This Web page is designed for the general education of patients and their families.
Disclaimer: The answers provided are the opinion of Dr.
Tom Chelimsky. No patient should make any changes in their care without
first consulting their physician.
Question 1: I have pots and know many individuals with the same disorder. It seems that most of us experience muscle weakness in the legs and arms. We also seem to experience some joint pain without swelling. We are at a loss to explain why this happens and if it is typical with pots. It seems the higher I keep my blood pressure the less the symptoms.
Dr. Chelimsky: No one really understands exactly the neural mechanisms underlying the sense of muscle weakness or fatigue, nor why joint pain occurs when there is not joint inflammation. Many factors play a role, and lack of blood flow to muscle can clearly cause the muscle to feel fatigued, as well as if it is inflamed, or over utilized. The most likely explanation in POTS is as follows: when you contract your muscle, the pressure within the muscle rises, and your autonomic nervous system automatically produces an increase in overall blood pressure to match or exceed the pressure within the exercising muscle. This allows blood to flow to the muscle (consider if the pressure is higher in the muscle than in the blood vessel, blood cannot enter). If your autonomic nervous system has trouble maintaining even normal levels of blood pressure, it will be quite difficult to get pressure even higher than normal during muscle exercise. However, don't give up! Continue gentle and increasing exercise, especially in a pool, where the water up to your neck will act as a pressure blanket forcing blood back to the heart, and increasing overall pressure to the muscles. Just allow frequent periods of rest during exercise for muscle to be replenished (at times when the muscles feel excessively fatigued or weak). Similar joint pains occur when one deprives normal individuals from sleep, and their cause has not been ascertained. They may originate in a central nervous system mechanism signaling overall "fatigue", as seen in fibromyalgia syndrome.
Question 2: I also saw from a previous post that pots usually lasts 5-10 years. How did you come up with this figure?
Dr. Chelimsky: This is the average figure quoted in the literature if it is non-hereditary, and matches my clinical experience.
If you have a question, please submit it to Dr. Chelimsky.