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How is PoTS Diagnosed?

Detailed questioning of the patient is the key to accurate diagnosis. Physical examination and appropriate investigations are also important. Other causes of symptoms need to be considered and identified.

Patients are usually diagnosed by a cardiologist, neurologist or medicine for the elderly consultant.

To be given a diagnosis of PoTS, a person needs to have:

  • A sustained increase in heart rate of greater than 30 beats per minute within 10 minutes of standing
  • Those aged 12-19 years require an increase of at least 40 beats per minute
  • These criteria may not apply to those with a low heart rate when resting
  • There is usually no drop in blood pressure on standing

Investigations

It may be necessary for patients to have some or all of the tests below

Electrocardiography (ECG)

An ECG is performed to rule out any heart problems that may cause symptoms similar to those found in PoTS.

The Active Stand Test

The active stand test can be used to diagnose PoTS. Under careful supervision, heart rate and blood pressure are measured after resting lying down, then immediately upon standing and after 2, 5 and 10 minutes. This test may bring on symptoms of PoTS and some people may faint.

Head-Up Tilt Table Test

This involves lying on a table that can be tilted to an angle of 60 to 70 degrees in a quiet, dimly lit, temperature controlled room. Blood pressure and heart rate are recorded in a continuous manner. After a period of 5 to 20 minutes of lying flat, the table is tilted. Although a diagnosis of PoTS should be made by an increase in heart rate of 30 bpm within the first 10 minutes, this upright position can last between 10 and 45 minutes. The patient will be asked how they are feeling during the test, so symptoms can be matched with heart rate and blood pressure. The test will end if your blood pressure becomes too low, satisfactory results have been obtained, or the maximum time has elapsed.

If facilities are available, some patients are tilted after a carbohydrate drink (liquid meal challenge), exercise or heat.

24 hour ambulatory blood pressure and heart rate monitor

Sticky patches are applied to the chest and are linked to a little box which is attached by a belt your waist. It monitors heart rate over a 24 hour period. A blood pressure cuff on your arm will intermittently check your blood pressure. The patient is asked to go about their usual daily activities, trying to reproduce events that seem to cause the symptoms. A diary stating the time and activity performed at the moment when the symptoms started should be kept. Doctors look to see if there is a fast heart rate or drop in blood pressure at the time of symptoms.

Echocardiogram (Heart Ultrasound)

This test is to check if the heart’s structure is normal. In this test a technician will apply some jelly on the chest and will roll an ultrasound probe in many directions to create a 3 dimensional image of the heart. It is a painless and harmless test that similar to the ultrasound scan used routinely during pregnancy to look at the unborn baby.

24-hour Urine Collection

Individuals with PoTS often have low urinary sodium levels of less than 150 millimole per 24 hours.

Another 24 hour urine collection may be carried out to test for high levels of noradrenaline and epinephrine to rule out pheochromocytoma (a growth on the adrenal gland) as a possible cause of symptoms.

Blood tests

Bloods are taken to rule out other conditions. These may include:

  • Kidney function
  • Blood count including ferritin
  • Liver tests
  • Thyroid tests
  • Calcium levels
  • Glucose

Blood can also be taken for norepinephrine whilst lying and then standing (or when upright on the tilt table); if levels exceed 600 picogram/millilitre, it may suggest hyperadrenergic PoTS.

Other tests which may be carried out

  • EEG
  • Autonomic function screening tests
  • Sweat testing

Written by: PoTS UK Team
Medically approved by: Dr John Purvis and Dr Satish Raj
Updated:1/2/15
review date: 1/2/18
version 4

Providing information and support about postural orthostatic tachycardia syndrome (PoTS) for sufferers, medical professionals, family, and friends – aiming to raise awareness.

Are At-Home Drug Tests Accurate?

Wednesday February 21, 2018

E ven though more Americans than ever have access to legal cannabis, many people still have to take a drug test as a stipulation for employment, and in some states, as a prerequisite to receive state assistance like food stamps and unemployment benefits.

At-home drug tests are easy to find in both drug stores and online. And they are affordable, too, costing anywhere from $5 to $30. But if failing a drug screening causes a loss of work and benefits, should you really rely on the results of a cheap test? Let’s take a closer look.

Cannabis and Body Fat: What’s the Deal?

Most people who must consent to a drug screening are concerned about testing positive for cannabis, and for good reason. Cannabis’ metabolite, THC-COOH, can remain in the body for a while, depending on several factors.

THC-COOH gets stored in body fat and how long it stays in the body depends on body fat percentage. THC metabolites dissolve in lipids and fats, so, the more fat you have, the more cannabis will accumulate, thereby extending elimination time.

For more information on how to flush marijuana out of your system, click here. To purchase products to help pass a drug test, click here.

How much metabolite remains in your system depends on how frequently cannabis has been used, what kind, and how much was ingested. Therefore, if someone who smokes one or two joints a day and has a higher percentage of body fat than someone who uses at the same rate but has less body fat, it will take a longer time for the person with a higher body fat percentage to eliminate THC-COOH from their body.

And, even if a person has a thin physique, they could still be “skinny fat,” meaning that their weight and BMI may be normal, but the ratio of fat to muscle is unhealthy. Even thin people aren’t off the hook.

Another thing to keep in mind is how THC metabolizes in the body. It metabolizes in the liver and is regulated by a different set of enzymes than those that regulate fat metabolism. So, if you have a speedy metabolism, nice work! Just remember that it won’t help to get rid of THC-COOH any quicker.

Types of Drug Tests

There are a few different ways to test for drugs: saliva/oral fluid tests, urine tests, blood tests, and hair.

Saliva/oral fluid tests have the shortest window of detection, or the amount of time a drug can be detected. Because it has a small window, these tests are not used very often.

Urine tests are so widely used that 90 percent of the 55 million drug tests administered in 2015 were urine tests. They are more accurate than saliva/oral test while still being affordable. Urine tests also have a longer window of detection.

Hair tests can detect a history of drug use and have the longest window of detection. For example, if cannabis was used for a period of time, abstained from, then restarted, a hair test would show that. But, they can sometimes be incorrect because of contaminants like dust.

Blood tests can measure the amount of drug in the system and also detect impairment as well. These tests are especially difficult to pass for heavy cannabis consumers because cannabis metabolites can be detected for longer periods of time than other testing methods.

Should I Try That At-Home Drug Test?

Maybe. These tests are generally pretty sensitive to the presence of drugs, so a positive result is definitely an indication that a lab test would show a positive, too. However, at-home drug tests are easy to mess up, and external factors can change the accuracy. Here are some things to keep in mind:

External Factors:

  • Was the collection done during the window of detection?
  • Are there any other medicines present in the body that may affect test outcome?
  • Is the sample free from contaminants?
  • Is the urine the right temperature (between 96-99 degrees Fahrenheit)

It’s also important not to get too excited if the test shows negative. Occasionally, a test can show a negative result because it has passed its expiration date, or the test detection chemicals are not working properly.

Ultimately, relying on an at-home drug test is probably not the most accurate plan if you need to pass a drug test with heavy implications on the line.

Still, it may be worth it to pick up several different ones to get a general feel for if you might pass or fail your upcoming test.

What if My Drug Test is Next Week?

If failing a drug test is not an option for you, then the first step is to try to reschedule the test for later. Barring that, there are some strategies.

Quick Tips:

  • Find out what kind of test will be used. Knowing which test can help hatch a plan
  • Stop using cannabis immediately, consuming more will only harm your chances of passing
  • Hit the gym. Lowering body fat will help free those cannabis metabolites. But be sure to back off the exercise routine about 24 hours before the test to slow down metabolite release
  • Watch those calories. Diet and exercise go hand-in-hand, and creating a daily calorie deficit can add up to a larger reduction of body fat
  • Drink lots of water. The goal with a urine test is to get a value of less than 50 ng/ml, so diluting urine with water may work. But, testing labs look out for diluted urine, so up your B Vitamins and Creatinine

Still failing that at-home test? Plan b!

Alternative Ways to Pass:

  • Fake urine is actually a thing. A powdered human urine kit comes with drug-free product, a 50 ml vial, a heater and temperature strip to ensure the proper temperature. This will only work, though, if you are unmonitored during the test
  • During the test, try to give the middle of your stream as the sample, not the beginning or end, since most metabolites are present in the beginning and end of the stream. And don’t give morning urine, which will have the highest presence of metabolites

Have a hair test coming up? Keep these ideas in mind!

Key Hair Test Info:

  • Shaving your entire body to avoid submitting a sample will definitely arouse suspicion, but sites like TestClear have a lot of options, including a shampoo, that may work
  • Remember, hair tests can be thrown off by contaminants. Figuring out a way to muddle the sample could be an option, but it’s no guarantee

The Future of Cannabis and Drug Tests

Until testing for cannabis as a condition of employment or other benefits is a thing of the past, a long-term plan for cannabis consumption and potential testing will help you avoid detection.

And as more and more states adopt progressive cannabis laws, it’s not uncanny to think we’ll begin seeing laws change around consumption on personal time.

Recently, Maine approved a law prohibiting employers from discriminating against employees for their cannabis use outside of work.

While employers in Maine still maintain the right to prohibit cannabis use and possession in the workplace and can still discipline employees for being high at work, this law marks the first time in United States history that protects off-site marijuana use outside of work.

Hopefully more states will catch on and start creating similar laws. Until then, keep the tips above in mind if you’re getting drug tested!

Have you tried an at-home drug test before? What was your experience like? Comment below!

Erin Hiatt is a New York City-based writer who has been covering the cannabis industry for more than six years. Her work – which has appeared in Hemp Connoisseur Magazine, PotGuide, Civilized, Vice, Freedom Leaf, MERRY JANE, Alternet, and CannaInvestor – covers a broad range of topics, including cannabis policy and law, CBD, hemp law and applications, science and technology, beauty, and psychedelics.

Many people who need to pass a drug test use at-home tests to see if they will pass or fail. But are at-home drug tests accurate? ]]>