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I want to thank Dr. Bolognese for answering extra questions this month. He

rarely has extra time on his hands, and he took some of that extra time to

help us out.

For past questions and answers you can find them on our website at:

http://www.chiariconnectioninternational.com/doctor.php

This question came across the board this past month:

I have heard some people talk about having Autonomic

Failure.....from what I have read/heard about, it has a

lot to do with POTS. I also thought POTS was involved

with Chiari and Instability issues.....at NSUH

told me that the fusion usually helps the POTS.

But then I've heard from people on the boards that say

that POTS and Autonomic Failure are related to EDS and

have nothing to do with ACM/CCI. I didn't think that POTS

was caused by EDS????? Do you know the answer to this?

Dr. Bolognese's response:

POTS and autonomic failure (AF) can occur along with a number of disorders

including EDS, CMI, and craniocervical instability

Different disorders can cause POTS and AF by different mechanisms

Some disorders like EDS can cause POTS and AF with more than one mechanism

Poor sympathetic tone, suboptimal vascular constriction, impaired

neurovegetative reflexes are treated conservatively

Other mechanisms can be treated surgically; the best example is when the tip

of the odontoid compresses the part of the brainstem called medulla (where

an important nucleus devoted to the regulation of the overall vascular tone

is located, along with circuitry controlling the heart rate); if cervical

extraction can reverse such compression, then a craniocervical fusion can

help

About these special cases, TCI has treated over the years a number of

patients who could not get up from their own beds for more than a few

minutes at the time, and now can stand and go around for up to 6 hours at a

time

Thanks again for all of the doctors help with our never ending list of

questions.