DEAR DR. DONOHUE: After multiple tests and visits to neurologists for symptoms similar to multiple sclerosis, one doctor finally recognized in our daughter the characteristics of postural orthostatic tachycardia syndrome -- POTS. She now sees a doctor who specializes in this disorder. Many others have told her that they too have the illness but suffered terribly until they obtained the correct diagnosis. Please let readers know how important this is. -- P.R.
A: POTS -- postural orthostatic tachycardia syndrome -- is a relatively new addition to the catalog of illnesses. It's something that happens most often to younger people between the ages of 14 and 45. The syndrome takes its name from one of its signs: the speeding up of the heart (tachycardia) upon standing (orthostatic).
Other symptoms are dizziness and the feeling of being on the verge of fainting. People with the syndrome are tired all the time. They often suffer from nausea and stomach cramps.
The trouble is a misfiring in the autonomic nervous system. It's the part of the nervous system not under our willful control. It operates on automatic pilot and takes care of such things as heartbeat regulation, blood pressure adjustments and the rate of breathing. In POTS, something has gone wrong with the chemical messengers of that underground nervous system.
One diagnostic test is the tilt table test. The patient is strapped to a table that can be tipped 90 degrees vertically. When that is done, a person with POTS develops a very rapid heartbeat.
Medicines can often alleviate symptoms and permit a person to live a normal life. One is fludrocortisone. It keeps blood volume on the high side to prevent the symptoms of POTS. Beta-blocker medicines are also effective. Aerobic conditioning, when supervised by a person experienced in this condition, is another important aspect of treatment.
DEAR DR. DONOHUE: Can you guide me in the right direction regarding the Baker's cyst behind my knee? It is so very painful. My doctor drained it with a needle, but it filled up again. What kind of doctor takes care of this problem? -- T.M.
A: An orthopedic surgeon is the doctor who's a Baker's cyst expert.
A Baker's cyst is a behind-the-knee bursa that's filled with fluid. Bursas are flat discs that nature puts between tendons and bones to reduce friction as tendons rub against the bones. The one behind the knee has a connection with the knee. Fluid from the knee finds its way into that bursa and distends it. The actual trouble is usually in the knee itself, and elimination of the knee problem -- a torn cartilage, for example -- eliminates the Baker's cyst.
If a doctor drains the cyst and then injects a cortisone drug into the bursa, that can often prevent recurrence.
In resistant cases, and it sounds like yours is one, removal of the bursa takes care of the problem forever.
READERS: People with swollen ankles and feet can find answers to the problem in the booklet on edema and lymphedema. To obtain a copy, write: Dr. Donohue -- No. 106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I hope you can help me with a loved one. She never ventures outdoors except for a yearly doctor's appointment. She's retired and has no friends and no social life. All she does is eat, sleep and watch TV. Because I was once depressed, I wonder if she's suffering from depression. What do you think? -- R.S.
A: I think your friend has a serious psychological problem that's making her life miserable. Many such problems are due to a quirk in the production of brain-chemical messengers, and medicines can often correct the chemistry. Depression is one of those illnesses that often respond to drugs with this capability. She might also have agoraphobia, a fear of public places. It makes a person want to stay inside the house at all times. It, too, yields to talk treatment and medicines. Her doctor can recommend a specialist.