Postural Orthostatic Tachycardia Syndrome (POTS) Logbook: Track Symptoms, Pain, Triggers, Meals, Activities, Medications for Dysautonomia, Anemia

Triggers, Symptoms

Triggers - pre-listed options include low sodium, sleeping position, heat, stress, dehydration, alcohol, lack of compression, and more.

Symptom Location - mark on the image (both front and back are available)

Symptoms - select from options including vertigo, fainting, shaking/tremors, blood pressure, irregular heart rate, vision, discolored hands or feet, fatigue, brain fog, gastroparesis and more.

Daily Assessments, Blood Pressure, Heartrate

Circle applicable arrow to indicate 'Increased, Same, Decreased' for Pain, Stress, Fatigue, Energy, Activity, Mental Clarity, Activity Level, General Mood, Sleep Quality

Sleep hours - both night and day

Option to enter Blood Pressure and Heart rate at different times

Circle applicable arrow to indicate 'Increased, Same, Decreased' for Vertigo, Nausea, Anxiety, Bloating, Palpitations for the day

Activities, Notes and Meals

Activities - select from prelisted options (walking, self-care, socializing, hobbies, employment, house/yard work, childcare, commute) and enter time.

Check box for pacing.

Check box for recommended exercise.

Symptomatic Activities - enter activities where you felt symptoms such as vertigo, palpitations, shortness of breath and more. Enter the time, and in the adjacent column enter your heartrate/pulse at the time.

Notes - insights, reminders, questions

Meals & Snacks - list and check applicable box to indicate if meal contained salt, red meat, dairy, gluten, sugar, fats

Medications

Medications - check box to indicate just your usual daily medications. There is also a checkbox for usual daily supplements.

If additional medications are taken you can list them, the dose, time and whether it helped.

Example of completed section

Daily Assessments - note that stress, fatigue and general mood are marked as increased, energy and sleep quality have decreased while pain, activity and mental clarity have remained the same/consistent.

Vertigo, nausea and palpitations are increased by anxiety and bloating have decreased.

Symptomatic Activities - note that while shopping felt dizzy with palpitations (heartrate was 115 at the time), and at 9pm while walking the dog felt faint and heartrate was 122 then.

Personal Information and Healthcare Team

Introductory page has space for personal info including emergency contact, allergies, medical alerts and health conditions.

Enter name, address, phone # for physician, specialists, pharmacy as well as insurance information.

Medications and Changes

Page for current medications / supplements along with reason and refill due date.

Page for CHANGES to medications and supplements with reason for the change, new dose, and date effective.

Tests/Results and Medical Appointments

Upcoming medical appointments - with whom? for what reason, and date

Tests, date performed, and the results.

Additional Logs

Additional Logs

Left Page

Right Page