April 21, 2025 • 39 mins
Dr. Ayla Wolf, DAOM, unpacks the complex nature of dysautonomia beyond the common POTS diagnosis, explaining how this autonomic nervous system dysfunction affects multiple body systems and presents differently in each individual.
• The autonomic nervous system makes automatic adjustments for body functions like heart rate, breathing, and digestion
• Dysautonomia refers to dysfunction of these automatic processes, affecting multiple body systems
• Common misconception that dysautonomia always means too much sympathetic (fight-or-flight) activity
• Symptoms can include cardiovascular issues like racing heart, increased heart awareness, and lightheadedness
• Digestive symptoms often include nausea, GI discomfort, and food sensitivities
• Respiratory, temperature regulation, cognitive function, and immune function can all be affected
• POTS is just one specific form of dysautonomia with clear diagnostic criteria
• Testing for dysautonomia includes pupil response tests, Valsalva maneuver evaluation, and sustained handgrip testing
• Dysautonomia can be primary, secondary (after concussion, surgery or viral illness), or co-exist with other conditions
• Proper assessment requires comprehensive testing rather than symptom-based treatment
• Vagal nerve stimulation is not a universal solution and may not help all forms of dysautonomia
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Ayla Wolf DAOM, L.Ac (00:00):
And then other people can have what
I call increased heartbeatawareness, where their heart
feels like it's pounding intheir chest, but it's not.
It may not be pounding fast, soit's not necessarily that the
speed is abnormal, but it's thesensation of the heart is strong
.
Sophia Bouwens L.Ac. (00:18):
Welcome to the Life After Impact podcast,
where we do a deep dive into allthings concussion and brain
injury related.
We talk about all the differentsymptoms that can follow a
brain injury, different testingmethods, different types of
specialists out there anddifferent therapies available.
I'm Sophia Bowens.
I'm here with Dr Ayla Wolf andwe will be your guide to living
(00:41):
your best life after impact, andwe will be your guide to living
your best life after impact.
I'm super excited about thistopic today.
It's a really big one and it'sfull of just a lot of confusion
and you bring so much clarity toit.
Dr. Ayla Wolf DAOM, L.Ac (00:58):
Well, that's because it is confusing.
And so whenever I had patientscoming in, I kept finding that
there was some type ofdysautonomia, very frequently
underlying a lot of theirsymptoms, and it had gone missed
by you know so many differentproviders because they weren't
looking for it and they weren'tnecessarily looking at the human
(01:22):
physiology from thatperspective.
And, just like with concussions, every single person can have
such a different set of symptomswith a concussion.
If we even just look at it froman autonomic perspective and
say if dysautonomia is present,we can also say that in every
single individual that's goingto look very different.
Sophia Bouwens L.Ac. (01:42):
Very different.
So this episode is calledUntangling Dysautonomia Beyond
POTS and Vagal Nerve Hacks, soreally important.
Let's just start it with abrief overview of dysautonomia
and the autonomic nervous system.
Dr. Ayla Wolf DAOM, L.Ac (01:57):
Yes, so our autonomic nervous system
is named as such because a lotof the functions it performs are
supposed to be auto, right,automatic.
Automatic Meaning that we don'tnecessarily have to be actively
trying to do things right.
So when I go to stand up, myheart rate is probably going to
(02:18):
elevate a little bit and myblood pressure is going to
elevate a little bit, and thosesmall adjustments account for
the fact that gravity is tryingto take my blood and pull it
down towards my feet right andso, to stand up, our body makes
these adjustments without ushaving to consciously think
about it, it's just automatic.
It's automatic Just like whenwe go to bed at night.
(02:38):
We continue to breathe becausewe have specific nuclei in our
brainstem that are basicallythat's.
Their job is to keep usbreathing while we're
unconscious.
Sophia Bouwens L.Ac. (02:49):
And they're part of the autonomic
nervous system.
Dr. Ayla Wolf DAOM, L.A (02:52):
Exactly , and like sweating is another
example.
If we are nervous, we can havekind of this like emotionally
driven, you know, increasedsweating response to being
nervous about having to, youknow, give a speech in front of
a room full of people.
But when we go outside and it'shot out, that sweating response
is autonomic.
(03:12):
It's our brain saying it's hotout, I need to cool my body down
, and so I'm going to do thatthrough sweating.
Or if I'm a dog, I'm going todo that through panting right.
Sophia Bouwens L.Ac. (03:21):
So this complex automatic nervous system
really gets broken down mostsimply into two different parts
sympathetic and parasympathetic,or fight or flight, and rest
and digest.
Dr. Ayla Wolf DAOM, L.Ac (03:33):
Yes, and even those kinds of
categories are maybe also alittle bit overly simplified,
because there's, you know, aparasympathetic arm that goes to
our pupil, that helps toactually constrict our pupil.
That's a parasympatheticresponse, but we don't normally
associate our pupil size withresting and digesting, so that's
(03:54):
also a bit of anoversimplification, but it does
get the point across.
The other thing that I like topoint out is that when we talk
about this idea between you know, fight or flight as being a
sympathetic response, so oftenthe sympathetic nervous system
gets demonized.
You know, we're all told, likewe all have too much sympathetic
(04:15):
activity, and sympatheticactivity is bad and sympathetic
is evil and parasympathetic isgood, and that's also not true.
It's not, you know, it's notthe reality that it is good and
that's also not true.
It's not, you know, it's notthe reality.
And so you know, the way that Ialways like to frame it is that
our autonomic nervous system isdesigned to make beat to beat
(04:36):
adjustments in order for us tohave an appropriate response in
the moment.
So when I'm exercising, I needa really strong sympathetic
output because I'm about to goput a lot of effort into, you
know, running, jumping, lifting.
Sophia Bouwens L.Ac. (04:50):
You need different blood flow, different
breathing patterns, differentblood pressures to adjust to
that situation.
Dr. Ayla Wolf DAOM, L.A (04:56):
Exactly , and so we need our sympathetic
nervous system.
It is so important.
Sophia Bouwens L.Ac. (05:00):
It's just we don't need it overly active
at the wrong times, andsometimes people can get stuck
in this sympathetic dominance orthis fight or flight mode, and
then I think that brings us toan interesting talk about what
the arm that counters that is,which is that parasympathetic
response, or yeah so theparasympathetic system.
Dr. Ayla Wolf DAOM, L (05:21):
Basically , if we get into anatomy, you
know, we can ask the question ofwhat makes a nerve a
sympathetic nerve versus whatmakes a nerve a parasympathetic
nerve.
And so we have what are calledpreganglionic fibers and
postganglionic fibers.
So if we look at sympatheticnerve fibers and we compare them
(05:41):
to parasympathetic, there's away anatomically that we're
differentiating whethersomething is parasympathetic or
sympathetic, and it's all basedon the length of the nerve
tracts that are eitherpreganglionic or postganglionic.
So sympathetic nerve fibershave a short preganglionic fiber
and then a very longpostganglionic fiber ganglionic
(06:06):
fiber and then a very longpost-ganglionic fiber, and then
the parasympathetic have a verylong pre-ganglionic tract and a
very short post-ganglionic tract.
Sophia Bouwens L.Ac. (06:11):
So anatomically they're mirrors too
.
Dr. Ayla Wolf DAOM, L.A (06:14):
They're opposites to each other.
Yes, and so there are theseanatomical differences that
define whether a nerve fiber isa sympathetic or a
parasympathetic.
And so again, I think that whenwe bring it back to just
anatomy and classificationsbased on the length of the nerve
, either pre or postganglionic,again all of a sudden it's like
(06:35):
there is not this is good andthat's bad, it's just this is
short and that's long right,Exactly Easy, easy easy.
Sophia Bouwens L.Ac. (06:41):
Yeah, exactly, so the vagus nerve, the
longest nerve in our body,gives our brain a lot of
information about what our bodyfunction is doing.
One of the anatomical andfunctional things that
fascinates me about this nerveis that its main component is to
tell the brain about what isgoing on in the body.
They go from the body to thebrain.
(07:02):
I think it's like 90% of theinformation in the vagus nerve
goes that way.
Dr. Ayla Wolf DAOM, L.Ac (07:08):
Yeah, I think like 80% is yeah, 80% is
going from the body to thebrain, and that is very
important, because what thatmeans is that we have this part
of the brain called the insularcortex, which is where we have
what's called interoception,right?
So when I ask you, sophia, howare you doing today, you know
it's actually you're kind oftapping into your interoception
(07:31):
of how am I feeling today, and alot of that has to do with, you
know, this sense of internalstate.
So if you were super nauseousand I asked you, how are you
today, that nausea is probablygoing to be the first thing on
your mind, right?
You can probably read it on myface yeah, exactly.
And so there's certain thingslike when I ask you, how are you
(07:52):
today?
Well, if you're, you know,overheated and you feel like
you're about to pass out, that'sgoing to be at the top of your
list the driving factor, forsure.
Yeah, you're not going to say Ifeel great, unless you're just
straight up lying to me.
Sophia Bouwens L.Ac. (08:03):
If I'm in that condition.
But if I'm in a differentcondition, I might feel great
and tell you that and I'll beable to notice in my body I have
a calm heart rate, my breathingfeels good, a state of balance.
Dysautonomia is marked often byhigh anxiety and I think a lot
of that is because that internalstate feels really off.
Dr. Ayla Wolf DAOM, L.Ac (08:22):
Yeah, and it can be off in kind of a
vague way so that when you asksomebody with dysautonomia how
are you, they might just havethis sense of not being well
right.
Maybe they feel tired, maybethey have a little bit of mild
nausea, maybe they are eithertoo hot or too cold, maybe they
feel a little anxious in thiskind of vague way where it's not
(08:43):
necessarily related to any onething that happened.
It's just this kind of vagueway where it's not necessarily
related to any one thing thathappened.
It's just this kind of vaguesense of restlessness.
Sophia Bouwens L.Ac. (08:48):
Yeah, like what are some of the main
symptoms of this dysautonomia,what you just listed?
Are there other things thatcome up or get categorized?
Dr. Ayla Wolf DAOM, L.Ac (08:56):
Yeah, the complexity of dysautonomia,
because if we're sayingdysautonomia is a dysregulation
of the autonomic nervous system,well then we have to ask the
next question, which is well,what are the functions of the
autonomic nervous system?
Sophia Bouwens L.Ac. (09:16):
Well, that's a great question.
What are the functions of theautonomic nervous system?
Dr. Ayla Wolf DAOM, L.Ac (09:21):
I think it's easiest to break it
into categories of function.
And then, when you break itinto the categories, then you
can start to look at well, whatdoes this do?
So if we look at, say,cardiovascular function, if
somebody has dysautonomia andit's very much affecting their
cardiovascular system, they'reprobably going to say that they
(09:42):
either have a racing heart andthat can be at random times.
They might just be sitting onthe couch and all of a sudden
their heart starts racing, orthey walk up their short flight
of stairs, which normally wouldbe no big deal, but all of a
sudden they walk up their stairsand they feel like their heart
is racing.
Yeah, and then some people haveheart palpitations where it
almost just feels like it'sskipping a beat.
(10:02):
I always liken heartpalpitations to like a
submersible pump water pump in afish tank where, like when the
water gets too low, all of asudden that pump starts
cavitating.
Yeah, and like that's how I feel, like you, like, that's how I
like to describe heartpalpitations.
And then other people can havewhat I call increased heartbeat
awareness, where their heartfeels like it's pounding in
(10:25):
their chest, but it's not.
It may not be pounding fast, soit's not necessarily that the
speed is abnormal, but it's thesensation of the heart is strong
.
That awareness becomes reallyheightened, yeah, and you know,
like if you just startedsprinting and you were running
sprints uphill, when you stopyour heart's going to be fast
(10:47):
and it's going to be poundingand that's going to be normal,
and so you wouldn't necessarilyfeel anxious, because you know,
like I was just sprinting uphill, of course my heart is going to
be pounding and it's going tobe fast, but if you're sitting
on the couch watching a reallycalm documentary and all of a
sudden your heart starts racinglike that it feels like it is
racing like that.
Sophia Bouwens L.Ac. (11:05):
It might cause some worry.
Dr. Ayla Wolf DAOM, L.Ac (11:06):
That can definitely make people feel
anxious.
And then, of course, you knowthere's a lot of other
cardiovascular symptoms, likepeople can actually have chest
pain, they can have dizziness ora feeling of lightheadedness
because when they go to stand upmaybe again their heart is
beating really fast or maybetheir blood pressure is dropping
, or, you know, people can haveall these different changes in
(11:26):
heart rate and blood pressurethat can lead to dizziness and
lightheadedness and evenfainting.
And so there's all of thesekind of symptoms that come with
orthostatic intolerance and thecardiovascular system not
responding appropriately tosomebody changing position.
And commonly people will getdiagnosed with POTS for this
reason, right, because of thiscomponent, yes, and so we'll
(11:48):
circle back to POTS, because alot of people are kind of
equating dysautonomia to POTS,when really, if we look at
dysautonomia as this bigumbrella, pots is just one
component, well-definedsubcategory that falls
underneath the dysautonomiaumbrella, but it's not all forms
of dysautonomia, and so Icertainly have had actually more
(12:12):
and more, because I think a lotof people on TikTok and YouTube
are talking about POTS- it'skind of become the new popular
diagnosis and so a lot of peopleare talking about it.
But I've definitely had patientscome to me and say I think I
have POTS and when I run themthrough a ton of autonomic
testing I'm like, well, you dohave something wrong with you,
(12:35):
but it's not POTS.
That's not how this ispresenting.
Sophia Bouwens L.Ac. (12:38):
There's more.
Let's come back to that.
Dr. Ayla Wolf DAOM, L.Ac (12:39):
Let's put a pin in that for a second
because you before that there'smultiple systems that this can
show up in, and started with thecardiovascular system.
What are other systems thatthis dysautonomia can show up in
?
So the next one is therespiratory system, and so that
involves, obviously, breathing,but also the ability of our body
to regulate the balance betweenoxygen and carbon dioxide, and
(13:02):
so that's really important too,and when people have poor carbon
dioxide regulation and thatgets out of balance, that can
cause a lot of symptoms too interms of breathlessness and
lightheadedness.
And so when we think about thiswhole picture of anxiety and
restlessness in the body,there's just so many things that
(13:22):
when they're off within theautonomic nervous system, then
they cause you to feel anxiousand restless.
Sophia Bouwens L.Ac. (13:29):
I could see that leading into other
diagnoses like fibromyalgia orRaynaud's or just ways that
their circulation or oxygendelivery isn't getting places.
And it's not to say that thosediagnoses are always a
dysautonomia.
But some of what you're talkingabout makes me think about
those conditions, because yousee these vague but also really
(13:51):
diffuse symptoms.
Dr. Ayla Wolf DAOM, L.Ac (13:54):
Well, and Raynaud's really is a, you
know, a dysautonomia.
There's a lot of existingdisorders or diseases that
really do have dysautonomia askind of like this comorbidity or
kind of coexisting with them,and so, yeah, we can get into
that too.
But like, for example, CRPS,complex regional pain syndrome
(14:16):
you know, that's kind of a formof dysautonomia.
And then we look at, you know,small fiber neuropathy that's
present in diabetes and that'skind of a form of this
dysautonomia coexisting withdiabetes.
We also have like Sjogren's,which is an autoimmune disorder,
and so classically people havedry mouth and dry eyes.
(14:37):
But there's kind of a wholenother aspect of Sjogren's that
is maybe an atypicalpresentation that doesn't
necessarily have the dry mouthand dry eyes as the main symptom
.
It's actually people have moreof like this fatigue and muscle
pain and joint pain anddifficulty breathing, and so
there's this whole feeling wrongbecause this autonomic nervous
(14:58):
system Exactly yeah, so there'sa lot of, I think, disorders and
diseases that people arefamiliar with that don't, but
maybe they don't even recognizethat the dysautonomia is really
wrapped up in that.
Sophia Bouwens L.Ac. (15:10):
It's a component of that.
Dr. Ayla Wolf DAOM, L.Ac (15:11):
It's a component of it, exactly.
Sophia Bouwens L.Ac. (15:13):
So we have the cardiovascular, the
respiratory.
Dr. Ayla Wolf DAOM, L.Ac (15:16):
Yeah, so with the respiratory symptoms
, a lot of people do feel likethey, you know, breathe
shallowly or they havedifficulty taking a full breath.
They also might report thattheir symptoms are worse with
changes in barometric pressureas a response to kind of
perfusion in the body.
Sure, and then I would say thatone of the huge categories is
(15:38):
digestion, and when I I mean, Itaught a dysautonomia class way
back in, I think, 2017, and Ipresented basically three cases
side by side, which were allyoung women, who all complained
of nausea and loss of appetiteas like their primary complaints
.
And then when I examined them,it turned out that all of them
(16:00):
had POTS, and so they basicallyall presented with dysautonomia.
And because their maincomplaint was nausea, I think
every other doctor they went towere just looking at it
symptomatically as opposed tolooking at the big picture to
say, well, what's driving thenausea?
Sophia Bouwens L.A (16:17):
Functionally what's going on?
So POTS can be this orthostaticimbalance you feel, but it
shows up as many other thingstoo.
But it is a clearly defineddiagnosis, which is not the case
for all dysautonomias.
Dr. Ayla Wolf DAOM, L.Ac (16:31):
No, and that's what's confusing to
people is, you know, you canhave POTS and then you can have,
say, somebody gets a concussionand maybe they don't develop
POTS but maybe they developdysautonomia that manifests in a
completely different way interms of like migraine headaches
and orthostatic intolerance,where when they go to stand up
(16:51):
again, they feel lightheaded,their maybe headaches get worse,
they then have nausea.
So you can have these otherdysautonomia symptoms that come
on after a concussion that don'tnecessarily fit into a classic
POTS diagnosis, that don'tnecessarily fit into a classic
POTS diagnosis, and so they arealmost a bit more vague.
You know it's a more vaguepresentation of dysautonomia,
(17:12):
but it's just as importantnonetheless to identify and
there's ways of doing that.
Sophia Bouwens L.Ac. (17:17):
There's a lot of complexities in this.
So the gastrointestinalsymptoms you described make
sense, because we hear aboutthis as rest and digest, so, of
course, digestion.
Are there other symptoms orsystems that we see we're
commonly with?
Dr. Ayla Wolf DAOM, L.Ac (17:31):
Yeah, and I mean going back to
digestion real quick.
You know I mentioned nausea asbeing a big one, but a lot of
people you know will report thatafter they eat they might
actually feel like they havetachycardia or their heart is
beating.
Or we know that a lot of peoplewith dysautonomia can actually
(17:53):
have pooling of blood in theirpelvic cavity, Because when you
do eat, your blood goes to yourstomach to help you rest and
digest, right, but then when youstart to get up and move around
and do other things, it'salmost like your autonomic
nervous system is still stuck inrest and digest and it's not
controlling blood flow properlyand so you can have this kind of
pooling of blood in theabdominal cavity.
That feels uncomfortable andcauses these other symptoms too,
(18:13):
Because if your blood ispooling down below, that means
it's not getting to your brainand that's going to cause
problems as well.
So, but I mean people can have Imean vomiting and, like you
know, really bad nausea plusvomiting.
They can have changes in bowelmovements, a lot of bloating,
People can have foodsensitivities and just like
general sense of abdominal painor abdominal tension, and then
(18:37):
some people also report thatthey will start choking on, like
if they have to swallow pills,they'll start choking on pills
and actually have kind of a lossof the gag reflex.
Yeah, choking on pills andactually have kind of a loss of
the gag reflex.
So there's a lot of othersymptoms too.
That, of course, each of thesesymptoms by itself doesn't
necessarily mean oh, you havedysautonomia.
Sophia Bouwens L.Ac. (18:55):
But if I hand somebody a list of, say,
100 symptoms and they'rechecking every single box in my
questionnaire I start to, thenyou know, it makes some sense,
right, and I think a lot ofpeople have a form of
dysautonomia or there's somedysautonomic regulation, so it
can happen on its own.
It can happen as a response totrauma, some disruption, a
(19:16):
concussion, or it can happen aspart of something else going on.
Dr. Ayla Wolf DAOM, L.Ac (19:21):
Yeah.
So we can kind of break it upinto either like a primary type
so, for example, multiplesystems atrophy is a
neurodegenerative disorder thatis a primary form of
dysautonomia.
Then we have these secondaryforms of dysautonomia that are a
result of, say, a concussion,or I mean POTS, for example, can
(19:42):
actually come on as a result ofa surgical trauma.
I've had a patient that thatwas the case for her.
And then we can also now have,you know, POTS, I think has
become more popular because ithas become a side effect of
COVID, and so you can havepost-viral dysautonomias, you
can have post-surgicaldysautonomia, you can have
(20:03):
dysautonomia as a result of abrain injury.
So those would all be secondarytypes.
And then there's, you know, theidiopathic dysautonomias, where
they just are not quite surewhat's driving the process, and
then those kind of coexistingones that we already talked
about.
Sophia Bouwens L.Ac. (20:18):
Right.
So this is an interesting thingbecause I think a lot of times
people will break it down andsay well, dysautonomia means
that your sympathetic nervoussystem is in overdrive, so we
need to stimulate yourparasympathetic or your vagus
nerve to get you into betterbalance, right?
So there's all these vagalhacks to help with these
dysautonomias.
Why might that not be the fullpicture?
Dr. Ayla Wolf DAOM, L.A (20:41):
Because in some cases people aren't
having a proper sympatheticresponse.
It's not that their sympatheticnervous system is stuck in
overdrive.
For some people it's the exactopposite.
Their sympathetic is notresponding appropriately.
It's actually they don't haveenough sympathetic output.
And then so in some cases theparasympathetic nervous system
is not necessarily the problem.
(21:02):
It's not the thing that isn'tworking.
The problem, it's not the thingthat isn't working.
And so to try to simplifydysautonomia, to say that it's
always too much sympatheticactivity and not enough
parasympathetic, that's justsimply not true, and so we can't
say that that is the case foreverybody and we can't jump to
that conclusion for anybody.
(21:23):
And so just simply doing vagalnerve stimulation is not the
solution, it's not theappropriate response.
Because if you haven't had allthe proper tests done to see, do
I have the right sympatheticoutput, you know what is my
parasympathetic nervous systemdoing.
You know those tests areimportant to be able to
(21:44):
understand what category eachindividual person falls into, to
then know what is theappropriate treatment.
Sophia Bouwens L.Ac. (21:51):
And so some of these conditions, like
POTS, have clearly definedtesting and parameters.
What might be some other typesof testing that we would do to
gauge the autonomic nervoussystem functioning or not
functioning well?
Dr. Ayla Wolf DAOM, L.Ac (22:05):
We can look at the pupils and we can
look at how the pupils respondto light in terms of what is the
rate of constriction of thepupil when you flash a light in
the eye, and then also how longdoes it take for the pupil to
dilate again.
So we call that the 75%recovery time of what was the
original pupil size.
(22:25):
What did it constrict down to?
And then how long did it taketo then get back to 75% of the
original size?
And so we have these verywell-established parameters to
say we know how the pupilconstriction is mediated as a
parasympathetic response, and weknow that dilation is a
(22:46):
sympathetic response.
And so we can look at the pupilto just say what does the
orchestration of the autonomicnervous system look like with
this one reflex which is sopowerful?
Sophia Bouwens L.Ac. (22:57):
And how are these partners dancing and
who might be misstepping andwhere?
Dr. Ayla Wolf DAOM, L.A (23:01):
Exactly .
Sophia Bouwens L.Ac. (23:01):
Yeah, gives us insight into the pupil
dilation and constriction.
Dr. Ayla Wolf DAOM, L.Ac (23:05):
So that's one of them.
And then you can also look at aValsalva maneuver.
So if somebody is, you know,holding their breath and bearing
down, like right when yousneeze, you have that internal
pressure right.
So when we do a Valsalvamaneuver, there's also this kind
of response by the heart rateand the blood pressure in
response to that increasedpressure.
(23:26):
And so Valsalva is another wayof looking at, you know, is the
system responding appropriately?
Sophia Bouwens L.Ac. (23:33):
So checking all these measures.
That part of the nervous systemgoverns, right.
So blood pressure pupildilation.
Dr. Ayla Wolf DAOM, L.Ac (23:40):
I would say that the other kind of
bedside test that's reallyvaluable for understanding, if
there's enough sympatheticoutput, is looking at this
five-minute sustained hand griptest where you find somebody's
max grip strength.
You take 30% of that and thenthey have to hold that for five
minutes.
Sophia Bouwens L.Ac. (23:59):
I love that test.
I think there was a paper thatyou got really excited about
when you first brought that tomy attention how they had
correlated it really stronglywith dysautonomia.
Dr. Ayla Wolf DAOM, L.Ac (24:12):
So this has been around for a long
time, but I almost feel like itdidn't get popular enough, and
part of the problem is again,like our modern medical system
really relies on lab work andimaging right, and so they don't
often throw in a lot of these.
You know, bedside tests thattake five minutes, where you're
having to look at blood pressureand heart rate over and over
(24:34):
again and make somebody gripthis thing right.
Sophia Bouwens L.Ac. (24:37):
And also if you have a 15-minute
increment with someone andyou're going to have them sit
there for five minutes, it'slike a third of your time with
them and you have so much to getthrough.
Dr. Ayla Wolf DAOM, L.Ac (24:45):
Right, yeah, and so that's where you
know.
I think if medicine got betterat doing more screenings to like
.
There's the Compass 31questionnaire.
For example, one of my teachershe basically just said you know
, I have all my patients fillout the Compass 31.
And if they don't score veryhigh on this, then I know that I
(25:06):
don't necessarily need to spendan hour assessing their
autonomic nervous system.
If they can actually go throughthis questionnaire, and they
don't, they don't have very manyof these symptoms, right, and
so you know, for me.
That's why I also love mysymptom checklist, which is
maybe, you know, a lot more thanthe compass, but I love to
gather information.
Yes, you do so.
(25:27):
Yeah, it's that same concept oflike.
If we just did more screenings,you know, this would probably
get caught more.
Sophia Bouwens L.Ac. (25:33):
And be better treated, because we can
maybe see how and where thecomplexities are happening right
.
Dr. Ayla Wolf DAOM, L.Ac (25:40):
Yes, and because it is so complex and
there can be a lot of differentdrivers for you know, like what
is causing the dysautonomia,treatment is definitely not
straightforward and it's noteasy and it's not simple, it's
really complex stuff, which iswhy I think a lot of people just
kind of like they're like goes.
So we have the cardiovascularsystem, the respiratory system.
Sophia Bouwens L.Ac. (26:07):
We have the digestive system.
Are there other systems thatyou would name or involve?
Dr. Ayla Wolf DAOM, L.Ac (26:14):
Yeah, one of the things that is also,
I think, important todifferentiate is that you know I
mentioned the autonomic nervoussystem is in charge of these
beat to beat adjustments, but italso has, like long term
control over our immune systemand also our circadian rhythms.
And so a lot of times whenpeople have dysautonomia, they
also have immune systemimbalances.
(26:35):
There's a lot of kind ofcoexisting autoimmunity that can
happen with dysautonomia andeven just beyond that.
People can have frequent coldsand flus, or they might even
have mild fevers, they can havechronic fatigue or even
unexplained vertigo.
That might actually beassociated with some kind of
autoimmune imbalance because ofthe dysautonomia.
(26:58):
So it can get pretty complex inthat regard.
And then, because of the factthat it is involved in their
circadian rhythms, a lot ofpeople also have very poor sleep
because the circadian rhythmsare affected.
And then we mentioned sweatingtoo, and so, again, the
sympathetic nervous system isresponsible for sweating.
So some people might say theysweat way too much.
(27:20):
Other people might say theycan't sweat at all.
A lot of people say that theyhave heat intolerance.
Right, if you can't sweat, ifyou can't vent your heat, then
you're going to have a lot ofheat intolerance.
Sophia Bouwens L.Ac. (27:31):
You can't stand heat.
Yes for sure.
Dr. Ayla Wolf DAOM, L.Ac (27:33):
And so that's where you know a lot of
people are talking about.
You know the use of saunasbeing so helpful as well, and
you know usually I pay attentionand even like 20 years ago when
I was first learning Chinesemedicine, you know they would
teach you.
It's like you're feeling yourpatient's pulses.
But how do their hands feel?
Are their hands super clammyand wet?
(27:54):
Are they super hot?
Are they super cold?
I mean just like thetemperature of somebody's hands
and the moisture content cantell you a lot.
Sophia Bouwens L.Ac. (28:02):
And I think that Chinese medicine
tunes into the autonomic nervoussystem way more than we realize
.
Dr. Ayla Wolf DAOM, L.Ac (28:07):
Yeah, I mean the language of Chinese
medicine.
It really is a language offunction and balance.
I mean that's really what it is.
It's a language of what are thedifferent functions and the
original word for sympatheticthe reason why they called it
the sympathetic nervous systemis that that word actually came
from people back in I don't knowthe 1800s, saying you know, we
(28:29):
think there's this nervoussystem that is sympathetic to
the other organs.
Like these organs aresympathetic to each other.
Yeah, they pay attention toconditions.
Yeah, the organs are likepaying attention to what is
happening with the other organs,and so we have this nervous
system.
That's like communicatingbetween the internal organs and
sympathizing with them.
Sophia Bouwens L.Ac. (28:48):
That's where it came from and the
dysautonomia is the difficultyin the sympathizing and
adjusting.
It's a difficulty with thesympathizing.
Dr. Ayla Wolf DAOM, L.Ac (28:56):
Yes, the hardest like not
sympathizing appropriately withwhat's happening with the
kidneys and the blood pressure.
Sophia Bouwens L.Ac. (29:02):
What else needs to happen.
Dr. Ayla Wolf DAOM, L.Ac (29:03):
Yeah.
Sophia Bouwens L.Ac. (29:04):
Okay, so there's so many different
symptoms.
Are there more even that youwould note?
Dr. Ayla Wolf DAOM, L.Ac (29:09):
Yeah, so a lot of the peripheral
nerves are involved, becauseobviously our peripheral nerves
are bundles of sensory, motorand autonomic fibers.
Sophia Bouwens L.Ac. (29:18):
And peripheral, being the ones far
away from the center of our body.
Dr. Ayla Wolf DAOM, L.Ac (29:22):
The nerves that don't directly go
into the brain or the centralnervous system.
Sophia Bouwens L.Ac. (29:25):
Outside of the central nervous system.
Yeah, on the outside.
Dr. Ayla Wolf DAOM, L.Ac (29:28):
And so because of that, a lot of
people can have numbness andtingling.
And the key there is a lot oftimes it moves around, so like,
if you've got carpal tunnel,your numbness and tingling is
really in one place.
It stays in the same place.
A lot of people withdysautonomia can actually have
numbness and tingling that movesaround and doesn't necessarily
(29:48):
follow a clear pattern, butpeople can complain about
generalized weakness, about kindof random muscle soreness or
joint pain.
That doesn't seem to reallymake sense.
A lot of people will say thatthey feel shaky or they have
this sense that they're likeinternally they're kind of
shaking and sometimes I can feelthat and sometimes I can't.
(30:09):
You know, somebody says thatthey feel like they're shaky and
sometimes they hold out theirhand and you can literally see
their hand shaking.
Sometimes you can't see theshaking, but when you put your
hands on their feet, for example, all of a sudden you can just
feel the whole body is vibrating.
So the shakiness is real.
So that's a common thing.
And then a lot of times you know, especially with concussions,
(30:33):
exercise intolerance is a formof orthostatic intolerance,
because usually you're uprightright but obviously there's a
lot of exercise that can be doneon your back or in other
different positions, upside down, whatever but exercise
intolerance is again theinability to have the right
autonomic response to the factthat you are now using your
(30:54):
muscles and you're trying toexert energy in a way where you
need to shunt blood to yourmuscles, and so if your body is
failing to do that appropriately, people are going to have
things like, you know nausea,headaches, lightheadedness,
dizziness, fatigue, maybetachycardia, and so the exercise
intolerance one I would say inthe world of kind of sports
(31:17):
concussions is huge, because ifyou're an athlete and you can't
do your sport.
Sophia Bouwens L.Ac. (31:21):
That's a problem.
Dr. Ayla Wolf DAOM, L.Ac (31:23):
And so exercise intolerance is kind of
a big you know.
I would say it's well describedas far as a form of
dysautonomia.
We also have the Buffalotreadmill test, which is a very,
you know now, well-establishedmeans of kind of categorizing
that.
So that's another important onetoo sure are there others.
Sophia Bouwens L.Ac. (31:44):
I mean this.
The list goes on, doesn't it?
Dr. Ayla Wolf DAOM, L.A (31:47):
there's so many well, I mean, I think,
those that you can definitelyhave, um, urinary functions, so
different changes in bladdercontrol.
A lot of people that I workwith with dysautonomia they say
that they have to go to thebathroom like all the time.
Frequent urination, right, um,and then some people might say
they actually have difficultylike initiating urination too.
So changes in bladder function,changes in bowel function, and
(32:10):
then there are cognitive andemotional symptoms too, like we
mentioned, a lot of times peoplefeel a sense of agitation,
restlessness, anxiousness.
You know, I know for me I hadmaybe some mild dysautonomia
with all of my differentconcussions, but one of the
things I really felt was that ifI ever had to wait in line, I
(32:34):
would start to get very anxiousand restless.
And I think for me that was abit of this like orthostatic
intolerance, where I had tostand upright in a line, not
moving, and so I wouldconstantly be like shifting my
feet and I'd feel agitated thelonger I had to stand there.
And so I think, you know, forme there was a long period of
time where I didn't understandwhy I was so restless and
(32:58):
agitated and anxious anduncomfortable in my own body,
and it was probably because Ihad dysautonomia, and I just
didn't know it at the time.
Sophia Bouwens L.Ac. (33:05):
It was just coming out as this like
restlessness or irritability, soit could be seen as different.
Dr. Ayla Wolf DAOM, L.Ac (33:11):
And obviously, you know, the
autonomic nervous system issupposed to send blood to the
area that needs it the most, andthat's true for the brain as
well.
So if we're trying to performcognitive activities that
require us to shunt blood to ourfrontal lobe and our autonomic
nervous system is failing to dothat, well then we're going to
(33:31):
have brain fog and difficultyfocusing and concentrating.
People can even have blurryvision as a result of
dysautonomia because of bloodflow issues.
So there's tons of you know,like cognitive and emotional
things that are associated withit as a result of the autonomic
nervous system failing to shuntblood to where it's needed in
(33:52):
the moment.
Sophia Bouwens L.Ac. (33:52):
So this is one of the reasons I was so
excited to dive into thisconversation.
I think we just scratched thesurface too.
It's such a big one and it'sreally misunderstood because it
is very complex and it getsoversimplified incredibly into
this rest and digest, imbalance,fight or flight and then over
put into like, well, we justneed to stimulate your vagus
nerve and you're going to be OK.
(34:13):
I wonder we'll maybe do somemore episodes on different
caveats of this.
But are there main takeawaysthat you want our audience
members to know from thisinitial conversation?
But are there main takeawaysthat you want our audience
members to know from thisinitial conversation?
Dr. Ayla Wolf DAOM, L.Ac (34:24):
Yeah, I would say the main takeaways
are kind of what you describedis that dysautonomia is actually
very complex and it does notautomatically mean that the
parasympathetic system needs tobe stimulated or like that,
vagal nerve stimulation is theanswer to everything, because
it's not so.
That's a huge takeaway is thatpeople really need to get
(34:46):
properly assessed and evaluatedto understand exactly how the
dysautonomia is manifesting forthat individual person and they
need to be able to work with aprovider who understands how to
also then triangulate otherissues that might be driving the
dysautonomia, then triangulateother issues that might be
(35:07):
driving the dysautonomia.
So you know, the ocular motorsystem.
If there's imbalances therethat can drive dysautonomia.
If there are vestibularimbalances, the vestibular
system fires so heavily into thebrainstem If that system is
sending you error messages.
It's the equivalent of livingin a house with a fire alarm
going off.
Sophia Bouwens L.Ac. (35:23):
All the time.
Dr. Ayla Wolf DAOM, L.Ac (35:29):
And so we have to recognize that when
there are problems with thefunctioning of the vestibular
system, the cerebellum, the youknow the frontal lobes, the
ocular motor system, the immunesystem, all of these things can
drive dysautonomia.
And so we have to look at itfrom a very individualized
perspective to say what is goingon with this one particular
person and what are what's thebest path forward in terms of,
you know, addressing some of thedrivers for that individual.
(35:52):
And and then what do we need todo to not only manage their
symptoms but then also treat theproblems?
Sophia Bouwens L.Ac. (35:58):
The driving cause yeah Right, yeah
Bigger picture.
Dr. Ayla Wolf DAOM, L.Ac (36:02):
So that's, that's kind of like.
The big takeaway is that thisis way more complex than TikTok
would make you think rightAbsolutely, and that vagal nerve
stimulation is not the answerto everything.
And then I would say, like nexttime we can actually do a
deeper dive into POTS becausethere's a lot of fascinating
data on POTS.
(36:23):
Has really predictable measures,we know yeah, I mean, the one
good thing about like awarenessaround it growing is the fact
that up until now, a lot ofpeople that suffer from pots
often have to go for many, manymonths to years before they get
the right diagnosis, and so I'mhoping that now that just
everybody is kind of more awareof it, that maybe the actual
(36:46):
screenings will happen better ormore frequently and that people
won't have to wait three orfour years before somebody
figures out that that's whatthey're dealing with.
Sophia Bouwens L.Ac. (36:54):
Well, let's dive into that next
episode we do, just on exactlywhat those screenings are and
some of these complexities withPOTS, to understand even more
this dysregulation of thisautonomic nervous system.
Perfect, yeah, let's do it Allright, stay tuned.
Dr. Ayla Wolf DAOM, L.A (37:13):
Medical disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
professional healthcare services.
Thank you for medical advice,diagnosis or treatment, and
consumers of this informationshould seek the advice of a
(37:45):
medical professional for any andall health-related issues.
A link to our full medicaldisclaimer is available in the
notes.
And then other people can have what
I call increased heartbeatawareness, where their heart
feels like it's pounding intheir chest, but it's not.
It may not be pounding fast, soit's not necessarily that the
speed is abnormal, but it's thesensation of the heart is strong
.
Sophia Bouwens L.Ac. (00:18):
Welcome to the Life After Impact podcast,
where we do a deep dive into allthings concussion and brain
injury related.
We talk about all the differentsymptoms that can follow a
brain injury, different testingmethods, different types of
specialists out there anddifferent therapies available.
I'm Sophia Bowens.
I'm here with Dr Ayla Wolf andwe will be your guide to living
(00:41):
your best life after impact, andwe will be your guide to living
your best life after impact.
I'm super excited about thistopic today.
It's a really big one and it'sfull of just a lot of confusion
and you bring so much clarity toit.
Dr. Ayla Wolf DAOM, L.Ac (00:58):
Well, that's because it is confusing.
And so whenever I had patientscoming in, I kept finding that
there was some type ofdysautonomia, very frequently
underlying a lot of theirsymptoms, and it had gone missed
by you know so many differentproviders because they weren't
looking for it and they weren'tnecessarily looking at the human
(01:22):
physiology from thatperspective.
And, just like with concussions, every single person can have
such a different set of symptomswith a concussion.
If we even just look at it froman autonomic perspective and
say if dysautonomia is present,we can also say that in every
single individual that's goingto look very different.
Sophia Bouwens L.Ac. (01:42):
Very different.
So this episode is calledUntangling Dysautonomia Beyond
POTS and Vagal Nerve Hacks, soreally important.
Let's just start it with abrief overview of dysautonomia
and the autonomic nervous system.
Dr. Ayla Wolf DAOM, L.Ac (01:57):
Yes, so our autonomic nervous system
is named as such because a lotof the functions it performs are
supposed to be auto, right,automatic.
Automatic Meaning that we don'tnecessarily have to be actively
trying to do things right.
So when I go to stand up, myheart rate is probably going to
(02:18):
elevate a little bit and myblood pressure is going to
elevate a little bit, and thosesmall adjustments account for
the fact that gravity is tryingto take my blood and pull it
down towards my feet right andso, to stand up, our body makes
these adjustments without ushaving to consciously think
about it, it's just automatic.
It's automatic Just like whenwe go to bed at night.
(02:38):
We continue to breathe becausewe have specific nuclei in our
brainstem that are basicallythat's.
Their job is to keep usbreathing while we're
unconscious.
Sophia Bouwens L.Ac. (02:49):
And they're part of the autonomic
nervous system.
Dr. Ayla Wolf DAOM, L.A (02:52):
Exactly , and like sweating is another
example.
If we are nervous, we can havekind of this like emotionally
driven, you know, increasedsweating response to being
nervous about having to, youknow, give a speech in front of
a room full of people.
But when we go outside and it'shot out, that sweating response
is autonomic.
(03:12):
It's our brain saying it's hotout, I need to cool my body down
, and so I'm going to do thatthrough sweating.
Or if I'm a dog, I'm going todo that through panting right.
Sophia Bouwens L.Ac. (03:21):
So this complex automatic nervous system
really gets broken down mostsimply into two different parts
sympathetic and parasympathetic,or fight or flight, and rest
and digest.
Dr. Ayla Wolf DAOM, L.Ac (03:33):
Yes, and even those kinds of
categories are maybe also alittle bit overly simplified,
because there's, you know, aparasympathetic arm that goes to
our pupil, that helps toactually constrict our pupil.
That's a parasympatheticresponse, but we don't normally
associate our pupil size withresting and digesting, so that's
(03:54):
also a bit of anoversimplification, but it does
get the point across.
The other thing that I like topoint out is that when we talk
about this idea between you know, fight or flight as being a
sympathetic response, so oftenthe sympathetic nervous system
gets demonized.
You know, we're all told, likewe all have too much sympathetic
(04:15):
activity, and sympatheticactivity is bad and sympathetic
is evil and parasympathetic isgood, and that's also not true.
It's not, you know, it's notthe reality that it is good and
that's also not true.
It's not, you know, it's notthe reality.
And so you know, the way that Ialways like to frame it is that
our autonomic nervous system isdesigned to make beat to beat
(04:36):
adjustments in order for us tohave an appropriate response in
the moment.
So when I'm exercising, I needa really strong sympathetic
output because I'm about to goput a lot of effort into, you
know, running, jumping, lifting.
Sophia Bouwens L.Ac. (04:50):
You need different blood flow, different
breathing patterns, differentblood pressures to adjust to
that situation.
Dr. Ayla Wolf DAOM, L.A (04:56):
Exactly , and so we need our sympathetic
nervous system.
It is so important.
Sophia Bouwens L.Ac. (05:00):
It's just we don't need it overly active
at the wrong times, andsometimes people can get stuck
in this sympathetic dominance orthis fight or flight mode, and
then I think that brings us toan interesting talk about what
the arm that counters that is,which is that parasympathetic
response, or yeah so theparasympathetic system.
Dr. Ayla Wolf DAOM, L (05:21):
Basically , if we get into anatomy, you
know, we can ask the question ofwhat makes a nerve a
sympathetic nerve versus whatmakes a nerve a parasympathetic
nerve.
And so we have what are calledpreganglionic fibers and
postganglionic fibers.
So if we look at sympatheticnerve fibers and we compare them
(05:41):
to parasympathetic, there's away anatomically that we're
differentiating whethersomething is parasympathetic or
sympathetic, and it's all basedon the length of the nerve
tracts that are eitherpreganglionic or postganglionic.
So sympathetic nerve fibershave a short preganglionic fiber
and then a very longpostganglionic fiber ganglionic
(06:06):
fiber and then a very longpost-ganglionic fiber, and then
the parasympathetic have a verylong pre-ganglionic tract and a
very short post-ganglionic tract.
Sophia Bouwens L.Ac. (06:11):
So anatomically they're mirrors too
.
Dr. Ayla Wolf DAOM, L.A (06:14):
They're opposites to each other.
Yes, and so there are theseanatomical differences that
define whether a nerve fiber isa sympathetic or a
parasympathetic.
And so again, I think that whenwe bring it back to just
anatomy and classificationsbased on the length of the nerve
, either pre or postganglionic,again all of a sudden it's like
(06:35):
there is not this is good andthat's bad, it's just this is
short and that's long right,Exactly Easy, easy easy.
Sophia Bouwens L.Ac. (06:41):
Yeah, exactly, so the vagus nerve, the
longest nerve in our body,gives our brain a lot of
information about what our bodyfunction is doing.
One of the anatomical andfunctional things that
fascinates me about this nerveis that its main component is to
tell the brain about what isgoing on in the body.
They go from the body to thebrain.
(07:02):
I think it's like 90% of theinformation in the vagus nerve
goes that way.
Dr. Ayla Wolf DAOM, L.Ac (07:08):
Yeah, I think like 80% is yeah, 80% is
going from the body to thebrain, and that is very
important, because what thatmeans is that we have this part
of the brain called the insularcortex, which is where we have
what's called interoception,right?
So when I ask you, sophia, howare you doing today, you know
it's actually you're kind oftapping into your interoception
(07:31):
of how am I feeling today, and alot of that has to do with, you
know, this sense of internalstate.
So if you were super nauseousand I asked you, how are you
today, that nausea is probablygoing to be the first thing on
your mind, right?
You can probably read it on myface yeah, exactly.
And so there's certain thingslike when I ask you, how are you
(07:52):
today?
Well, if you're, you know,overheated and you feel like
you're about to pass out, that'sgoing to be at the top of your
list the driving factor, forsure.
Yeah, you're not going to say Ifeel great, unless you're just
straight up lying to me.
Sophia Bouwens L.Ac. (08:03):
If I'm in that condition.
But if I'm in a differentcondition, I might feel great
and tell you that and I'll beable to notice in my body I have
a calm heart rate, my breathingfeels good, a state of balance.
Dysautonomia is marked often byhigh anxiety and I think a lot
of that is because that internalstate feels really off.
Dr. Ayla Wolf DAOM, L.Ac (08:22):
Yeah, and it can be off in kind of a
vague way so that when you asksomebody with dysautonomia how
are you, they might just havethis sense of not being well
right.
Maybe they feel tired, maybethey have a little bit of mild
nausea, maybe they are eithertoo hot or too cold, maybe they
feel a little anxious in thiskind of vague way where it's not
(08:43):
necessarily related to any onething that happened.
It's just this kind of vagueway where it's not necessarily
related to any one thing thathappened.
It's just this kind of vaguesense of restlessness.
Sophia Bouwens L.Ac. (08:48):
Yeah, like what are some of the main
symptoms of this dysautonomia,what you just listed?
Are there other things thatcome up or get categorized?
Dr. Ayla Wolf DAOM, L.Ac (08:56):
Yeah, the complexity of dysautonomia,
because if we're sayingdysautonomia is a dysregulation
of the autonomic nervous system,well then we have to ask the
next question, which is well,what are the functions of the
autonomic nervous system?
Sophia Bouwens L.Ac. (09:16):
Well, that's a great question.
What are the functions of theautonomic nervous system?
Dr. Ayla Wolf DAOM, L.Ac (09:21):
I think it's easiest to break it
into categories of function.
And then, when you break itinto the categories, then you
can start to look at well, whatdoes this do?
So if we look at, say,cardiovascular function, if
somebody has dysautonomia andit's very much affecting their
cardiovascular system, they'reprobably going to say that they
(09:42):
either have a racing heart andthat can be at random times.
They might just be sitting onthe couch and all of a sudden
their heart starts racing, orthey walk up their short flight
of stairs, which normally wouldbe no big deal, but all of a
sudden they walk up their stairsand they feel like their heart
is racing.
Yeah, and then some people haveheart palpitations where it
almost just feels like it'sskipping a beat.
(10:02):
I always liken heartpalpitations to like a
submersible pump water pump in afish tank where, like when the
water gets too low, all of asudden that pump starts
cavitating.
Yeah, and like that's how I feel, like you, like, that's how I
like to describe heartpalpitations.
And then other people can havewhat I call increased heartbeat
awareness, where their heartfeels like it's pounding in
(10:25):
their chest, but it's not.
It may not be pounding fast, soit's not necessarily that the
speed is abnormal, but it's thesensation of the heart is strong
.
That awareness becomes reallyheightened, yeah, and you know,
like if you just startedsprinting and you were running
sprints uphill, when you stopyour heart's going to be fast
(10:47):
and it's going to be poundingand that's going to be normal,
and so you wouldn't necessarilyfeel anxious, because you know,
like I was just sprinting uphill, of course my heart is going to
be pounding and it's going tobe fast, but if you're sitting
on the couch watching a reallycalm documentary and all of a
sudden your heart starts racinglike that it feels like it is
racing like that.
Sophia Bouwens L.Ac. (11:05):
It might cause some worry.
Dr. Ayla Wolf DAOM, L.Ac (11:06):
That can definitely make people feel
anxious.
And then, of course, you knowthere's a lot of other
cardiovascular symptoms, likepeople can actually have chest
pain, they can have dizziness ora feeling of lightheadedness
because when they go to stand upmaybe again their heart is
beating really fast or maybetheir blood pressure is dropping
, or, you know, people can haveall these different changes in
(11:26):
heart rate and blood pressurethat can lead to dizziness and
lightheadedness and evenfainting.
And so there's all of thesekind of symptoms that come with
orthostatic intolerance and thecardiovascular system not
responding appropriately tosomebody changing position.
And commonly people will getdiagnosed with POTS for this
reason, right, because of thiscomponent, yes, and so we'll
(11:48):
circle back to POTS, because alot of people are kind of
equating dysautonomia to POTS,when really, if we look at
dysautonomia as this bigumbrella, pots is just one
component, well-definedsubcategory that falls
underneath the dysautonomiaumbrella, but it's not all forms
of dysautonomia, and so Icertainly have had actually more
(12:12):
and more, because I think a lotof people on TikTok and YouTube
are talking about POTS- it'skind of become the new popular
diagnosis and so a lot of peopleare talking about it.
But I've definitely had patientscome to me and say I think I
have POTS and when I run themthrough a ton of autonomic
testing I'm like, well, you dohave something wrong with you,
(12:35):
but it's not POTS.
That's not how this ispresenting.
Sophia Bouwens L.Ac. (12:38):
There's more.
Let's come back to that.
Dr. Ayla Wolf DAOM, L.Ac (12:39):
Let's put a pin in that for a second
because you before that there'smultiple systems that this can
show up in, and started with thecardiovascular system.
What are other systems thatthis dysautonomia can show up in
?
So the next one is therespiratory system, and so that
involves, obviously, breathing,but also the ability of our body
to regulate the balance betweenoxygen and carbon dioxide, and
(13:02):
so that's really important too,and when people have poor carbon
dioxide regulation and thatgets out of balance, that can
cause a lot of symptoms too interms of breathlessness and
lightheadedness.
And so when we think about thiswhole picture of anxiety and
restlessness in the body,there's just so many things that
(13:22):
when they're off within theautonomic nervous system, then
they cause you to feel anxiousand restless.
Sophia Bouwens L.Ac. (13:29):
I could see that leading into other
diagnoses like fibromyalgia orRaynaud's or just ways that
their circulation or oxygendelivery isn't getting places.
And it's not to say that thosediagnoses are always a
dysautonomia.
But some of what you're talkingabout makes me think about
those conditions, because yousee these vague but also really
(13:51):
diffuse symptoms.
Dr. Ayla Wolf DAOM, L.Ac (13:54):
Well, and Raynaud's really is a, you
know, a dysautonomia.
There's a lot of existingdisorders or diseases that
really do have dysautonomia askind of like this comorbidity or
kind of coexisting with them,and so, yeah, we can get into
that too.
But like, for example, CRPS,complex regional pain syndrome
(14:16):
you know, that's kind of a formof dysautonomia.
And then we look at, you know,small fiber neuropathy that's
present in diabetes and that'skind of a form of this
dysautonomia coexisting withdiabetes.
We also have like Sjogren's,which is an autoimmune disorder,
and so classically people havedry mouth and dry eyes.
(14:37):
But there's kind of a wholenother aspect of Sjogren's that
is maybe an atypicalpresentation that doesn't
necessarily have the dry mouthand dry eyes as the main symptom
.
It's actually people have moreof like this fatigue and muscle
pain and joint pain anddifficulty breathing, and so
there's this whole feeling wrongbecause this autonomic nervous
(14:58):
system Exactly yeah, so there'sa lot of, I think, disorders and
diseases that people arefamiliar with that don't, but
maybe they don't even recognizethat the dysautonomia is really
wrapped up in that.
Sophia Bouwens L.Ac. (15:10):
It's a component of that.
Dr. Ayla Wolf DAOM, L.Ac (15:11):
It's a component of it, exactly.
Sophia Bouwens L.Ac. (15:13):
So we have the cardiovascular, the
respiratory.
Dr. Ayla Wolf DAOM, L.Ac (15:16):
Yeah, so with the respiratory symptoms
, a lot of people do feel likethey, you know, breathe
shallowly or they havedifficulty taking a full breath.
They also might report thattheir symptoms are worse with
changes in barometric pressureas a response to kind of
perfusion in the body.
Sure, and then I would say thatone of the huge categories is
(15:38):
digestion, and when I I mean, Itaught a dysautonomia class way
back in, I think, 2017, and Ipresented basically three cases
side by side, which were allyoung women, who all complained
of nausea and loss of appetiteas like their primary complaints
.
And then when I examined them,it turned out that all of them
(16:00):
had POTS, and so they basicallyall presented with dysautonomia.
And because their maincomplaint was nausea, I think
every other doctor they went towere just looking at it
symptomatically as opposed tolooking at the big picture to
say, well, what's driving thenausea?
Sophia Bouwens L.A (16:17):
Functionally what's going on?
So POTS can be this orthostaticimbalance you feel, but it
shows up as many other thingstoo.
But it is a clearly defineddiagnosis, which is not the case
for all dysautonomias.
Dr. Ayla Wolf DAOM, L.Ac (16:31):
No, and that's what's confusing to
people is, you know, you canhave POTS and then you can have,
say, somebody gets a concussionand maybe they don't develop
POTS but maybe they developdysautonomia that manifests in a
completely different way interms of like migraine headaches
and orthostatic intolerance,where when they go to stand up
(16:51):
again, they feel lightheaded,their maybe headaches get worse,
they then have nausea.
So you can have these otherdysautonomia symptoms that come
on after a concussion that don'tnecessarily fit into a classic
POTS diagnosis, that don'tnecessarily fit into a classic
POTS diagnosis, and so they arealmost a bit more vague.
You know it's a more vaguepresentation of dysautonomia,
(17:12):
but it's just as importantnonetheless to identify and
there's ways of doing that.
Sophia Bouwens L.Ac. (17:17):
There's a lot of complexities in this.
So the gastrointestinalsymptoms you described make
sense, because we hear aboutthis as rest and digest, so, of
course, digestion.
Are there other symptoms orsystems that we see we're
commonly with?
Dr. Ayla Wolf DAOM, L.Ac (17:31):
Yeah, and I mean going back to
digestion real quick.
You know I mentioned nausea asbeing a big one, but a lot of
people you know will report thatafter they eat they might
actually feel like they havetachycardia or their heart is
beating.
Or we know that a lot of peoplewith dysautonomia can actually
(17:53):
have pooling of blood in theirpelvic cavity, Because when you
do eat, your blood goes to yourstomach to help you rest and
digest, right, but then when youstart to get up and move around
and do other things, it'salmost like your autonomic
nervous system is still stuck inrest and digest and it's not
controlling blood flow properlyand so you can have this kind of
pooling of blood in theabdominal cavity.
That feels uncomfortable andcauses these other symptoms too,
(18:13):
Because if your blood ispooling down below, that means
it's not getting to your brainand that's going to cause
problems as well.
So, but I mean people can have Imean vomiting and, like you
know, really bad nausea plusvomiting.
They can have changes in bowelmovements, a lot of bloating,
People can have foodsensitivities and just like
general sense of abdominal painor abdominal tension, and then
(18:37):
some people also report thatthey will start choking on, like
if they have to swallow pills,they'll start choking on pills
and actually have kind of a lossof the gag reflex.
Yeah, choking on pills andactually have kind of a loss of
the gag reflex.
So there's a lot of othersymptoms too.
That, of course, each of thesesymptoms by itself doesn't
necessarily mean oh, you havedysautonomia.
Sophia Bouwens L.Ac. (18:55):
But if I hand somebody a list of, say,
100 symptoms and they'rechecking every single box in my
questionnaire I start to, thenyou know, it makes some sense,
right, and I think a lot ofpeople have a form of
dysautonomia or there's somedysautonomic regulation, so it
can happen on its own.
It can happen as a response totrauma, some disruption, a
(19:16):
concussion, or it can happen aspart of something else going on.
Dr. Ayla Wolf DAOM, L.Ac (19:21):
Yeah.
So we can kind of break it upinto either like a primary type
so, for example, multiplesystems atrophy is a
neurodegenerative disorder thatis a primary form of
dysautonomia.
Then we have these secondaryforms of dysautonomia that are a
result of, say, a concussion,or I mean POTS, for example, can
(19:42):
actually come on as a result ofa surgical trauma.
I've had a patient that thatwas the case for her.
And then we can also now have,you know, POTS, I think has
become more popular because ithas become a side effect of
COVID, and so you can havepost-viral dysautonomias, you
can have post-surgicaldysautonomia, you can have
(20:03):
dysautonomia as a result of abrain injury.
So those would all be secondarytypes.
And then there's, you know, theidiopathic dysautonomias, where
they just are not quite surewhat's driving the process, and
then those kind of coexistingones that we already talked
about.
Sophia Bouwens L.Ac. (20:18):
Right.
So this is an interesting thingbecause I think a lot of times
people will break it down andsay well, dysautonomia means
that your sympathetic nervoussystem is in overdrive, so we
need to stimulate yourparasympathetic or your vagus
nerve to get you into betterbalance, right?
So there's all these vagalhacks to help with these
dysautonomias.
Why might that not be the fullpicture?
Dr. Ayla Wolf DAOM, L.A (20:41):
Because in some cases people aren't
having a proper sympatheticresponse.
It's not that their sympatheticnervous system is stuck in
overdrive.
For some people it's the exactopposite.
Their sympathetic is notresponding appropriately.
It's actually they don't haveenough sympathetic output.
And then so in some cases theparasympathetic nervous system
is not necessarily the problem.
(21:02):
It's not the thing that isn'tworking.
The problem, it's not the thingthat isn't working.
And so to try to simplifydysautonomia, to say that it's
always too much sympatheticactivity and not enough
parasympathetic, that's justsimply not true, and so we can't
say that that is the case foreverybody and we can't jump to
that conclusion for anybody.
(21:23):
And so just simply doing vagalnerve stimulation is not the
solution, it's not theappropriate response.
Because if you haven't had allthe proper tests done to see, do
I have the right sympatheticoutput, you know what is my
parasympathetic nervous systemdoing.
You know those tests areimportant to be able to
(21:44):
understand what category eachindividual person falls into, to
then know what is theappropriate treatment.
Sophia Bouwens L.Ac. (21:51):
And so some of these conditions, like
POTS, have clearly definedtesting and parameters.
What might be some other typesof testing that we would do to
gauge the autonomic nervoussystem functioning or not
functioning well?
Dr. Ayla Wolf DAOM, L.Ac (22:05):
We can look at the pupils and we can
look at how the pupils respondto light in terms of what is the
rate of constriction of thepupil when you flash a light in
the eye, and then also how longdoes it take for the pupil to
dilate again.
So we call that the 75%recovery time of what was the
original pupil size.
(22:25):
What did it constrict down to?
And then how long did it taketo then get back to 75% of the
original size?
And so we have these verywell-established parameters to
say we know how the pupilconstriction is mediated as a
parasympathetic response, and weknow that dilation is a
(22:46):
sympathetic response.
And so we can look at the pupilto just say what does the
orchestration of the autonomicnervous system look like with
this one reflex which is sopowerful?
Sophia Bouwens L.Ac. (22:57):
And how are these partners dancing and
who might be misstepping andwhere?
Dr. Ayla Wolf DAOM, L.A (23:01):
Exactly .
Sophia Bouwens L.Ac. (23:01):
Yeah, gives us insight into the pupil
dilation and constriction.
Dr. Ayla Wolf DAOM, L.Ac (23:05):
So that's one of them.
And then you can also look at aValsalva maneuver.
So if somebody is, you know,holding their breath and bearing
down, like right when yousneeze, you have that internal
pressure right.
So when we do a Valsalvamaneuver, there's also this kind
of response by the heart rateand the blood pressure in
response to that increasedpressure.
(23:26):
And so Valsalva is another wayof looking at, you know, is the
system responding appropriately?
Sophia Bouwens L.Ac. (23:33):
So checking all these measures.
That part of the nervous systemgoverns, right.
So blood pressure pupildilation.
Dr. Ayla Wolf DAOM, L.Ac (23:40):
I would say that the other kind of
bedside test that's reallyvaluable for understanding, if
there's enough sympatheticoutput, is looking at this
five-minute sustained hand griptest where you find somebody's
max grip strength.
You take 30% of that and thenthey have to hold that for five
minutes.
Sophia Bouwens L.Ac. (23:59):
I love that test.
I think there was a paper thatyou got really excited about
when you first brought that tomy attention how they had
correlated it really stronglywith dysautonomia.
Dr. Ayla Wolf DAOM, L.Ac (24:12):
So this has been around for a long
time, but I almost feel like itdidn't get popular enough, and
part of the problem is again,like our modern medical system
really relies on lab work andimaging right, and so they don't
often throw in a lot of these.
You know, bedside tests thattake five minutes, where you're
having to look at blood pressureand heart rate over and over
(24:34):
again and make somebody gripthis thing right.
Sophia Bouwens L.Ac. (24:37):
And also if you have a 15-minute
increment with someone andyou're going to have them sit
there for five minutes, it'slike a third of your time with
them and you have so much to getthrough.
Dr. Ayla Wolf DAOM, L.Ac (24:45):
Right, yeah, and so that's where you
know.
I think if medicine got betterat doing more screenings to like
.
There's the Compass 31questionnaire.
For example, one of my teachershe basically just said you know
, I have all my patients fillout the Compass 31.
And if they don't score veryhigh on this, then I know that I
(25:06):
don't necessarily need to spendan hour assessing their
autonomic nervous system.
If they can actually go throughthis questionnaire, and they
don't, they don't have very manyof these symptoms, right, and
so you know, for me.
That's why I also love mysymptom checklist, which is
maybe, you know, a lot more thanthe compass, but I love to
gather information.
Yes, you do so.
(25:27):
Yeah, it's that same concept oflike.
If we just did more screenings,you know, this would probably
get caught more.
Sophia Bouwens L.Ac. (25:33):
And be better treated, because we can
maybe see how and where thecomplexities are happening right
.
Dr. Ayla Wolf DAOM, L.Ac (25:40):
Yes, and because it is so complex and
there can be a lot of differentdrivers for you know, like what
is causing the dysautonomia,treatment is definitely not
straightforward and it's noteasy and it's not simple, it's
really complex stuff, which iswhy I think a lot of people just
kind of like they're like goes.
So we have the cardiovascularsystem, the respiratory system.
Sophia Bouwens L.Ac. (26:07):
We have the digestive system.
Are there other systems thatyou would name or involve?
Dr. Ayla Wolf DAOM, L.Ac (26:14):
Yeah, one of the things that is also,
I think, important todifferentiate is that you know I
mentioned the autonomic nervoussystem is in charge of these
beat to beat adjustments, but italso has, like long term
control over our immune systemand also our circadian rhythms.
And so a lot of times whenpeople have dysautonomia, they
also have immune systemimbalances.
(26:35):
There's a lot of kind ofcoexisting autoimmunity that can
happen with dysautonomia andeven just beyond that.
People can have frequent coldsand flus, or they might even
have mild fevers, they can havechronic fatigue or even
unexplained vertigo.
That might actually beassociated with some kind of
autoimmune imbalance because ofthe dysautonomia.
(26:58):
So it can get pretty complex inthat regard.
And then, because of the factthat it is involved in their
circadian rhythms, a lot ofpeople also have very poor sleep
because the circadian rhythmsare affected.
And then we mentioned sweatingtoo, and so, again, the
sympathetic nervous system isresponsible for sweating.
So some people might say theysweat way too much.
(27:20):
Other people might say theycan't sweat at all.
A lot of people say that theyhave heat intolerance.
Right, if you can't sweat, ifyou can't vent your heat, then
you're going to have a lot ofheat intolerance.
Sophia Bouwens L.Ac. (27:31):
You can't stand heat.
Yes for sure.
Dr. Ayla Wolf DAOM, L.Ac (27:33):
And so that's where you know a lot of
people are talking about.
You know the use of saunasbeing so helpful as well, and
you know usually I pay attentionand even like 20 years ago when
I was first learning Chinesemedicine, you know they would
teach you.
It's like you're feeling yourpatient's pulses.
But how do their hands feel?
Are their hands super clammyand wet?
(27:54):
Are they super hot?
Are they super cold?
I mean just like thetemperature of somebody's hands
and the moisture content cantell you a lot.
Sophia Bouwens L.Ac. (28:02):
And I think that Chinese medicine
tunes into the autonomic nervoussystem way more than we realize
.
Dr. Ayla Wolf DAOM, L.Ac (28:07):
Yeah, I mean the language of Chinese
medicine.
It really is a language offunction and balance.
I mean that's really what it is.
It's a language of what are thedifferent functions and the
original word for sympatheticthe reason why they called it
the sympathetic nervous systemis that that word actually came
from people back in I don't knowthe 1800s, saying you know, we
(28:29):
think there's this nervoussystem that is sympathetic to
the other organs.
Like these organs aresympathetic to each other.
Yeah, they pay attention toconditions.
Yeah, the organs are likepaying attention to what is
happening with the other organs,and so we have this nervous
system.
That's like communicatingbetween the internal organs and
sympathizing with them.
Sophia Bouwens L.Ac. (28:48):
That's where it came from and the
dysautonomia is the difficultyin the sympathizing and
adjusting.
It's a difficulty with thesympathizing.
Dr. Ayla Wolf DAOM, L.Ac (28:56):
Yes, the hardest like not
sympathizing appropriately withwhat's happening with the
kidneys and the blood pressure.
Sophia Bouwens L.Ac. (29:02):
What else needs to happen.
Dr. Ayla Wolf DAOM, L.Ac (29:03):
Yeah.
Sophia Bouwens L.Ac. (29:04):
Okay, so there's so many different
symptoms.
Are there more even that youwould note?
Dr. Ayla Wolf DAOM, L.Ac (29:09):
Yeah, so a lot of the peripheral
nerves are involved, becauseobviously our peripheral nerves
are bundles of sensory, motorand autonomic fibers.
Sophia Bouwens L.Ac. (29:18):
And peripheral, being the ones far
away from the center of our body.
Dr. Ayla Wolf DAOM, L.Ac (29:22):
The nerves that don't directly go
into the brain or the centralnervous system.
Sophia Bouwens L.Ac. (29:25):
Outside of the central nervous system.
Yeah, on the outside.
Dr. Ayla Wolf DAOM, L.Ac (29:28):
And so because of that, a lot of
people can have numbness andtingling.
And the key there is a lot oftimes it moves around, so like,
if you've got carpal tunnel,your numbness and tingling is
really in one place.
It stays in the same place.
A lot of people withdysautonomia can actually have
numbness and tingling that movesaround and doesn't necessarily
(29:48):
follow a clear pattern, butpeople can complain about
generalized weakness, about kindof random muscle soreness or
joint pain.
That doesn't seem to reallymake sense.
A lot of people will say thatthey feel shaky or they have
this sense that they're likeinternally they're kind of
shaking and sometimes I can feelthat and sometimes I can't.
(30:09):
You know, somebody says thatthey feel like they're shaky and
sometimes they hold out theirhand and you can literally see
their hand shaking.
Sometimes you can't see theshaking, but when you put your
hands on their feet, for example, all of a sudden you can just
feel the whole body is vibrating.
So the shakiness is real.
So that's a common thing.
And then a lot of times you know, especially with concussions,
(30:33):
exercise intolerance is a formof orthostatic intolerance,
because usually you're uprightright but obviously there's a
lot of exercise that can be doneon your back or in other
different positions, upside down, whatever but exercise
intolerance is again theinability to have the right
autonomic response to the factthat you are now using your
(30:54):
muscles and you're trying toexert energy in a way where you
need to shunt blood to yourmuscles, and so if your body is
failing to do that appropriately, people are going to have
things like, you know nausea,headaches, lightheadedness,
dizziness, fatigue, maybetachycardia, and so the exercise
intolerance one I would say inthe world of kind of sports
(31:17):
concussions is huge, because ifyou're an athlete and you can't
do your sport.
Sophia Bouwens L.Ac. (31:21):
That's a problem.
Dr. Ayla Wolf DAOM, L.Ac (31:23):
And so exercise intolerance is kind of
a big you know.
I would say it's well describedas far as a form of
dysautonomia.
We also have the Buffalotreadmill test, which is a very,
you know now, well-establishedmeans of kind of categorizing
that.
So that's another important onetoo sure are there others.
Sophia Bouwens L.Ac. (31:44):
I mean this.
The list goes on, doesn't it?
Dr. Ayla Wolf DAOM, L.A (31:47):
there's so many well, I mean, I think,
those that you can definitelyhave, um, urinary functions, so
different changes in bladdercontrol.
A lot of people that I workwith with dysautonomia they say
that they have to go to thebathroom like all the time.
Frequent urination, right, um,and then some people might say
they actually have difficultylike initiating urination too.
So changes in bladder function,changes in bowel function, and
(32:10):
then there are cognitive andemotional symptoms too, like we
mentioned, a lot of times peoplefeel a sense of agitation,
restlessness, anxiousness.
You know, I know for me I hadmaybe some mild dysautonomia
with all of my differentconcussions, but one of the
things I really felt was that ifI ever had to wait in line, I
(32:34):
would start to get very anxiousand restless.
And I think for me that was abit of this like orthostatic
intolerance, where I had tostand upright in a line, not
moving, and so I wouldconstantly be like shifting my
feet and I'd feel agitated thelonger I had to stand there.
And so I think, you know, forme there was a long period of
time where I didn't understandwhy I was so restless and
(32:58):
agitated and anxious anduncomfortable in my own body,
and it was probably because Ihad dysautonomia, and I just
didn't know it at the time.
Sophia Bouwens L.Ac. (33:05):
It was just coming out as this like
restlessness or irritability, soit could be seen as different.
Dr. Ayla Wolf DAOM, L.Ac (33:11):
And obviously, you know, the
autonomic nervous system issupposed to send blood to the
area that needs it the most, andthat's true for the brain as
well.
So if we're trying to performcognitive activities that
require us to shunt blood to ourfrontal lobe and our autonomic
nervous system is failing to dothat, well then we're going to
(33:31):
have brain fog and difficultyfocusing and concentrating.
People can even have blurryvision as a result of
dysautonomia because of bloodflow issues.
So there's tons of you know,like cognitive and emotional
things that are associated withit as a result of the autonomic
nervous system failing to shuntblood to where it's needed in
(33:52):
the moment.
Sophia Bouwens L.Ac. (33:52):
So this is one of the reasons I was so
excited to dive into thisconversation.
I think we just scratched thesurface too.
It's such a big one and it'sreally misunderstood because it
is very complex and it getsoversimplified incredibly into
this rest and digest, imbalance,fight or flight and then over
put into like, well, we justneed to stimulate your vagus
nerve and you're going to be OK.
(34:13):
I wonder we'll maybe do somemore episodes on different
caveats of this.
But are there main takeawaysthat you want our audience
members to know from thisinitial conversation?
But are there main takeawaysthat you want our audience
members to know from thisinitial conversation?
Dr. Ayla Wolf DAOM, L.Ac (34:24):
Yeah, I would say the main takeaways
are kind of what you describedis that dysautonomia is actually
very complex and it does notautomatically mean that the
parasympathetic system needs tobe stimulated or like that,
vagal nerve stimulation is theanswer to everything, because
it's not so.
That's a huge takeaway is thatpeople really need to get
(34:46):
properly assessed and evaluatedto understand exactly how the
dysautonomia is manifesting forthat individual person and they
need to be able to work with aprovider who understands how to
also then triangulate otherissues that might be driving the
dysautonomia, then triangulateother issues that might be
(35:07):
driving the dysautonomia.
So you know, the ocular motorsystem.
If there's imbalances therethat can drive dysautonomia.
If there are vestibularimbalances, the vestibular
system fires so heavily into thebrainstem If that system is
sending you error messages.
It's the equivalent of livingin a house with a fire alarm
going off.
Sophia Bouwens L.Ac. (35:23):
All the time.
Dr. Ayla Wolf DAOM, L.Ac (35:29):
And so we have to recognize that when
there are problems with thefunctioning of the vestibular
system, the cerebellum, the youknow the frontal lobes, the
ocular motor system, the immunesystem, all of these things can
drive dysautonomia.
And so we have to look at itfrom a very individualized
perspective to say what is goingon with this one particular
person and what are what's thebest path forward in terms of,
you know, addressing some of thedrivers for that individual.
(35:52):
And and then what do we need todo to not only manage their
symptoms but then also treat theproblems?
Sophia Bouwens L.Ac. (35:58):
The driving cause yeah Right, yeah
Bigger picture.
Dr. Ayla Wolf DAOM, L.Ac (36:02):
So that's, that's kind of like.
The big takeaway is that thisis way more complex than TikTok
would make you think rightAbsolutely, and that vagal nerve
stimulation is not the answerto everything.
And then I would say, like nexttime we can actually do a
deeper dive into POTS becausethere's a lot of fascinating
data on POTS.
(36:23):
Has really predictable measures,we know yeah, I mean, the one
good thing about like awarenessaround it growing is the fact
that up until now, a lot ofpeople that suffer from pots
often have to go for many, manymonths to years before they get
the right diagnosis, and so I'mhoping that now that just
everybody is kind of more awareof it, that maybe the actual
(36:46):
screenings will happen better ormore frequently and that people
won't have to wait three orfour years before somebody
figures out that that's whatthey're dealing with.
Sophia Bouwens L.Ac. (36:54):
Well, let's dive into that next
episode we do, just on exactlywhat those screenings are and
some of these complexities withPOTS, to understand even more
this dysregulation of thisautonomic nervous system.
Perfect, yeah, let's do it Allright, stay tuned.
Dr. Ayla Wolf DAOM, L.A (37:13):
Medical disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
professional healthcare services.
Thank you for medical advice,diagnosis or treatment, and
consumers of this informationshould seek the advice of a
(37:45):
medical professional for any andall health-related issues.
A link to our full medicaldisclaimer is available in the
notes.
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