Evidence
Accessible readings of the research behind interventions and diagnostic concepts, written from an educated-amateur standpoint with appropriate caveats. These pieces always weave in my own data and experience rather than just summarising literature.
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Ivabradine for POTS: evidence, dosing and side effects
What the evidence says about ivabradine for POTS: how it slows the heart without lowering blood pressure, the randomised trial data, the long-COVID findings, typical dosing, side effects, and how it's prescribed off-label in the UK.
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Salty snacks that earn their keep
Ten high-sodium snacks arranged from zero effort to ten minutes at the counter, each delivering roughly a gram of sodium from a different source. Practical options for hitting the daily salt target between meals.
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Salt in POTS: evidence and everyday practice
Most people with POTS are running on too little blood. This piece covers the physiology, what the major cardiology guidelines recommend, how to raise intake practically, and ten high-sodium recipes for real-food eating.
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POTS and IST: what's the difference, does it matter, and how do you tell?
POTS and inappropriate sinus tachycardia share many symptoms and can coexist, especially in post-viral presentations. This piece covers what each condition is, how to tell them apart, and what the distinction means for treatment.
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New daily persistent headache: the complete patient guide (UK-focus)
NDPH is one of the most treatment-resistant headache conditions: daily from the start, often post-viral, and poorly understood by most GPs. A complete UK patient guide covering diagnosis, treatments, NHS navigation, and the connection to post-viral syndrome.
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Low-dose naltrexone for long COVID: microglia and the evidence
What the evidence says about low-dose naltrexone, microglial activation and neuroinflammation in post-viral illness and long COVID: proposed mechanisms, the human trial data so far, and what remains uncertain.
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Pyridostigmine for POTS and ME/CFS: what the evidence says
Pyridostigmine is the only POTS medication with RCT evidence for improving exercise capacity in ME/CFS. This is how it works, what the key studies show, and how it compares to ivabradine.
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Amitriptyline, propranolol, and candesartan for chronic headache: evidence and trade-offs when autonomic dysfunction complicates the picture
For someone with both chronic daily headache and autonomic dysfunction, the choice of headache preventive matters more than usual. A review of the evidence and autonomic trade-offs for each option.
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What a CPET shows and why it matters
A cardiopulmonary exercise test is the gold standard for unexplained exercise intolerance. This is what it measures, what patterns it reveals in post-viral conditions, and why it matters for management.
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POTS diagnosis: 30 bpm increase within 10 minutes of standing
The criterion for diagnosing POTS in adults is a sustained heart rate increase of 30 bpm (or 40 in adolescents) within 10 minutes of standing, without a drop in blood pressure. What the threshold means, where it comes from, and its limits.
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Post-exertional malaise: what it is and why pushing through makes it worse
Post-exertional malaise is the defining feature of ME/CFS and one of the most common features of long COVID. This piece explains what it is, why graded exercise therapy causes harm, and what pacing actually means in practice.
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Breathing pattern disorder vs autonomic breathlessness: how to tell the difference
If you have post-viral breathlessness with normal lung function tests, someone will likely suggest breathing pattern disorder. This piece examines how to distinguish it from autonomic breathlessness, and why the distinction matters for treatment.
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Salt, water, compression, and electrolytes: what the evidence says
These four interventions are universally recommended as first-line management for POTS. The evidence behind each, what it actually shows, and the honest limits of what it can tell us.
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HRV as a tracking metric: what it tells you and what it doesn't
An accessible review of what heart rate variability actually measures, why it's relevant to dysautonomia and post-viral conditions, and the limits of using it as a personal tracking tool.
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Long COVID, ME/CFS, POTS, dysautonomia, post-viral syndrome: making sense of overlapping conditions
A guide to the confusing set of overlapping terms used to describe post-viral illness, how they relate to each other, and why the features matter more than the labels.
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What's actually going on: a plain-language guide to post-viral autonomic dysfunction
If you've developed unexplained fatigue, a racing heart, breathlessness, or exercise intolerance after a viral illness, and your blood tests keep coming back normal, this is an attempt to explain what might be happening.