When You’re Both the Doctor and the Patient
Most doctors can recite the clinical definition of Postural Orthostatic Tachycardia Syndrome (POTS): a form of dysautonomia characterized by an abnormal increase in heart rate when standing, accompanied by symptoms like lightheadedness, fatigue, and cognitive dysfunction. But very few doctors can tell you what it feels like from the inside.
I can.
I’m Dr. Sarah Diekman — a physician, researcher, and founder of Diekman Dysautonomia in Maryland. But before any of that, I was a medical student desperately trying to make it through the day while experiencing a storm of unexplained symptoms. I wasn’t just studying the human body — I was living in one that wouldn’t cooperate. It took years to find the right diagnosis: POTS.
That journey shaped everything I do now as a clinician. At Diekman Dysautonomia, I don’t just treat patients with dysautonomia — I am one. And that means when I say “I understand,” I truly mean it.
Let me show you what living with POTS really feels like — and what we’re doing to help people live better with it.
What POTS Actually Feels Like
It Starts With the Stand
Most people don’t think twice about standing up. For someone with POTS, that one motion can feel like a system crash.
You might stand and suddenly feel your heart race — 120, 130, 150 beats per minute — with no warning. A wave of lightheadedness hits. Your vision might blur. Your legs might feel weak or tingly. You instinctively look for something to lean on.
In that moment, it’s not just uncomfortable. It’s frightening. And it happens multiple times a day.
Fatigue That Doesn’t Budge
This isn’t the kind of tiredness that improves with a nap. This is bone-deep fatigue — the kind that makes brushing your teeth feel like running a marathon. POTS patients often describe it as a sense of never having enough energy in the tank, no matter how carefully they ration it.
It’s hard to explain to others. On the outside, you might look fine. But your body is in survival mode.
Cognitive Dysfunction or Mental Clouding
POTS messes with your mind, not just your heart. The “brain fog” — or more precisely, cognitive dysfunction or mental clouding — can feel like your thoughts are wrapped in cotton. You forget words. You lose track mid-sentence. You reread the same paragraph over and over.
As a student, I struggled to keep up in class. As a physician, I’ve worked hard to build systems that protect cognitive bandwidth — for myself and for my patients.
Gastrointestinal Mayhem
Digestive symptoms are common with POTS. Nausea, bloating, constipation, and early satiety (feeling full too quickly) are frequent complaints. In my own case, eating was a balancing act — too much or too little could trigger a cascade of symptoms.
At Diekman Dysautonomia, we factor in how nutrition, fluid intake, and gastrointestinal health interact with POTS to create a more holistic treatment plan.
It’s Not “Just Anxiety”
One of the most damaging misconceptions around POTS is that it’s simply anxiety. It’s not. While anxiety can be a secondary symptom (and who wouldn’t feel anxious about nearly passing out in public?), the root cause is autonomic nervous system dysfunction.
Too many patients, including myself at the start, are told it’s all in their heads. That kind of invalidation delays care — and causes harm.
The Medical Side: Understanding the Dysregulation
Clinically, POTS is defined as a sustained increase in heart rate of at least 30 beats per minute in adults (or at least 40 bpm in adolescents) within 10 minutes of standing, in the absence of orthostatic hypotension.
But beneath that simple definition are complex mechanisms, including:
- Hypovolemia (low blood volume)
- Autonomic neuropathy
- Hyperadrenergic states
- Mast cell activation disorders
- Small fiber neuropathy
Each patient’s presentation is unique, and successful treatment often involves addressing coexisting conditions, not just the tachycardia.
That’s why our approach at Diekman Dysautonomia combines:
- Occupational and Environmental Medicine
- Telemedicine-based care
- Patient-specific protocols
- Long-term goal setting and support
What Makes Care at Diekman Dysautonomia Different?
We don’t just treat numbers on a chart. We treat real lives interrupted by dysautonomia.
Listening — Deeply
Your story matters. Many POTS patients have seen a dozen doctors and still don’t feel heard. Here, we take time to understand what you’ve been through — not just what shows up on a tilt table test.
Building Individualized Treatment Plans
There’s no one-size-fits-all approach to POTS. Some patients benefit most from lifestyle adjustments (salt, fluids, compression), while others need medications, IV therapy, or allergy treatment. We tailor everything to your physiology.
Patient Education
You deserve to understand what’s happening in your body. We walk you through the science — without medical jargon — so you feel empowered in your own care.
Helping You Set Realistic Goals
For some, that goal is returning to school. For others, it’s getting through the day without crashing. Whatever your starting point, we help chart a course forward — not just survive, but engage in life again.
What Patients Often Say
“I finally feel believed.”
“This is the first place that looked at the whole picture.”
“Dr. Sarah Diekman really gets it — because she lives it, too.”
These aren’t just testimonials — they’re reminders that empathy plus expertise changes outcomes.
What I’ve Learned From Sitting on Both Sides
Being a doctor with POTS has taught me humility, creativity, and resilience. It’s also taught me that the best care doesn’t come from medical textbooks alone. It comes from listening, collaborating, and never assuming a patient’s experience.
POTS may be invisible — but it is very real. And with the right support, it is manageable. My story is proof. So are the stories of my patients.
Ready to Be Heard?
If you’re struggling with symptoms that no one seems to take seriously — dizziness, fatigue, brain fog, racing heart — you’re not alone. And you’re not imagining it.
At Diekman Dysautonomia, we’re here to help. We offer telemedicine services, personalized care plans, and a real partnership on your path forward.
Because your voice matters. And we’re ready to listen.
Schedule a new patient appointment today.
Let’s find answers — together.
