Postural Orthostatic Tachycardia Syndrome Attorney
POTS, aka Postural Orthostatic Tachycardia Syndrome, is a disorder of the autonomic nervous system. It can be a debilitating illness. When severe, individuals cannot work. This page discusses POTS, its symptoms, treatment, and what you can do if you are diagnosed. It may be helpful to reach out to a POTS attorney. The Law Offices of Scott Glovsky have litigated POTS cases.
What is POTS?
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that affects the nervous system and blood flow. Postural orthostatic tachycardia is an increased heart rate when a person changes the position of their body from a reclined position to standing upright. Patients with POTS experience symptoms such as dizziness, lightheadedness, fainting, and rapid heart rate upon standing up from a seated position. Typically, heart rate and blood pressure coordinate to keep the body’s blood flowing to all parts of the body at a healthy rate, regardless of the physical position a person is in. In people with POTS, the body is unable to properly regulate the blood vessel and heart rate responses as it changes positions. This leads to unsteady blood pressure, an increased heart rate, and a multitude of symptoms.
POTS is a type of dysautonomia, which is an autonomic nervous system disorder. The autonomic nervous system regulates involuntary bodily functions, such as blood pressure, heart rate, and body temperature. POTS is not a result of a heart abnormality but can occur as a result of a lower-than-normal amount of blood in circulation, pooling of blood in the lower half of the body while upright, high levels of certain hormones, such as epinephrine and norepinephrine, or any combination of these factors.
When a person stands, gravity causes more blood to fall to the lower half of their body. This can make it difficult for the brain to receive enough blood. To regulate this, the body typically activates autonomic nervous system responses. The nervous system releases hormones that instruct the blood vessels to tighten, which raises blood pressure. The increase in blood pressure pushes the blood back to the upper half of the body and to the brain. Once the brain receives enough blood, the nervous system settles, and blood pressure returns to normal. In people with POTS, the blood vessels fail to tighten, allowing more blood to fall to the lower half of the body. The nervous system will continue trying to tighten the blood vessels by releasing more and more epinephrine and norepinephrine, which causes the heart rate to increase rapidly. This can cause heart palpitations and chest pain. As the brain is not receiving enough blood, symptoms such as lightheadedness, fatigue, brain fog, and fainting also occur.
What are the Symptoms of POTS?
There are many different symptoms associated with POTS, and symptoms vary from person to person. Not all patients with POTS experience all the symptoms listed below, but most suffer from two or more. Symptoms include:
- High blood pressure OR low blood pressure
- High heart rate OR low heart rate
- Blurred vision
- Forgetfulness and trouble focusing
- Chest pain
- Nervousness, restlessness
- Abdominal pain
- Exercise intolerance
- Diarrhea OR constipation
What Causes Postural Orthostatic Tachycardia Syndrome?
While doctors aren’t entirely aware of all factors that may lead to POTS, there are a few general reasons one might experience symptoms. POTS can be caused by one factor or a multitude of factors, and these factors vary from patient to patient. The most common causes are categorized into four loose types of POTS:
- Hyperadrenergic POTS refers to POTS symptoms caused by high levels of norepinephrine, which is a stress hormone produced by the nervous system.
- Neuropathic POTS refers to POTS symptoms caused by small-fiber neuropathy. Small fiber nerves are responsible for the constricting of blood vessels – if they are damaged, the body is not able to regulate blood pressure as it should.
- Hypovolemic POTS refers to POTS symptoms related to abnormally low blood levels, known as hypovolemia.
- Finally, Secondary POTS refers to POTS symptoms that arise due to another condition that may have caused damage to the nervous system. Diabetes, Lyme disease, lupus, and Sjögren’s syndrome are all known to contribute to POTS symptoms.
How is Postural Orthostatic Tachycardia Syndrome Diagnosed?
POTS can be a difficult syndrome to diagnose. In fact, one study found that most patients don’t get diagnosed with POTS until a year or longer after seeing a doctor and that the average diagnosis delay is five years. POTS symptoms involve many different organ systems, and the severity of each symptom depends on the patient. Because of the variety of ways that POTS can present, there can’t be one set of symptoms required for a diagnosis. The road to a POTS diagnosis can be months long and requires several different tests, such as physical examinations, bloodwork, and a tilt table test.
During the tilt table test, the patient is strapped onto a table that is lying flat. The table is then raised into an upright position, and the patient’s response to the change of position is recorded. Heart rate, blood pressure, blood oxygen, and exhaled carbon dioxide levels are monitored and measured throughout the test. If the patient has an abnormal heart rate response and general POTS symptoms occur/worsen after being turned upright, there is a good chance that the patient has POTS.
There are other possible tests that a physician may order. The Valsalva maneuver tests the reaction of autonomic nerves that control the heart. The quantitative sudomotor axon reflex test (QSART) can be used to measure the response of the autonomic nerves that control sweating. In some cases, doctors may also order an MRI or other imaging tests to rule out other physical abnormalities, such as tumors.
POTS can be diagnosed once other conditions, such as orthostatic hypotension, are ruled out, and when there is no dehydration or blood loss.
More recently, an estimated 2% – 14% of COVID-19 patients develop POTS.
Who Gets POTS and How Many Americans Have The Disease?
Prior to COVID-19, one to three million Americans had the disease. Since the pandemic, an estimated additional one million people have POTS. According to the 2019 study referred to above, POTS mostly affects Caucasian (93%) females (94%) during their childbearing age (12 to 51). Half of these individuals develop symptoms when they are adolescents.
How is POTS Managed and Treated?
As every POTS case presents with different causes and symptoms, each patient must be treated differently. Doctors typically create individual treatment plans for each patient. POTS cannot be cured, but it can be managed with a combination of diet, exercise, and medicinal treatment.
Nonmedicinal treatments include special diet and exercise routines. An increase in water and salt can be crucial in improving POTS symptoms. For most POTS patients, doctors recommend drinking at least 2 to 2.5 liters of water a day. Doctors also recommend increasing the intake of salty foods, even suggesting salt tablets. These modifications help to increase the amount of water in the bloodstream, helping more blood reach the heart and brain. Certain foods should be avoided by patients with POTS, such as alcohol and beverages with caffeine. Alcohol diverts blood away from the central circulation, which exacerbates the body’s inability to push blood to the brain. Alcohol also causes an increased loss of fluids. Caffeine can lead to increased nervousness and lightheadedness. Doctors can help patients understand their unique dietary needs.
Physical therapy is also an option for the treatment of POTS. Exercise often exacerbates POTS symptoms, so many POTS patients are unable to exercise. The goal of physical therapy is to increase the patient’s tolerance to exercise, which helps to increase blood volume. Many patients must start very slowly, and typically in a horizontal or reclined position. As POTS symptoms improve with diet and medication, the patient’s tolerance to exercise may improve, and exercise intensity can be increased. Experts have found that physical therapy can help address issues with nerve tightness and range of motion, which ultimately improves the patient’s tolerance to exercise.
Many physicians prescribe a combination of diet, exercise, and medication. The medication chosen to treat POTS depends on each individual patient’s symptoms, causes, and needs. There is no medication that can treat all POTS symptoms, so medications are usually chosen to target the main origin or primary symptoms of each patient. Finding the right medication or combinations of medication can take some time. Medications prescribed to treat POTS symptoms may focus on increasing blood volume, reducing heart rate, blocking effects of adrenal hormones (beta-blockers), improving blood vessel constriction (midodrine), and improving the kidneys’ sodium retention (fludrocortisone).
Other suggestions include limiting behavior that is known to worsen POTS symptoms, wearing compression garments, and sitting or sleeping in specific positions. With the right combination of diet, exercise, and medication, many patients see improvement in their POTS symptoms.
Will Health Insurance Companies Cover POTS Treatment?
Treatment of POTS can take many different forms, so it’s not easy to determine whether POTS treatment will be covered by any given health insurance company. Most insurers will cover physical therapy costs, and most will also cover drugs approved by the FDA.
However, if a medication is extremely expensive, many health insurers will attempt to utilize “step therapy” in which they deny more expensive drugs in favor of cheaper alternatives. In step therapy, patients are first required to try less expensive treatment options. Only after treatment is proven ineffective against a patient’s symptoms will the insurance company consider covering a more expensive treatment. In California, a patient must try the insurer’s approved drug for at least 60 days before the insurer will approve another drug. Unfortunately, this process can be long and drawn out. If patients are required to try multiple different treatments before being approved for the medication they know will work, this delays their recovery and forces patients to live with debilitating symptoms in the meantime.
Coverage for POTS treatment ultimately depends on the health insurance company and may be difficult to acquire for more expensive treatments.
Are There Other Types of Insurance Coverage for POTS?
Sometimes people with severe POTS must go on disability. Severe POTS may mean you cannot work for a year or longer. You might have private disability insurance. And you might be eligible for state disability. For state disability, you must meet the Social Security Association’s definition of disability. The SSA uses the “Blue Book” to categorize disabilities. The Blue Book may not include POTS, but you can look for other disabilities with similar symptoms. You can learn more about the Social Security Administration’s disability evaluation process here.
How Do I Coordinate and Organize My Care?
POTS can be difficult to diagnose, and it can also be very difficult to treat. During the diagnosis process, multiple different tests must be ordered, symptoms must be recorded closely, and patients oftentimes must advocate for themselves with their doctors and insurers. Once a patient receives a diagnosis, figuring out the treatment plan also takes time. Trial and error on types of medications, dosages, and combinations of different medications can be drawn out and frustrating.
It’s important that patients keep all records and test results organized. Having as much documentation of testing and medication trials as possible can help patients advocate for themselves and provide evidence of the medical necessity of certain treatments, especially for expensive medications that health insurance providers may be resistant to covering.
POTS can be debilitating but managing and finding relief from POTS is possible with patience, determination, and doctors who are willing to fight for answers.
Contact Law Offices of Scott Glovsky if You Need a Postural Orthostatic Tachycardia Syndrome Attorney.
The Law Offices of Scott Glovsky has represented injured consumers for over two decades. The firm focuses on health insurance bad faith, catastrophic personal injury, sexual abuse and consumer-related litigation. We get justice for our clients and hold the wrongdoers accountable.