If you've been diagnosed with POTS, chances are you haven't gotten terribly clear guidance on what to do about it. That's because there isn't one clear way to handle it. Each person's individual treatment will be very different, based on factors like physical condition, severity of the syndrome, other ailments, lifestyle, etc. There are, however, some general areas of treatment that apply to everyone. Here's my summary of the broad categories.
Water intake
The first thing you will probably hear is to drink water. A lot of water. A lot, a lot of water. The idea is to become "hypervolemic", meaning your blood volume is increased. This will help keep your blood pressure up.
Compression Hose
Yeah, my least favorite part of the plan. Old lady socks. A necessary evil because they improve the return of blood from your feet to your torso, whether your circulatory system wants to cooperate or not. Blood is important, and it has better places to be than your toes.
Salt
Salt helps with making you hypovolemic, so it's generally recommended for POTS patients to take in a ton of it. It's better for this to be dietary salt, rather than salt from tablets. It's also better for salt intake to be spread out through the day, so that you don't have a huge spike in the morning that runs out later on.
Diet
It's a good idea to eat smaller amounts throughout the day. The idea is to keep the amount of food in your stomach relatively constant. Never let yourself get starving hungry, never let yourself get stuffed full. You should fluctuate around a comfortable level. This keeps the blood required by your digestive system at a constant level, so that you don't have sudden drains on your cardiovascular system as it struggles to send a rush of blood to your stomach. For similar reasons, it is sometimes advised to cut back on carbs. POTS also sometimes comes with a side of Celiac, so a gluten free (GF) diet helps some people.
Exercise
For many POTS sufferers, this is the only hope for a normal life. It's terribly ironic, because exercising is the last thing you want to do if you have POTS, but if you don't do it you will feel worse. Deconditioning is the bane of the POTS lifestyle, and reconditioning is the key to health and happiness. Starting slow is a must, and consistency is vital. Small, gentle, daily workouts are the start of the road back to living well.
Medicine
Prescription medicines can be used to help ease your symptoms, but their efficacy appears to be limited. There are three types of drugs you can use: Fludrocortisone or Midodrine to raise blood pressure, Beta Blockers to slow your heart rate, or Anti-Depressants to reduce dilation of the veins and stop blood from pooling. Each person is different, each drug has it's pros and cons, and the decision is often a matter of trial and error. However, in depth testing can guide this process and save some guesswork.
Mitigating "Triggers"
Most people can identify "triggers" that make their symptoms worse. Keeping a log or journal can help you to identify your personal triggers so that you can take steps to avoid or mitigate them.
Caffeine
For some, a couple of cups of coffee in the morning can work wonders. For others, it's just a bad idea. Just remember, if you are a coffee person then you need to be an even bigger water person. Caffeine can dehydrate, and hydration is important to keeping blood volume and, consequently, blood pressure in a good place. Also, try to avoid it late in the day so you can get a good night of sleep.
The key to treating POTS is to HAVE A PLAN!!! I was fortunate to attend a patient education course on POTS at the Mayo Clinic, and that was an amazing piece of advice they offered. It's not a simple, straightforward, "quick fix" to treat POTS. Taking in enough salt and water takes planning. Getting in that all important workout takes planning. Having salty snacks on hand all day takes planning. The whole thing can get overwhelming if you don't have a clear picture of what you are going for, and it's easy to become discouraged when you don't see results. But if you don't have a plan and you aren't taking in enough salt or water or forget to take your meds or skip that trip to the gym, results will just not happen. Having a plan also makes it easier to tell other people how they can help and support you.
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