Dysautonomia is a term used to describe dysfunction of the autonomic nervous system.
The autonomic nervous system is part of the nervous system.
It regulates your heart rate and blood pressure.
It controls your gut motility or your digestion controls,
your temperature, your sweating, um, and also tear production.
And most people take these functions for granted.
But when this part of your nervous system is impaired,
it can lead to life altering and disabling symptoms.
One of the most common manifestations of dysautonomia is a syndrome called pots or
postural orthostatic tachycardia syndrome.
This syndrome is defined by impaired heart rate and blood pressure regulation.
The autonomic nervous system does not work properly and the blood pools in
the legs leading to less blood flow returned to the heart and consequently less
blood flow to the brain.
This leads to a number of symptoms of orthostatic intolerance where patients do
not tolerate standing for prolonged periods of time.
Patients can experience dizziness, brain fog,
and profound weakness with standing as well as a racing heart.
Many patients also can experience exertional intolerance,
where even the smallest activity can lead to them having weakness and muscle
aches for days. And many patients with POTS also have a significant fatigue.
And this is not fatigue like most people get after working a long day.
This is fatigue, severe exhaustion,
bone crushing exhaustion in which, uh, activities of daily living,
such as going to the grocery store or even getting up and walking across the
room can cause severe exhaustion.
Many patients get symptoms of dysautonomia and POTS following Lyme disease,
and there's many reports of this in the literature, and this is not a,
a new phenomenon.
There are treatments that can target the dysautonomia and help give the patient
some quality of life back.
There are numerous autonomic tests that can be used to diagnose dysautonomia.
The most commonly known test is called the tilt table test,
where the patient lies on a table and the heart rate and blood pressure is
monitored, uh,
with a patient laying at rest and with the patient in an upright position.
If the heart rate increases by more than 30 beats per minute,
when the patient is tilted upright, then that is diagnostic of pots.
POTS and disin is a dynamic disease that can wax and wane.
So sometimes patients have flares where they're increasingly symptomatic and
other times they feel better. And so sometimes when we do a tilt table test,
for example, um,
we may capture a patient on a good day and it may not be diagnostic of pots,
even though the patient clearly has a history that's consistent with the
syndrome.
There are numerous treatments that are available for dysautonomia and POTS to treat
pots. The foundation of the treatment is really lifestyle change,
so increased fluid and salt intake to optimize the circulation and,
uh, improve blood flow is very important.
Compression stockings and an abdominal binder can also help to pump the blood
back up to the heart and brain where it needs to go.
Many patients with POTS cannot tolerate normal exercise programs, um,
and they need to have an exercise program specifically designed for them.
Other treatments are targeted towards gut, uh, or GI tract dismotility.
There are many medications that can increase gut motility.
And then there also are many medications that can, uh,
improve circulation either through reducing the heart rate or increasing the
blood pressure, or, uh, targeting the op, the autonomic nervous system itself.
We know that many infections can cause pots,
POTS after Lyme disease and COVID 19 share many similar symptoms and they also
look a lot like patients with myalgic.
Encephalomyelitis are also called chronic fatigue syndrome,
and this has led many people to hypothesize that these syndromes all share a
common underlying pathology.
There are a lot of interesting studies showing that the autonomic ganglia may be
affected in these syndromes.
The autonomic ganglia is a cluster of nerve cells that lies at the sides of
the spinal cord,
and they are responsible for transmitting signals from the environment to the
brain.
There is an enormous mismatch between the number of patients with dysautonomia
and medical providers with knowledge of this field,
especially with the COVID 19 pandemic.
There is now an enormous influx of patients with dismia and the medical system
has had a lot of difficulty accommodating these patients.
Many doctors are not aware of dysautonomia,
and so it's common that many patients will see multiple specialists
before the possibility of dysautonomia is even brought up.
And even once a patient is suspected to have dysautonomia,
it is difficult to find autonomic testing
Facilities and also find a specialist with knowledge in this field.
There's a lot of exciting research right now in discovering novel autoantibodies
or blood markers in patients with dysautonomia.
These can be a sign of a dysregulated immune system in this disease,
and more research is needed to understand which patients have these
autoantibodies and how it should affect our treatment.
Many of these autoantibodies target the autonomic nervous system.
There's a lot of exciting research right now on the use of immunomodulatory
medicines to treat dysautonomia.
One of the most studied medications right now is a medication called IVIg or
intravenous gammaglobulin.
This is a medication that is used to treat many autoimmune diseases,
including myositis and myasthenia gravis.
Our experience tells us that some patients with dysautonomia may respond to this
medication, but clinical trials are currently studying this right now.
My particular research interest is in discovering novel immune biomarkers in
POTS after Lyme disease and covid 19.
I'm also interested in studying the immune dysregulation in dysautonomia and
understanding which patients may respond to immunomodulatory medications. I, um,
hope to develop novel biomarkers and treatments for patients.