Ep. 167 Managing POTS: Insights and Treatments with Dr. Jeffrey Boris Part 2

Pediatric cardiologist Dr. Jeffrey Boris reviews practical POTS management with an emphasis on individualized care. He discusses medication options such as pyridostigmine (for autonomic modulation) and carefully selected stimulants like methylphenidate or dextroamphetamine for cognitive dysfunction/brain fog, outlining benefits, side effects, and the need for monitoring. He covers IV saline—when short-term rescue infusions may help—and cautions against chronic IV access due to risks. Foundational non-pharmacologic strategies include consistent high fluid and salt intake (with pragmatic guidance on targets and sources), and thoughtful use of caffeine and sports drinks. He highlights sex-specific considerations, including premenstrual symptom flares and the value of tailoring care around the menstrual cycle. A long-term outcomes perspective offers hope, noting many patients improve over time with education, social support, and multimodal management. The episode underscores collaborative, nuanced care for patients and families, and provides resources via telemedicine services.