Katie Ledecky has POTS (orthostatic intolerance)

U.S. Olympian Katie Ledecky swam so smoothly in the water at the Paris Olympics, winning two gold medals, one silver medal, and one bronze medal, bringing her 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 has had to deal with POTS, which in this case stands for Postural Orthostatic Tachycardia Syndrome.

Each word in POTS is a clue to what the condition is. “Postural” means it has to do with your body’s position. “Orthostatic” means standing upright. “Tachycardia” is when your heart rate exceeds 100 beats per minute. And “syndrome” is when a set of symptoms occur together. In his recently published memoir, ” Just Add Water: My Swimming LifeLedecky explained how she was diagnosed with POTS after the 2015 World Swimming Championships in Russia.

POTS is a pool problem. Not a swimming pool problem, but a situation where blood pools in your arms, abdomen, pelvis and legs and not enough blood goes up to your head and brain. Normally when you stand up, gravity causes about 10% to 15% of your blood to go to your lower body. Because there’s less blood going to the round part of your neck, you may sometimes feel momentary lightheaded, especially when you stand up quickly.

But your leg muscles and your autonomic nervous system can help minimize that sensation. Normally, when you stand, your leg muscles contract to keep blood flowing upward, and your autonomic nervous system stimulates the release of epinephrine (adrenaline) and norepinephrine, two hormones that increase your heart rate and tighten your blood vessels a bit, which also increases blood flow to your brain, which is fancy jargon for your head and brain.

When someone with POTS stands up, more blood than usual pools in their lower body, and their blood vessels may not respond normally to norepinephrine and epinephrine, so their heart has to beat faster to compensate.

In her memoir, Ledecky describes POTS this way: “When you stand up, blood pools in the blood vessels below your heart. Your body then releases extra norepinephrine or epinephrine, putting more stress on your heart, causing it to beat faster. The result is dizziness, fainting, and fatigue.”

These symptoms of POTS can be alleviated by lying down again. But, needless to say, you can’t lie down and take your life and POTS with you. POTS itself is not life threatening, but it can be very life-altering in a negative way. After all, think about how dizziness, fainting, and fatigue impact your life. And then there are the other symptoms of POTS, such as palpitations, anxiety, brain fog, tremors, excessive sweating, shortness of breath, chest pain, headaches, sleep problems, bloating, facial pallor, and purple discoloration of parts of the body below the heart.

The problem is, people can suffer from POTS for a long time, even years, without being properly diagnosed. Not all medical professionals are familiar with POTS, and doctor visits usually last less than 15 minutes — less than it takes Ledecky to swim 1,500 meters freestyle — which isn’t enough time to discuss all of her symptoms and experiences with a doctor.

So you may need to be especially proactive in getting properly tested for POTS. You may need to ask to take a tilt table test, which is exactly what it sounds like: you lie on a table, which is tilted at different angles, from completely flat to almost upright. In each position, your heart rate, blood pressure, and sometimes the amount of oxygen in your blood and the amount of carbon dioxide in your breath are measured. With POTS, within 10 minutes of standing upright, your heart rate may increase by more than 30 beats per minute or exceed 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 causes of your symptoms. This may include urine tests, blood tests, imaging tests, breathing tests, and even a nerve biopsy. The type of tests you undergo will depend on your medical history and situation.

At this time, the specific cause of POTS is unknown. It often develops after the body goes through some kind of stress, such as pregnancy, surgery, trauma, or a viral illness. There is some evidence that it may be an autoimmune disease in which the immune system attacks healthy body tissues; however, the jury is still out on this.

If the cause is unclear, treatment focuses on managing symptoms. This may include adding a little more salt to your diet and drinking plenty of fluids to keep your blood volume full. In some cases, medications such as fludrocortisone, midodrine, phenylephrine, or beta-blockers may be taken to increase blood flow to the brain. Wearing compression stockings on the legs can also help deal with orthostatic intolerance (basically difficulty standing up).

POTS can be very difficult to deal with, especially if others are unfamiliar with the condition and its effects, so getting the right mental health support is also important.

Another thing that may help with orthostatic intolerance is exercise. Drum roll please. Swimming is one of them. In case you didn’t know, Ledecky already does this, so it’s a happy coincidence that her profession is also helping her condition. If you have orthostatic intolerance, this exercise might help you, too. Of course, you don’t have to win 14 Olympic medals or 21 World Championship gold medals to do it.