Katie Ledecky has POTS, Orthostatic Tachycardia Syndrome

U.S. Olympian Katie Ledecky looked pretty smooth 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 tally to 14. But beneath the surface , things haven’t been entirely smooth sailing for Ledecky over the past nine years. The nine-time Olympic gold medalist was dealing with POTS. And in this case, POTS stands for orthostatic tachycardia syndrome.

Each of the words in POTS is a clue to the condition. “Posture” means it has to do with how your body is positioned. The word “Orthostatic” refers to standing upright. “Tachycardia” is when your heart rate exceeds one hundred beats per minute. And “Syndrome” is when you have a group of symptoms that occur together. In her recently published memoir titled Just Add Water: My Swimming LifeLedecky shared 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 condition where blood pools in your arms, abdomen, pelvis, and legs and doesn’t get enough to your head and brain. Now, typically, when you stand up, about 10% to 15% of your blood is going to fall into the lower half of your body because of, you know, gravity. Since this means less blood in that round thing that sits in your neck, you may occasionally and temporarily feel a little dizzy here and there, especially if you stand up fairly quickly.

But you can thank your leg muscles and autonomic nervous system for minimizing such feelings. Normally, your leg muscles will contract as you stand to keep the blood flowing upwards, and your autonomic nervous system will trigger the release of epinephrine (adrenaline) and norepinephrine. These two hormones will also help blood flow to your kidney—a highly technical term for your head and brain—raising your heart rate and constricting your blood vessels a bit.

When you have POTS and stand up, more blood than normal rushes 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.

In her memoir, Ledecky described POTS this way: “I get blood pooling in the vessels below my heart when I stand. My body then releases extra norepinephrine or epinephrine, which adds extra stressors to my heart, making it beat faster. Which, in turn, causes dizziness, fainting and exhaustion.”

You can relieve these POTS symptoms by lying down again. But of course you can’t just take life and SKINNY lying down, so to speak. While POTS itself will not be life threatening, it can be quite life changing in a bad way. Besides, think about how dizziness, fainting and exhaustion can affect your life. Then there are the other possible symptoms of POTS, like palpitations, anxiety, brain fog. shaking, excessive sweating, shortness of breath, chest pain, headaches, trouble sleeping, bloating, pale face and purple discoloration of the parts of the body below 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 are usually 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 of your symptoms and experiences with a doctor.

Therefore, you may need to be extra proactive about proper treatment for POTS. You may need to ask to do a tilt table test. It kind of sounds like that. You lie on a table that can then be tilted at different angles, from being completely flat to an almost upright position. 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, you tend to feel an increase in your heart rate of more than 30 beats per minute or a heart rate that exceeds 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 urine tests, 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 present, the specific causes of POTS remain unknown. It often begins after your body has experienced some type of stress such as pregnancy, surgery, trauma, or a viral illness. There is some evidence that this could be an autoimmune disease where your immune system attacks your body’s normal tissue. But the jury is still out on this one.

Without an actual known cause, treatment focuses more on symptom management. This often involves adding a little more salt to your diet and making sure you drink plenty of fluids to keep your blood volume high enough. In some cases, you may be given medicines to help the blood flow to your brain, such as fludrocortisone, midodrine, phenylephrine, or beta-blockers. Wearing compression stockings on your feet can also help with postural intolerance, which is basically when it’s hard to stand up and stand up.

Dealing with POTS can be very frustrating, especially since others may not be familiar with the condition and the impact. Therefore, the right mental health support can also be important.

Another thing that can help with postural intolerance is exercise, including swimming. Ledecky, in case you didn’t know, already does. So it’s a happy coincidence that what she does for a living can also be beneficial to her situation. It could also help if you have POTS. Of course, you don’t have to win 14 Olympic medals and 21 world championship gold medals while doing it.