Truth v Gossip

There is one thing that I have found since having several chronic health conditions that people simply do not understand and that is the fatigue levels that come with them. I know some people have created this fairy tale in their heads that either have withdrawn from society or that Mr Myasthenia Kid doesn’t let me out in the world. People stupidly believe this gossip rather than actually ask me. They are simply untrue, the reason I don’t go out very much is because I get so exhausted by doing very little outside the home.

At home I have an environment I can control. I have regular household sounds, lighting etc. All of which my body is used to. The minute any of that becomes too much I can go to bed, lie down, limit the light and sound. Out of the home I have zero control over the additional stimuli my body is bombarded with. Also these days I am using a scooter a lot of the time, the concentration levels involved in driving this even for a short period of 20 minutes, drains me. It makes it hard for me to manage a conversation and drive. The minute I don’t concentrate like when driving a car accidents can happen. I have almost gone off the sea wall down at the seafront because I was trying to talk and drive. It takes a lot out of me and unless you have to balance your activity and rest periods people just don’t understand it.

Since Sunday I have had an extraordinarily busy week, for me. For normal people this will probably sound like a leisurely few days. On Sunday we went to Pets at Home the big one so around 20 minutes in the car to get there. Then we went to Tesco to upgrade our phones which took about an hour. We had Dembe with us who behaved beautifully. There were lots of people in Tesco that I knew that haven’t seen me since I have lost 49lbs in weight and who also wanted to meet Dembe. So it was very busy. After the morning we had around 90 minutes sit down and then we went to visit friends with Dembe. It was lovely to see them both and Dembe really enjoyed his visit too. However by 6pm I was completely drained and was up in bed resting, before dropping off just after 8pm.

Many of you will be thinking how can that low level of activity wear you out? I wish I knew, my only explanation is the assault on all my senses just physically and mentally wears me out. The extra noise, people, lights, smells, physical activity of driving a mobility scooter. Being upright with my legs down and blood pooling, changes in temperature, all those things combined just zap any charge that was left in my batteries. On Monday it took me hours to get moving. I was fit for nothing until about 2pm, which is crazy. My body just felt like there were 15lb weights attached to each limb and my head, well I just couldn’t really focus on anything that demanded more than a limited amount of mental acuity. 

On Tuesday I felt a lot better as I had spend Monday recuperating, which again if you have never suffered from bone crushing levels of fatigue you would struggle to understand. We needed to take Dembe to the vets to be weighed and to get his worming tablets / flea / tick treatment. We were there around 20 minutes as we like to have a catch up with the staff as Dembe is very popular there. We then popped up to Tesco for a few items, we took Dembe with us to give him some more environmentalization training. We only needed three things but Dembe has such a huge fan club amongst the staff and customers that it took 40 minutes. I then spent as much of the afternoon as I could resting with my feet up as in the evening we had our first night back at our weekly dog training class.

Evenings are the absolute worst time for me to be out of the house. Purely because I go to bed every evening between 7pm – 8pm or earlier if it is a rubbish day. By then I struggle to hold myself upright, co-ordinate my movements and as I discovered last night I can also end up struggling to talk because my brain can’t channel the words to my mouth. Ending up with me looking like a fish out of water. I thought I would be ok, after all I did the dog training in the summer. But I don’t think I had been out as much during the day. The dog training lessons are intense. Even though I just sit there and let Jay do all the training. I can’t do the walking around or being up on my feet that much. 

I coped ok in June and July so it was really surprising ( and frustrating ) to me last night to get half an hour in and to start feeling really, really unwell. I don’t know about anyone else but I hate having to ask for help or potentially making a scene due to being ill. I have in the past been known to wait for everyone to leave the room before I have allowed myself to projectile vomit. Thankfully there was nothing for anyone to see, although I may have gone more pale than normal. I just suddenly had the internal organ sinking feeling, then felt I experienced some feelings of dissociation. I knew I was in the room but I didn’t feel I was part of it. Unless you have felt this it is a difficult feeling to explain. I can feel like this just before I faint and I knew that is what my body was preparing to do. As I was sat down I rapidly starting clenching my bum cheek and tensing my calves in an attempt to get the blood moving. The whole time I was absolutely terrified I was going to wake up surrounded by people having taken a nosedive from the chair.

The weird thing was I could see poor Dembe trying to alert Jay to what was happening as hit lay down on the floor and had his head turned to me. He was watching ensuring I was ok. When I spoke to Jay afterwards to let him know what had happened he said “why didn’t you get up and go to the car so you could lie down?” which is a reasonable enough question as normally I do have quite a bit of warning so I can avert a faint. I just said to him that I felt so bad I was terrified if I stood up that I would go down with a bang. He then said “well why didn’t you shout me?” the simple fact of the matter was I just didn’t want to do anything that would draw attention to me.

 I really HATE the spotlight being on me, I hate it even more if it is because I am having a funny turn or have fainted. It is stupid I know but I just can’t, it makes me feel so very uncomfortable. Like I am causing a nuisance or being melodramatic. This probably goes back to various incidents at school and at work where I have been seriously unwell and been called a drama queen or that I was causing a scene. When I was younger I was never believed when I was sick, even when I have had major surgery, I had work colleagues say I was doing it for attention. How on earth you get a team of NHS surgeons to open you up from pubic bone to sternum just for fun I have no idea but apparently I can.

Thankfully my funny turn went after 10 minutes but it left me feeling seriously drained. I spent the entire journey home yawning non stop which is always a sign that my blood pressure has dropped. I was in bed by 8pm and asleep by 9pm.

Today ( Wednesday ) I am seriously pooped but like I always say I’d rather be knackered due to going out and having fun or just living a normal life than being this wiped out from doing nothing. Again it has taken me all morning to get going. I have been up since 7am and it is only now at 13.30 that I am starting to feel human and that I can do anything that needs any mental clarity. On days like this I have to take advantage of any window of opportunity when I feel well enough physically and mentally to be able to get up and crack on with something I want to do.

Obviously having the Weimaraners did curtail my activities outside the house. It was too expensive to get dog sitters in all the time and there are only so many times you can ask friends to do it for you. They were too destructive to leave by themselves, so in the end it just became easier to not go out or just one of us go, than stress out about finding someone to stay with them. Our friends have been fabulous, Imogen looked after them so much in 2015 when I had my CSF leak. If it hadn’t been for her I wouldn’t have been able to attend half the appointments I did. She also looked after them when we went to the Emma Bridgewater factory for the day which was a 14 hour (plus) stint . My friend Sharon also did us a massive favour when she stayed with them so that Jay could appear on Sewing Quarter TV. Both Ellie and Heather have stepped up too and looked after them, along with Tracey, Sarah and so many others over the years. But even with that massive pool of helpers it wasn’t fair to continually ask them to look after them. So our outside activities took a back seat, plus a lot of the time I just wasn’t well enough.

Now we have Dembe and we are training him to be my assistance dog it means the whole world has opened up to me again. It is really weird after having 12 years of not really going anywhere but the hospital, the doctors surgery or the dentist. Those visits also wiped me out. We are so used to being home we are having to force ourselves to go out. Which is another reason why we are doing all the training with Dembe as it means at least once a week I will leave the house and also that he will be a well behaved assistance dog whom we can take everywhere with us. But I will always have to pace my activities. I will never be well enough to go out all day, every day of the week. I just don’t have the stamina or physical reserves to be able to cope with that. And that is fine with me. I do quite like my own company and being able to do the things I want to do. I guess I am saying I like a balance.

So when someone tells you that someone is a recluse or that they aren’t allowed to go out. Have a good long think about that person’s circumstances. Think about if they have a chronic health condition, suffered a bereavement all manner of things that could be the cause of them not being outside in the world as much as you think they should. Don’t take the easy option and accept the gossip no matter how credible the source because it is just that their take on what they “think” is happening. Which doesn’t make it the truth.

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Warning shot

This last week has been a tad crazy. By “normal” people’s standards it’s a very light week, especially when you consider there was no full-time or even part-time work involved. My body is still playing catch up and my mind despite it being ten years on (since becoming sick) is struggling to come to terms with the fact that I can’t just do stuff like a normal non chronically sick person would.

 

There have been various things that have needed doing around the house for an absolute age, actually just months rather than years but the week before I had got to the point of no longer being able to put up with these jobs not being completed. Our tumble dryer (condenser) had developed a leak and now was having the habit of tripping out the electrics after it had been used. It had been unplugged and unused for the summer however we hit September and all it seemed to do was rain. I don’t mind drying the day-to-day washing on an airer in the house if it’s not possible to dry it outside but towels and sheets are another story. I bite the bullet and arranged for an engineer to visit. He would be coming on Tuesday which was also hubbys day off.

 

Two weeks prior I had arranged with my hairdresser to come over on Wednesday 6th to sort my hair out. It needed a full head of highlights as my greys were starting to show or fairy glitter strands as I like to call them. Plus I couldn’t do a thing with it, so it needed a good cut as well.

 

In January this year we had a leak behind a plasterboard, it was all sorted and settled. We decided that we would sort out getting the repairs done ourselves and then redecorate at our own pace. Hubby had been given the job of sorting out the plasterer. I had simply refused to be the responsible adult all the time just because I was at home and don’t work. It’s not just that, hubby also has a bit of a phobia about contacting people he doesn’t know (in his home world, in the world of work it’s not a problem), so he avoids it at all costs rather than confronting his fear. I was practicing some tough love but after 8 months I had to admit defeat. If I didn’t want to put tinsel around the holes in the plasterboard at Christmas I was going to have to sort it out myself. Luckily on a local community group on social media someone asked for a recommendation for a plasterer. Two names were mentioned I contacted both, arranged for them to come over and have a look at the job / give me a quote. The one I chose was available the following Thursday (7th).

 

I knew as I looked at the week ahead it was going to be tiring but I just assumed that I would bounce back after a good night’s sleep and be fine for the following day’s  activity. What an idiot I was. I am still trying to recover from last week. I have suffered with fatigue before but the levels of fatigue I am suffering with at the moment make me feel on a pretty regular basis that I am having an out-of-body experience.

 

Tuesday wasn’t too bad other than it was embarrassing. The cause of the leak in the tumble dryer was that the water collection point at the very back of the machine not accessible to mere mortals like you or I was completely choked up with dog hair. When an engineer tells you that’s the worst they’ve ever seen one blocked up, you want the ground to swallow you whole. The tumble dryer is cleaned regularly, the filter is cleaned after every load that is dried. The condenser unit is washed through once a week and it is hoovered inside at least once a month but even doing all that wasn’t enough to stop it getting overrun with dog hair! Remember we have three so maybe that is why? That cost us £50 for about 5 minutes work but it needed to be done.

 

That night I used the tumble dryer on one load. I really wished I hadn’t as once I had gone to bed as I spent the night panicking that it would have knocked the electric out in that part of the kitchen which unfortunately the fridge freezer is in. A few times before the tumble dryer had been fixed I had come down in the middle of the night to find that the fridge freezer had no power being supplied to it. What had been happening was the automatic safety cut off for the tumble dryer had been triggered which was then knocking out the fuse but not in the main fuse box. Wednesday morning I was absolutely exhausted from having very little sleep. And of course the Fridge-Freezer was absolutely fine.

 

My hair took three hours and by the time it was finished all I wanted to do was go to bed and rest, which is exactly what I did. I could barely sit or stand as my back was so painful from sitting upright for so long. My hairdresser did a fantastic job and she said my hair has come back lovely and thick after it thinning due to my hormones being out of whack. I am much happier with how it looks and I am so glad I can get it done at home without the added stimulation of the lights / noise / people at a salon. I thought going to bed for the rest of the day would be enough for me to bounce back for Thursday and the plasterer being here. No it wasn’t.

 

Thursday was an early start, I’d had to set my alarm as I knew with being so exhausted I would want to sleep on. That luxury wasn’t available to me when the plasterer had said he would be here for 9am. I had assumed that the job which was to skim a wall and fix two holes in the plasterboard would take a couple of hours, after all it wasn’t a whole room. Jay would be at work so I would have to ensure the dogs behaved and were out of the guys way. We installed a free-standing baby gate at the bottom of the stairs so that the dogs wouldn’t bother him whilst he worked. Normally the dogs are pretty good when there is someone working in the house, after the initial excitement they tend to just settle down and go to sleep. Not last Thursday they decided that they would bark and generally make a nuisance of themselves. I did managed to keep them occupied by stuffing Kongs with peanut butter and bread. Eventually they did just flake out and go to sleep but not until after a stressful first few hours.

 

The plastering took over 5 hours and by the time he left I was on my knees with exhaustion. I could barely function at all I was so tired. Again I thought with a good night’s sleep and I would be ok. I would have a lazy day Friday and everything would be fine. In the old days when I first got sick and possibly up until last year that would have been the case. However for some reason this year it has all changed and it’s taking me much longer to recover and smaller things are causing major recuperations. It is very frustrating as my brain is refusing to acknowledge this. Friday I just felt drunk or extremely hung over all day. I couldn’t watch TV or listen to the radio as I just couldn’t follow what was going on.  I did as little as possible Friday and Saturday I just slept on and off all afternoon. I had hoped by Sunday that I would have turned the corner but after a short visit from my parents in the early afternoon I just crashed and ended up in bed for a few hours.

 

This week is a quiet week, I had a friend visit Monday which was good as it forced me to behave and do nothing. Tuesday hubby was day off so he did the cleaning and any household chores that needed doing. My head is still giving me lists of things it insists I must do but my body is saying no. I had hoped I would be ok this week so I could potter around and get a few jobs done before Mr Myasthenia Kids holiday next week but it’s just not going to happen. Mestinon / Pyridostigmine Bromide is only lasting 3-3.5 hours instead of the 4-6 it had been lasting previously, this is a warning shot to let me know I can’t keep pushing myself and expect no consequences. Hopefully the next 6 and a bit weeks are going to be very quiet before we go on an adventure to the Emma Bridgewater Pottery factory as a birthday treat.

 

 

Hello Darkness My Old Friend

Last week was a bit of a nightmare. I was so fatigued it was ridiculous. I was sleeping hours but still felt like a zombie when I awoke. My legs felt like they were made of lead. My brain was sending the messages to them to move but they would refuse, causing me to fall over. When I could move them they felt as if they were made of lead. Climbing the stairs (which I limit anyway) felt like I was scaling mount Everest. Then on Tuesday afternoon, I recognised a feeling that I haven’t had in a long time. My face, eyelid and eyebrow were beginning to drop. I ended up going to bed for a lie down and slept for three hours. When I awoke the feeling was gone and I was relieved to have dodged a bullet. But I hadn’t, when I woke up on Wednesday morning this had happened.

 

 

Now I have a level of Ptosis everyday, normally unless you were specifically looking for it you wouldn’t know it was there. My eyelid droops to where the pupil starts to become obscured. That level of Ptosis I can cope with, it doesn’t affect my vision and it doesn’t tend to make me feel unwell.

Wednesday morning I woke up feeling horrendous, arms and legs both felt like they were made of lead. I was dizzy and due to my eye being nearly completely closed I couldn’t see very well. My forehead felt as if it was being ripped in two, with my left eyebrow arching in an attempt to keep the right eye open, only it was failing miserably. After a couple of hours I decided this really wasn’t worth the hassle of trying to stay out of bed. At 8am (I had risen at 6am) I gave up, took some HuzerpineA (like a herbal Mestinon as I can’t tolerate the real stuff) and set my alarm for 9am hoping when I woke up the Ptosis would be gone.

 

I gave myself an hour as like Mestinon this stuff takes about 20-30 minutes to get working. Plus I was also having a friend over, so needed to be washed and dressed before she arrived. I naively thought an hour in bed would be the magic cure. What an idiot! When it’s bad like this even proper Mestinon can fail to work. I should have realised when my alarm went off, that this was not a good day. I never fall straight back to sleep after being up for a few hours. I messaged the friend to advise them I would have to cancel, something I hate doing as it means I have knackered their plans for the day. She was absolutely fine about it but it doesn’t stop the guilt over cancelling. I text my husband to let him know I would be staying in bed for the day and that I might need him home if things got worse. I then went straight back to sleep.

 

Most of Wednesday was spent asleep if I am honest, I have a few brief periods awake mainly to get something to eat and have a cigarette. The fact that I was so utterly incapacitated scared me. This reminded me of the bad old days when I first got sick in 2007. How I had gone from working full-time to a year later being ill-health retired. I hadn’t been this sick what I call MG sick in years. Probably close to nine years, so you can imagine my shock, when this came totally out of the blue.

 

Thursday I woke up feeling an awful lot better but then by the afternoon was back in bed on home oxygen. I couldn’t take a deep breath in, as my chest just felt like it couldn’t expand. This really scared me as I have been blue lighted to hospital barely conscious due to breathing difficulties. This was exactly how it had started in 2008, I tried to walk across the lounge floor but stumbled as my legs wouldn’t work properly. The following day whilst hubby was out getting some shopping (helpfully forgetting to take his mobile phone) I had collapsed unable to take a proper breath in. I’d had to call 999 myself, trying to stay calm whilst the supply of oxygen in the house felt like it was running out.

There have only been a few times in my life I have been utterly terrified by my symptoms and that was one of them. I ended up being wheeled straight into resus, placed on oxygen running at 15 litres a minute and I still had very poor oxygen saturation. They  discussed with me about putting me into a medically induced coma and putting me on a ventilator. They wanted Jay to be at the hospital, I now realise it may have been to say goodbye, at the time I was oblivious and said he had to look after the dogs. I look back now and it moves me to tears. I wasn’t frightened at the time I was just exhausted from not being able to breathe.

 

I had all this running through my head again on Thursday, thankfully within two hours I was feeling much better but I had to spend the rest of the day in bed.

Gradually I have improved and back to my normal (but limited) levels of activity. However I am still having days where my arms and legs are refusing to work the way that they should. Today I was trying to do stuff around the house and I kept falling over my own feet as they felt as if they were stuck to the floor every time I went to move. I have started choking again (frequently) on fluids, something which hasn’t happened in a really long time.

It’s frustrating that despite in many aspects of my health improving a great deal, no more headaches, much less joint pain since giving up dairy, that this has started up again after leaving me alone for such a long time. Thankfully I have a hospital consultants appointment coming up at the end of next month and I will be able to discuss it with him then. I think it maybe time to bring up the possibility of Myasthenia Gravis again as seronegative MG seems to be much more accepted than it was ten years ago.

 

This song was going through my mind the whole of Wednesday and Thursday

 

 

Could it be Postural Orthostatic Tachycardia Syndrome – PoTS?

I posted this in August last year. Due to having a crazy week (Insomnia/painsomnia)  and a dentist’s appointment today I find myself too exhausted to write a new blog post.

I had one of those moments this week when searching through the archives of my blog I realised that I had never done a straight forward, honest to goodness post about PoTS. I may have mentioned it in passing but there is no one post based solely on it. I know that many people use my blog to try to explain their medical conditions to friends and family, so I am sorry its not happened until now.

My own diagnosis has moved away from “just” PoTs (although that is still part of it) and is now called Severe Autonomic Nervous System Dysfunction, which as far as I can tell is just a long winded way to say Dysautonomia. Which isn’t a medical term that seems to have caught on in the UK. All it means is instead of just the basic PoTs stuff going on I have developed O.I (orthostatic intolerance – my blood pressure drops in to the toilet on standing), breathing difficulties which have been with me since the MG/ not MG diagnosis, bladder problems ( I get acute urinary retention on a regular basis), unable to maintain my body temperature just to name a few. This is a new and emerging area of medicine and many medics are yet to catch up on PoTS let alone Dysautonomia. Straight away please let me direct you to this website pots.uk.org so if you are currently battling to get a diagnosis you can print this guide for gp’s and take this with you at your next appointment.

The first symptom I developed was sweating heavily when sleeping, be it a nap or a proper night’s sleep. That was back in 2006 and which I now know is reactive hypoglycemia (blog post) from monitoring my blood glucose levels. Throughout my life I had been told I had low blood pressure (not a prerequisite for PoTS as people with all levels of blood pressure can have it), I had a lot of dizzy spells, odd cravings for salt, palpitations. I put my palpitations down to anxiety, as I had always been quite an anxious person. However once my anxiety issues had been dealt with and I learned how to combat them I continued to be left with a feeling of my heart wanting to beat out of my throat on random occasions. I would also on a regular basis get very lightheaded when changing from a sitting to standing position.

So many patients with PoTS are misdiagnosed as having anxiety, health anxiety or depression or other mental health labels before they eventually get diagnosed correctly that it is criminal. Unfortunately once you have had the mental health label attached by the medics it is a hard one to shake off. Even now when going into hospital as an emergency, I still get somatiform disorder brought up when it has been completely and utterly disproven. The problem is that to an uninformed doctor PoTS can sound very like anxiety, racing heart rate, tremors the feeling of adrenaline coursing through your body and an exaggerated flight or fight response. With the majority of PoTS patients also being women it can be even harder to be taken seriously. It seems the modern medical profession still believe in the condition hysteria.

By the time I discovered the little known condition of PoTS, like many I had been written off by the medical profession as overly anxious, internet searching for syndromes with probable somatiform disorder. It took me over a year of battling to finally get the test that would prove beyond all reasonable doubt I had PoTS. A medical condition at the time my old gp had told me didn’t exist. For more info on my experience of the Tilt Table Test please click here as I don’t want to bore you by repeating myself.

My main symptoms at the time of diagnosis were as follows

  1. palpitations
  2. feeling faint or fainting (aka pre-syncope and syncope. Please remember only about 30% of PoTS patients faint but many feel faint)
  3. feeling like an elephant was sat on my chest and not being able to breathe properly
  4. racing heart rate every time I changed position, even rolling over in bed.
  5. greying out, especially after eating.  (My peripheral vision greys out)
  6. Insomnia (BIG TIME)
  7. Dizziness
  8. Migraines and shockingly bad almost migraines
  9. Cognitive deficit (aka brain fog /aphasia/ short term/long term memory problems)
  10. Chest pain (too many times to mention I thought I was going to have a heart attack)
  11. Reduced sweating (some people start getting excessive sweating, I only get excessive sweating at night)
  12. Fatigue

This list probably doesn’t cover all my symptoms and unfortunately many PoTS symptoms also merge into EDS symptoms as in the gut problems and bladder problems that many of us with both conditions have. It can get very difficult to differentiate the two. For a full list of symptoms please click here.

So what can you do if you suspect you have PoTS?

I can only base this on how I went about getting my diagnosis but it is the same advice I give everyone who asks my advice. 

Firstly get hold of a decent blood pressure monitor especially one that can also take your pulse at the same time. Here is a list of blood pressure monitors that have been validated by the British Heart Foundation as accurate enough to monitor your blood pressure at home. If you can afford it get one with a memory so it records your readings so that you can’t be accused of making the numbers up. It is important to understand that blood pressure does not play an important part in getting a diagnosis. Some people with PoTS have normal blood pressure, some have low and others have high. Why you need the BP monitor is so that you can start tracking your pulse and your blood pressure. If you can’t afford a blood pressure monitor for whatever reason, a pulse oximeter ( a little device than can read your pulse by clipping onto your finger) is the next best thing and you can pick them up online from as little as £10. 

Please remember people with PoTS tend to have very cold fingers (and toes) so before using a pulse oximeter ensure your fingers are warm enough to provide an accurate reading. Before my second tilt table test (yes I was stupid enough to do it twice) I had to sit with my fingers in a bowl of warm water as the pulse ox couldn’t get a reading.

Secondly understand what PoTS is!

PoTs is a rise in your pulse / heart rate of at least 30 beats per min (bpm) or hitting 120bpm or over, within the first ten minutes of standing. In children (up to the age of 19) the rise needs to be over 40bpm. If your heart rate doesn’t increase by 30bpm or over 120bpm within the first ten minutes of standing it is unlikely to be PoTS. 

When a normal person goes from sitting to standing their pulse / heart rate will increase on average by 15-20bpm. Within a minute or so their heart rate will go back to normal. A person with PoTS could start with a baseline heart rate of 80bpm and on standing increase to at least 110bpm. Then as they continue to stand their pulse could increase further. I know on my own tilt table test my own heart rate increased to 150bpm, unfortunately I don’t know what my baseline measurement was. Usually my pulse is in the 80’s and if that was the case I certainly managed the increase of 30bpm and smashed the 120bpm threshold.

Because many people (but not all) with PoTS also seem to have low blood pressure that is why I recommend getting a monitor. It helps to see what your blood pressure and pulse are doing after specific triggers such as climbing the stairs, raising your hand above your head, eating – particularly carb loaded meals. Many people with PoTS find their symptoms are much worse after eating heavy carb meals, so it is recommended to eat high protein low carbohydrate meals which don’t cause postprandial symptoms.

Thirdly conduct your own poor man’s tilt table test.

You maybe wondering what on earth is a poor man’s tilt table test, that is ok I was left scratching my head after first hearing this term on a forum called DINET. Because none of us own our very own tilt table designed for testing people for PoTS amongst other things, we can replicate how we will respond to the actual test by completing the poor man’s tilt table test and some gp’s who are PoTS savvy will do this in their consulting room or at the very least conduct a standing test.

To conduct a poor man’s tilt table test, you need somewhere comfortable and relaxing to lie down, without interruptions and preferably away from harsh or natural light. A wall to stand against which is adjacent to the relaxing lie down area however if you don’t have this don’t worry you can still conduct the test. You also need your bp monitor / pulse ox and a handy sidekick to record your test results. Also your sidekick can rescue you should you faint whilst completing this test so please be careful and do not attempt to complete it without having someone with you. Please also ensure that the area is safe should you decide to face plant, so free from things you could hurt yourself on. Cushions or pillows on the floor can help prevent injury!

To start the test you need to lie down and relax, no talking, no interruptions for 20 minutes. If you can darken the room in anyway before starting the test do. At the end of the 20 minutes with as little movement as possible take your blood pressure and pulse readings. These are your base line readings and what you will use to compare against the reading you get during the test.

Once you have your baseline readings stand as quickly as you can placing your back against the wall. The wall just helps prevent you from moving, people with PoTS tend to be natural fidgets because we either faint or feel like we are going to faint. Moving keeps the blood flowing, we don’t want you to do that whilst you are standing up as it may mess up the results. If you don’t have a wall to prop yourself up against try and keep your legs as still as possible.

Then at 1 minute, 2 minutes, 5 minutes, 7 minutes and 10 minutes take readings of your blood pressure and pulse or get your trusty assistant to do it. After the ten minute reading has been taken, sit down get your legs elevated and have a drink of water. You may notice that your feet / legs have gone a nice shade of red or purple. Don’t be alarmed this is called blood pooling and is very common with PoTs.

Now take a look at your readings if it shows an increase of 30+ bpm / 120 bpm this is positive for PoTS. Do not despair if it doesn’t show PoTS one negative poor man’s tilt table test does not mean it’s not PoTS, it may just mean you weren’t particularly symptomatic that day. Try to complete the test on a day when your symptoms are more evident.

Other things that might show during a poor man’s tilt table test are things like orthostatic intolerance ( your blood pressure goes below 90/60 on standing), you may have also fainted, if so I am sorry. The blood pressure readings could also reveal if you suffer from hyper-PoTS, which is where you have high blood pressure and PoTS. This needs to be treated differently to “normal” PoTS as most doctors will avoid giving you medication that will increase your blood pressure.

If you can’t for whatever reason do the poor man’s tilt table test you could perhaps try what is known as the standing test. Instead of lying down you sit down for 5 to 10 minutes to get your baseline pulse and blood pressure readings and then stand for as long as you can. Taking your readings at the same intervals as the poor mans test. This can also show PoTS. Remember PoTS stands for postural (position) orthostatic, tachycardia (fast heart rate / pulse), Syndrome (collection of symptoms and no two patients are alike).

What to do next?

Print off the gp’s guide from http://www.potsuk.org/gp_guide and book an appointment with your gp or a doctor at the practice who has been the most supportive. Sometimes these aren’t necessarily the same. Whilst waiting for your appointment take a look (if you are in the UK) at the Doctors list on the same website. This will give you an idea of who you can ask to be referred to, not all cardiologists are knowledgeable in the area of PoTS so it makes sense to see an expert, rather than someone who will give you the run around. For international readers DINET also has a Physician’s list.

If you have a disappointing gp visit and they still will not listen to you even when provided with your own test results and the gp guide, do not give up. Try every doctor at the practice if you have to and if that doesn’t work contact the practice manager. If you get no joy after all of that try reaching out to one of the many UK facebook PoTS groups. They have members all over the country and they maybe able to help you find a new gp practice with more sympathetic gp’s who are aware of the condition. 

If you have a disappointing consultants visit because despite your request of being sent to a specific doctor who is knowledgeable about the condition and you didn’t get to see one, you have a right to ask for a second opinion and ask once again to see one of the doctors named on the potsuk.org website.

You will get there in the end!

Most doctors will not confirm a diagnosis of PoTS without conducting a Tilt Table Test, ECG and possibly 24 hour blood pressure / heart monitoring. I was diagnosed on my tilt table results alone possibly because from 2007-2011 I had so many other investigations conducted they decided nothing more was needed.

The good news is that many people recover from PoTS especially if they have primary PoTS. Primary PoTS is usually caused by pregnancy, a virus, trauma or prolonged bed rest. Astronauts suffer from PoTS when returning to the Earth’s atmosphere and when their bodies re-adjust to the Earth’s gravitational pull their symptoms disappear.

Teenagers who develop PoTS also have a high chance of growing out of it. Researchers believe that teenagers develop PoTS due to the hormonal changes and growth spurts they are subjected to. Patients like these tend to grow out of their symptoms by their mid- twenties.

Patients with secondary PoTS, so PoTS that has happened due to a primary condition such as cancer, autoimmune diseases (like M.S, Lupus, Sjogrens), Ehlers Danlos Syndrome can also look forward to on the whole having the condition managed through medication and lifestyle changes (exercise, increased fluids, salt, adequate rest).

However I would be remiss if I didn’t state that there are patients like me that have refractory PoTS (it doesn’t respond to medication) and go onto develop more issues relating to our autonomic nervous system. We are the minority though not the majority. I don’t want to scare anyone who has just started on this journey I just want to be truthful.

My symptoms now are pretty much the same as when I first started on this journey with PoTS / Dysautonomia. I still have Ptosis on and off which no one has ever been able to explain. I still have issues with my breathing, fatigue, syncope and pre-syncope. A good day means that my heart isn’t continually feeling like it is fighting out of my chest on every change in posture. A bad day means not being able to sit up in bed without feeling faint, my heart rate not dropping below 100bpm even at rest. 

With my combined conditions each day is very much different with a new set of symptoms to overcome. It is exhausting, it makes me angry, it makes me sad and quite a lot of the time it makes me laugh because my body is just so screwed up!

One last thing…..if you are diagnosed with any type of tachycardia, including PoTS and you hold a driving licence you must inform the DVLA. You can do that via this Link. You will also need to contact your car insurance providers.

Another great source of information is Stars another charity which helps people suffering with a variety of conditions including PoTS.

Tired and in Pain

Last month I celebrated or not my 9 year anniversary of being sick. You’d think with this much time passing and me not getting any better I wouldn’t feel like I still have to constantly explain what is wrong with me those that know me. I do try to cut them some slack, obviously there is a lot wrong and even I struggle to remember every single condition. However it does become really grating when yet again someone asks a stupid question or suggests a cure or tells me they “feel” the same way I do.

I will apologise in advance because this is probably going to turn into a slightly ranty post. I do feel that it is warranted due to the sheer lack of understanding that is displayed towards me. So just to clear things up I will break it down for those of you struggling to understand.

1.Tired
When I say I am tired, I am tired. Not tired as in I have been to the gym, had a haircut and wandered around the shops for a few hours tired. It is not the kind of tired where you’ve worked an 8 -10 hour day. I am the kind of tired where I haven’t slept more than 4 hours a night for a few days or I have had excessive amounts of pain to deal with or I am fighting an infection which is causing my PoTs to go crazy or I am dealing with all of those things. I am the kind of tired where stringing more than a few words together is difficult, I am so tired that I could fall asleep standing up (if I could stand for longer than a few minutes without feeling faint or fainting). I feel so tired that it’s actually getting difficult to walk because I am struggling to lift my legs up.

This is where I cut people a little slack because I am tired pretty much all of the time. After a few hours of being out of bed I would quite happily go back there for the rest of the day but I can’t because my back would cause me all sorts of problems. I guess the issue is language due to there being a limited amount of words to describe what I am feeling. Exhausted seems a little melodramatic for my liking, using it every day would diminish its effect. Fatigue is another word I have an issue with again because it just doesn’t sound quite expressive enough. Saying or texting the sentence “I am fatigued” just seems a bit wishy-washy. I’m shattered equally doesn’t really cover it. It’s the kind of word you use after a 5 day week and partying all weekend, it is a throw away term.

The problem is so many people in society complain of tiredness due to the stress and pace of their lives, it is an overused word which has lost its impact. It is partly my fault because when I say I am tired you can only compare it to your own level of tiredness. When you are chronically sick fatigue / exhaustion / tiredness take you to a whole new level one you never knew even existed. Sometimes even I am shocked that my body is still able to function when I am suffering from this level of fatigue.

2. Pain
Now let me be crystal clear I am not diminishing anyone else’s pain nor claiming I am the only person in the world that suffers with it but it is slightly irritating when someone claims to be in agony yet they are a) still working full-time b) going out socially or c) telling everyone about it on social media. Everyone has different pain threshold my definition of agony will be different to others because we all perceive pain differently. However I think many of you will agree with this
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I also have on a number of occasions had this look on my face when someone has told me that they are in agony. When I am in agony my phone is the last thing I am looking at. I am usually counting down the minutes until I know my pain medication is in my system.

Pain is subjective, what I class as a 10/10 on the pain scale others may class as a 5. In my daily life I have pain, every single day. It is at a level where sometimes it is background noise and other days like today despite being almost maxed out on pain medication it is wanting to make itself heard. A 10 out of 10 pain for me is usually caused by bowel adhesions, the pain from these will cause me to black out. I use this as my 10 as I don’t have labour to compare it with. When you are female childbirth is always used as an example of a 10 out of 10 pain. Heaven knows what they tell men, I never get the male example given to me they are usually completely stumped when I utter the words “I don’t have kids”. Today clearly my pain is not at a 10 out of 10 level because I am typing my blog however to be able to do this my neck is in a soft collar (because since Saturday my upper back has been going in and out of spasm and the pain is originating from my neck. Possibly having my hair cut today was not a great idea.) and I have four hot water bottles placed on various parts of my body. I would rate my pain today a 6/10 it’s noticeable but not completely incapacitating. To someone who wasn’t used to this level of pain or who had a different pain threshold it could be their 10 or their 1.

The word agony is thrown around quite easily, I think most of us would agree when you stub your toe it is sheer agony for a few minutes. It can in those few minutes be incapacitating but after a while the pain subsides. It may throb for the rest of the day but you can carry on your planned activities. Agony is not being able to go to work or walk around the shops or carry on with your planned activities. Agony to me is not being able to get out of bed despite taking enough morphine to sedate a bull elephant. Maybe I just see things through Chronic pain / illness tinted glasses but the word agony is being distorted through overuse. You can tell a doctor that you are in agony but get zero response, firstly because they can’t feel your pain and secondly you are probably the 10th person that day to tell them that.

Agony is a lonely place to be because others don’t understand it and can not feel it. You can’t share it, you can only carry that burden alone and wait patiently for the meds to kick in. I find pain that creeps above a 7 on my personal pain scale starts to alter my mood. I become very angry, snapping at everyone and finding everything annoying. Pain at that level will move me towards “I’m not doing people today” because the pain is interfering with my brain so much I can barely function. So I get frustrated when people use the term at the drop of a hat. There are other words to use to describe pain discomfort (that would describe my current level of pain perfectly), sore, aching, throbbing and one of my favourite “twinge”. I have twinges in my back quite a bit. I don’t know if it is because we are becoming lazy with language or more and more people are discovering a flair for the dramatic but it is a pet hate of mine when others use the word agony when they clearly aren’t in agony.

Unfortunately I use the word tired and the phrase “in pain” quite a bit. I imagine that also causes people to not hear what I am saying because they hear it so often. I need you to hear me, I don’t mention my pain until it’s hit a level that I can’t ignore, the same goes with tiredness. I am sorry if you don’t understand that however the problem is yours not mine. If you ask me how I am and I actually tell you the truth, you are amongst the privileged few. If I acknowledge pain in front of you, it has reached a level where my energy is being drained away and it is interfering with my cognitive function. I don’t tend to announce it as I don’t want to put a downer on the proceedings. If it’s mentioned I can’t physically or emotionally hide it anymore.

I don’t want bucket loads of sympathy, I just want to be heard and acknowledged like everyone else on the planet. So understand me when I say I am tired or my back is hurting I don’t expect you to fix it but I also don’t want you to ignore it. I want you to respect that at this point in time I will not be the life and soul of the party, I will not be jumping to attention if you ring or text me. A little understanding goes a long way.

I in turn will not diminish your pain or your level of tiredness after a long day at work because 9 years ago I was you.

Another Grey Area……

Last weeks blog post stirred up a lot of emotion in me, I didn’t realise just how angry I was at my treatment at my last hospital appointment. 

After writing that post I had received a letter stating all my hospital blood tests had been normal. Showing no signs of any inflammatory markers, so there was no explanation for my tiredness or hirsutism or increased joint pain. So when I retrieved a letter from the hospital out of our mailbox on Saturday morning, I really wasn’t perturbed. We have a mailbox as the three mutts like to shred our post given half a chance. I have so many hospital appointments on the go at the moment it feels like quite a juggling act keeping track of them. The contents of the letter sent me into a tail spin.

The letter was a copy of the one that my hospital consultant had sent my gp and one of the blood tests was far than normal. To shut me up and prove me wrong (because he had accused me of looking for syndromes on the internet) the dr had tested my prolactin levels. I had suggested to him that maybe it was possible I was suffering from PCOS (polycystic ovary syndrome), it runs in families (my sister has it) and it would explain my weight gain every time I ate carbs, the facial hair I was growing, acne and my periods deciding to come whenever the hell they wanted despite me being on a progesterone only contraceptive pill. I had brought this up with the registrar I saw back in February and my bloods had only now been tested for it.

I could have quite easily been one of those patients whose symptoms are missed because their doctor thinks they are trying to collect labels / syndromes.

The letter read;

“It is interesting to see that Rachel’s prolactin levels are high at 2629mu/l. There is no evidence of macroprolactin. This is out of keeping with polycycstic ovary syndrome and it may well be her menstrual irregularity is secondary to her high prolactin at the moment. I had better get an MRI scan of her brain organised and will do this forthwith and copy the letter through to her so she knows what is going on.”

*for USA readers to convert to ng/l divide by 10.6 which should give you the figure of roughly 253.

Immediately I was sent into a panic, I knew that high prolactin wasn’t good as an internet buddy had just had an investigation with her levels being half of what mine were. She had asked me to find out about prolactin. I had done a quick search and knew from doing that it meant Pituitary Gland Tumour. I was alone, it was a bank holiday weekend so all my friends were either working or a way. In a fit of panic I called my parents who were nearby at their caravan and explained the letter to my dad. Well actually I probably freaked out on my dad and said my blood tests show I might have a brain tumour. I went into full on drama mode because I knew a little and not enough.

Looking back over the Saturday what has annoyed me more was the fact my consultant knew that I knew high prolactin meant the possibility of a tumour, it was sent by 2nd class mail over a bank holiday weekend where if I wanted / needed to speak to someone medical I would have to wait until the Tuesday. It was thoughtless. I know he has no control as to when the letter is sent but to send out a letter like that in this day and age where information good and bad is at your fingertips is just wrong.

My parents arrived without warning around 20 minutes after I made my call to them. I am extremely grateful. In that time I had googled quite a bit (and I have googled quite a bit more again). The information I was getting was conflicted. In the USA a figure of 250ng/l or more is what all the articles say is highly suggestive of a tumour. In the UK all the articles say levels over 2000mu/l need investigated but only levels over 5,000mu/l mean there are a tumour. So it would seem I am in another grey area……again. Could be a tumour might not be a tumour.

Normal prolactin levels are <400 (if like me it has taken you forever to work out what those arrows mean, its less than). Between 400-1000 is classed as mildly elevated, 2000+ is classed as high, over 5,000 didn’t have a classification so I am guessing that it’s “very high” or WTF?? So as you can see I am sat in the middle again, possibly, possibly not a tumour.

Medications can elevate your prolactin levels, I am on 3 such medications and have been on them a long time. Lansoprazole since 2002 and opiates (morphine) since 2011, the contraceptive pill on and off since 1990. So if either of those three were the culprits I would have had symptoms well before now. 

Prolactin is the hormone that stimulates milk production in females, so is normally high during pregnancy and lactation. One of the symptoms of high prolactin is milk production and it can happen in males also. I have been lucky and been spared that symptom. Otherwise I would be able to wet-nurse my new nephew. I should imagine producing milk as a male is pretty distressing. Most males with high prolactin aren’t discovered until their levels are in the 5,000 level because another symptom of high prolactin is irregular menses (periods).

My menses / periods have been up the creek since last summer. Initially I put it down to being changed from the branded version of my contraceptive pill to the generic version. Which could be just coincidental, the rest of me felt fine, apart from the black hair that has decided to sprout on my top lip, chin, neck and face. When you are naturally blonde it can be quite distressing having to pluck the random hairs that seem to appear a foot long only a day after your last check. Over the course of the last 6-9 months I have developed a chin full of blackheads, my back is covered in acne and my neck is also joining in. I can hand on heart say that I went through puberty with barely a spot much to the annoyance of my peers. So to have all this acne / bad skin now has been confusing and unsettling. I just presumed I was heading towards the menopause. In fact I discussed this possibility with my gp at my last appointment. He told me tests for the perimenopause were terribly inaccurate but it could well be that I was heading down that path.

The problem is when you hit your forties the menopause is pretty much all that is suggested when your periods come and go as they please. The doctors have never taken my complaints of sprouting black hairs seriously, it is probably because I don’t venture outside of the house with a full handlebar moustache, that they just don’t get it. They take a quick look at my face see no facial hair and presume that it is all in my head. There is no way that I would be seen in public with dark black hairs on my face. As a woman I find their presence deeply upsetting. However it isn’t just my face these jet black hairs are appearing, they have popped up on my arms and thighs. I feel like I am turning into a Yeti ( it is nowhere near as bad as some poor ladies I have seen who have to shave twice a day and my husband isn’t getting stubble rash when we kiss) but until now my complaints have fallen on deaf ears and it has been something I have been complaining about since 2006.

I don’t know why the black hair upsets me so much, it’s possibly because I worry about when I am old and demented that I shall look like the bearded lady from the circus.

My other symptoms have been that no matter how hard I diet my weight barely moves in a downwards pattern. As soon as I have alcohol ( a glass of wine or two I am not a heavy drinker) or carbohydrates I put on half a stone (7lbs). My reaction to these foods is over the top, I eat much less than I ever have but the weight keeps piling on. I find myself constantly wearing my fat jeans instead of my “normal” jeans because my stomach seems to be attracting all the extra fat cells. I have also been suffering from crippling fatigue, I have been tired before but nothing like this. Bone tired is what I call it, where I can’t move for feeling tired. I have no motivation to do anything. I am not depressed, I still laugh, see people and have fun it is just I am so exhausted that I can’t manage to do things.

The thought of having friends over fills me with dread, not because I don’t want to see them but because I know the whole morning will be spent recuperating from having a shower. I am sleeping every afternoon, something I haven’t done since 2007/2008 and it’s not for lack of sleep at night (my sleep can be broken but I am managing 8 hours in total). I am just so tired by just doing the things I have taken for granted normal living stuff not painting the town red.

After a lot of googling medical articles, discussion boards, health pages I have discovered my vague symptoms all fit what I have hyperprolactinemia (another label). So after my initial freak out, I felt vindicated. I wasn’t going mad, I wasn’t being lazy, I wasn’t depressed. Then I got angry, very angry because yet again I hadn’t been listened to when I told the doctors that I knew something was wrong. I could feel my body was out of whack. I didn’t know what it was but I knew what I was feeling wasn’t normal. I knew it was hormone related due to the acne on my chin etc yet I had been told I spent too much time looking up syndromes on the internet  or was met with blank stares. 

Even without the presence of a tumour my high prolactin levels are going to have to be treated with medication. Pituitary tumours of this nature a prolactinoma are treated with medication to make them shrink, very rarely if ever are they removed. They are almost always benign, so all brilliant news. High prolactin though is damaging to the bones and can cause osteoporosis (thinning), having Ehlers Danlos Syndrome already means that I am at high risk of losing bone density when I hit the magical time of the menopause. I could also need replacement hormones to get my cycle back on track which would be given in the form of HRT. This is all dependent on what the endocrinologist thinks when I eventually get to see one.

My MRI with contrast is booked for next Tuesday (8th September). I have had many head MRI scans so its nothing new I know it’s noisy etc. The only thing that concerns me is getting the cannula in as my veins are so shoddy. Fingers crossed it goes ok. When I will get the results from the MRI scan I am not sure, I should imagine they will need reviewed by several people before a final report is given.

I am swinging from one emotion to another, worry, anger, calm and then back again. I am hoping that I get some treatment soon so I can start to feel better than this, where I am begging to go to sleep constantly. I never appreciated fatigue until this happened.

My handlebar moustache is probably here to stay, so I will be looking into laser treatment when the health stuff is sorted.

Thanks for reading!

Links for further information:

Prolactinoma

Hyperprolactinaemia  

 

Could it be Postural Orthostatic Tachycardia Syndrome – PoTS?

 

I had one of those moments this week when searching through the archives of my blog I realised that I had never done a straight forward, honest to goodness post about PoTS. I may have mentioned it in passing but there is no one post based solely on it. I know that many people use my blog to try to explain their medical conditions to friends and family, so I am sorry its not happened until now.

My own diagnosis has moved away from “just” PoTs (although that is still part of it) and is now called Severe Autonomic Nervous System Dysfunction, which as far as I can tell is just a long winded way to say Dysautonomia. Which isn’t a medical term that seems to have caught on in the UK. All it means is instead of just the basic PoTs stuff going on I have developed O.I (orthostatic intolerance – my blood pressure drops in to the toilet on standing), breathing difficulties which have been with me since the MG/ not MG diagnosis, bladder problems ( I get acute urinary retention on a regular basis), unable to maintain my body temperature just to name a few. This is a new and emerging area of medicine and many medics are yet to catch up on PoTS let alone Dysautonomia. Straight away please let me direct you to this website pots.uk.org so if you are currently battling to get a diagnosis you can print this guide for gp’s and take this with you at your next appointment.

The first symptom I developed was sweating heavily when sleeping, be it a nap or a proper night’s sleep. That was back in 2006 and which I now know is reactive hypoglycemia (Blog Post) from monitoring my blood glucose levels. Throughout my life I had been told I had low blood pressure (not a prerequisite for PoTS as people with all levels of blood pressure can have it), I had a lot of dizzy spells, odd cravings for salt, palpitations. I put my palpitations down to anxiety, as I had always been quite an anxious person. However once my anxiety issues had been dealt with and I learned how to combat them I continued to be left with a feeling of my heart wanting to beat out of my throat on random occasions.I would also on a regular basis get very lightheaded when changing from a sitting to standing position.

So many patients with PoTS are misdiagnosed as having anxiety, health anxiety or depression or other mental health labels before they eventually get diagnosed correctly that it is criminal. Unfortunately once you have had the mental health label attached by the medics it is a hard one to shake off. Even now when going into hospital as an emergency, I still get somatiform disorder brought up when it has been completely and utterly disproven. The problem is that to an uninformed doctor PoTS can sound very like anxiety, racing heart rate, tremors the feeling of adrenaline coursing through your body and an exaggerated flight or fight response. With the majority of PoTS patients also being women it can be even harder to be taken seriously. It seems the modern medical profession still believe in the condition hysteria.

By the time I discovered the little known condition of PoTS, like many I had been written off by the medical profession as overly anxious, internet searching for syndromes with probable somatiform disorder. It took me over a year of battling to finally get the test that would prove beyond all reasonable doubt I had PoTS. A medical condition at the time my old gp had told me didn’t exist. For more info on my experience of the Tilt Table Test please click Here as I don’t want to bore you by repeating myself.

My main symptoms at the time of diagnosis were as follows

  1. palpitations
  2. feeling faint or fainting (aka pre-syncope and syncope. Please remember only about 30% of PoTS patients faint but many feel faint)
  3. feeling like an elephant was sat on my chest and not being able to breathe properly
  4. racing heart rate every time I changed position, even rolling over in bed.
  5. greying out, especially after eating.  (My peripheral vision greys out)
  6. Insomnia (BIG TIME)
  7. Dizziness
  8. Migraines and shockingly bad almost migraines
  9. Cognitive deficit (aka brain fog /aphasia/ short term/long term memory problems)
  10. Chest pain (too many times to mention I thought I was going to have a heart attack)
  11. Reduced sweating (some people start getting excessive sweating, I only get excessive sweating at night)
  12. Fatigue
This list probably doesn’t cover all my symptoms and unfortunately many PoTS symptoms also merge into EDS symptoms as in the gut problems and bladder problems that many of us with both conditions have. It can get very difficult to differentiate the two. For a full list of symptoms please click here.
 
So what can you do if you suspect you have PoTS?
 
I can only base this on how I went about getting my diagnosis but it is the same advice I give everyone who asks my advice. 
 
Firstly get hold of a decent blood pressure monitor especially one that can also take your pulse at the same time. Here is a list of blood pressure monitors that have been validated by the British Heart Foundation as accurate enough to monitor your blood pressure at home. If you can afford it get one with a memory so it records your readings so that you can’t be accused of making the numbers up. It is important to understand that blood pressure does not play an important part in getting a diagnosis. Some people with PoTS have normal blood pressure, some have low and others have high. Why you need the BP monitor is so that you can start tracking your pulse and your blood pressure. If you can’t afford a blood pressure monitor for whatever reason, a pulse oximeter ( a little device than can read your pulse by clipping onto your finger) is the next best thing and you can pick them up online from as little as £10. 
 
Please remember people with PoTS tend to have very cold fingers (and toes) so before using a pulse oximeter ensure your fingers are warm enough to provide an accurate reading. Before my second tilt table test (yes I was stupid enough to do it twice) I had to sit with my fingers in a bowl of warm water as the pulse ox couldn’t get a reading.
 
Secondly understand what PoTS is!
 
PoTs is a rise in your pulse / heart rate of at least 30 beats per min (bpm) or hitting 120bpm or over, within the first ten minutes of standing. In children (up to the age of 19) the rise needs to be over 40bpm. If your heart rate doesn’t increase by 30bpm or over 120bpm within the first ten minutes of standing it is unlikely to be PoTS. 
 
When a normal person goes from sitting to standing their pulse / heart rate will increase on average by 15-20bpm. Within a minute or so their heart rate will go back to normal. A person with PoTS could start with a baseline heart rate of 80bpm and on standing increase to at least 110bpm. Then as they continue to stand their pulse could increase further. I know on my own tilt table test my own heart rate increased to 150bpm, unfortunately I don’t know what my baseline measurement was. Usually my pulse is in the 80’s and if that was the case I certainly managed the increase of 30bpm and smashed the 120bpm threshold.
 
Because many people (but not all) with PoTS also seem to have low blood pressure that is why I recommend getting a monitor. It helps to see what your blood pressure and pulse are doing after specific triggers such as climbing the stairs, raising your hand above your head, eating – particularly carb loaded meals. Many people with PoTS find their symptoms are much worse after eating heavy carb meals, so it is recommended to eat high protein low carbohydrate meals which don’t cause postprandial symptoms.
 
Thirdly conduct your own poor man’s tilt table test.
 
You maybe wondering what on earth is a poor man’s tilt table test, that is ok I was left scratching my head after first hearing this term on a forum called DINET. Because none of us own our very own tilt table designed for testing people for PoTS amongst other things, we can replicate how we will respond to the actual test by completing the poor man’s tilt table test and some gp’s who are PoTS savvy will do this in their consulting room or at the very least conduct a standing test.
 
To conduct a poor man’s tilt table test, you need somewhere comfortable and relaxing to lie down, without interruptions and preferably away from harsh or natural light. A wall to stand against which is adjacent to the relaxing lie down area however if you don’t have this don’t worry you can still conduct the test. You also need your bp monitor / pulse ox and a handy sidekick to record your test results. Also your sidekick can rescue you should you faint whilst completing this test so please be careful and do not attempt to complete it without having someone with you. Please also ensure that the area is safe should you decide to face plant, so free from things you could hurt yourself on. Cushions or pillows on the floor can help prevent injury!
 
To start the test you need to lie down and relax, no talking, no interruptions for 20 minutes. If you can darken the room in anyway before starting the test do. At the end of the 20 minutes with as little movement as possible take your blood pressure and pulse readings. These are your base line readings and what you will use to compare against the reading you get during the test.
 
Once you have your baseline readings stand as quickly as you can placing your back against the wall. The wall just helps prevent you from moving, people with PoTS tend to be natural fidgets because we either faint or feel like we are going to faint. Moving keeps the blood flowing, we don’t want you to do that whilst you are standing up as it may mess up the results. If you don’t have a wall to prop yourself up against try and keep your legs as still as possible.
 
Then at 1 minute, 2 minutes, 5 minutes, 7 minutes and 10 minutes take readings of your blood pressure and pulse or get your trusty assistant to do it. After the ten minute reading has been taken, sit down get your legs elevated and have a drink of water. You may notice that your feet / legs have gone a nice shade of red or purple. Don’t be alarmed this is called blood pooling and is very common with PoTs.
 
Now take a look at your readings if it shows an increase of 30+ bpm / 120 bpm this is positive for PoTS. Do not despair if it doesn’t show PoTS one negative poor man’s tilt table test does not mean it’s not PoTS, it may just mean you weren’t particularly symptomatic that day. Try to complete the test on a day when your symptoms are more evident.
 
Other things that might show during a poor man’s tilt table test are things like orthostatic intolerance ( your blood pressure goes below 90/60 on standing), you may have also fainted, if so I am sorry. The blood pressure readings could also reveal if you suffer from hyper-PoTS, which is where you have high blood pressure and PoTS. This needs to be treated differently to “normal” PoTS as most doctors will avoid giving you medication that will increase your blood pressure.
 
If you can’t for whatever reason do the poor man’s tilt table test you could perhaps try what is known as the standing test. Instead of lying down you sit down for 5 to 10 minutes to get your baseline pulse and blood pressure readings and then stand for as long as you can. Taking your readings at the same intervals as the poor mans test. This can also show PoTS. Remember PoTS stands for postural (position) orthostatic, tachycardia (fast heart rate / pulse), Syndrome (collection of symptoms and no two patients are alike).
 
What to do next?
 
Print off the gp’s guide from http://www.potsuk.org/gp_guide and book an appointment with your gp or a doctor at the practice who has been the most supportive. Sometimes these aren’t necessarily the same. Whilst waiting for your appointment take a look (if you are in the UK) at the Doctors list on the same website. This will give you an idea of who you can ask to be referred to, not all cardiologists are knowledgeable in the area of PoTS so it makes sense to see an expert, rather than someone who will give you the run around. For international readers DINET also has a Physician’s list.
 
If you have a disappointing gp visit and they still will not listen to you even when provided with your own test results and the gp guide, do not give up. Try every doctor at the practice if you have to and if that doesn’t work contact the practice manager. If you get no joy after all of that try reaching out to one of the many UK facebook PoTS groups. They have members all over the country and they maybe able to help you find a new gp practice with more sympathetic gp’s who are aware of the condition. 
 
If you have a disappointing consultants visit because despite your request of being sent to a specific doctor who is knowledgeable about the condition and you didn’t get to see one, you have a right to ask for a second opinion and ask once again to see one of the doctors named on the potsuk.org website.
 
You will get there in the end!
 
Most doctors will not confirm a diagnosis of PoTS without conducting a Tilt Table Test, ECG and possibly 24 hour blood pressure / heart monitoring. I was diagnosed on my tilt table results alone possibly because from 2007-2011 I had so many other investigations conducted they decided nothing more was needed.
 
The good news is that many people recover from PoTS especially if they have primary PoTS. Primary PoTS is usually caused by pregnancy, a virus, trauma or prolonged bed rest. Astronauts suffer from PoTS when returning to the Earth’s atmosphere and when their bodies re-adjust to the Earth’s gravitational pull their symptoms disappear.
 
Teenagers who develop PoTS also have a high chance of growing out of it. Researchers believe that teenagers develop PoTS due to the hormonal changes and growth spurts they are subjected to. Patients like these tend to grow out of their symptoms by their mid- twenties.
 
Patients with secondary PoTS, so PoTS that has happened due to a primary condition such as cancer, autoimmune diseases (like M.S, Lupus, Sjogrens), Ehlers Danlos Syndrome can also look forward to on the whole having the condition managed through medication and lifestyle changes (exercise, increased fluids, salt, adequate rest).
 
However I would be remiss if I didn’t state that there are patients like me that have refractory PoTS (it doesn’t respond to medication) and go onto develop more issues relating to our autonomic nervous system. We are the minority though not the majority. I don’t want to scare anyone who has just started on this journey I just want to be truthful.
 
My symptoms now are pretty much the same as when I first started on this journey with PoTS / Dysautonomia. I still have Ptosis on and off which no one has ever been able to explain. I still have issues with my breathing, fatigue, syncope and pre-syncope. A good day means that my heart isn’t continually feeling like it is fighting out of my chest on every change in posture. A bad day means not being able to sit up in bed without feeling faint, my heart rate not dropping below 100bpm even at rest. 
 
With my combined conditions each day is very much different with a new set of symptoms to overcome. It is exhausting, it makes me angry, it makes me sad and quite a lot of the time it makes me laugh because my body is just so screwed up!
 
One last thing…..if you are diagnosed with any type of tachycardia, including PoTS and you hold a driving licence you must inform the DVLA. You can do that via this Link. You will also need to contact your car insurance providers.
Another great source of information is Stars another charity that helps people with a variety of conditions including PoTS.