Employment and POTS
Postural Orthostatic Tachycardia Syndrome (POTS) falls under the more general umbrella of disorders called dysautonomia. POTS is characterized by dysfunction of the autonomic nervous system which controls many “automatic” physiological functions including blood pressure, heart rate, blood vessel and pupil diameter, peristaltic movements of the digestive tract, and body temperature. In dysautonomia, the person can suffer from a wide range of symptoms that are ultimately connected by the dysfunction of the autonomic nervous system. One of the hallmark symptoms of POTS is orthostatic intolerance, a physiological problem resulting in gravity pulling blood to the lower body when standing that can result in dizziness, light-headedness, and fainting.
One of the problems when thinking about employment is that every person with POTS is different. People with milder cases of POTS may be able to get control of their symptoms through use of exercise and medication. They rarely experience dizziness and lightheadedness when moving from sitting to standing, nor do they have nearly constant fatigue, brain fog and pain. For individuals with well controlled symptoms, no accommodations may be necessary for employment. Many people with POTS don't fall into this category, however. For those with moderate to severe POTS, symptoms can occur sporadically throughout the day (when moving from sitting to standing) or be present constantly. These employees might require accommodations in the workplace or be better suited for work that they can do at their own pace at home.
It is important for individuals with POTS to consider employment opportunities that are conducive to your particular POTS status. Jobs that are sedentary are perfect if brain fog is not a significant symptom for you! Employment opportunities that can be done while sitting will reduce symptomatic flares. Look for something that you think you can physically accomplish on a regular basis. Large and/or government companies often have target numbers for disabled employees and are better able to provide the flexibility that you need to deal with your illness.
Thinking about Work Accommodations
Choosing to disclose whether you have a disability on an employment application is a personal decision. You are not required by law to disclose medical information. Federal law states that employers may not disqualify you as an applicant due to POTS or any other health condition. If you are able to work, carefully consider whether this disclosure is necessary during the application process.
In the workplace, all applicants and employees should have equal access to benefits that are available to others. If you are looking for a job or needing accommodations as your health changes, you will need to ask your employer for that accommodation. This might be as simple as asking for frequent breaks, lighting adjustments, a temperature controlled workplace, or access to medications and liquids as needed. Others might include flexibility to work from home on days when you are highly symptomatic or to take time away from work to seek medical treatment. People with moderate to severe POTS may require periodic hospitalization to control symptoms, and flexibility for medical leaves is more important.
Here are some helpful links to the Job Accommodation Network: Accommodation Information by Disability: A to Z and Accommodation Information by Limitation: A to Z. The Job Accommodation Network also help individuals and employers to discuss work accommodations.
Remember that employers don’t have to provide accommodations that pose undue hardship to the company. Companies have the option to choose accommodations that meet your needs. Employers are not required to remove essential functions, create new positions, or lower standards as an accommodation. If your employer doesn't feel that you can manage the essential functions of the position, they have the right to hire another applicant.
Working from Home
If you feel that working from home might be a better option for you, these websites offer a variety of job opportunities with flexibility. While this may help with issues of orthostatic intolerance, flexibility still needs to be negotiated for days when your symptoms are flaring or your brain fog is particularly thick.
Not Everyone with POTS Can Work
While the severity of POTS symptoms varies, unfortunately 25% of individuals with POTS can’t physically work at all and may apply for medical disability. Many researchers compare the physical effects of POTS to having congestive heart failure or chronic obstructive pulmonary disorder (COPD). Managing the normal tasks of adulthood are difficult enough without adding a debilitating, chronic illness like POTS. Because a person with POTS uses three times more energy to stand than normal, even minor movements can increase symptoms and make employment challenging at best. If working regular hours is not possible, you might consider applying for disability.