Just a quick update now a new year has begun! Things are looking a lot more positive than this time last year. I have a diagnosis, can manage my symptoms and hopefully am not far off going back to work.
Being able to manage my symptoms while working will be very challenging but it’s something I want to do, having been off work for so long, even if it’s not quite what I expected I’d be doing a year and a half after qualifying as a nurse.
I can’t believe how things have changed since this time last year. In early 2017 I was still waiting for a diagnosis, in fact had only just heard of PoTS, but was sure I’d be working again in a couple of months. Little did I know things would first get worse before they got better, and that I would be off work for such a long time.
2018 has started off in a much more positive way. I’ve been able to enjoy celebrating Hogmanay in Edinburgh, have had a weekend away in the Peaks walking, and visited friends and family. I’m so grateful to have amazing and supportive people around me and am also glad that I am getting to make the most of my time off now I feel well enough to enjoy myself. It’s been a long journey to get to this point and it’s taken a lot of patience, determination and perseverance. I know that while I’ll still have ups and downs symptom-wise, I’m now in a much better position to get through the down parts.
So now all that’s left is to wait and see what there is in store for me jobs wise (oh I forgot to mention, Occupational Health have finally cleared me as fit to work, in a desk based role rather than clinical nurse, so I am just waiting for a meeting regarding my redeployment to a new job with my manager and HR) which seems like a huge step in the right direction!
It’s been a while since I last wrote and I’ve been very busy! I was originally waiting to write this blog post after having a meeting about going back to work with HR/my manager however that meeting which was scheduled for October kept being rescheduled and finally happened last week.
So here we are two months later than planned! The outcome of that meeting is that I am unlikely to be able to go back to work as a nurse, as although (in my PoTS nurse’s opinion) I am doing really well in terms of managing my symptoms, I can’t stand for more than 15 minutes before becoming very symptomatic. That doesn’t bother me in my everyday life as I have become very good at working round this, but clearly it’s not ideal if you have a job that requires you to be on your feet all day (or night!). So I’m waiting to see if I can be redeployed to a desk based job. Meanwhile I’ve also sent off a work capability assessment form as I’m being reassessed for benefits. As I’ve improved so much in the last couple of months, I’m extremely doubtful as to wether I will continue to get benefits. This is extremely frustrating as they will no doubt assess me as capable to work, when work and Occupational Health are assessing me as incapable to work!
In more happy news, I’m able to make the most of my time off by spending my weekends visiting friends and family, and generally beginning to feel very Christmassy! Most weekends have seen me on a train to various parts of the country and I’ve got very adept at train travel with PoTS now!
I’m continuing to manage my symptoms so that I rarely have a ‘bad’ day now. I don’t mean to say I’m symptom free, it’s just that I’ve got used to how to best manage the symptoms I do have, and to pace myself throughout the day. I’m beginning to recognise warning signs that I’ve overdone things and can slow down accordingly.
For example, it’s getting easier and easier to keep on top of my fluid intake as it’s a natural part of my daily routine now, which is a big help in terms of keeping hydrated throughout the day and really helps reduce my morning brain fog and dizziness. In the winter I’m also finding it easier to keep a constant body temperature and not get too hot, which is helping me not develop symptoms due to overheating.
It’s all getting a bit easier to manage as I’m getting used to the changes I’ve had to make in order to get this far. I had a cold last week which made my PoTS symptoms resurface with a vengeance so it’s not all plain sailing but it’s definitely a positive step forward.
When I took my first Ivabradine it was so small I wasn’t even sure I’d swallowed it! It’s a tiny tablet anyway, but I have to cut them in half which is near impossible. It describes itself on the box as ‘salmon’ coloured. I was wondering if it came in fuchsia or teal but sadly not. Fun fact: pharmaceutical companies don’t like to make drugs a green colour because it’s considered unlucky. See, I have remembered SOMETHING from my nursing degree!
Ivabradine will obviously affect everyone differently, but so far I’ve experience headaches (normal for me), dizziness (normal for me, but occasionally it felt more like vertigo when the wheelchair would feel like it was moving when I had the breaks on; normally my dizziness feels like I’m looking through a haze). I have felt my heart rate slow, occasionally it’s felt really ‘heavy’ and pronounced, even more so than my usual palpitations. It’s a really slow acting drug though, which peaks after 30 mins and wears off after 4 hours.
I’m not looking forward to the most common side effect which is light sensitivity seeing as I’m very light sensitive anyway at the moment and am wearing sunglasses pretty much 24/7 so might have to become a mole or something. Lets hope that’s not a side effect I get (I mean light sensitivity, not turning into a mole. I’m pretty sure I didn’t read that as a side effect in the leaflet!). So far I’ve not felt a reduction in my PoTS symptoms but not sure if that’s because I’m feeling so extremely exhausted and rubbish at the moment anyway. Hopefully I’ll see some improvement in a couple of days when this ‘flare-up’ has settled.
Today’s been a big day. I was up bright and early (well it was early for me anyway, so before midday!) for my second ever appointment with the PoTS nurses. The day I’d find out if I had PoTS or I was a delusional mad woman making all my symptoms up for sh*ts and giggles like some GPs might have thought… It was no surprise at all to find out that yes I do in fact have PoTS. Which is good considering what I’ve called this blog.
In all seriousness though it was such a relief because there was always that niggling doubt that I’d turn up and they’d say hey, that GP was right, you really should be back at work there’s nothing wrong with you. Or hey, I know you only spent 24 hrs in bed that one time with D&V 6 months ago but you are just DECONDITIONED (I hate that word I’ve heard it far too often!) and there’s nothing wrong with you that a 30 minute run and some abdominal crunches won’t fix.
I won’t bore you with stats but during the tilt table my heart rate increased by quite an impressive amount (you need an increase of at least 30 bpm upon standing to be diagnosed with PoTS and I definitely qualified!!) and in the words of the nurse my bp was ‘all over the place’ despite only spending 15ish minutes upright.
Inevitably I’ve been started on a wonderful drug (well I’m not sure how wonderful it is yet, only had three doses!) called Ivabradine to slow my heart rate, increased my salt intake to 1 teaspoon a day (yuk) and am keeping on with the super tight compression tights and the 3 litres of water that makes me need to pee every 30 mins or so (not easy when you’re wrestling with the compression tights I can tell you!!).
The specialist nurse said today was like ‘day one’. It’s the start of things rather than the end. Now I have my diagnosis things can move forward and symptom wise can only get better. Well I can’t remember exactly what she said (thanks brain fog) but it was something positive and lovely like that!
So I’m feeling pretty good about things (well, symptom wise I’m feeling horrendous but you know what I mean!) …roll on the future!
note: I feel I need to clarify, the huge vast majority of GPs I’ve ever met are absolutely amazing and deserve much more credit than they get. I think part of the problem is the lack of awareness surrounding PoTS which means when people like me come along over a number of years with vague, random symptoms they don’t even understand themselves, it’s so hard to join the dots and get a diagnosis. There are so many health professionals out there who simply don’t know that PoTS even exists.
I won’t go into too much detail because there are websites out there that are much more informative and accurate than I could ever be. ‘PoTS UK’ is especially good and I would recommend having a look if you’re interested. In America they use the term ‘dysautonomia’ to describe when the autonomic nervous system goes wrong. As this includes PoTS you may find useful information by googling ‘dysautonomia’. There’s a website called ‘dysautonomia international’ which is helpful as well as plenty of other blogs.
‘PoTS’ stands for ‘Postural Tachycardia Syndrome’, also known as ‘Postural Orthostatic Tachycardia Syndrome’. You can also see it written as POTS, POTs and other variations.
Put (very) simply, it means that you get a really fast heart rate with a change of position (such as going from lying to standing, although mine goes fast when I sit for long periods as well as when I lie on my side). No-one is absolutely certain why this happens but it is thought to occur when the autonomic nervous system (remember that from biology?!) goes wrong.
The autonomic nervous system is responsible for a whole host of processes in the body from digestion to regulation of temperature and heart rate which in turn result in some weird and wonderful symptoms that are different for everybody which mean it can be very difficult to get a diagnosis.
Usually when a person stands up the body should adjust. The blood vessels narrow in order to force blood to overcome gravity and reach the brain and return to the heart.
It is thought that this doesn’t happen effectively in people with PoTS, that the blood vessels don’t constrict and also there is evidence to suggest that those with PoTS have up to a third less blood volume. To compensate for this low blood volume/dilated blood vessels the heart rate needs to increase. A lot. So even just standing can take a lot more effort and energy for someone with PoTS.
The reduction of blood to the brain can cause symptoms like fainting, headaches and migraines, nausea and vomiting, brain fog (the inability to concentrate or remember things, it literally feels like you have fog in your brain). I often get ‘pre-syncope’, a posh word meaning before-fainting. So I get symptoms as if I’m going to faint but I never do. For example when I stand up I can see spots in front of my eyes, I’ll feel all hot and clammy and sometimes everything will go black and my knees will give way, I’ll feel really sick and I’ll have to sit or lie down but I won’t actually fall over. I also get migraines and feel dizzy most of the time. Sometimes I don’t feel my increase in heart rate, but other times I do and get chest pain. It’ll be going so fast that it feels like I’m having palpitations and it can be quite scary. Especially when you end up in A&E having blood tests and being monitored to see if you’re having a heart attack!
There is some good news though, these symptoms can be relieved… by lying down. Which it is not always appropriate to do in a supermarket or shopping centre apparently. It is like a fight or flight response, and you get an unbearable need to lie down. Like in the sense you would turf an old lady out of her seat in order to sit down kind of survival mode. Not that I have ever done that, I might add!! I don’t know why but if I can’t lie down or am stood up for a while I get really irritable and feel unnecessarily angry, I’ll become withdrawn and can’t hear what is going on around me, and I become unable to speak to anyone as it feels like too much effort. It’s really strange.
The worst symptom I have at the moment is fatigue, I just can’t shake it off and standing for 5 mins to boil the kettle and make a brew wipes me out so I need to lie down for the rest of the afternoon. Heck, even sitting up in bed to type this is exhausting! I can’t sit though an hour long episode of Life on Mars without having to lie down 15 minutes in.
There are also other symptoms to do with regulating temperature, so you feel hot when you should feel cold and vice versa, I really struggle with hot temperatures and can’t cool myself down very well. There are also gastric problems (so problems with digestion) for example heartburn and acid reflux, some people find that cutting out gluten or dairy can help but make sure you talk to your specialist first. I get blood pooling especially in my feet which can be quite painful. Symptoms are different in everyone so I’ve mentioned the main ones that affect me but I’m sure there are plenty more out there!