I’ve written before about the impact of different medical conditions on body piercing, from Ehlners-Danlos Syndrome, PCOS, and Psoriasis to Eczema. Today, I’d like to talk about Postural Tachycardia Syndrome, often abbreviated PoTS. Simply standing up can be a challenge for affected people as their body is unable to adjust to gravity. PoTS is due to an abnormal response by the autonomic (automatic) nervous system and is characterized by orthostatic intolerance (the development of symptoms when upright that are mostly relieved by lying down).
Symptoms include palpitations, lightheadedness, fatigue, sweating, nausea, fainting, and headaches, and are associated with a persistent increase in heart rate from the lying to upright position. Clients with PoTS may find that piercings can be a trigger for them, and as piercers it’s our job to be educated and aware of these conditions, and work with clients to create safe piercing experiences.
“Postural orthostatic tachycardia syndrome (POTS) is a condition that causes your heart to beat faster than normal when you transition from sitting or lying down to standing up. It’s a type of orthostatic intolerance. Each word of “postural orthostatic tachycardia syndrome” has a meaning:
Postural: Related to the position of your body.
Orthostatic: Related to standing upright.
Tachycardia: A heart rate over 100 beats per minute.
Syndrome: A group of symptoms that happen together.
Normally, your body’s autonomic nervous system balances your heart rate and blood pressure to keep your blood flowing at a healthy pace, no matter what position your body is in. If you have POTS, your body can’t coordinate the balancing act of blood vessel constriction (squeezing) and heart rate response. This means that your body can’t keep your blood pressure steady and stable. This causes a variety of symptoms. Normally, when you stand up, gravity causes about 10% to 15% of your blood to settle in your abdomen, legs and arms. This means that less blood reaches your brain, which can cause brief lightheadedness. If you don’t have POTS, this lightheaded feeling doesn’t happen often because your leg muscles help pump blood back up to your heart. In addition, your autonomic nervous system turns on a series of rapid responses. To compensate for the lower amount of blood returning to your heart after standing up, your body releases the hormones epinephrine (adrenaline) and norepinephrine.
These hormones typically cause your heart to beat a little faster and with more force. Norepinephrine also causes your blood vessels to tighten or constrict. This all results in more blood returning to your heart and brain. People with POTS tend to pool a larger amount of blood in vessels below their heart when they stand. Their body responds by releasing more norepinephrine or epinephrine to try to cause more squeezing of their blood vessels. For several reasons, their blood vessels don’t respond normally to these hormones. Because their heart remains able to respond to the norepinephrine and epinephrine, their heart rate often increases.
One of the biggest concerns for clients with PoTS is fainting after being pierced. I have a whole blog post about fainting here, but for folks with PoTS it’s the rule, not the exception. However, there is a lot that can be done to help make this more comfortable or minimize the risk. First of all, be honest with your piercer that you have PoTS! Ideally, a piercer will already be familiar with this condition and have a plan in place. That could look like a few different things:
-Being Pierced Sitting Up- Some folks with PoTS feel more comfortable remaining in a seated position to be pierced, rather than lying down. This can sometimes avoid the symptoms that can occur when transitioning from lying to sitting or standing. If a piercer's space allows for it, and if the piercing allows for it, this can be a great option. However, not every space or piercing may accommodate this adjustment, and sitting up to be pierced can still induce fainting in some folks.
-Glucose Before Piercing- A glucose tab had just before piercing can work wonders, even for folks with PoTS, to minimize those shaky post-piercing feelings. While the issues with PoTS are from blood pooling in the legs and elevated heart rate, boosting your blood sugar can often help with the drop that occurs from the production of adrenaline during piercing, and help folks feel more stable through the process.
-Longer Appointments- I personally like to have about an extra 15-20 minutes in my appointment time for clients with PoTS. This allows us to take the time to do a slow transition from laying to sitting if needed, spend time sitting and sipping water or juice, and also gives us buffer time in case they do faint or get light-headed. Some of my regulars with this condition simply faint every time, no matter what we do. So we plan for it!
-Bring a Friend- If you have PoTS and are unsure how your body will respond to piercing, it’s a good idea to bring a friend or caretaker. That way, if you do feel rough afterward, you have someone else who can help you get to your car or transportation and get you home.
Clients should be transparent with their piercers about this so we can prepare to pierce you safely, and we know what to expect. Piercers should be educated about medical conditions like PoTS which can effect how we do our jobs!