POTS makes the sports section: It must be real!

POTS Makes the Sports Section: It Must Be Real

If you ever visit my office, it will be immediately apparent that I’m a sports fan — particularly a hockey fan. The main artwork in my waiting area (or, as we call it, the “living room”) is a signed lithograph from former Rangers captain Jacob Trouba. My exam rooms are numbered with iconic New York uniform numbers: #1 for Ed Giacomin, #2 for Derek Jeter, and #3 for John Starks—or Josh Hart, depending on the day.

My family has had Rangers season tickets for over a decade now. We’re on our second rebuild (sorry—“re-tool”), and many of my favorite players are now scattered across the league, sitting behind broadcast desks, or quietly stepping away from the game altogether. That’s how sports—and time—work.

But recently, I found myself rooting for a player I’ve never really followed closely. Not because of his goals or assists, but because of something far more relevant to what I do every day.

Last summer, while skimming The Athletic—which I happily subscribe to and can least afford to give up—I came across a headline that stopped me mid-scroll:

“Predators captain Roman Josi will play next season despite POTS diagnosis.”

I remember feeling two things at once: admiration for the optimism, and a bit of disbelief.

Because in my world, POTS doesn’t come with a timeline. You can’t say, “three months, six months, back to normal.” It doesn’t behave like an ACL tear or a broken bone. It’s far less predictable—and often far more frustrating.

What Is POTS (and Why It’s So Frustrating)

POTS—Postural Orthostatic Tachycardia Syndrome—is– at its core– a disorder of how the body responds to being upright.

Patients often experience:

• Lightheadedness
  
  
• Weakness
  
  
• Fatigue
  
  
• Brain fog
  
  
• A rapid increase in heart rate when standing
  
  

To formally meet criteria, symptoms should persist for at least three months. But in reality, many patients are dealing with this much longer before anyone puts a name to it.

POTS can arise without a clear cause, but often it follows a trigger: a viral illness (COVID, mononucleosis), emotional stress, head injury, or underlying immune or inflammatory conditions. It’s a sneaky condition—one that doesn’t announce itself clearly and doesn’t follow predictable rules.

And perhaps most frustrating of all: there is often no clear endpoint. Some patients recover in months. Others take years. A few continue to struggle long-term.

The “Syndrome” Problem

Here’s a general rule I share with families:

If a condition is named after a person—Marfan Syndrome, Turner Syndrome—it’s usually well-defined, with clear criteria and a specialty that claims ownership.

If it ends in “syndrome” after a description… things get murky.

Postural. Orthostatic. Tachycardia. Syndrome.

Or, loosely translated: “When people stand up, their heart rate goes up… syndrome.”

Which, of course, happens to everyone.

But for a subset of patients, that normal physiologic response becomes exaggerated—and debilitating.

The Invisible Illness Problem

If the physiology is frustrating, the experience of being a patient can be even more so.

Many POTS patients look completely fine. Their vital signs may be normal at rest. Standard lab tests come back unremarkable. There’s no fever, no infection, no obvious diagnosis.

And yet, they feel awful.

They miss school. They miss work. They try to push through, only to be completely depleted by the time they arrive. Symptoms are real—but subjective.

So the questions start:

• “Are they exaggerating?”
  
  
• “Is this anxiety?”
  
  
• “Are they avoiding something?”

I’ve seen high-achieving, driven teenagers suddenly unable to function. Students who were thriving – academically reduced to barely making it through the day — or not making it in at all.

Families bounce from specialist to specialist: cardiology, neurology, allergy, GI, endocrinology. Each rules out something important—but no one quite ties it all together.

And sometimes, the consequences go beyond frustration.

I have known parents—dedicated, exhausted parents—who were reported to social services under suspicion of Munchausen by proxy. Not because they were doing anything wrong, but because they refused to accept that their child’s symptoms were “nothing.”

A Patient Who Changed My Perspective

My first true POTS patient—though I didn’t recognize it at the time—was a teenager who hadn’t attended school for eight months. Her mother led with this statement: “She would be in the National Honor Society if she could just get to school.”

I’ll be honest—my initial reaction was skepticism. It didn’t quite fit.

But they stuck with their story.

Eventually, she was evaluated at the Mayo Clinic, where she received a diagnosis: POTS. She came back with a binder full of information—structured, imperfect, but real.

We followed the plan.

Slowly, she improved. She returned to school—later than her peers, but determined. She went on to college, then law school, and ultimately became exactly the person her mother said she was from the beginning.

That experience changed me.

Now, when a patient walks in with this story, I start from a different place:

I believe them.

Diagnosis: Necessary, But Not Sufficient

One of the most misunderstood aspects of POTS is diagnosis.

Yes, patients with POTS typically have an increase in heart rate—about 30–40 beats per minute (sometimes more in adolescents) within 10 minutes of standing.

But here’s the key:

So do many completely healthy people.

That heart rate response is required for the diagnosis—but it is not diagnostic on its own.

I’ve met healthy teens who were told they had POTS based solely on that measurement. Imagine being in the middle of track season, feeling fine, and suddenly being told you have a chronic condition that can derail your life.

That kind of over-diagnosis can be confusing—and even harmful.

A proper diagnosis requires context: symptoms, patterns, and careful exclusion of other causes.

Treatment: Simple Concepts, Hard Execution

The mainstays of POTS treatment are not particularly complicated—but they are not easy.

They include:

• Increased fluid and salt intake
  
  
• Regular, gradual exercise (often starting from a very low baseline)
  
  
• Structured sleep habits
  
  
• Compression garments
  
  
• Avoiding triggers like caffeine and alcohol

These are recommendations that sound simple—but for someone who struggles to get out of bed, they can feel overwhelming.

Medications can help in select cases—beta blockers, fludrocortisone, midodrine, ivabradine—but they are often trial-and-error, and not universally needed.

One of the ongoing challenges is that POTS doesn’t clearly belong to any one specialty. Cardiologists, neurologists, and primary care physicians all play a role—but no one always takes full ownership.

So patients can end up navigating this largely on their own.

Why Time Matters

In most clinical settings, visits are brief—15 to 20 minutes if you’re lucky.

That’s rarely enough for POTS.

In my practice, initial visits are often much longer. It takes time to:

• Hear the full story
  
  
• Understand what’s already been evaluated
  
  
• Identify what still needs to be ruled out
  
  
• Build a realistic, individualized plan

But perhaps the most important part is something simpler:

Explaining what’s happening—and validating that it’s real.

Because once patients understand the “why,” they are far more likely to engage in the “how.”

This is why that headline about Roman Josi mattered so much to me.

He returned. He played. He contributed—at age 35, no less.

And in doing so, he gave POTS something it has long needed:

Visibility.

The same can be said for Kristaps Porziņģis, who has publicly dealt with POTS while continuing to compete, albeit inconsistently at times.

Before his diagnosis was  known,there was speculation:

Was he injured? Was he disengaged? Did he still “want it”?

That narrative is all too familiar.

It mirrors what many POTS patients face every day.

Why This Matters for Patients

Not every patient will return to professional sports.

But every patient deserves:

• To be heard
  
  
• To be believed
  
  
• To have a clear, thoughtful plan

We have made progress in recognizing POTS—but there is still work to be done in awareness, diagnosis, and coordinated care.

Final Thoughts

For patients with POTS, the journey can be long, frustrating, and at times isolating.

But improvement is possible.

And sometimes, it takes something as unexpected as a sports headline to remind us—and our patients—that:

This is real. And there is a path forward.

So yes—I’ll be rooting for Roman Josi.

And for Kristaps Porziņģis.

But more importantly, I’ll be rooting for every patient walking into my office with a story that doesn’t quite fit—and hoping someone finally listens.