The Driscoll Approach™
POTS Interesting Cases
We evaluate conditions that can contribute to the worsening of POTS symptoms, while searching for underlying causes of chronic, idiopathic POTS.
Here are some interesting cases of POTS syndrome we’ve handled in the past.
Shaking, tremulousness, weakness, tachycardia, inability to think clearly, dizziness, sweating, anxiety, nervousness, irritability and headache – sounds like a POTS flare, right?
These abrupt symptoms were found to be reactive hypoglycemia in this patient, and were easily corrected. Although not the cause of this patient’s POTS, dramatic changes in blood sugar were contributing to disability, yet had been assumed to be POTS exacerbations by her physicians. At POTS Care, we have a better chance of catching such comorbid conditions because we see patients for an entire week. More time with health care professionals often translates to more complete care.
Confusion, lethargy, flushing, sweating, rapid breathing, drowsiness, tachycardia – although these symptoms are often seen in cases of POTS, this patient was suffering from metabolic acidosis, episodically exacerbating her symptoms (confirmed with blood work). Her symptoms of acidosis resolved with immediate treatment, and the search for her underlying causes of POTS resumed. These symptoms can be assumed to be due to POTS if careful analysis is not performed. At POTS Care, we carefully review all symptoms and signs of illness in attempt to avoid missing such critical findings.
Fatigue, muscle weakness, constipation, irritability, excessive thirst, urination, nausea – Although these symptoms sound like POTS / Chronic fatigue, this patient was suffering from high blood calcium levels secondary to Vitamin D supplementation, exacerbating her POTS. We verified that the patient’s high serum calcium levels were not due to parathyroid problems, which can also cause POTS symptoms.
This patient became ill the day after her Gardasil vaccination 8 years ago, and had endured years of treatment by dysautonomia experts. We found that her D-Dimer levels (a measure of clotting) were high and her treatment included protecting her from clot formation. Although still recovering, she was able to return to work 12 hours a day weeks after her visit to POTS Care.
Pancreatitis and malabsorption blamed on mold exposure resulted in weakness, POTS, and numerous signs/symptoms of malnutrition in this patient. After 3 years of ineffective treatment for mold, the patient was instead found to be suffering with poor vagus nerve function, immediately responsive to treatment.
This 20 year old patient was told to have her neck fused to correct symptoms that mimicked symptoms of craniocervical instability, yet responded positively overnight with Diamox to reduce intracranial pressure. She was also found to be suffering with mixed connective tissue disease (an autoimmune condition) contributing to systemic inflammation.
This patient had long standing diagnoses of Chronic Lyme disease, yet was resistant to antibiotic treatment (administered over 3 years). Instead, she was found to have EDS / POTS — a dramatic treatment shift resulted in some immediate improvements.
Long-standing gastroparesis forced this patient to rely upon a feeding tube and a port for water (she was not able to drink fluids or eat food). She was found to suffer from poor vagus nerve function and responded immediately to treatment. She was eating small amounts of food and drinking by mouth the next day.
Flushing, tachycardia, anxiety, and sensitivity to chemicals, sights, and sounds – although this can be mast cell activation (MCAS), this patient was incorrectly diagnosed with MCAS. Testing for MCAS was negative, and after blood work and witnessing this patient’s episodes first hand, we determined she experienced a problem with inflammation that mimicked MCAS. We immediately altered her treatment and this patient now confidently manages her condition, and has never felt better. We often find patients being treated (unsuccessfully) as MCAS patients, even in the face of negative blood work. Until we look beyond mast cells, the patients can continue to suffer.
After receiving the Gardasil vaccine, this patient developed POTS with pseudoseizures. Her peudoseizures were determined to be psychogenic (all in her head). She was told by the physicians at Mayo Clinic that she would have to live with her condition for the rest of her life (and did so for 3 ½ years). After careful review of her case, we found she was suffering from Sjogren’s Syndrome, high intracranial pressure and a severe vitamin deficiency. After two days of treatment for her vitamin deficiency, our patient’s pseudoseizures stopped completely. We were then able to turn her treatment toward high intracranial pressure, and begin treatment for her autoimmune condition. Her doctors now have what they need to continue her care, and her life has completely turned around.
Patient came in suspecting Mast Cell Activation Syndrome or Mastocytosis. Digging deep we found that this diagnosis was incorrect. Periodic flushing, hives on her chest, many food and medication sensitivities, some diarrhea and bloating, tachycardia, hot flashes, difficulty breathing, and sleep disturbances. This mother of three came to POTS Care and was especially concerned about her young daughter who was complaining of similar symptoms. Her main concern was that she and her daughter could have mastocytosis. Instead, the team investigated further into her genetics and determined she had hereditary Alpha Tryptasemia. This validation gave her peace of mind, saved her from invasive procedures, and guided her treatment.
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“I have gotten more answers in this one week at POTS Care than I have gotten in the four years that I have known I have had POTS, and within 10 years that I started getting sick after Gardasil, and that is a true blessing.“
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