Whither POTS?

One day, a sweet nice 17-year-old young lady came to my office for help with her heart. She had to go to the Mayo Clinic to get a diagnosis of sorts; she told them, among other things, “every time I stand up, my heart beats real fast.” They told her she had Postural Orthostatic Tachycardia Syndrome.

I laughed. Did she pay money for that? All they did is repeat back what she said, in Greek.

Turns out, they were closer to the truth than they thought. A small minority of people with POTS have a condition known as “autoimmune ganglionopathy.” She did, and we were able to treat it.

For the vast majority of people with POTS, though, the disorder does not arise in the immune system. The question for those people is, what causes it, and how to treat it? For one possible answer, we can look at the interaction between the body and the mind.

Control of the mind and body

The interface between emotion and the body is the autonomic nervous system. “Autonomic” sort of sounds like “automatic,” and maybe “automatic nervous system” might have been a better name for it. Because it refers to how the brain controls certain automatic functions, like heart rate, blood pressure and sweating. When we are frightened, our heart rate goes up, blood pressure goes up, and we get sweaty. Thus, anxiety has an emotional component, and a physical component as well.

To understand how the autonomic nervous system works, it’s helpful to imagine that the mind is like a car. It has a steering wheel, an accelerator, and a brake. The steering wheel refers to our ability to think about things on purpose. To make decisions, and solve problems.

The sympathetic nervous system controls the accelerator. This gets you revved up, and gives you the energy to act and think. A little of that goes a long way. A little too much of that and you can’t think straight. Way too much of that, and you might freeze.

The parasympathetic nervous system controls the brakes. This lowers the blood pressure and the heart rate, and helps you think more clearly.

Like a car, your brain handles best if there’s skillful application of both accelerator and brake.

It’s not difficult to imagine what might happen if this system is out of whack. If the accelerator is stuck on full throttle, you might have panic attacks all the time, or suffer from high blood pressure or palpitations. If the brakes are stuck on, you might have chronic fatigue, and be prone to fainting (when the heart rate or blood pressure get too low).

Under this theory, POTS is an example of this system being out of balance from one moment to the next. You may be driving your mind like my daughter drives her car: one minute, the accelerator is floored; the next minute, she’s slamming on the brakes.

Treatment implications

At the outset, there are two potential treatment strategies: a psychological approach, or a physical approach.

Bill outlined the psychological angle in his book, “Realisation of Concepts.” (It’s fairly technical but very clearly written and might be worth a shot if you’re a sophisticated consumer of healthcare related books.) He has been developing the physical angle in a series of articles and book chapters, we have some of those articles posted here.

The question is, how to treat it? Doctors tend to be on one side of the fence or the other. Some recommend a psychological approach. Psychotherapy, meditation and yoga definitely help. But patients accurately perceive that the problem is every bit as much in the body as in the mind. And to be sure, you have to be really diligent with your yoga or psychotherapy to make progress controlling the body’s automatic functions. I’m not saying it can’t be done. I’m saying, it’s really, really hard.

But throwing pills at the problem doesn’t help either. Most of the patients I see wind up zombie-fied on multiple medications, some of them highly addictive. If you wind up hooked on Xanax, for example, you’ll find that the treatment to be much worse than the disease.

The Body-Mind Analyzer

Bill has come up with a pretty astonishing answer to this: a procedure that allows a person to see, in real time, what the brakes and accelerator are doing. All wrapped up in an iPhone app.

Bill achieved a milestone of sorts yesterday, when his app finally appeared on the Apple App Store for further development and testing. It should be available for early adapters shortly. Read more here, and watch this space for updates. My best estimate is, this is going to be really, really big news for a lot of people.

My goal, as a doctor, is to put myself out of business. I want my patients to be so healthy, they don’t need a doctor. Imagine if self-help were the answer to POTS. Imagine how empowering that would be.

4 thoughts on “Whither POTS?

    • Our HR/HRV device for measuring alignment between the sympathetic (gas) and parasympathetic (brakes) nervous systems should be available soon on Apple store. It would offer a self-help way to learn how somatic and mental systems are more or less in sync. We are thinking of offering personalized instructions on how to use the device. Access to this will be shown on the website soon.

      Best Wishes,

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