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When it comes to what were referred to in the past as "vasovagal" or pre-syncopal episodes,

(and even much longer ago as "fainting spells),

a complex of symptoms in one patient, may be similar to those of another patient.

And yet, the underlying responsible mecanisms, ... the pathologic findings, ... may be

quite distinct.

Clearly, the response to any selected therapy will also vary (sometimes greatly) based on

what is actually going on at a cellular level in different regions of the body.

These "goings-on" include differences in the messages sent from one part of the body (and to select one; the carotid body sensor at the origin of the internal carotid artery) to the heart and the brain, and peripheral vascular "resistors" in an extremity. These communications can be "wired" (as most consider the autonomic nervous system to be), or "wireless." In that latter form of messaging, cells in a certain milieu may

"read" their "environment" and release substances into tissues and blood that will then be interpreted at a distance (might be brain,... might be heart, etc.).

While the above may sound like a variant on basic endocrinology, in which a hormone is released because a "releasing factor" 'higher up' (like the pituitary) at a distance said it should be released, ... the "messaging" between cells and tissues gets beyond that, and is so individual-specific that (to put it simply), what works for one person's problem doesn't work for the next subject's condition though seemingly the same at face value. Apocrine effects are also part of endocrinology, where a hormone-like substance is blobbed onto neighboring cells rather than carried by the blood to distant "neighbors" to get a result. 

Many meds are formulated based on this endocrine model. If something is mediated by receptors, make a substance in the lab that "fits" into the receptor to get more action. And

if you've already got too much "action," make a substance in the lab that blocks the receptor.

But the intricate and variable cell-to-cell messaging that is going on in this specific illnesses of the autonomic nervous system require a more gentle and patient approach to get to the underlying diagnosis. Not all POTS are the same.

So the "message" one time may be a cytokine released from a cell, and the next time from a specific frequency of electromagnetic radiation, also "sent out" by certain cells. And with subsequent (and almost instantaneous) entrainment by other cells.

So what is one to do? I mean, if one wants a clear answer, it certainly hasn't emerged yet from what has been written on this page.

One approach may be similar to what I heard at times emerging from a surgical suite where an "orthopod" was fixing something: "If it doesn't fit, get me a bigger hammer."

Autonomic dysfunction needs the right hammer, and probably a whole series of small hammers. It needs someone who will patiently study "the parts" involved, to better understand

the various "messages" that are circulating. Hard to find in today's Medical practice I believe.

But that's just my personal judgement that the reader can completely ignore.

An often seen knee-jerk reflex is to reach for a beta-blocker of one variety or another.

For me, that's a "bigger hammer." Why not start with smaller hammers of salt and water management?

"So what is one to do?"

Well, I would start by developing an appreciation for Dr. Blair Grubb's work with his associates

in all of this.

Then, find a physician familiar with Grubb's work to manage the presenting challenge at hand. One method for sorting potential practitioners might be based on a response to the polite question: "Doctor, have you read Doctor Grubb's article on orthostatic intolerance?"

Something like that ...

And the same question might be addressed to a neighbor who likes to give advice based on "personal experience."

Clinical disorders of the autonomic nervous system associated with orthostatic intolerance: an overview of classification, clinical evaluation, and management

Not all POTS have been filled from the same faucet.

And while wating patiently for a cure, never forget:

Dysautonomia is better than no autonomia at all.

And here I've gone off again on another subject that doesn't seem related to my work on this site with participants with "long-term" COVID-19 and their experience with the intervention that usually concerns us here.

But of course, it is related. 

It's all about listening for subtle messages rather than hammer blows.

And when you get done with Grubb, follow this link to

Further literature findings on orthostatic intolerance.

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