Postural Orthostatic Tachycardia Syndrome (POTS)/Need to increase sodium

Triathlon Forum
1

Has anyone ever had any experience with this? I was diagnosed with this yesterday after 5 months of trying to figure out what has been going on with my body.

For reference, some of what started going on is here: http://forum.slowtwitch.com/gforum.cgi?post=2076481;search_string=;#2076481 and here: http://forum.slowtwitch.com/gforum.cgi?post=2175212;search_string=;#2175212.

Further info on POTS is here:
http://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndrome
http://www.ninds.nih.gov/disorders/postural_tachycardia_syndrome/postural_tachycardia_syndrome.htm
http://home.att.net/~potsweb/POTS.html

Thankfully my case does not appear to be as severe as it could be and the dr doesn’t know what set off my symptoms so quickly, as he said I have probably had it all along.

For now, the treatment plan is to increase my sodium intake to 5000-6000 mg a day! I recently realized I was probably borderline hyponeutremic as I have always had over a gallon of water a day, but starting with my allergy diet in the fall and even moreso since the start of the new year, I have been averaging way less than 1000 mg of sodium a day.

I also am supposed to wear compression socks now for biking and running. I just wish I could get some printed with “I have a heart problem” so people don’t think I’m some wannabe out plodding along at a snail’s pace at the park wearing $60 compression socks.

If my symptoms don’t improve, there are a few drugs they can try to make my kidneys retain salt in a better way, and beta blockers. Beta blockers are apparently total hell to be on, so I’m crossing my fingers that I do not have to go down that route. (also secretly hoping 5000-6000 mg of sodium doesn’t completely wreck my status in the Biggest Loser challenge at work!).

Has anyone ever been diagnosed with this? I have found barely any info at all regarding POTS in athletes. I’m also trying to figure out the whole compression sock thing. I have to wear them while bikng and running now. I wear the injinji socks on my long runs and don’t want to have to give those up. I did find that injinji actually has tall compression-like socks now, but I don’t know how much compression they offer (they are in the mail now). I am also trying to figure out what to do about racing. I’ve read some of the other posts regarding the sleeves, but for medical purposes, you really need the compression down into your feet, not stopping at your anlkes. I did find some toeless medical compression socks I will try out as well, hoping I may be able to swim in those.

Lastly, does anyone know of any salt tablets that have more sodium that S! caps? That is the highest I have found so far and at that I would have to take 15 caps a day! I have been eating healthier than ever and seems like I have to change my diet for the worse to get more sodium. I do not want to increase the calories I have to eat in order to take in more sodium because at the same time I’m trying to maintain my weight/lose ~3-4 lbs for race season. I’m afraid the 5000-6000mg is going to make me the michelin tire man instead.

2

I actually did an internship/worked with a doctor at Johns Hopkins a couple of summers ago who treated a large number of patients with POTS. (He specifically saw patients with chronic fatigue syndrome, but found that a large number of them had orthostatic intolerance and if that was treated, the fatigue symptoms would lessen/disappear). I know he also saw a number of athletes (including M. Phelps) who were having trouble with fatigue and some kind of orthostatic intolerance. I’m still in touch with him and although he is usually pretty busy, if you shoot him an email I’m sure he would get back to you at some point.

Dr. Peter Rowe, Johns Hopkins Hospital

If you have trouble finding his contact info let me know…good luck with everything!

3

I use Saltstick Salt Tabs and prefer them, over S! caps and Lava Salts. SS caps have about the same sodium as S! caps, but more electrolytes I believe. If it’s the sodium alone you’re looking for, the S! caps can’t be beat.

Bob

4

Thank you very much. I am glad someone had at least heard of it in athletes. I will probably get in touch with your guy in a little while if I have questions. I don’t necessarily have tons of questions yet because I am still trying to soak it all in and will give the sodium/compression socks a go for a while to see if I see any improvements. I have been seeing gradual improvements over the last few months as it is (started training by heart rate and never got over Z2). I don’t know if the POTS was going away or if my lower heart rate training was paying off - hard to know the answer to that.

Do you know of any additional resources where I might find some stuff to read about POTS and athletes, or is that why you were telling me to contact that dr, that he may be able to provide more into?

5

Sorry to hear that you have been diagnosed with POTS. I was diagnosed 3 years ago after seeing a dramatic decline in my sprint triathlon performance. I was both relieved to find out there was something wrong and upset that I had something that might limit my athletic performance.

I’ve been on beta blockers and detested them. Although they helped my sleep, I put on 10 pounds in a matter of no time and have yet to get the weight off, despite having gone off them 2 years ago. Also, my doc who is a cardiologist and a triathlete was in favor of me not being on them as they can change your VO2 max and raise your bad cholesterol levels.

Here is what I have found works for me:

  1. No training in temps over 90 - go inside and run on the treadmill.
  2. Monitor your HR with a heart rate monitor both during exercise and at rest to see if your POTS gets kicked up. If it does, take a day off, drink lots of gatorade, and hopefully, you will be back on track by the next day.
  3. Eat every 3 hours to keep the blood sugar levels stable. This helps keep the POTs under control.
  4. Do lots of core work as this will minimize the pooling.
  5. Accept that you have this and don’t get upset when you have to back down a little to get it under control.
  6. If your HR is under control yet you feel tired, get up and do something. Sometimes resting too much simply aggravates the orthostatic intolerance.
  7. Being in the best shape your schedule allows is the best way to fight this thing, but do get some rest.
6

Oh wow! Someone who knows what in the world I am talking about!

Thanks for the advice. I am starting to realize it is “eposide-ish” as in few minute-hour episodes and few day episodes. Hopefully I can keep it to that. It took forever to find out what was going on.

As for the 90 degree stuff…good to know…unfortunately I live in Houston. Fortunately all of our summer long runs are usually done before the temps hit 90, but I’m not sure about bike rides. I did IMAZ in April the past 2 years, so no heavy, long training in the summer, but I’m signed up for CDA and FL this year so it may be a different story.

Do you wear compression socks? I’ve started wearing them and my only issue is that I don’t sweat properly in my lower legs from the POTS, so adding socks just makes me soooo hot.

I guess the socks and the POTS are good reason to work on my core - I want to run in just a sports bra and shorts when I have the socks on because they are so hot, but I hate my jelly belly. So I guess there are 2 good reasons now to work on it!

I think I have been fortunate as so far my case seems relatively mild when it comes to daily activities. I hope it stays that was, but that is something no one can tell me (whether it will get worse or not).

7

I don’t wear compression stockings, but I’m probably not doing the distances in my training that you are. The longer you are upright, the more chance of pooling in your legs. I do keep a pair handy. I also have an Rx for Florinef which I only take for races or extensive training sessions (longer than one hour in the heat). Florinef makes your body hold water and thus keeps the blood volume up. You might want to ask you doc about this and consider using it for your race in Florida. Try training with it first though to see how your body responds to it. Here is something else I have noticed - taking 2 tablets of ibuprofen at night seems to keep it under control the next day. Makes me wonder if POTS has something to do with excess prostaglandins.

My doc told me I’ve probably had this all along. He said that had I never done triathlons or trained for them, I may have never known that I had POTS. Supposedly, it is not supposed to manifest itself for my entire life. I’m 42 almost 43. I do think it has gotten better in the last year or so.

My main sport is swimming and fortunately, it is not as much an issue there since swimming is horizontal. If all I do is swim, however, I find that POTs will act up more in my day-to-day life (standing in line and just plain standing up) than it does if I keep my running up.

I’m impressed you’ve been able to do tris of the distance you mention with POTS. I’m working hard to get back to the sprint tri level.