What is POTS?

Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia that is estimated to impact over 1,000,000 Americans, and millions more around the world(1). POTS is a form of orthostatic intolerance that is associated with the presence of excessive tachycardia and a drop in blood pressure upon standing. Current diagnostic criteria is a heart rate increase of 30 beats per minute (bpm) or more, or over 120 bpm, within the first 10 minutes of standing (1,2,3,4,8). The gold standard test for diagnosis is the Tilt Table, although bedside measurements conducted by a physician are of option as well.

Now that you know about POTS. Let me tell you a real story, my story.

POTS Trigger

I remember that night as if it were yesterday. I went to bed for the last time as a healthy overachieving active fifteen-year-old. I had scary dreams that I was ill. I remember feeling like I couldn’t catch a break. When I woke up the next morning; I thought I was victim to a restless nights sleep and wired brain. But what I came to find was those dreams were real. I was now ill.

I remember walking out of my bedroom, simply following my morning routine to find my Mom cooking breakfast in the kitchen. I asked that she take a look at my back; I sensed her hesitation. She immediately asked how I was feeling and instructed me to go lay down on the couch until breakfast was ready. I found her response to be odd, but I did so anyways, scanning the news for what to wear for school that day.

Not long after I had laid down on the couch, her hesitation was validated. I was dog tired. I felt like an elephant was sitting on top of me. I lifted my shirt to unveil my abdomen and hives larger then my fist. Every morning for five days my parents drove me to the local clinic. I had developed pleurisy, swollen extremities, joint pain, additional hives, extreme weakness and fatigue. Blood work was done, markers indicated negative readings.

I knew my physician felt helpless. You could see it in her eyes. We kept doing testing and as weeks started to pass, I felt like whatever this was, was my new norm. I was glued to the recliner. I couldn’t breath, my chest hurt, my blood vessels were non existent. I was missing school, sports and my friends. Depression started to set in.

Then, luck knocked at the door. Another Pediatric Physician shared with my parents that he had been in the know of their daughter (me) “the mystery patient”. He happened to attend a symposium that talked of this misunderstood syndrome called POTS. With permission he would like to examine me and encouraged that we seek treatment at Mayo Clinic in Rochester, Minnesota.

Of course my parents gave consent. We booked an appointment. Four months later I was in the “land of 1o,000 lakes” staying on Mayo Clinics campus in Rochester, Minnesota.
Not the way I thought I’d spend Easter that year, but I’d take it.

POTS Diagnosis

To this day, many doctors and patients are unable to label the cause for POTS. Some individuals are labeled as “Primary” POTS with no other identifiable medical condition (also known as “idiopathic” POTS). “Secondary” refers to POTS with the presence of another medical condition known to cause or contribute towards POTS symptoms(1). This syndrome has no prejudice against age, gender or race. Statistics show that roughly 80% of patients are female between the ages of 15 and 50(2). At the time in 2005, I was 15-years-old and I was 1 in 5 in Michigan to be diagnosed.
The complex symptoms of POTS include:

• hypovolemia (low blood volume)
• increased sympathetic nervous system activation
• fatigue
• headaches
• lightheadedness
• heart palpitations
• exercise intolerance
• nausea
• diminished concentration
• brain fog
• syncope (fainting)
• coldness or pain in the extremities
• chest pain
• shortness of breath

For my specific situation, lets begin my shedding some light on my experience at Mayo. The capacity and shear size of this academic medical center easily breathed new life into my fatigued body. Mayo Clinic was welcoming from day one. If I could summarize the staff in one word. It’d be compassionate. I didn’t feel alienated there. I felt believed. I felt for the first time in a long time a sense of normalcy. I didn’t feel like a subject but rather a possibility for healing.

This time around, the tests were hands on. I was riding bikes (wingate testing), running on treadmills (stress testing), I had a heart rate monitor attached to my hip for all of it, I did pulmonary function testing and the most interesting one of all was the Tilt Table test.

That Tilt Table test, solely gave me my answers I had long been waiting for. I recall the technician encouraging me to relax. What I think she read as possible anxiety on my face really was a large amount of curiosity. I began asking questions, why the numbers were changing, what the dial meant etc. She happily answered. As my heart rate began to rapidly increase and blood pressure dramatically dropped she offered comforting words and offered a heads up that I may soon pass out . This amazed me. I was in a controlled setting, with talented medical professionals. I felt safe and believed. My vitals were showing everything I had been dealing with, felt and cried over for the past several months. The test was done. Ding ding ding. We have a POTS patient.

That office visit was one of the best conversations I have had with another human being in my lifetime to date. Dr. Fischer said, “I know what you have Kaitlin.” (ew, full name). I nearly fell off my seat…He proceeded by saying, “but before I tell you I need to ask you a few more questions.” I could have strangled the man. I knew he had the answers for me in his tidy manila folder. Yet he questioned “why I wanted to heal?” “How the past five months had been for me?”. I kept the answers short. “because I want to get back to my life” “it’s been a big change, I don’t feel good, I want to get better”. He responded with okay Kaitlin (full name sounded again so uncomfortably formal) are you ready to know what you have? Insert strangle. “POTS. You have a syndrome called POTS”.

I started crying. I didn’t know what he said just meant. But it was an answer. It was the beginning to a new chapter. One we had long been waiting for.

Mayo Clinic Held the Answers

Each individuals conditioning and health differs to which modes of treatment is most suited. Consulting with a physician who specializes in autonomic disorders is necessary. Modes of treatment include pharmacological, non-pharmacological or a mix of both (1,2)

The most common treatments include:

• Increasing fluid intake to 2-3 liters per day
• Increasing salt consumption to 3,000 mg to 10,000 mg per day
• Wearing compression stockings
• Raising the head of the bed (to conserve blood volume)
• Reclined exercises such as rowing, recumbent bicycling and swimming
• A healthy diet
• Avoiding substances and situations that worsen orthostatic symptoms
• The addition of medications meant to improve symptoms such as Fludrocortisone, Beta Blockers, Midodrine, Clonidine, Pyridostigmine, Benzodiazepines, SSRIs, SNRIs, Erythropoietin and Octreotide (1,2).

For my specific situation, According to Dr. Fischer I had acquired an unidentifiable virus that had overwhelmed my body and sent my autonomic nervous system (ANS) to dysfunction. “The good news is, you can exercise. It won’t be easy, but you can exercise.” I heard the word exercise and I immediately interrupted saying, “When can I start?” The test results he had at hand reflected my previous fitness level and health status prior to becoming ill, even with POTS now tossed into the mix I responded well to testing. My doctor new I liked to be active, he knew I liked a challenge.

He proceeded to tell me there were two lines of treatment. I had the option of medication. I could take a beta-blocker and/or follow a holistic line of treatment that would involve a high sodium diet and frequent exercise. I zoned in on the holistic route as my Mother took notes on medication options. It was then he summoned the nurse in to go over my plan in detail.

My nurse Dawn, was amazing. Her bed side manner was relatable, grounded and positive. I still have her drafted plan. She wrote my program outline in pen on a hot pink of 8×11 piece of paper. Like it was nothing to stress over. Just do it type of attitude and with time and patience you will be on your way kind of thing.

The plan read just as I have typed below:

• 1) Coping*School: carry water with you at all times. Take beta blocker to help put balance back 1 tablet in AM and 1 tablet at Noon. Seek therapy if necessary.
• Controlling Exercise: Upright, sustained and vigorous. 10 min, 6days/wk. Increase 1-2 min per week (good week increase exercise duration, bad week stay the same). Goal is 30 min of aerobic activity. Include 25 each of tiptoe, squats and arm curls (stand against wall for posture).

*Fluids: At least 2 liters. Non-caff. Water, Gatorade, Powerade, Propel

*Salt: LOTS! Pizza, Pickles etc3) Cure – Time & Patience.

Life with POTS

Currently there is no cure for POTS. The most recommended advice given is time, patience and compliance. Some patients have fairly mild symptoms and can continue with normal work, school, social and recreational activities. Some claim to grow out of the syndrome. For others, symptoms may be so severe that normal life activities, such as bathing, housework, eating, sitting upright, walking or standing can be significantly limited(1). Approximately 25% of POTS patients are disabled and unable to work (3).

For my specific situation, Mayo Clinic had given me hope and the tools I needed for an independent future. That flight from Minnesota back to Michigan was a moment in time.
Now, I felt like I was finally headed into the unknown with a sense of direction. I was going to exercise. I was going to eat salt. I was going to be put to the test. I was going to heal.

Once we arrived home my family and I created a new norm. I followed a strict schedule with nutrition, sleep and scheduled exercise six days of the week. I went back to school. Slowly. We started with half days. We found out quickly that my nervous system wasn’t in agreeance as much as we’d hoped it would be. I found at times I would function great for three days and then fall back into a lull for three more. Nonetheless, I remembered what my doctors had said, time & patience. So, I kept pushing forward.

My new high school norm was :

• Frequent visits to the office for salty snacks
• Frequent visits to the sick room to lay down in the dark
• Frequent visits to the bathroom
• Frequent absence from class
• Frequent at home learning, teach myself learning, frustrated learning.
• Frequent absence from sports teams.

The biggest challenge was balancing stress levels. In addition to undergoing the stress of ANS dysfunction daily, I had to face acceptance of losing all hopes of teenage normalcy (if that is even a thing?). Ask any adolescent. Stress is their middle name. From biological, physiological and even emotional variables and factors adolescents are riding a constant wave of change. It is quite the balancing act. Then toss this complex syndrome into the mix. Tachycardia, fainting spells, cognitive dysfunction, poor circulation, heat intolerance and fatigue were a common occurrence.

I learned that I had to keep a pro-active mindset to keep symptoms at bay. I referenced that pink sheet my nurse had drafted frequently. Salting foods and trying to introduce appropriate autonomic function via exercise. I was given access to a few POTS support groups but found them to lack the positive support and knowledge I was looking for to heal (keep in mind this was in 2006, social media has much more to offer now). I had no certified coach or trainer to guide me through mindfulness, to coach me through exercise bouts or check in on nutrient intake. What I had was, Mom.

My Mom gained several new rolls just as quickly as I did. She was a constant reminder to stay prepared, not to forget x,y,z but most importantly she was there when I couldn’t be. During the lowest of the lows. Needless to say, I had support; I wasn’t in this alone.

I made a pact with myself to not take a single day for granted . This pact became my why, my promise to myself that kept me motivated to adhere to my daily schedule to heal, to stay positive and to re-train my ANS into full function. This wasn’t my life as I knew it; there was more. During my sophomore year (prior to my diagnosis) I had gained attention from college basketball recruits. The memory of meeting scouts at games still tugs at my heart strings. Apparently, to them I was someone worth watching at age 15. I was still going to keep their attention and play, I had two years to train to recover and train to play ball.

Exercise

Physical reconditioning with regular exercise is the cornerstone of treatment for POTS (Sheldon et al., 2015) especially in the chronic state when physical disability has been compounded by cardiovascular deconditioning. A structured exercise program featuring endurance (aerobic) reconditioning with some resistance (strength) training for
the lower body described below in detail is recommended for patients with POTS, and supervised exercise training is preferable to maximize functional capacity in these patients (6). Exercise routines must be customized for each patient. It is important to find an exercise option the patient can enjoy, tolerate and keep up with (8).

For my particular situation, after having been granted physician consent to exercise didn’t mean I was handed a clean bill of health to get up and go. Some days walking to the front door and back was enough. Some days sitting up in bed wasn’t an option. Some days I could run. I learned to not question the pattern of this, but to focus on what I could offer my body. Consistent stimulation to encourage appropriate ANS function via exercise.

To ensure I was exercising in the prescribed target heart rate zones Mayo Clinic prescribed, I purchased a polar heart strap and watch. This tool aided my efforts in improving accuracy of each exercise session I endured. If my heart was beating too fast my watch would beep. If I wasn’t pushing my heart hard enough it would beep. If I was pushing myself just right all I could hear was repetitive breathing thanks to my healthy heart and lungs. Pure bliss. I recognized this as a guaranteed step away from deconditioning and one step closer to optimal ANS function.

During my Junior year my parents and I decided that my symptoms were too unpredictable to dedicate myself to a team just yet. I needed to dedicate myself to a competition of my own, to beat POTS and re-gain my quality of life. I poured my competitive, driven and athletic body into the weekly grind. My training calendar consisted of adequate meals, salt, fluids, appropriate sleep and exercise. Alternating the daily minimum of mile walks/runs that eventually led to running the country block (4 miles) 5-6 days a week.

A few teammates registered in a local 5k with me the summer prior to my Senior year. I won my age division. Crossing that finish line was such an emotional victory. I recall my Mom and Aunt crying. That accomplishment told not only myself, but my loved ones and my community that my mental and physical health had made leaps and bounds. I was going to be present on that basketball court my senior year of high school. I had accepted that challenge at Mayo to heal holistically and I did it.

Managed Symptoms

Many individuals find that medication aids in regulating symptoms. In addition, adapting appropriate behaviors such as adhering to a routine, dietary habits, exercise and leading a low stress life leads to a higher quality of life.

For my specific situation, every day counted. I became self regulated. I now was a basketball player who loved to run, I had a new insight into my work ethic, friendships, and the value of time. My sweet sixteen, exams, drivers training, prom, homecoming etc. were milestones of my high school career that I didn’t fall absent to. I passed my drivers test; I danced the dances. I played my Senior year of Varsity sports. Wearing a jersey that year held a whole new meaning then belonging to a team. It symbolized accomplishment, health, freedom and a new normalcy.

Flourishing with POTS

I have been privileged to get to know many individuals around the world with POTS. Some identify as Moms, coaches, bodybuilders, students and even disabled. All of these individuals have their own medical history and profile of health. They are each fighting the fight and are not to be compared to one another. What they all have in common is they combat POTS with modalities that work for them to achieve their optimum quality of life. From sodium, IVs, liquid IVs, ports, water intake, meditation, exercise, physical therapy, etc.

For my particular situation, I graduated high school hopeful for the future. Rarely experiencing symptoms I set off for Michigan State University. It didn’t take me long to make a phone call though. It was to a scout in Holland, Michigan. He surprisingly accepted the idea of taking me in as a sophomore for the 2009/2010 basketball season at Hope College. I spent the spring and summer of 2009 conditioning. I was running 2-3 times a week, another 2 days a week were devoted to lifting/cross-training on top of basketball drills. That fall I transferred and played collegiate basketball. What an awesome experience.

No one knew I had POTS on my team. Why? I didn’t feel the need to share that traumatic experience and to be honest, I wasn’t symptomatic at the time. I pushed my body and took my talents to new places. However, the end of season I started to experience tachycardia. After chatting with my Mom, she encouraged me to reach out to my nurse Dawn at Mayo Clinic. I recall leaving a psychology lecture, scrolling through my contact list for “Nurse Dawn” (that’s how awesome the staff is at Mayo Clinic; I had her cell) and clicked call.

It had been four years since I was in her office, but she remembered me. She was shocked to hear that I had actively participated in a season of collegiate basketball. After we discussed my experience she offered the science/reasoning for the increase in symptoms. The biggest takeaway was basketball is an anaerobic based sport. Due to the lack of steady state cardio my ANS wasn’t receiving the appropriate aerobic stimulation needed to achieve/maintain a homeostatic response. Also, the demanding schedule of practice and travel caused an increase in unwanted stressors. I decided then and there it was not in my best interest to play basketball at that level anymore. I got to play. It may not have been what I dreamt it to be at age 15, but I worked hard, I did it and it was now time to pursue new interests.

So I did, I went back to a strict training schedule 5-6 days a week that included cardio with a base of total body strength training. My symptoms became less frequent and I felt great. I joined clubs, competed in events, tolerated social outings and traveled! By my Junior year of college I kept a maintenance program that involved 2-3 days a week of steady state cardio such as running or biking.

My Career

The longest follow-up study done to date comes from Mayo Clinic. Mayo Clinic did a survey of their pediatric POTS patients seen between 2003 and 2010. Of those who responded to the survey, 18.2% reported a complete resolution of their POTS symptoms, while 52.8% reported persistent but improved symptoms. Male patients were twice as likely to report recovery. The average survey respondent had been diagnosed for about 5 years. Both patients who fully recovered and those who did not had mental health scores similar to the national norm (5).

As for my particular situation, I was a part of that study. Mayo Clinic sent me a couple different surveys inquiring of my behaviors/habits and quality of life after my appointments in 2005. At the time the data I offered was valued to research. I was happy to be a part of it. There was never a doubt POTS had impacted my life; I realized then that it had sparked a passion, too.

As a college student, it was a perk to have access to thousands of research articles. Every chance I got I would search POTS. While at Hope College in 2009 there wasn’t much to be found, a handful, but year after year I kept tabs. When asked to write a literature review as part of my Exercise Physiology class I naturally chose POTS as my topic. My professor was intrigued to see something new. I was happy to spread awareness.

Every lecture on ANS function, stroke volume or capillary density made me realize what was physiologically happening to my body during acute flares. My Junior year of college I pursued a personal training certification through the National Strength and Conditioning Association (NSCA-CPT). It was then I realized what I had done for my body through cardio and strength training.

I did a lot of spiritual and mental growth during my college years. My sister was a phone call away. At age 20 I can say I truly found God. Out of pure interest I was always at the gym. Whether it was playing ball on a c0-ed intramural team, lifting weights or sampling in new cross-training programs I was active on top of my 2-3 days a week of steady state runs, rowing or biking. I was symptom free.

I obtained my bachelors of science from Grand Valley State University with a specialization in Health Fitness Instruction. Paired with my NSCA-CPT I accepted my first job out of college as an Exercise Specialist at Munson Medical Centers Healthy Weight Center. My patient load included those with cancer, diabetes, obesity, anorexic, bulimia, exercise addiction etc. I found I connected so well with those with chronic illness; especially youth. I began to ask my co-workers who were licensed dieticians, social workers, athletic trainers their take on the syndrome POTS. That was the first time I was viewing my illness from an objective standpoint.

I eventually was inspired to form KO Wellness LLC in 2014. I began working as the contracted Wellness Coach for Interlochen Center for the Arts. It was at this job that I felt I was taking my part in teaching and guiding youth in preventative health. Showing the power of wellness via Exercise Foundations, Group Exercise Classes and Personal Training.

Motherhood

I met my husband Alex in 2011, we were married in September of 2013 and gave birth to our first born in October of 2014. It wasn’t until my third trimester of my first pregnancy I started to have tachycardia. My husband started to gain a front row seat into the stories I had told him of my health as a teenager. He was so supportive sharing the same attitude my nurse, doctors and family had. Lets just do it, sort of thing.

I have retrained my ANS four times, three of them by choice. First at age 24 with my first pregnancy then again at age 26 and 29. My confidence to willingly place my body under stressors that would cause a relapse with POTS can only be credited to my knowledge, gained exercise expertise, personal relationship with my own body and my support system.

Each pregnancy was different just as the severity and frequency of acute flares. I adjusted my management plan as needed and consulted with my obstetrician and a cardiologist if advised. Unfortunately I seemed to know more about POTS then they did. With their input I was the one to write my birthing plan and to suggest the use of my polar heart strap to monitor changes in HR, keeping acute flares at bay and avoiding their highly recommended inductions or bed rest. I knew what my body was capable of and I would again heal. I was POTS Strong.

Wellness Coaching

I have been so blessed to be of aid to so many individuals over the past ten + years. Wellness truly is for everyone; it is theirs to be had. Depending on individuals needs and interests, a unique balance is necessary. There is no such thing as a one size fits all approach for any population. As a coach, the three core variables nutrition, exercise and mindfulness will transform individuals lives for the better. The POTS population is no different, we may just be a bit more sensitive when experiencing the change that occurs.

Fall of 2018 I was at work in the middle of greeting parents at Interlochen Center for the Arts. It was Parents Weekend and my priority was to fill my class schedule with eager students who wanted to actively take interest in their personal fitness/wellness for the upcoming school year.

A student began asking me what class entailed and what we’d be learning. After I offered my response, she politely said, “thank you.” and proceeded to walk by. I smiled at her Mother who offered explanation, “My daughter won’t be able to do that”. I simply asked, “Why?”. The Mother ended with, “She has an illness, you’ve probably never heard it before; it’s called POTS.” I responded with, “I have POTS”. Her mom said, “Really?”. In that very moment; a fire was ignited. At the time it had been thirteen years since my POTS diagnosis. During that time I had never casually met anyone with POTS.

Our conversation continued and we devised a plan. We followed protocols, I coached her daughter and overtime her symptoms became managed. She thrived. The POTS Strong identity was born and I found myself elbow deep in thoughts, dreams, and goals for others who were or wanted to live POTS Strong.

There we were, amongst general public doing general things. I wouldn’t have known, but I asked. She would have kept to herself as most of us do and slipped away by feeling like the odd man out. But I asked, and I’m so grateful I did.

Sharing and Helping Others

I want to help the POTS population. I want to raise awareness for POTS specificity training and to bring awareness to what can be such a debilitating illness. I know other POTS warriors who, through exercise, proper nutrition and mindfulness practice have a great quality of life. If you have POTS or know of a loved one with POTS, every ounce of me goes out to you. I feel an immediate bond when I meet people whos lives have been affected by this illness. I know the power of support and knowledge firsthand, and I also know the effort it takes emotionally, mentally and physically to cope.

When Covid-19 came to the United States, I lost my ability to train my students in-person. I found extra time on my hands to program, dream and brainstorm. I purchased software rights December 31, 2020. New years day, 2021 I began building the POTS Strong App.

POTS Strong Mission Statement:
POTS Strong offers the structure and accountability needed to manage and further minimize POTS Symptoms. The POTS Strong Method utilizes necessary variables, science based protocols & education in achieving the optimum quality of life.’

POTS Strong is: a behavioral based tool designed specifically for the Postural Orthostatic Tachycardia Syndrome Community in utilizing and effectively applying patient specific non-pharmacological modes of treatment.

POTS Strong offers: the desired structure and accountability in gauging progress in managing or minimizing POTS symptoms. By promoting a positive experience individuals feel understood and address the root of their autonomic dysfunction by implementing the POTS Strong Method.

The three variables of focus are listed below and together make-up the
POTS Strong Method:

1. Nutrition :
   –Whole Food Eating
   – Meal Frequency
   -Nutrient Timing
   – Salt
   -Electrolytes
   -Water Intake
   
2. Exercise:
   -Aerobic conditioning: increase stroke volume, VO2Max and muscular endurance.
   -Muscular Strength: increase proper circulation and intravenous pressure.
   -Flexibility: improve joint mobility and exercise induced tension.
   -Prescribed Target Heart Rate Zones : Levine Protocol , POTS Training Program
   -Target Heart Rate Zone Measurability: Polar Heart Strap/Watch
   -Environmental education -orthostatic tolerant exercise modalities, training in
   heat vs. cold & altitude effects.
   -Rest vs Active Recovery
   
3. Mindfulness: Breathing -Parasympathetic Control -Practice

POTS Strong utilizes prompts on a daily basis to complete lessons, adhere to the recommended training calendar and incorporate the POTS Strong Method.
Overall, increasing personal awareness in daily behavior and offering the support and expertise necessary to manage or minimize POTS symptoms.

Physician Consent is required to participate in POTS Strong Support Programming or Coaching Services. It is highly encouraged that the necessary Target Heart Rate Zones be calculated and be periodically adjusted as their cardiovascular fitness increases. Target Heart Rate Zones (THRZ) -Base Pace, Maximal Steady State &Recovery
Levine Protocol

The Invisible Part of Me Blog

I have talked to over 100 individuals with POTS and have found comfort in knowing majority have been encouraged to follow non-pharmacological modes of treatment. Sadly I was surprised to hear how many were told to just Google Modified Dallas POTS Exercise Program and follow it. Others were encouraged to join a gym and hire a personal trainer. My immediate questions was “what success did you find with that advice”. Majority said no change, they seemed to lack confidence in their attempts. They felt defeated. Yet they were still searching for help and support.

I want to bridge that gap that currently exists for the POTS population in patient and physician care. I want to raise awareness for non-pharmacological modes of treatment, I want to be that support person needed for those wanting to achieve their optimum quality of life. I believe that POTS Strong is the tool patients can utilize knowing they aren’t wasting time and will grant them the confidence needed in daily efforts. It is a tool that my 15 year-old self wished for.

I know first hand as a wellness coach if I don’t offer accountability and measurability; clients will not find success. We are most effective as coaches when we meet our clients where they are at. Majority of individuals have the knowledge at hand, they just don’t know what to do with it. I am happy to bridge that gap. The POTS Strong App is the tool the POTS population has been in search of to further manage and/or minimize POTS symptoms.

Writing the Invisible Part of Me Blog wad daunting. Thinking of my backstory and personal experience dug up a lot of memories. Some painful. I kept reminding myself of the why I was writing and the words began to pour out. The Invisible Part of Me blog contains my story, POTS information, links to credible education and testimonies. Meet Hannah, a 14 year-old girl I coached utilizing the POTS Strong App. Testimony may be found here.


If you identify as living POTS Strong or want to learn more about gaining accountability in your health journey, please email me directly at potsstrong@ko-wellness.net

References

1.  Postural Tachycardia Syndrome. Blair P. Grubb, Circulation. 2008; 117: 2814-2817.
2. National Institute of Health, Neurological Institute of Neurological Disorders and Stroke, Postural Tachycardia Syndrome Information Page. 
3. The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management. Satish R Raj, MD MSCI, Indian Pacing Electrophysiol J. 2006 April-Jun; 6(2): 84-99.
4. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonomic Neuroscience: Basic and Clinical 161 (2011) 46-48.
5. Long-term outcomes of adolescent-onset postural orthostatic tachycardia syndrome. S.J. Kizilbash, S.P. Ahrens, R. Bhatia, J.M. Killian, S. A. Kimmes, E.E. Knoebel, P. Muppa, A.L. Weaver, P.R. Fischer. Clin. Auton. Res. October 2013. Abstract presented at the 24th International Symposium on the Autonomic Nervous System.
6. Exercise and non-pharmacological treatment of POTS. Autonomic Neurosicience: Basic and CLinical (2018) 20-27.
7. Dysautonomia International: Dysautonomia Awareness, Dysautonomia Advocacy, Dysautonomia Advancement (2021)
8. The Dysautonomia Project- Understanding Autonomic Nervous System Disorders for Physicians and Patients. K Freeman, D.S. Goldstein, C.R. Thompson. Bardolf & Company (2015)