Katie Ledecky has POTS, postural orthostatic tachycardia syndrome

U.S. Olympian Katie Ledecky looked pretty slick 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 wins to fourteen. But beneath the surface, things are not quite right. swimming smoothly for Ledecky for the past nine years. The nine-time Olympic gold medalist has dealt with POTS. And in this case, POTS stands for postural orthostatic tachycardia syndrome.

Each of the words in POTS is indicative of the condition. ‘Postural’ means it has to do with how your body is positioned. The word ‘orthostatic’ refers to standing upright. Tachycardia occurs when your heart rate exceeds one hundred beats per minute. And ‘syndrome’ is when a group of symptoms occur together. In her recently published memoir entitled Just add water: my swimming lifeLedecky described how she was diagnosed with POTS after the 2015 World Swimming Championships in Russia.

POTS is a pool problem – not a pool problem, but a situation where blood pools in your arms, abdomen, pelvis and legs and not enough blood gets to your head and brain. When you stand up, about 10% to 15% of your blood will normally fall to the lower half of your body due to gravity. Because this means less blood to that round thing sitting in your neck, you may occasionally experience temporary lightheadedness, especially if you stand up quite quickly.

But you can thank your leg muscles and autonomic nervous system for minimizing such feelings. Normally, when you stand, your leg muscles will contract to keep blood flowing upward and your autonomic nervous system will trigger the release of epinephrine (adrenaline) and norepinephrine. These two hormones also help with blood flow to your head (a very technical term for your head and brain) by increasing your heart rate and tightening your blood vessels a little.

When you have POTS and stand up, more blood than normal flows to 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 for this.

In her memoir, Ledecky described POTS this way: “I collect blood in the blood vessels under my heart when I stand. My body then releases extra norepinephrine or epinephrine, which puts extra strain on my heart, causing it to beat faster. Which in turn causes dizziness, fainting and exhaustion.”

You can relieve these symptoms of POTS by lying down again. But of course, you can’t just put life and POTS aside, 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 are the other possible symptoms of POTS, such as heart palpitations, anxious feelings, brain fog. shakiness, excessive sweating, shortness of breath, chest pain, headache, trouble sleeping, bloating, pale face, and purple discoloration of parts of the body lower than your heart.

The problem is that you can suffer from POTS for a long time – even years – without being properly diagnosed. Not all healthcare professionals may be familiar with POTS. And medical visits typically last no more than 15 minutes—less time than it takes Ledecky to swim the 1,500-meter freestyle—which isn’t enough time to really discuss all your symptoms and experiences with a doctor.

So you may need to be particularly proactive to get the right preparation for POTS. You may need to ask for a tilt table test. This is roughly what it sounds like. You lie on a table that can then be tilted to different angles, from completely flat to almost upright. At each position, your heart rate, blood pressure and possibly your blood oxygen and exhaled carbon dioxide levels are measured. With POTS, within 10 minutes of standing up, you tend to experience an increase in your heart rate greater than 30 beats per minute or a heart rate greater than 120 beats per minute.

You may have other tests to check the function of the nerves that affect your sweating and heart and to rule out other possible causes of your symptoms. This may include urinalysis, 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 are still unknown. It often starts after your body experiences some form of stress, such as pregnancy, surgery, trauma, or a viral illness. There is some evidence that this could be an autoimmune disease in which your immune system attacks your normal body tissues. But the jury is still out on that.

Without a truly known cause, treatment is more focused on managing the symptoms. This often means adding a little more salt to your diet and making sure you drink enough fluids to keep your blood volume high enough. In some cases, you can take medications to ease blood flow to your brain, such as fludrocortisone, midodrine, phenylephrine, or beta blockers. Wearing compression stockings on your legs can also help manage orthostatic intolerance, which basically means difficulty getting up and standing.

POTS can be very frustrating to deal with, especially because others may not be familiar with the condition and its effects. That’s why having good mental health care can also be important.

Another thing that can help orthostatic intolerance is exercise, including, drumroll please, swimming. Ledecky, in case you didn’t know, already does this. So it’s a happy coincidence that what she does for a living can simultaneously benefit her condition. It can also help you if you have POTS. Of course, you don’t have to win 14 Olympic medals and 21 world championship gold medals.