Posted 9/28/2021 2:09 PM (GMT 0)
I think this depends on your overall condition, the severity of your POTS, and the underlying reasons you have it. (I know that "it depends" is an annoying answer!)
If you were losing consciousness every time to you walked to the bathroom, then I doubt you'd be asking this question. Clearly in that circumstance it's a critical safety issue to control POTS by whatever measures necessary ASAP. If your POTS is somewhat manageable, then the answer is murkier. For a while I had to use a wheelchair any time I left the house and couldn't go downstairs in my house for months, which some might consider manageable and some might not. At one point, my heart would spike to over 155 BPM if I just sat upright, for which I was hospitalized, so I didn't consider that manageable. For a while, POTS was only a problem for me when I was really hot, had to stand still for a long time, or when there was a sharp barometric pressure drop. But right now, I only experience POTS symptoms when I'm significantly dehydrated.
Have you tried lifestyle modifications to treat it? Proper hydration - not too much or too little - can make a big difference, as well as lots of salt (2 tsp per day) to stabilize blood volume. Compression stockings also can make a big difference, particularly for people who have noticeable blood pooling in their feet and legs. Recumbent exercise can be good to keep your cardiovascular system toned. Nervous system support practices like vagus nerve exercises, meditation and guided visualizations, and limbic system retraining programs can also be very helpful. These things were enough to help me improve, along with treating mast cell activation syndrome.
I know some people who have been helped by the various drugs prescribed to treat POTS, but mostly the drugs have not helped the folks I know personally. My POTS specialist (who is great - let me know if you need a recommendation in the Boston area because dysautonomia specialists are very rare!) says that the drugs are about as effective as a placebo, which means some of them DO help, just not that often. Midodrine seems to have fewer side effects than propranolol. If you would like to try a beta-blocker (which is what propranolol is) but are averse to pharmaceuticals or want to titrate up your dose gradually, then butterbur is an herbal beta-blocker.
I do recommend skipping the tilt-table test. You can be diagnosed with POTS and dysautonomia in general without the obnoxious and unpleasant tests.
Good luck!