits
Centers for Medicare & Medicaid Services: Coverage & Benefits Related to COVID-19 Medicaid and CHP Foundation Resources
Centers for Disease Control & Prevention: Communication Resources Patient Advocate Foundation: COVID-19 Operational Response Plan Nielsen Training & Consulting, LLC: COVID-19 Resources for Nonprofit Leaders Exercise
Orangetheory:  Orangetheory At Home Gold’s Gym: Stronger Anywhere Peloton: Free App Planet Fitness: Home Work-Ins Crunch: Crunch Live 305 Fitness: Group Classes Corepower Yoga: Keep Up Your Practice American Heart Association: Choose Your Own Workout Entertainment
Two Disabled Dudes: Podcast Global Genes: RARECast (Podcast) Rare in Common: Podcast Instagram Live: John Legend Instagram Live: Luke Combs Instagram Live: Coldplay, Chris Martin Instagram Live: Gentle Hours with John Mayer Global Genes: RARE Daily

Featured below are ongoing studies related to dysautonomia and POTS related illnesses.  DINET does its best to select the studies that we believe will best appeal to our community. If you know of a study that you would like to share with DINET, please email the information with the link to the study, to webmaster@dinet.org All information will be reviewed.  
Open Recruitment Studies (updated May 2020)
Patient research:  NIH supported research is being conducted by the Rare Disease Clinical Research Network on the impact that the COVID pandemic is having on people living with rare diseases.  You do NOT have to have been tested for COVID or have had symptoms of illness, the only criteria is to be under 90 years old and to have a rare disease.  Caretakers or parents of children with rare diseases are also encouraged to participate.  Read more about the goals of the study and the process at this link: https://www.rarediseasesnetwork.org/COVIDsurvey
Neurology research: New research study conducted by Dr. Blitshteyn to examine the impact of COVID-19 on patients with pre-existing neurological disorders including POTS, OH, MSA, Neuropathy and Chronic Migraine. The study includes a 5 min anonymous survey that a patients neurologist would fill out.  Please share this survey with your neurologist if you have tested positive for COVID-19 and you are being treated by a neurologist for the disorders listed. 
***RECRUITING:  DINET has partnered with PCORI  (Patient-Centered Outcomes Research Institute), the University of Pittsburgh and the University of Pittsburgh Medical Center in the Story Booth project.  Research is crucial to helping us further our understanding of POTS and other forms of dysautonomia and to identify ways to prevent or cure these conditions.  That's why DINET is parterning with the Patient-Centered Outcomes Research Institute (PCORI) and the University of Pittsburgh on their MyPaTH Story Booth Project.  The project aims to help researchers better understand the dysautonomia patient experience with illness, coping and the healthcare system.  Researchers hope their findings will lead to the development of reserach studies that address topics that are important to patients and caregivers.  Please visit our Story Booth page for more detailed information or to get started sharing your story.  https://www.dinet.org/member-stories/story-booth-project-sharing-the-stories-of-patients-and-caregivers-r209/
RECRUITING:  John Hopkins University is examining the use of a temporary celiac ganglion block before celiac ganglion resection in dysautonomia-related bowel dysmotility.  Autonomic celiac ganglia resection has been shown to alleviate symptoms of dysautonomia-related dysmotility by interrupting the sympathetic stimulation to the GI system.  Currently there has been no test to confirm this diagnosis pre-surgery.  This studies objection is to temporarily block the ganglion to see if the symptoms go away, therefore confirming diagnosis and allowing for the more permanent surgical action.  This study is recruiting patients with chronic dysmotility who are considering Celiac Ganglion resection.  For further criteria and information about this study, please visit:
Contacts:  Christos Georgiades, MD PHD cgeorgi@jhmi.edu
Beatriz Kohler, bkohler@jhmi.edu
RECRUITING: Clarkson University is conducting a study to learn about what factors affect the function and quality of life for people living with various chronic illnesses.  The study should take approximately 45 minutes to complete and asks similar questions to those asked by healthcare providers. Questions will include quality of sleep, fatigue, pain, etc. All answers will be anonymous. Participants must be 18 years or older. Each person participating is requested to ask one healthy person to also participate but this is not required. To learn more about this study or to begin the questionnaire, visit https://www.surveymonkey.com/r/V3P7S9J  This is an IRB exempt study. 
RECRUITING:  A study is being conducted to examine the affect on parents who are raising a child with POTS.  This study is being conducted through the University of Mississippi, under the Principle, Abigail Armstrong for her Master's thesis.  Abigail is a POTS patient and DINET member. 
This is an IRB approved study.
To participate:
You must be a parent or primary caregiver of a child 8 - 17 years of age who has been diagnosed with POTS
The child's diagnosis must have been made 6 months ago or longer
You must be able to speak and read English proficiently
This study will be conducting completely online and will take 10 - 15 minutes to complete.  The purpose of this study is to better understand the impact POTS has on the parents and the child.  The study will ask you to complete a series of brief questionnaires about yourself, your experiences as a parent, and your child diagnosed with POTS.  
Please email Abigail with any questions about the study at abigail.armstrong@usm.edu
To begin the study, click on the link provided: https://usmep.co1.qualtrics.com/jfe/form/SV_cIpzp1ncQXLJdad
RECRUITING:  Vanderbilt University is conducting a study entitled "Pathophysiology and therapy of Orthostatic Intolerance."  Studies to identify the role of the brain, the autonomic nervous system and the vasculature in Orthostatic Intolerance.  Blood pressure and HR are measured laying down and standing at regular intervals.  Blood samples are drawn for hormones affecting blood pressure control.  Some studies require tilt table testing and medication administration.  
Eligibility:  All participants are adults.
Contact Information:
Principles:  David Robertson, M.D., Bonnie Black, RN
Vanderbilt University, Clinical Research Center
Nashville, TN 
FAX:  615-343-8649
email:  ADCResearch@vanderbilt.edu
RECRUITING:  Clinical Trial:  Dr. Satish Raj and the University of Calgary is recruiting POTS patients for a study of the effects of compression on the symptoms of POTS  

OPEN ENROLLMENT:  The Mayo Clinic is conducting a study to better understand the causes of autonomic disorders.  The study includes the collection of DNA for future studies.  This study is being conducted in part by Dr. Philip Low, one of the leading researchers in this field.
Eligibility:  Males and females (non-pregnant) age 13 years and older diagnosed with MSA, PAF, Autonomic Neuropathies, NOH, POTS, Dysautonomia and healthy participants.   Orthostatic range must include a systolic BP deduction of > 30 mm Hg or mean BP reduction of > 20 mm Hg that occurs within 3 mins of head-up tilt. 
For help understanding the criteria or for more information about the study, please contact Tonette Gehrking CAP at gehrking.tonette@mayo.edu or call 507-284-4462  
Participating Clinics:  Rochester, Minnesota. 
RECRUITING:  University of CA is studying the effect of the drug Ivabradine, a drug currently used for heart failure, to examine the possibility of its use as a treatment for heart rate issues in POTS patients.  
University of CA, San Diego
Investigator:  Pam Taub, MD
For more information: https://clinicaltrials.gov/ct2/show/NCT03182725?cond=Postural+Orthostatic+Tachycardia+Syndrome&rank=3
RECRUITING:  Parent-Child Dyadic Experiences Living with Postural Orthostatic Tachycardia Syndrome (POTS) during Emerging Adulthood.  What is it like living with POTS during emerging adulthood?  Virginia Tech wants to know.  If you are interested in joining a family science study on POTS, please contact Masumeh@vt.edu.  Participants must be 18-29 years old, diagnosed with POTS.  This is a parent-child study, so both must be willing to participate.  Participants must reside in the U.S.   
Virginia Polytechnic Institute and State University
Department of Human Development
Principal Investigator: Dr. Carolyn Shivers
Co-Investigator: Masumeh Farchtchi
Contact: Masumeh@vt.edu   
Specifics about the study and a consent form will be emailed to you if you are interested. 
ACTIVE NOT RECRUITING:  Clinical Trial:  University of Oklahoma and Vanderbilt University are recruiting POTS patients for the Autoimmune Basis for Postural Tachycardia Syndrome study.  They are looking at the levels of immune proteins (autoantibodies) in POTS patients and their relation to symptoms over time.  https://clinicaltrials.gov/ct2/show/NCT02725060?term=autonomic+dysfunction&cond=Postural+Orthostatic+Tachycardia+Syndrome&rank=5   
Recruiting:  Vitamin D Deficiency in Dysautonomia  In previous work the investigator identified a group of children between the ages of 10-18 years whose diagnostic workup for chronic nausea unexplained by conventional diagnostic tests has unexpectedly revealed underlying cardiovascular instability manifesting as orthostatic intolerance, primarily defined as postural orthostatic tachycardia syndrome (POTS) (88%). While this is an atypical initial presentation for orthostatic intolerance in general, the investigator believes that the cardiovascular problem is serious and represents a cause of nausea in a majority of these individuals, as treatment of the POTS with fludrocortisone reduced the symptoms of nausea. While fludrocortisone treatment abrogates the fall in baroreflex sensitivity (BRS) during tilt in part, it did not completely correct the tachycardia symptoms or the BRS suppression during HUT. Furthermore, it caused an elevation in MAP in a supine position, which may lead to future cardiovascular problems such as early onset hypertension and cardiac hypertrophy. This argues for a different treatment approach. The investigator presents preliminary data in this application revealing that OI subjects tend to have lower 25-hydroxyvitamin D (25(OH)D) compared to non OI subjects.
Open to children 10 - 18
Still Recruiting:  ME/CFS Activity Patterns and Autonomic Dysfunction  The purpose of this study is to identify daily activity patterns, negative life events and autonomic abnormalities that may be related to non-improvement in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). For both naturalistic studies and behavioral intervention trials, roughly 50% of patients report worsening or unchanged illness. The proposed four-year study would be the first to look at the relationship between illness non-improvement, patient activities at home and autonomic function. Our long-range goal is to identify physiological signals and activity patterns that predict non-improvement and relapse and develop a self-management program that prescribes improvement-linked behaviors and discourages non-improvement activities.
Contact: Particia Bruckenthal, PhD, RN   631-444-1172  particia.bruckenthal@stonybrook.edu
Contact: Jenna Adamowicz, MA  631-371-4417  jenna.adamowicz@stonybrook.edu
Recruiting:  The investigators propose to conduct a safety, tolerability and early proof of concept efficacy study of phosphatidylserine in patients with FD.  The long-term goal is to find an effection nutritional therapy that will improve the quality of life for patients with FD and alter disease prognosis  Contact & participation information is available  - https://clinicaltrials.gov/ct2/show/NCT02276716?cond=Dysautonomia&rank=5
Completed, Results TBA  PET Imaging Study of Neurochemical and Autonomic disorders in Multiple System Atrophy (MSA) from the University of Michigan.
This study aims to better understand the patterns and timings of nerve degeneration relatively early on and how it affects symptoms and progression. 
Eligibility:  30 - 80 years old
Gender:  AllSubject:  diagnosis of MSA or probable MSA of the Parkisonion subtype (MSA-P) or Cerebellar subtype (MSA-C), Subject must be willing and able to give informed consent. Normal cognition as assessed by MiniMental State Examination
Timeline:  Less than 4 years from the time of documented diagnosis
See study online for exclusions and further information. 
Contacts:  Arijit K Bhaumik, B.A. CCRP, 734-936-8281 arijit@umich.edu
Edna Rose, Ph.D., RN, MSW, BC, 734-936-7359, ednarose@umich.edu
Estimated Primary Completion Date:  July 2018
Recruiting:  A Study of Pyridostigmine in Postural Tachycardia Syndrome.
This is a 3-day study being conducted by the Mayo Clinic comparing pyridostigmine vs placebo in the treatment of POTS.  Researchers expect pyridostigmine to improve tachycardia and stabilize blood pressure.
Eligibility:  Diagnosis of Postural Tachycardia Syndrome using the following criteria:
Orthostatic heart rate increment greater than or equal to 30 beats per minute (BPM) within 5 minutes of head-up tilt.
Symptoms of orthostatic intolerance. These include weakness, lightheadedness blurred vision, nausea, palpitations, and difficulty with concentration and thinking.
Both criteria must be fulfilled
See study online for exclusions and further information
Mayo Clinic location, Rochester MINN, Principal Investigator:  Dr. Philip Low
Contact:  Tonette Gehrking, CAP, 507-284-4462, gehrking.tonette@mayo.edu
(Completed,  Results TBA) The Safety and Tolerability of Kinetin, in Patients with Familial Dysautonomia 
The overall objective of this study is to assess the safety and tolerability of administering kinetin in patients with FD. The specific aim of this proposal is to determine the safety of a once-daily dose of kinetin in patients with FD using a dose ascending titration and to determine the long-term safety and tolerability during 3-years of receiving a maximum tolerated steady state dose of kinetin. The investigators hope to also demonstrate early proof of concept that kinetin enhances the ability of the neuronal tissue to correctly splice IKAP mRNA.
Eligibility: Male or female 16 years of age and older, confirmed a diagnosis of familial dysautonomia by genetic testing, written informed consent to participate in the trial and understanding that they can withdraw consent at any time without affecting their future care. And the ability to comply with the requirements of the study procedures.
See study for more info and exclusions:  
New York University School of Medicine 
Estimated Completion date:  September 2019
Contact:  Horacio Kaufmann MD, 212-263-7225,horacio.kaufmann@nyumc.org Contact:  Jose Martinez, MA, 212-263-7225, jose.martinez@nyumc.org
Two new studies open for patients with MSA 
The NYU Dysautonomia Center has 2 new clinical trials to test new drugs that are being developed for the treatment of OH in patients with MSA.  Both compounds work by enhancing the body’s levels of norepinephrine. Both studies are also being carried out at the Autonomic Dysfunction Center at Vanderbilt University.  NYU Dysautonomia Center and Vanderbilt are longtime collaborative partners in rare autonomic disorders.
(CLOSED RECRUITMENT) Study 1: A Phase 2 Study to Assess the Effect and Safety of TD-9855 in Subjects with Neurogenic Orthostatic Hypotension
This Study is in collaboration with Theravance Biopharma R & D  They are testing the acute efficacy and safety of a new compound (TD-9855) in improving blood pressure and reducing orthostatic symptoms in patients that have neurogenic orthostatic hypotension (nOH), which includes those with MSA.  This study is also open to patients with Pure Autonomic Failure (PAF) and Parkinson’s Disease (PD) with NOH.
Eligibility: 40 years and older, All Genders
Diagnosed with symptomatic orthostatic hypotension due to Parkinson’s disease, MSA or PAF (ie.neurogenic orthostatic hypotension)
At screening, a subject must meet the diagnostic criteria of neurogenic orthostatic hypotension, as demonstrated by a > 30 mm Hg drop in systolic blood pressure (SBP) within 5 minutes of standing.
Impaired autonomic reflexes, as determined by the absence of BP overshoot during phase IV of the Valsalva maneuver, in subjects where Valsalva is performs as appropriate.
For the optional open-label extension study subjects must have demonstrated a pressor effect and completed dosing in Cohort 1.
Estimated completion date:  June 2018 (Completed, results not yet published)
See study for further info and exclusions: https://clinicaltrials.gov/ct2/show/NCT02705755 
NYU Information sheet:  https://dysautonomiacenter.com/2017/04/10/two-new-studies-open-for-patients-with-msa/
STILL RECRUITING:  Study 2:  Norepinephrine Transporter Blockade, “Autonomic Failure”
This study is supported by The Food and Drug Administration’s Office of Orphan Product development. , We are testing whether we can repurpose an available drug (atomoxetine) as a treatment for neurogenic orthostatic hypotension (nOH). This study is also open to patients with MSA, pure autonomic failure (PAF), and Parkinson disease (PD) with OH.
Eligibility:  40 to 80 years old, any gender, with Neurogenic Orthostatic Hypotension (defined by a reduction of > 30 mmHg drop in SBP within 3 minutes of standing, associated with impaired autonomic reflexes as assessed by autonomic function tests.
Estimated completion date:  July 2020 
Contact:  Bonnie Black, RN, 615-*343-6862, bonnie.black@vanderbilt.edu
Contact: Jose Martinez, 212-263-7225, Jose.Martinez@nyumc.org
See study for further info and exclusions:  https://clinicaltrials.gov/ct2/show/NCT02784535
NYU Information sheet: https://dysautonomiacenter.com/2017/04/10/two-new-studies-open-for-patients-with-msa/
Recruiting:  Vagal Stimulation in POTS - The Autonomic Inflammatory Reflex (Pilot 3) 
The purpose of this study is to investigate how the electrical stimulation of a nerve in the skin of your earlobe (transcutaneous vagal nerve stimulation) affects the way your autonomic nervous system controls your heart rhythm.
Eligibility:  Participants must be female between the ages of 18-45 diagnosed with POTS.
See Study for further information and exclusions: https://www.rarediseasesnetwork.org/cms/autonomic/6111 
This study is a part of the Rare Disease Clinical Research Network and the Autonomic Disorders Consortium 
Contact:  Vanderbilt University Medical Center Nashville 
Misty Hale CCRP, 615-322-2931, misty.hale@Vanderbilt.edu
Recruiting:  The Big POTS Survey is still recruiting  
This study’s lead investigator is Dr. Satish Raj MD MSCI, Adjunct Professor of Medicine at Vanderbilt University’s Autonomic Dysfunction Center.  Dr. Rah says that the information collected as part of this survey “will help us learn more about the possible underlying causes and risk factors for developing POTS, treatments, and the economic, educational and social impact of POTS on patients and their families.”  Dr. Raj serves on the Medical Advisory Board for DINET and Dysautonomia International. DI is sponsoring this survey. 

DINET collects relevant research related to dysautonomia disorders and related conditions & illnesses.  This is in no way meant to be a complete list of all research currently underway or the results of research currently made public.  But it is a summary of key research studies that we hope are relevant and potentially important to our members' ongoing treatment and prognosis.  Please check back as this page is regularly updated. 
COVID-19 Research: New research study conducted by Dr. Blitshteyn to examine the impact of COVID-19 on patients with pre-existing neurological disorders including POTS,  OH, MSA, Neuropathy and Chronic Migraine.  The study includes a 5 min anonymous survey that a patient's neurologist would fill out.  Please share this survey with your neurologist if you have tested positive for COVID-19 and you are being treated by a neurologist for the disorders listed. 
NEW:  A look at POTS as an autoimmune disease and updates on the latest autonomic research  https://link.springer.com/article/10.1007/s10286-019-00661-5
NEW:  Drug discovery programs for synucleinopathies in Multiple System Atrophy  https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1008222
NEW:  The impact of dysautonomia on patients with Guillian-Barre Syndrome  http://bit.ly/2wu9tJZ
NEW:  Test developed for CFS/ME to detect the reaction of immune cells and blood plasma to stress. (Pub May 2019)  https://www.pnas.org/content/early/2019/04/24/1901274116 
Research published by Frontiers in Neuroscience demonstrate improvements in cognitive function, as well as a decrease in HR in POTS patients after rapid water ingestion.  (Pub April (2019) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465605/
Study released by Dr. Lucy Diss and colleagues about the effects of propofol on motility.  Published in Autonomic Neuroscience. (in progress for Pub July 2019)  Abstract: https://www.sciencedirect.com/science/article/abs/pii/S1566070219300426  
Study released by Dr. Julian Stewart and colleagues discusses Postural Hyperventilation and the resulting variant POTS disorder.  Pub Journal of the American Heart Association. 
An examination of the experimental and clinical trials conducted in the treatment and diagnosis of MSA.  Pub Science Direct, Autonomic Neuroscience Vol 211
The Journal of Parkinson's Disease reviewed the impact of different exercise modes on people suffering from Parkinson's Disease. Pub IOS Press, Feb 2019 https://content.iospress.com/articles/journal-of-parkinsons-disease/jpd181484
Updated Info:  Dr. Raj and associate, Dr. Miller's updated article about the pharmacotherapy for POTS.  Pub. May 2018 in Science Direct, Autonomic Neuroscience. 
NEW:  An examination of whether the impairment of the Corticol Autonomic Network (CAN) of the brain is involved int the psysiology of Neurogenic Orthostatic Hypotension (NOH) Pub. Oct 2018  https://www.ncbi.nlm.nih.gov/pubmed/30332348
NEW RESULTS:  The need for specific diagnosis and treatment for patients labeled with CFS and Fibromyalgia.  Important research results from one of DINET's Medical Advisors, Dr. Svetlana Blitshteyn and her colleague, Pradeep Chopra, Pub date Oct 2018  Read full article:  2018CFS_Fibromyalgia_ChronicPain_PubKarger.pdf
Updated info from the CDC on HPV Vaccine safety for POTS patients  https://www.cdc.gov/vaccinesafety/vaccines/hpv/hpv-safety-faqs.html  Follow up to: HPV Vaccine and POTS - https://www.ncbi.nlm.nih.gov/pubmed/28689455
Complex Regional Pain Syndrome, Type 1 -  Diagnosis and management.  https://www.ncbi.nlm.nih.gov/pubmed/29409405?_ga=2.71311891.1204982470.1531704876-989465291.1526426607
Study results:  A presentation made by the American Association for Cancer Research at their annual meeting reported findings related to health risks in post-menopausal women using medication for high blood pressure.  The report claims an increased risk of pancreatic cancer in post-menopausal women using short-acting calcium channel blocking medications for their blood pressure treatment.  Read the information from the AACR.
Study results:  NE Journal of Medicine releasing study results for episodic migraine treatment using Erenunab.  The publication is reporting a 50% or greater reduction in the average number of migraine days per month.  Read more about this study
Study results:  Physical maneuvers are viewed as important and promising strategies for reducing recurring episodes of syncope in vasovagal syncope patients.  Read the result of the study published Jan. 2018
Study results:  University of Alberta & McGill University release their findings for a new therapeutic agent  that may hold the potential for the prevention of MS
Article synopsis:  https://bit.ly/2GhF5FK
Research Article:  https://insight.jci.org/articles/view/98410  
Study results:  Could gut bacteria be the key to preventing autoimmune disorders?  Researchers from Yale, New Haven, CT are reporting that discovery that bacteria in the small intestine can travel to other organs and induce an autoimmune response.  They also are reporting that antibiotic treatment or vaccine may be the key to combating this reaction.  The study results were originally published in the journal Science.  This article from Medical News Today gives a synopsis of the findings and links to the full study.   https://www.medicalnewstoday.com/articles/321157.php
Genomics and Health Impact Blog -  a discussion about gene testing from the CDC
There have been enormous contributions towards disease prevention in women's health, in particular, the development of consumer testing for the BRCA gene.  The benefits cannot be applauded enough. However, health protection & research organizations like the CDC, are increasingly warning consumers about the need for professional counsel when interpreting results.   This article, humorously entitled "Think before you spit"  tempers the amazing breakthroughs with the cautionary information we need to have to be able to put a perspective on the results testing may give us.  https://blogs.cdc.gov/genomics/2017/04/18/direct-to-consumer-2/
1st lab test to detect concussion approved by FDA
For any person who has fainted or fallen and hit their head, the blood test approved recently by the FDA could be a lifesaver.  The test detects concussion by looking for specific proteins released into the blood within 12 hours after the head trauma.  Known as the Banyan Brain Trauma Indicator it can reduce the need for CT Scans and radiation and will produce results within 3 - 4 hours following injury.  Read more about this important breakthrough
Neuroprotective diet having good results for people living with MSA
POTS & Ehlers-Danlos Syndrome 
"Postural tachycardia in hypermobile Ehlers-Danlos syndrome: A distinct subtype?" by Miglis MG, Schultz B, and Muppidi S, from the Departments of Neurology and Psychiatry at Stanford University Medical Center.
"It is not clear if patients with postural tachycardia syndrome (POTS) and Ehlers-Danlos syndrome (hEDS) differ from patients with POTS due to other etiologies. We compared the results of autonomic testing and healthcare utilization in POTS patients with and without hEDS."

In theory, young people with CFS and orthostatic intolerance (plus or minus some form of hypermobility) should not be at greatly increased risk of severe coronavirus disease compared to others their age, provided they don’t have untreated  respiratory conditions like asthma.
The data from China and from the state of Washington both suggest that not only do children and adolescents have milder disease and fewer hospitalizations, but they also seem to get the coronavirus less frequently. Only 1% of the known cases in China were children, even though children represent 20% of the Chinese population. That is a curious phenomenon, and might ultimately prove to be due to the fact that the young people were asymptomatic and didn't go in with illnesses that would warrant testing. In any event, it speaks to the milder nature of the illness in younger people. 
The epidemiologic data suggest a marked increase in disease severity for each decade above 50-60, especially for those with lung disease like chronic obstructive pulmonary disease (COPD), high blood pressure, and diabetes. So, my pediatric and young adult patients should be relatively protected from severe disease because of their younger age. They also know more than most about social isolation and avoiding illness than most of the general public, so they have much to teach others about how to manage. That said, we don’t have all the facts to make good decisions yet. All I can tell you is that I have not had anyone from my clinic develop coronavirus thus far, acknowledging that we are early in the pandemic.
I completely agree with being cautious. The more we can do now to prevent person-to-person spread, the less likely we will be to replicate the Italian experience where the hospitals are overwhelmed. Using all of the CDC recommendations makes good sense (hand washing, elbow bumps, sanitizer, social isolation, avoiding crowds). On the issue of using face masks, I differ from some of my medical colleagues. Many of their comments are an attempt to deal with limited supply of face masks. But, we are all advised in the hospital to don a face mask when dealing with patients who have respiratory symptoms. So, as a protective measure I would wear a mask in public even though the official recommendation is that it won’t stop the spread of droplets of virus. I suspect it will stop at least some droplets, but the neglected point about facemasks is that they help remind you to not touch your face and inoculate the nasal passages with virus from your hands. They may also create a bit of social isolation, as people will keep their distance from anyone wearing a mask! Some people have been sewing their own facemasks, in an effort to help address the shortages. This is an amazingly positive effort.
My Pediatric Pulmonary colleagues do not think asthma will be a big risk factor, based on their reading of the evidence. Similarly, we don’t think EDS and mast cell activation will necessarily confer an increased risk.
Most classes have been cancelled by now. For those who are working, I would try to work remotely, especially in the next couple of weeks. This might be acting in an overly cautious manner, but I think none of us have to apologize for being overly cautious at this juncture.
The key at this stage is to be very rigid and strict about complying with the recommendations for social distancing and isolation. Remind your friends and family (skeptical or not) that this is no joke, and that lives depend on us pulling together like we all did in response to 9/11/2001. We can do this!  
Peter Rowe, MD
Director, Children's Center Chronic Fatigue Clinic
John Hopkins University School of Medicine
Professor of Pediatrics
Adolescent Medicine, Chronic Fatigue Syndrome, Orthostatic Intolerance, Pediatrics, Postural Orthostatic Tachycardia Syndrome (POTS), Syncope
Chronic fatigue syndrome; Fibromyalgia; Elhers-Danlos Syndrome; Orthostatic intolerance syndromes; Gulf War illnesses; Pelvic congestion syndrome

Below are articles full of information designed to help people living with dysautonomia.  There are guides  written to help your family and friends understand your illness and help you all learn to live with it together. The POTS Guide for kids was created to be used as a handout for your child's teacher, coach, tutor, school nurse, their best friend's mom, or anyone else that may be responsible for your child when you are not there. Many guides include links to pdfs to make it easier to print, email or share.  The Patient's Guide is to help patients with tips to prepare for a visit to the ER or a new medical provider. The Information Sheets are designed to help you remember the information you should have with you.  The Life with Chronic Illness section includes links to newsletter articles on a variety of subjects about the issues faced for people with chronic illness. 
A guide for family and friends
POTS GUIDE - for the family of children & teens living with POTS
I know a kid who has POTS  
Hydration and POTS
Preparing for the ER and new medical visits
Managing and enjoying life - surviving guilty feelings, service dogs, dehydration,  beat the heat, visiting national parks.
Thriving with chronic illness - traveling, adaptive devices, technology, hyperPOTS patient story, finding balance.

Paths and Stories
After reading an article, use your browser's back button to easily return to the Table of Contents on this page.
Mental Health and Chronic Illness by Hallie MacDonald
Lefty-Loosey, Righty-Tighty: The Autonomic Nervous System, Blood Vessels and POTS by Susanne Rimm
Meet the Member: Claire's Story by Chelsea Goldstein
The Story Booth Project: Sharing the Stories of Patients and Caregivers by Ellen Driscoll
Meet DINET's Board of Directors
Updated: Research and News about Dysautonomia and Related Illnesses
Updated: Open Recruitment Studies

By Hallie MacDonald
Q: Statistics report an estimate of 25 to 33% of people living with chronic illness also suffering from depression. What is the difference between situational or stress-related depression and chronic or major depression? Is one type more common for people with chronic illness?
A. First, it is essential to understand the differences between different types of depression. Clinical depression (also called Major Depressive Disorder) often refers to one or more serious depressive disorders that can occur with or without the person experiencing a specific stressor. The symptoms are generally more severe or last far longer in comparison to situational depression, and they usually will interfere with the person’s ability to function in their day to day life (work, school, family responsibilities,etc.). Common examples of clinical depression are:
Dysthymia - persistent depressive disorder - a low-grade depression lasting two or more years. Seasonal Affective Disorder (SAD) - depression related to the reduction in natural light usually begins at the start of the fall/winter seasons. Postpartum depression - can be debilitating and has various degrees of severity following pregnancy and giving birth. Bipolar depressive disorder - the person experiences alternating periods of elation and depression.   A person experiencing a major depressive disorder will generally have five or more of the following symptoms and requires a medical diagnosis:
Sleep difficulties, changes to sleep patterns, including waking unusually early without desire or need. The inability to feel joy or take pleasure in most or all daily activities. Noticeable agitation or unusual slow movements - extreme lethargy Feelings of worthlessness, self-loathing or self-hatred Excessive feelings of guilt Suicidal thoughts or beliefs that the world/family may be better off without you. Significant weight loss or gain in a month without intention (5% or more of body weight) In children - increased irritability Commonly, major depressive disorders require medication as well as therapy to manage symptoms and learn coping skills. Clinical depression can be severe and requires the intervention of a medical professional. If you believe you or a loved one may be experiencing symptoms of clinical depression, contact a PCP or mental health professional for diagnosis and treatment.
Situational depression refers to symptoms of depression that are related to one or more specific stressors the person is experiencing. Situational depression is common after significant life changes such as divorce, death, job loss, etc.  
Situational depression can cause emotional and behavioral symptoms that can look and feel very much like clinical depression. However, it is important to remember that it is reasonable to feel sad or anxious when life circumstances are difficult or overwhelming. The treatment for situational depression is supportive, such as seeking out organizations or support services that may help by giving and receiving support from others who have experienced similar stressors, such as; grief support groups or chronic illness support services.  
Most people who are living with chronic illness experience situational depression or stress at different times during their lives. It is normal and expected. There is a period of mourning and feelings of grief as they adjust to the parts of their life that may be lost and while they adapt to a new self-image. This period of mourning is different for everyone. Finding a support group for people with related physical symptoms or similar disabilities is an essential tool because it offers the opportunity to feel validated and supported as well as to give validation and support to others in a similar situation. Just as crucial for people with a chronic illness is to develop coping skills to help with the everyday stress inherent in dealing with pain and illness regularly. Finding new activities or new ways to enjoy old activities can be an effective de-stressor, as well as continuing to connect with family and friends.
It is critical to recognize that more than one type of depression can be present at any time in a person’s life. Therefore anyone experiencing symptoms of depression must be screened by a medical professional. Suicidal thoughts experienced by you or a loved one requires immediate attention, contact the National Suicide Prevention Association at www.suicidepreventionlifeline.org or call the 24/7 hotline at 1-800-273-8255
Resource: National Association of Mental Illness https://www.nami.org/Blogs/NAMI-Blog/April-2017/Situational-Symptoms-or-Serious-Depression-What-s

Q: People living with dysautonomia disorders are commonly treated with BP medications, many of them with depression as a side-effect. How can medication-induced depression be treated? Is the treatment different than other types of depression? How can you tell if the depression is a side-effect or a symptom of the illness or a condition unrelated to dysautonomia?
A. Determining whether the symptoms are a side effect of the medication or are coming from another source requires an in-depth patient history. A physical exam and lab findings confirm the amount of medication in the bloodstream, as well as any additional intoxicants that may be present.  
There is no specific treatment for depressive feelings brought on by medication use, other than switching to another medication. Usually, the side effects of most medications lessen or disappear as the body acclimates to it. If there is no improvement, then an alternative treatment will be needed. If the symptoms persist after four weeks, another source for the depression needs consideration.
Resource:  https://www.verywellmind.com/drugs-that-can-cause-depression-1067458
Q: Anxiety is also prevalent with dysautonomia patients because so many of the symptoms can cause fear - high HR and palpitations, chest pain, fainting or near-fainting, etc. Anxiety can exacerbate the symptoms. Are there techniques that can help a person control their anxiety, or is medication necessary?
A. Many natural techniques can help reduce anxiety.
Practice deep breathing techniques. Take a deep breath in through the nose (breath in as slowly as possible), then breathe out steady and slow through pursed lips (position your lips as though you are going to whistle). It is important to keep the inhale and exhale even (counting helps) to avoid over-breathing that can cause hyperventilation.  It will feel awkward at first, but if you practice, it will be a coping mechanism that is ready for you when you need it most. This technique also has the added benefit of being the most effective way to re-oxygenate your body and prevent hyperventilation.  Add a time-out to your day - listen to music, meditate, practice visualization, yoga if you can, do light exercise (whatever you can even from a sitting position). Develop preventative habits. Eating well-balanced nutritious meals, avoid excessive sugars, and caffeine as both can add to anxious feelings. Give yourself a consistent sleep pattern by forming rituals that help you relax before going to bed.   Find reasons to laugh. Rent a comedy, stream stand-up shows by comedians, hang out with a friend who likes to laugh Practice acceptance - you can’t control your illness, but you can control how you respond to it. Accepting what you can and can not do and finding ways to feel fulfilled and useful will add to your overall sense of well-being and reduce the feelings of anxiety. Get involved. Reach out to your support network when you are feeling anxious about your illness. Explore what you are feeling and see if you can recognize a pattern or see triggers. Volunteer with the network if possible or find other volunteer opportunities. There are many opportunities to volunteer online. Getting out of your head is one of the best ways to deal with feelings of anxiety.  Medication is not usually necessary, and for people living with chronic illness, drugs for anxiety may be counterproductive or may not be possible. Consult with your physician if you feel you need medication.
Resource:  Anxiety and Depression Association of America   https://adaa.org/tips
Q: Dysautonomia, particularly POTS, is caused by a dysfunction in the autonomic nervous system, specifically the Sympathetic Nervous System (SNS) responsible for the fight or flight response in the body (the release of norepinephrine). What effect, if any, does this have on a person’s anxiety level or in causing depression?
A. Norepinephrine is a neurotransmitter associated with the fight or flight mechanism in the body and feelings of anxiety in the nervous system. Because dysautonomia creates an instability in the SNS, a person’s fight or flight response activates without an external need for that response. This instability is at the core of POTS symptoms. Physicians not familiar with the disorder can frequently assume the symptoms described are a result of the person’s inability to appropriately deal with anxiety or are living with depression. 
Resource:  Science Direct  Journal Neuron Volume 87
"Norepinephrine and Corticotropin-Releasing Hormone: Partners in the Neural Circuits that Underpin Stress and Anxiety" by  Yaijie Sun, Sarah Hunt, Panka Sah
Q: Chronic illness requires the person to adapt to a new sense of self and to establish a new “normal” for their life. For example, a person's professional identity may need to change if they can no longer work. A person's role within their family as the "go-to" person may also need to change if they now need help from their family instead. How can family and friends help support the chronically ill person making this transition? 
A. Loved ones of a chronically ill person should encourage or help (if wanted) the person find a support group or mental health professional that they can talk to without feelings of guilt or the need to censor their feelings or thoughts. Recognize that there are many parts of your loved one's adjustment that you will not be able to help directly. Be available and open to what they need and avoid telling them what they “should” feel. In a patient survey that DINET offered a few years back, members expressed what helped or hurt them in their encounters with family and friends. The number one thing cited as “help” was listening. The second helpful thing was believing the person about how they feel. Example, on Tuesday, your family member says they are too sick to get out of bed. But then later that week, they say they feel well enough to go out. Avoid questioning or discouraging their decision.  
Dysautonomia is a disorder with a wide range of symptoms that can change quickly. Believing what they say and letting the person take the lead is empowering and validating.
The top two things that “hurt” patient encounters with family and friends were dismissive language such as “you don't look sick” or “think positive” and being told what they feel or should feel, such as “don’t think that way” or “you should feel grateful that things aren’t worse.” 
Take the lead from the person. If they miss what they used to do for work, help them explore ways to use those skills in another capacity. Even the most physically active careers have skills that can translate to other uses without the physicality of the former activity. For example, a person who used to play sports may find a place for themselves in Special Olympics or through coaching. A business person may be able to volunteer with an organization in need of their business skills but without the demands of full time work. 
In some cases, people find it too depressing to be on the fringes of what they used to do. In that case, help your loved one explore new hobbies or disciplines. Perhaps they aren’t up to attending classes, but you may suggest or help them find an online course they would find interesting. There may be new hobbies that you can do with the person. Whatever the action, be sure it is something the person wants to do or is receptive to your help. There is nothing wrong with making a suggestion but give the person the respect of truly hearing what they need from you.
People make the transition in their own time. There is no right or wrong way to go through it. You may have feelings of frustration that your loved one isn’t moving forward quickly enough or won’t let you cheer them up in the ways you think they should happily accept. Try and remember that this is their journey, and they have to find their way to their new “normal.” If you are a caretaker or close family member, and you are having feelings of sadness or anxiety about your loved one’s illness, seek out outlets for yourself. The chronically ill person can’t absorb your feelings about this transition. You can be honest while still being careful not to give responsibility to the sick person to make you feel better.
Resource:  Help Guide:  "Living well with a disability
* Coming up:  Part Two of Mental Health and Chronic Illness.
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By Susanne Rimm
Many symptoms experienced by people living with POTS and other dysautonomias are related to a miscommunication within the Autonomic Nervous System) (ANS) between the sympathetic and the parasympathetic systems. The ANS controls the pressure inside our blood vessels.  This complicated process involves many aspects of anatomy ( heart and vasculature ), hormones, chemicals, and nerves. 
Efficient circulation is necessary to provide the body systems with adequate oxygen and nutrition to perform their specific tasks. Some organs or parts of the body need a constant rate of circulation ( i.e., the brain ), and some need more at certain times ( i.e., the digestive tract ). Maintaining and directing blood flow within the body is dependent on the harmonious communication between the sympathetic and parasympathetic nervous systems. These systems influence blood flow by widening the blood vessels (vasodilation) or tightening the vessels (vasoconstriction).   Vasodilation lowers the pressure within the vessels vs. vasoconstriction which raises the pressure. These systems respond differently to various triggers within the body ( endogenous ) and from outside of the body ( exogenous ). 
What are blood vessels?
Blood vessels are precisely that – vessels that transport blood. Anatomically they are tubular structures with an inner lining (endothelium), which is surrounded by connective tissue. They contain smooth muscle cells that respond to small nerve fibers directly connected to the ANS. Arteries carry oxygenated blood from the heart through the body, and veins return the blood through the lungs to the heart. 
Widening of blood vessels increases blood flow, lowers blood pressure, and occurs when the smooth muscle cells within the walls relax. This can occur in response to endogenous factors such as hormones, chemicals, or nerve impulses. An increase in carbon dioxide, potassium ions, hydrogen ions, and adenosine can all lead to vasodilation. Another cause is the release of the hormone epinephrine caused by the activation of beta-2 receptors in the muscles of the blood vessels. Other causes for vasodilation are the release of nitrous oxide ( a substance released by certain nerves during inflammation ) as well as the release of histamine.  (1,2)
Exogenous factors that can cause vasodilation are heat, certain foods, or beverages (e.g. alcohol ) or light and noises from the environment. Pharmaceuticals can also cause vasodilation and can be used to treat certain conditions like angina or hypertension.  Vasodilation can lead to hot, flushed skin by drawing circulation to the periphery and away from the core. Other symptoms include sweating, tachycardia, nausea, dizziness, vision and hearing changes, headaches, and more. (1,2)
Narrowing of blood vessels occurs when the smooth muscles of the vessel walls constrict, resulting in restricted blood flow.  This increase in vascular resistance raises systemic blood pressure and causes a localized reduction in blood flow. The general mechanism leading to vasoconstriction is an increased concentration of calcium ions in the smooth muscle cells.  This concentration occurs because of an increase in epinephrine or activation of the sympathetic nervous system through the release of norepinephrine. These neurotransmitters interact with adrenergic receptors. 
Again, vasoconstriction can be caused by endogenous and exogenous factors. Examples for exogenous causes are exposure to severe cold temperatures, which cause the cutaneous vessels to constrict in an attempt to reroute the circulating blood to the core. This constriction is what causes the skin to become pale in cold weather as less blood reaches the surface.  Medications such as antihistamines, amphetamines, or stimulants are vasoconstrictors. They can be used to increase blood pressure or reduce local blood flow.     
The most crucial endogenous trigger for vasoconstriction is the normal attempt of the ANS to correct the sudden drop in blood pressure that occurs when standing to avert orthostatic hypotension.  A critical trigger for vasoconstriction is the narrowing of blood vessels necessary during sudden hemorrhage. As the body attempts to stop or limit blood loss, circulation is diverted towards vital organs and away from the source of the bleeding.  The more common symptoms of vasoconstriction are tremors, cold extremities, paleness or bluish color skin, tachycardia, palpitations, chest pains, and more. (3)                                                                              
Autonomic Tone
Autonomic Tone is the balance of sympathetic and parasympathetic activity. It is regulated by the hypothalamus ( the primary control of the ANS ). In healthy individuals, the autonomic tone is responsible for restoring homeostasis, the body's ability to maintain a constant internal environment. In dysautonomia, this balance is disturbed, and one or the other branch dominates, causing an overcompensation or withdrawal of the sympathetic or parasympathetic activity.  (4) 
How it all ties together
Since there are so many different ways that the pressure within the blood vessels can be influenced, it is no surprise that a malfunction can have similar symptoms yet completely different causes. Here are a few examples of why different types of dysautonomia cause inappropriate vasodilation or vasoconstriction. (5,6)
This type of dysautonomia is thought to be caused by the partial denervation of the sympathetic nerves of the lower limbs. Since the smooth muscle cells of the vascular walls respond to the peripheral small fiber nerve endings of the ANS, this denervation may lead to inadequate vasoconstriction. Therefore,  the ANS is unable to prevent or correct blood pooling, leading to a drop in BP and a compensatory increase in heart rate (HR) in response to orthostasis. A study by Jacob et al. showed that patients with neuropathic POTS had normal neuronal norepinephrine release in their arms but less norepinephrine in their lower body.    Meaning there was less sympathetic activation in the blood vessels of the legs. A secondary form of neuropathic dysautonomia occurs in diabetic or alcoholic neuropathy resulting in ineffective blood pressure control via the vascular innervation. (5,6)
Ehler-Danlos Syndrome
Ehlers-Danlos-Syndrome (EDS), or joint hypermobility syndrome, can cause abnormal connective tissue in the vessel walls, which permits the veins to dilate excessively. This dilation causes blood pooling in the lower limbs and a  decrease in blood pressure. Some of these patients also display alpha and beta-adrenergic hyper-responsiveness. (6) 
Mast-Cell Activation
MCAD results in the release of the vasodilator histamine and other mast cell mediators, which may contribute to POTS. The excessive vasodilation caused by this reaction can cause many symptoms consistent with POTS and marked by flushing episodes. (6)
Hyperadrenergic POTS  (HyperPOTS)     
This type of dysautonomia is characterized by an increased level of the neurotransmitter norepinephrine, a vasoconstrictor.  This can occur in several ways: 
Sympathetic overcompensation - Norepinephrine gets dumped in response to a drop in BP, possibly due to vasodilation Parasympathetic withdrawal - the ANS fails to counteract sympathetic activation  or the inability to clear excess NE out of the synaptic cleft.  Hyperadrenergic POTS is often accompanied by high BP, high HR, and symptoms of sudden and extreme vasoconstriction brought on by the "fight-or-flight" response. This can lead to a loss of circulation to the brain and result in syncope or seizures in severe cases. (7)
Neurocardiogenic syncope
The conscious state depends on adequate cerebral blood flow, which is auto-regulated by the ANS. Normal orthostasis is maintained by a brief increase in the sympathetic tone and maintenance of BP.  In neurocardiogenic syncope, there is an inappropriate decrease in sympathetic tone followed by a compensatory increase in parasympathetic tone. This fluctuation leads to a sudden drop in both BP and HR due to vasodilation, often accompanied by a sudden loss of consciousness due to a temporary loss of cerebral circulation. The causes include orthostasis, hot temperature, and emotional triggers.
This article is a brief overview of the intricate and complicated correlation between the ANS and our cardio-vascular system.  Hopefully, this aids in a better understanding of why we experience the symptoms typically experienced with POTS and other forms of dysautonomia. (8)
https://biologydictionary.net/vasodilation/ https://healthfully.com/how-do-blood-vessels-constrict-dilate-4240725.html https://en.wikipedia.org/wiki/Vasoconstriction https://graduateway.com/chapter-15-the-autonomic-nervous-system-4-essay/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1501099/  https://www.dinet.org/info/pots/what-causes-pots-r98/ https://www.dinet.org/info/pots/hyperadrenergic-pots-hyperpots-an-overview-of-a-pots-subtype-r220/ https://www.dinet.org/info/ncs/neurocardiogenic-syncope-info-r104/  

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