Part 4: Two sides of the same coin
August 2022 - September 2022 (Month 8-9)
August 2022 brought long-needed relief in the form of medication. After months of suffering from the effects of POTS but without any clear diagnosis or treatment options, I decided it was time to figure out how to get some pharmaceutical assistance. One of the standard, in-office diagnostics for POTS is to do a sit-to-stand or lean test, consisting of measuring heart rate and blood pressure lying down, sitting, and standing up over a period of about 15 minutes in total. Of course in German there’s a way funner name for this — a Schellong Test. I came prepared for my next doctor’s appointment with the Canadian Cardiological Society’s position statement on POTS, as well as a list of pharmaceutical options should this Schellong Test be positive. My doctor, being the fantastically open and supportive doctor she is, agreed we should do the tests and look at some medication options after. Thankfully and surprisingly, the test is painfully easy to perform so a BP cuff purchase and a few self-administered tests later, and I finally have a POTS diagnosis. I try a few off-label medications for POTS and they bring immediate relief. The ceaseless pounding of my heart, the adrenaline rushes from just standing up and walking around, the dizziness from walking around in the heat at 140 BPM, they all subside with one tiny dose of a magic pill called a beta blocker. For those that aren’t aware, these medications are made for treating high blood pressure. They work by blocking adrenaline from reaching the “beta receptors“ in your body, which are found in organs such as the heart and lungs, as well as your vascular system. In turn this causes blood vessels to dilate, and most importantly for me was a slower heart rate. This is classic symptom management though and it’s modifying the illness in any way, just hiding the symptom. But when quality of life matters so much, that’s just fine.
Armed with my daily beta blocker dose, I could finally rest. My mind would slow down and my muscles would relax fully for the first time this year. The first beta blocker I tried, propranolol, had terrible side effects though. It’s a first generation beta blocker and has the effect of blocking beta receptors non selectively on all organs, and it also happens to cross the blood-brain barrier, making it ripe for producing nasty side effects. My doctor and I decided to try bisoprolol next, a second generation beta blocker which selectively blocks only the beta receptors in the cardiovascular system. Success at last. The only real downside was the one side effect that maybe hurt the most — more fatigue. I was continuing my light exercise regiment at this time, but after a few months of physiotherapy, it just felt unsustainable. I couldn’t keep pushing myself to exhaustion every couple of days. My limitations were also no longer improving, and the extra fatigue from the beta blocker was just all too much. I was exhausted.