Adolescent Fatigue, POTS, and Recovery: A Guide for Clinicians Sarah J. Kizilbash, MD, Shelley P. Ahrens, RN, CNP, DNP, Barbara K. Bruce, PhD, Gisela Chelimsky, MD, Sherilyn W. Driscoll, MD, Cynthia Harbeck-Weber, PhD, Robin M. Lloyd, MD, Kenneth J. Mack, MD, PhD, Dawn E. Nelson, RN, MSN, Nelly Ninis, MD, MSc, MBBS, Paolo T. Pianosi, MD, Julian M. Stewart, MD, PhD, Karen E. Weiss, PhD, Philip R. Fischer, MD

Foreword: Adolescent Fatigue, POTS, and Recovery: A Guide for Clinicians When Dr. Philip Fischer first told me about his work at the Mayo Clinic POTS and Pain Recovery Clinic, I found myself in that familiar embarrassing situation that starts in medical school and recurs through your medical career: I was facing a medical acronym that I did not recognize (you know, do you confess or do you bluff?). I did not know what POTS was (I confessed), but when he described the patients who came for evaluation of postural orthostatic tachycardia syndrome, I realized that I was familiar with the patients—and with the challenges that these adolescents pose for their primary care physicians. The program evaluates teenagers who are suffering from a combination of chronic fatigue and autonomic dysfunction, with symptoms ranging from dizziness to abdominal pain, along with orthostatic intolerance and marked postural tachycardia. These are adolescents whose lives have been interrupted—their schooling, their social lives, their activities, their families—by the puzzling and debilitating symptoms that persist over long periods of time and send families from medical specialists to psychiatrists in search of answers. They are frustrating to care for, but also frequently frustrated by the medical system, and what they need most—a coordinated approach to workup and treatment—is often missing, though many are subjected to multiple tests and endless workups, in a search for medical answers. The article in this issue, “Adolescent Fatigue, POTS, and Recovery: A Guide for Clinicians,” does a great service to these patients—but also to their clinicians—by laying out what is known about this

Curr Probl PediatrAdolesc Health Care, May/June 2014

condition, reviewing cardiovascular and GI physiology in the setting of POTS, and considering headaches, chronic pain, and fatigue and deconditioning. The authors take a practical and clinically useful approach to the treatment and management of these patients, and they offer truly family-based strategies that combine many different modalities (from increased fluid and salt intake to exercise and conditioning to medications to cognitive behavioral strategies) and hold out the promise of real progress and recovery. Primary care providers who have encountered patients with this often puzzling and frustrating range of symptoms will find the pathophysiology instructive and the treatment approach a profoundly humane blend of science and sense. Collectively, the authors of this article have amassed a remarkable range of experience with a very specialized group of families, caring for adolescents who are at the extremes of a disorder that is still not very well known. I think that many primary care providers will immediately think of adolescents they have cared for, whose symptoms might warrant some investigation for some of the underlying physiologic findings of POTS, and whose management would benefit from the systematic family-based approach outlined here, with its emphasis on returning the adolescent to full functioning, including school, and restoring the interrupted life.

Perri Klass, MD

New York University

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Foreword: Adolescent fatigue, POTS, and recovery: a guide for clinicians.

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