POTS specialist near me: POTS testing and care in the San Francisco Bay Area

Many people with POTS live with symptoms for months, sometimes years, before they are diagnosed. Part of the reason is that the key tests are done in specialized autonomic labs that are not available everywhere. This guide explains what a POTS specialist does, which tests confirm POTS, how it is treated and how to be seen at Integrated Neurology & Pain Management (INPM) in the East Bay or North Bay.

What is POTS?

Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia, a problem with the autonomic nervous system, which controls heart rate, blood pressure, sweating and circulation without you thinking about it. In POTS, the heart rate rises by 30 beats per minute or more (40 or more in adolescents) within 10 minutes of standing, without a significant drop in blood pressure. Cleveland Clinic estimates that POTS affects over 500,000 people in the United States.

Common symptoms include:

• Lightheadedness or dizziness when you stand up
• A racing heart when you stand
• Fainting or near-fainting
• Fatigue or trouble exercising
• Trouble concentrating, often called brain fog
• Abnormal sweating: too much, too little or in the wrong places

What does a POTS specialist do?

A POTS specialist confirms the diagnosis, looks for what is driving it and builds a treatment plan with you. In practice, that means:

• Measuring how your heart rate and blood pressure respond when you move from lying down to upright, usually with a tilt table test
• Testing the rest of the autonomic nervous system, such as sweating and blood flow, to see how widespread the problem is
• Looking for related conditions, such as small fiber neuropathy, diabetic autonomic neuropathy, long COVID or lasting symptoms after a concussion
• Telling POTS apart from other causes of fainting and a fast heart rate, such as seizures or heart rhythm problems
• Adjusting the treatment plan over time, based on how you respond

Should you see a neurologist or a cardiologist for POTS?

Both can be involved. Because POTS is a disorder of the autonomic nervous system, which is part of the nervous system, neurologists with access to autonomic testing are well placed to diagnose it and to look for nerve-related causes such as small fiber neuropathy. Cardiologists also see patients with POTS, especially when a heart rhythm problem needs to be ruled out. At INPM, neurologists and physician assistants evaluate POTS with testing done in our own offices.

When should you look for a POTS specialist?

Ask your primary care physician about a referral if you have:

• A racing heart, lightheadedness or near-fainting that happens again and again when you stand
• Fainting episodes without a clear cause
• Symptoms that began after COVID-19 or after a concussion
• Fatigue, brain fog or trouble exercising that get worse when you are upright
• Abnormal sweating together with any of the symptoms above

Get emergency care if fainting happens with chest pain, a racing or irregular heartbeat, shortness of breath, a head injury, or trouble speaking or moving afterward.

How is POTS diagnosed at INPM?

INPM performs a complete autonomic testing battery in its own offices. It takes about 45 minutes, uses no radiation, no injected dye and no IV needles, and a technologist stays with you throughout.

Depending on your symptoms, your clinician may also order a nerve fiber skin biopsy to look for small fiber neuropathy, carotid and transcranial Doppler to study blood flow to the brain, or an EEG to tell fainting from seizures.

How to prepare: for 24 to 48 hours before the test, avoid caffeine, alcohol, nicotine and chocolate. Eat a light meal 2 to 3 hours before and wear loose, comfortable clothing. Some medicines may need to be paused, and our office will give you specific instructions; do not stop any medicine on your own. If you are prone to fainting, have someone drive you home.

Related service at INPMFainting, syncope and POTSSyncope evaluation at INPM in Walnut Creek and Vallejo for fainting, near-fainting and POTS, with in-office autonomic testing, Doppler and skin biopsy.

How is POTS treated?

There is no cure for POTS, but symptoms can often be managed. Treatment depends on the cause and on your symptoms, and it usually combines several steps, as your clinician recommends:

• More fluids and salt
• Changes in physical activity
• Compression garments
• Medicines, when needed
• Treatment of a related condition, when one is found

Where can you see a POTS specialist in the Bay Area?

INPM performs autonomic testing at both of its offices, so patients in the East Bay and North Bay can be evaluated close to home:

• Walnut Creek (East Bay): 301 Lennon Lane, Suite 203. Convenient for Walnut Creek, Concord, Pleasant Hill, Lafayette, San Ramon, Oakland and Berkeley. See the Walnut Creek office.
• Vallejo (North Bay): 160 Glen Cove Marina Road, Suite 103, in the Glen Cove area of Vallejo. Convenient for Vallejo, Benicia, American Canyon, Napa and Fairfield. See the Vallejo office.

INPM accepts most major insurance plans, including Medicare, Anthem Blue Cross, BlueCross BlueShield, UnitedHealthcare, Aetna, Humana and Health Net; the John Muir Physicians Network, Hill Physicians and Brown & Toland HMOs; and Partnership Health Plan Medi-Cal for patients in Solano County. Call the number on the back of your insurance card to confirm that your plan covers visits with INPM. See insurance plans.

How do you get an appointment with a POTS specialist at INPM?

1. Ask your primary care physician for a referral to Integrated Neurology & Pain Management for an evaluation of POTS or fainting. If you think you need autonomic testing, mention it. Your doctor’s office sends the referral by fax to (707) 980-6692 or through EPIC. See how to get a referral.
2. Call (707) 980-6636 and press 1 to schedule your visit in Walnut Creek or Vallejo.
3. Fill out the New Patient Packet and bring a photo ID and all your insurance cards.