Stupid Games
We Planned for It
My friend drove me to the appointment and stayed close, second shot. The existing stack already brutal: RA, lupus, intracranial hypertension, years of autoimmunity gone undiagnosed. Until a brain-bleed forced it into the open.
We stopped by his dad's place afterward to visit. Within minutes...
Arm pain at the injection site. Entire left side lit up, nerves firing millions of hot stabbing needles. A crushing pressure descended, like it had its own gravity.
Flashes from decades earlier working at a body shop. A car pinned me above the knee when a coworker panicked and floored the gas, unreal crushing pain. My boss bolted across the shop and dove through the passenger window to kill the ignition. Saved me from amputation by car that day. Almost a year of PT before I could walk normally again.
The pain after the second shot was far beyond that incident. For two years after: left arm paralysis, maybe 10-20% function on a good day. Constant left-side nerve pain from head to toe. Turned up to 11, 24/7, and stacked over everything else. Five years on, I still get episodic left-side nerve pain, the kind that steals your breath away.
And yet, I just sat there in that living room chair.
Later, my friend said it looked like I was in pain, figured I was a big boy and would say something if I needed to go. He was right about the first part. The second was blocked by decades of ingrained programming.
By then thinking was expensive and pain wasn't localized anymore. Body broadcasting emergency signals on every channel at once. Standing up demanded everything I had. A deliberate, agonizing effort to keep from going over like a felled tree.
Eventually, a tilt table test and my neurologist gave it a name. POTS entered the room, not gradually, all at once. In a chair at someone's dad's house, while I said absolutely nothing.
This isn't a vaccine story.
It's what can happen when your system is suddenly challenged...
When already at the deep end of its limit, furiously treading water.
Postural Orthostatic Tachycardia Syndrome
The nervous system failing to regulate heart rate and blood pressure on standing.
Like getting your swerve on in the worst way, just trying to stand up. Full-on sloppy drunk, heart racing, head pounding, ready to kneel before the porcelain god. You never had the drinks or the fun, but you're paying the price like you did.
The management protocols assumes a patient who can or will reduce activity.
That's where the orthodoxy and I part ways.
This isn't a protocol, it's one person's adaptation to living with POTS from the context of an active outdoors lifestyle.
What The Clinic Says
Standard management: aggressive fluids and sodium, lower-body compression garments, head-of-bed elevation, heat avoidance, and limiting prolonged standing. Exercise is typically graded: starting recumbent and progressing slowly toward upright activity.
Medications may include beta blockers, fludrocortisone, or midodrine, depending on presentation and subtype.
How I Adapt
Fluid and sodium intake, adjusted to well past what might look reasonable. Blood volume is the target, not thirst.
Hydration strategies beyond electrolytes alone, aimed at the cellular level, not just the tank.
The standard medications made my situation worse. So I looked at other options.
Garments and gear reconsidered base on my other conditions, not against POTS in isolation.
Cardio kept in, not cut. Deconditioning accelerates POTS, so the goal is capacity, not rest.
Heat managed proactively. Routes often includes shade within a quarter to half mile, when possible. On open trails with little to no cover, go closer to dusk or dawn. Predators are more active then. Obviously, don't try to pet the big kitty.
Not a protocol. The least-bad version of the tradeoffs, for my specific circumstances. Arrived at after a diagnosis, not before one.
→ Adaptive Trailcraft: Hiking with POTS (early signal recognition on-trail)
Still Playing
The math is straightforward and a little absurd. A condition that punishes upright movement, managed through upright movement.
The games are stupid. I'm still playing it.
Further Reading & Resource Links
→ POTS After COVID-19 Vaccination: A Systematic Review (BMC, 2024) — Incidence, mechanisms, and clinical implications of POTS following vaccination.
→ COVID-19 Vaccination and New-Onset POTS (Heart Rhythm, 2024) — Association between mRNA vaccination and new or worsened POTS symptoms.
→ Renin-Aldosterone Paradox and Plasma Volume in POTS (Circulation, 2004) — Why many people with POTS have chronically low blood volume despite normal compensatory mechanisms.
→ Effect of High Dietary Sodium in POTS Patients (PMC, 2021) — High sodium intake expands plasma volume and reduces orthostatic tachycardia.
→ Creatine and Dysautonomia: Cellular Hydration and POTS (RTHM, 2026) — Creatine's osmotic properties support intracellular hydration and may reduce exercising heart rates in heat conditions.
→ Exercise Interventions in POTS: A Scoping Review (PMC, 2024) — Evidence that aerobic training improves symptoms and autonomic function.
→ Beta Blockers for POTS (RTHM, 2026) — Why beta blockers help some patients but worsen symptoms in others.
→ Parsonage-Turner Syndrome Following COVID-19 Vaccination (Case Reports in Neurology, 2022) — Acute shoulder pain and upper-limb weakness with immune-mediated brachial plexus inflammation following vaccination.
→ COVID-19 Vaccines and Axillary Nerve Dysfunction (PMC, 2023) — Case report documenting post-vaccination axillary nerve injury with two-year recovery tracked by nerve conduction studies.
→ Acute Peripheral Neuropathies Following COVID-19 Vaccination (Medicina, 2023) — Acute peripheral neuropathies after vaccination, examining immune-mediated neurological complications in susceptible individuals.
Trail Crossings & Waypoints:
→ Adaptive Trailcraft: Hiking with POTS
→ Dead Reckoning
→ Layer One: Start Where You Are
→ Raising the Floor: Tools That Helped Me Function Again
→ Fieldcraft for the Feral Generation
→ Trauma-Illness Connection: Your Body Isn't Broken, It's Adapted
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* Peer reflection, not medical, nutrition or therapy advice. Your body is yours — what works for me may not work for you. *
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