Hi, Julie, thanks for your response. Alex has been extensively worked up here in Boston and we also had a wk long visit to the Mayo recently. He doesn't seem to have any other diagnoses at this point except POTS. At first, we were trying medicines like crazy, probably too quickly and not giving them enough chance to work. He tried Midodrine, Inderal, Paxil, Effexor, Mestinon, Provigil,antidiuretic hormone and even had two courses of IVIG. Currently, he is on Adderal which helps a little, Metoprolol which has really been keeping his heart rate down, and Ambien because he has very bad insomnia. He has been sick for a little over a year. Dr Fischer at Mayo stressed the need to exercise and push through the postexercise fatigue, and I think taking that advice to heart has made him ever so slightly better. We stored the wheelchair away two days ago which was a big step! How is your son doing and what has been helpful to him? Martha