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Tired Teens

Understanding and conquering chronic fatigue and POTS


What do you do as a teenager when you go from being an active A-student with a busy social life to suddenly feeling as if you have no energy left? What's happened? Why do you feel so tired all of the time? And why is it so difficult to pinpoint what's wrong and get the right treatment? In Tired Teens, Dr. Fischer offers answers, hope and healing. He draws on his years of experience treating thousands of young patients at Mayo Clinic to transfer hard-earned knowledge in a clear and compassionate way to his readers. If you're a teenager bothered by persistent tiredness — or a parent of one — than this book is for you.

Tired Teens: Understanding and conquering chronic fatigue and POTS is an extension of Dr. Fischer's groundbreaking work at Mayo Clinic. In this book for teens, parents of teenagers, educators, and health care providers, Dr. Fischer explains the sudden and disruptive development of chronic tiredness and fatigue that occurs in some teens. He discusses where symptoms may come from, including disorders such as autonomic dysfunction and postural orthostatic tachycardia syndrome (POTS). Most importantly, he offers hope and guidance about how to overcome chronic fatigue and POTS for good.


Table of Contents


Section 1: Chronic Fatigue

Chapter 1 Got sleep?

Sleep needs • Sleep and the rhythms of life • Regulating sleep cycles • External influencers of sleep • Sleep disorders • Depression and anxiety

Laura • Quick Take • Notes from a Nurse • Laura’s Parents

Chapter 2 I’m tired because I’m sick

Iron deficiency and anemia • Hormone issues • Kidney problems • Liver problems • Other digestive troubles • Infection?

Does puberty make you tired? • Quick Take

Section 2: What’s happening in the body

Chapter 3 You feel bad but don’t know why

A perspective on medical problems • A matter of function, not structure

Laura • Laura’s parents

Chapter 4 The autonomic nervous system

The central nervous system • The autonomic nervous system • Sympathetic and parasympathetic nerves • What does all of this have to do with you?


Chapter 5 Mitochondria, muscles and marathons

Microscopic energy factories • Muscles, users of energy • Marathon lessons • Winning your marathon

Quick Take • What about coenzyme Q10? • Quick Take • Laura • Notes from a Nurse

Chapter 6 Lessons from history

Space cases • Advancing medical science • My experience with POTS • Connecting the dots

Quick Take

Section 3: All about POTS

Chapter 7 POTS!

What is POTS? • A closer look • The head-up tilt test • Getting the whole story

Laura • Laura’s parents • Notes from a Nurse

Chapter 8 Symptoms, symptoms and more symptoms

Fatigue • Dizziness • Sick to my stomach • Headache • Pain • Brain fog • Blue feet • Palpitations • Hot stuff • Thinking outside of POTS • Symptoms — so what?

POTS in context • Laura • Paddling a canoe to comprehend POTS

Chapter 9 Causes of POTS

Genetics • Infection • Immunity and autoimmunity • “Just” deconditioning • Genetic, learned or epigenetic? Yes, yes and yes!

Section 4: Evaluation and recovery

Chapter 10 Evaluating teens with possible POTS

Before your arrival • An initial visit • Lots of tests and consults • An introduction to STEPS • A wrap-up visit

Notes from a Nurse

Chapter 11 How to overcome POTS

Make a team • Maximize intake • Move • Motivation and direction • A healing mindset

Can compression stockings help?

Chapter 12 Possible medications

Beta blockers • Midodrine • Serotonin? • Other POTS medications • Medications for associated conditions • On the path to recovery

Chapter 13 The power of placebo and the danger of distractions

Lesson #1 Look before you leap • Lesson #2 Make sure the information is really relevant • Lesson#3 Beware of the placebo effect • Lesson #4 Promote the power of placebo

Chapter 14 Optimism about the future

No crystal ball • Evidence of recovery

Laura • Laura’s parents

Philip R. Fischer, M.D., is a pediatrician in the division of General Pediatric and Adolescent Medicine at Mayo Clinic Children's Center in Rochester, Minnesota, and a Professor of Pediatrics at the Mayo Clinic College of Medicine and Science. He has published widely in a variety of medical journals and serves as editor of several journals that are focused on pediatrics. His research interests include chronic fatigue in adolescents, adolescent autonomic dysfunction, postural orthostatic tachycardia syndrome (POTS) and pediatric nutritional deficiencies. Dr. Fischer's work has contributed to an increased awareness of autonomic dysfunction as a cause of chronic fatigue in adolescents. This has prompted better diagnosis and management for tired teenagers, and as a result, thousands of adolescents now have lives with improved function.