Dec 27, 2010

Dictionary of POTS Terms

Here's a plain English explanation of some of the fancy medical terms you may want to learn if you or someone you know has POTS:

Hypo - the term "hypo" at the beginning of a medical term means "under" or "low."  Examples:
hypotension - low blood pressure
hypovolemia - low blood volume (in simple terms: not enough blood)
hypoxia or hypoxic - low oxygen
hypochloremia - low blood chloride

Hyper - the opposite of hypo; used at the beginning of a medical term meaning "over," "high" or "too much" of something.  Examples:
hyperglycemia - high blood sugar
hyperkalemia - high blood potassium
hypernatremia - high blood sodium

Most of the "hypo" medical terms can be changed to the "hyper" terms.  Examples:
hypotension - low blood pressure
hypertension - high blood pressure

emia - used at the end of a medical term means "of the blood."  Examples:
hypoglycemia - low blood sugar
anemia - low red blood cell count

Syncope (pronounced sink-o-pea)
Partial or complete loss of consciousness with interruption of awareness of oneself and ones surroundings. (plain English - fainting, blacking out, passing out).

Some people get one or more warning signs from their body that they are about to faint.  For example, my legs start to feel heavy, and then as though they are weighed down with cement shoes, I get all sweaty from head to toe, I feel like the blood has flushed from my upper body downwards to my lower half, I lose my hearing and get a ringing sound (tinnitus) in my right ear, and I start to see only one color in tunnel vision - usually a grey blurry visual field, but sometimes red.  I'm also told by people who can see me that I tend to freeze in one place (probably because I'm trying not to fall over or bump into something, since I can't see) and I get a really spaced out look on my face.  These are called pre-syncope or pre-syncopal symptoms.  Not everyone with POTS has pre-syncope signs or symptoms.  Some people faint without any warning.

While many people use these terms interchangeably, it's important to be able to use them correctly when explaining symptoms to your doctor.  "I'm dizzy" isn't really that precise.  Try to describe your dizziness to your doctor in more precise terms:
Vertigo - a feeling of motion when one is stationary - you aren't moving but the room is spinning in circles around you (drunk college kids call this "the spins").  Sometimes you feel like the blood inside your head is spinning like a blender, but the room isn't spinning.
Lightheadedness - weakness or feeling as though your are about to faint (usually a pre-syncope symptom)
Disequilibrium - feeling or being off balance, most often characterized by frequent falls in a specific direction.

Blood Pressure (BP) -  BP is the pressure exerted by circulating blood upon the walls of your blood vessels. During each heartbeat, BP varies between a maximum pressure (known as systolic pressure) and a minimum pressure (known as diastolic pressure).  BP is usually expressed as systolic over diastolic. For example, a 'normal' adult blood pressure reading taken from your arm about 1 inch above your elbow would be 120/80 mmHg.  120 is the systolic pressure, 80 is the diastolic pressure and mmHg means millimeters of mercury - the measurement standard doctors use for blood pressure readings.

Orthostatic Hypotension - defined by the American Autonomic Society and the American Academy of Neurology as a systolic blood pressure decrease of at least 20 mm Hg or a diastolic blood pressure decrease of at least 10 mm Hg within three minutes of standing. 

Renin-Aldosterone Axis (RAA)
There is a very complex system of hormones, neurotransmitters and receptors in your body that regulate your kidneys and your blood volume.  Many people with POTS have an imbalance somewhere within the RAA system, which is also called the Renin Angiotensen System (RAS). Rather than explaining it here, just know that it's important for your doctor to check this system if you may have POTS.  For a more detailed explanation of the RAA/RAS, visit Wikipedia.

Arrhythmia - any abnormal heart rhythm caused by an abnormal electrical signal to the heart.

Sinus Arrhythmia (also known as Respiratory Sinus Arrhythmia [RSA]) - a naturally occurring variation in heart rate that occurs during a breathing cycle. Heart rate increases during inhalation and decreases during exhalation.  In some POTS patients, or patients with other forms of dysautonomia, the sinus arrhythmia can become exaggerated and may be considered abnormal.

Tachycardia - fast heart beat

Bradycardia - slow heart beat

Peripheral Nervous System vs. Central Nervous System - Your nervous system can be divided into two main parts: The Central Nervous System (CNS) includes your brain and the nerves in your spinal cord.  The CNS is like the supercomputer of your body - it processes all of the information received from other parts of your body and it helps one part of your body communicate with other parts to help all of our complicated body parts function smoothly as one body.  The peripheral nervous system includes all of the nerves in your body except the ones in your brain and spinal cord.  The main purpose of the peripheral nervous system it to connect your brain to all of you other organs (heart, kidneys, stomach, skin, etc.) and your limbs (arms, legs, fingers, etc.).  The peripheral nervous system can be divided into two parts: the autonomic nervous system and the somatic nervous system.

Somatic Nervous System - processes sensory information (smell, touch, taste, sight, sound) and controls almost all of the voluntary muscular systems in the body (moving your arms, legs, toes, etc.)

Autonomic Nervous System (ANS) - Your ANS controls all of the involuntary system of your body (e.g., the ones you don't have to think about for them to work.  For example, your ANS controls the speed in which your food travels through your digestive system, from your esophagus, to your stomach to your intestines, etc.).  The ANS is part of your peripheral nervous system and it plays a major role in controlling your heart rate, respiration rate, salivation, perspiration, temperature control, the diameter of your pupils, sexual arousal, digestion, bowel movements and urination.

Dysautonomia (autonomic dysfunction) is a broad term that describes any disease or malfunction of the autonomic nervous system.  This includes POTS, inappropriate sinus tachycardia (IST), vasovagal syncope, neurocardiogenic syncope (NCS), mitral valve prolapse dysautonomia, pure autonomic failure, neurally mediated hypotension (NMH), and a number of lesser-known disorders such as cerebral salt wasting syndrome. Dysautonomia is associated with Lyme disease, primary biliary cirrhosis, Chronic Fatigue Syndrome, Fibromyalgia, Shy-Drager Syndrome (multiple system atrophy), Marfan Syndrome, Ehlers-Danos Syndrome, hyerflexibility, and other rare genetic diseases.

Since I want this blog to be tween/teen friendly, I'm including a list of some of the different types of specialty doctors that POTS patients may utilize:

Neurologist - specializes in the nervous system (hopefully you can find a neurologist who has a sub-specialty in autonomic disorders)

Cardiologist - specializes in the heart and cardiovascular system

Pulmonologist - specializes in the lungs and breathing problems

Endocrinologist - specializes in metabolic issues like diabetes, and endocrine issues (adrenal, thyroid & pituitary glands, etc.)

Gastroenterologist - specializes in gastrointestinal issues (esophagus, stomach, intestines, colon problems).

Urologist - these doctors specialize in the function of the kidneys, ureter, bladder (and in men, the prostate) and all aspects of urination

Infectious Disease Specialist - some people with POTS may have or may have previously had an infection that caused or is causing their POTS symptoms.  An infectious disease specialist can help you diagnose and possibly treat infections.

Allergist/Immunologist - while these are two different specialities, doctors that practice one of these often work closely with doctors in the other specialty, or sometimes one doctor with hold degrees in both specialities.  An allergist looks for an helps treat allergies to foods, drugs, or environmental factors (like dust or pet dander).  An immunologist specializes in the diagnosis and treatment of immune system disorders, also called autoimmune disorders - like Lupus, Celiac, etc.

Psychologist - helps people learn to cope with the feelings, like anger, anxiety or depression, that can sometimes accompany serious medical problems like POTS.

Psychiatrist-similar to a psychologist, but a psychiatrist can prescribe medications to help deal with mental health issues in addition to providing counseling and various forms of therapy.

Physical Therapist - a P/T can help you design an exercise regimen suitable to your abilities that will make sure you're muscles and joints are strong and flexible.  This can help improve your symptoms over time.

Chiropractor - chiropractors help people maintain good posture and can help relieve back and joint pain.  They focus on proper alignment and support of the spine.

I try to define medical phrases in simple terms whenever I can throughout this blog.  If you can think of medical terms related to POTS that you would like to se listed here, please post a comment and I will add  them to the blog.

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