1 00:00:00,240 --> 00:00:04,080 Aaron and Danny to lifelong best friends, take turns picking 2 00:00:04,080 --> 00:00:06,040 topics. Then they see where it ends. 3 00:00:06,080 --> 00:00:08,480 So wild. It's weird and sometimes 4 00:00:08,480 --> 00:00:11,520 specific. Whatever it is, you know it will 5 00:00:11,520 --> 00:00:13,600 be terrific. It's. 6 00:00:13,600 --> 00:00:19,600 Hyperfixation time Welcome back to Hyperfixation Time. 7 00:00:19,640 --> 00:00:21,600 I'm Danny. And I'm Aaron. 8 00:00:22,080 --> 00:00:26,480 And today, it's Aaron's turn to take us down a rabbit hole that 9 00:00:26,480 --> 00:00:29,440 she has not stopped thinking about. 10 00:00:29,800 --> 00:00:31,160 I don't know what it's going to be. 11 00:00:31,280 --> 00:00:35,160 She said that last week that I had something to do with 12 00:00:35,160 --> 00:00:37,920 something medical. So we'll see what that is. 13 00:00:38,920 --> 00:00:42,800 But before we get into that, we're going to quickly catch up 14 00:00:42,840 --> 00:00:46,280 and inform each other about whatever our micro fixations 15 00:00:46,280 --> 00:00:49,800 are. Anything you wanted to talk 16 00:00:49,800 --> 00:00:53,200 about today? I think we just wanted to bring 17 00:00:53,200 --> 00:00:55,800 up our bias. A coffee link. 18 00:00:56,360 --> 00:00:59,240 Oh yes. So you'll find that in our show 19 00:00:59,240 --> 00:01:01,920 notes and whatnot. Obviously no expectations, but 20 00:01:01,920 --> 00:01:04,239 just, you know, we are coffee addicts. 21 00:01:04,239 --> 00:01:06,640 So if you feel like feel fueling our addiction. 22 00:01:07,600 --> 00:01:10,760 Yeah, we will. We will definitely put that to 23 00:01:10,760 --> 00:01:12,600 good use. Or boba tea. 24 00:01:12,600 --> 00:01:13,680 Or, you know, or Boba. Tea. 25 00:01:13,720 --> 00:01:18,000 Yeah, exactly, exactly. So you'll find that link there. 26 00:01:19,400 --> 00:01:22,360 Do you have a microfixation of the week? 27 00:01:22,960 --> 00:01:27,640 So yeah, so mine, I have like 2 quick ones hopefully because 28 00:01:27,640 --> 00:01:31,040 they both have to do with previous microfixations that you 29 00:01:31,040 --> 00:01:32,720 mentioned. OK. 30 00:01:33,560 --> 00:01:38,440 So 1 is I did listen to all of that podcast, Beth's dead. 31 00:01:38,720 --> 00:01:40,440 Oh, you did. What do you think? 32 00:01:41,160 --> 00:01:44,960 It was very interesting, like very interesting story. 33 00:01:44,960 --> 00:01:47,760 I feel like personally, they probably could have made it in 34 00:01:47,760 --> 00:01:50,800 like 6 episodes. Yeah, instead of 10. 35 00:01:51,000 --> 00:01:52,840 Yeah. Particularly like in the middle, 36 00:01:52,920 --> 00:01:56,800 it kind of dragged out. Like I was like, OK, like you've 37 00:01:56,800 --> 00:02:00,200 read a lot of emails and conversations that you've had. 38 00:02:00,200 --> 00:02:03,200 We probably could have summarized that a little bit, 39 00:02:03,200 --> 00:02:04,680 but. Probably, yeah. 40 00:02:05,040 --> 00:02:08,000 But it was very interesting and I think worth the listen. 41 00:02:08,000 --> 00:02:11,160 I'm very curious. And just a recap for anybody 42 00:02:11,160 --> 00:02:15,120 listening, I guess Beth Stead was a is a podcast like a short 43 00:02:15,120 --> 00:02:18,120 10 episode series. One of the hosts is Monica 44 00:02:18,120 --> 00:02:23,640 Padman from Armchair Expert, and it's kind of like true crime 45 00:02:23,640 --> 00:02:28,080 vibes, I would say like a documentary style about a 46 00:02:28,080 --> 00:02:30,760 situation that happened. You said you have another one. 47 00:02:30,920 --> 00:02:32,840 Yeah, so the other one was Stranger Things. 48 00:02:32,840 --> 00:02:34,520 We finished Stranger Things finally. 49 00:02:35,080 --> 00:02:37,960 What do you think? I was bawling, to be honest. 50 00:02:37,960 --> 00:02:40,000 That was. Crazy, I know. 51 00:02:40,000 --> 00:02:41,320 Me too. Me too. 52 00:02:41,680 --> 00:02:44,800 And so, yeah, no spoilers for anybody that hasn't watched it 53 00:02:44,800 --> 00:02:48,880 yet, but it was so good. And I actually had heard that 54 00:02:48,880 --> 00:02:51,440 some people didn't like it, which I mean, people are going 55 00:02:51,440 --> 00:02:55,040 to have different opinions, but. Right, Yeah, I heard a lot of 56 00:02:55,320 --> 00:02:57,600 backlash about it, which I, I don't know. 57 00:02:57,720 --> 00:03:00,000 I didn't necessarily get. I liked it. 58 00:03:00,200 --> 00:03:01,040 I thought I was. Really good. 59 00:03:01,040 --> 00:03:04,440 I both really enjoyed it a lot. And yeah, I was just feeling 60 00:03:04,440 --> 00:03:06,800 like, emotional at the end, Like, this is such a big 61 00:03:06,800 --> 00:03:08,880 chapter. Yeah. 62 00:03:08,880 --> 00:03:10,800 And like, it was crazy. They showed, you know, a lot of 63 00:03:10,800 --> 00:03:13,120 clips from, like, season 1, Season 2. 64 00:03:13,560 --> 00:03:16,040 And also they were literal children. 65 00:03:16,080 --> 00:03:17,440 Like I knew the. Little. 66 00:03:17,560 --> 00:03:20,400 It was still shocking to see how little they were, you know? 67 00:03:20,400 --> 00:03:22,920 Yes, yes, I totally get what you mean. 68 00:03:22,920 --> 00:03:25,440 You don't realize it when it's like that far in between each 69 00:03:25,440 --> 00:03:30,280 season, but then it's like holy crap, they really were like 8-8 70 00:03:30,280 --> 00:03:32,280 years old probably. Right. 71 00:03:32,720 --> 00:03:35,000 When they started and now they're like in their 20s. 72 00:03:35,520 --> 00:03:38,320 That's insane. Maybe I'm wrong, but that's just 73 00:03:38,440 --> 00:03:41,120 my. No, I think it is something like 74 00:03:41,400 --> 00:03:42,800 that. Something like that, yeah. 75 00:03:43,720 --> 00:03:48,360 So yeah, I really enjoyed it. I felt very emotional and it was 76 00:03:48,360 --> 00:03:50,000 a good time. Good, good. 77 00:03:50,560 --> 00:03:56,120 What's your microfixation? Well, I actually started I who 78 00:03:56,120 --> 00:03:59,440 have never known men really. OK. 79 00:03:59,600 --> 00:04:02,360 Wow this is so crazy. I know, I know. 80 00:04:03,200 --> 00:04:07,240 I listened to about 2 1/2 hours today while I was doing chores 81 00:04:07,240 --> 00:04:09,680 and whatnot. Very intrigued. 82 00:04:09,880 --> 00:04:13,480 Yeah, it's, it's getting interesting. 83 00:04:13,480 --> 00:04:17,920 I mean, it has been interesting, but yeah, I so I started that. 84 00:04:17,920 --> 00:04:20,560 So that's been my. I'll let you know how I think as 85 00:04:20,560 --> 00:04:22,240 I keep going, OK, what I think about it. 86 00:04:22,960 --> 00:04:25,640 It's so funny that we both were like, let's report on things 87 00:04:25,640 --> 00:04:33,800 that you mentioned previously. I know all right well, any 88 00:04:33,800 --> 00:04:36,000 guesses? All right. 89 00:04:36,000 --> 00:04:39,120 Well, you said medical, so I do have two guesses. 90 00:04:39,520 --> 00:04:42,560 OK. One guess is PCOS. 91 00:04:43,160 --> 00:04:48,800 OK, guess 2 is, well, I don't know, just I'm just taking a 92 00:04:48,800 --> 00:04:50,160 gander over here. Gander. 93 00:04:52,840 --> 00:04:56,320 Because I have PCOS, that's why. Yeah, that's fair. 94 00:04:56,320 --> 00:04:57,360 OK. Which I. 95 00:04:57,720 --> 00:05:00,480 Think you've said on the pod maybe, maybe you haven't. 96 00:05:00,480 --> 00:05:02,560 It's not. I mean, yeah, it's just a part 97 00:05:02,560 --> 00:05:04,280 of me. No, no, not at all. 98 00:05:04,320 --> 00:05:09,640 Yeah, more awareness in any way. Second guess was that you're 99 00:05:09,640 --> 00:05:11,160 going to tell me what's going on with your eye. 100 00:05:11,920 --> 00:05:18,600 Oh OK, those are good guesses. I do not have an update on my 101 00:05:18,600 --> 00:05:21,520 eye. I am going in in April so. 102 00:05:21,520 --> 00:05:24,760 That's. All out yet, PCOS is a really 103 00:05:24,760 --> 00:05:27,680 good guess as well. Yeah, that's something that I 104 00:05:28,840 --> 00:05:33,520 have and have been battling for a while and there's a lot to it 105 00:05:33,600 --> 00:05:37,400 and I do wanna at some point get a little bit more into it. 106 00:05:37,640 --> 00:05:39,960 Yeah. It's not either of those good 107 00:05:39,960 --> 00:05:42,880 guesses though. Like I said, I think let me just 108 00:05:42,880 --> 00:05:46,520 pull up my information here one SEC. 109 00:05:46,960 --> 00:05:52,920 It might take a second. What are you up to? 110 00:05:53,440 --> 00:05:55,520 I feel like you're so up to something. 111 00:05:57,320 --> 00:06:01,160 I might be. Who are we phoning someone in 112 00:06:03,240 --> 00:06:06,000 hi? Hello. 113 00:06:06,520 --> 00:06:10,080 We are phoning someone in. How exciting my. 114 00:06:10,080 --> 00:06:15,160 Sister. Katie and she is a doctor of 115 00:06:15,160 --> 00:06:16,360 nurse. What do you say? 116 00:06:16,360 --> 00:06:18,080 Nurse practitioning nurse practitioner. 117 00:06:18,080 --> 00:06:19,840 Doctor of Nursing. Nursing. 118 00:06:19,840 --> 00:06:22,840 OK, there you go. Doctor Katie, you can call her. 119 00:06:22,840 --> 00:06:27,000 She's my sister. And the topic I really wanted to 120 00:06:27,000 --> 00:06:29,480 talk about today she's an expert in. 121 00:06:29,800 --> 00:06:34,440 So I figured it would be helpful to have her to tell us a little 122 00:06:34,440 --> 00:06:37,160 bit more about it. And also then I didn't have to 123 00:06:37,160 --> 00:06:41,600 research things this week. Self-serving. 124 00:06:41,680 --> 00:06:43,360 I love it. Exactly. 125 00:06:43,680 --> 00:06:46,240 But we have to do have you? Yeah. 126 00:06:46,240 --> 00:06:48,640 Thank you for having me. So exciting. 127 00:06:49,560 --> 00:06:52,760 Yes, I decided to switch things up. 128 00:06:53,240 --> 00:06:56,840 Surprise, Danny, I was telling Aaron that I some of my like 129 00:06:56,840 --> 00:07:01,280 earliest memories of you, as you know, sort of part of our 130 00:07:01,280 --> 00:07:04,840 family, one of an extra sister was you probably don't remember 131 00:07:04,840 --> 00:07:08,520 this, but I learned how to French braid on your hair 132 00:07:08,720 --> 00:07:12,240 because you have like the best like thickest. 133 00:07:12,840 --> 00:07:15,760 You had such long hair. Yeah, my hair like went down to 134 00:07:15,760 --> 00:07:19,680 my butt for any listener. Yeah, it did. 135 00:07:19,760 --> 00:07:22,680 And there would be times when, like, you would come over and 136 00:07:22,680 --> 00:07:25,520 your sister Will would have already braided your hair. 137 00:07:25,560 --> 00:07:29,120 And God, I really wanted to do it because it was so good. 138 00:07:29,240 --> 00:07:33,560 That's so funny. No, actually you definitely did 139 00:07:33,600 --> 00:07:36,040 my hair for my third grade school picture. 140 00:07:36,520 --> 00:07:42,560 I, I requested Leia buns. And so you like did 2 pigtail 141 00:07:42,560 --> 00:07:45,160 braids and then how do you do a Leia bun? 142 00:07:45,200 --> 00:07:47,200 We don't know. So then you like spiraled them 143 00:07:47,200 --> 00:07:50,880 like this. And so I had two braids like 144 00:07:50,880 --> 00:07:54,240 this for my third grade picture, which like, well, on my parents 145 00:07:54,240 --> 00:07:56,560 thought they were just like, yeah, OK, go to school. 146 00:07:56,680 --> 00:07:58,680 Yeah, that's awesome. Good. 147 00:07:58,960 --> 00:08:01,720 I love it. I feel like I remember that too. 148 00:08:01,720 --> 00:08:05,280 Seeing well. Katie, do you want to introduce 149 00:08:05,280 --> 00:08:07,400 our topic for today? Sure. 150 00:08:07,560 --> 00:08:08,920 Do you tell her at all what it was? 151 00:08:09,520 --> 00:08:11,240 I just told her it's something medical. 152 00:08:11,440 --> 00:08:16,520 That's all she knows right now. OK, so yes, I am like Karen 153 00:08:16,520 --> 00:08:19,640 said, I'm a nurse practitioner, family practice board certified, 154 00:08:19,640 --> 00:08:23,720 but I've been in the neurology arena for pretty much my entire 155 00:08:23,720 --> 00:08:26,560 practice. And specifically, one of the 156 00:08:26,600 --> 00:08:29,920 flavours of neurology that I practice the most with is 157 00:08:30,120 --> 00:08:34,360 patients who have POTS. And I don't know if you've heard 158 00:08:34,360 --> 00:08:36,919 of that before, but I. Have you? 159 00:08:36,960 --> 00:08:39,200 Have. I but I don't know that much 160 00:08:39,200 --> 00:08:41,320 about it. I thought you said that. 161 00:08:41,360 --> 00:08:43,559 Maybe you have that too, but. Yes, I can remember. 162 00:08:43,559 --> 00:08:46,480 For sure. I was trying to think if I told 163 00:08:46,480 --> 00:08:48,360 you, but yes, that is something that I have. 164 00:08:48,560 --> 00:08:52,360 Katie, you have. It is ripe in our family. 165 00:08:52,720 --> 00:08:55,760 Yeah. Even before, you know, I sort of 166 00:08:55,760 --> 00:09:00,080 learned how to treat it and diagnose it and all that stuff, 167 00:09:00,080 --> 00:09:03,680 too. So it's sort of known as the 168 00:09:03,680 --> 00:09:07,320 most common disorder you've never heard of because it 169 00:09:07,320 --> 00:09:12,720 affects like, well, like up to 1% or so is what what they say 170 00:09:12,840 --> 00:09:18,120 of people who have POTS or some kind of neurologic dysautonomia, 171 00:09:18,480 --> 00:09:21,720 the kind of bigger word for the type of condition it is. 172 00:09:22,040 --> 00:09:26,520 And it's primarily females that develop that and it tends to, 173 00:09:27,280 --> 00:09:30,680 you know, have genetic comorbid things. 174 00:09:31,160 --> 00:09:34,840 And our family is it has has quite a bit of that. 175 00:09:34,840 --> 00:09:41,480 So yes, so couple of the sisters have been diagnosed and treated 176 00:09:41,560 --> 00:09:45,600 and Aaron's drinking her water like a good little pops patient 177 00:09:45,600 --> 00:09:47,120 with. My electrolytes in it. 178 00:09:47,520 --> 00:09:49,520 Yeah, with your electrolytes. Exactly. 179 00:09:49,520 --> 00:09:52,560 You had a girl that's smart. Yeah. 180 00:09:52,560 --> 00:09:57,440 So I practice and I've been seeing patients with this for 181 00:09:57,440 --> 00:09:59,720 almost a decade. So I'm happy to go over 182 00:09:59,840 --> 00:10:02,920 anything, any questions or anything, or just give you a 183 00:10:02,920 --> 00:10:07,160 little rundown on what it is. What does it stand for? 184 00:10:07,440 --> 00:10:11,880 So it stands for postural orthostatic tachycardia syndrome 185 00:10:12,320 --> 00:10:18,280 and most people just know it as POTS, but anytime disorder has 186 00:10:18,560 --> 00:10:23,240 the word syndrome in it, it means it's like a collection of 187 00:10:23,240 --> 00:10:25,880 symptoms. So meaning that like there's 188 00:10:25,880 --> 00:10:30,160 lots of different parts of it that can can manifest physically 189 00:10:30,160 --> 00:10:33,280 in patients. So, so postural orthostatic 190 00:10:33,280 --> 00:10:40,120 tachycardia syndrome or POTS is, is part of this umbrella of 191 00:10:40,120 --> 00:10:43,120 neurologic disorders that we call disautonomia. 192 00:10:43,480 --> 00:10:48,000 And that's basically just a big fancy word for saying, you know, 193 00:10:48,000 --> 00:10:51,880 some part of your autonomic nervous system doesn't work the 194 00:10:51,880 --> 00:10:54,720 way it should. And for those who don't know 195 00:10:54,720 --> 00:10:57,400 what the autonomic nervous system is, it's extremely 196 00:10:57,400 --> 00:11:02,200 complicated but fascinating part of your neurologic makeup. 197 00:11:02,200 --> 00:11:04,760 And it controls everything you don't have to think about South. 198 00:11:05,480 --> 00:11:08,680 Everything from your blood pressure, heart rate, sweat 199 00:11:08,800 --> 00:11:12,440 function, saliva tear function, bowel function, bladder 200 00:11:12,440 --> 00:11:15,400 function, all of that stuff that like is supposed to just happen 201 00:11:15,440 --> 00:11:19,440 naturally. There's a disruption somewhere 202 00:11:19,520 --> 00:11:23,160 in that. So POTS is one of those types of 203 00:11:23,160 --> 00:11:25,800 disordinomias. I didn't know that actually that 204 00:11:25,800 --> 00:11:29,520 it was like the, I mean, I I've heard Disordinomia, but I didn't 205 00:11:29,520 --> 00:11:32,320 know that that was, I guess I didn't put it together that 206 00:11:32,320 --> 00:11:34,360 yeah, like you're like normal functions, OK. 207 00:11:34,840 --> 00:11:36,800 Yeah, there's lots of different types out there and there's lots 208 00:11:36,800 --> 00:11:40,960 of different ways that that we diagnose it and, and we see it 209 00:11:40,960 --> 00:11:43,400 as a comorbid. We see people who develop 210 00:11:43,400 --> 00:11:46,680 autonomic disorders or disotonomias with other like 211 00:11:47,080 --> 00:11:50,400 chronic diseases, Parkinson's, Ms. stuff like that. 212 00:11:50,400 --> 00:11:52,280 That kind of comes secondary to that. 213 00:11:52,280 --> 00:11:55,800 But POTS is like probably the the version of it that most 214 00:11:55,800 --> 00:11:59,800 people have heard about and or have seen it, you know, all over 215 00:11:59,800 --> 00:12:01,960 the socials because it's all over there. 216 00:12:02,200 --> 00:12:06,200 I feel like in the last like what, 5:00-ish years, it's 217 00:12:06,200 --> 00:12:09,160 become more well known, would you say or? 218 00:12:09,160 --> 00:12:13,040 Totally, Yeah, that's one of the Silver Linings of COVID, the 219 00:12:13,040 --> 00:12:15,040 pandemic is. Is that it? 220 00:12:15,040 --> 00:12:20,640 Sort of raised awareness to POTS because unfortunately it's 221 00:12:20,800 --> 00:12:26,720 really common manifestation of long COVID, right or the ongoing 222 00:12:26,720 --> 00:12:30,440 symptoms of people who had COVID, but it definitely existed 223 00:12:30,440 --> 00:12:33,920 before that. It definitely is like under 224 00:12:33,920 --> 00:12:38,040 recognized and there's a lot of misinformation out there about 225 00:12:38,040 --> 00:12:44,000 it, but it's it's a fascinating disorder and once you find 226 00:12:44,000 --> 00:12:47,960 somebody who knows about it and is willing to sort of go on the 227 00:12:47,960 --> 00:12:51,560 journey of living with it with you, the outcomes and the 228 00:12:51,560 --> 00:12:54,040 prognosis for patients is really, really great. 229 00:12:54,040 --> 00:12:55,920 So. And that's what you do is. 230 00:12:56,160 --> 00:13:00,480 Yes, yes, it's not an easy disorder to live with. 231 00:13:00,640 --> 00:13:06,680 That's not at all what I'm saying, but with the right 232 00:13:06,720 --> 00:13:11,320 interventions that I help with and sort of tailor to each 233 00:13:11,320 --> 00:13:15,560 patient, we can at least hopefully get him feeling and 234 00:13:15,720 --> 00:13:18,120 kind of operating as as best as we can. 235 00:13:19,520 --> 00:13:22,080 What happened? Like, I guess if you can break 236 00:13:22,080 --> 00:13:26,120 down what POTS is like, how does it manifest in people? 237 00:13:26,120 --> 00:13:30,000 I know he said that it's like a variety and that's totally fair, 238 00:13:30,000 --> 00:13:32,800 but like what are some of the main things for that? 239 00:13:33,000 --> 00:13:33,600 Yeah. OK. 240 00:13:33,600 --> 00:13:37,600 So the, the criteria, if you will, the diagnostic criteria 241 00:13:37,600 --> 00:13:40,880 and how POTS is characterized is that it has a heart rate 242 00:13:40,880 --> 00:13:45,080 increase upon standing, significant heart rate increase 243 00:13:45,080 --> 00:13:48,160 with on standing. And the number of 30 or 40 beats 244 00:13:48,440 --> 00:13:52,120 varies depending on your age. But adults it's, it's 30 beats 245 00:13:52,120 --> 00:13:55,480 or more that your heart rate increases just by standing. 246 00:13:55,520 --> 00:13:58,760 There's, there's nuances where like blood pressure can't drop, 247 00:13:58,760 --> 00:14:02,960 but but, or your heart rate can get to a certain Max and sustain 248 00:14:02,960 --> 00:14:07,080 at that point, but it's got to be happening within the 1st 10 249 00:14:07,080 --> 00:14:10,440 minutes of, of standing. So that's sort of the like 250 00:14:10,600 --> 00:14:15,520 textbook definition is that you have heart rate increment of 30 251 00:14:15,520 --> 00:14:19,520 beats or more upon standing without blood pressure drop 252 00:14:19,520 --> 00:14:22,240 along with symptoms of intolerance. 253 00:14:22,240 --> 00:14:25,600 So people don't feel good when they stand up, right? 254 00:14:25,600 --> 00:14:29,520 It's sort of like standing up is exercise for you, right? 255 00:14:29,560 --> 00:14:32,560 You get your heart rate up pretty quickly and sort of 256 00:14:32,560 --> 00:14:36,920 without warning. So, so there's, there's, there's 257 00:14:36,920 --> 00:14:40,320 definitely like specific diagnostic criteria that people 258 00:14:40,320 --> 00:14:44,720 have to meet. And once we have a simple sort 259 00:14:44,720 --> 00:14:48,120 of set of blood pressure, heart rate, vital sign measurements in 260 00:14:48,120 --> 00:14:51,760 clinic, we can give the, the diagnosis of POTS. 261 00:14:51,800 --> 00:14:56,080 And then, then I try to sort of break it down and figure out 262 00:14:56,520 --> 00:14:59,880 what, what kind of POTS it is. There's there's three different 263 00:14:59,880 --> 00:15:04,080 types of POTS, which is interesting and. 264 00:15:04,080 --> 00:15:06,920 I didn't realize that. Yeah, there's a little bit 265 00:15:06,920 --> 00:15:12,080 different mechanism for each one, but I sometimes we can 266 00:15:12,080 --> 00:15:14,880 figure out, sometimes people vacillate, you know, sort of 267 00:15:14,880 --> 00:15:17,320 between the like low blood volume 'cause they're 268 00:15:17,320 --> 00:15:22,560 dehydrated. Some people have a a neuropathy 269 00:15:22,560 --> 00:15:26,120 or damage to those nerves from like a secondary cause like an 270 00:15:26,120 --> 00:15:29,680 autoimmune disease or genetic connective tissue disorder 271 00:15:30,040 --> 00:15:33,640 that's considered an auto. Wait, autoimmune disease? 272 00:15:34,520 --> 00:15:36,440 OK, Well, I've been saying that. No, OK. 273 00:15:36,720 --> 00:15:40,520 No, it's just autonomia, but not autoimmune, OK. 274 00:15:40,640 --> 00:15:43,720 Yeah, but yeah, cuz the auto like part of that word is the 275 00:15:43,720 --> 00:15:46,160 autonomic nervous system. OK. 276 00:15:46,280 --> 00:15:47,480 OK. That makes sense. 277 00:15:47,480 --> 00:15:51,280 And my question was like, so you're talking about diagnosing 278 00:15:51,280 --> 00:15:53,760 it? It sounded like a fairly simple 279 00:15:54,320 --> 00:15:57,320 diagnosis, but like from what I've seen, like you said on the 280 00:15:57,320 --> 00:16:00,960 Internet, it always sounds like POTS is really hard to diagnose, 281 00:16:00,960 --> 00:16:03,000 but like what you just said sounded so easy. 282 00:16:03,000 --> 00:16:05,840 So like, is it that easy or is it like a lot harder? 283 00:16:06,040 --> 00:16:07,880 Do you know what I mean? Yeah, yeah. 284 00:16:07,880 --> 00:16:10,400 It's really unfortunate. That's why it's not diagnosed 285 00:16:10,600 --> 00:16:13,720 very well because there are elaborate tests. 286 00:16:13,720 --> 00:16:17,720 There are, you know, sort of gold standard is by putting 287 00:16:17,720 --> 00:16:22,560 patients on what we call a tilt table and, and, and, you know, 288 00:16:22,640 --> 00:16:25,800 tilting them up to 70° and measuring their blood pressure 289 00:16:25,800 --> 00:16:28,680 and heart rate. But really you can do simple 290 00:16:28,680 --> 00:16:31,800 measurements in the office. Even even your primary care 291 00:16:31,800 --> 00:16:35,800 provider can do that. But it gets sort of like sticky 292 00:16:35,800 --> 00:16:39,480 though, because it's got to come with like certain symptoms of 293 00:16:39,480 --> 00:16:42,320 intolerance. You got to have like, you know, 294 00:16:42,680 --> 00:16:46,240 more than just your heart rate increase and then it's got a 295 00:16:46,240 --> 00:16:49,320 sort of persist for a long time. So, so one example we always 296 00:16:49,320 --> 00:16:53,080 tell patients is that like most of the astronauts, when they, 297 00:16:53,080 --> 00:16:57,480 when they come back to Earth meet the criteria for POTS, if 298 00:16:57,480 --> 00:17:00,960 we were to do the, the blood pressure and heart rate in the 299 00:17:00,960 --> 00:17:05,520 office, But it's, it's because they're deconditioned, right? 300 00:17:05,520 --> 00:17:08,520 They're, they're kind of coming back down to the forces of 301 00:17:08,520 --> 00:17:11,680 gravity. And so it's, it's, you know, 302 00:17:11,680 --> 00:17:13,960 it's not an expensive way to diagnose. 303 00:17:14,119 --> 00:17:17,720 You know, to you, you can, it's not like expensive Mris and, and 304 00:17:17,720 --> 00:17:20,359 all this stuff. It's it's not that hard, but 305 00:17:20,359 --> 00:17:23,960 people are intimidated by it, especially healthcare providers. 306 00:17:24,359 --> 00:17:25,200 Intimidated. That's. 307 00:17:25,200 --> 00:17:27,040 Unfortunate, yeah. Good question. 308 00:17:27,040 --> 00:17:28,000 I know. Yeah. 309 00:17:28,000 --> 00:17:30,320 So it's female predominant like 80%. 310 00:17:31,600 --> 00:17:36,600 Wow, I know. Yeah, you might get to this at 311 00:17:36,600 --> 00:17:40,000 some point, but is there any correlation between this and 312 00:17:40,000 --> 00:17:44,160 like migraines or are they different things? 313 00:17:44,400 --> 00:17:47,680 Asking for a. Friend, big big question. 314 00:17:48,000 --> 00:17:49,480 I know I. Was when we started the episode 315 00:17:49,480 --> 00:17:52,120 I was like is you going to tell me all about my migraines today? 316 00:17:52,280 --> 00:17:53,920 Yeah, I can do that too, because. 317 00:17:54,720 --> 00:17:59,600 It is a migraines are very commonly seen in patients who 318 00:17:59,600 --> 00:18:02,080 also have POTS. Makes sense, but technically 319 00:18:02,080 --> 00:18:05,600 they're kind of, they're their own set of, of neurologic 320 00:18:05,600 --> 00:18:07,520 disorders. But yeah, so some of the like 321 00:18:07,520 --> 00:18:12,320 common symptoms and like struggles that people have with 322 00:18:12,320 --> 00:18:15,720 it other than just the heart rate increases, they feel like 323 00:18:15,840 --> 00:18:20,680 they could pass out or they feel, you know, sort of woozy, 324 00:18:20,680 --> 00:18:25,680 lightheaded when they stand up. Fatigue is a huge part of it's 325 00:18:25,680 --> 00:18:28,120 probably the number one complaint I get from my POTS 326 00:18:28,120 --> 00:18:32,000 patients is this profound fatigue, brain fog. 327 00:18:32,360 --> 00:18:34,640 There's somebody pains that come with it. 328 00:18:34,640 --> 00:18:40,720 There can be nausea, there can be kind of slow GI motility that 329 00:18:40,720 --> 00:18:43,240 comes with it. So when I have a new POTS 330 00:18:43,240 --> 00:18:47,800 patient, my approach is always like, let's go head to toe and I 331 00:18:47,800 --> 00:18:53,360 want to hear what you're all feeling and see if I can sort of 332 00:18:53,360 --> 00:18:58,040 suss out what is potentially the cause of this or like, what can 333 00:18:58,040 --> 00:19:02,000 I do to help your quality of life and your symptoms get a 334 00:19:02,000 --> 00:19:05,320 little bit better? So when people come to you, do 335 00:19:05,320 --> 00:19:08,800 they like already kind of feel like they have like they already 336 00:19:08,880 --> 00:19:11,840 have pre diagnosed themselves with POTS and then you're just 337 00:19:11,840 --> 00:19:15,160 kind of confirming or is it like, here's my symptoms and 338 00:19:15,160 --> 00:19:16,240 then you tell them what's going on? 339 00:19:16,960 --> 00:19:20,560 Yeah, that's a good question. By the time patients get to me, 340 00:19:20,560 --> 00:19:24,840 it's pretty much that we know that they've had it because I I 341 00:19:24,840 --> 00:19:26,920 never can find this exact statistic. 342 00:19:26,920 --> 00:19:31,720 So don't like look it up. But when I first started my 343 00:19:31,720 --> 00:19:35,040 mentor, and this is mostly just for kind of dramatic effect, but 344 00:19:35,040 --> 00:19:38,720 it's, but if you listen to anecdotally patients, this is 345 00:19:38,720 --> 00:19:43,040 this is a true reality is, is it takes seven years and 12 346 00:19:43,040 --> 00:19:45,440 different clinicians to get the right diagnosis. 347 00:19:46,360 --> 00:19:50,120 So most patients by the time they get to me, they've already 348 00:19:50,120 --> 00:19:53,840 been told you have anxiety, like you're just deconditioned, 349 00:19:53,840 --> 00:19:57,480 you're overweight, you, you know, this, that other thing and 350 00:19:57,480 --> 00:20:00,720 not really like put it all together and sort of do that 351 00:20:00,720 --> 00:20:03,560 simple test. So yeah, people come to me and 352 00:20:03,560 --> 00:20:05,560 they're like, I'm pretty sure I have POTS. 353 00:20:05,680 --> 00:20:10,760 And we sit, we chat, we do the blood pressure heart rate 354 00:20:10,760 --> 00:20:14,520 measurements. If they meet the criteria in the 355 00:20:14,520 --> 00:20:17,840 office and I really high suspicion, we go right into it. 356 00:20:17,840 --> 00:20:20,920 We go into, OK, this is it. Let's like wrap this all a bit 357 00:20:20,920 --> 00:20:23,280 of bow and and tell you how to live with it. 358 00:20:23,280 --> 00:20:25,680 Some some patients it's not that easy. 359 00:20:25,680 --> 00:20:28,960 Like if they don't meet that very specific criteria with with 360 00:20:28,960 --> 00:20:31,800 the heart rate, then I have to do a little bit more digging to 361 00:20:31,800 --> 00:20:34,360 rule out like, is this a hormonal thing? 362 00:20:34,360 --> 00:20:37,760 Like are they, you know, is there thyroid out of whack? 363 00:20:37,760 --> 00:20:41,240 Is it, is it something else that can kind of like mimic these 364 00:20:41,400 --> 00:20:45,600 these symptoms? But one thing I like to really 365 00:20:45,600 --> 00:20:50,160 say is, is that a lot of my patients come in and say, oh, I 366 00:20:50,160 --> 00:20:52,120 pass out. That means I have POTS. 367 00:20:52,920 --> 00:20:57,120 And that's a really common misconception in that actually 368 00:20:57,120 --> 00:21:02,480 in POTS it's near passing out. That is, is, is important to 369 00:21:02,480 --> 00:21:08,200 distinguish their complete loss of consciousness is not part of 370 00:21:08,200 --> 00:21:12,640 the the disorder that, that, that that wouldn't be like my 371 00:21:12,640 --> 00:21:16,000 clue that like I got to rule out some other stuff that's, that 372 00:21:16,000 --> 00:21:18,440 could actually, you know, cause complete loss of consciousness. 373 00:21:18,440 --> 00:21:20,520 That's what a lot of people say. I think they see a lot of that 374 00:21:20,520 --> 00:21:22,200 on social media. They say I pass out and. 375 00:21:22,720 --> 00:21:26,280 Yeah, that makes sense. Yeah, I was just going to ask 376 00:21:26,280 --> 00:21:29,720 too. So like, is this literally every 377 00:21:29,720 --> 00:21:35,080 single time the person stands up then they like feel that way? 378 00:21:35,160 --> 00:21:38,720 Or is it just kind of like a most of the time, 25% of the 379 00:21:38,720 --> 00:21:41,760 time, Like what is it? Yeah, good question. 380 00:21:41,760 --> 00:21:44,360 It's hard to know exactly cuz no one's wearing a, you know, heart 381 00:21:44,360 --> 00:21:47,720 monitor all the time. But if they're not well treated 382 00:21:47,880 --> 00:21:52,440 right, if they are, you know, not diagnosed and aren't doing 383 00:21:52,440 --> 00:21:55,240 all the other measures to help improve it, it will be almost 384 00:21:55,240 --> 00:21:56,800 all the time that they feel that worse. 385 00:21:56,840 --> 00:22:00,440 Mornings, Mornings are really, really hard for patients. 386 00:22:01,040 --> 00:22:04,440 It can take a lot even to just get them out of bed. 387 00:22:04,920 --> 00:22:07,800 But, you know, as the day sort of trickles on and you get water 388 00:22:07,800 --> 00:22:11,480 and salt and and you do your other treatments, then then they 389 00:22:11,480 --> 00:22:14,480 might not actually have that sustained heart rate increase 390 00:22:14,480 --> 00:22:18,000 with with standing. But yeah, it's pretty 391 00:22:18,000 --> 00:22:21,240 persistent. I was gonna ask cuz you said 392 00:22:21,240 --> 00:22:23,600 both of you ladies have it. Yeah. 393 00:22:23,880 --> 00:22:27,800 So like how like how do you guys feel upon standing? 394 00:22:27,800 --> 00:22:31,040 Like, I don't know, it's just, I'm sorry to hear that you guys 395 00:22:31,040 --> 00:22:33,840 feel that way, you know, or go through that. 396 00:22:34,360 --> 00:22:37,480 Go ahead, Aaron. I mean, for me, I can just tell 397 00:22:37,480 --> 00:22:41,560 when I got up too fast, like and and that's most of the time. 398 00:22:41,560 --> 00:22:45,840 And it just gets like a moment of OK, I need to like stabilize 399 00:22:45,840 --> 00:22:49,760 myself for a minute and then I'll be OK after that. 400 00:22:50,280 --> 00:22:54,560 That happens probably a couple times a day, I would say. 401 00:22:54,840 --> 00:22:59,640 And to her point about like a hydration and salt, that's what 402 00:22:59,640 --> 00:23:03,120 I try to keep up with and we'll talk I'm sure a bit more about 403 00:23:03,120 --> 00:23:06,800 that. But that's my heart rate also is 404 00:23:06,800 --> 00:23:10,120 just it's always just like higher than like PJS. 405 00:23:10,120 --> 00:23:12,320 Like I'll compare it. I'm just like, yeah, we just did 406 00:23:12,320 --> 00:23:15,360 the exact same thing. And, you know, we're generally 407 00:23:15,360 --> 00:23:19,520 healthy, but my heart rate is like 20 beats per minute higher 408 00:23:19,520 --> 00:23:23,360 than yours doing this exercise or something like that. 20 to 409 00:23:23,360 --> 00:23:26,280 30, honestly. But standing up, yeah, it it 410 00:23:26,280 --> 00:23:29,440 happens quite a bit. It's, yeah. 411 00:23:29,480 --> 00:23:32,880 The thing is, is that like most, most people that have it have 412 00:23:32,880 --> 00:23:35,200 had it for a while and now they're used to it, so they 413 00:23:35,200 --> 00:23:40,040 don't sort of complain about it. In my case, I first started 414 00:23:40,040 --> 00:23:44,000 showing symptoms in like my early 20s, like 2021. 415 00:23:44,360 --> 00:23:47,840 And I mean, now I know how to treat myself. 416 00:23:48,240 --> 00:23:53,040 And so I just like do all of my, you know, all of my 417 00:23:53,040 --> 00:23:56,480 interventions so that I really don't have symptoms most days. 418 00:23:56,760 --> 00:24:00,400 If I'm sick, if I did a hard workout, if I, you know, 419 00:24:01,080 --> 00:24:04,960 whatever comes about, then I will then I will have some more, 420 00:24:04,960 --> 00:24:06,760 more symptoms. And yeah, like she said, it's 421 00:24:07,040 --> 00:24:10,200 sort of just you don't feel good when you stand up. 422 00:24:10,200 --> 00:24:11,880 It can be nausea, it can be Lightheadedness. 423 00:24:11,880 --> 00:24:14,360 It can be like sweating. Some people it causes them to 424 00:24:14,880 --> 00:24:18,480 like overheat and have that like temperature intolerance is a big 425 00:24:18,480 --> 00:24:21,800 problem with it to be real debilitating for people. 426 00:24:22,800 --> 00:24:26,360 But the good news I tell patients is that like, this is 427 00:24:26,360 --> 00:24:29,800 not a fatal disorder. You know, this is not going to 428 00:24:29,800 --> 00:24:31,600 shorten your lifespan that you don't. 429 00:24:31,600 --> 00:24:33,560 It's not going to make your heart weak. 430 00:24:33,560 --> 00:24:36,480 Like you're not. You don't die from POTS. 431 00:24:37,680 --> 00:24:41,520 The sort of gold standard treatment is really not 432 00:24:41,520 --> 00:24:43,400 medications. Absolutely. 433 00:24:43,400 --> 00:24:47,960 Some patients we have to use multiple or single or trial and 434 00:24:47,960 --> 00:24:51,200 error medications. But most patients, if we can 435 00:24:51,200 --> 00:24:54,920 start them off on the what we call home care measures or non 436 00:24:54,920 --> 00:24:59,520 pharmacologic intervention, non drug measures even that makes a 437 00:24:59,520 --> 00:25:04,040 big difference in how they feel. So the first visit is always 438 00:25:04,040 --> 00:25:08,720 like a big teaching one, right? It's very much like explaining 439 00:25:08,920 --> 00:25:12,280 giving them the tools, I call it the tools that put them in their 440 00:25:12,280 --> 00:25:16,560 toolbox so that they can go home and implement these things. 441 00:25:16,560 --> 00:25:19,760 And yeah, so it's like water, right? 442 00:25:19,800 --> 00:25:24,400 Sounds simple, but like dehydration or D you know, lower 443 00:25:24,400 --> 00:25:28,280 blood volume or hypovolemia as we call it, that like I said 444 00:25:28,280 --> 00:25:31,960 alone is going to be the cause for for patients to have POTS. 445 00:25:31,960 --> 00:25:36,720 So yeah, drinking like 100 ounces of Oz of water a day is 446 00:25:36,720 --> 00:25:40,680 sort of the bare minimum are like math that we usually tell 447 00:25:40,680 --> 00:25:43,920 patients is is that you take your weight in kilograms and 448 00:25:43,920 --> 00:25:46,760 multiply it by two and that's how many ounces of water you 449 00:25:46,760 --> 00:25:48,560 need minimum. Got you. 450 00:25:49,680 --> 00:25:51,640 I need to. Do better. 451 00:25:54,240 --> 00:25:58,200 Which I know that sounds easy for it sounds like I just have 452 00:25:58,200 --> 00:26:01,240 to drink water, but that's a lot of water because that comes with 453 00:26:01,240 --> 00:26:04,600 more like going to the bathroom and a lot of people have nausea 454 00:26:04,600 --> 00:26:06,480 with it. And so that can be hard for them 455 00:26:06,960 --> 00:26:11,120 to maintain that, but that's where we use things like salt 456 00:26:11,120 --> 00:26:15,200 supplementation. Salt is, you know, sort of in 457 00:26:15,200 --> 00:26:18,120 the American diet, pretty excessive already. 458 00:26:18,560 --> 00:26:21,960 But people with POTS need more salt. 459 00:26:21,960 --> 00:26:23,680 I. Think that's why I like salty 460 00:26:23,680 --> 00:26:27,400 snacks so much. That will do it. 461 00:26:27,800 --> 00:26:29,720 Yeah. I, I mean, like pickle juice 462 00:26:29,720 --> 00:26:32,960 shots are like a real thing in the POTS community. 463 00:26:32,960 --> 00:26:35,720 They they're like, let me just do a shot of pickle juice or I 464 00:26:35,720 --> 00:26:38,080 know. I love Pickles. 465 00:26:39,400 --> 00:26:44,240 So yummy, right? You know, the the general 466 00:26:44,240 --> 00:26:48,800 guidelines for how much salt to get is some somewhere between 4 467 00:26:48,800 --> 00:26:52,640 and 8g. So 4000 or 8000 milligrams a day 468 00:26:52,840 --> 00:26:58,200 of of salt again, like sounds easy, but realistically like 469 00:26:58,360 --> 00:27:01,800 again, that can come with bloating that can come with, you 470 00:27:01,800 --> 00:27:05,080 know, people feeling like extra swollen in their in their limbs 471 00:27:05,080 --> 00:27:07,960 and stuff. So you have to do it, but the 472 00:27:07,960 --> 00:27:11,480 reality is, is a lot of times that's not enough for patients. 473 00:27:12,240 --> 00:27:16,720 So why salt? Like what does that do for pots? 474 00:27:17,080 --> 00:27:21,240 So salt keeps basically all the water you drink in your blood. 475 00:27:22,800 --> 00:27:25,760 It basically just like, yeah, it takes all the water that you 476 00:27:25,760 --> 00:27:29,600 have that you drink and it keeps it in your blood volume and it 477 00:27:29,800 --> 00:27:31,600 it increases that. So right. 478 00:27:31,600 --> 00:27:34,240 Like that's why it caused, it can cause high blood pressure 479 00:27:34,240 --> 00:27:37,920 for patients, for people that have excessive salt, because 480 00:27:37,920 --> 00:27:41,280 it's like you're increasing that blood volume to much and there's 481 00:27:41,280 --> 00:27:43,120 a whole physiologic change that happens. 482 00:27:43,120 --> 00:27:47,240 But but again, like one of the versions of POTS is hypovolemia, 483 00:27:47,240 --> 00:27:50,320 low blood volume. And so salt increases that. 484 00:27:51,280 --> 00:27:52,880 Interesting. OK, I never knew. 485 00:27:52,880 --> 00:27:56,960 I just like, OK, I'm gonna take my element in my water every 486 00:27:56,960 --> 00:27:58,200 day. That's nice. 487 00:27:58,600 --> 00:28:00,840 I know. Yeah, that's make me thirsty. 488 00:28:01,280 --> 00:28:02,760 I know. Way to go. 489 00:28:02,760 --> 00:28:06,040 You have your Owallas and Stanley's or Yetis that's 490 00:28:06,280 --> 00:28:07,440 important. Yeah. 491 00:28:08,800 --> 00:28:11,600 So fluid salt important for POTS. 492 00:28:11,600 --> 00:28:14,800 Third intervention is compression, specifically 493 00:28:14,800 --> 00:28:21,400 abdominal compression is the is a You don't do that. 494 00:28:22,280 --> 00:28:24,400 You're making me look bad. I don't know. 495 00:28:24,400 --> 00:28:25,880 It's not your fault. It's me. 496 00:28:25,960 --> 00:28:29,000 I'm sure you told me. Yeah, compression again, like 497 00:28:29,000 --> 00:28:32,680 because when we stand up and the heart rate goes up, you have a 498 00:28:32,680 --> 00:28:36,640 shift of blood that basically like kind of pools and where it 499 00:28:36,640 --> 00:28:40,880 pools is in the vessels of your of your abdomen, specifically 500 00:28:40,880 --> 00:28:43,760 the splank neck vessels. So, so compression on the 501 00:28:43,760 --> 00:28:47,760 abdomen literally just like pushes it back up and that's. 502 00:28:47,760 --> 00:28:49,200 So what do you? How do you do that? 503 00:28:49,320 --> 00:28:52,240 Yeah, So honestly, the easiest thing is like shapewear. 504 00:28:52,560 --> 00:28:57,000 So my teenage patients love to be like, that means I can get 505 00:28:57,200 --> 00:29:00,880 Skims or whatever, like compression tanks they are 506 00:29:00,880 --> 00:29:05,320 Lululemon or whatever, like all those fancy compression leggings 507 00:29:05,320 --> 00:29:07,600 they like. But yeah, that that's literally 508 00:29:07,600 --> 00:29:09,200 it. So you can do garments like 509 00:29:09,200 --> 00:29:11,800 that. You can get abdominal binder or 510 00:29:11,800 --> 00:29:16,240 a waist trainer. It's called a little bit of, I 511 00:29:16,240 --> 00:29:19,520 don't know, pressure right here. Yeah, interesting. 512 00:29:19,520 --> 00:29:20,480 I didn't know that. OK. 513 00:29:21,360 --> 00:29:24,400 Corset. I also like the yeah corset. 514 00:29:25,320 --> 00:29:28,560 Don't compression socks Do those help too? 515 00:29:28,560 --> 00:29:31,040 Yeah, or not. Those help, which is like 516 00:29:31,040 --> 00:29:34,000 circulation in general. And yeah, if you can tolerate 517 00:29:34,240 --> 00:29:37,120 they'll, they'll help to an extent. 518 00:29:37,240 --> 00:29:43,280 They won't be as like dramatic game changer usually symptoms 519 00:29:43,280 --> 00:29:45,520 for patients. But yeah, like in in the long 520 00:29:45,520 --> 00:29:49,480 run and if you can tolerate that day-to-day that'll be good that 521 00:29:49,480 --> 00:29:51,520 I mean that will help with your with your symptoms. 522 00:29:52,000 --> 00:29:53,360 OK. So how does wait? 523 00:29:53,360 --> 00:29:56,480 How does a compression socks help with it? 524 00:29:56,800 --> 00:29:59,920 If it's like because of your explanation of like, the abdomen 525 00:29:59,920 --> 00:30:02,120 made pulling. Yeah, yeah, same. 526 00:30:02,120 --> 00:30:04,640 It's the same thing, right, Because because blood like sort 527 00:30:04,640 --> 00:30:07,240 of pulls down in in the extremities then there's like 528 00:30:07,240 --> 00:30:10,720 some some like triggering of the the nerves in the lower 529 00:30:10,720 --> 00:30:13,360 extremities to make the blood flow go as well. 530 00:30:13,720 --> 00:30:19,240 It is fluid salt compression are you know the, the you know 531 00:30:19,400 --> 00:30:23,080 easiest if you will things for people and it's it's really just 532 00:30:23,080 --> 00:30:26,400 like it's fighting gravity. The 4th 1 and the this is the 533 00:30:26,400 --> 00:30:30,200 hardest one to sell. 4th intervention is exercise. 534 00:30:31,520 --> 00:30:35,600 It's not an easy thing to do with POTS because you already 535 00:30:35,600 --> 00:30:41,040 have a high heart rate, but there are lots of protocols out 536 00:30:41,040 --> 00:30:44,280 there. There are lots of ways to modify 537 00:30:44,280 --> 00:30:50,000 how you exercise to make it make it more tolerable for you. 538 00:30:50,000 --> 00:30:53,520 Pool is great. I mean, the pool is, again, like 539 00:30:53,520 --> 00:30:56,240 even that little bit of pressure on the abdomen from the water 540 00:30:56,600 --> 00:31:00,240 and the swimsuit, you know, can. Yeah, can help symptoms. 541 00:31:00,240 --> 00:31:03,240 I had to when I was taking classes at the gym. 542 00:31:03,720 --> 00:31:06,480 I learned pretty quickly that burpees are not my thing. 543 00:31:06,600 --> 00:31:09,680 I can't do it because it's because you're up and down so 544 00:31:09,680 --> 00:31:15,640 fast and, and that's like, you know, main part of POTS as well 545 00:31:15,640 --> 00:31:17,320 as like getting up too fast and whatnot. 546 00:31:17,320 --> 00:31:20,480 I think too. So I had to modify that. 547 00:31:20,760 --> 00:31:23,840 And I think cardio in general is hard for me. 548 00:31:23,840 --> 00:31:27,600 And I don't know if that's normal or if that's like, is it 549 00:31:27,640 --> 00:31:31,320 good for people that have POTS to do extensive cardio? 550 00:31:32,080 --> 00:31:35,280 Under supervision, I mean, is it safe? 551 00:31:35,400 --> 00:31:40,160 Yes, I would say it's safe. It will can, could they be 552 00:31:40,160 --> 00:31:42,520 pretty symptomatic afterwards? Totally. 553 00:31:42,520 --> 00:31:47,680 So following the protocols and do slow, gradual work your way 554 00:31:47,680 --> 00:31:52,480 up to to doing, you know, kind of heavier cardiovascular 555 00:31:52,480 --> 00:31:57,360 exercises you can get there. But if you're brand new Potsy 556 00:31:57,360 --> 00:32:00,560 and I say go exercise, like no, I'm not saying you're going to 557 00:32:00,560 --> 00:32:04,720 go run on the treadmill for 30 minutes, like you will crash and 558 00:32:05,840 --> 00:32:07,680 crashes. The word that that they use 559 00:32:07,680 --> 00:32:10,560 where it's like it overexerts them too much and then they'll 560 00:32:10,560 --> 00:32:13,480 be like sleepy and tired for three or four days afterwards. 561 00:32:13,600 --> 00:32:18,560 So it's I prefer to utilize like other specialties to to help 562 00:32:18,560 --> 00:32:22,160 teach patients how to do that. But anything that's like core 563 00:32:22,160 --> 00:32:28,000 lower body strengthening along with gradual increase in 564 00:32:28,000 --> 00:32:31,640 cardiovascular, you know, exercise like that. 565 00:32:32,400 --> 00:32:36,240 Maybe like yoga like. I was just going to say so 566 00:32:36,240 --> 00:32:40,120 before this is about yoga. Yeah, we both really like and I 567 00:32:40,120 --> 00:32:45,320 think it is that it doesn't. It's still, it's, it's like a 568 00:32:45,320 --> 00:32:49,440 workout, you know, for sure. But you don't get like overly 569 00:32:50,040 --> 00:32:53,360 high heart rate, sweaty necessarily. 570 00:32:53,920 --> 00:32:57,440 Yeah, I think that that at least for me, that fits, really it 571 00:32:57,440 --> 00:33:00,080 fits a lot better for my lifestyle. 572 00:33:01,000 --> 00:33:04,720 Yeah, totally. Yoga can be can be triggering 573 00:33:04,720 --> 00:33:07,160 for some patients because with downward dog and stuff like it 574 00:33:07,160 --> 00:33:11,880 can be the I know yeah, but a lot of it is is on the floor, 575 00:33:11,960 --> 00:33:13,640 right. Most, I mean, it's on the floor, 576 00:33:13,640 --> 00:33:16,520 but like some of it is what we call soup pioneer, like laying 577 00:33:16,520 --> 00:33:19,400 on your back and that's really tough. 578 00:33:19,600 --> 00:33:23,520 Honestly, floor Pilates, reformer Pilates, those are 579 00:33:24,120 --> 00:33:26,560 those are great. Yeah, you do Pilates, don't you? 580 00:33:27,240 --> 00:33:31,760 Yeah, yeah, it's, it's definitely a important thing 581 00:33:31,760 --> 00:33:34,840 because there's also a lot of breath control and there's a 582 00:33:34,840 --> 00:33:39,280 whole science of, of the vagus nerve and and how our breathing 583 00:33:39,280 --> 00:33:42,120 and diaphragmatic breathing contribute to POTS and symptoms 584 00:33:42,120 --> 00:33:46,240 and whatnot. So how we breathe during 585 00:33:46,240 --> 00:33:50,320 exercise even day-to-day will help symptoms as well. 586 00:33:51,200 --> 00:33:54,080 So fluid salt, exercise, compression. 587 00:33:54,960 --> 00:33:58,000 Those are the big ones. Those are the big ones that that 588 00:33:58,000 --> 00:34:02,160 people need to sort of have in their reptoire, sort of, yeah, 589 00:34:02,280 --> 00:34:05,600 the pots, one-on-one stuff. That needs to be the norm for 590 00:34:05,600 --> 00:34:09,920 people that have it OK. But then then comes me, right? 591 00:34:09,920 --> 00:34:13,360 And that's like, like primary care providers can, can learn 592 00:34:13,360 --> 00:34:16,600 sort of the basics for patients with POTS and, and start that. 593 00:34:16,639 --> 00:34:21,840 And but then like clinicians need to sometimes help with, 594 00:34:21,920 --> 00:34:25,920 with medications. So the reality is for a lot of 595 00:34:25,920 --> 00:34:31,880 people, they also need some pharmacologic help too. 596 00:34:32,400 --> 00:34:36,000 Like what? Or yeah, so it kind of depends 597 00:34:36,000 --> 00:34:39,520 on the type of pots you have. I like to do that. 598 00:34:39,920 --> 00:34:44,960 So there's, there's medications out there that help similar to 599 00:34:44,960 --> 00:34:49,520 salt, like help retain the the fluid in your blood and in your 600 00:34:49,520 --> 00:34:52,639 vasculature. There are some that actually 601 00:34:52,639 --> 00:34:59,080 slow down the the heart rate. Beta blockers are a big one that 602 00:34:59,080 --> 00:35:01,400 we use like Propranolol. Is that a? 603 00:35:01,840 --> 00:35:02,320 Yeah. OK. 604 00:35:02,880 --> 00:35:06,880 Yeah, I have that. I also took that for migraines 605 00:35:06,880 --> 00:35:09,400 before. Yeah, it didn't help me, but you 606 00:35:09,400 --> 00:35:11,560 know. It didn't familiar that I'm 607 00:35:11,560 --> 00:35:14,640 always like, if I have patients who have both POTS and 608 00:35:14,640 --> 00:35:16,440 migraines, I'm like. Let's try this. 609 00:35:16,440 --> 00:35:18,920 Maybe we can. Get one if you have anxiety. 610 00:35:20,680 --> 00:35:21,640 There. You go. 611 00:35:22,120 --> 00:35:28,240 Exactly, I lost a beta blocker. We have to use caution of 612 00:35:28,240 --> 00:35:29,320 course. Like that's just not a 613 00:35:29,320 --> 00:35:31,040 generalized statement. Everyone should be on beta 614 00:35:31,040 --> 00:35:32,960 blockers because blood pressure stuff too. 615 00:35:33,480 --> 00:35:37,400 There are ones that constrict vessels too, like especially 616 00:35:37,400 --> 00:35:40,520 patients who do have also have low blood pressure when they 617 00:35:40,520 --> 00:35:43,400 stand up, they it will like just squeeze them. 618 00:35:43,400 --> 00:35:46,640 So then it pushes the the blood back up to the brain. 619 00:35:46,960 --> 00:35:48,880 There are ones. The name of those? 620 00:35:49,360 --> 00:35:51,400 Sorry, like what do you call those? 621 00:35:51,480 --> 00:35:54,120 Mitadrine is a big one that we use. 622 00:35:54,640 --> 00:36:00,000 It is, yeah, I, it works specifically on like narrowing 623 00:36:00,000 --> 00:36:02,120 the blood, the blood vessels peripherally. 624 00:36:02,120 --> 00:36:06,760 So it like it's, it works on the alpha adrenergic block receptors 625 00:36:06,760 --> 00:36:08,560 and and it it you, Yeah. Those like this, yeah. 626 00:36:08,560 --> 00:36:12,600 Yeah, exactly. You know what those are? 627 00:36:13,440 --> 00:36:15,320 Yeah, no, I know. So, so that helps. 628 00:36:15,320 --> 00:36:19,640 There's there's a couple like non like off label use of some 629 00:36:19,640 --> 00:36:25,520 medications out there that work on the nervous system in a 630 00:36:25,640 --> 00:36:29,720 complicated way that mostly are like symptomatic and and like 631 00:36:29,720 --> 00:36:33,840 help people with other of the other like complications. 632 00:36:34,160 --> 00:36:38,760 So beta blockers, mitadrine, pyridostigmine is one of those 633 00:36:38,760 --> 00:36:43,400 that we use. Ivapidine is another one kind of 634 00:36:43,400 --> 00:36:47,120 the newer one that we're using that's really helpful that works 635 00:36:47,160 --> 00:36:48,840 on like the pacemaker of the heart. 636 00:36:48,840 --> 00:36:51,160 So it can bring your, your heart rate down. 637 00:36:51,880 --> 00:36:55,720 Lots of, I mean there's other ones out there that are really 638 00:36:55,720 --> 00:37:00,120 like off label use and sometimes we have to use multiple, right, 639 00:37:01,120 --> 00:37:05,760 depending on, on the patient. But the good thing is, is that 640 00:37:05,760 --> 00:37:09,480 like, like most of these medications are really safe to 641 00:37:09,480 --> 00:37:12,600 take long term. And you know, with the exception 642 00:37:12,600 --> 00:37:15,360 of like we need to do some electrolyte monitoring, 643 00:37:15,360 --> 00:37:17,520 potassium, stuff like that in some of them. 644 00:37:18,160 --> 00:37:22,040 But again, like, they're not too intimidating. 645 00:37:22,040 --> 00:37:27,840 I think of medications to to use and they they help a lot. 646 00:37:28,520 --> 00:37:32,040 People ask me if there's a cure. I was just gonna ask if there's 647 00:37:32,040 --> 00:37:35,320 ever, like, do you ever stop having pots? 648 00:37:35,520 --> 00:37:36,880 Yeah, yeah. I was curious about that as 649 00:37:36,880 --> 00:37:38,640 well. Which is the opposite weight 650 00:37:38,640 --> 00:37:41,320 pots and stop, STOP. OK, sorry. 651 00:37:42,000 --> 00:37:45,320 It's so. Funny, I like it. 652 00:37:46,560 --> 00:37:51,080 So, OK, what I tell patients is that yes, like you can sort of 653 00:37:51,080 --> 00:37:56,400 grow out of or you can live a life that mostly doesn't meet, 654 00:37:57,040 --> 00:37:58,800 you know, meet the criteria for POTS. 655 00:37:58,800 --> 00:38:02,840 You can you can manage it with lifestyle without medications 656 00:38:02,840 --> 00:38:05,680 and you can, you know, go on without it. 657 00:38:06,280 --> 00:38:09,840 And that's the goal is that we get patients to that state, 658 00:38:09,840 --> 00:38:11,760 right? So that they just don't need to 659 00:38:11,760 --> 00:38:14,400 see me because like, you know what to do, right? 660 00:38:14,400 --> 00:38:18,800 So that's where like the early intervention is key because like 661 00:38:18,800 --> 00:38:22,080 I said, it's female predominant, it's women of childbearing age. 662 00:38:22,320 --> 00:38:26,600 Many of the cases are like after menstruation in like the teenage 663 00:38:26,600 --> 00:38:30,520 years. So it's like, yeah, let's see, 664 00:38:30,520 --> 00:38:33,040 I've, I got a 16 year old in my office. 665 00:38:33,040 --> 00:38:36,040 Like, let's get the basics down. Let's make sure there isn't 666 00:38:36,040 --> 00:38:38,160 anything we're missing. But today I give you a treatment 667 00:38:38,160 --> 00:38:40,440 plan. And my hope is, is that like, 668 00:38:40,800 --> 00:38:44,040 you'll be able to live the rest of your like, meaningful adult 669 00:38:44,040 --> 00:38:47,320 life without having to, you know, have some, you know, have 670 00:38:47,320 --> 00:38:49,400 continued follow up. That doesn't happen all the 671 00:38:49,400 --> 00:38:51,680 time. I tell patients too that like 672 00:38:52,040 --> 00:38:56,600 you might go years without any symptoms of POTS and then like a 673 00:38:56,600 --> 00:38:59,920 knock on and would you get COVID or, or something like that? 674 00:38:59,920 --> 00:39:03,640 And then like symptoms are going to probably come back and 675 00:39:03,640 --> 00:39:05,960 you'll, you'll notice them as as well. 676 00:39:06,920 --> 00:39:11,040 So it's COVID that well, as an example, COVID is something that 677 00:39:11,040 --> 00:39:14,040 can trigger it. It's not the vaccine of the 678 00:39:14,040 --> 00:39:18,040 COVID vaccine. Is debated No, we really can't 679 00:39:18,040 --> 00:39:21,920 really we don't always you know know exactly what is the 680 00:39:21,920 --> 00:39:26,560 underlying like what caused it what causes it but a lot but we 681 00:39:26,560 --> 00:39:31,920 know that it's we think it is driven by an immune response. 682 00:39:31,920 --> 00:39:36,520 So whether you have, you know, when you get a vaccine, your 683 00:39:36,520 --> 00:39:41,640 your body is supposed to produce this immune response and it's 684 00:39:41,640 --> 00:39:45,800 sort of like maybe attacks maybe triggers these nerves in a 685 00:39:45,800 --> 00:39:50,360 certain way that we don't totally know great yet or have 686 00:39:50,360 --> 00:39:54,760 perfect way to to confirm, you know, confirm that. 687 00:39:55,000 --> 00:39:57,720 But yeah, it can be sort of from any insult. 688 00:39:57,760 --> 00:40:01,480 I I like to say insult. So that insult meaning like 689 00:40:01,920 --> 00:40:06,520 illness, right trauma, like physical, physical, emotional 690 00:40:06,520 --> 00:40:09,440 trauma is a big one really as well. 691 00:40:09,440 --> 00:40:13,040 Yes, that can that can cause that you know autoimmune. 692 00:40:13,400 --> 00:40:16,960 Disorders, some types of bleeding disorders, connective 693 00:40:16,960 --> 00:40:22,800 tissue disorders are other things that are even like a sort 694 00:40:22,800 --> 00:40:27,320 of type of allergy response is one that we see in patients too. 695 00:40:27,320 --> 00:40:31,960 So yeah, it can be triggered by a lot. 696 00:40:32,040 --> 00:40:33,120 Yeah, a lot. A lot of. 697 00:40:33,360 --> 00:40:35,800 Things. And we don't always know, you 698 00:40:35,800 --> 00:40:38,760 know, we just don't know. A lot of times my patients will 699 00:40:38,760 --> 00:40:47,120 say I was fine up until blank, up until I had mono or I, yeah, 700 00:40:47,120 --> 00:40:51,880 had COVID or, you know, had some kind of physical trauma or 701 00:40:51,880 --> 00:40:54,080 emotional trauma or something like that. 702 00:40:54,480 --> 00:40:57,800 So not to dissuade people from getting a vaccination, but just 703 00:40:57,800 --> 00:41:01,200 like there are multiple things that can trigger this 704 00:41:01,200 --> 00:41:03,160 essentially if you have it. Yeah. 705 00:41:03,560 --> 00:41:07,280 And in some cases, like patients who have connective tissue 706 00:41:07,280 --> 00:41:14,280 disorders that are genetically linked, usually I sort of say 707 00:41:14,640 --> 00:41:19,040 that chances are something would have probably triggered this for 708 00:41:19,040 --> 00:41:21,280 you. Like if it wasn't COVID it might 709 00:41:21,280 --> 00:41:24,480 have been something else. Like you have a propensity to to 710 00:41:24,480 --> 00:41:26,640 developing this. It would, yeah. 711 00:41:26,640 --> 00:41:29,720 It would happen at some point, one way or another, OK. 712 00:41:30,280 --> 00:41:32,920 And what exactly was a connective tissue disorder? 713 00:41:33,640 --> 00:41:35,920 Oh. Yeah, that's, that's probably 714 00:41:35,920 --> 00:41:39,880 the one that is most people we identify. 715 00:41:39,880 --> 00:41:42,800 Well, I should say I that I my patients is that I see a lot of 716 00:41:42,800 --> 00:41:44,800 patients who have connective tissue disorders. 717 00:41:44,800 --> 00:41:51,200 So basically what it means is that the collagen type portions 718 00:41:51,200 --> 00:41:57,280 of your body are genetically incorrect, right. 719 00:41:57,280 --> 00:41:59,640 So like so like hypermobility is a big one. 720 00:41:59,760 --> 00:42:06,120 So people who have yeah, yeah, yeah, hypermobile Alers Danlos. 721 00:42:06,680 --> 00:42:12,320 So it's the like your joints, you know, your your vessels, 722 00:42:12,320 --> 00:42:16,720 your like esophagus sort of the like hollow parts of your body 723 00:42:16,720 --> 00:42:19,680 are just are like more stretchy than they're supposed than 724 00:42:19,680 --> 00:42:26,160 they're kind of supposed to be. So it's like it takes more 725 00:42:26,160 --> 00:42:28,880 effort kind of to make those things work. 726 00:42:28,880 --> 00:42:33,840 So there's there's other types out there, but that is one of 727 00:42:33,840 --> 00:42:39,200 the more common. What we think is, is a cause, is 728 00:42:39,280 --> 00:42:42,000 it likely cause for people to have have pots? 729 00:42:42,560 --> 00:42:46,480 Interesting. So connective tissue means like 730 00:42:46,480 --> 00:42:49,040 the hollow parts or the like. What would you? 731 00:42:49,560 --> 00:42:51,720 Yeah. Well, there's, there's different 732 00:42:51,720 --> 00:42:56,200 types, yeah. But the ones that that I see are 733 00:42:56,840 --> 00:42:59,320 yes, like anything that's hollow in your body is sort of what we 734 00:42:59,320 --> 00:43:01,080 say, right. So swallowing your stomach, 735 00:43:01,080 --> 00:43:04,720 your, you know, your intestine, your blood vessels, you know, 736 00:43:04,760 --> 00:43:07,440 your those types of anatomical regions. 737 00:43:07,640 --> 00:43:10,400 But but right, there's joint like a lot, you know, joint 738 00:43:11,000 --> 00:43:12,920 elasticity, that kind of thing. I mean, there's connective 739 00:43:12,920 --> 00:43:14,520 tissue everywhere throughout your whole body. 740 00:43:15,120 --> 00:43:19,720 So like Katie, show your arm. I don't know, it doesn't help. 741 00:43:20,480 --> 00:43:22,760 Yeah, yeah. It goes, it goes out. 742 00:43:23,840 --> 00:43:27,720 Yeah, yeah. So like interesting, you know, 743 00:43:27,760 --> 00:43:28,680 it's. Pretty cool. 744 00:43:30,120 --> 00:43:32,960 Yeah. So that's I can tell when people 745 00:43:32,960 --> 00:43:35,680 walk in like new patients, like you have a connective tissue 746 00:43:35,680 --> 00:43:37,960 disorder. I can tell like this is you 747 00:43:37,960 --> 00:43:40,480 probably got this. Yeah, it's interesting. 748 00:43:41,200 --> 00:43:42,560 Yeah. And actually a lot of patients 749 00:43:42,560 --> 00:43:44,720 with connective tissue disorders also get migraines. 750 00:43:44,880 --> 00:43:49,840 So it's like all together. Fine times. 751 00:43:50,480 --> 00:43:54,560 I know, I know. That has to be so difficult with 752 00:43:54,560 --> 00:43:57,760 diagnosing stuff that like, I don't know, just like if you 753 00:43:57,760 --> 00:44:00,680 have multiple things and then it's like, how do you know what 754 00:44:00,680 --> 00:44:03,240 symptom is for what thing? And then I don't know. 755 00:44:03,240 --> 00:44:04,480 I just feel like it's complicated. 756 00:44:04,600 --> 00:44:08,040 It must be complicated. It's complicated honestly, like 757 00:44:08,040 --> 00:44:11,240 the best diagnostic tool is just listening to people. 758 00:44:11,240 --> 00:44:13,800 I mean, thank. You a lot for that, I love that. 759 00:44:14,360 --> 00:44:18,880 Yeah, like a lot of times people need to be believed, they need 760 00:44:18,880 --> 00:44:21,360 to be heard. They need to not say this is 761 00:44:21,360 --> 00:44:25,600 just in your head, this is, you know, this is just attention 762 00:44:25,600 --> 00:44:28,160 seeking. A lot of like, you know, when 763 00:44:28,160 --> 00:44:30,960 there's teens that can't get up in the morning because they're 764 00:44:30,960 --> 00:44:33,080 so symptomatic, they're like, well, she's just trying to get 765 00:44:33,080 --> 00:44:34,040 out of school. Like. 766 00:44:35,640 --> 00:44:38,760 You know, probably not right for for this case. 767 00:44:38,760 --> 00:44:45,240 So it takes a lot of not a lot. You just have to listen is 768 00:44:45,240 --> 00:44:49,800 really a big a big part of it. And unfortunately, like, you 769 00:44:49,800 --> 00:44:52,560 know, there's a little bit of a stigma out there that patients 770 00:44:52,560 --> 00:44:57,920 that have POTS are difficult that they like, you know, people 771 00:44:57,920 --> 00:45:00,040 are kind of intimidated by the science. 772 00:45:00,040 --> 00:45:04,560 So they clinicians I'm talking about are intimidated by the 773 00:45:04,560 --> 00:45:06,480 science. So they don't they they don't 774 00:45:06,480 --> 00:45:08,280 really want to learn. They're just going to say, I 775 00:45:08,280 --> 00:45:10,560 don't see this. It's that kind of thing. 776 00:45:10,560 --> 00:45:15,680 And my view is, is just, I mean, it's real medicine. 777 00:45:15,960 --> 00:45:21,160 It's a real thing that effects from real people and like it's 778 00:45:21,160 --> 00:45:24,600 sort of our duty to to investigate further. 779 00:45:24,600 --> 00:45:27,000 And if we don't know what to do with it, that's fine. 780 00:45:27,000 --> 00:45:28,880 You can like ask around cardiologist, 781 00:45:28,880 --> 00:45:33,480 electrophysiologist, neurology, somebody probably has at least 782 00:45:33,560 --> 00:45:36,680 heard of it if you're willing to listen. 783 00:45:38,080 --> 00:45:41,920 But it's a head to toe disorder. I've had the fortune of like 784 00:45:41,920 --> 00:45:46,200 going to a lot of medical meetings and hearing experts 785 00:45:46,200 --> 00:45:49,440 talk about it. And it's an intimidating sort of 786 00:45:49,440 --> 00:45:54,080 field of medicine because the symptom range is, is wide, 787 00:45:54,200 --> 00:45:56,080 right? It's like I said, I, we, I go 788 00:45:56,080 --> 00:45:58,680 head to toe with patients, tell me what you're feeling. 789 00:45:58,680 --> 00:46:02,840 And we have to utilize often more than one specialty. 790 00:46:02,960 --> 00:46:07,480 There isn't a, you know, A1 cure or one thing that that fixes it 791 00:46:07,680 --> 00:46:09,120 for patients. One-size-fits-all. 792 00:46:09,200 --> 00:46:11,200 Yeah, yeah. It's probably a combination of a 793 00:46:11,200 --> 00:46:14,360 lot of different things and it just depends person to person. 794 00:46:15,000 --> 00:46:17,320 Basically, Yep, totally, totally. 795 00:46:18,040 --> 00:46:21,320 I love it though, I think it's an interesting disorder. 796 00:46:22,320 --> 00:46:24,400 Agreed to. Clarify she doesn't love that 797 00:46:24,400 --> 00:46:26,480 people have it. You're right, you're right. 798 00:46:26,960 --> 00:46:29,920 I don't, I don't love it when people have it, but it is like 799 00:46:30,200 --> 00:46:33,640 super interested in it. It's interesting. 800 00:46:33,640 --> 00:46:38,000 It's interesting and like we're getting a lot more, you know, 801 00:46:38,000 --> 00:46:42,080 research and, you know, learning more about it and. 802 00:46:42,400 --> 00:46:46,200 And it's because it's, it's treatable. 803 00:46:46,920 --> 00:46:47,340 Yeah. Mm. 804 00:46:47,340 --> 00:46:50,280 Hmm. So and I feel like in the last 805 00:46:50,960 --> 00:46:53,440 how long? Like I feel like, and it's been 806 00:46:53,440 --> 00:46:57,480 around, but I think like it's become more of a conversation in 807 00:46:57,480 --> 00:46:59,840 the last like 10 years or so, would you say? 808 00:46:59,840 --> 00:47:06,200 Yeah, yeah, totally, totally. I mean, I started this practice 809 00:47:06,240 --> 00:47:13,360 in 2017 working in this field and like, I mean, I've been busy 810 00:47:13,360 --> 00:47:16,520 non-stop seeing patients. So it's definitely like picking 811 00:47:16,520 --> 00:47:21,320 up the pace. But at any given time, I mean, 812 00:47:21,320 --> 00:47:25,080 the wait list to to see a clinician is usually really long 813 00:47:25,080 --> 00:47:29,240 and the like I said, there's only like 54. 814 00:47:30,360 --> 00:47:34,040 That number might not be right, but around the 50 something 815 00:47:34,800 --> 00:47:38,360 autonomic neurologists that, you know, physicians that are 816 00:47:38,360 --> 00:47:43,280 trained in this type of neurology in the whole US So 817 00:47:43,280 --> 00:47:46,600 there's like not a lot, there's not a lot of testing centers. 818 00:47:46,680 --> 00:47:50,240 Yeah. So we need to like, raise 819 00:47:50,240 --> 00:47:55,520 awareness and spread the word. Yeah, that's why I kind of 820 00:47:55,520 --> 00:47:57,960 wanted to talk about this. Yeah, I wanted to talk about 821 00:47:57,960 --> 00:48:00,440 this because I think that, yeah, it's important. 822 00:48:00,560 --> 00:48:03,240 And I don't think, I don't think people are talking about it 823 00:48:03,280 --> 00:48:06,200 enough. That's right, it should be part 824 00:48:06,200 --> 00:48:10,920 of every clinician every like nurse, doctor, PA. 825 00:48:10,920 --> 00:48:15,960 They're like hyper fixation. Some point to like spend some 826 00:48:15,960 --> 00:48:19,520 time and learn about this 'cause you will see it in your in your 827 00:48:19,520 --> 00:48:21,200 practice. Yeah. 828 00:48:21,520 --> 00:48:26,680 And last question, for me at least, do you think that it 829 00:48:26,680 --> 00:48:31,360 hasn't been as well researched because it is mostly women 830 00:48:31,360 --> 00:48:33,280 'cause I think that that's something in the medical field 831 00:48:33,280 --> 00:48:37,360 that is a problem, that a lot of things that mostly affect women 832 00:48:37,360 --> 00:48:39,920 are not researched as much. Do you feel like that's? 833 00:48:39,920 --> 00:48:42,240 Again, migraines. Yeah, migraines. 834 00:48:42,440 --> 00:48:45,120 Yep. Yep, I, I think that's a huge 835 00:48:45,120 --> 00:48:48,320 barrier for it. A huge, huge barrier is, is that 836 00:48:48,360 --> 00:48:52,840 it's female predominant child bearing age it it can mimic 837 00:48:52,840 --> 00:48:55,720 symptoms of anxiety and a lot of people have that too, right. 838 00:48:55,720 --> 00:48:58,360 High heart rate, kind of sweating, feeling like you're 839 00:48:58,360 --> 00:49:02,680 going to pass out, nausea. You know, it mimics, mimics 840 00:49:02,680 --> 00:49:06,360 that. And both are real things, right? 841 00:49:06,360 --> 00:49:11,400 And they but, but they are different phenomenons that are 842 00:49:11,480 --> 00:49:14,480 happening. And people can have POTS without 843 00:49:14,480 --> 00:49:18,440 having anxiety. And so just, you know, treating 844 00:49:18,440 --> 00:49:23,400 it as if it's anxiety isn't going to be helpful. 845 00:49:23,920 --> 00:49:26,120 Yeah, interesting. OK. 846 00:49:26,600 --> 00:49:30,760 So yeah, females, I think that's a big part of it. 847 00:49:31,600 --> 00:49:34,760 Yeah, I believe it. That was really interesting. 848 00:49:34,760 --> 00:49:36,280 Thank you. I learned a lot even though I 849 00:49:36,280 --> 00:49:38,560 have it like. You're welcome. 850 00:49:39,040 --> 00:49:41,600 There's a lot going on with this, but. 851 00:49:41,680 --> 00:49:45,680 Yeah, yeah. It's, it's a really fascinating 852 00:49:45,680 --> 00:49:48,920 complicated science if you really like dig into it. 853 00:49:48,920 --> 00:49:53,600 But it's it can be life changing for people to just listen to 854 00:49:53,600 --> 00:49:59,000 them and, and help them with it. So yeah, chances are somebody in 855 00:49:59,000 --> 00:50:02,560 your circle has it right. Somebody you know has it. 856 00:50:02,560 --> 00:50:07,320 Somebody you you know, someone you know knows somebody who has 857 00:50:07,320 --> 00:50:09,760 it. But it's. 858 00:50:10,760 --> 00:50:14,800 Salt water exercise and. Fluid, salt, exercise, 859 00:50:14,800 --> 00:50:15,800 compression. Yeah. 860 00:50:15,800 --> 00:50:17,200 The compression, there we go. Yeah, OK. 861 00:50:17,600 --> 00:50:22,840 I like to add this is like my own little like pitch is, is 862 00:50:22,840 --> 00:50:25,400 that like breathing? So breath work, meditation, 863 00:50:25,400 --> 00:50:30,880 mindfulness, Tai chi, all of that like vagus nerve training 864 00:50:30,880 --> 00:50:34,800 is also crucial to add to that too. 865 00:50:34,800 --> 00:50:39,000 So again, like non drugs ways that we can, we can treat it. 866 00:50:39,800 --> 00:50:41,560 Yeah, yeah. Thank you. 867 00:50:41,560 --> 00:50:45,600 Guys for having me on this is definitely my career and passion 868 00:50:45,760 --> 00:50:48,400 and. I was like, I can speak to this, 869 00:50:48,400 --> 00:50:50,840 but I know somebody who can speak to this a lot better than 870 00:50:50,880 --> 00:50:53,720 I can. Yeah, I was going to say that 871 00:50:53,720 --> 00:50:55,360 like you were going to talk about something medical. 872 00:50:55,360 --> 00:50:57,080 I told you my guess is at the beginning. 873 00:50:57,080 --> 00:51:01,400 And like one thing is migraines is on my list of possible 874 00:51:01,400 --> 00:51:04,640 topics, but like I haven't even gotten close to touching it yet 875 00:51:04,640 --> 00:51:08,480 just because it's like I feel scared talking about something 876 00:51:08,480 --> 00:51:10,520 medical when I'm not a medical professional. 877 00:51:10,520 --> 00:51:13,080 Like I don't want to. Like, I do know a lot and I'm 878 00:51:13,080 --> 00:51:16,480 sure that it would be accurate, but it's like, I don't know. 879 00:51:16,480 --> 00:51:18,920 I just feel scared talking about it when it's not my profession. 880 00:51:18,920 --> 00:51:22,240 So I'm happy that you were here today because it is your 881 00:51:22,240 --> 00:51:24,680 profession so. Thank you. 882 00:51:25,040 --> 00:51:29,600 Well and just remember that like even if what you share and you 883 00:51:29,800 --> 00:51:33,960 say is not like from a textbook and a peer reviewed journal, 884 00:51:33,960 --> 00:51:36,000 it's true. It's what you experience and 885 00:51:36,000 --> 00:51:38,280 that that's what, what your journey is like. 886 00:51:38,280 --> 00:51:43,640 And people resonate with other people going through struggles, 887 00:51:43,640 --> 00:51:45,840 struggles like that. And it's comforting to know that 888 00:51:45,840 --> 00:51:47,800 others are are going through it too. 889 00:51:47,800 --> 00:51:50,600 So I would encourage you to, yeah, Share your story. 890 00:51:52,280 --> 00:51:54,800 Thank you guys for having me. I love that I could be like the 891 00:51:54,800 --> 00:52:01,800 1st guest. 1st guest and yeah, this goes out to, you know, any 892 00:52:01,800 --> 00:52:03,480 other friends and family members. 893 00:52:03,480 --> 00:52:06,480 If you want to have a guest spot with us, just let us know. 894 00:52:06,480 --> 00:52:09,040 We want to hear what you guys are, you know, hyper fixated on 895 00:52:09,040 --> 00:52:10,040 as well. It's interesting. 896 00:52:11,760 --> 00:52:12,840 Yeah, bring it on. It's fun. 897 00:52:13,240 --> 00:52:14,600 I hate it. I. 898 00:52:14,600 --> 00:52:18,160 Loved it, that was a lot of fun. Thank you so much for being our 899 00:52:18,160 --> 00:52:21,200 first guest. That's it for this week's Rabbit 900 00:52:21,200 --> 00:52:24,360 hole. I guess I should give a clue for 901 00:52:24,360 --> 00:52:26,880 next week. My clue is that it has to do 902 00:52:26,960 --> 00:52:30,720 with music, which is why I skipped it the other week. 903 00:52:30,920 --> 00:52:33,000 Katie has no idea what we're talking about right now, but. 904 00:52:34,240 --> 00:52:36,480 I'm a follower. I know, but these episodes 905 00:52:36,480 --> 00:52:38,080 haven't come out yet that we're talking about. 906 00:52:39,000 --> 00:52:40,400 We're ahead. We're ahead of schedule. 907 00:52:40,400 --> 00:52:43,240 I'll be surprised we're ahead. So yeah, it's going to be it has 908 00:52:43,240 --> 00:52:44,640 to do with music. So that's my clue. 909 00:52:44,720 --> 00:52:47,640 But let us know everybody what you're hyper fixated on. 910 00:52:47,680 --> 00:52:51,520 Let us know in the comments, send us Adm or an e-mail and 911 00:52:51,520 --> 00:52:54,440 maybe your obsession will make it into a future episode. 912 00:52:54,720 --> 00:52:58,240 But until then, embrace the spiral, stay curious and we'll 913 00:52:58,240 --> 00:53:00,880 see you next time. Bye bye.