U.S. Olympian Katie Ledecky looked pretty smooth in the water at the Paris Olympics, where she swam to two gold medals, a silver and a bronze, to bring her career Olympic medal haul to 14. But beneath the surface, things haven’t been completely smooth swimming for Ledecky for the past nine years. The nine-time Olympic gold medalist has had to deal with POTS. And in this case, POTS stands for postural orthostatic tachycardia syndrome.
Each of the words in POTS is a clue to what the condition is. “Postural” means that is had to do with how your body is positioned. The word “Orthostatic” refers to standing upright. “Tachycardia” is when your heart rate exceeds a hundred beats per minute. And “Syndrome” is when you have a group of symptoms occurring together. In her recently published memoir entitled Just Add Water: My Swimming Life, Ledecky chronicled how she was diagnosed with POTS after the 2015 swimming world championship held in Russia.
POTS is a pool problem—not a swimming pool one but a situation where blood is pooling in your arms, abdomen, pelvis and legs and not enough is getting up into your head and brain. Now, typically, when you stand up, around 10% to 15% of your blood will fall to the lower half of your body because of, you know, gravity. Since this means less blood to that round thing that sits on your neck, you may occasionally and temporarily feel a bit lightheaded here and there, especially if you stand up rather quickly.
But you can thank your leg muscles and autonomic nervous system for minimizing such feelings. Normally, your leg muscles will squeeze as you stand to keep blood flowing upwards and your autonomic nervous system will trigger the release of epinephrine (adrenaline) and norepinephrine. These two hormones will also help with blood flow to your noggin—a highly technical term for your head and brain—by increasing your heart rate and tightening your blood vessels a bit.
When you’ve got POTS and stand up, more blood than normal pools down in the lower half of your body. And your blood vessels may not respond normally to norepinephrine or epinephrine. Therefore, your heart tries to beat even faster to compensate.
In her memoir, Ledecky described POTS as follows: “I pool blood in the vessels below my heart when I stand. My body then releases extra norepinephrine or epinephrine, which adds additional stressors on my heart, making it beat faster. Which, in turn, brings on dizziness, fainting, and exhaustion.”
You can relieve these symptoms of POTS by lying down again. But of course you can’t simply take life and POTS lying down, so to speak. While POTS itself won’t be life-threatening, it can be quite life-altering in a bad way. After all, think about how dizziness, fainting and exhaustion can affect your life. Then there’s the other possible symptoms of POTS such as heart palpitations, anxious feelings, brain fog. shakiness, excessive sweating, shortness of breath, chest pain, headaches, sleep issues, bloating, a pale face and purple discoloration of body parts that are lower than your heart.
The trouble is you can go a long time—even years—suffering from POTS without being properly diagnosed. Not all health professionals may not be familiar with POTS. And medical visits typically are no longer than 15 minutes—less time than it takes Ledecky to swim the 1500 meter freestyle—which isn’t enough time to really discuss all of your symptoms and experiences with a doc.
So, you may have to particularly proactive about getting the proper work-up for POTS. You may have to ask to get a tilt table test. This is sort of what it sounds like. You lay on a table that can then be tilted different angles, going from you being completely flat to being in an almost upright position. At each position, your heart rate, blood pressure and potentially your blood oxygen and exhaled carbon dioxide levels get measured. With POTS within 10 minutes of going upright, you tend to experience an increase in your heart rate of more than 30 beats per minute or a heart rate that exceeds 120 beats per minute.
You may undergo other tests to check the function of nerves that affect your sweating and heart and rule out other possible causes of your symptoms. This can include urine tests, blood tests, imaging tests, breathing tests and even biopsies of your nerves. The types of tests may vary depending on your medical history and circumstances.
At this time, the specific causes of POTS remain unknown. It often starts after your body has experienced some kind of stress such as pregnancy, surgery, trauma, or a viral illness. There is some evidence that this could be an autoimmune disease where your immune system attacks your normal body tissue. But the jury is still out on that.
Without a real known cause, treatment is focused more on managing the symptoms. This frequently includes adding a little more salt to your diet and making sure that you are drinking plenty of fluids to keep your blood volume high enough. In some cases, you may take medications to facilitate blood flow to your brain such as fludrocortisone, midodrine, phenylephrine or beta-blockers. Wearing compression stockings on your legs may help as well deal with orthostatic intolerance, which is basically when it is hard to deal with getting and standing up.
POTS can be very frustrating to deal with, especially since others may not be familiar with the condition and the impact. Therefore, having proper mental health support can be important too.
One other thing that may help orthostatic intolerance is exercise, including, drum roll please, swimming. Ledecky, in case you didn’t know, kind of does this already. So, it is a happy coincidence that what she does as a profession can at the same time be beneficial for her condition. It could help you as well if you have POTS. Of course, you don’t have to win 14 Olympic medals and 21 world championship gold medals while doing it.
