In this YouTube talk, Dr. Aaron Hartman challenges patients who feel stuck in their recovery by highlighting dysautonomia—particularly Postural Orthostatic Tachycardia Syndrome (POTS)—as a frequently overlooked, treatable cause of persistent illness. He explains that dysautonomia is an imbalance between the sympathetic and parasympathetic nervous systems that impairs blood flow to the brain, producing symptoms that mimic anxiety, panic attacks, brain fog, night‑time heart racing, temperature dysregulation, and more. Hartman outlines the broad prevalence (1‑5% of the population), common comorbidities (mast‑cell activation, mold exposure, Lyme disease, hypermobility/Ehlers‑Danlos, autoimmune and gut disorders, long COVID), and typical diagnostic tools such as the at‑home NASA lean test, blood pressure/pulse monitoring, and subtle physical‑exam signs like pupil undulation and fine resting tremor. He stresses that treatment hinges on restoring autonomic balance through adequate fluids/electrolytes, compression garments, graded strengthening, and regular nervous‑system‑regulating activities (meditation, nature, creative pursuits). Hartman also shares his own professional evolution—initially avoiding integrative fields like mast‑cell or Lyme care, then embracing them as they proved essential for his patients—underscoring the need for clinicians to broaden their skill set. The talk concludes with a call to patients to consider dysautonomia/POTS as a possible explanation for their lack of progress and directs them to resources on his website.
Chapters
Why are you still sick? Why is your body not healing and self-repairing? You've heard from us over and over again, your body was made to heal. You were made to self-heal and self-repair. If you just give your body what's lacking, remove what's blocking your healing, you will do what you're made to do, self-heal and self-repair. But you're stuck. You're not getting better. Why are you still sick? Why did all the specialists, other doctors say nothing's wrong with you? You can't be helped. Maybe even it's all in your head. What could be one of the things that's being overlooked? The next thing I would like to talk about is dysautonomia and POTS. Now, what is POTS? What is dysautonomia? Basically, it's an imbalance in your nervous system—the sympathetic, parasympathetic nervous system. I'm going to make this super simple because it is actually a quite complex topic, and there's textbooks on the on the whole topic that are in the weeds. And Tom will revolve mainly around POTS, which is. Postural orthostatic tachycardia syndrome, which is the most common one people talk about. But the general idea is your nervous system is dysregulated and can't really get blood to your brain. So you might stand up, feel lightheaded and dizzy. You might be sitting and all of a sudden blood pools to your feet or sleeping in the middle of the night. And the symptoms can look like anxiety, panic attacks, brain fog, problem thinking, waking up in the middle of the night, Wide awake, waking up in the middle of the night with your heart racing, sitting, doing, just chilling, relaxing. And all of a sudden your heart spikes up where you feel it pounding really hard. Sometimes it can be associated with cold hands, cold feet, whitening of your hands, whitening of your feet. Your feet actually might turn bluish. You can get a mottling of your skin, almost like a spiderweb looking of that. If you get really cold, you can't, it's hard to regulate your temperature. You might have problems regulating your hormones, regulating your body temperature, regulating your mood, regulating your sleep. Dysautonomia touches a lot of different things and it tends to go along with mast cell, mold, Lyme, hypermobility, autoimmune issues, gut problems, a whole host of things. And it's commonly overlooked because who's a specialist who focuses on this? And the reality is, you look at universities, you know, One of the local guys here at Medical College of Virginia that was one of the first guys who looked at this, who's retired maybe 5 years ago, he was a nephrologist. He was replaced by a physical med rehab doctor that had a pulmonologist and neurologist helping. It's interesting how ultimately the people who get into this, there's not a specialty for it per se. It's usually a physician sees the need and leans into it. POTS and dysautonomia, depending on what you look at, can be anywhere from 1% to 5% of the population. Super common. We see it all the time. And what I think is a lot of it's overlooked because it's mild. You know, maybe when you sit to stand, your blood pressure, your, your blood pressure only drops 15 points. Your blood pressure only goes up 25 points. You don't meet criteria, but you feel better when you drink lots of fluids and electrolytes. You feel better when you get your Spanx really tight or you feel really better physically, mentally, emotionally after you've had some time to calm your nervous system down. So if any of this is true for you, positive dysautonomia might be one of the things you're dealing with. I mean, you might want to lean into that because if you have a dysregulation in your nervous system and you don't help it regulate, it's going to be hard for your immune system, your sleep-wake cycles, your hormones, your gut, all those to regulate because ultimately the brain regulates everything else, right? So what is, what is dysautonomia? Well, dysautonomia is a big rubric for a lot of different things, whether it's Rare stuff like autoimmune autonomic ganglionopathy, which I have several patients with that, to the more common POTS. It's a range of things, POTS being the most specific, but it's just a dysfunction in the regulating part of your nervous system. So what's supposed to happen is most of what your nervous system does is parasympathetic, rest and digest, recuperation, repair. You can go into sympathetic when you need, but you're supposed to be in a relatively calm state nervous system-wise. And you have the spikes of sympathetic when needed. Think about, you know, zebras. There's actually an interesting book called Why Zebras Don't Get Ulcers that has some interesting concepts. But the way I think about it, you see a zebra, you see like the National Geographic, right? I don't know if they still have these on TV or whatnot. When I was a kid, they had them where you can see the zebras or the whatever, the wildebeest just chilling, eating. Lion, tiger creeps up and they're eating for Days and days and days. But one day, lion hops up, frank fear, frank panic for a minute or 2. 5 minutes later, they're eating again. And you see the tiger eating their buddy in the background, right? And you're like, oh, they went from parasympathetic to near-death experience, back to parasympathetic, flip back, and they're back eating again. You and I can't do that. We have a consciousness, we have a mind, we have memories. We are wired differently. And when you have that traumatic event, it tends to stay with you. And part of dysautonomia is having these, it can be a single significant traumatic event. We saw a lot with people with COVID long COVID, with post-COVID vaccine issues. We've seen a lot of patients with Lyme disease, head concussions and injuries. One of my patients I'm working with right now, his stuff started after a major ICU event, concussion. And he's hypermobile, lots of things mixed together. But the gist is your nervous system gets dysregulated. If you want more details about POTS and dysautonomia, we've done a lot of things on our, our, our pod, both our podcast and the blogs and the website. Just go to the website, type in POTS, and a lot of stuff will pop up for you. But with this dysregulation, it can look like almost anything. So based, and this is where your history is huge, because if it's, if your POTS and dysautonomia started after concussion or head injury, Then we tend to do a lot more concussion work. If it's associated with your Lyme disease, we're going to lean into the Lyme disease. If it's associated with your hypermobility and you might actually have a low level of Ehlers-Danlos, then we focus more on fascial work, compression, a lot of different things, muscle strengthening, building. But ultimately you have to reregulate your nervous system. That's where having a regulating practice. Whether it's prayer, meditation, painting, nature walking, getting outside, playing a musical instrument, something that helps regulate your nervous system is a huge part of treating this. Not enough time to go into POTS and dysautonomia, super complicated, super detailed. It's one of the many things I've tried to avoid in my career. It's like, I'm not going to do Lyme disease. I'm not going to do mold. And I had to start doing those because so many people have that. I'm not going to do mast cell activation syndrome. Well, I have to do that because it's— when you saw it, it's funny, all the things I said I'd never do in my career. That I've been forced to do because they're so common. And if I want to help my patients, I have to learn how to do these things. I said I'd never do any kind of integrative cancer stuff. And I had to lean into that about a year and a half ago and study that in depth because I collected enough cancer and post-cancer patients. And I'm like, I need to help them maximally. I need to learn this whole different field. So, um, dysautonomia and POTS is one of those things I just have to lean into because it's so common. Um, but the point being is if you're not getting better, if you're healing stuck, Why are you not getting better? It could be because you have undiagnosed POTS and dysautonomia. We do have a resource available on our website. It's a thing called a NASA lean test. It's one of the many ways to diagnose POTS. I look at it a little differently. Also, when I do physical exam, I look at people's eyes. There's a thing called adrenal pupil, where if we shine a light in your eyeball, it should go down. And with patients with dysautonomia, with adrenergic dysautonomia, which is one of the types of POTS. The pupil will get small. It'll actually start getting bigger again. You're shining a light in it, but then the brain's like, wait a second, bright light. And it'll shrink back down again. And it'll be like, whoa, it'll open back up. And you'll see this, this thing where the pupil will literally undulate. That is a marker for a dysfunction in your autonomic nervous system. So there's a lot of nuances to it. You might have a fine resting tremor when you look at some of their tremors. Some of my hands tremor. You might see like a fine resting tremor. That sometimes is picked up when you do an exam. People put their hands out and you'll see if they find a tremor. Those smaller, more nuanced findings. But we, in general, we start with the nacelline test because it's something people can do at home. They can track it on their own. They can write the numbers down. You don't need to be a doctor to do a blood pressure and a pulse. I mean, you just need to push the button and wait for the machine to give you the number. But if you're not feeling better, you're stuck, why you're not getting well, think about POTS and dysautonomia as one of the possibilities of why you're not getting better. Take care. We'll talk to you soon. Thank you.
