In this enlightening episode, Dr. Sanjay Gupta shares his profound insights into the world of medicine, focusing on empathy, patient care, and the challenges faced by those with conditions like POTS and dysautonomia. The discussion highlights the importance of listening to patients and the transformative power of empathy in the healing process.

💡 Dr. Gupta explains how listening, validating, and empathizing with patients can be just as important as medical interventions. He also shares his clinical experience with methylene blue in sepsis and cardiogenic shock, discussing its off-label potential.

Key Topics You'll Discover with Dr. Sanjay Gupta

① Empathy in Medicine:
👉 Dr. Gupta emphasizes the critical role of empathy as a healing tool in medicine. He discusses how empathy can help alleviate the shame patients often feel and how it is essential for doctors to avoid adding to this shame.

② Patient Advocacy:
👉 The conversation touches on the importance of advocacy in patient care. Dr. Gupta explains that patients often seek medical help not just for access to medications but also for advocacy, which validates their experiences and gives them confidence.

③ Innovative Treatments:
👉 Dr. Gupta shares his experiences with using methylene blue in small doses for conditions like sepsis and cardiogenic shock, noting its potential benefits despite being an off-label use.

④ Post-Viral Conditions:
👉 The episode explores the connection between infections and post-viral conditions, such as dysautonomia, especially in the context of long COVID. Dr. Gupta discusses the historical context and current understanding of these conditions.

⑤ Holistic Care Approach:
👉 Dr. Gupta talks about his YouTube channel, “York Cardiology,” where he focuses on the importance of empathy, listening, and sharing as part of providing holistic care.

What You’ll Take Away from Dr. Sanjay Gupta

📌 Empathy is a powerful tool in medicine that can significantly impact patient healing and well-being.
📌 Advocacy and validation are crucial components of patient care, helping patients feel supported and understood.
📌 Exploring innovative and off-label treatments can offer new hope for patients with challenging conditions.
📌 Understanding the historical and current perspectives on post-viral conditions can enhance patient care strategies.

A holistic approach that includes empathy and listening is essential for effective medical practice.

Dr. Sanjay Gupta

Dr. Sanjay Gupta is a Consultant Cardiologist at York Hospital and an internationally respected advocate for preventative, patient-empowering healthcare. With a focus on lifestyle medicine and clear, jargon-free education, Dr. Gupta challenges the conventional model of disease management that relies heavily on medication. He believes in treating the root causes of illness rather than masking symptoms, and is passionate about helping people live fearlessly by taking control of their own health.

Through his widely followed online platforms, Dr. Gupta shares reliable, evidence-based medical information in an empathetic, accessible way—empowering patients around the world to make informed decisions and improve their quality of life. His mission is simple: to replace fear and confusion with clarity, confidence, and compassion in healthcare.

https://yorkcardiology.co.uk/
https://www.youtube.com/@YorkCardiology

Dr. Jill Carnahan, MD

Dr. Jill Carnahan is Your Functional Medicine Expert® dually board certified in Family Medicine for ten years and in Integrative Holistic Medicine since 2015. She is the Medical Director of Flatiron Functional Medicine, a widely sought-after practice with a broad range of clinical services including functional medical protocols, nutritional consultations, chiropractic therapy, naturopathic medicine, acupuncture, and massage therapy.

As a survivor of breast cancer, Crohn’s disease, and toxic mold illness she brings a unique perspective to treating patients in the midst of complex and chronic illness. Her clinic specializes in searching for the underlying triggers that contribute to illness through cutting-edge lab testing and tailoring the intervention to specific needs. 

A popular inspirational speaker and prolific writer, she shares her knowledge of hope, health, and healing live on stage and through newsletters, articles, books, and social media posts! People relate to Dr. Jill’s science-backed opinions delivered with authenticity, love and humor. She is known for inspiring her audience to thrive even in the midst of difficulties.

Featured in Shape Magazine, Parade, Forbes, MindBodyGreen, First for Women, Townsend Newsletter, and The Huffington Post as well as seen on NBC News and Health segments with Joan Lunden, Dr. Jill is a media must-have. Her YouTube channel and podcast features live interviews with the healthcare world’s most respected names. 

The Podcast with Dr. Sanjay Gupta

The Video with Dr. Sanjay Gupta

The Transcript – Overview

Overview

• Dr. Sanjay Gupta emphasizes the importance of patient-centered care, advocating for lifestyle medicine over conventional medication-heavy approaches in treating chronic conditions such as POTS.
• The common symptoms of POTS, including tachycardia and non-refreshing sleep, primarily affect young, previously healthy females, often triggered by infections like COVID.
• Dr. Gupta highlights the issue of patients accumulating multiple labels that hinder treatment progress, making them “invisible” to healthcare providers unaccustomed to complex cases.
• Genetic predispositions, such as joint hypermobility syndrome, are frequently associated with dysautonomia, indicating a need for holistic patient assessments.
• Gupta's diagnostic philosophy prioritizes patient narratives over test results, focusing on the quality of life rather than merely life-threatening conditions.
• The four-pillar treatment approach for POTS patients includes lifestyle modifications, physiotherapy, medications, and advocacy, aiming for substantial improvements over time.
• Medications like Ivabradine are vital for managing POTS symptoms effectively, demonstrating targeted interventions can bridge to longer-term solutions through physiotherapy.
• Intravenous saline has shown dramatic, short-term improvements in POTS patients, illustrating the potential for significant life quality enhancements with proper treatments.
• The discussion underscores the historical context of post-viral dysautonomia, linking it to current conditions like Long COVID as a significant healthcare challenge.
• Empathy, according to Dr. Gupta, is the cornerstone of healing; it helps address patient shame and fosters

Notes

• Host Introduction and Background (00:01 – 01:21)
• Dr. Jill introduces Resiliency Radio podcast focused on integrative and functional medicine
• Dr. Jill promotes her product store at doctorjillhealth.com featuring Biopeptide Beauty Cream and specialized bundles for mast cell activation, Epstein-Barr, and SIBO treatments

👨‍⚕️ Guest Introduction and Professional Background (01:21 – 02:36)

• Dr. Sanjay Gupta introduced as consultant cardiologist at York Hospital and advocate for preventative patient-empowered healthcare
• Dr. Gupta specializes in lifestyle medicine and challenges conventional disease management models that rely heavily on medication

🩺 Dr. Gupta's Journey into POTS/Dysautonomia (02:36 – 04:13)

• Dr. Gupta's entry into POTS specialty began with his inability to cut patients off during consultations, leading to discovery of patterns in complex patient stories
• Recognition that marginalized patients with complex labels were saying similar things, indicating real underlying conditions
• Philosophy that patients don't need to prove worthiness to doctors – empathy and listening are fundamental medical tools

📖 POTS Definition and Patient Experience (07:18 – 08:37)

• Medical textbook definition: excessive heart rate surge when standing up, which Dr. Gupta calls ‘dishonest' as it merely restates patient symptoms
• Real patient experience includes: inability to stand upright for prolonged periods, racing heart, severe brain fog, chronic fatigue, temperature dysregulation, headaches, gut motility issues, non-refreshing sleep
• Patients typically young, generally healthy, with symptoms often triggered by infections like glandular fever, COVID, or COVID vaccine

👩‍⚕️ Typical Patient Presentation (09:47 – 11:16)

• Demographics: Generally female patients (though males affected), typically young and previously healthy
• Symptom onset: Usually begins during puberty, worsens significantly after infections
• Core symptoms: Orthostatic intolerance, tachycardia, trembling legs, dizziness, severe fatigue, brain fog, temperature dysregulation, gut issues, non-refreshing sleep, headaches
• Additional symptoms: Heat intolerance, inability to stand still, coat hanger pain, joint pains, bladder symptoms, chest pain, breathlessness

🏥 Healthcare System Challenges (14:06 – 16:45)

• Patients accumulate multiple labels (POTS, IBS, chronic fatigue syndrome, functional neurological disorder) that don't advance treatment
• Labels create bias among healthcare providers who haven't seen the patient previously
• Patients become ‘invisible' not because of their condition but because healthcare professionals choose to be blind

🧬 Genetic Predisposition and Comorbidities (18:28 – 19:32)

• Common genetic vulnerability: joint hypermobility syndrome or Ehlers-Danlos syndrome
• Patients experience ‘too much flight and fight, too little rest and digest' – always wired and tired
• Mast cell issues commonly co-occur with dysautonomia conditions

💊 Dr. Gupta's Diagnostic and Treatment Philosophy (19:32 – 22:25)

• Emphasizes treating the patient, not the condition or test results
• Minimal testing approach – story is sufficient for diagnosis
• Test results shouldn't invalidate patient experience
• Focus on quality of life improvement rather than life-threatening conditions

🛠️ Four-Pillar Treatment Approach (25:11 – 28:14)

• Pillar 1: Lifestyle Changes (5-10% improvement maximum): 3-4 liters water daily, 6-10 grams salt daily, electrolyte supplementation, low-carb diet, compression garments
• Pillar 2: Physiotherapy – gentle, recumbent exercises to strengthen lower limbs and combat deconditioning
• Pillar 3: Medications – bridge to physiotherapy destination using off-label medications
• Pillar 4: Advocacy – supporting patients against gaslighting, providing documentation for schools/employers

💉 Medication Protocol (30:52 – 36:03)

• Ivabradine (Procoralan): First-line medication to lower heart rate without affecting blood pressure – most responsive medication
• Midodrine: Vasoconstrictor to push more blood to brain, like internal compression garments
• Mestinon (Pyridostigmine): Rest and digest enhancer, improves gut function and reduces hypervigilance
• Additional medications: Low-dose naltrexone (anti-inflammatory for fatigue), Ketotifen (mast cell stabilizer), Desmopressin, Fludrocortisone, Clonidine, Modafinil, ADHD medications

💧 IV Saline Treatment Success (36:03 – 37:20)

• Intravenous saline provides dramatic short-term improvement lasting couple of days
• Case study: Patient receiving weekly IV saline for two years went from suicidal ideation to wanting to see daughters grow up

🦠 Infection Triggers and Post-Viral Dysautonomia (39:38 – 41:10)

• Post-viral dysautonomias documented since Civil War – recruits unable to march after viral infections
• Long COVID patients likely have post-viral dysautonomia rather than separate condition
• Triggers include viruses, major trauma, periods of immobility

🔍 Healthcare System Reform and Discovery (43:41 – 45:01)

• Current medical system restricts innovation by telling doctors where to look and threatening consequences for looking elsewhere
• New discoveries require looking where others haven't been directed to look
• Empathy and curiosity are hallmarks of medical progress

🌐 Dr. Gupta's Resources and Community Building (46:24 – 49:08)

• YouTube channel: ‘Your Cardiology' featuring medical conditions, empathy, and holistic care content
• Website: potspecialist.com with templates for income protection, lifestyle information, and professional partnerships
• Community partnerships: Educational support, free physiotherapy consultations, dietitian access, pharmacy partnerships for affordable medications

🗣️ The Prisoner Story – First Patient Experience (49:08 – 50:58)

• Transformative case: 35-year-old patient with DNR form due to hopelessness from multiple labels and dismissal
• Treatment success: Patient went from suicidal ideation to having a baby, working part-time, helping husband
• Patient's reflection: ‘You've set a prisoner free' – with Dr. Gupta realizing he was also the prisoner

❤️ Empathy as Primary Healing Tool (52:36 – 54:19)

• Shame cannot survive empathy – patients carry shame from inability to contribute and being labeled as time wasters
• Empathy is the greatest healing tool doctors possess

---

Transcript

00:01
Dr. Jill Carnahan
Welcome to Resiliency Radio, your go to podcast for the most cutting edge insights integrative and functional medicine. I'm your host, Dr. Jill and with each episode we dive into the heart of healing and personal transformation. Join me as we interviewed renowned world leaders, thought leaders, medical doctors and people with interesting insights and stories here, hopefully to improve your life, help you with optimal performance and longevity and all things related to functional and integrative medicine. Today you're going to really enjoy our interview with Dr. Gupta who is in the UK. We're going to be talking about pots and dysautonomia and everything to do with this condition that is kind of mysterious that many of my patients have been suffering from and I think you'll really find this information helpful. 

00:50
Dr. Jill Carnahan
I also want to mention, if you haven't yet heard, we have all kinds of specially curated products at our store. It's at doctorjillhealth.com you can find Dr. Jill Beauty Products, especially my favorites, some of which are right here. I often share this at the beginning of the podcast. This is my very favorite Biopeptide beauty Cream, one of my absolute essentials for anti aging. You can find that at Dr. Jill health.com under Dr. Jill Favorites or the Biopeptide Beauty Cream and many other products and things. If you're looking for something specific for mass cell activation, we have our Mast cell bundle, we have our Epstein Bar bundle, we have Sibo treatments, the Sibo Trio and many other products and things that can help you live your best life. So ch drjillhealth.com okay, without further ado, let me go ahead and introduce our guest. 

01:42
Dr. Jill Carnahan
My guest is Dr. Sanjay Gupta. He's the consultant cardiologist at York Hospital and an internationally respected advocate for preventing preventative patient empowered healthcare. With a focus on lifestyle medicine and clear jargon free education, Dr. Gupta challenges the conventional model of disease management that relies heavily on medication. He believes in treating the root cause of illness rather than masking symptoms and is passionate about helping people live fearlessly by taking control of your health. Oh, you're going to love this interview. Join me now for Dr. Gupta. Dr. Gupta, it is so nice to officially meet you here. I have seen your work and it's been so profound because you have this incredible expertise in an area where a lot of cardiologists do not understand or talk as deeply as you do. And you also have a great deal of compassion for those suffering from these conditions. 

02:36
Dr. Jill Carnahan
How did you get to be interested more in the POTS world? Dysautonomia and what the work that you do. What's your story? 

02:44
Dr. Sanjay Gupta
Thank you so much for having me. It's a real privilege to be invited to your show. I guess the thing was, when I became a doctor, I was never really very good at anything. The only thing I was good at was I was just nice. And I couldn't cut people off when they started talking, which is probably why I was a little bit late today. So. So. So when someone talks, I just allowed them to talk. And that was it, really. And that wasn't even because I was necessarily very interested in what they were saying. I have to admit that it was just. I was too nice a person to cut them off. And as a consequence, I managed to. I came across a few patients who had these very complex labels, who came across as being very complex. 

03:40
Dr. Sanjay Gupta
And when I allowed them to talk, I was struck by, firstly, how affected they were in terms of their quality of life. But also when you start listening to a bunch of people, they seem to say the same things. So you start recognizing patterns in the story. And when you start recognizing patterns, you say, okay, well, you know, these. A lot of these patients, unfortunately, are sort of marginalized and stigmatized and made to feel that they're a bit mad. But then you start saying, well, why is everyone else, you know, why are so many people saying the same things? And the more you listen to them, the more you can't help but empathize with what they're experiencing. 

04:25
Dr. Sanjay Gupta
But also the more you start realizing that, hey, you know, maybe there is all that light that we cannot see, you know, and maybe we need to become more aware of its existence. And perhaps that is the only way we are going to try and address this unmet need. I think it's very important to understand that as doctors, we don't. We shouldn't focus on treating conditions or test results. We treat patients. And therefore a patient doesn't have to prove their worthiness to me as a doctor. That deal is already done. When they come into the room, they're asking for help. I'm setting myself up for help. So if nothing else, even if I may not have the answers, I should still offer them my empathy, my listening ear. And that is where I got started. 

05:19
Dr. Sanjay Gupta
And slowly and gradually I started realizing that actually what I thought was my weakness, that is just being nice and not wanting to interrupt something, has actually become a strength because I've started identifying so many interesting patterns, which books don't necessarily describe. But the sheer wealth of experience, having listened to so Many people's stories allows you to sort of contribute in trying to work out what may be going on with them. 

05:47
Dr. Jill Carnahan
Oh, Dr. Gupta, you just so articulately really discussed the heart of what medicine should be. Right. Like as healers going into a patient. And I've for so many years always thought I learned so much from my patients if I just shut my mouth and sit there and give them a space to tell their whole story. And you literally just articulated that heart of medicine. And honestly, that's why we go into medicine is to heal and to help. And I think so much of the healing is actually even just listening and giving them that space to share something where maybe someone else would have cut them off. So with this, you have obviously gone deep into and into dysautonomia, neurogenic hypotension, pots, all of these syndromes. 

06:29
Dr. Jill Carnahan
For those who are listening, who maybe don't know what that is, do you want to frame that as far as what is this system and series of symptoms that we have labels for? Kind of give us a framework of what that really means for someone listening that maybe not even know what it is? 

06:43
Dr. Sanjay Gupta
Yeah, I think the first thing is, I mean, the when you read the books, the definitions in the books are very different from the lived experience of the patient. So that's the first thing. So what is. Let me talk you through what is pots. And then what I have come across, so if you look at the textbooks, the man made definition that everyone abides by is that this is a condition that is characterized by an excessive surge in the heart rate when a patient stands up and the patient says they don't like it. And in some ways, if you think about it, that's quite a dishonest diagnosis because it's not really telling you anything more than what the patient has told the doctor. I stand up, my heart goes fast, I don't like it. 

07:28
Dr. Sanjay Gupta
Oh, let's give it a nice fancy name, make it jargonized and make it sound like it's a diagnosis. And then when you start looking further, you find that there are lots of other such diagnoses which don't really mean anything. It's like people saying, I've got fatigue all the time, so, oh, let's just call it chronic fatigue syndrome. I've got neurological symptoms. Oh, well, we can't find anything wrong. You're probably a bit mad. Let's call it fnd or even I've got a bunch of symptoms no one can work out. Let's call it medically Unexplained symptoms. So. So those are the kind of things, right? And. But when you talk to the patients are typically, they will say, I was okay. 

08:12
Dr. Sanjay Gupta
And in my teenage years or after I got an infection like glandular fever, or more recently with COVID and the COVID vaccine, I've started noticing a bunch of different symptoms. One of those symptoms is that I cannot stand upright for a prolonged period of time. The second is my heart races. The third is I have severe brain fog. Like my mind is wading through treacle. I am tired all the time. I have temperature dysregulation. I have headaches. I have gut motility issues. I never wake up feeling refreshed. 

08:46
Dr. Jill Carnahan
Hey, guys, just a quick moment to remind you to hit the subscribe button. If you haven't yet done so, you can hit the bell to be notified of future episodes. We so appreciate all of the over half a million of you who have already subscribed and listened to the show. It helps us to reach more people. Thanks so much. And now back to the episode. So what a great story of how you get into this. One thing I really want to talk about is for those who are just listening and maybe haven't heard your great. 

09:12
Dr. Jill Carnahan
Because you've got a lot of YouTube videos out there, I want to make sure people where to find you at the end of this, but POTs, dysautonomia and all the things that go along with this, a lot of people may not even know what that is, or maybe they're experiencing symptoms and when they hear you talk about it, they will be like, oh, well, that's what my problem is. Do you want to frame a little bit about what that might look like in patients and in the various forms that it can take? 

09:35
Dr. Sanjay Gupta
Yeah. So I think the. The typical patient with a dysautonomia. And I'll try and explain the difference between dysautonomia and POTS as well. The typical patient is generally more like. But there are males affected as well. They tend to be generally healthy and young. And they will describe a bunch of symptoms which are to do with too much adrenaline within the body. So they basically describe things like an inability to stand up for a prolonged period of time. When they stand up, their legs feel trembly, their heart races, they may feel dizzy, they may feel like they want to pass out. They don't like being upright, and they cannot manage being upright for a prolonged period of time. But in addition to that, they will all describe a bunch of other symptoms. Universally severe Fatigue, unexplained fatigue, brain fog, which can be unpredictable. 

10:37
Dr. Sanjay Gupta
Prolonged temperature dysregulation. So one minute they're really hot, another minute they're very cold. There are parts of their body that could be feel very hot, and there are other parts that are freezing. Gut issues. Most of them will describe that their gut just doesn't move. It feels bloated. They get constipated, they may have diarrhea. Often they're diagnosed with irritable bowel syndrome. They will describe lack of refreshing sleep. They can sleep 12 hours and wake up like they haven't slept at all. They will describe headaches right the front, like a pressure. They don't tolerate heat well. They feel much worse around heat. In heat. They don't tolerate standing still. They feel better if they're fidgeting, but if they stand still, they feel like they're going to pass out. They're worse in women, certainly around their periods. 

11:33
Dr. Sanjay Gupta
They may describe joint pains, coat hanger pain around the neck and shoulders. They may describe the fact that their legs feel like lead when they're standing up for a prolonged period of time. They'll describe heart palpitations where the heart is racing out of their chest. When they stand up, they may get chest pain, they may get breathlessness, they may even have bladder symptoms. So the typical patient would be generally women. But there are men affected as well. They would normally start noticing some symptoms during puberty, and then they will have glandular fever or Covid or the vaccine and suddenly find that everything becomes so much worse, to the point that they find that they become more and more limited in terms of what they can do. They tend to avoid standing up because they tend to avoid standing up. 

12:30
Dr. Sanjay Gupta
They become more deconditioned because they become more deconditioned. They feel worse because they feel worse. They become socially isolated. Because they become socially isolated, they get depressed. And when they get depressed, they get pain. And they find themselves in this horrendously vicious cycle. And it is one of those conditions because it tends to affect generally younger, healthier people. The poor patient is viewed with great suspicion because on the outside they look well, yeah. But within themselves, they feel absolutely awful. So because they look okay, everyone seems to think, oh, my God, they're just a little bit sort of weak or, you know, feeble. But actually they're horrendously limited. And that is your typical patient who. This is the patient that we're talking about. Now. The problem is when these patients turn up, they go to their doctor. 

13:30
Dr. Sanjay Gupta
The doctor will Say, okay, you know, let me interest myself in only that one system that interests me. So, for example, the patient says, my heart races crazy fast when I stand up. So the doctor goes, okay, will you go. Go off to see a cardiologist? And the cardiologist will then say, okay, see what happens to your heart when you stand up, what happens to your heartbeat? And the patient will be stood up and their heart rate does go up. This is one of the things that you observe, not necessarily all the time, but it is something you observe. And it's very difficult for anyone to make that up. That that really does happen. So doctors then say, okay, well, we've observed that when you stand up, your heart rate goes very fast. Let's do some tests, some anatomical tests. 

14:17
Dr. Sanjay Gupta
And of course, the anatomical tests come back normal because these are not people who have a structural problem with their heart. They have a imbalance between the amount of adrenaline in their body and the amount of rest and digest hormones in their body. So they're more in flight and fight mode all the time and hardly ever in rest and digest mode. So they are wired and tired. So when the doctor does that, they say, okay, your heart rate does go up, but we've not found a problem, so we'll just give it a name. You know, when you stand up, your heart rate goes fast. You don't like it. Let's jargonize it, call it pots. Right. But that does patients a disservice because it implies that their condition is only one which is off standing up. 

15:03
Dr. Jill Carnahan
Yes. 

15:04
Dr. Sanjay Gupta
And because then there are these textbook definitions made by man. And at that point, man hadn't seen what we're seeing now, particularly after the pandemic, they say, oh, well, if the heart rate doesn't go up every time, well, then you don't have it. Or if the heart. None of that one can't be so rigid. Sometimes people feel okay, sometimes they feel much worse. And it's times of the day people are much worse first thing in the morning, etc. So unfortunately, they get diagnosed with POTS, but then that doesn't capture their gut symptoms. So when they got continues to bother them, they get sent to a gastroenterologist who will then look into the tummy and say, oh, it looks fine. There's nothing on endoscopy, and we'll just call this irritable bowel syndrome. What does that mean? Well, your gut's bad. 

15:49
Dr. Sanjay Gupta
We don't know what it is, so we'll just call it irritable bowel syndrome. And then because these people feel dizzy or, you know, the brain fog. They go to a neurologist and the neurologist will do anatomical test, mri. Oh, it's fine. Well, let's call it functional neurological disorder. And then you go and say, well, I'm tired all the time. Oh, well, you've got chronic fatigue syndrome. So these poor folks get accrue a list of labels. None of those labels are honest labels. None of those labels actually move the patient forward, in fact, hamper their treatment. Because the minute a doctor who doesn't know the patient starts seeing those labels, they automatically formulate a mental image of a mad patient and they spend even less time with that patient. And this is the typical patient. 

16:39
Dr. Sanjay Gupta
So you will find patients who basically say, we have, we are invisible. 

16:45
Dr. Jill Carnahan
Yes. 

16:45
Dr. Sanjay Gupta
And, and they're not invisible. It's just that the healthcare professionals have chosen to be blind. And they describe the same thing, a bunch of different symptoms as a condition that have afflicted them to the point that many are bed bound or housebound for 6, 7, 8 years. List of labels as long as your arm, none of which has moved them forward. And they just sit there. And because the doctors say you're okay, their families stop believing them as well. And it's a horrendous state of affairs for patients they try and disentangle. That can be very difficult. But I think what I would like to say to anyone who is watching is that, you know, whatever you are, it is real, your experience is real. And as doctors, you don't have to prove your worth to me as a patient. 

17:48
Dr. Sanjay Gupta
You don't have to be a patient who fits in a nice box. You know, a good doctor should sit there and build that box around you. The person. 

17:58
Dr. Jill Carnahan
Yeah. 

17:59
Dr. Sanjay Gupta
In partnership with you. And, and so those are the people who have a dysautonomia. And usually this happens in patients who are genetically more vulnerable. So the commonest genetic vulnerability is joint hypermobility syndrome or Ehlers Danlos syndrome. So if you have a patient who has joint hypermobility syndrome, Ehlers Danlos even, and maybe some aren't even diagnosed yet, but you have these symptoms, you know, too much flight and fight, too little rest and digest. You're always wired and tired. You started accruing a bunch of labels and every time you go for help, the doctors just turn a blind eye and tell you everything's okay, you're just a bit anxious, then you probably have this. 

18:40
Dr. Jill Carnahan
Yeah, and what a great thing, like we talked in the beginning is Our job as healers and physicians is really to listen. I just this week in my clinical practice had a young 25 year old with some gut issues that she had been to all the major medical centers in the US and been told, oh, we can't find anything. It turns out, you know, there was some issues going on. And she was so basically gaslit told that this was all in her head. And as she sat with me and I listened and I kind of was able to tell the story back to her of like what I thought was going on. She's in tears because I'm sure you've had this as well. Because I really listened and I, I said, I know what's going on. 

19:14
Dr. Jill Carnahan
This is not in your head, but this is the same with this type of patient. And I see a lot of them. And then there's these things that go together. You mentioned the ers, Danlo, the dysautonomia and whatever form that takes, whether it's normal heart rate with a drop in blood pressure or whether it's the true pots and they're all together. And then I see a lot of them have mast cell issues as well, which I'm sure you've seen those things together. So if you have someone who comes in and tells you their story and this is part of it, what do you do as far as any diagnostics or is it a clinical diagnosis? And then we talk about some of the solutions, of course. 

19:50
Dr. Sanjay Gupta
So the first thing is, I mean, I've got about three or 4,000 patients with this. 

19:55
Dr. Jill Carnahan
Yes. 

19:56
Dr. Sanjay Gupta
So I've spent 10 years of my life just investing in patients with this and I've become very, you know, they're my community. I feel like I'm part of that community. The one thing I would say, so when people come to me and they say, oh, you're a POTS expert and we really need to see a POTS expert because no one is helping us. We've seen so and so and so and so I say to them, the difference between me and the people you have seen is that I don't pretend to understand this condition. 

20:29
Dr. Jill Carnahan
Yes. Yeah. 

20:33
Dr. Sanjay Gupta
I recognize from the lived in experience, having listened to people's stories, as to the sheer vastness of the condition. 

20:43
Dr. Jill Carnahan
Yes. 

20:43
Dr. Sanjay Gupta
And when you take that stance that you don't understand the condition, then you say, I'm not here to treat the condition, I'm here to treat the patient. 

20:54
Dr. Jill Carnahan
Yes. 

20:56
Dr. Sanjay Gupta
And when you do that, then suddenly it becomes a little bit easier because when you go out to treat A condition, you have to go to the textbooks, you have to look for guidelines, what you know. But when you start getting the patient on your side and you say, okay, you know, I don't know, I don't understand it, but I see you. Yes, I hear you, and I'm not going to look away. 

21:21
Dr. Jill Carnahan
Yeah. 

21:24
Dr. Sanjay Gupta
So let's try this and let's try that. So the first thing is I don't do much testing. Yeah, the story is enough because, you know, as you described that, oh, some people have the high heart rate, some people have the blood pressure. The reality is, to my mind, I think you can do the same test on the same patient on two consecutive days and you can get a different response. 

21:47
Dr. Jill Carnahan
And ultimately the thing I was just going to mention is this is very varied depending on heat and hormones. And so I actually wanted to make that point is some days these patients feel great and many days they feel terrible and they won't be able to tell you for sure what the difference was. So I actually love that you said that. Because it doesn't have to be a consistently difficult situation. It can be intermittent. 

22:09
Dr. Sanjay Gupta
Exactly. And you treat the patient again. You know, the patient has come to you, so you listen to them. And so I don't do much testing and I don't think a test result should invalidate the patient's experience of what they're telling you know, because. And there is no good test. You know, the definition is wrong for sure. The definition is inadequate, completely inadequate. There is no good test that reliably excludes that possibility. And so I've always taken the stance that you just go and try some treatment that is the quickest way of getting from A to B. 

22:48
Dr. Jill Carnahan
Yes. 

22:49
Dr. Sanjay Gupta
Right. So. Because a lot of times we'll say, oh, we've got to do this and we've got to measure you. We don't understand the condition. What are we going to doing all these tests? Most of these people have had the thing for seven, eight years. You know, they're generally healthy. They've gone through all the MRIs and endoscopies and everything and no one's found anything. That in itself tells me that I'm not dealing with a life threatening condition. What I'm dealing with is a quality of life affecting condition. And quality of life matters. Quality of life matters the most. So, you know, to be fobbed off by saying, okay, well, whatever you're feeling, it's okay. Doesn't really matter. You're not gonna die. That doesn't that doesn't cut the busted for me. No. 

23:30
Dr. Sanjay Gupta
Because, you know, you have an 18 year old child who you know, I would kill to be 18 and here's a child who's sitting in a wheelchair not being able to go out and be an 18 and that should be heartbreaking for all of us. 

23:45
Dr. Jill Carnahan
Yes. 

23:47
Dr. Sanjay Gupta
And so I just believe the patient, whatever the patient tells me, there is no judgment, there is nothing. You're the patient, you've come to me for help, I'm going to listen to you. And if your story fits that pattern of too much flight and fight, too little rest and digest and you want to get better, let's just go for it. 

24:11
Dr. Jill Carnahan
Yeah. 

24:12
Dr. Sanjay Gupta
And so I would make. Sorry, go. 

24:14
Dr. Jill Carnahan
Interventions are also quite safe even if were wrong for some reason, which usually you listen and you hear, they're so. And maybe we can go into some of that, like where do you start with the patient as far as interventions. 

24:26
Dr. Sanjay Gupta
So the most important thing is for the patient first and foremost to feel validated. And as you say, they will all break down in tears. 

24:34
Dr. Jill Carnahan
Yes. 

24:34
Dr. Sanjay Gupta
So all my patients will start crying. 

24:37
Dr. Jill Carnahan
Yeah. 

24:37
Dr. Sanjay Gupta
When you say this, the second thing I say is, so I, again, we don't have any real guidance on how to manage it. But I'd say, okay, there are four things I do for my patients. So I have this four pillared approach. One, lifestyle changes. And whilst lifestyle changes are important, the reality is most patients do that and they still don't feel much better. So I would say lifestyle changes have done really well, could make like a 5, 10 at most to the symptomatology of the patient. But in terms of lifestyle changes, what we do is basically what we know is they are generally orthostatically intolerant, they do not like being upright. And therefore you have to say, well, what is it about being upright that is different from lying flat? 

25:29
Dr. Sanjay Gupta
Because if we know what happens normally, then maybe we could work out what's going wrong in those patients. And so obviously when you're upright, your brain is further away from the ground and gravity is going to pull the blood down to your legs. And so anything that makes you taller or bigger or more vasodilated or drier will make you worse. 

25:51
Dr. Jill Carnahan
Yes. 

25:52
Dr. Sanjay Gupta
And that makes you smaller, like compression garments, fills your body up with blood. So hydration, salt, electrolytes, low carb diet, those things make you better. 

26:08
Dr. Jill Carnahan
Yeah. 

26:09
Dr. Sanjay Gupta
So, you know, we Recommend Lifestyle changes. 3,4 grams. Sorry? 3 to 4 liters of water a day, 6 to 10 grams of salt a day, a couple of sessions of electrolytes, a low carbohydrate diet, compression garments which go up as high as possible to push more blood to the brain. And with those changes, maybe a 5 to 10% improvement at most. That's my experience. So. But when they come to me, I say, well, definitely do those things, but let's not stop here right away. Let's do everything together. Because I don't want you to go away for six months and come back and say you're no better. I don't want you to waste a single day of your life. You know, I want you to have everything. So I advise them on lifestyle changes. 

27:02
Dr. Sanjay Gupta
Physiotherapy is a good thing because if you can strengthen the lower limbs, the musculature, the deconditioning that happens as a result of patients not moving makes everything worse. So physio, but the physio has to be gentle. Physio, it has to be done in a recumbent way initially because they struggle with standing up still. But physio is clearly a destination, but quite difficult to get to you. So often you need a bridge to that destination. And that is where medications come in. And I'd be very happy to talk to you about the different medications I use. 

27:36
Dr. Sanjay Gupta
But the fourth thing I think is advocacy and actually making these people feel that they're not alone anymore and making sure that they feel that they, that you've got their back and all the kind of gaslighting that happens and all the people who at work who try and you know, a lot of them are told that they're just not good workers, they're lazy, etc. So supporting them with all that makes a huge difference, you know, and this is where I've realized how much weight the words of a doctor can carry. 

28:14
Dr. Sanjay Gupta
So that makes a big difference for them because if there's a child who's got their exams and they're worried because they feel rubbish all the time, they may have worked really hard, but they may then get bad brain fog and, and you know, that thing could actually stop them from achieving a lifetime ambition of going into a career. So having a doctor there and try, who can actually educate the school and say this can happen, you must make provision for this can make a huge difference to that child's life. And so the advocacy I think is really important, you know, but the reason, and I say to patients, you know, the reason you're paying to come and see me is one access to medications and B advocacy. Those are the two things. 

29:02
Dr. Jill Carnahan
I love that framework. And I'm sure this is why I reached across the ocean to say, you got to be on the show because you have that way in your own videos of really validating treating the patient. And so often that's the start. Because all of a sudden then they have the confidence to say, oh, wait, maybe I can get better. When there's this mystery around illness, part of that is the illness, right? Because they're like, well, I don't know what's going on. It must be a mystery. Or something must be wrong in my head or. And at least in the US sometimes doctors are liable to say, well, maybe you need antidepressant. And I think that's the worst insult because it tells the patient, oh, maybe there is something wrong with me. 

29:35
Dr. Jill Carnahan
And of course you'd be depressed if you can't get out of bed and you can't stand up for very long. And then there's also this thing you said, often the people I see as well look pretty healthy. They're often more young, sometimes women, there's less men, and then they sometimes will have good days. And so that's also confusing to them because someone can see them upright on a day when it's not hot and their immune system's working well and they're doing okay, or they're not just over an illness. And I think that's so important, the validation. So thank you for being that in the world and being a light out there for those patients. Patients, let's talk a bit about medications. I think that's worthwhile for people to know that there are some solutions. 

30:12
Dr. Sanjay Gupta
There are. The first thing is because this is a poorly understood condition, it's been poorly researched. And so all the medications that we use are not specifically licensed or created for this condition. So they're all used in an off license indication, which is where a lot of doctors, because we live in a very defensive kind of world now, doctors don't want to prescribe, but I've always taken the approach that you develop a rapport with the patient and the patient needs to know that you are trying to do something to help them. And if you have that confidence, I often go to patients and I say, look, you know, there are these medications that have been tried out in 50 patient studies, and have helped. We don't have 10,000 patient studies. 

31:06
Dr. Sanjay Gupta
There are no guidelines, but I could give you one of those if you wanted to try. And let's see how it happens. And patients often come back and say, anything, please, I will try anything. And I say, as long as, you know, I'm doing it in your best interest. You know, with whatever we're going down this journey together, we both have to be agree to be a little bit uncomfortable, but that's that's, that's the joy. That's the joy. That's where we make the connection that I'm willing to be uncomfortable with you. You know, we're on the journey together. So through that I started accruing a huge amount of expertise in different medications. Not many are being used in mainstream medicine. But I'll talk you through what I used to. The problem is people don't use them because they say, well, there's no evidence. 

31:56
Dr. Sanjay Gupta
Well, how will you have evidence if you don't have any experience? So if you're not going to prescribe anything, you'll never develop experience. So where are you going to find these patients to do a research study on? So we've said, well, experience matters, so let's do it. So the things that I use are, I use a medication called Ivorbradin, Iva Bradin or Procorelan in the US and this is a medication which simply lowers the heart rate. And for a lot of these patients, because there's all this adrenaline, the heart's going very fast when they stand up and that's very disconcerting. Just lowering the heart rate can be something that they really appreciate. And I would say Iva Bradin is by far the agent that most people respond to. 

32:42
Dr. Sanjay Gupta
They feel a bit better, they don't feel completely better, but they feel a bit better because their heart rate doesn't go up. 

32:48
Dr. Jill Carnahan
Up. 

32:49
Dr. Sanjay Gupta
You could use a beta blocker as well. But the problem with beta blockers is beta blockers lower the blood pressure. And most of these people probably run a low blood pressure anyway, unfortunately, because they have too much adrenaline. When you measure their blood pressure, it measures high and often they, the doctor will give them blood pressure lowering medication which makes them worse. 

33:08
Dr. Jill Carnahan
Yeah. 

33:09
Dr. Sanjay Gupta
So I, so I find that when you give them a blood pressure lowering medication, they would get worse. So I just give them Ivo Bradin, which doesn't lower the blood pressure, but beta blockers are an alternative. So you lower the heart rate with Ivo Bradin. Then the next step is you want to try and push more blood up to the brain. And I use something like midodrine, which is a bit like wearing compression garments. It's working from the inside, pushing more blood up to the brain. And so I give them iva brad and then I say after doing this take two to three weeks to climatize. It's either going to make you feel better or it's going to make you feel worse or you're going to feel no different. 

33:49
Dr. Sanjay Gupta
If you feel worse, it's not for you, why would you take it if it makes you feel better? Why wouldn't you take it if it's no different? Come back and we can try and increase the dose and see if we get somewhere. And then two to three weeks later they add in some midodrine, squeeze the blood vessels, push more blood up to the brain. Again, same principle. It's going to either make you feel better or worse. We'll find out. Yeah, but that's where we need to do something, right? We can't just pretend that we know exactly what this and this will work or this won't work. Let's just give you everything. And then after another two to three weeks I use something called mestinon, period astigmine. Mestinon is a rest and digest enhancer. 

34:30
Dr. Sanjay Gupta
So these patients have too much adrenaline, too little rest and digest. Iva, bradin and beta blockers are suppressing the adrenaline, mestinones bringing the rest and digest up. So people say I feel a bit more rested, my gut improves, you know, and the very gentle drug. Other medications I use are low dose naltrexone ltn, which is this very gentle anti inflammatory, very good for fatigue, pain, post exertional malaise. I use ketotifen. Ketotophen is a mast cell stabilizer. Most of these patients say I'm intolerant to lots of things. I allergic, I get blushing, etc and ketotife and being a muscle stabilizer seems to improve their sleep, improves their gut, etc. And I say to them these are all working synergistically so you know, try a little bit of everything and just let's see if we can get you better. 

35:23
Dr. Sanjay Gupta
Other things I've tried desmopressin which is this medication that used to be given to bed wetters. It makes you retain more florinef which is flutron, cortisone and mineralocorticoid. I've used lotus clonidine which is a central sympatholytic agent. We use things like modafinil. A lot of patients are diagnosed with adhd. Is it a different condition or is it the same condition? No one knows. But treatment for adhd, Ritalin, methylphenidate seems to help them. So it's all a case of trial and error. But what I have definitely found is no one has come to irreparable harm as a result of this strategy. Most people will come and say, I didn't like that one, so I've stopped it. But please, can I have a bit more of this one? Because this is right. 

36:17
Dr. Sanjay Gupta
And then we say, okay, where we're getting somewhere, and it's a partnership, and we're always learning. And then when something works really well, that inspires me to try it more in someone else. The one. The one intervention, I think that makes a dramatic difference, albeit for only a short period of time, is intravenous saline. If you give people IV saline, they really perk up and they feel like, oh, my God, I feel like a new person. But unfortunately, it only lasts a couple of days or so. But I have several patients. I have a woman who was. Who actually wrote to me, and she'd approached me because she was so awful she couldn't do anything. And I organized for her through our ex prime minister to give her intravenous saline once a week. And she did that for two years. 

37:05
Dr. Sanjay Gupta
And two years down the line, she wrote to me and she said, you know, this two years ago, this time, I was thinking of taking my own life, and now I want to be here to see my girls grow up. 

37:16
Dr. Jill Carnahan
Wow. 

37:16
Dr. Sanjay Gupta
So very difficult not to be moved by stories like that, you know? And I've never had anyone, I can promise you, as a cardiologist, no single patient that I've prescribed a statin to has come back and said that to me. Right. 

37:30
Dr. Jill Carnahan
A great analogy, because it's so. And you're right. It's like when we listen and. And any new medical discovery, even 100 years ago, started with someone like you or I saying, well, what if we tried? And the truth is, as a cardiologist, we know that you have this volume and you have preload and heart rate that are pushing the cardiac output. Right? And so if you have a low preload because you're depleted intravascularly, you give saline or you give electrolytes or you give salt. And then, of course, then the tachycardia responds because you're not getting that back. And then I love you describing those, because in my mind, when I'm treating these patients, I tell them, you're like a water tower. Right? Like, they'll. 

38:07
Dr. Jill Carnahan
At least in the US we have these water towers where the water's pumped up to the head, and if you don't have enough compression or pressure getting that water to your head, you're going to feel terrible. And a lot of the drugs you described are causing either peripheral constriction so that you can get the water flow back up to the head. And I, I found a couple studies. They're small, but they're stimulants to increase norepinephrine, which causes vasoconstriction. And it's used off label just like you said and it's in the literature for POTS dysautonomia, so it makes perfect sense. And I just love talking about this, I love highlighting what you're doing because there are so many people suffering and being told there's no answers and the only way to do it is to carefully, with informed consent, start to experiment with the patients. 

38:50
Dr. Jill Carnahan
And then like you said, so many patients do feel better. One thing interestingly I've been finding is methylene blue. I saw quite a few studies being used in the hospital systems for sepsis and cardiogenic shock, which is that collapse of the vascular system. So I've been using small doses like anywhere from 5 to 10, even 15 milligrams orally. And it does quite, I mean again, it's a small, maybe 5% improvement but because it causes just a little bit of peripheral and we may not even know the mechanism, but that's one of those that also is kind off label and fascinating. Well, in our last little bit here, this has been so helpful and so interesting. Infections, you mentioned it and we see this, but post viral infection, especially post pandemic, we saw that trigger a lot more people into this. 

39:38
Dr. Jill Carnahan
Do you, and I love your humility too, because the truth is we don't really understand. But do you have any thoughts about the connection between infections and patients who maybe genetically were predisposed that start to develop more symptoms? 

39:51
Dr. Sanjay Gupta
Yeah, there's absolutely no doubt that we have known of these post viral dysautonomias since the Civil War. And you know, when there would be these conscripts, these recruits, general lay people being recruited into the army and they'd catch a virus and then they would not be able to march for as long and they would drop out and then they would go away on leave and come back and they would never quite be able to keep up with that. The question is, I guess what, how does the virus do it? And I, I, I, I don't know, I don't have a good explanation. But there is absolutely no doubt that when you go back, most people will describe either a virus or some kind of major trauma or a period of immobility, road traffic accident or something like that, and bang. So viruses by far. 

40:52
Dr. Sanjay Gupta
But other things like trauma, et cetera can also be a trigger. Why does it happen? I mean, we know that coronaviruses do that from before. It's not surprising. I mean, I think a large proportion of long COVID patients probably have a post VI dysautonomia. The problem is the definition of long Covid is just a very loose one, isn't it? You got Covid, you get better. Well, that could be anything. 

41:17
Dr. Jill Carnahan
Right? 

41:18
Dr. Sanjay Gupta
But the long COVID patients, the patients who go on for years struggling after this, they have a post viral dysautonomia for sure. And this is why I think the problem is that, you know, there are. We're probably seeing the tip of the iceberg because we're seeing people who are actually declaring themselves. So I want to know about pots. What about all those poor patients who have been diagnosed with functional neurological disorder? Yes, many of them. 

41:45
Dr. Jill Carnahan
Which. Think about that. 

41:47
Dr. Sanjay Gupta
Absolutely. They're probably all the same. You know, we're just giving them different labels and the labels that actually harm the patient because they're confined to this. And now if you've got fnd, well, we need some research in fnd, but actually, if you've got the same symptoms as long Covid or parts, then why not try the treatment for POTS and see if your FND gets better? 

42:09
Dr. Jill Carnahan
Right, Right. 

42:10
Dr. Sanjay Gupta
So. So I think it's huge. I think it's an epidemic. I, I really do, you know, and it's incredible that you're on the other side of the ocean and you're. Your experience and my experience, and we've not collaborated before. 

42:26
Dr. Jill Carnahan
Right. 

42:26
Dr. Sanjay Gupta
We're saying exactly the same thing. So this cannot be a mad person's disease. This is a real thing. 

42:33
Dr. Jill Carnahan
Yeah. 

42:34
Dr. Sanjay Gupta
You know, and how is it possible that these highly educated people, these highly educated clinicians refuse to acknowledge a condition like this? It's incredible. 

42:47
Dr. Jill Carnahan
It is. And, and what you just said too, is that as I talk about it and speak about it and you speak about it, we see thousands and thousands, if not hundreds of thousands of people are that affected by it and have been suffering. And part of that is just I, I do believe curiosity is the hallmark of genius. And what, the other thing that you said that I want to acknowledge, you are so humble and that humility, when we bring that into the clinic and say, I don't know, all the answers. But I'm here to help you figure it out. And as long as we are in agreement about what's safe and maybe effective and you give me feedback, we're partners in this. And patients appreciate that so much. 

43:19
Dr. Jill Carnahan
They're so hungry for people like you out there that are just willing to listen. And I often push the boundary a little, just like you, in a sense of I do inform consent. But I'm saying, what if we tried this? If it doesn't work, that's okay. And I always go by, if something is relatively safe, even if it's, you know, off label and the patient has informed consent, by all means, if it's going to help them. And just like you, I've seen over and over again, patients come back and say, I feel so much better. But no one else was willing to step out on a limb and try this with me. So thank you for being that person out there as well. 

43:53
Dr. Jill Carnahan
Yeah. 

43:54
Dr. Sanjay Gupta
You know, it's very interesting, isn't it? Because, I mean, if we think about what we do as a cardiologist, we rarely ever get any kind of gratification. We never really, you know, you just prescribe because someone tells you to prescribe, give him aspirin, give him statin, etc. And, and actually what you're doing is you're following a bunch of instructions which have been written to treat a population. Whereas this allows you to actually involve your mind, engage your mind, be creative, be innovative, work in partnership. And that is the joy of medicine, that connection that you make, you know, and then the gratification you get, you learn. 

44:36
Dr. Jill Carnahan
Yeah. 

44:36
Dr. Sanjay Gupta
And as you say, all discoveries are made like that. 

44:40
Dr. Jill Carnahan
Yeah. 

44:40
Dr. Sanjay Gupta
You know, you don't make discoveries because everyone. So we live in a world now, in medicine, where someone tells us where to look and they say if you look anywhere else, you'll get into trouble. 

44:52
Dr. Jill Carnahan
Right. 

44:54
Dr. Sanjay Gupta
But hey ho, the new discovery that is going to change the world will be found exactly where we're telling everyone to look. 

45:01
Dr. Jill Carnahan
Right. Well, that's never going to happen how science works. 

45:06
Dr. Sanjay Gupta
The person who's prepared to look elsewhere. 

45:08
Dr. Jill Carnahan
Right, right. 

45:09
Dr. Sanjay Gupta
Permits himself to look elsewhere. 

45:11
Dr. Jill Carnahan
Yes. 

45:12
Dr. Sanjay Gupta
He's the person who's going to find something. 

45:15
Dr. Jill Carnahan
Yeah, yeah. 

45:16
Dr. Sanjay Gupta
And that's what we have to. 

45:17
Dr. Jill Carnahan
Yes. 

45:18
Dr. Sanjay Gupta
The light that we cannot see. 

45:20
Dr. Jill Carnahan
Yes. 

45:20
Dr. Jill Carnahan
I love that. And it starts with empathy and curiosity. And so often I think what I do love about our world now is physicians used to be held on such a high pedestal. And now the truth is like, yes, we have an education, but if we bring Just that conscientiousness, curiosity to the patient. So often, I'm sure you can say this as well. I learned so much from my patients because I'm curious and I'm asking them questions and even they'll be like, well, this helped me. And if I lie down for 20 minutes and then, you know, whatever the simple things they can sometimes really teach. Thank you for the work that you're doing. If people want to find out more about you, listen to some of your videos. Where can they find your resources? You put a lot together. 

46:00
Dr. Sanjay Gupta
So I have a YouTube channel called your cardiology where I not only try and talk about medical conditions, but more importantly now the importance of empathy and listening and sharing as a means of providing holistic care. So I'm a formal, formally trained cardiologist. That's my role in my day to day world. But that doesn't satisfy me. What satisfies me is connecting with people and so that's that. So the channel is called your cardiology. Some videos are kind of more philosophical, some are more condition based, some more treatment based. 

46:47
Dr. Sanjay Gupta
And I have a couple of websites, so I've set up a website called potspecialist.com and on that website I put out stuff like I've written up templates for people so that they can get income protection, so that they can, you know, so when a person says to their doctor, you know, I can't climb the stairs in my house and can you help me? And so to my mind, firstly, the challenge is to get the doctor to believe they have a thing. But then the bigger challenge is for the doctor to actually even formulate any kind of support. So I've created all those and I've said these are freely available. You just, you just take this to your doctor and say, look, you don't need to do anything, just sign on it so that I can get the help that I need. 

47:33
Dr. Sanjay Gupta
So that kind of thing, lifestyle information, we've got, we've set up partnerships with other people who have pots themselves or dysautonomia themselves, but have then become professionals helping other people. So we've got someone who sits in with students and supports them in educational panels and we've got a physiotherapist who'll talk to all my patients. Free. 

47:58
Dr. Jill Carnahan
Yeah. 

47:59
Dr. Sanjay Gupta
And we have a dietitian who's willing to talk to all my patients. So creating that kind of community and creating people who have that empathy towards patients is important. The good news is that There is some strength in developing a community because you can then. So for a lot of our patients, the doctors wouldn't prescribe the medications, they're off license, we're not going to prescribe them. Even if the patient says, I'm so much better as a consequence of these medications, I'm not going to prescribe them. So the question then is, well, what do you do? The poor patient isn't working, they can't afford to buy the medications privately. How do you do it? And as a consequence of the YouTube channel, the sheer volume of patients we have, we've managed to form partnerships with pharmacies. 

48:44
Dr. Sanjay Gupta
So medications are provided at the lowest prices comparable with if they were getting them on our National Health Service. So slowly and gradually we're empowering patients, we're making this work and it's the most, it's the best thing I've done in my life, I think. And one thing I really wanted to tell you about, because I think it is important is there's a talk I do about the first patient I ever met with this and the talk is called the Prisoner. And it was about the first patient I ever met. And basically very quickly, she was only 35 and she came in, long list of labels and the bed manager, hospital bed manager said get rid of her, we need the beds. 

49:38
Dr. Sanjay Gupta
And so I went in with the purpose of getting rid of her, discharging her and I went and I talked to her and she didn't put much of a resistance because I guess she was used to being shamed and thrown out and all this kind of stuff. But as I was going and I picked her notes up and as I was walking back something fell out of the notes and it was a do not resuscitate form that she'd signed and I was shocked because she was only about 36 and I said, why have you signed this? Yeah, you know. And she said, well, I don't have any life, what am I going to do? And suddenly I started thinking, gosh, all these labels that I've just chosen to be so blithe about and this is what this has led to this poor person saying. 

50:29
Dr. Sanjay Gupta
So that's where I started working with my first patient, listening to her, trying different things, etc, a few years down the line with intravenous saline, etc, you know, she was, she got to the point where she was, she started helping her husband, she started doing a part time job, she had a baby, the DNR form was burnt and rescinded and she came back Two years later. And she said, you know, you've set a prisoner free. 

51:05
Dr. Jill Carnahan
Yeah. 

51:06
Dr. Sanjay Gupta
And I said, yeah. And the prisoner was me. 

51:11
Dr. Jill Carnahan
Wow. 

51:13
Dr. Sanjay Gupta
And so that, I think, is really important, but actually, this community has given me something that no textbook could ever do, you know, and the idea that we, as doctors, our biggest healing tool is our empathy. And there is so much shame. There is so much shame in society, and these poor patients carry so much shame. The shame of not being able to contribute in the way that people expect them to. The shame of being made to feel like they're time wasters, you know? And the last thing we should do as doctors is add to that shame. 

51:53
Dr. Jill Carnahan
Yeah. 

51:54
Dr. Jill Carnahan
Wow. 

51:55
Dr. Sanjay Gupta
And when you have empathy, the one thing that shame can't survive is empathy. And so this is our greatest tool. When we start using that's when the process of healing begins. 

52:08
Dr. Jill Carnahan
Yes. Yes. 

52:10
Dr. Jill Carnahan
I love that we ended with that story. Dr. Gupta and I knew from afar, across the ocean, that you had something special. And now I know why. And it just. It is absolutely my pleasure to highlight the work that you're doing and just to talk to you human to human, and share stories, because only. Only medicine will only change if doctors like you and I will demonstrate with humility and empathy what the world needs. And honestly, this is. It's so. It's so needed. So thank you. Thank you from the bottom of my heart for sharing. Thank you for the work that you do. You guys are listening. We will be sure and link up. And it's just I am grateful to have the opportunity to get to know you. 

52:52
Dr. Sanjay Gupta
Likewise. Likewise. Thank you so much. And, you know, you're doing amazing work, and I will definitely look up all the stuff you're doing, and we should be learning from each other on all that is not Shared as Lost. 

53:06
Dr. Jill Carnahan
Yes, exactly. Exactly. Well, you have a friend and me across the world in Colorado. Bless you. Hey, everybody. Thank you again for joining me for Resiliency Radio. Wasn't that an awesome interview with Dr. Gupta? I just love his heart. This was the first time we've actually met, but I've seen his work online, and I saw him in one of his videos and just thought, I need to speak to that man. And it's. It's so obvious of why, with his heart of empathy and curiosity and all that he's done for the world of POTS and Dysautonomia. So please go check out his stuff. And thank you for listening to the show. As you know, we have new episodes out every single week on Wednesday. If you haven't yet subscribed, please hit the subscribe button. Hit the bell to be notified of future episodes. 

53:48
Dr. Jill Carnahan
If you're not on Spotify, itunes, or any audio platforms for our podcast, please do stop and leave a review. That's helpful and we appreciate your comments. By the way, if you do have comments, questions, anything, you can leave them in the feedback. I always check in here, especially on YouTube, and I will be commenting on those and checking in. If you leave something, you'll get a reply from me. All right, guys, we'll see you next week on another episode of Resiliency Radio.