References

Boris, J. (2015, December 22). [Telephone interview by the author].

Create a graph. (n.d.). Retrieved May 31, 2016, from NCES Website:
https://nces.ed.gov/nceskids/createagraph/default.aspx?ID=
Florinef. (2016). Retrieved May 31, 2016, from WebMD website:
http://www.webmd.com/drugs/2/drug-6801/florinef-oral/details
Kizilbash, S. J., Ahrens, S. P., Bruce, B. K., Chelimsky, G., Driscoll, S. W., Harbeck-Weber,
C., . . . Fischer, P. R. (2014). Adolescent fatigue, POTS, and recovery: A guide for
clinicians [.pdf]. Department of Pediatric and Adolescent Medicine, Mayo Clinic.
This paper, written by a number of physicians in the pediatric field including lead
author Dr. Sarah Kizilbash, explores the relationship between adolescent fatigue and
autonomic dysfunction, specifically links between adolescent fatigue and the
presentation of Postural Orthostatic Tachycardia Syndrome (POTS). The authors begin
the article by describing the definition, prevalence, factors relating to, and the effects
of adolescent fatigue. The authors then describe how chronic fatigue should be
diagnosed in adolescents, writing that physicians must conduct a thorough physical
examination as well as consult past medical records of a patient in order to try and
pinpoint the underlying cause of the fatigue. The authors write that specific screening
tests may be necessary to diagnose chronic fatigue or types of autonomic dysfunction
that often accompany chronic fatigue, such as POTS. Background information on
POTS is then presented by the authors, including information related to the definition
of POTS, the typical presentation of POTS, the physical and psychological features of
POTS,the cardiovascular physiology of POTS, and possible causes of POTS, among
other topics. Potential treatment methods for adolescent POTS are then delineated.
The paper was published within the last five years, specifically in 2014, which
makes it a relevant source in the medical field. Fourteen medical professionals are
credited as authors of this paper: twelve of the authors have at least medical degree, a

PhD, or both, and the other two authors are registered nurses. No contact information
was provided with the paper, as it was in the form of a pdf, though the information in
the paper can be verified by checking with the sources listed in the references section
of the paper. The researched information in the paper is presented in an objective and
professional manner, with the authors occasionally inserting their own opinions
regarding the best ways to diagnose chronic fatigue and autonomic dysfunction. The
purpose of writing this paper was to communicate to the medical community the links
between fatigue and conditions of autonomic dysfunction, specifically POTS. The
authors' intended audience is the medical community, specifically those physicians
who treat pediatric patients that seem to present with chronic fatigue and/or autonomic
dysfunction.
Le Gras, M. (2013). Overview of POTS syndrome. Retrieved December 13, 2015, from Pediatric
Cardiology Center of Oregon website: http://www.pccoforegon.com/blog/overview-ofpots-syndrome
In this handout written by Dr. Marc Le Gras, Le Gras details basic background
information pertaining to Postural Orthostatic Tachycardia Syndrome (POTS). He
provides the definition of this syndrome for both pediatric and adult forms, describes
potential causes of the syndrome in children, and also details symptoms that typically
accompany POTS. Le Gras concludes the handout by describing many nonpharmacological treatments for the syndrome including increasing blood flow,
increasing fluid intake, participating in regular physical exercise, maintaining a
consistent and healthy sleep schedule, wearing compression garments, avoiding
overheating, avoiding triggers, and increasing body weight. A thorough list of the
common medications used to treat POTS is also included at the conclusion of the
handout.

This article was last copyrighted in 2013, making it a relevant and relatively
current source in the medical field. The author, Dr. Marc Le Gras, is an accomplished
pediatric cardiologist for the Pediatric Cardiology Center in Oregon. He has a lot of
experience with treating patients with POTS, and he mentions throughout the article
what he does to assess patients and how he designs treatment plans for them. Though
the article does not provide specific contact information for the author himself, the
article was published by Le Grass place of employment and a contact phone number
is listed on the website the Pediatric Cardiology Center of Oregon. Dr. Le Gras
presents the information in this handout in a very objective manner. He occasionally
speaks in the first person, but only to describe how he interacts with POTS patients.
This handout is meant to be read by those who have POTS to learn background
information about their condition, and Le Gras effectively addresses this audience by
putting the information in simple enough terms and clearly describing how he handles
the diagnosis and treatment of POTS in patients that he has seen himself.
LeTellier, L. (2016). [Results of pediatric POTS treatment methods questionnaire]. Raw data in
preparation.
Levine, B. D., Fu, Q., VanGundy, T. B., Galbreath, M. M., Shibata, S., Jain, M., . . . Bhella, P. S.
(2010). Cardiac origins of postural orthostatic tachycardia syndrome. Journal of the
American College of Cardiology, 55(25), 2858-2868.
In this journal article, the authors, including lead doctor Dr. Benjamin Levine, describe
an experiment they conducted pertaining to the cardiac origins of Postural Orthostatic
Tachycardia Syndrome (POTS) as well as the effectiveness of exercise as a treatment
for POTS. The researchers had hypothesized that having a small-sized heart as well as
reduced blood volume could contribute to the occurrence of POTS, and they also
hypothesized that POTS could be effectively treated with exercise. The authors went

on the explain their methods: voluntary participants went through a series of different
tests before they were permitted to participate in the study, and the study then
consisted of participating in a planned exercise program for three months in a
controlled environment. After the three-month program, many of the participants
could not even be qualified as POTS patients anymore and each of the other
participants had an increase in their quality of life regardless of how effective the
program was for treating their POTS. All elements of the researchers hypothesis were
confirmed, and they now suggest that POTS can also be referred to as Grinch
syndrome because the Grinch in Dr. Seusss How the Grinch Stole Christmas had a
heart that was too small, like many POTS patients.
This article was published in 2010, but it can still be considered a relevant
medical source because it documents the only formal experiment that has been
conducted regarding the effectiveness of exercise as a treatment for POTS. Several
medical professionals are classified as authors on the article, with Dr. Benjamin D.
Levine being the lead doctor for the experiment.
No contact information was provided for any of the authors as this article was
published in a formal scholarly journal, the Journal of the American College of
Cardiology. The authors credited each of their sources at the conclusion of the article.
Despite the moderate amount of advanced medical terminology, this article could be at
least relatively understood by most readers. Other than the mention of a potential new
name for POTS, the authors present the information objectively and without any
inappropriate insertions of their own opinions. The authors purpose for writing this
article was to communicate the results of their study to the medical community.

Mayo Clinic Staff. (2016). Cognitive behavioral therapy. Retrieved May 31, 2016, from Mayo
Clinic website: http://www.mayoclinic.org/tests-procedures/cognitive-behavioraltherapy/home/ovc-20186868
POTS: What helps. (2013). Retrieved February 22, 2016, from Dysautonomia International
Website: http://www.dinet.org/index.php/information-resources/pots-place/pots-whathelps
This article on the Dysautonomia Information Network website presents
information on the various treatment methods that are used to treat general cases of
Postural Orthostatic Tachycardia Syndrome (POTS). The article first delineates
numerous pharmacological methods that are used to treat POTS. Medications like
Benzodiazepines and Beta Blockers are listed amongst various others. The author then
describes several non-pharmacological treatment methods that are used to treat POTS.
This list includes treatments such as making dietary changes, using cooling devices,
wearing compression garments, and increasing salt and fluid intake.
This article was last copyrighted within the last five years, specifically in 2013,
which makes it a relevant source in the field of medicine. Though no specific author is
credited with writing this article, it comes from the website of the Dysautonomia
Information Network, a nonprofit organization committed to helping those with
autonomic dysfunction to understand and to cope with their conditions. Contact
information for the directors of the organization can be found elsewhere on the
website, which would allow the reader to verify the information in the article. The
information could also be verified if one were to look into the extensive list of
references provided at the end of the article. The information in this article was
presented in an objective, factual manner. The purpose of the article was to inform
those who suffer from POTS of the many different treatment methods that are used to

treat the syndrome. Hence, the intended audience of this article was POTS patients of
no specific age.
PT for POTS. (2014, July 9). Retrieved April 7, 2016, from Johns Hopkins Children's Center
website: https://www.hopkinschildrens.org/pt-for-pots.aspx
Raj, S. R. (2013). Postural tachycardia syndrome (POTS). Retrieved December 13, 2015, from
American Heart Association website:
http://circ.ahajournals.org/content/127/23/2336.long
In this article, Dr. Satish R. Raj details basic background information regarding
Postural Orthostatic Tachycardia Syndrome (POTS), as well as describes the
experiences of a specific patient who lives with POTS. Raj begins the article by
describing the patient involved in his study and providing information regarding some
of the patients medical history before she was diagnosed with POTS. Raj goes on to
detail the process of blood circulation that occurs when a healthy person without
POTS assumes an upright posture, and he compares this process to that of a person
who has POTS. He briefly discusses how POTS is diagnosed and the symptoms that
are associated with it, and goes on to describe its pathophysiology, how POTS patients
are evaluated, nonpharmacological treatments for POTS, pharmacological treatments
for POTS, and concludes with a very basic overview of definition of the syndrome.
This article was published in 2013, making it a relevant source in the field of
medicine. The author, Dr. Satish R. Raj, works for the Autonomic Dysfunction Center,
Division of Clinical Pharmacology, Departments of Medicine and Pharmacology, at
Vanderbilt University in Nashville, TN. He provides both his email address and the
address of his place of employment under his name at the start of the article, which
allows for readers to contact him if they have questions, comments, or concerns about
the article. The information is presented in a very objective manner without any
insertions of the authors opinions, and Raj provides a lengthy list of references at the

close of the article. Though it contains some advanced medical terminology, the article
is relatively easy for anyone to follow and it could be understood by a wide audience.
The purpose of this article was to present a summary of background information for
POTS to the medical community and the general public.
Serani, D. (2011, February 22). Acceptance and commitment therapy. Retrieved May 31, 2016,
from Psychology Today website: https://www.psychologytoday.com/blog/two-takesdepression/201102/acceptance-and-commitment-therapy
Singer, W., Sletten, D. M., Opfer-Gehrking, T. L., Brands, C. K., Fischer, P. R., & Low, P. A.
(2012). Postural orthostatic tachycardia syndrome in children and adolescents: What is
abnormal? Journal of Pediatrics, 160(2), 222-226. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258321/
This scholarly journal article was written by six medical professionals to
analyze whether or not methods used for diagnosing adults with Postural Orthostatic
Tachycardia Syndrome (POTS) are appropriate to use when attempting to diagnose
pediatric cases of POTS. The authors describe the methods, data analysis, results, and
discussion points of their study within the article. The study they conducted involved
participants under twenty years of age. The participants underwent standard autonomic
testing, including a tilt table test, and the researchers recorded orthostatic symptoms
(heart rate and heart rate response) that presented in the patients during testing. The
researchers found that orthostatic intolerance presents a bit differently in pediatric
patients, as POTS is characterized by various increases in heart rate after one stands up
depending on his or her age, so pediatric cases of POTS using different diagnostic
criteria than that of adults. The authors end the article by setting forth their suggestion
for diagnostic criteria for pediatric POTS.
This article was published within the last five years, specifically in February
2013, which makes it a relevant source in the field of medicine. Four of the six authors
of the articles have medical degrees, making them well-qualified to write an article of

this nature. Contact information is provided for one of the authors, Dr. Philip Low,
including information regarding his place of employment, his business address, and
his e-mail address. Readers could verify the information in the article by contacting
Dr. Low, or they could check the information by looking into one of the sources
delineated in the list of references provided at the end of the article. The information in
the article was presented in an objective and factual manner. The intended audience of
the article would be medical professionals who work to diagnose and treat pediatric
cases of POTS. The language and terminology used in the article is very advanced, so
the information in the article would be best understood by someone with a higher
degree of expertise on the subject. The authors' purpose of writing this article was to
inform medical professionals of the results of their study and to set forth a suggestion
of diagnostic criteria that should be used when diagnosing POTS in pediatric or
adolescent patients.
Tilt table test. (2015, March 24). Retrieved March 13, 2016, from Mayo Clinic website:
http://www.mayoclinic.org/tests-procedures/tilt-table-test/basics/definition/prc-20019879