I’m writing in case my story can help anyone. My profession is as a scientist so I am able to read the literature and navigate the medical system a bit differently than people who are not a part of it.
Ivabradine: Like many people, after months and months of illness, I was diagnosed with hyperPOTS. This was after 6 months in bed debilitated and out of work. Lying in bed, I realized taking my BP (and HR) over and over again that when my resting heart rate was high I felt worse, when it was lower, I felt “better”. I realized that my BP was really not that important but heart rate was the key. I persuaded my cardiologist to give me Ivabradine 2.5mg twice/day. This stopped the light headed feeling and enabled me to exercise a few minutes a day. Since POTs is a circulation problem it doesn’t seem to matter if your BP is high or low, slowing HR is a goal. Beta blockers did not do enough and made me feel awful. Ivabradine is off-label for POTs. It is a heart failure medication, thus it is not covered by insurance. It can be about 450/month but that is at full strength, 5mg twice a day. Many people need only half that or even a quarter. There are also other ways to get it from Canada. It is in clinical trials for POTs. It will be approved, it is just a matter of time.
Transcutaneous Vagal Stimulator (tVNS): After several months on Ivabradine and with exercise I wanted to try to get off of the medication. When I stopped, my heart started racing again and was too light headed to stand. There is an old technology that is implanted into epileptics. It has been adopted to be used outside the body, through the vagus nerve in the ear. It clips onto your ear where your vagus nerve emerges and gives a low pulse of electricity to your vagus nerve. This slows your heart rate. After using this twice day for 45 min each, for a week, I was able to get off of the Ivabradine. I don’t know if it would have worked as well without the Ivabradine first. The tVNS is in clinical trials in Vanderbilt with and without mestinon, which also slows heart rate but not as effectively as Ivabradine.
I used this for 6 months as I exercised and I don’t need it anymore. My heart is normal now. A company in the UK sells it , Parasym. It can be shipped anywhere in the world but the US. So, If you are in the US, it has to be shipped to someone else and then to you. It is expensive, 800 dollars. A good source to understand it is through Dr. Nemechek, who has a strong online presence for autonomic dysfunction, concussion, autism. He uses his version of the tVNS with his patients. He has a youtube video where he explains how it works. He also recommends fish oil, olive oil, and inulin to fix the gut/brain axis. I have done these things as well. My feeling is that it can’t hurt to put yourself into an anti-inflammatory state to heal. Also no diary and gluten. I can’t know if that contributed to the healing but in general giving yourself the best chance to heal, taking away inflammatory foods is a good idea. The inulin promotes the growth of “good” bacteria. This helps the vagus nerve recover.
Losartan: For the hyperPOTs people. I tried at least 8 BP meds, they all made me ill. This one was recommended to me by a POTs doctor. It has other features, it increases nitric oxide signaling in your skin and improves circulation. I found it to be very stabilizing, not just for BP, 25mg/day.
I have spent hundreds of hours reading clinical trials, case studies, research papers and I am hoping that this can help someone. I am now back to work full time. I am still a bit dizzy (not lightheaded) with motion and thus driving is still difficult. This is my last problem to solve. I am a Professor, 50 years old, female. Before this I was never ill. It came out of nowhere. I had a lot of failure with medications but these are my successes. I had mostly terrible doctors that had no idea. Like everyone, they started thinking I was crazy. If I didn’t have the BP problem, they never would have believed me. Be persistent. You know how you feel. One terrible doctor did give me some good advice, which was exercise through the dizziness. As hard as it is, if possible, try to do a few minutes each day of something you can tolerate. It is part of the way out of this disease.