Hi. Hope all is well. Have interesting and long backstory, but will give the short of it. I have symptoms of orthostatic hypotension (OH) - though it may better be called neurally mediated hypotension (NMH) - for many years now after Lyme disease, which was a late diagnosis and became chronic and autoimmune. I have been receiving high doses of intravenous immunoglobulin (IVIG) since May of 2006 and made great advances, but OH never fully recovered. Was concomitantly taking Cymbalta, which I stopped, but had withdrawal symptoms from of which I am still recovering (and subsequently had to reinitate the drug at minimum dose) and it has increased OH and fatigue since I restarted. OH and fatigue levels had made great strides as well on IVIG. Two tilt table tests (10 minute tests) have both been negative. I have had twice documented cerebral hypoperfusion (when blood is not circulated in the brain properly) via SPECT scan, which is indicative though not conclusive of OH (or NMH, ie POTS). I have other autonomic problems on testing including decreased sweating (sweat test) and failure of pain sensory test. I also suffer from distal, idopathic neuropathy which the IVIG has been very helpful for. I am seeing my neurologist next week and want to discuss Mestinon with him, which I've read has had success in trials (versus Midodrine). I am not apt to take Flornief because its a steroid and has a high side effect profile. So I wanted to see some people's personal take on it. I am also wondering about Adderall, for its Norephinephrine reuptake inhibition (which is also indicated in OH), though I do not like the side effects of these stimulant drugs and was very displeased when I once tried Provigil as it made me very mentally hyper and agitated. I think I will try to test my Norephinephrine levels, which is a Catecholamines test. Unfortunately this test will have to wait until I am completely off Cymbalta for accuracy. Wondering if anyone has done that testing for Catecholamines? Also have never had cardio workup beyond EKG, but will do an ECHO (echocardiogram) in two weeks in time. Guess thats it for now. Thanks and be well. Zip