Many may be unaware that their #LongCOVID presentation would dx with infection-associated chronic illnesses like #MECFS, #POTS, #MCAS, et al.
I promised I'd put together a thread on #POTS after the thread about management advice for the condition.
So let's get started! (1/)
First, let's discuss what #POTS may feel like.
POTS is postural orthostatic tachycardia syndrome. It means that when you change position from lying down to sitting up, or sitting to standing, your heart may pound, you'll feel dizzy &/or nauseated, and you can even pass out! (2/)
#POTS is: "A heart rate increase from horizontal to standing (or as tested on a tilt table) of at least 30 BPM in adults, or at least 40 BPM in adolescents, measured during the first 10 minutes of standing." (JHU)
Note: delayed responses can happen, too! (3/)
POTS is autonomic, so it affects many body systems.
Most with #POTS report post-infectious onset, just like #MECFS. Before infection, you may have had mild symptoms, too-- but after infection they may have become far more severe. (4/) #LongCOVID
Certain autoantibodies have been associated with #POTS, showing something is off in the immune system as well as the nervous system. (5/) #LongCOVID pubmed.ncbi.nlm.nih.gov/28738696/
However, at a specialist clinic, they might perform a tilt table test (TTT) or full autonomic panel to diagnose #POTS. Here's a good quick rundown of tests that are typically part of an autonomic panel: (7/) medlineplus.gov/lab-tests/auto…
OK, you get diagnosed! Now what?
There are many self-management tricks and tips.
What follows is some of what I've learned as someone with a diagnosis of autonomic #POTS.
None of this is intended to be medical advice, and remember I'm not a clinician, myself. (8/)
(1) COMPRESSION
People with #POTS have blood pooling when they stand. I have mediumweight compression socks from Sockwell. This can help prevent blood pooling.
Others use abdominal compression, too. (9/)
(2) WATER & ELECTROLYTES
My doc recommended I fill two, 1-L bottles of water before bed, adding salt or electrolytes, & "make sure they disappear" by the next day (on top of whatever else I was eating/drinking).
I've used Nuun brand & Trace Minerals PowerPak electrolytes. (10/)
(3) RECUMBENT EXERCISE
Exercising while being upright can be challenging in #POTS. Recumbent bikes are good, as is recumbent yoga:
(b) Avoiding carb-only meals
Big shifts in blood sugar affect BP through insulin-dependent AND insulin-independent pathways. Good fats + protein + carbs is fine for many, but an only-carb meal may make a POTSie feel worse. (13/)
5) DIET
(c) Eating smaller meals
Even in healthy people, eating a meal redirects blood flow to the stomach and gut; and eating a heavy meal moreso.
Since folks with #POTS have blood flow issues in the first place, this can worsen symptoms. Four small meals > 2-3 big ones. (14/)
6) MEDS
Meds can make a big difference! If your GP is certain "there is nothing to do" for #POTS here are some of Cleveland Clinic's suggestions. Very mainstream but they have all the big players: fludrocortisone, pyridostigmine, beta-blockers, etc. (15/) my.clevelandclinic.org/health/disease…
Meds are very individual. Some people POTS swear by fludrocortisone and others have poor responses, for example.
Important to acknowledge that good management makes a big difference even in cases where it is challenging to access meds.
The thread that prompted the ask ⬆️ -- lots of good stuff in the comments too.
ASSISTIVE DEVICES--
(Of course!)
-Mobility aids (wheelchairs, walkers, walking sticks)
-Standing in line can be very hard for #POTS folk! Rocking back and forth and clenching the backs of your legs can help! There are also walking sticks that unfold to chairs. <3
One thing we didn't mention: heat is vasodilating. So #POTS folks may get dizzier in the shower, for example, especially as they're standing so long. Shower chairs help! I also make sure I have an ice-cold drink by my bed as part of my pre-shower routine.
This from the BMJ a day or two after my first thread with a lot of similar advice: but note no mention of excluding ME/CFS or PEM and no mention of other common comorbidities. Be aware of the omission!
Let's say you have #MECFS or #LongCOVID and you think you might be ready to work again.
But only if you received the right kind of accommodations at your workplace... how would your employer (or you, even!) know what to suggest?
A few years back, our own Ben Hsuborger (1/5)
...worked with a work accommodations website called AskJan to revise and update their page on #MECFS, and he did an incredible job. The best aspect is that, when you scroll down, you can see accommodations by symptom. (2/4) #DisabilityTwitter (2/5)
Issues with concentration, memory, and executive function are central to #MECFS presentation. You can find AskJan's list of accommodations for #ADHD and executive functioning here (note: two links to follow). (3/5)
Excellent news! #CDC has a new page on infection-associated chronic sequelae. Of particular import: these chronic symptoms linger "even after appropriate treatment". 🧵 (1/4)
Some highlights:
✨Lists pathogens known to lead to chronic issues, inc. COVID, Borrelia, EBV
✨Talks about how some symptoms are specific to pathogen, others are common to many infection-associated chronic illnesses
✨Lampshades #MECFS multiple times in the article (2/4)
Highlights, cnt'd
✨Common-language etiology section that outlines a very complex picture very clearly
✨Mentions that everyday testing may not show anything but this does not mean symptoms aren't impairing
✨Lists their current projects (could be more/better, but still) (3/4)
#Disability rates have skyrocketed in the United States in the wake of #COVID, with infection-associated chronic illnesses like #MECFS, #POTS, & #MCAS surging. US Census figures currently report that 14% of Americans are now disabled. (1/7) 🧵
Rather than address the growing crisis of an ongoing pandemic, not to mention those already disabled, the US Census is responding by changing the definition of disability.
And if they do so, the rate of disability as identified by the Census is slated to drop to 8%. (2/7)
Dr. Bonnie Swenor, Director of the Johns Hopkins Disability Health Research Center, says, "These changes have moved forward w/o the input of the disability community & have far-reaching, negative implications for disabled people..." (3/7)
Overjoyed to announce my Concise Clinical Review of ME/CFS in Mayo Clinic Proceedings (with updated diagrams!) Very glad to have worked with @GrachStephanie and Ravi Ganesh and Tony Chon on this! 🧵#MedEd #MedTwitter mayoclinicproceedings.org/article/S0025-…
A concise clinical review is limited to a specific word count and a specific citation count, so we did our best to include the most vital information for diagnosis and treatment of #MECFS. (2/)
Concise clinical reviews are also a way to offer CME credit. Medical providers can take the free CME by reading the paper carefully and then answering the case-based questions that follow. #MedEd (3/) mayoclinicproceedings.org/article/S0025-…
"We... emphasize the need to build on and complement, rather than merely repeat, existing research from similar conditions, such as #MECFS, #Lyme disease, #dysautonomia..." (2/)
"Further exacerbating PASC’s time pressure is the NIH’s historic underfunding of overlapping illnesses with potential post-viral origins that have extremely similar phenotypes to #LongCOVID (Komaroff, 2019). If research for diseases such as #MECFS... (3/)
Let's talk about the UK's Science Media Centre and its history.
The Centre calls itself "an independent press office for science, working closely with press officers from universities, scientific companies, research funders &leading science and engineering institutions."
The SMC is a publicly-funded PR group, representing influential corporations whose financial interests are threatened by the interests of the public.
Connie St. Louis, then president of the Association of British Science Writers, said:
St. Louis performed a study on SMC. Over half the SMC’s "expert reactions" were covered in the press and "in 23% of the stories... the only quotes were those that came from the centre."
“Whatever the SMC delivered to them is what they used,” she said. tinyurl.com/2hhf562n