A POTS/OI at-home, easy, free, safe rehab program hypothesis:

Made with Stable Diffusion by D. Troy Roach, 26th July 2023

Ground Rules:
1. Understand that this is just a theory. Your input will be valuable in improving the technique and refining it for future users.

2. Take care of yourself first. Do not push yourself or risk injury in any way. Actually, if there is danger or pain... then stop! Each step should be done from a place of calm & safety!

3. Each exercise/movement should be done with a calm/steady Heart Rate (HR) and Blood Pressure(BP). If your HR or BP spikes... then you are pushing too hard. No problem, take a break, take a step back and continue.

Step 1:

Read through and understand each part. Since you are doing this without 1-to-1 guidance, it is important to clearly understand the theories.

In summary, POTS/OI (Orthostatic Intolerance) is caused by dysautonomia. The nervous system is not communicating correctly with the cardiovascular system. This system used to know how to function correctly with zero effort on your part, but due to neurological damage, the brain needs to be retrained to rewire this autonomic nervous system (ANS). The ANS works without consciously thinking about how it should work. Therefore, thinking too much might get in the way of healing! The ANS needs to recalibrate. This can be done with some simple head and eye movements at different angles while monitoring your HR to make sure the ANS is calm and ready to learn.

Step 2:

Guaranteed blood flow/volume to the brain:

The brain needs blood to function and to heal.

You can start by learning the simple technique of lightly pressing on your jugular veins in the neck with your thumb and middle finger. Doing this for 5 to 10 seconds should be enough to feel a change in pressure in your head. Then you release and you should feel less OI when you start your ANS retraining.

The increase in blood pressure in the head should help avoid tachycardia or a drop in BP when you stand up.

To understand why this works: Have a look at the FAQ page of the Q30 device to learn how the device works and the research behind the device. 

The Q30 device is a collar that presses lightly on the jugular veins to maintain blood levels in the brain as a way to reduce or avoid concussions/TBIs in contact sports.  

https://q30.com/pages/faq

Do not buy the device! This is just to understand the theory and the safety of doing this light pressure technique.

Tips:
1. The pressure is applied on the SCM muscles of the neck, The pressure stops or reduces the blood leaving the brain through the veins. The blood pressure in the veins is very light so you probably will not even feel that change in your neck. The change will be noticed by a small increase in pressure in the head. Blood continues to come in, but less blood is getting out... the total amount of blood/pressure in the brain is higher.

2. You are not touching or restricting the flow of the jugular arteries. You can feel those by touching the front of the neck on each side of the throat. These have a clear pulse.

3. Doing this before sitting or standing up should reduce symptoms in day-to-day activities, but it also should speed up the ANS rewiring.

Step 3:
The At-home Rehab

This is where you rehab the nervous system so it can get back to doing its job.

NOTE:
We suggest that you use the POLAR H10 Heart Rate (HR) strap to monitor your HR, This will give you a much more accurate measure of your HR since devices like smartwatches often miss sharp spikes in HR and fingertip HR monitors can be easily affected by temperature and changes of position.

First: Starting from a prone position (lying down), breath calmly, make sure your HR is normal/steady and focus on the breathing (5 or 6 seconds in, 5 or 6 seconds out). Don't be too strict with yourself and the breathing... and eventually you will feel quite calm.

Second: Apply light pressure to the jugular veins with the thumb and the middle finger for a few seconds to make sure the head has plenty of blood/oxygen.

Third: Do the head and or eye-movement exercises as slowly, smoothly and as calmly as you can for a few minutes.

Fourth: This is where having another person to help is a good idea. Use your smartphone to monitor the App while you are doing the exercises to make sure there are no sudden spikes in the HR which would mean that you are going too fast. As long as there are not POTS spikes in HR... hurray! You are doing it right and the brain is recalibrating with the information that it is getting from the movement of the head and the eyes (the only part of the brain we can see and touch!).

Fifth: You then slowly progress over a few weeks to a 30ª inclination, 45º, 65º, sitting and then standing and finally walking.

Understanding the Simplicity of the Movements

A Dr Keiser and his team specialized in this kind of rehab explaining in detail some of the tests he performs and the different eye and movement exercises he does to help people rehab.

They explain the tests they do and the techniques and theories. Watching these videos can help you understand some of the science behind why these simple exercises are so powerful. However, you don't really need to understand why since the ANS will be doing all the work. You are just giving the ANS the tools it needs to do it safely.

POTS rehab after a concussion and neck injury:
https://www.youtube.com/watch?v=A-DlKGYTpcA

2-year POTS gone after 1 month of treatment
https://youtu.be/wYX18xfU1Io

8-year POTS case recovers enough to stop using the wheelchair after a month of rehab:
https://youtu.be/GVvBmcsk9Sw

FND Case and POTS:
https://youtu.be/CmvIxP3-gVk

A similar Symptom-based-rehab System...
but it sounds like they don't do anything between 0 and 90 degrees.
How Does Autonomic Conditioning Work? | With Dr Jenna Tosto-Mancuso - YouTube

Step 4: Disbelief

This seems too easy! I am dealing with a crippling disease with many complex symptoms! Maybe this is junk science! The exercises are easy and you might be able to do this from home for free. The challenge will be consistency! Doing the ANS rewiring daily for weeks requires commitment. This is not like a mental exercise that you can speed through. The ANS only understands repetition and it has to be done from a calm, safe place. Even if you only do a few minutes, plan a time and be consistent to improve your chances of success. And if you miss a day or two, don't beat yourself up. Just continue when you can!

These rehab ideas are not new! They have been used for minor traumatic brain injuries (mTBIs) for a long time. However, for whatever reason, POTS has not been considered a physical brain injury -- even though it clearly is. And neuroplasticity has been seen as something that did not exist in adults, however, that has been disproven as well. The tools are there... it is just about applying the right tools at the right time and getting out of the way so the brain can adapt and heal.

Listen to a few minutes of this Huberman podcast explaining how simple Eye Movement Exercises are done to diagnose and treat concussions.

Practice the "Pencil Pushups" and the "smooth following movement" exercises to help retrain the brain through the eyes:
https://www.youtube.com/watch?v=_ltcLEM-5HU&t=2484s

Here is a video on pencil pushups to help people with a range of motion issues. This neurorehab has nothing to do with MECFS or LC, but the basics of the science are applicable. He explains the science of why this creates a window of neuroplasticity for the brainstem to adapt.
https://www.youtube.com/watch?v=etNC4Xun4n4 

These are the links to the exercises mentioned by the Researchers in the podcast:

“Pencil Pushups” Near-Far Exercise:   • The Science of Vi...   Smooth Pursuit Eye Exercises:   / visualexercises   *Note: Eye movement exercises can be made easier by keeping the eyes fixed and moving the head! And doing a couple of rounds at a time is best so the muscles are not overworked or overstressed. For more information see: The Stanford Vision Performance Center: https://med.stanford.edu/vpc.html

Bonus things you can do to help improve Healing:

1. A tip from Dr Nathan Keiser on taking advantage of  Sun/Red-light Radiation exposure... and contrast therapy to help to heal:

https://www.youtube.com/watch?v=PpYimJr74PA

2. Mindfulness, breathing and shifting the focus to HRV instead of HR or BP!

Idea #1: Physiological Sigh to "Force control" over breathing, heart rhythm

Want to know how to calm the ANS in a few seconds? Do this 3 times...
Physiological Sigh = 2 breaths in with the nose and one slow breath out (mouth or nose)

https://www.youtube.com/watch?v=msGKrclcsbc

Idea #2: HRV breathing practice. Find a comfortable spot where you are breathing in and out for 5 or 6 seconds. Twice a day for 10 minutes will show great improvement in HRV in only a few weeks.

Surprisingly, thinking about positive thoughts like gratitude can greatly improve this exercise. Maybe because that keeps the mind from defaulting to the "negative mindless thoughts" it often does when not focused on a set task.

This exercise is twice as powerful when combined with biofeedback. There are different devices that will measure your HRV in real-time. You can see how your breathing and thoughts affect the HRV score while you are doing the exercises. Watching the HRV curves become smoother while the HRV increases will improve the outcome. I use the Polar H10 chest strap, paired with the free Elite HRV app to do these exercises. This device is the most accurate in the market. It works much better than a smartwatch and it even beats the electrodes used by the doctors in hospital in accuracy for some measurements!

Idea #3: These short HRV breathing exercises are free and can be done from anywhere, at any time.

Breathing Exercise to Feel Pure Gratitude, Heart Coherence Resonant Breathwork: TAKE A DEEP BREATH

https://www.youtube.com/watch?v=dJHpZBuc3e4

A 10-minute video of guided HRV breathing.
https://www.youtube.com/watch?v=eRWtytSjKZs

3. Supplements/Diet? 

Make sure you are giving the brain the resources it needs to heal. There are diets like the Mediterranean diet and supplements like Omega 3 which are great for heart and brain health. The gut is the bottom half of the brain. The brain will have issues if the gut has issues. I will not go into detail here because there is already a lot of information online and each person needs to find what works for them since it is very individual.

4. Medications?

There are no (additional) medications needed for this treatment. Follow your doctor's indications for treatments. Some drugs like SSRIs and nicotine patches help improve neuroplasticity. This might help the brain rewire faster. 

5. The Nicotine Patch. Can I do both at the same time?

This is not clear yet. Nicotine actually affects the cholinergic system in a way that is similar to some POTS medications. There might be interactions. You will have to speak with your doctor.
However, nicotine patches have shown the ability to increase neuroplasticity (which can help the ANS rewire faster) and nicotine patches affect blood flow in different ways. In some areas, it is a vasodilator (like in the brain and the main arteries) and a vasoconstrictor in peripheral tissue like the skin. It might be beneficial for some people and detrimental for others. This is a topic for future research to see if those with POTS who use the Nicotine Patch improve faster or slower than those who stick to the basics of this rehab method and let the body heal at its own pace.

As always... Be safe, Take care of yourself and email me with any questions, doubts or suggestions!
Contact email: TheNictotineTest@gmail.com