Feb 22, 2011

Managing Your Finances When You Have POTS

Almost anyone who has a prolonged serious illness will eventually find themselves facing financial difficulties.  If you can't work and you have huge medical expenses, it's not surprising.  One in three Americans living with disabilities lives below or at the poverty level - so this doesn't just apply to POTS.

Here are some things that may help you adjust your finances and make ends meet.  These suggestions probably impact adult POTS patients more than teenagers, but even teens should mention these things to their parents see if there is any financial help available to the family to help deal with medical expenses.

How To Save On Medical Expenses
If you have a doctor you've been seeing all the time, ask them if they will be willing to accept just what your insurance company pays them, and forego your co-pay or take just 1/2 your normal co-pay.  They are not supposed to do this, but I know of several doctors who do it with patients when they are in a financial squeeze.

If you end up with a pile of medical bills you can't afford to pay all at once, call the doctors, let them know you have a huge pile of bills you can't pay all at once and ask if you can make payments over time until the amount is paid in full.

Similarly, most hospitals have financial assistance programs you can apply for.  If you meet the financial need requirements set by the hospital they may discount or entirely eliminate your bill.  Even if you don't meet the financial requirements, they may be willing to let you pay a set amount of your bill over time.  Just be sure they won't report you as a late payer to a credit or collection agency, because you don't want to mess up your credit score over this.  Make sure your get the name, title and phone number of the person at the hospital who agrees to the payment plan, just in case you start getting calls from another department at the hospital or a collection agency saying you owe the full amount.

When your doctor is giving you a prescription, ask if there is a cheaper version of it available, like a generic or a different dosage that your insurance company may charge less for.  If you don't have a set co-pay amount, compare prices between a few different local pharmacies.   Be extra careful about buying each of your drugs from different pharmacies, because it will not be as easy for your pharmacist to notice possible adverse drug interactions.  Whenever you buy a prescription, ask the pharmacist to check to make sure the drug you are paying for doesn't have a bad reaction with the other drugs you are currently taking.  You can also search the internet and your doctors waiting room for coupons or free samples of the drugs you are taking.

Make sure all of your procedures/lab tests will be covered by your insurance company BEFORE you have the test.  I cannot tell you how many times I thought something was covered, only to find out that the doctor's office failed to get pre-approval.  Then I got stuck with a bill and had to argue with the doctor and the insurance company in order to get it resolved.  This is stress you don't need, so always make sure it's covered BEFORE the test.

Be Thrifty and Reduce Your Household Bills
Do you really need that 2000 minutes per month cell phone plan with unlimited texting and internet?  Probably not - so call your cell phone company, tell them you are sick and out of work and ask to switch to a lower plan, or cancel that cell phone altogether since you are probably home near a regular phone most of the time anyway.

Do you need 1000 TV channels?  I didn't think so.  Call the cable company and tell them the same thing you told the cell phone company.  My mom called our cable company and threatened to switch to Verizon Fios unless they cut her bill in half, and amazingly they agreed to do that.  That saved mom over $70 a month and we still get 1000 channels (and there is still nothing good to watch!).

Don't pay for movie rentals at Blockbuster or through Netflix - your local library probably has tons of free DVDs and videos for free, and if there is something you want to see and they don't have it in stock, they can often borrow it from another local library, or may even be willing to order it for you next time they are ordering new materials.

If you spouse/kids are buying lunch at work or school everyday, encourage them to take yummy dinner leftovers or a brown bag lunch more often to save money.  My husband was spending about $80 per week on lunch, and now he only goes out for lunch one day a week, and he only goes out for pizza, saving us about $75/week.

Sit down with your family and think of other ways to trim the fat off your monthly budget.  Cut coupons, wait till pantry items like paper towels or pasta go on sale before buying them, and turn off the lights when you aren't using them.  There's always a way to find a few more pennies to get by.

My husband carpools to work about once a week with another guy from his office.  This saves us some a few bucks each time he does it and limits wear tear on the car.  Plus it's good for the environment and they can go in the HOV lane, which gets them to work faster.

Sell Your Old Junk 
If you are home all day anyway, why not take some pictures of your junk and post it on Craig's List?  I sold extra dried lavender and seedlings from my garden, old tires, furniture that's been in the attic for 10 years and one of my antique surfboards (I got a little misty eyed when I sold it, but I can always buy a new one when I'm healthy enough to go surfing again).  This is a good way to clean out your storage and make a few bucks on the side.  Next item for sale will be my Jeep Wrangler, since I haven't been able to drive for about a year.  When I am up for driving again, I can always get another car - but there is no point in letting it rust away in the driveway and paying for insurance on it while I'm not using it.

Rent a Room In Your House
This may be illegal or require special permits depending on where you live, but you can earn a few hundred bucks a month if you are willing to rent out a spare bedroom in your house/apartment or have a roommate.  You may also need landlord approval if you rent or live in a co-op.  This is especially easy if you live near a college and you just want someone temporary - one semester or one school year.  That way your not stuck with some person you don't like in your house.

Apply for Worker's Comp/Disability
Each State is different, but here in NY, employers are required to provide a minimum level of disability insurance to their employees - which you probably pay a small fee for from each of your paychecks.  In NY, the minimum benefit period your employer's must provide is 6 months, although some companies offer longer benefit periods.  Talk to your Human Resources, Office Manager or Union Representative to see what is available.  This is usually meant for the first six months or so that you are unable to work.  The statutory minimum payments aren't much.  I got about $170 a week for six months, but every little bit helps.

Apply for Social Security Disability
If you are unable to work because of your POTS symptoms, you should seriously consider applying for Social Security disability benefits.  Social Security disability is meant for people who have a disability that prevents them from earning at minimum amount of money each month, and they are not improved or expected to improve within one year from the start of the disability. You do not have to wait for the one year to pass in order to apply. You should apply as soon as you have a POTS diagnosis if you can't work, since POTS is not a disease expected to resolve itself within one year.  I applied and I received it without even having an in person interview at my local Social Security office.

Some people with POTS who applied for Social Security disability have been turned down, and each case is different, but it may be worth it for you to talk to an attorney who specializes in social security applications.  Try to find a lawyer who does not charge a fee unless you actually receive payments from Social Security.  Once you receive Social Security disability benefits for two years, you will automatically get Medicare benefits, which can help cover hospital fees and and some other medical expenses.  This is particularly helpful if you don't have your own insurance.

It is important for you to discuss this with your doctor before you apply, because your chance of being approved is greatly increased if your doctor has carefully and accurately documented your symptoms and your physical limitations.  You can collect the most relevant medical documentation to send to social security, but if you don't they will contact your doctors and you will not know what the doctor's office sends, so you won't be sure that social security has all the relevant info needed to make a decision in your favor.  As an attorney, I do subscribe to the old saying "[h]e who has the most paperwork wins," especially when you are dealing with a massive federal bureaucracy like the Social Security Administration.  If your doctor won't help you, find another doctor.  You can also send a letter with your application documenting all of your symptoms yourself.  The more detail, the better.  You really have to demonstrate truthfully how your POTS limits your activities and your ability to earn a living.

I was reluctant to apply for Social Security disability at first, because I didn't want a hand out from the government.  One of my wise older relatives reminded me that I have been paying taxes into Social Security's coffers since I started working at age 14, so I shouldn't feel bad about it.  Also, if you have to choose between your pride and keeping a roof over your head, swallow your pride and take the disability check so you can pay the mortgage and afford your medications!

Apply for "Welfare"
If you have little to no income, even if you don't qualify for Social Security disability benefits, you may qualify for Social Security's "Supplemental Security Income" - also known as welfare or SSI.  I don't know much about this, but you can read about it online.  There are government agencies and community service organizations who can help you apply, since it can be a bit confusing.

In addition to SSI, which is run by the federal government, you may also qualify for assistance from local or State agencies or non-profits, like food stamps, housing assistance or discounted health insurance.

If you live alone and can't cook for yourself because of your POTS symptoms, you may be able to get Meals on Wheels or a local community group that can bring you food once in awhile.  Don't be ashamed to ask for help.  When you are healthy again, you can promise yourself that you will volunteer for a group that helps other sick people to "pay it forward."

If you are under 18 and have POTS, your parents should look into various programs that may help you.

Check Out Local Disability Services
Most local governments have a Division of Health & Human Services or a Division of Disability Services, although the name of the agency may differ depending on where you live.  This is just a good place to start.  Tell them about your disability and what your needs are and they may be able to suggest some resources for you - financial, medical, social/activity resources, etc.

Work From Home
If you have POTS and you still have enough energy to work, but just not in the same way you did before you were sick, ask your employer if there is a way change your schedule to have fewer hours, or work from home, or do a different type of work, so you can still make a positive contribution to your employer.  Federal and State law provides certain protections for disabled workers, and most types of employers are required to provide a "reasonable accommodation" to allow disabled workers to be able to work.  This does not mean that your employer has to agree to every accommodation request you ask for... there are limitations on what is a "reasonable" accommodation and what is unreasonable.  If you need advice on this, you can research "reasonable accommodation" and "American's With Disabilities Act" online, or you can contact your local EEOC (Equal Employment Opportunity Commission) office.  These laws also apply to disabled students in schools, and disabled individuals interviewing with new potential employers.  If you think you have been discriminated against because of your disability, you may contact the local EEOC office and file a complaint or talk to a private attorney with experience in employment/disability law.

Start a Home Business
I haven't done this because it requires a great deal of effort and I'm putting all of my effort and energy into trying to get better so I can go back to my normal job as an attorney.  But, if you've got enough spare energy and time to make the effort, there's always something productive you can do from home to make a few extra bucks.

For example, a disabled friend of mine folds and packages socks for a guy who sells them at flea markets.  Not exactly a dream job, but it's physically easy for her to do and he pays my friend about $40 for each box she folds and packages.

Another example is making something at home you can sell, like wool scarves, jewelry, or artwork.  Plenty of disabled people have taken to the Internet to sell craft items in recent years, and some of them have made a decent living doing it.  Even before I came down with POTS, I sold some photos I had posted on art.com. I got a royalty check in the mail and I wasn't even trying to make any money!  A friend of mine recently started an online gluten free baking company and she's doing well.

Come to think of it, maybe this blog is my big fortune waiting to happen.  OK, probably not, but I do get a few pennies every time someone clicks on one of the Google Ads on the right side of the page... so feel free to click away.  In two months I had 507 page viewers and I made $3.02.  So watch out Facebook, I'm catching up to you fast!

Feb 21, 2011

Things to Avoid When You Have POTS

Here are things you may want to avoid when you have POTS because they can make you're symptoms worse.

Avoid Alcohol
Alcohol lowers lowers blood pressure and causes dehydration.  If you have POTS, you may have low blood pressure and low blood volume, which will only be made worse if you are dehydrated.

Avoid Large Meals
May POTS patients, including yours truly, feel a worse about a hour after eating a large meal.  This could be from any number of things, but doctors have found that many POTS patients have post-prandial hypotension.  Post-prandial hypotension is a drop in blood pressure large enough to cause you to feel dizzy/faint/lightheaded that is caused by blood pooling in your abdominal region, which happens when you digest food.  The more food you eat at once, the more blood is needed to help digest the food, the dizzier you can feel.  It doesn't help if you already have low blood pressure to begin with either.  You can minimize post-pradial hypotension by eating smaller meals more often throughout the day and by wearing compression stockings that come all the way up to your waist or an abdominal binder - basically a big elastic girdle like belt that squeeze your whole mid-section.  Ladies - you don't need an abdominal binder from a medical supply store, you can just wear those tummy control "Spanx" or a corset like undergarment that holds in your tummy and love handles.

Large meals also make me POTS triggered acid reflux/GERD worse, so there's another reason I avoid large meals.

Avoid High Carb Meals/Sugary Meals
Some patients also have reactive hypoglycemia.  Whether this is directly related to POTS or a separate medical problem that some POTS patients just happen to have, is not clear.

Reactive Hypoglycemia is not the same thing as hypoglycemia caused by diabetes.  It is a temporary state of hypoglycemic symptoms like shakiness, cold, shivering, heart palpitations, etc. occurring 1-2 hours after eating a high carb or sugary meal. It is thought to be be caused by an inappropriately high insulin release into the body in response to the high carb/sugary meal.  They only real treatment for it is to not eat high carb sugary meals - which is healthier for you anyways.

If you are having these hypoglycemic symptoms at all, it is a good idea to been seen by a doctor to make sure your don't have diabetes, which is a very serious disease.

Avoid Junk Food
If you have POTS, you need nutrition packed healthy food, not junk food.  You probably need more than the normal potassium, magnesium and calcium.  You can cheat and take a multi-vitamin, but you're body will be able to absorb those important vitamins and minerals better from food, rather than synthetic chemicals packed into a little capsule.  Most people think if you take Vitamin C (ascorbic acid) in a pill, you're getting the amount of Vitamin C in your body as it claims on the label.  Did you know that your body needs other substances in order to be able to absorb and utilize the ascorbic acid.  Guess where these other substances are found - in citrus fruits and other food sources of ascorbic acid.  If you have really good vitamins, they may contain some of these compltementary substance, like bioflavanoids, but mother nature is not easy to bottle, so you are better off getting your nutritional needs met by eating healthy food, the way mother nature intended.

Also, junk food has so many nasty chemicals, like petroleum by-prodcts (most food coloring and artificial flavorings).  If you're not feeling well, your body is telling you that it is under a great deal of stress.  When you eat junk food, you are just adding stress to your body.  To think about this another way... you wouldn't eat coal tar, so why would you eat something that is made from it?  If you can't pronounce it, don't eat it.

Avoid Dehydration
Becoming dehydrated causes low blood volume (hypovolemia), low blood pressure (hypotension) and puts unneeded stress on all of your organs.  Some POTSies are more prone to dehydration in the first place, so it takes extra effort to say properly hydrated and keep the devastating symptoms caused by hypovolemia and hypotension at bay.

Avoid Hot Baths/Hot Tubs/Pools/Saunas/Steam Rooms/Hot Weather
Submersing yourself in hot water or hanging out in hot sauna dilates the blood vessels in your skin, which lowers your blood pressure.  This can increase your POTS symptoms, and some POTSies take a longer time to recover from dilated blood vessels that healthy people, because their autonomic nervous system doesn't respond properly.  S if you have POTS, you may want to skip the "hot yoga" class.  Regular swimming pools can even be hot enough to trigger this if you are sensitive.  Heated indoor swimming pools are kept anywhere from 92-100 degrees, and the air will be steamy warm in an indoor pool facility too, so take extra precautions.

Avoid Allergic Reactions
A naturally occurring chemical in your body called Histamine is released by your body when you have an allergic reaction to something.  Besides the stuffy nose, itchy skin, watery eyes and asthma that a flurry of histamines rushing through your body can can cause, histamines also cause your blood vessels to dilate, which can lower your blood pressure.  Since many POTSies already have low blood pressure, or have autonomic nerve damage that prevents their body from responding properly to changes in blood pressure, you want to avoid histamines and thus, avoid allergens.

I avoid known allergens as much as possible, use a HEPA air-filter in my house to clear the area of pollen and pet dander (I refuse to get rid of my doggie even though I'm super allergic to her) and I take over-the-counter anti-histamine medicine when my allergies get really bad (10 mg of Certirizine - generic name for Zyrtec, but much cheaper at BJs wholesale).  Before POTS, I used to just grin and bear it with my allergies because they weren't so bad, but now I notice that my allergies are worse and my blood pressure and pre-syncope symptoms are noticeably worse when I'm having allergies.

Elevated histamine levels triggered by allergic reactions can also cause an increase stomach acid production, which can worsen acid reflux/GERD.  In fact, many of the drugs developed to combat acid reflux are actually anti-histamine drugs (like Ranitadine), although the work on a different histmaine receptor than most drugs meant specifically for allergies.  Histamine based allergy drugs target the H2 receptors associated with the lining of the stomach and histamine based acid prevention drugs target H1 receptors associated with tissue containing capillaries.

Avoid Prolonged Standing or Sitting
I'm not saying lay in bed all day (that's on the "avoid" list too), but if you stand still with your knees locked in one place for too long, eventually even the healthiest person will pass out.  Gravity pulls blood down to your feet when you stand up, and moving your muscles in your lower half will help your body pump the blood back up to your heart.  If you feel particularly lightheaded, there are special "counter maneuvers" you can perform to help.  If you're waiting in line at the grocery store, just keep your legs moving by casually walking in place or shifting weight from one foot to the other. You can squeeze your calf, thigh or butt muscles a bit.  Go up on your toes and then back to flat feet.  Crossing your legs when sitting or standing, squatting, and bending at the waist can also help.

Avoid Prolonged Bed Rest
As best as you can, try not to lay like a lump in bed all day because you will get weaker, lose muscle tone, and get aching muscles and joints.  Prolonged bed rest causes deconditioning, which can lead to decreased cardiac function, decreased lung function, lower blood volume, lower blood pressure, loss of bone and muscles mass, bed sores, increased likelihood of infections, etc.

If you are having a lay in bed kind of day, at least stretch and change your posture often.  Try your best to walk around the bedroom a few times a day.  I force myself to get out of bed during commercials when I can.  Small steps are better than no steps at all, and will hopefully lead to better health in the long run.

Feb 15, 2011

Coping With POTS

There is no 'cure' for POTS or Orthostatic Intolerance.  If you're lucky, you're symptoms may mostly resolve someday, and there are things you can do to try to support your body and improve your number of symptom free days.  Some people are able to get their symptoms under control enough to return to work or school full time and live a pretty normal life, but many others are not.

If you have POTS or Orthostatic Intolerance, you may want to talk to your doctor about the following treatment options:

Stay Hydrated
Drink at least 2-3 liters of water and other fluids per day.  For comparison, 3 liters is the same as 6 regular sized (500 mL) Poland Spring water bottles.  I use a 1 liter re-usable Nalgene water bottle to keep track of how much I drink each day.  Gatorade and coconut water are full of electrolytes, which will help you feel better.  Stay away from carbonated and sugary drinks.  Clear soup broth and milk counts towards your fluid intake too.  Some people with POTS have digestive problems that make it hard to drink that much fluid - including me.  I have figured out that if I drink about a hour before and an hour after eating, my reflux is not as bad.  Something about plain water makes my reflux worse, so I drink decaffeinated green tea wit a little piece of ginger in it to help my tummy (caffeine can bother some people with POTS, although other POTSies swear it makes them feel better-it probably depends on which type of POTS you have).  I also eat lots of soup and "wet" veggies - steamed spinach and squash and other watery veggies.  Sometimes I put chicken broth in a mug and have it like tea.

Get Salty
Increase you sodium intake to 3000-8000 mg per day (do not do this without talking to your doctor first!)  You can purchase 1000 mg (or 1 gram) sodium chloride tablets online or ask your local pharmacy to order them for you.  They are about $10 per 100 pills.  You do not need a prescription in the U.S.  They also sell Thermotabs at the Vitamin Shoppe and online, which have salt and potassium, but you'd have to take about 10 of them at a time to get enough sodium.  Try sea salt instead of regular table salt, because you may get too much iodine if you eat 3000 mg a day of regular table salt, which is "iodized" in the US unless it specifically says "non-iodized salt."  The sodium chloride pills can be harsh on your throat and GI tract, so try to eat them with food and drink them with lots of fluids.  I tried crushing them and putting them in empty gel caps you can buy at the Vitamin Shoppe, but once the gel cap dissolved in my stomach it was like an explosion of salt (too much surface area of salt hitting my stomach at once!) and I puked big time.  If you can't tolerate salt pills, you can eat a high sodium diet.  Pickles & pickle juice, soup broth, miso soup, and cheese are very high and salt and fairly healthy.  Stay away from fatty or process foods that are high in salt - you need lots of vitamins to get better and processed foods usually aren't that nutritious.  Add sea salt to everything you eat or drink.  At first, you will notice the salty taste and it's a little gross, but after a few weeks you barely notice the salt taste anymore.

Eat a Low Carb/Low Glycemic Index Diet
and eat several smaller meals throughout the day, rather than 3 larger meals.  I tend to graze all day now, and it definitely helps.  With each mini-meal I eat a high protein item first, then a fruit or veggie.  This helps keep your blood sugar from spiking high then low.  If you can, stick to organic fresh fruits and veggies, fresh poultry, fish, lean meats, healthy fats (like grapeseed oil and walnuts) and whole grains (brown rice, quinoa, barley, oats, etc.).  I highly recommend checking out Dr. Andrew Weill's anti-inflammatory diet food pyramid.

Try a Gluten/Casein free diet -  (but get yourself tested for gluten intolerance/celiac first!)
Many people, even those who don't have POTS, have Celiac Disease and don't even know it.  One out of 133 people in the U.S. has it, and most of them don't know it.  Some people can trace the origin of their POTS to Celiac Disease, which causes an autoimmune inflammatory response and can cause problems with absorption of essential nutrients.  Some POTSies who have tested negative for Celiac report an improvement in symptoms when they switch to a gluten free diet.

If you have Celiac, gluten damages your gastrointestinal tract, and can cause permanent gastrointestinal problems, as well as nerve and endocrine damage if left untreated.  If you have Celiac, you may not feel anything happening, or you may struggle daily with terrible GI issues.  Untreated celiac has been casually linked to some forms of cancer, thyroid problems and other serious medical problems.  The only real treatment for someone who has Celiac Disease if a lifetime diet that contains NO gluten, not even a trace amount.  There is no safe amount of gluten for someone who has Celiac.

Also, since Celiac is an autoimmune reaction to a chemical called gliadin, which your body produces when you eat foods containing gluten, you may also want to avoid foods containing casein, a milk protein.  Casein also causes your body to release gliadin, and thus triggers a similar autoimmune response.  Some research indicates that the anti-gliadin antibody that Celiac patients produce also attacks cells in your brain and other nerves which over the long term can cause severe neurological and endocrine complications.  HOWEVER, before you switch to a gluten free diet, ask your doctor to run a panel of tests to see if you may have Celiac.  Most of the various blood tests for celiac look for the antibody produced against gluten and if you aren't eating any gluten, this antibody will eventually be so low the blood tests won't be able to find it, even if you do have celiac.  Also, there are several tests that are used to diagnose celiac, and none is 100% accurate.  If you are already eating gluten free, you can have a genetic test for celiac.  If it's negative, then you don't have celiac, and if its positive, you may or may not have celiac - so even the genetic test isn't a 100% reliable.  You can also have a biopsy to check for Celiac.  Finally, even if you have all of the tests and you're doctor tells you that you don't have celiac, you may still feel a bit healthier if you eat less gluten.  Many people with chronic illnesses report feeling a little better when the go gluten free - so give it a try.  There are many websites that explain what products have gluten in them and provide yummy recipes for gluten free versions of all your favorite foods (celiac.com, glutenfreemommy.com).

Try A Lactose Free Diet
If you are having abdominal cramps or other GI symptoms, you should try a lactose free diet.  You can get a lactose intolerance test from your doctor, but it's probably easier to eliminate milk products from your diet for a week or two and see if you feel any better.  When I stopped eating lactose, my GI symptoms started to improved in a day or two.  Every other month I would try a small glass of milk again to see if my lactose intolerance had resolved, and for awhile it did.  I was super excited to eat fresh mozzarella again!  Unfortunately, it came back a few weeks later.  Dairy products are inflammatory and that is something you probably want to avoid if you have POTS or any other chronic health problem.  

My gastro doctor explained to me that when your GI tract is very irritated or gets an infection, it heals itself by shedding the cells that line the GI tract and slowly regrowing healthy new cells.  He said that the last part of the GI tract to grow back is the tiny cillia that stick out into the intestines, and the cillia are where the enzyme that breaks down lactose is formed.  If the cillia are not there because they have not grown back yet, your body will not be able to tolerate lactose.  I also learned that about 80% of the global population is lactose intolerant after the age of 3.  Humans did not evolve to drink milk after the first few years of life, when a baby can be breastfed from it's mother.  So even if you're not noticing profound GI symptoms, give a lactose free diet a try for a few days. 

Just like gluten, there are lactose free or low lactose alternatives for everything.  I just had Tofutti's 'Better Than Cream Cheese' yesterday and it's just like the real thing, without the stomach ache. And there are some low lactose cheeses, like naturally aged cheddar and parmesean, that most lactose intolerant people can still eat in moderation.  You can also buy Lactaid milk and try taking Lactaid supplements just before eating a dairy product, to help your body break down the lactose before it upsets your tummy. 

Wear Compression Stockings
Medical grade compression stockings help encourage the blood in your lower body to return to your heart (and then your brain!).  These stockings can be uncomfortable, but I've found that you get what you pay for.  The more expensive ones ($100-$130 for full pantyhose) are MUCH more comfortable.  The come in knee highs, garter style and regular pantyhose style, with toes and without toes - for men and women.  I wear 20-30mm Hg ultra soft compression stockings without toes (the ones with toes cut of circulation to my toes and make them cold all day).  If you get the regular pantyhose style, you can cut out the cotton crotch area to make them more comfortable.  If you are wearing them everyday this is a good way to prevent yeast infections.  Some POTS medications, like Fluorinef, make you more likely to get yeast infections, so even though the stockings look funny with the crotch cut out, you'll be glad you did it.  The knee high and garter styles are probably more comfortable, but since lots of POTS patients have blood pooling in their stomach area after eating which lowers there overall blood pressure (this is called post-prandial hypotension), you may benefit from the regular pantyhose style since they help compress your tummy area, which helps return blood flow to your heart and helps increase your blood pressure.  If you have the type of POTS that sometimes causes very high blood pressure, try just wearing the knee highs.  I have multiple styles for different days, depending on how bad my blood pressure if when I wake up.  I also notice that the full length pantyhose, since they are tight all the way up to my waist, can trigger my acid reflux sometimes.  If they are pressing hard on your stomach and your stomach is producing to much acid, the only place the acid has to go is up, and that's how you get reflux/heartburn.  Sometimes I just use the leg-only stockings, and other times I just roll them down to my hip bones, so they aren't pressing on my tummy.

Elevate Your Bed or Use a Bed Wedge 
POTS doctors have explained to me that elevating the head of your bed so that your kidneys are above your feet is a good way to increase blood volume over time.  When you lay down totally flat, your kidneys go into sleep mode and they allow more sodium and water to be filtered out of your blood.  That's why most people have to pee as soon as they wake up in the morning.  If you elevate your bed, you can trick your kidneys into conserving some of that sodium and water, and this is supposed to increase or at least help maintain your blood volume better than laying flat.  If you have a spouse who simply cannot tolerate an elevated bed (like me) buy a good bed wedge.  You should get one that is long enough to go from your tush to just above your head.  I bought a decent one at J.C. Penny online for about $20.  You do not want a bed wedge that is just meant for propping up your neck or head.  Your kidneys have to be elevated above your feet. If you have acid reflux/GERD, like many POTS patients do, do not prop your head and neck up on a bunch of pillows, because this will only cause you to compress your belly and this will cause more reflux.  Make sure your whole spine is on an angle, from your tush to your head.  Elevating the head of the bed is the best option for blood volume control and reflux.  Try using two bricks under each leg at the top of the bed, or one cinder block.  The official term of the position you are trying to achieve is the "Reverse Trendelenburg" position.

Get A Heart Rate Monitor
If you have severe tachycardia upon sitting, standing, walking, exercising, etc., it may give you piece of mind to wear a heart rate monitor.  After a while, you won't even need to look at the monitor to know what your heart rate is.  I can tell the difference between 130 and 110 beats per minute now.  These monitors can be used to make sure your heart rate isn't going too high or too low.  I also found it useful to help figure out what made my heart rate go high, and what lowered it - which was helpful for my doctor to know to help with my diagnosis.  You can also use a heart rate monitor as you begin an exercise regime, to make sure your heart rate stays within a targeted zone.  See the Exercise section below for details.

Get a Home Blood Pressure Cuff
Most pharmacies sell home blood pressure monitoring cuffs for less than $60.  I have an easy to use  battery operated one that stores the last 10 blood pressure and heart rate readings along with the date and time.  This is very helpful to track your blood pressure levels, especially if you are changing medications or trying new methods to improve your symptoms.  Many people have what doctor's call "white coat hypertension" - what it means is that your blood pressure goes higher than normal when you visit the doctor or hospital, so that your doctor doesn't see your actual blood pressure, he/she only sees a higher version of your normal blood pressure.  If you have POTS, your doctor needs to know your accurate blood pressure so he/she can treat it appropriately.  

For example, my blood pressure was always "normal" when I went to the doctor, but then I was fainting at home all the time, probably from low blood pressure.  Before I was diagnosed with POTS, some of my doctors did not think low blood pressure was causing my fainting, until I went and bought a home blood pressure monitor and recorded my blood pressure six times a day for a few weeks.  When I showed this to my doctors, they finally believed me that low blood pressure was part of the problem.  This was the main symptoms that lead me to diagnose myself with POTS, which my doctors confirmed after they carefully reviewed all of my other symptoms.

You can also check how well some medications are working with detailed blood pressure recordings.  I started .2mg of Flourinef daily and after a few weeks of months of good to high blood pressure readings, I wanted to see if I could lower the dose and still have good blood pressure.  With my doctors permission, I lowered my dose to 1.5mg per day.  To make sure my BP wasn't going to low again, my doctor had me take my blood pressure 12 times a day for two weeks.  One hour before meals and one hour after meals, and each time your take it, take it after laying for 5 minutes and take it again after standing for 5 minutes (assuming you can even stand for 5 minutes!).  This showed that my BP was still in a good range on the lower Flourinef dose, so I was able to do this at home safely because of the home BP cuff.  There is no way you can go to the doctor 12 times a day for two weeks, and most insurance companies probably won't let your stay in the hospital just to have your blood pressure checked all day long.

Even though all of us POTSies are exhausted with a capital "E" all the time, it is so important to keep your muscles toned and your body as flexible and relaxed as possible.  A few weeks of bed rest can lead to a 50% decrease in muscle strength.  Even short periods of bed rest have serious consequences.  For example. you lose 3% of your thigh muscle mass within just seven days in bed.

Even if you are stuck in bed 24/7, you should try doing leg lifts, writing the alphabet with your toes, pushing you heels into the bed, lifting water bottles or soup cans, pushing with your arms against the headboard of the bed or a wall, full or partial sit ups, etc.  Do whatever you can to keep moving, even if you can only do 2 or 3 reps at a time.  Two legs lifts are better than no leg lifts, and hopefully if you do 2 this time, you'll be able to 3 next time, and so on.  

On "good" days I try to get up and walk around for a minute or two during each commercial break when I'm watching TV.  If I'm having a bad day and I'm stuck in bed, I try to mini-bursts of exercise laying in bed during commercials.  Even though it isn't much, its better than laying there like a lump all day. 

If you spend lots of time on the computer, you can download a free meditation clock or mindfulness clock that sets off a gentle chime every 30 minutes or so to remind you to stretch and relax your eyes for a few minutes.  Just Google it.  I downloaded a free one called ProdMe that is pretty cool.

I also stretch several times a day because I am so sore from laying in bed too much and from trying so hard to breathe.  Lots of POTS patients get 'coat hanger' muscle soreness in their neck, upper back, chest and shoulders.  This is partly from slouching and laying in bed to much and using your upper chest muscles to breathe, rather than your diaphragm.  My doctors think I may have some neuropathy that is affecting my diaphragm, which may be why I rely on my upper chest muscles so often to breathe.  I do deep breathing exercises to (hopefully) strengthen my diaphragm which will hopefully improve my breathing over time.  I also put a book on my belly and try to lift and lower it with my breath. 

Yoga is a good way to stay flexible and strengthen muscles that doesn't make your heart race as much as other forms of exercise.  Yoga can also help you relax, which many of us POTSies need because of our high catecholamine (adrenaline) levels.  For those of you who can't get out of bed to do yoga, there are modified versions of yoga developed for the elderly or people with severe arthritis.  I found these helpful when I was in the hospital on strict bed rest.   Call your local library to see if they have any tapes or CDs to help guide you through this.  If you have a Wii, the Wii Fit yoga has some moves you should be able to do in bed or laying on the floor, and it helps tracks your progress over time if you stick with it.

There is a doctor in Texas, Dr. Benjamin Levine, who has developed a detailed cardio exercise protocol for people with POTS that has worked well for several of his patients, allowing them to feel better and return to a more normal level of functioning.  His research study using the exercise protocol is published online here.  In order to get the actual exercise protocol, you have to e-mail him your doctor's name and contact info, and he will send your doctor some information about the exercise protocol.  The e-mail address for Dr. Levine and his research team is: THR-IEEM-POTSRegistry@texashealth.org

Some POTSies with Ehlers Danlos Syndrome have to take extra precautions with exercise because they can easily injure their joints.  If you have POTS, before you begin an exercise regimen you should speak with your doctor and you should also get yourself tested for Ehlers Danlos - a genetic disorder that causes hyperflexible joints, super elastic skin, heart valve problems and other complications.  Many people with POTS have Ehlers-Danlos, and it is very hard to diagnose.  There are genetic tests and clinical signs that an expert will be able to detect - maybe not your regular doctor.

Also, patients with Chronic Fatigue Syndrome (many POTS patients have been diagnosed with CFS as well) can get worsening fatigue with exercise, so it's a good idea to talk to your doctor before beginning an exercise program if you have CFS.  Although, there is another school of thought that says people with CFS should try to get some exercise, even if it makes them more exhausted in the short term, because it is important to their long term recovery.  I don't know which is the correct answer, so I'd suggest you speak with your doctor.

Keep a Journal
I was able to diagnose myself with POTS (later confirmed by my doctors) because I kept a seriously detailed journal of my every activity for several months - my symptoms, my blood pressure, my pulse, my oxygen levels, what I ate, what medications/vitamins I took, how much fluid I drank, how much I peed, what color was it, how long I was able to stand up, trips to the ER, etc. etc.  It seems a little crazy, but  I only did this because my doctors couldn't figure me out, so I realized I'd have to figure it out myself.  Now that I have a pretty certain POTS diagnosis, I keep a journal of any new symptoms, and I try to write down good things that happen and solutions I find for my symptoms - to remind myself that I CAN GET BETTER.  It's helps remind you that even when you're having a really horrible symptomatic day/week/month, there will always be another day that you feel a little bit better and good things can still happen in your life even though you feel like crud.  A friend has suggested keeping track of how any hours a day you sit, stand, lay down and do active tasks like exercise or chores.  She had Chronic Fatigue Syndrome and she used this log to see how she was slowly improving over the long term.

Talk to Your Doctor About Medications
I don't like taking meds, but POTS is a serious illness and sometimes your quality of life can be significantly improved with meds.  I'm going to write a separate blog post all about POTS medications in the future, but the most common POTS medications are Flourinef (to help increase blood volume/blood pressure), beta blockers (to help minimize tachycardia and the anxiety like symptoms some POTS patients experience) and Midodrine (to help increase vascular constriction and lower your heart rate).  I am only on Flourinef at the moment because I can not tolerate beta blockers or Midorine.  Even the Flourinef has side effects, but for the time being I don't have any other options unless I want to pass out everyday, so I'm sticking with it.  If your doctor doesn't know what these drugs are or isn't familiar with POTS (and most doctors aren't familar with POTS - even so called POTS experts barely understand it), print out some online research for them and ask them to brush up on it so they can help you manage your POTS.  If they don't seem interested in learning how to help you, then find another doctor who is willing.

Have Some FUN!
When you feel like a wet noodle it can be hard to muster the energy to do anything, no less something non-essential, but you should consider having fun as an essential part of your recovery.  Having fun keeps your spirits up, distracts you from how crappy you feel and can help you avoid depression, which so many people with a chronic illness eventually develop.  Your friends and family probably miss the 'old you,' so it's nice for them to get to see you happy and having fun too.  To have fun, POTS style, I do lots of stuff laying down or resting on the couch - computer games, blogging, silly arts & crafts (find your inner kindergartener and break out the construction paper and Elmer's glue!), play board games, card games, rent movies for free from your local library, watch TV, watch movies and TV shows for free on Hulu.com on your computer, research your family history on Ancestry.com (they have a 2 week free trial), have some friends over and play some video games, bake some healthy treats, read some new books and magazines from the library, pick a totally random subject to become an expert in (something really odd like 18th century men's shoes, butterflies of the Arizona desert or the history of the Jamaican government) and get every book and article you can on the subject until you master it.  There is no such thing s useless knowledge - you never know when you are going to need that info in a game of Trivial Pursuit or Jeopardy.

Dealing With the Emotional Side of POTS:
Don't get mad at yourself when you have a "bad" day or even a bad "month."  There will always be a better day or a better month in the future, even if it's not perfect.

Don't waste your energy wishing you could be "like you used to be" or that you could get your old life back.  You may get it back someday, and you may have an even better life after POTS, but dwelling on what you used to have won't get you better - it will just make you depressed.

Consider talking to a therapist, a counselor, a priest, a rabbi, a friend or anyone who will listen.  It's OK to 'let it out' and cry your heart out to a total stranger sometimes.  Right now your life is hard, and you are allowed to be mad, frusturated, and/or sad about that.  Talking to someone can help.

I know it's a cliche, but remember that as bad as you have it, there is always someone who has it worse.  For example, when having a particularly bad day, I remind myself how lucky I am to have a supportive family and husband and healthy food to eat and access to advanced medical care - imagine having POTS and being homeless without family and broke in a third world country?

Be thankful for what you have, even if it isn't much.  I learned this when I spent two months in the hospital in NYC.  I was feeling pretty sorry for myself and I kept asking God, why are you doing this to me?  Since I was in the neurology intensive care unit, I had roomates coming in and out every few days.  Most of them were in much worse shape that I was.  One girl younger than me had been run over by a hit and run driver on her way walking to work a day before her birthday.  She had major brain damage and couldn't remember her own name.  Another young woman, who had a 5 year old daughter, was in for her second surgery to try to remove her brain tumor, and the surgery had caused her to forget her words and forget where she was, which was very frightening for her.  An older woman I met had a hugh brain tumor in the front of her skull, and she had waited years to have the surgery to remove it - she had come all the way from a small village in Africa.  She was an amazingly beautiful woman, inside and out.  She said by the window quitely reading her Bible every day, and when I asked her if she was ever scared knowing she had cancer and having to wait so long for surgery, without hesitating she smiled and told me "no" because she knew that she was going to be OK because God would take care of her and he wouldn't put her through anything he had not prepared her to handle.  I have never been that outwardly religious, but I really respected her for having such a strong faith and I have tried to adopt her positive way of thinking into my life.  Another woman I met was going to die in a few days - she had been fine a week earlier, but she unexpectedly had a severe stroke and her children were all coming to say goodbye to her before she died.  She cried out loud all night long in a flurry of incomprehensible babble.  Another woman, I did not meet her but I heard her screams in the next room, had a tumor pressing on a part of her brain that made her yell out random words all day and all night long.  She couldn't help it, and I felt so bad for her family because they couldn't care for her anymore.  So my point is, yes POTS really stinks, but you're very unlikely to die from it and at least you can still tell your loved ones that you love them everyday, and you can understand what they mean when they say it back to you  - so it could be worse!

I think of Professor Stephen Hawking, the world famous physicist who has ALS (Lou Gehrig's Disease).  He is in a wheelchair, breathes through a tube in his throat and talks using a computer.  Despite his severe physical limitations, he has contributed more to the advancement of modern physics and the interest in physics among the general public more than most other scientists who have no physical limitations.  He is truly an amazing spirit and I highly recommend reading his posts on living with a disability.

Try to think of some of the positive things that go along with POTS.  I bet many of your friends wish they could stay in bed all day and watch Oprah and Golden Girls re-reruns.  In our pre-POTS life, most of us were probably too busy to exercise everyday and too busy to take the time to always eat healthy.  Since POTS tends to give you lots of free time, consider it your goal to eat 100% healthy and to get each of your muscles as toned and buff as possible.  I bet most of us POTSies now have a better understanding of human anatomy & physiology than we did before we had POTS.  We are also very attuned to our bodies.  We also have lots of time to think about stuff, contemplate our belly buttons and meditate.  Buddhism teaches that mediation and contemplation is the way to reach the highest spiritual plane.  So consider yourself lucky that you have more free time to contemplate and meditate and thus have a better chance to reach your highest spiritual plane than your busy friends who don't lay in bed all day with POTS.

Set goals for yourself and do something everyday to help reach that goal.  You can do it!

To boost your spirits and confidence, make a list of all of the things YOU CAN DO, even though you have POTS.  The list is longer than you think.  When you are feeling really cruddy, find this list and chose something on it to do.  Add new things to the list as you think of them and eventually you will stop thinking about the things you can't do right now (and I say right now because someday you may be fully recovered!).

When you're chronically ill, it's important to maintain as much as a normal life as possible.  If you were a social butterfly before POTS, you should try to be that way with POTS, but just realize that you may have to alter the way you socialize.

Try your best to keep in touch with friends and family.  Since you never know when you are going to have a good day or a bad day, it can be hard to make plans in advance to hang out with friends.  Make plans with a group of friends and tell them you want to hang out if it's a good day for you, but if you can't, then you just want them to hang out without you and you'll try to reschedule.  If they are good friends, they will understand.

You can also feel more comfortable hanging out if it's at your house, so ask your friends to plan to come over, but let them know if you are having a bad day, you'll have to reschedule.  I had a friend come visit me on a bad day once, and I think it freaked him out a bit to see me that sick.  But being a true friend, he didn't judge me for it.  He was so worried after seeing me like that, that he called a family friend who is a doctor at the Mayo Clinic and that doctor ended up helping me out a little bit.  I think it's hard for people who have never experienced POTS or another severe illness to understand how sick you really are, especially on a bad day.  This is especially true because most people don't even know what POTS is.

Sometimes I am so short of breath and I have such a sore throat, I can't talk in person or on the phone with anyone.  So I try to keep in touch with e-mail and Facebook, and those are things you can do when you have the energy, and you can skip them when you are too wiped out.

If some of your friends seem to abandon you... don't be shocked.  When previously healthy people suddenly develop a severe illness or a chronic illness, it is very common for people who they always thought were their friends to disappear.  Don't be too upset about this.  First, realize that some people just can't deal with another person's sadness or difficult issues.  It's a sign that this friend is immature and/or self-centered.  Second, if someone you thought was a good friend walks out of your life just because you're sick, they are not a real friend.  Consider yourself lucky to have found out that this so-called friend is really a jerk and not worth the time and effort true friendship requires and deserves.  You are much better off with one or two really genuine friends than a larger group of fair-weather fake 'friends.'

Join the Dysautonomia Information Network and POTS groups on Facebook and make some friends who also have POTS - it feels good to know you are not alone.

If you don't feel like socializing, then don't... and don't feel guilty about it.  When I'm having a bad day, the last thing I want to do is see my 'healthy as can be' friends and hear their stories about snowboarding in Italy and the great wine festival they went to last weekend.  I'm glad their having fun, but it only makes me feel worse to hear about all the fun their having when I'm feeling like crud.  In fact, I find it very difficult to talk to most of my old friends and colleagues without getting emotional.  When I am not around them or talking to them, I can focus on getting better and what good things I still have.  For some reason, every time I talk to a friend from my college days or a co-worker, I get all teary eyed because it really makes me think about the wonderful things I am missing out on and "what could have been."  It's very unhealthy to dwell on the "what could have been."  I haven't figured out what to do about this yet, so if you have any suggestions - drop me a note.

Be Productive!
Try to find something productive to do, so you can have something to be proud of.  Make a contribution to society.  There are a million ways to do this, but here are some POTS friendly suggestions:

1 - If you can, do your schoolwork from home, or if you work, try to find a way to do your work from home;

2 - start a blog about your POTS experience to help keep your friends and family in the loop and to help let other people know they are not alone;

3 - do something to help raise awareness about POTS-write an article for your school newspaper, or if you're not in school anymore, for your local newspaper;

4 - ask your friend and family to help you throw a POTS fundraiser and donate the money to a medical center doing POTS research or to the Dysautonomia Information Network.; or,

5 - participate in a POTS research project/clinical trial (talk to your doctor first!).

6-Volunteer - even if you can't go in person, maybe you can be a phone volunteer for a local charity or political candidate, or an online volunteer.

7-Tutor a local kid: maybe you're neighbor's 8 year old is having trouble with reading?  Spend an hour a week reading a book with him and you'll both benefit.  Even tweens and teens can tutor younger kids - maybe your little cousin just needs homework help or a good idea of the school science fair.  The person needing a tutor can come to your house, so you don't have to even get out of your chair/bed.

Find Out About Disability Services In Your Community
Most local governments have a Division of Health & Human Services or a Division of Disability Services, although the name of the agency may differ depending on where you live.  This is just a good place to check out.  Tell them about your disability and what your needs are and they may be able to suggest some resources for you - financial, medical, support groups, activities, etc.