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S Blitshteyn MD, Dysautonomia Clinic Profile picture
@dysclinic
Apr 1 • 3 tweets • 4 min read Twitter logo Read on Twitter
Interesting European study that confirms the US findings: #POTS is the most common autonomic disorder, both after #COVID19 and #covidvaccines. It's important to remember that in the past, the European Medical Agencies rejected the idea that #POTS can follow #HPV vaccination. 1/n
But #Covid #pandemic showed us that jumping to conclusions prematurely and denying reality observed in various countries - which is that #POTS can be triggered by HPV vaccines - serves no purpose in scientific process or #PatientCare. 2/n
pubmed.ncbi.nlm.nih.gov/31832903/
The house of cards has fallen. We can all agree now that #POTS is one of the major post-infectious AND post-vaccination adverse events and can finally invest money/resources in studying it and bringing effective therapies to millions of pts with POTS. 3/3
nature.com/articles/s4416…

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More from @dysclinic

S Blitshteyn MD, Dysautonomia Clinic Profile picture
Mar 8
This is a highly relevant study from Japan on #Dysautonomia, #gAchR antibodies and #FND!

I'll explain why it's important and what it means in clinical terms. 1/🧵

#MedTwitter #NeuroTwitter @Dysautonomia

frontiersin.org/articles/10.33…
@Dysautonomia What the study found:
✅ Out of 59 patients who qualified for #FND diagnosis by DSMV criteria, 88% had autonomic symptoms!!!
✅ 27% were positive for ganglionic acetylcholine receptor antibody (gAchR Ab) via LIPS assay.
✅ 50% had #POTS.
✅ 50% had orthostatic hypotension.
2/🧵
@Dysautonomia Why is this important?
✅ Our patients are often misdiagnosed with #FND, and this study proves that.
✅ When #FND is diagnosed, treatment is psychotherapy & physical therapy, which is not a treatment for #Dysautonomia.
✅ We MUST identify and treat #Dysautonomia symptoms.
3/🧵
Read 4 tweets
S Blitshteyn MD, Dysautonomia Clinic Profile picture
Feb 9
On biomarkers: Patients with #Dysautonomia have preload failure. Invasive caridopulmonary testing or cardiac catheterization proves it. I just had a patient with post-Covid #POTS who had the tests done to rule out heart disease. She had no CAD, but did have preload failure. 1/🧵
Her excellent cardiologist @FudimMarat identified the problem and correctly diagnosed it. His findings were consistent with Dr. Systrom's study on preload failure. 2/🧵
onlinelibrary.wiley.com/doi/10.1086/68…
This patient was fortunate: she wasn't dismissed because her 2D cardiac echo & 24-hr Holter monitor were negative. Many patients with #Dysautonomia and #LongCovid are simply discounted as anxious or deconditioned when their routine cardiac & neurologic tests are unrevealing. 3/🧵
Read 5 tweets
S Blitshteyn MD, Dysautonomia Clinic Profile picture
Feb 2
I love it when a patient tells me that they feel 70% better compared to a few months ago. How did we achieve this? By using MEDICATIONS. I see so many #POTS patients who's seen many doctors for years, but barely any meds have been tried. Finding the right meds is the key. 1/🧵
Most of my patients have seen dozen of doctors before. They're not interested in me recommending increased fluid and salt intake: they've already tried it, and it's not enough. They want symptomatic relief. They want regaining their ability to work. They want solutions! 2/🧵
We have a variety of medications to offer from different classes and with different mechanisms of action. I encourage my colleagues to use them: start one medication at a time and at a low dose. One failed beta blocker trial doesn't preclude trying another beta blocker. 3/🧵
Read 5 tweets
S Blitshteyn MD, Dysautonomia Clinic Profile picture
Jan 3
✍️ Inspired by others, here is my top 10 list of noteworthy 2022 studies on #POTS & other common forms of #Dysautonomia (in no particular order). #MedTwitter 🧵1/10

1⃣ "Malmö POTS symptom score: Assessing symptom burden in POTS" by @ArturFedorowski et al.
onlinelibrary.wiley.com/doi/10.1111/jo…
@ArturFedorowski 2⃣ "Platelet storage pool deficiency and elevated inflammatory biomarkers are prevalent in Postural Orthostatic Tachycardia Syndrome" by Blair Grubb et al.
mdpi.com/2073-4409/11/5…
@ArturFedorowski 3⃣ "Worsening Postural Tachycardia Syndrome Is Associated With Increased Glucose-Dependent Insulinotropic Polypeptide Secretion" by @cyndyashibao1 et al.
ahajournals.org/doi/10.1161/HY…
Read 10 tweets
S Blitshteyn MD, Dysautonomia Clinic Profile picture
Dec 20, 2022
Believers that #LongCovid is "all in your mind" because there are on specific biomarkers or routine diagnostic tests are "normal" need to look at other autoimmune/inflammatory disorders. In #MultipleSclerosis, or example, it took decades to refine the diagnostic criteria. 1/🧵
First, before MRI/CT scans were invented, many #MS pts were misdiagnosed with psych disorders, including hysteria. Spinal taps in MS patients did not always reveal abnormalities. Many patients had various non-specific white matter lesions in MRI, but some had few or none. 2/🧵
Some #MS pts had optic neuritis, but many did not. Some had a lesion in the cervical cord, and many did not. How do you make sense of it all? It took many years and several revisions to come with the diagnostic criteria that we use today to diagnose MS and MS variants. 3/🧵
Read 8 tweets
S Blitshteyn MD, Dysautonomia Clinic Profile picture
Dec 5, 2022
🧵The new generation of doctors should be trained in compassion & non-biased approach in patients with chronic illness. Many of us have been trained to think "it's just anxiety" or "they're somatizing" when faced with a difficult patient. We were primed to dismiss & gaslight. 1/n
I remember attendings teaching us that if a nonparalyzed pt is in a wheelchair w/ sunglasses on for light sensitivity, that's a bad sign (ie a sign that they have psych problems, not real physical illness). I didn't know then that they would be my patients with #Dysautonomia. 2/n
I now teach medical students who work with me to never assume that the patient's complaints are due to a psychological problem: do the workup thoroughly, and if you still don't know what's wrong, tell them so and then refer them to someone else. Don't dismiss, label or judge. 3/n
Read 5 tweets

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