A thread to share your experiences of orthostatic intolerance - problems being upright.

Paramedics have an ECG device in a bag, so maybe district nurses have it, too.

If the doctors are understanding, they might organise a holter monitor to wear without you seeing them in person. Given how rarely it happens, it'd probably make more sense to get one for a week or two rather than the usual 24 or 48h

So there are some options to begin with, if there is a will on their side.

Given how rarely it happens and that it was captured by your wearable and not a medical device, it's possible that they dismiss it.
 
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I agree very much with this:
Subjectively I believe there are two aspects to OI [...] I can do an activity lying down for dramatically longer than the same amount of exertion upright. This is very clear with cognitive exertion [...] Under this explanation being upright does not obviously trigger negative symptoms such as reduce blood pressure or tachycardia but does contribute towards triggering PEM.

Acute symptoms are often not all that obvious when I stand up, but it's always true that I will be able to follow a conversation, read, think straight etc. much longer if I'm lying down.
 
I don't consider myself to have OI. I get PEM symptoms after being upright, but this is related to physical exertion. I don't experience lightheadedness or a feeling of having to lie down.

What I've noticed for the first time about four months ago is that sometimes my heart rate drops into the 40s to 60s although I'm either sitting or standing. My resting heart rate during the day when I'm lying flat is normally in the 70s! Standing should be at least 80s. I don't experience symptoms during these episodes, but my watch records sharp drops. I would say this happens 2-3 times a month. I don't have low blood pressure afaik.

AI calls it Bezold-Jarisch mechanism which is concerning. Should I get this checked out as it may not be ME/CFS related? Going to the GP in person or worse, a specialist, is going to result in PEM so I'm hesitant unless it's serious.
I think I’d like to get a watch that does this to this level because it’s possible this sounds familiar. I only picked it up because I always thought my ‘have to lie down’ turns were low blood pressure so one day happened to have that near when I had one. And instead of that being low it was high for me with pulse at 40 (it took me a while to get it on tho) and then as I measured the next five times went up to 80 as my blood pressure went down. Strangely given some of the ideas that come up for that suggesting head elevation it was getting in a recliner that caused that relief and standing doing something when the turn occurred.

It obviously feels like I missed the important beginning of the story there to know which was chasing which as a compensation.
 
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I have the objective signs of POTS, that is, raised hearth rate by more than 30 BPM when going from lying down to standing. But I don't have any clear subjective symptoms. No vertigo or dizziness or unpleasant palpitations or feeling like I'm about to faint. So the condition doesn't bother me at all in any clear way.

However I'm thinking that maybe the raised heart rate contribute to why I feel tired fast when I am standing or walking. I am lucky to have pretty high physical endurance compared to many people with ME/CFS, I can be active on my feet for maybe 20-30 minutes without any problems. But after about that amount of time it gets harder and harder to remain upright, even without any activity. It feels like hard effort just to keep standing, like if I had run a marathon and just need to lay down. For a long time I thought that this is just because of low energy level in general, but maybe POTS contributes a little or a lot.

Are there other forum members who recognise this?

Do anyone have experience with medication that has made it easier to remain upright for a longer time?

@Liie,

My OI is similar to yours. Well documented POTS. standing still is the worst but moving back-and-forth helps when standing in line, etc.

I consulted with a cardiologist and ended up on a beta blocker. It helps.
 
Just thought I could add a couple of things:

The tilt table test was devised to investigate fainting in human beings, among other things. It was then noticed that there is a normal pattern of fainting (healthy people) and various abnormal ones, including not fainting when it might be expected (seen in POTS patients according to Dr Satish Raj).

Sir Roger Bannister is said to have created the first autonomic laboratory by installing a tilt table in a storeroom.

***

It’s important to distinguish between “normal” OI and OI syndromes or OI being part of a disease.

Limited and explainable episodes of OI happen to almost every human being, just like vomiting, diarrhoea and fainting. All undesirable but unfortunately part of being human (orthostasis) or being an organism with a gut.

The OI syndrome comes into play when the episodes are (some mixture of) frequent, severe and chronic, and continue for three months plus (or some period considered to qualify for diagnosis). The person may feel generally unwell, and there may be problems not obviously relating to upright posture such as poor sleep, digestive problems and heat intolerance.

OI being part of a disease is too wide a field for me to go into and beyond my knowledge, but, for example, it’s found in a surprising number of autoimmune diseases, not just Sjögren’s. Also OH in Parkinson’s.
 
The OI syndrome comes into play when the episodes are (some mixture of) frequent, severe and chronic, and continue for three months plus (or some period considered to qualify for diagnosis). The person may feel generally unwell, and there may be problems not obviously relating to upright posture such as poor sleep, digestive problems and heat intolerance.
What’s the reason for creating a separate clinical entity (syndrome) for OI here? Why would you say that OI, poor sleep and heat intolerance are connected, rather than probably being a part of another disease (or syndrome like ME/CFS)?
 
What’s the reason for creating a separate clinical entity (syndrome) for OI here? Why would you say that OI, poor sleep and heat intolerance are connected, rather than probably being a part of another disease (or syndrome like ME/CFS)?
I am not sure whether POTS is a different syndrome, a phenotype of ME/CFS (ME/CFS with OI), or a stage of severity in ME/CFS. It seems to me that the pattern of PEM is somewhat different in POTS, and the main issue for such patients is not PEM but OI. The reasons for separating POTS are proper presentation of patients to clinicians and researchers on the forum and beyond, as well as advocating for hemodynamic-related research, which is not popular on the forum.

A comment from Reddit, not mine, to better illustrate my point. (I don't know if links are allowed)
As someone with just plain POTS I've had crashes that lasted for days. This especially used to happen for me after situations where I did a lot of walking, like festivals and farmer's markets.

One difference between me and someone with ME/CFS is that the crashes almost immediately follow the activity. I'd go lift at cardiac rehab, do some errands, then get home and crash once I stopped moving.

Another difference is I've felt like this before. Now, I've had POTS symptoms for a long time, so my "before" is a bit muddied, but I feel like I would if I'd simply done a lot more activity than I actually did. I'm not a runner, but I might feel after a 5k what someone else feels after a marathon (especally if they undertrained for it). It's disproportionate to the amount and intensity of activity I did, but not qualitatively different.

I also fully recover to the same baseline even if it takes 2 or 3 days. This period of time has drastically shortened now that my POTS is better managed; I can wear myself out and just feel a bit hit by a truck for the evening and then feel fine after good hydration and a sleep.
 
I am not sure whether POTS is a different syndrome, a phenotype of ME/CFS (ME/CFS with OI), or a stage of severity in ME/CFS. It seems to me that the pattern of PEM is somewhat different in POTS, and the main issue for such patients is not PEM but OI. The reasons for separating POTS are proper presentation of patients to clinicians and researchers on the forum and beyond, as well as advocating for hemodynamic-related research, which is not popular on the forum.

A comment from Reddit, not mine, to better illustrate my point. (I don't know if links are allowed)
As someone with just plain POTS I've had crashes that lasted for days. This especially used to happen for me after situations where I did a lot of walking, like festivals and farmer's markets.

One difference between me and someone with ME/CFS is that the crashes almost immediately follow the activity. I'd go lift at cardiac rehab, do some errands, then get home and crash once I stopped moving.

Another difference is I've felt like this before. Now, I've had POTS symptoms for a long time, so my "before" is a bit muddied, but I feel like I would if I'd simply done a lot more activity than I actually did. I'm not a runner, but I might feel after a 5k what someone else feels after a marathon (especally if they undertrained for it). It's disproportionate to the amount and intensity of activity I did, but not qualitatively different.

I also fully recover to the same baseline even if it takes 2 or 3 days. This period of time has drastically shortened now that my POTS is better managed; I can wear myself out and just feel a bit hit by a truck for the evening and then feel fine after good hydration and a sleep.
I’ve responded in this other thread so I don’t derail the experience thread.
 
When I read about OI and related syndromes online, it’s often written something like “symptoms are worse when standing and are relieved by sitting or lying down.”

In my case, once I have “provoked” the OI past a certain point, e.g. standing to make breakfast in the kitchen, sitting or lying down doesn’t easily “relieve” the symptoms. For a certain time after, I will have worse symptoms.

I tried to learn more about the upper body pain I was experiencing in my shoulders and arms that I think is provoked by standing, in part. The most similar sounding thing I could find is “coat hanger pain,” but again, this is often described as resolving when the patient lies down. This is absolutely not the case for me.

So, in my case I would say, symptoms are worse when standing and may be more minimal if prevented by sitting or lying, but sitting or lying does NOT resolve the symptoms once they’ve initiated.
 
So, in my case I would say, symptoms are worse when standing and may be more minimal if prevented by sitting or lying, but sitting or lying does NOT resolve the symptoms once they’ve initiated.
Same for me. It's a sort of orthostatic fatiguablity, like physical fatiguability during and after physical activity. The rise in symptoms doesn't immediately go away when I lie down and rest. It does eventually ease, so I can be upright again for a short time, but the same cycle starts again immediately I'm upright.
 
In my case, once I have “provoked” the OI past a certain point, e.g. standing to make breakfast in the kitchen, sitting or lying down doesn’t easily “relieve” the symptoms. For a certain time after, I will have worse symptoms.
Same. Lying down before reaching that point always relieves it. If I stick it out, I can be sure of worse symptoms that last hours.
 
What’s the reason for creating a separate clinical entity (syndrome) for OI here? Why would you say that OI, poor sleep and heat intolerance are connected, rather than probably being a part of another disease (or syndrome like ME/CFS)?

A couple of reasons, I imagine:

To distinguish chronic OI from “normal” OI, as I explained in my post (which was in answer to a couple of posts pondering this earlier in the thread).

And because chronic OI often arises on its own, e.g. POTS patients who don’t have ME/CFS nor any other condition that could account for their symptoms.

Dr Blair Grubb has covered the history in some of his lectures and articles, and Dr Satish Raj usually covers the constellation of symptoms well. Dr Peter Novak seems to have coined the term OI syndrome.

I seem to have inadvertently started a discussion of defining a disease entity. My apologies.

Anyway, the key is discriminating between an explainable episode of OI that resolves with time or first aid, and one that continues without a simple explanation being found and possibly comes with generalised symptoms.
 
I want to read the thread, but i am operating from the thread title and first post for health reasons. This might be useful to somebody, because i haven't heard of these symptoms.


In my case, the word "horizontal" needs altering to address body state, not geometry. Or else the OI disease phenomenon needs to be distinguished from geometry.

Supine is always better than even a few seconds of sitting or standing, but my body generally does not consider supine to be horizontal enough.

My body generally considers side and prone to be 'more horizontal' (i.e. Better) than supine. However, very often, no position is horizontal. I would need to be "more horizontal than horizontal" to get no oi symptoms.


Arms have to be flat when supine or they cause orthostatic stress. A special ergonomic keyboard would accommodate this, but i have not been able to get one.

This would have 2 parts, one on each side, while i am supine, to prevent having to raise arms from bed surface to my 'lap', which i am currently doing. Being supine would still be a significant problem, because of oi and gastroparesis, but this would help the arm problem, which is oi.

i sometimes need to raise or not raise legs, but currently have no means to do that other than putting both legs on bed surface or one above the other while on side, both positions being needed at different times.


A doctor saw a never before seen blanching/flushing with clear line of demarcation when raising arm for only a brief period. This was apparently a sign of severe oi and raynaud's. I have the description someplace. The sign is pretty much always there i think, but probably more pronounced even raising arms to 'lap'.


Side/prone transitivity of postures is less obvious than stand<sit<supine<side.

In the many many hours it takes to rest before removing the dark towel over my eyes after sleeping, i often have to vary left side vs. mostly prone vs. prone and back for orthostatic intolerance.

This includes arm position.

I haven't figured it out completely. Arm might be in bad shape being up on my leg instead of flat, but it might help my overall orthostatic intolerance to have arm up. Or vice-versa. But there are times when global requires prone and arms flat to get partial relief.

I sometimes have right arm flat or on leg or between legs or behind my back if prone. Shape of arm and hand matter also as does head position.


Left side is better for gastroparesis stomach emptying than right or supine in my case, so side generally means left side.

Most of the time i cannot be supine due to gastroparesis or oi (thus can't use computer).

In case not obvious, I am bedridden almost al lthe time.


my brain turns off when vertical. my extreme executive dysfunction gets even worse.

the feeling is 'i HAVE to be horizontal'. being less horizontal causes overall worse health and progresses the disease.


Stuff that might or might not be related:

It often feels like body fluids are moving when i change posture.

Recently, head gets kind of dizzy or disoriented when i turn to left side from supine or more vertical postures.

When i shake my head, or shake a toothbrush, i get a physical brain moving sensation, which i can almost hear, as if it is hitting skull. Idk if that qualifies me for the looney bin these days, but it is what i experience.

I had a major head injury at age 4, never followed up on.


Capitalization errors will exist.
 
Dr Blair Grubb has covered the history in some of his lectures and articles, and Dr Satish Raj usually covers the constellation of symptoms well. Dr Peter Novak seems to have coined the term OI syndrome.

As a physician I would question the authority of people like this. Medicine is full of folklore and hype. What I have read from these people does not give me any confidence they know what they are talking about.

There is no doubt that some people have OI that is not just the normal shift in blood distribution seen in tall people who have been in a position with venous pooling. Some of those have tachycardia and some do not. The role of the tachycardia i the OI is unclear. It is all a muddle and when everything is a muddle in medicine the honest thing to do is to admit it to the patients rather than lead them to believe that they have some well defined syndrome.
 
Anyway, the key is discriminating between an explainable episode of OI that resolves with time or first aid, and one that continues without a simple explanation being found and possibly comes with generalised symptoms.
Thank you for explaining. Why not just call it «chronic OI» or «episodic OI» or something similar, rather than creating a syndrome that conveys far more understanding than what we actually have?
 
@Utsikt, perhaps it would help clarifying things if you would give your definition of a "syndrome".
In this context it’s a group of signs and/or symptoms that are are grouped together because it’s reasonable to believe they are connected somehow.

For POTS specifically, it’s claimed that postural/orthostatic tachycardia (POT, substantially higher HR when not lying down) is a core feature. This has then been added together with orthostatic intolerance (OI, feeling unwell when not lying down), blood pooling in lower extremities, fatigue and various other symptoms, along with plenty of vague notions of «dysautonomia» and such.

We know that many with OI do not have POT if you defined it as an increase of at least 30 bpm, and many with POT do not have OI, which presumably invalidates the claim that POT or even HR is important for causing the symptoms.

I think it will be much more fruitful to talk about what can be observed, like OI or POT, than to talk about syndromes that implies knowledge that we don’t have or that’s outright wrong.
 
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