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Because the primary identifying features for POTS are similar to those seen with anxiety disorders, patients are often assumed to have issues with mental health. Ironically, anxiety and depression may develop in a person with POTS, basically because their condition is not appropriately recognized or treated. However, anti-anxiety drugs do not solve the tachycardia that occurs with POTS. TREATMENT There is no cure for POTS or other types of autonomic dystonia. Treatment is aimed at managing symptoms through several types of interventions. Patients might be advised to raise the head of their beds. High-salt diets combined with up to two liters of non-caffeinated, non-alcoholic fluid per day can help maintain appropriate blood pressure. People with extreme forms of this condition might wear compressive garments to reduce the pooling of fluid in the legs. Exercise is an important part of POTS treatment for several reasons. It improves heart function, so the tachycardic episodes may feel less extreme. It can help counterbalance negative feelings associated with this disorder, especially since it often affects young people. If POTS symptoms are extreme, patients might be counseled to choose exercises that allow them to be in a reclining position. These might include swimming, rowing, or using a recumbent bicycle. Many people have POTS that is relatively mild and manageable with these lifestyle adjustments. However, medications for POTS may be necessary. These include drugs that impact heart rate, blood vessel dilation, and how the kidneys retain sodium. IMPLICATIONS FOR MASSAGE Massage therapy has some benefits to offer people with POTS, if we can anticipate and make appropriate accommodations. People with POTS may feel that their body is unreliable, and that they can't depend on being able to do the things they need to do. Receiving massage therapy may help boost a person's sense of inner strength and ability to cope with the challenges of living with this condition. Exercise is an important part of the treatment plan for most people with POTS. Tachycardia can be frightening, but experiencing that sensation in association with health and strength can help mitigate that fearful feeling. Experts suggest that manual therapies that promote the ability for people with POTS to exercise can be especially helpful. What Accommodations Might Be Needed? If clients who have POTS worry about dizziness or faintness when they sit up or stand up, the prospect of receiving massage might not be especially attractive. POTS has been seen to develop as a complication of an underlying problem like diabetes or AIDS. It is also often seen with Ehlers-Danlos syndrome (see Massage & Bodywork, November/December 2019, page 38, for more on Ehlers-Danlos syndrome), hepatitis C, and Chiari malformation, although its connection to these conditions is not known. POTS involves a problem with maintaining blood pressure when a person changes position in relation to gravity. When a healthy person rises from a reclining or sitting position to standing, the arteries in the neck constrict a bit. This helps move blood to the brain with more force, so the person doesn't get dizzy. But this slight increase in blood pressure doesn't happen in people with POTS. Instead, the arteries in the neck stay relaxed, the brain is deprived of blood (causing dizziness or lightheadedness), and the heart beats extra hard to make up for the loss. POTS is identified when the heart rate rises by at least 30 beats per minute upon standing, or when the heart rate is at 120 beats per minute within 10 minutes of standing. SIGNS AND SYMPTOMS OF POTS The main symptom of POTS is the sensation of tachycardia, or rapid heart rate, which happens when a person goes from reclining to an upright position. This may be accompanied by rapid breathing and a sense of panic, which may serve to prolong the episode. In addition, a person with POTS may have palpitations, chest pain, fatigue, nausea, brain fog, and migraines. Episodes of fainting are possible. Blood flow in the extremities is affected too: Raynaud's phenomenon may develop in the hands, and blood may pool and discolor the feet and legs. While it can be lovely to finish a massage session with relaxing forms of touch that promote peace and tranquility, clients with POTS are more likely to benefit from a session that finishes with techniques that promote alertness. 38 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 2 0