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Dysautonomia: OI & POTS

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About

Dysautonomia, including Orthostatic Intolerance (OI) and Postural Orthostatic Tachycardia Syndrome (POTS), involves dysfunction of the autonomic nervous system, which regulates essential bodily functions like heart rate, blood pressure, and digestion. 

POTS is characterised by an increased heart rate upon standing, leading to symptoms like lightheadedness, fainting, and exercise intolerance. OI refers to difficulty tolerating an upright posture, often resulting in dizziness and low blood pressure. 

These conditions can significantly impact daily life, but understanding and managing them through symptom-focused treatment can improve quality of life.

Managing your OI & POTS symptoms

Years ago in our clinic, we noticed many of our clients who had fatigue or pain also had postural symptoms, such as dizziness, light-headedness, visual disturbances, sensitivity to the heat, lights, noise, and swelling in their hands and/or feet.

 

This led us, in collaboration with numerous specialists in Melbourne, to investigate why people had these additional symptoms, which are known as Orthostatic Intolerance (OI) or Postural Orthostatic Tachycardia Syndrome (POTS). We have since developed a program for OI & POTS that utilises the latest research to change people's lives, and has even been successfully used by our team (a few of us actually)!

Orthostatic Intolerance & POTS

Orthostatic intolerance is the umbrella term for a range of different conditions including orthostatic hypotension and POTS, in which an individual has difficulty with the upright posture, particularly standing. The most dramatic problem people with orthostatic intolerance suffer is fainting, but in between fainting episodes they may feel dizziness, weak, lightheaded, experience palpitations, abnormal sweating, and experience problems with concentration.

True orthostatic hypotension was defined by consensus in 2011, as sustained reduction of systolic BP >20 mm Hg or of diastolic BP >10 mm Hg within 3 minutes of standing or head-up tilt, while POTS is characterised by an increase in heart rate of 30bpm.

POTS is a form of chronic orthostatic intolerance for which the hallmark physiological trait is an excessive increase in heart rate ≥30 beats/min within 10 minutes of standing or head-up-tilt (HUT) which is sustained in the absence of orthostatic hypotension (a drop >20 mmHg in systolic blood pressure [BP] or >10mmHg in diastolic BP). Children must meet a higher HR threshold ≥40 beats/min for a diagnosis due to their greater physiologic orthostatic tachycardia. 

Patients with POTS experience cardiac and non-cardiac presyncopal symptoms chronically (≥6 months). POTS is not considered to be a unique disease but rather the common phenotype of a number of heterogeneous, overlapping pathophysiological processes.

OI & POTS can present alongside other conditions, such as chronic fatigue syndrome / myalgic encephalomyelitis, chronic pain / fibromyalgia, hypermobility type Ehlers Danlos Syndrome, migraine, bowel irregularities, and autoimmune disorders but can also be a stand-alone condition.

Symptoms of OI & POTS:

Palpitations

Restless legs 

Shortness of breath

Cognitive dysfunction

Salt cravings

Cold hands and feet

Headaches

Pre-syncope

Intolerance to alcohol

Exercise intolerance

Postural dizziness (from lying/sitting to standing)

Postural vision spots or blindness

Sensitivity or intolerance to the heat, humidity, and/or fluctuations in temperature

Swelling and/or discoloration in the feet after sitting or standing still for prolonged periods

Nausea, over-fullness and a lack of appetite, food intolerances

Non-cardiac related chest pain

Irregular sweating patterns

Light-headedness whilst showering or abnormal fatigue after showering

These symptoms can be exacerbated by numerous factors including dehydration, heat exposure, prolonged recumbency, alcohol, and menstruation.

Our Program
Title

Our program is designed and focused on OI & POTS rehabilitation and helps our clients understand and manage their symptoms through a holistic approach. We complete a thorough assessment of your health during your first appointment. Our initial assessment allows for us to address the whole person, not just the condition presenting.

The sessions focus on:

Setting up a movement/exercise routine

Understanding the neurophysiology of your condition

Setback planning

Gradual exposure strategies

Stress, anxiety and mood management strategies

DIM/SIMS – Threats and safety to the mind/body

Symptom Mapping

Return to work planning

Ergonomics for pain

Return to school planning

How to identify your body’s stress response

OI & POTS physiology and management, including hydration, salt intake, compression and medications

Identifying the demands of your activity and your capacity (using a variety of tools eg. heart rate monitors, heart rate variability and activity diaries)

Pacing strategies (physically, mentally, socially, environmentally, emotionally)

Trigger identification and modification

Causes of sleep disturbances and techniques to help with sleep

Parasympathetic activity / Relaxation techniques

Mindfulness exercises and how to live more mindfully

For AFAB: Understanding your menstrual cycle, its impact on your symptoms and how to support this
Title

Our program aims to help you have a ‘normal day’ or return to work or school, without increasing your symptoms. We know this journey is a bit rocky so we give you the skills to deal with any future problems, through setback planning and providing you with a therapy manual you can turn to in times of need.

 

We can also refer you to a specialist near you to help you manage your health and get access to medication if appropriate.

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Cost and questions

For program costs and rebates available, please call the clinic.

Do I need a referral? What if I can't get to your clinic? 

A referral isn't always necessary however may impact on your ability to get a rebate - speak to our friendly reception staff and they can help you.
 

Our clinics are located in Blackburn, Mornington, Bendigo & Essendon, Victoria, however, all services are offered via telehealth also. 

What if I've already done another treatment program?

If you have had treatment for OI & POTS in the past, that's great! We take an inclusive approach and can build on and increase your understanding and progress through our program. We won't make you redo things you have already done through another program.

What causes OI & POTS?

The cause of OI & POTS is still unknown, however, patients often report that their symptoms began immediately following an acute stressor (eg: viral illness, pregnancy, surgery, concussion) but in some patients, symptoms develop more gradually and subtly over time. Many patients report that their symptoms started around puberty.

 

While the precise aetiology remains unknown, orthostatic tachycardia in POTS is thought to reflect the convergence of multiple pathophysiological processes, as a final common pathway. Based on this, POTS is often described as a clinical syndrome consisting of multiple heterogeneous disorders with overlapping clinical features.

Dietetics in Dysautonomia

Living with Dysautonomia can be challenging, especially when some of the most common symptoms of this condition like nausea, lack of appetite, bloating and changes in bowel movements seem to be working against you.

 

Our dietitians have a wealth of experience working with patients who live with OI and POTS, or other forms of Dysautonomia.

 

Some topics that may be covered to support you and your body with your OI and POTS includes:

Strategies and education around adequate hydration and salt intake

Nervous system regulation surrounding meal times 

Eating strategies for gastroparesis (delayed gastric emptying) or rapid gastric emptying

Create a sustainable and consistent eating routine to improve your energy levels across the day

Symptom management through medical nutrition therapy for gastrointestinal and non-gastrointestinal symptoms

Our guarantee

Our program provides you with a holistic approach that encompasses your daily needs and activities. This means we will work out an appropriate movement/exercise baseline and progressions, and also teach you about exercise types and postures, your environment, the pacing of day-to-day activities, sleep, nutrition, and stress and anxiety management. Exercise may be one of the most beneficial tools to help you recover, but it can't reach its maximum potential without these accompanying therapy tools.

 

Time to get on top of your pain?

Dietetics in Dysautonomia

Living with Dysautonomia can be challenging, especially when some of the most common symptoms of this condition like nausea, lack of appetite, bloating and changes in bowel movements seem to be working against you.

 

Our dietitians have a wealth of experience working with patients who live with OI and POTS, or other forms of Dysautonomia.

 

Some topics that may be covered to support you and your body with your OI and POTS includes:

  • Strategies and education around adequate hydration and salt intake
  • Nervous system regulation surrounding meal times 
  • Eating strategies for gastroparesis (delayed gastric emptying) or rapid gastric emptying
  • Create a sustainable and consistent eating routine to improve your energy levels across the day
  • Symptom management through medical nutrition therapy for gastrointestinal and non-gastrointestinal symptoms

Cost and questions

For program costs and rebates available, please call the clinic.

Do I need a referral? What if I can't get to your clinic? 

A referral isn't always necessary however may impact on your ability to get a rebate - speak to our friendly reception staff and they can help you.
 

Our clinics are located in Blackburn, Mornington, Bendigo & Essendon, Victoria, however, all services are offered via telehealth also. 

What if I've already done another treatment program?

If you have had treatment for OI & POTS in the past, that's great! We take an inclusive approach and can build on and increase your understanding and progress through our program. We won't make you redo things you have already done through another program.

What causes OI & POTS?

The cause of OI & POTS is still unknown, however, patients often report that their symptoms began immediately following an acute stressor (eg: viral illness, pregnancy, surgery, concussion) but in some patients, symptoms develop more gradually and subtly over time. Many patients report that their symptoms started around puberty.

 

While the precise aetiology remains unknown, orthostatic tachycardia in POTS is thought to reflect the convergence of multiple pathophysiological processes, as a final common pathway. Based on this, POTS is often described as a clinical syndrome consisting of multiple heterogeneous disorders with overlapping clinical features.

Our AHC Program

Our program is designed and focused on OI & POTS rehabilitation and helps our clients understand and manage their symptoms through a holistic approach. We complete a thorough assessment of your health during your first appointment. Our initial assessment allows for us to address the whole person, not just the condition presenting.

 

The sessions focus on:

Setting up a movement/exercise routine

Understanding the neurophysiology of your condition

Setback planning

Goal setting

Gradual exposure strategies

Stress, anxiety and mood management strategies

DIM/SIMS – Threats and safety to the mind/body

Symptom Mapping

Return to work planning

Ergonomics for pain

Return to school planning

OI & POTS physiology and management, including hydration, salt intake, compression and medications

Identifying the demands of your activity and your capacity (using a variety of tools eg. heart rate monitors, heart rate variability and activity diaries)

Pacing strategies (physically, mentally, socially, environmentally, emotionally)

Trigger identification and modification

Causes of sleep disturbances and techniques to help with sleep

Parasympathetic activity / Relaxation techniques

Mindfulness exercises and how to live more mindfully

How to identify your body’s stress response

For women: Understanding your menstrual cycle, its impact on your symptoms and how to support this

Our program aims to help you have a ‘normal day’ or return to work or school, without increasing your symptoms. We know this journey is a bit rocky so we give you the skills to deal with any future problems, through setback planning and providing you with a therapy manual you can turn to in times of need.

 

We can also refer you to a specialist near you to help you manage your health and get access to medication if appropriate.

Dysautonomia: Orthostatic Intolerance (OI) & Postural Orthostatic Tachycardia Syndrome (POTS)

We See

Dysautonomia: Orthostatic Intolerance (OI) & Postural Orthostatic Tachycardia Syndrome (POTS)

Contact Us

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