The experience of COVID is highly variable, as we have all learned by now. For some people, the infection is so mild they may not even notice the symptoms, while for others the virus wreaks devastating havoc. The post-COVID syndrome may afflict even those who had mild infections initially, and it can make life very difficult.
Among the possible complications that can affect people after recovery are frightening fatigue, brain fog and an autonomic nervous system problem known as POTS (postural orthostatic tachycardia syndrome). Symptoms of POTS include racing heart, dizziness or even fainting, shortness of breath and inability to exercise normally.
POTS had been described before COVID-19, but it was considered uncommon and many doctors do not have much experience treating it. This dysautonomia may be an autoimmune disorder. Like many other autoimmune conditions, POTS appears to be more common among women. Treatments include simple measures to increase blood volume and raise blood pressure (eat more salt, drink more water and wear compression hose) as well as drugs that can tamp down the immune response.
One of our guests is a psychiatrist, treating some patients for PTSD as they recover from COVID. She herself has post-COVID syndrome, including POTS, that limits her activity. Dr. Shannon Caspersen is an active participant in the online forum called Body Politic, especially the discussion group for people suffering long COVID.
We also check in with Dr. Christina Kokorelis, who has spent years treating patients with POTS. She describes this condition, the challenges of diagnosing it, and the most common treatments.
Shannon Caspersen, MD, is triple-boarded in Adult Psychiatry, Child & Adolescent Psychiatry, and Addiction Medicine.
Dr. Caspersen is an assistant professor at Weill Cornell Medical College/New York Presbyterian Hospital. Her website is ShannonCaspersenMD.com
Christina Kokorelis, MD, is a member of the Johns Hopkins POTS program. She is a rehabilitation physician specializing in pediatric and adult postural orthostatic tachycardia syndrome (POTS), orthostatic intolerance and musculoskeletal rehabilitation. She takes a comprehensive, team-based approach to patient care. Dr. Kokorelis also treats children with concussions and chronic pain disorders. Dr. Kokorelis is an assistant professor in the Johns Hopkins Department of Physical Medicine and Rehabilitation.