Thread by @BadgleyLaurence

RESTLESS LEGS: the question becomes, why would the autonomic nervous system evoke involuntary leg movements when people are reclined and drifting into sleep; in those with POTS?

https://twitter.com/mastopedia/status/1333271337159196673

POTS highly associated with connective tissue Hypermobility & manifests as hypotension/tachycardia upon sudden upright posture; as body blood column descends. Perhaps Mitral Valve regurgitation is involved + laxity/sluggishness of autonomic-driven constriction of vein walls.

Blood returns from legs to heart vis superior-directed propulsion of lower blood column by means of leg muscle contractions; restless legs provide such muscle contraction propulsions par excellence.

Mitral valve prolapse (MPV) is highly associated with connective tissue laxity in Hypermobility. Heart valves are derivations of connective tissue. Of course blood regurgitation via MV would contribute to diminished forward flow of blood & tendency toward hypotension, i.e., POTS.

I have tried to demonstrate MVP in those with Hypermobility & the best I were usually able to find was “trace of regurgitation”. Eventually, it dawned on me: the ultrasound exam to demonstrate MVP is performed while the patient is reclined.

When the patient is reclined, the blood volume is variously horizontal, & the heart has an easier mechanical effort propelling the blood column towards the brain, where autonomic transducers monitor blood pressure & pronate body involuntarily if brain is being deprived of blood.

Authentic study of the blood column burden on the mitral valve should be performed within an upright body, wherein weight of the blood column is maximally imposed on the water-tight seal of closed mitral valve leaflets.

Unfortunately, upright ultrasound echocardiogram studies of heart valve functions are not extant; because this technology has not yet been invented; at least there are no such studies available at the community hospital level. Someday!

Therefore, I suspect that Mitral Valve Prolapse (MPV) is integral to the POTS phenomenon. Since there is no data to the contrary, my theory is as good as the next.

What is known is that Mitral Valve Prolapse is highly associated with both Hypermobility & Panic Attacks, which are a keynote symptom in those with Hypermobility. It is not unusual for women with Hypermobility to have several Panic Attacks per week.

Unfortunately, most physicians, unable to discern either Hypermobility or MVP, commonly fall back on the trusty diagnosis available when anxiety is involved, “mental aberrations”. Most of these poor women become branded as hysterics & are triaged to Psychologists.

Once these women become tagged as neurotic, this label is conveniently transferred to many of the other dysautonomias that attend Hypermobility & Fibromyalgia; which themselves are highly associated.

These misdiagnoses bring to mind some faulty theorems that work to allay the anxieties of physicians who lack diagnostic acumen: “when everything is wrong this usually means that nothing is wrong”, meaning that the collection of symptoms is “functional & in the mind”.

Another shibboleth is the concept that, “absence of evidence is evidence of absence”. I have always wondered why logic is not a compulsory study in medical schools & how did so many doctors come to disregard the power of logical thinking.

I think the answer to the phenomenon of illogical medical thinking derives from the dominant personality styles chosen to study medical sciences: egotism & narcissism are strong survival traits in the internecine war of medical students & the ferocious competitions they undergo.

Narcissists can be very commercially successful doctors: first belittle & sham patients to gain their obedience, then tell them that you, the doctor, have expert knowledge to save their very lives.

All the while the doctor-egoist-narcissist cannot reveal any weakness in expertise nor shatter any part of an aura of invincibility about all knowledge able to be known about functioning of the human body.

Over the years, the Physician Guild amassed absolute control of the medical marketplace such that competition from Naturopaths, Acupuncturists, Ayurvedic Doctors, Oriental Herbalists, etc. has been effectively blocked from the marketplace. Until recently, & public outcries.

So before I sign off from this rant, back to an uncompleted thought about Panic Attacks. My theory is that Panic Attacks start when the blood column of people, mostly women, fails to deliver adequate blood to the brain, the body organ with greatest need for uninterrupted oxygen.

Women with Hypermobility, & in whom leg venous vessel clamping is sluggish, experience autonomic nervous system alarms: sudden speeding up of heart pump (tachycardia), increased respiration rate (more oxygen into blood). Often these sudden changes are accompanied by chest pain.

These women, who experience these autonomic alarms (dysautonomias) become flushed, sweaty, fearful, & with an impending sense of doom. Their distress becomes embarrassingly obvious to others. After a few of these unannounced episodes, these women begin to shun public events.

It is no accident that the billing code for Panic Attack includes the annotation “agoraphobia”; Latin for fear of the “agora”, the marketplace. Women with frequent Panic Attacks can evolve, in the worst behavioral trait, to home bound recluses fearful of public humiliations.

It should be regarded that aberrant behavior of these women is primarily physiological, & not from weakness of character, mind, or will. Doctors who understand this thread of physiological events need to teach these women how to forestall these events, but that is another story.

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