Research Interview

When approached with a new POTS patient, what is usually the first step?

-“I usually conduct a second evaluation. I do things that a doctor would collect such as get their background, family history, medical history, etc. Then I ask the patients about what their goals are (what they want to do/ what they used to be able to do).
I never realized how similar physical therapist and common doctors can be. I’ve realized in my internship that many times physical therapist repeat what doctor’s do and act somewhat like spellcheck. (they look over things and make corrections when needed)

Is POTS a lifelong condition? Can it disappear just as sudden as it appears?

“According to current research, yes. POTS is a condition that deals with the patient’s connective tissue and muscles surrounding the heart, this is not something that can simple be “reversed”.”
I find it pretty amazing that this condition can be non-existent to a patient’s life, and out of nowhere suddenly their connective tissue is now weak? While current research says no, I do wonder if there are ways to medically strengthen these muscles besides exercises.

How does POTS effect one’s day-to-day life

“A patient must routinely monitor things such as their salt/water intake, follow a strict wake/sleep schedule, and work through daily exercises. POTS creates a huge lifestyle change.”
When id first heard about POTS it seemed like a pretty mild thing. I looked at it like something that could be fixed by simply not standing up so quickly. After I looked harder though, it’s crazy the amount of things that POTS demands from one’s life. Many times people’s whole lives are flipped around by this condition.

Are there different severities of POTS, or are most cases similar?

“There are varying degrees of POTS, but we tend to be able to determine that from a patient’s medical history.”
I assumed that there were different severities, but now I wonder what exactly causes this. Perhaps if doctors focused on this they could find a definite cause of POTS.

What are the most popular ways to assure a patients comfort?

“We find ways for patients to make things a little easier by adjusting things like their sleeping position (so getting up isn’t such a drastic move) and prescribing compression garments to avoid sudden rushes of blood flow through one’s body”
During a particular session, I was able to see firsthand how a compression garment worked. I do need to gather more information on how constant wearing of such a thing may negatively affect a POTS patients extremities, especially for teen that are still growing.

What do exercises for POTS patients achieve?

“We mostly use exercises to work on strengthening for lower extremities and the heart in order for to pump blood strongly. Exercises also increase a patient’s cardiovascular endurance so they can with stand a sudden spike in heart rate without fainting.”
Does a certain level of physical fitness indicate a slight appearance of one “overcoming” POTS? If someone is able to become very fit while battling POTS, is there a point in which it would have negative effects?

Is physical therapy for POTS patients a lifelong commitment?

“Physical therapy itself is a choice and every patient is different in regards to that. Exercises however, become a necessity that must be done outside of PT, for us PT’s we only here to help with teaching them what to do.”
While physical therapist aren’t necessarily needed for POTS patients, I do wonder why so many POTS patients don’t take advantage of the opportunity to learn things that could benefit their physical fitness/health in regards to POTS.

Is there a specific cause of POTS

“Research shows that the underlying trigger is a sickness or another medical condition, but the mechanics has to do with the weakness of the connective tissue and the fact it isn’t strong enough to support the patient’s heart and circulatory system in a sudden upright position. There’s actually been talk about there being a hormonal link to POTS due to the fact it occurs at the onset of puberty, and happens more so to girls than boys.”
It’s odd that so many illnesses that have absolutely nothing to do with the muscles/connective tissue have been known to lead to POTS. If there is a particular hormone responsible for POTS, would doctors be able to prevent it? Since it occurs more so in women I could assume that this mystery hormone is Estrogen, but would the benefit to blocking Estrogen in developing women outweigh the costs?

How does one diagnose POTS? What are the criteria?

“POTS is diagnosed mostly by Cardiologists. It’s diagnosed when a patient’s heart rate shows a significant increase from the laying down/standing up position. Your heart rate shouldn’t change at all from this.”
Aren’t their other factors that can cause an increase in heart rate? (obesity for example) Are these taken into account? Is this diagnosis really so cut and dry?

Do high/low altitudes exacerbate ones symptoms?

“I’m not sure. I only deal with patients in this general area, so I couldn’t add to it but that’s a good question.”

I’m glad she’s honest. I looked into this myself and it states that differences in altitudes can affect some people with POTS (some more so than others). I came up with this question due to the thought on how high altitudes make it harder for people to breath, so if this is true for POTS patients then can their lungs also play a part in their condition?

Research

What is POTS?

POTS is simply explained as a defect in the autonomic response system (the part of the brain that controls functions that we don't think about to make happen) in which the act of sitting/standing up from an at rest position causes one's heart rate to skyrocket. This elevation is due to the delayed response from the brain telling the heart to pump faster and the blood vessels to contract. This defect then causes blood pooling towards the feet and in most cases fainting.

How is it Treated?

POTS is treated/regulated in numerous ways. The first and most important way is by keeping a strict workout regimen in order to strengthen the heart, therefore allowing the heart to counteract the mass amount of stress. Another way is by using beta-blockers (medication that slows down one's heart rate). Lastly for comfort, things like compression socks are used in order to force vessels to compress therefore not allowing such drastic blood pooling.

What causes POTS?

The cause of POTS is still unknown but research has pointed towards there possibly being an underlying trigger that can be caused by many common illnesses (as many people first see symptoms soon after). There is also cause for speculation that POTS is sparked by huge hormonal changes due to the fact it is mostly seen in teens at the onset of puberty as well as older women during menopause. There is also a very strong gender correlation as girls are more likely to develop this syndrome.

Research Questions

1. Through the beginning of my internship I realized that the cases we were dealt seemed to be very definite. Definite as in we new the reason/cause/and exact treatment needed. This for-sure knowledge was very comforting, but just a couple of weeks in i was faced with something quite different. My first introduction into POTS came with the arrival of a young teen-aged boy. Though tall in stature and seemingly strong, i was amazed by the fact that he struggled to simply walk down the corridor. His lack of cardiac strength and crippling fatigue had detrimental effect on his way of life. Through my intrigue of such a puzzling dilemma, i formed my essential question" How can doctors and physical therapists as a whole diagnose Postural Orthostatic Tachycardia syndrome and ensure comfort in patient's lives? ." The mystery and confusing origin of this life altering condition attracted me to the subject. I thought that choosing a question with open ended answers will lead to a better discussion as well as allow for me to use more effective critical thinking.

2. At a first glance i was confused as to what to think. Not only was i unsure about what exactly POTS entailed, but i also wondered what the big issue was. I mean sure its not good to faint but maybe just get up slower,right? Wrong. As the patient struggled to complete the simplest of tasks it was obvious the severity of his POTS, but why? My first conclusion came about from learning how it usually comes about post puberty/ post illness. Is it hormonal? possibly a virus sparks a chain of events? It was time for research.

3. While i used many sources to find the information that i needed, i relied heavily on the expertise and events of patients. While using personal,honest insight from people educated and living with POTS, i was able to create a project that reflects very accurately to a patients life. While paying attention during sessions, i also learned a lot from my mentor as she is the most knowledgeable therapist about the disorder. Through my dig for knowledge though, i also looked into studies and documentaries by well known sources.This way i allowed for numerous differing opinions as well as similar facts to create an objectively valid conclusion.

4. Through my findings, i have established a much deeper understanding of POTS. While i still cannot pinpoint a for-sure cause, I have found it focuses on genetics and hormones. This conclusion is supported by the fact that 1 in 8 people diagnosed with POTS reportedly have some sort of orthostatic intolerance within their family. Also due to the fact that POTS is seen during the onset of puberty as well as during menopause (and since it has ties to estrogen due to women's high estrogen levels), the syndrome is very particular in whatever cause it has. I have learned that POTS has a wide array of effects on people and while the symptoms may be minor in one patient, it can be devastating to another. Through a regulated table test, this orthostatic disability is able to be determined (something that wasn't checked for in the past). Though referred to as the "invisible Illness" due to it previously being thought of as a mental disorder, the effects are very much real. With 97% of patients referring to fatigue as its most common symptom, this has stopped people from being able to go to school/work/live their lives. Patients many times vocalize that they feel as if their life is slipping away. Because of this, i am a very strong supporter for patients to follow a strict, detailed regimen everyday to maintain their progress (this includes their specific food restrictions, cardiac exercises, and compression garments). The fact that POTS can neither be prevented nor cured makes these tasks even more essential to their way of life.