Another Covid and Vaccine Related Condition

I read about another condition, postural orthostatic tachycardia syndrome or POTS,  which has been associated with the Covid vaccine. Although the author of the article did acknowledge that this condition also occurs with getting sick from Covid, they glossed over this fact and focused on the vaccine being the problem. The author is a physician I follow and respect, but he has gone down a few rabbit holes which I don’t always agree with. I would not call him an antivaxer, but a Covid vaccine skeptic for sure. 

To be clear,  I’ve gone down many rabbit holes on many topics myself and I am also a vaccine skeptic, but I continue to read the literature, follow the issues, and balance the risks, not only to me and my patients, but society as a whole. As of today, to me, the risks of getting the vaccine are far outweighed by the risks of getting sick and contributing to this disease continuing to simmer around the world. That is the bottom line. I have a serious arrhythmia diagnosed during the pandemic, a number of months after I got the vaccine. I have some structural issues with my heart which puts me at risk for this arrhythmia, but I couldn’t help but think about any possible relationship to the vaccine. It is definitely an issue I have thought about and researched at length, often at 3 am when my brain goes bananas. But ultimately, I keep coming back to the same conclusions. If I get Covid, or certainly a bad case of Covid, things could be much worse. The vaccine will help protect me. In addition, on a societal level, we can’t just think about ourselves and must care about those around us and from that standpoint, vaccines, including the Covid vaccine, are also crucial. 

Back to POTS.

In a nutshell, POTS is a condition in which a reduced volume of blood returns to the heart after an individual stands up from a lying down position (orthostasis). Symptoms of POTS include:

• Dizziness or lightheadedness, especially when standing up or during prolonged standing in one position.
• Exercise, including even walking.
• Fainting or near fainting.
• Forgetfulness and trouble focusing (brain fog).
• Heart palpitations or racing heart rate.
• Exhaustion/fatigue.
• Feeling nervous or anxious.

Most of these symptoms can be traced back to the heart rate and/or blood pressure not responding properly, ensuring maintained blood flow to the brain and other organs. I see these symptoms a LOT in my office when evaluating people with dizziness, although most do not have POTS. In the majority of cases, patients are on at least one, and often as many as 4 different blood pressure medications. The most guilty culprits are diuretics like HCTZ (hydrochlorothiazide or lasix) which get rid of fluid or beta blockers, which prevent the heart rate from going up or blood vessels from constricting. So in a sense, they do have POTS, except it is medically induced. With true POTS, it is something occurring in the body independent of medications.

The cause of POTS is unknown although there is clearly an imbalance between the sympathetic (fight or flight) nervous system and parasympathetic (rest and digest) nervous system. The sympathetic system increases blood pressure and heart rate, dilates pupils improving vision, raises cortisol, all of which prepares the body to deal with acute stress (like being chased by a lion or a robber or an angry boss). Other interesting things which happen when the sympathetic nervous system is activated include decreased libido and reduced blood flow to the gut since sex and digestion are not activities one should be focusing on when you are running away from the lion, or robber or your boss. This also might explain why people with chronically uncontrolled stress responses have poor sex drive and various GI issues. The opposite happens when the parasympathetic nervous system is activated. It’s the “chill out” system. The body digests food, cleans out debris and lowers blood pressure and heart rate. Why this imbalance between the two opposing systems occurs is not clear. As an aside, a quick way to destress and activate the parasympathetic system is to do a 4-7-8 breathing technique. Breathe in for 4, hold for 7 and exhale slowly for 8. The key is to keep the exhalation longer than the inhalation. The opposite happens when the sympathetic system is activated. We breathe faster and shorter.

Before Covid was on our radars, POTS was a well known condition, being diagnosed around 200,000 a year in the US. Various conditions can precipitate this condition however most episodes occur without any kind of inciting event. Sometimes it is seen after a viral infection, a significant hormonal event like menopause and yes, vaccination, of any kind. It has been seen a little more after the mRNA vaccines like the Moderna and the Pfizer Covid vaccines than from other types of vaccines including the Flu vaccine. It is not clear why.

One study of over 200,000 people identified a rate of POTS after Covid vaccination of 0.268%.  This is more (double) than the background rate of .176% but significantly less than the rate of developing POTS after getting Covid which was almost 1% (4x higher).

As I have posted many times before, everything we do or consume has risks and benefits. Clearly smoking and drinking too much alcohol has many well documented and undeniable risks and consequences, but people still do them. The most common drugs purchased over the counter in the US are acid reducers like Prevacid. Despite the significantly increased risks for heart attacks and strokes, osteoporosis and dementia from these drugs, people continue to consume them rather than stop overeating, eating too late or eating poorly all of which are clearly associated with causing reflux. All vaccines come with risks, but the risks of getting the disease they are meant to prevent or minimize are significantly worse and can last a lifetime.

I’m getting my vaccines next week. I’m getting the Covid and Flu vaccines simultaneously at my local Rite Aid. I’m getting the Pfizer (#7). I’m holding off on the RSV and Pneumococcal vaccines for now. To me, my overall health picture, exposure risk and transmission risk is small for those other 2 infections. 

I’m very happy to be heading to a wedding of the son of some close friends this weekend. I’m planning to wear a mask (N95) at the airport and on the plane. It just makes sense to me. I won’t be wearing one at the wedding and although that is somewhat of a risk, it is a calculated one. Recent blood work shows that I still have measurable Sars Cov-2 spike protein antibodies but no nucleocapsid antibodies. This confirms that I respond to the vaccine but have not actually had Covid. How that is possible given my line of work, I can’t explain. To me that means that the vaccine is protecting me. I probably have a robust enough immune system, and possibly some genetic protection, that I combat infection well. I have not been sick in any way (other than my heart stuff) certainly in the 8 years since I have been Vegan. I also exercise regularly and do my best to meditate. My sleep is not great, but I work on it. Those lifestyle practices help for sure.

I’m still getting the vaccine though.

It’s very hard to know what to think when our access to information is so great and we get conflicting information from influencers and self proclaimed, and even legitimate, health gurus. That includes me. Trust but verify! It’s important to get as much information you can, without overloading yourself, so you can make the best decision possible. Make your own practical, compassionate and researched decisions.

And it need not be complicated or perfect. As Dr. Dean Ornish says: Eat Well, Love More, Move More and Stress Less.

As far as diet goes, journalist Michael Pollan said it best: Eat Real Food, Mostly Plants and Not Too Much.

Stay safe and be well.

AC

According to the World Health Organization, Covid cases overall worldwide remain relatively low but stable. The problem with this is that only 40% of countries are reporting ANY Covid data to the WHO and less than half of those are reporting any death data at all.

3 countries known to provide somewhat reliable data, the US, the UK and Italy, are all showing slight, but continuous increases in case numbers as well as hospitalisations and deaths. I say “somewhat” reliable because even in these countries, case reporting is dramatically reduced. Hospitalization and death data is the most reliable since it is trackable. Few people are testing for Covid and virtually no one is reporting anything if they are positive. To be quite honest, there is no longer anyone to report cases to anyway since most of these systems have been dismantled.

I wanted to point out the findings of 2 recent studies looking at cardiovascular deaths and disease and Covid infections.

The first was an autopsy study looking at people who died from Covid related complications, not necessarily from a cardiovascular complication of it however.  They all had a history of cardiovascular disease of varying degrees and all of them had viral particles and inflammation identified in the plaques in their coronary arteries. The virus is known to activate inflammatory cells which contributes to plaques rupturing and leading to complete clots and subsequent heart attacks, strokes and microemboli all over the body.

The second looked at the incidence of heart attacks and strokes after Covid infections. Rates were dramatically higher than baseline (no history of infection and this included those who were vaccinated). Of even greater concern, heart attack rates remained higher for up to a year after they had Covid. Any infection can increase the risk of having a heart attack or a stroke because of the increased inflammation and stress, but the rates after Covid are 7x higher than after having the flu. 

We know that the SARS-Cov-2 virus attacks the heart, as well as many other organs. Biopsy studies show that there are still live virus particles in various organs, even months after infection.

The bottom line with all this is that you want to continue to try to avoid catching this virus, or transiting it to someone else.

Do whatever you can to stay safe. We all hate masking, but there are some situations where it just makes sense. I was just on a trip to Nashville for a meeting and to visit my son Daniel who lives there. The number of people wearing masks, even the crappiest ones, was shockingly low. In fact, on our return flight, there was only 1 other person wearing a mask on the plane and she happened to be sitting next to us. Unfortunately, ther person sitting right behind us who was coughing, was not!

But be practical. If you are outside, masks are not necessary. Wear a good quality mask (N95 or KN95).

Please get your Covid booster if it has been more than 6 months since your last shot or infection. Since Covid is not seasonal, I would get this ASAP.

Please also get the flu vaccine. I would wait towards the end of October to ensure the best coverage throughout the whole Flu season which can last into April.

You can get both simultaneously.

I’ve been asked about the RSV vaccine. If you are healthy and under 65, I would probably hold off. I am not getting it. But for kids, if you are over 65 or anyone with immune issues, I would consider it.

Have a great weekend.

Stay safe and be well.

AC