October is Dysautonomia Awareness Month

Dysautonomia is an umbrella term that is used to describe several different medical conditions that relate to the Autonomic Nervous System. The Autonomic Nervous System is the “automatic” regulation of things we don’t consciously think about in order to function, such as: pupil dilation, blood pressure, heart rate, body temperature control, digestion and many more.

Dysautonomia is not a rare disease, but it is not well known either. Approximately 70 million people worldwide have some form of dysautonomia. This topic is near and dear to my heart because I have not just one family member with it, but two.

Our journey started when my youngest daughter started passing out at school. She has a history of concussions, so our biggest concern was her hitting her head and getting another concussion. The second time she passed out at school, she was taken to the nearest hospital. After many tests were run, one of the doctors mentioned POTS – Postural Orthostatic Tachycardia Syndrome. It sounded familiar to me, but I wasn’t quite sure. I knew about Orthostatic Hypotension when someone stands up and their blood pressure dropped. This would explain the dizziness, but not much more. It wasn’t until an ENT doctor tested her and confirmed POTS. With POTS, it’s not just the blood pressure, but you have to closely watch the heart rate. When there is a difference of 30 beats per minute, or over 120 beats per minute upon sitting up or standing up (within 10 minutes), this is what we call Postural (going from laying down to sitting up, or sitting up to standing up) Orthostatic (blood pressure) Tachycardia (heart beats faster) Syndrome (because it’s more than just one symptom).

POTS Syndrome means there are multiple symptoms in the same disorder
POTS – Syndrome means there are multiple symptoms in the same disorder

No one is sure what exactly causes POTS or Dysautonomia. There are many thoughts as to what may cause this, but no definitive answers. All that can be done is treat the symptoms as they arise. For most POTS patients – who are typically between the ages of 15 – 50 with a mild prevalence to females – this means medical management such as beta-blocker medicine to control heart rate and blood pressure. Most POTS patients have dizziness and fainting, which can also be considered as Neurocardiogenic Syncope. According to Dr. Michael McConnel, the POTS specialist in Georgia, the dizziness is the last effort of the body to get blood and oxygen up to the brain. He also reminds us that when treating POTS and Dysautonomia, to remember that “this is marathon, not a sprint”. This was tremendously helpful to hear but difficult to accept. Unfortunately, Dr. McConnell has since retired.

Along with POTS are several other symptoms or dysfunctions. As the picture above shows, many symptoms of Autonomic Dysfunction include exercise intolerance, gastro-intestinal problems (gastroparesis, nausea, vomiting), brain fog, headaches such as migraines. Pain seems to be the most difficult to conquer and this is mostly due to the body’s inability to shift between the two branches of the Autonomic Nervous System: Sympathetic and Parasympathetic Nervous Systems.

Most patients are stuck in Sympathetic Nervous System Overload or Sympathetic Dominance. When the Sympathetic Nervous System can’t settle down, their bodies are stuck in the Fight, Flight or Freeze phase. The opposite of this is the Parasympathetic Nervous System known as the Rest and Digest phase, where relaxation lives. Many POTS people live in that hyper-adrenaline state and are unable to calm down. Think about when you see a scary movie: you get scared for a moment and scream, then settle back down for the next scene. With POTS, there is no coming down from that first scary scene. This person stays in that ultra excitable state for hours, or even days.

There are many home remedies to help with POTS. Many people end up wearing compression socks or stockings to help with the blood pooling down to their feet. Sometimes it’s necessary to do a lot of squeeze-release technique where you squeeze the muscles in your lower body, then release that tension. This helps to pump the blood back towards the body and up to the brain. It also helps with getting the muscles to relax. Salt tablets or increasing salt intake is another home remedy that works wonders with POTS to increase the volume of blood and raise the blood pressure so they don’t faint. It is estimated to increase salt up to 3 – 5 grams per day. This is completely opposite of what we tell everybody else, but this is a completely different syndrome. When feeling dizzy, the person with POTS is supposed to lay down and elevate their feet above their head to get the blood flowing back up to the body and the brain. People with POTS are also encouraged to engage in recumbent exercise such as a recumbent bike or floor exercises like yoga or Pilates. This helps to recondition the body and the cardiovascular system while keeping blood flow in the body more horizontal, rather than vertical.

I have asked many people, parents of children who have POTS and people who live with POTS, about chiropractic care. Most people with POTS have done very well with chiropractic care, especially the functional neurology branch of chiropractic care. POTS people also do much better with the more gentle types of chiropractic care where special caution is taken to balance the autonomic dysfunction. I have found that using Thompson technique and mostly SOT Sacro-Occipital Technic helps to shift people in to the parasympathetic state of rest and relaxation. The other most effective modality has been deep tissue, therapeutic massage, not just for the prolonged parasympathetic state, but also for pain relief.

If you live in the metro-Atlanta area and would like a consultation to see if you may have POTS or how chiropractic and massage can help your POTS symptoms, please feel free to contact me.

~Dr. Cynthia

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