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So I'm very sorry that you're having to listen once again to recording on. I can't be with you. I can't help know the irony that, um, I'm unable to attend a conference about cool bit because of cough It, um, I'm going to be discussing the management off pops balls in the cove it long called it and non coated setting. Generally speaking, the management of pots involves lifestyle alterations or self management and on sometimes, medication on board. Much of the treatment was actually hijacked from the treatment for orthostatic hypertension and days of vehicles syncope, and therefore, obviously, they're going to be a lot of similarities in the approach. First of all, you want to, um, try to avoid any triggers that will exacerbate symptoms. Stop any medication such as medication that lowers BP or has a tendency to increase heart rate been post usual tachycardia syndrome on. Many patients find that prolonged standing worsens their symptoms, and in some patients, even prolonging sitting can make things worse than sitting with your feet. Elevated could be helpful, and heat um, alcohol vasal dilate and tend to make things worse on also heavy meals. Where are heavy moods, ricin and refined carbohydrates. Um, tent it make things worse? Um, it's necessary usually to you. Increase the blood volume with, um, salt on increased fluid intake. I'm take a detailed fluid history from your patient because often they underestimate how much clued they're having in a day on Been fact mecca. Mending bottles that actually measure the amount that the patients taking or using a nap there. So quite a few left the absolute and the Internet that can be downloaded on, used to monitor fluid intake on patient should aim for around three liters a day more if they're in a hot environment or exercising. Usually recommend that Children who are smaller in size drink until their urine is a pale stroke color on patients who usually a bit dehydrated overnight and therefore the boost before rising in the morning. And this is useful on what? What rapid water drinking is interesting. Drinking two glasses of cold water in quick succession helps to raise the BP, and we just the heart rate within minutes and well before the food is actually entered the blood stream and we usually recommend, um, additional 6 g off salt per day, which is the same as a A level teaspoon or 10 slow sodium tablets. Obviously, you have to take care in patients who have renal disease, cardiac disease and in Children who particularly sensitive to salt in a number of other conditions as well and small and Children should normally have their the amount of salt calculated on individual basis and got symptoms are very common in court pots, depending on the study of air and the effects 70 to 90% of patients on nausea, abdominal pain, constipation, bloating, diarrhea and heartburn of the communist symptoms. There's been very little research into which dietary measures will help or worsen Cynthy symptoms or, in fact, help for worsen pulse. There's a lot more research into the tissues in hyper Mobil understand most enjoyable and which, of course, commonly effects patients with parts. It's the looks likely that either celiac disease or gluten intolerance may be more common in people with pots, and some patients can have really very severe got symptoms or multiple intolerances referral to a dietician or a gastroenterologist, and maybe necessarily on, you know, dietary supplements or or medication. Venous may be necessary. T control symptoms and eight. Nutrition A number of tests to help with, with, um eating well in pots. Very often, patients respond to small meals. It's and more frequently throughout the day. Eat slowly and to food thoroughly and eat foods with a log I Simic index, such as the one shown in the image there on avoiding liquids for half an hour before and after. Meals could be useful, too. Lie down for 30 minutes after meals when post prandial symptoms are usually worse on but for some reason, increasing salt and water. Accuse to improve symptoms off nausea in props regarding activity for some patients. Find exercise very difficult and can feel unwell for hours afterwards. So we usually recommend a very, very graduated exercise regime, often increasing over months and months. Um, and patients sometimes don't feel the benefit for weeks or months, and taking exercise in the supine and condition such as Politis and swimming is useful. Living on to recumbent exercise biking, ruling on then brisk walking on it could be important. Teo piece activities and throat the day to Regis severity off flare ups. Um, compression clothing needs to be at least close to and waste time to be effective. Um, a number of patients find the traditional prescription compression tights intolerable. And they find that, for example, some of the sports, um, compression closing is more acceptable. They're postural maneuvers, which can help to prevent fainting. And these are the same as the ones used in the vehicle syncope, um, and orthostatic hypertension on. They can also Regis symptoms, and that involves things like tightly crossing the thighs, squeezing the buttocks, elevating leg so that blood doesn't pull or squatting down in an emergency or even lying down flat, putting your legs up in the air and when things are beyond recovery. And but remember, if you squat down that when we stand up that usually markedly exacerbates symptoms. Cognitive behavioral therapy can be useful in pots. Patients could be resistant because they've often in our study. Half of patients have been labeled with psychological problems to account for their physical symptoms, and I believe the same person long cough it, um, so if you think it would be helpful, it may be necessary to explain in some detail that it's to help a patient adjust to living with her a long term um, illness where perhaps they were, you know, healthy recently before or some of the symptoms of imports and long coverage, for that matter can be really quite frightening on em. CBT can help patients to manage the's symptoms. Better medication should be considered where patients are there have very severe symptoms when we initially present or are still sent symptomatic after they've tried the norm. Formal Kalashnikov strategies, usually for between three and six months and the main names of medication, or to improve the blood volume. Now your blood vessels. Or blunt the tachycardia in pots of the sort of medication. This could be used particularily in patients with a very high heart rate and very small doses of bitter blockers or evaporate in convenience. Full Ondimba, a sh inssue have more of a tendency to look. BP, a particularly mitral, is helpful. Also, such cortisone pyridostigmine could be used. Operative injections rarely clonidine in the hyperactive nerves. Jake for pots and doesn't press in a sometimes being used as a sort of pill in the pocket were patients to take it on a day when they know that they're probably gonna have worse symptoms such as exams or and weapons funerals, that sort of thing. And there's been a bit of of all creases only for intravenous fluids and the concertante be useful in an emergency situation where patients are dehydrated, saved you to a gastroenteritis or at a high premises, um, in pregnancy. But there are some of these risks with regular intravenous therapy. In Onder, I would suggest that that's used with caution when the advantages airways up against the significant risks. Yeah, um, that are more resources for your patients on the Pulse UK with sites, and there's also a section for healthcare professionals on. Also, the Royal College of GPS has a Post Corbett and the learning Module, which I believe is open access on the recently published Royal College of GPS and Computer Kit is also open access on on their website and has a small section on pots. And if there are a number of circumstances in which it might be necessary to refer patient to a Potts sent specialist center, and there is a list of some specialists in the UK on the Pops UK website, you would be thinking about referring if you know you're not very sure about the diagnosis. There's this diagnostic doubt to exclude, for example, with patient has chest pain or palpitations. In some circumstances, it might be necessary to exclude a cardiac condition. Patients that don't respond to formula pharmacological measures and basic medication on in more complex case is, for example, I'm quite a lot of pots. Patients have associative conditions such as I understand most syndrome. I'm chronic fatigue syndrome, autoimmune disorders, severe gut disorders and any circumstances that may need the important number or specialists. And so thank you very much for listening on. I just like to take this final opportunity to thank the team that pops UK the trustees. Onda are two administrators in particular, and Joe, who has been working so hard over the number of months and to make this happened and, of course, to Doctor Nickel, who has we've worked with for a number of years, and we're very pleased to be able to deliver this master class with Nick once again