September 22, 2013

Pregnancy, POTS and our trip to Stanford Cardiovascular to meet Dr. Friday!

After having a really high heart rate and very low blood pressure since hitting the third trimester, my cardiologist decided it was time for us to take a visit to a POTS specialist.  He was able to reach Dr. Karen Friday at Stanford who I've heard lots about through different POTS people online and she squeezed us in this Thursday even though her next opening isn't until December.

Dr. Friday was extremely knowledgeable and was able to explain all of my symptoms.  Basically all of my issues come back to the basis of POTS.  People with POTS almost always have low blood volume.  People with POTS also have issues with the blood vessels constricting when they stand to.  Those constricting blood vessels keep the blood pumping throughout the entire body.  In order to counteract this, my heart rate speeds up (to keep the blood pumping everywhere) and in turn keeps my blood pressure stabilized.  On the beta blocker, the heart rate doesn't get too high and therefore my blood pressure doesn't drop.  Which is why most of the time, I have very limited POTS issues.  Stress and exhaustion are my two biggest triggers to throw off this balance.

But now we add in the pregnancy factor.  This doctor explained that although blood volume does increase when you're pregnant, since my blood volume is already low, the extra blood volume just goes straight to the baby.  But the additional blood volume also makes it harder for my blood vessels to constrict.  Then you add in the pressure from baby and my uterus on the blood vessels in my abdomen and it creates a recipe for lots of problems because it's harder for the blood to get up to the upper region of my body when standing.  Hence the increased tachycardia and lower blood pressure I've been having.

The good news is she says there is absolutely no reason to worry about baby.  She says everything the baby needs is going straight to baby...and I get the leftovers which results in my symptoms.  So we talked about where we go from here.  She says keep the fluids, salt, and compression stockings up.  At work...in order to stay off of bed rest...I need to be sitting as much as possible.  She wants me to try and do supine position activities (i.e. swimming).  She said if drinking the fluids doesn't work or my symptoms are starting to get more severe then I should receive saline fluids via IV.  We talked about labor and delivery and she agrees that avoiding a C-section is the goal and she suggested that I stay on IV fluids the entire time we are in the hospital up until discharge.  We were also excited to hear that she sees absolutely no reason why I should need to be induced early.  She's also agrees with my cardiologist that I should keep using compression stockings and keeping my salt intake up.  She did provide us with a lot of prescription options that we could try if I wasn't pregnant or if my issues get much more severe; but we're holding off on that for now.

Overall it was a very long day; but we left feeling like we got great reassurance and information from someone who specializes in the study and treatment of POTS.  Plus, Dr. Friday was really nice and funny...and that combination is almost never present with these specialists...

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