29 - Lorna Nicholson - PoTS & Breathing

Episode 29 of the Long Covid Podcast is a chat with Lorna Nicholson, founder of PoTS UK and breathing aficionado.

We try to de-mystify the condition of PoTS that so many people with Long Covid seem to have developed, as well as talking about my new favourite topic of breathing and how we can help our bodies. Lorna's experience of having PoTS means that she really gets what a lot of us are going through.

I hope you enjoy listening to her as much as I did.

Links:
http://lornanpilates.co.uk/

https://www.sirpa.org/

https://podcasts.apple.com/gb/podcast/episode-159-recovery-from-long-covid-with-kurt/id1439580309?i=1000543810781

https://podcasts.apple.com/gb/podcast/episode-122-recovery-from-covid-long-haul-with-lieke/id1439580309?i=1000510720985

Long Covid - a mindbody perspective (1) video

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(music credit - Brock Hewitt, Rule of Life)

Transcript

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Jackie Baxter 0:45

Welcome to this episode of the Long COVID Podcast. I'm delighted today to be talking to Lorna Nicholson, who founded POTS UK but also specialises in all sorts of other useful things. So we're going to be chatting a bit about this mystery condition of PITs that so many people with long COVID seem to have suddenly become aware of, and a bit about breathing too, because it's awesome. So welcome to the podcast, Lorna.

Lorna Nicholson 1:10

Thank you for having me.

Jackie Baxter 1:11

It's lovely to have you here. Would you mind starting off by introducing yourself a wee bit? So who are you and what do you do?

Lorna Nicholson 1:19

So the the what I do, I seem to do many things, but my background is nursing. So I trained as a nurse. I worked in AI, accident emergency for many years. I then went on from there to work in primary care. So I worked as an advanced nurse practitioner in a GP surgery. I now teach plates. I have a lovely class for people with POTS, long COVID hypermobility that's on Zoom, that's just brilliant. So it's using movement to help help people on their journey. So plates is one of the things I do. I'm also passionate about breathing, helping people to breathe well and helping to become aware of their breathing. So I've trained in Buteco. I've also done some training with Bradcliffe in terms of long COVID. And I also work as a SERPA practitioner, which is a stress-induced recovery practitioner. And that's very much linking the mind and the body. So why the symptoms? Why the fatigue? Why the fast heart rate? Why the breathing pattern disorder? Why is our breathing dysfunctioning? And working on a nervous system level to help people on their recovery journey. So that's a summary of what I'm doing now.

Jackie Baxter 2:40

Fantastic. Yeah, it sounds like you've got a lot of tools in your box, so to speak. So POTS, what is POTS?

Lorna Nicholson 2:51

So POTS stands for postural tachycardia syndrome. Postural means upright. And so on the whole, people have symptoms when they're upright, but you can have symptoms sitting, and some people will have symptoms lying down as well. Tachycardia means fast heart rate, and syndrome means a collection of other symptoms are usually associated. So fast heart rate fatigue, dizziness, stomach issues, and a whole collection of other symptoms. The O in the POTS stands for orthostatic, but postural and orthostatic kind of mean the same thing. So we we've dropped the O and to become a little O. So that's why it's still POTS, but it's postural tachycardia syndrome. So the the actual definition is an increase in heart rate from your resting heart rate to when you stand up of greater than 30 beats a minute. And on the whole, that is a sustained increase in heart rate. On the whole, when you lie down, the heart rate settles. So many people will say sitting down they feel fine, but as soon as they start to move, they feel the heart racing and banging away, and they can get symptoms of dizziness along with that as well. So the pot spit is the increase in heart rate. But it's often kind of under this umbrella of orthostatic intolerance. So with that, you can get low blood pressure. So it's really common for people with POTS to have low blood pressure as well. And then some people have episodes of what we call vasovagal syncope, where you might be standing up too long and your blood pressure drops. So it tends to be an episodic, something triggers something to make you pass out. And so all of those go together. So low blood pressure, fast heart rate, and some people have episodes of the vasovagal fainting episodes as well. So that's kind of uh what POTS is.

Jackie Baxter 4:57

Yeah, that's quite a lot of different things, as you say, and quite a lot of symptoms that are in common with a lot of the symptoms that people with long COVID seem to experience.

Lorna Nicholson 5:09

Exactly. Yes.

Jackie Baxter 5:11

Do we know why a lot of people with long COVID seem to have developed it? And why is it not more widely known about? Because I had never heard of it until recently, and I don't think that's unusual.

Lorna Nicholson 5:24

Yeah, so that's kind of two questions. Pots has been um becoming more known about over the last so many years. Um so I founded Potts UK 2010 along with another lady called Susan Whitfield, she was the number one founder, I will say. Um, but then I developed it into a charity. And the role of POTS UK is to raise awareness about POTS. Um is involved with little research projects, um supporting people, providing evidence-based information, which is predominantly what the website is all about. So over time, the awareness of POTS has become a lot more in the forefront. And long COVID has increased that further. Um, a GP friend of mine said, she said she'd only heard of POTS because of me, but now she's she said that it's just there's so much more awareness of it, which is great. So it's time has made a difference. I have no doubt that Pots UK has made a difference. Um, so my current involvement with POTS UK is um I've stepped down from a sort of trustee role. I'm more in the background, mainly involved with information production. So I've got time to do all the other things that I'm passionate about. And then the your other question was about why long COVID and POTS. So I see I see POTS and long COVID under a sort of this big umbrella of a nervous system that's dysfunctioning. So what we do know about POTS is that there's a dysregulation of the autonomic nervous system, immune system, um, energy system, so mitochondria, hormonal system comes into it, and there's a dysregulation. So that's what we know. Um, and when you look at the potential causes of long COVID, it's the same list as what we would talk about with POTS and again with MECFS. So I see it as all under this one umbrella of a dysfunctioning nervous system. Um, so in terms of what is the cause of this. Um, and when you look at you think about the autonomic nervous system, so everybody knows with POTS, the autonomic nervous system isn't functioning correctly. But why would it not be functioning correctly? Um, so we have uh really simply the autonomic nervous system is divided into the sympathetic and parasympathetic. So sympathetic is our fight-flight response. So when we're in a fight-flight response, we are responding to a perceived or real threat. So if there was a bear in the room, then it would be appropriate for your heart rate to speed up, um your breathing rate to speed up, your muscles to contract and get tight, ready to fight or flight this bear. But in our society today, it's there's not a bear, but often our body is responding to these threats, which aren't actually there anymore. And often these threats are things from our past, so past trauma experiences, that are held in the nervous system. And it's it's only, yeah, sort of with time these things start to show themselves. And again, with with POTS and long COVID, so that's a sort of autonomic side of things. Um there's also the immune system side of things. So with long COVID, there's a lot of talk about MCAS, Mars cell activation syndrome, and again, it's common in POTS, which is really interesting. So again, the immune system is very much linked with the fight-flight system. So when we we are going to fight a battle, or if you think of an animal sort of fighting a predator, their hormones release the cytokinines is released, which is initially anti-inflammatory. So, should you as an animal get injured, those hormones are ready to deal with the injury. But if that stress is persistent and ongoing, it becomes inflammatory. So, again, with long COVID, we talk, there's a lot of talk about inflammation. A lot of people are super sensitive to their environment. Um, they they get triggered by allergens over nothing, they're sensitive to food. So, again, this is all linked with the what's going on with the nervous system at the time. So, all these conditions are a very similar kind of pattern that I see. Um so when when we think of the stresses, um, I think of current life stresses, COVID itself, when you think of the situation, the fear that's been associated with COVID, the fear that's been put out there by the media, that has, I feel, has really driven sort of long COVID situation. And often the people I come across, their nervous system has been sort of in this sympathetic overdrive for a long time. So I've had people say, I've been in a state of chronic stress for years, I've been running on adrenaline for years. So when that nervous system is out of balance already, then you get all this fear. So it's a trigger for your body saying, Okay, I can't deal with this anymore. Something needs to change, something needs to be different. So think about life stresses, and then you've got personality types. So again, our own personality can become a self-induced stress. So you've you've got things. I I asked this of all my long COVID clients, and I show them a little list. So these are things like being perfectionists, being driven, overly responsible, a helper, want to do everything for other people, like to be in control, feeling a bit anxious tends to worry about things. Um, that's a sort of personality type that I see over and over again. When I show this list, everyone's like, that is me. Um but where's that come from? Why why the need to be a perfectionist? What is driving that? And so all these personality types, what is the driver? They can be really positive, but they can be a stress, a self-induced stress. And then linked with that, it's what has gone on in your childhood? Where has this all come from? Um even when we're we're born, and when you're sort of um in the uterus, the stress of your mother will influence the nervous system of you. So if you had a really stressful your mother's stress at the time, you could be born already in this slightly sympathetic overdrive state. And then as you go through life, other things will start to influence that.

Jackie Baxter 12:48

That's really interesting. Um, that it actually can happen before you're even born.

Lorna Nicholson 12:53

Yeah. And do you know, even generationally, so things that have happened through your family line can influence the state of your nervous system. And often um stresses we think of the big the big sort of traumas that are abuse and neglect. And often it's not those big traumas, it's you might have a mother who's overly critical of you, you might have a father who's angry, your your parents might have just not given you the love and attention that you really needed as a child. Medical traumas, that's that's quite a common one. Children who've had a medical procedure, they'll be terrified, and that fear is held in the nervous system. Um and if it's not processed at the time, it stays there, and then it takes a trigger like COVID to show itself.

Jackie Baxter 13:48

Yeah, that is really interesting. I've certainly spoken to people who have talked about, oh, I nearly died doing something or other, and they'd sort of worked out that maybe there was something to do with the way that they had or hadn't processed that trauma that had certainly contributed to what they were experiencing as a result of COVID. So it's it's really interesting, isn't it?

Lorna Nicholson 14:12

Absolutely. And I would say everybody who I've come across, there is something in their background. Uh and most people have had a history of something like fibromyalgia, ME, postviral fatigue, prone to allergies anyway, so tended to be overly sensitive, history of anxiety, history of unexplained aches and pains, back pain, um, all sort of indications that the nervous system is in a bit of sympathetic, is dysregulated, isn't where it should be. So there's a whole history there, and then COVID being the trigger to bring all of this to the head, to the surface.

Jackie Baxter 14:57

Totally. And it's almost like it will manifest itself in different ways, so as long COVID or as POTS or as um any number of other things, or more than one, maybe.

Lorna Nicholson 15:11

Yeah, exactly. And so it might be um another person, they might have a chronic pain issue, um, but the route is often the same, but how it manifests is very different with different people.

Jackie Baxter 15:27

And I suppose that sort of explains the wide variety of symptoms that people with lung COVID experience as well, does it? Because it's a huge amount, and I mean, I know from my experience that I've experienced quite a lot of them at different times over the last um however long. Uh, but there are people that have experienced completely different ones. I think, oh, I haven't had that one.

Lorna Nicholson 16:33

I mean, you know, never say never, but and what I will say is this is all that your symptoms are real. They are there, there is um a physiological response to what's going on with the nervous system. So all of this is is subconscious. Um, your nervous system is showing itself in symptoms, things that haven't been dealt with. Your body keeps a score, um, your body is knocking. What what this symptom, what is your body actually trying to say? It's trying to tell you something. Um, but are you listening to what your body is saying?

Jackie Baxter 17:09

So we've talked about the symptoms of POTS, but is it one of those conditions that's really hard to diagnose because it's got so many symptoms in common with other conditions? Is that part of the problem?

Lorna Nicholson 17:21

No, in many ways it's quite easy to diagnose. So medically, they they use something called a stand test or a tilt test. So, really simply, a person might uh lie down for 15 minutes and have their heart rate blood pressure checked, then you stand up, and then uh every every sort of three, five, ten minutes, heart rate blood pressure is checked, and that will give an indication of what's going on. So the tilt test is a more sophisticated way of doing the same thing. You lie on this table, this table you're wired up to a heart rate blood pressure monitoring, and it it measures that continuously. The table tips up, you don't do anything, you just stand there and it watches your physiological response to being upright. So that's a sort of test. But some of these, so like the tilt test, it's mainly used to rule out other conditions which might be causing the symptoms, but it's also sort of the history is really important, and the history will give you a really good clue. So often when you go and see a physician uh about symptoms of pots, that they will listen to the history, they might do a tilt test, they might do a stand test, putting all those pieces together and then make the diagnosis based on that. What one of the downsides with a sort of tilt test is symptoms vary from day to day, and you have good days and bad days, and some days your heart rate might be a bit more wacky than others. So if you have a test on a good day, then it might not you might not meet that exact criteria. But again, looking at the whole picture will give a physician um more of an idea of what's happening. Um, so the the stand test is something that you can do at home. So just lie lying down. Uh if you've got a blood pressure monitor, monitor it, stand up, write your recordings, write it down. And actually, that's quite useful information to take to a specialist so they get a picture of what's happening on a day-to-day basis rather than just basing a diagnosis on one test on one day.

Jackie Baxter 19:39

Yeah, that's a really good point, actually, because I'm sure we've all had the experience where on a good day you've popped outside for a short walk or something, and you've met someone you knew and they've said, Oh, but you look fine. And you've said, Well, that's because today is a good day. Yesterday I couldn't leave my bed. So, you know, that uh different symptoms on different days, good days, bad days thing, absolutely. Um I know a lot of people that have sort of diorised their symptoms. Um, I keep meaning too. I started doing that yesterday. I thought, oh, I'll just remember it, but never gonna remember all of that.

Lorna Nicholson 20:14

No, no. And there's advantages and disadvantages for in the short term to help get a diagnosis can be helpful. Long term, if you focus on the symptoms too much, they can sort of um sort of become more ingrained. So it's a bit of a balance with accepting the symptoms, sitting with the symptoms, but not becoming too focused on the symptoms.

Jackie Baxter 20:35

Yes, definitely. I know I'm one of these people that likes answers. I uh had my counsellor having a go at me for that this morning, so which obviously might be even more cranky. So um assuming someone has got a diagnosis of POTS or even thinks that it is something that they might have, how can people alleviate symptoms and is there a cure?

Lorna Nicholson 21:00

So good question. So the the medical approach is medication can help. Lots of people are on um medication to lower the heart rate, and there's medication that can increase blood pressure, and that does help. We talk about um compression stockings, which are meant to be waist high. Now, to be honest, they say do this, but I haven't actually come across many people who say this really helps me, and they're uncomfortable, they're hot, and so most people tend to ditch them, but it's an option worth a try. Some people do find them helpful. Um, increased fluids, so making sure you're drinking plenty and increased salt can help if your blood pressure is low. So, just normal table salt, just be generous with it, don't be afraid to eat salt. Focusing on a healthy diet, some people find a lower carbohydrate diet, so that's not no carbohydrate, it's just reducing how much carbohydrate you you take in. Um, so that's the sort of basic medical management and also keeping yourself active. Exercise is challenging, and so it's not go there and ride your bike, and which I I talk about this quite a lot. What do we mean by exercise? Often you'll you'll go to a POTS clinic and they'll say, right, you need to do some exercise. So what comes into people's mind is right, I'll go, I need to go for a run or I need to go to the gym. And you do that and you wear yourself out and you feel rubbish, and you're like, I can't exercise. But when you break down what do we mean by exercise, you you could break it down into um you've got muscle strength and endurance, you've got joint range of movement and flexibility, you've got balance and coordination, as well as the cardiovascular side of things. So when I teach Pilates, it's all about working on the other components of fitness and exercise, but we take out the cardiovascular because that's really hard, but that's what everybody focuses on. And everybody says exercise, or I should say, increased physical activity, does help, but other things need to be put in place for you to do that, and it's thinking how do you do that and how do you achieve it for you, and what's the best way? Swimming, some people find helpful in terms of um physical activity, um, so that's the The sort of main medical model of how it's managed. I look at it more on the nervous system point of view. So thinking looking at the stresses, what is the cause of the symptoms? What's going on in the nervous system? How can we work with the nervous system and influence the nervous system to dampen down the effects of the sympathetic nervous system? So that's some of the work I do with a SERPR approach. So thinking about what has been suppressed, what are the emotions that have been suppressed over years? Let's start to feel those emotions. Let's start to work out how we can bring the nervous system from a more sympathetically driven nervous system into a bit more of a parasympathetic rest and digest and calm nervous system. How can we get that balance a little bit better? And there are many tools that I use in my SERPA work. One of the really useful tools is breathing, which is one of the reasons I'm I'm so passionate about breathing. And my interest in breathing came about because there was a study done a few years ago with people with POTS and identified that people with POTS had a breathing pattern disorder, dysfunctional breathing. And I was like, well, what does this mean? What is this? In all my years of um being involved with medicine, I'd never heard of this. It's like we just breathe, don't we? I hadn't thought anything other than that. So it got me on a mission to find out more about it. And this sort of came off the back of I teach Plates. We talk about breathing in Pilates. I teach Pilates teachers about POTS, chronic fatigue, long COVID, but something's missing in my knowledge here. So I went on a mission to learn. And the more of a mission I went on, the more I found it absolutely fascinating how we can use breathing. Because it's a real link between the we can't influence our heart rate, but we do have some influence on our breathing. So when you your heart rate's going, your breathing rate will increase. You can't make your heart consciously make your heart to slow down, it just doesn't work. But you can focus on your breathing, which will then have an influence on your heart rate.

Jackie Baxter 26:14

Right. So you can influence the influencers way of putting it. So this idea of breathing, I mean, since I discovered on my long COVID journey that I had a breathing pattern disorder, which was probably as a result of COVID, but people never know for sure. I've become a bit of a breathing fanatic as well. And uh this whole idea of how the breathing influences everything has just kind of blown my mind a little bit. So would you mind just talking a little bit about what breathing pattern disorders are?

Lorna Nicholson 26:52

So I see breathing as a bit of a continuum with optimal breathing at one end, and then at the sort of extreme end, you've got this hyperventilation syndrome, which is breathing too much, too fast, taking big breaths of air, air in. And what all of us are somewhere on this spectrum, and all of us can learn to breathe better. Um so a breathing pattern disorder is when symptoms are linked to not breathing quite so well. And it's interesting when I look at a list of symptoms of a breathing pattern disorder, it's things like dizziness, fast heart rate, feeling of not getting enough air in, fatigue, um, chest discomfort, feeling lightheaded, loss of balance, and that they're all very similar symptoms to someone with long COVID or POTS. And it's like, ah, interesting, what's going on? What's going on here? How much of um and the symptoms are usually due to a shifting chemistry of your body. So the your carbon dioxide level is too low, which stimulates you to breathe too much, which then causes you to get rid of too much carbon dioxide. So that's that's what we mean by a breathing pattern disorder. Um I tend to see it as this continuum, and we can all move ourselves on this continuum towards more optimal breathing. Um, so that's kind of how how I see it.

Jackie Baxter 28:26

Yeah, I mean, I I suppose I never really considered any of this. Um, and then when I realized that it wasn't just that I needed to breathe better, it was actually the fact that I was not breathing well had caused my body to kind of biomechanically change. Yes, yeah, was quite a big thing for me. And uh in some ways I liked it because it gave me something that I could work at, and I I quite like a puzzle. Um I can sort of sit and work at something, but it's it's almost like I think lots of people want to take a pill for something and for that pill to make it better, and that's not something you can really do with this, is it?

Lorna Nicholson 29:10

Um so it's it's a real superpower, it's uh underestimated tool that we have in our box in so many different ways. Um, so uh there's always a question why the breathing pattern disorder? And again, if you're in this constant sympathetic overdrive, you're using your sort of emergency breathing muscles, your upper chest, your um shoulders and neck muscles to breathe, which again might be part of why a lot of people get shoulder and neck pain because of this dysfunctional breathing. So these muscles shouldn't be used all the time at rest. So it's where the breathing pattern disorder comes from, why the sympathetic overdrive. And often it might be that you you've had a particular trauma, it might be a one-off event which has kind of triggered that breathing pattern, but then the trauma's gone and it might be dealt with, but the pattern still is still there. So there's a habit, and sometimes just unlearning the habit can help. Um for some people, the the cause of the breathing pattern disorder, the the being in the fight-flight response is still there. So I've had people who who say, I'm doing all the right things, but I can't seem to influence my breathing. The other side of it is, okay, what is the cause of this? What are the driving forces? Um, why is your nervous system behaving like it is? And unless you start to address that side of things, I think it's very difficult to actually really change the breathing pattern until we can shift ourselves into a better parasympathetic balance. Um so it's it's a two-way thing. So it's addressing the habit, addressing the mechanics of breathing, but also using breathing to influence the nervous system to bring you into parasympathetic. Um, so what we do know is slow belly breathing will help you shift into the parasympathetic. So I think of the sympathetic being in your red zone, your parasympathetic being in your green zone, so the rest and digest. Um so learning to slow belly breathe is probably the most useful tool you can do to help yourself. Some people find that really hard. Um there's a lot of stuff out there that I would suggest in terms of what's on the internet with how to breathe, that is, I would say, too hard for most people. And they they try and do some of the counting exercises and seven in, five out, and it's just too hard. Um so ultimately working with somebody who can give you a clue with where to start is would be the ideal. Um it's not always possible for everybody. So, again, this is one of the things that I do is help people and give them a few tools for them that's more individualized. But the the other the other way is just learning to breathe well, slow belly breathing, steadying the upper chest, gradually slowing down the breathing, taking less air in as you breathe rather than taking big breaths. Most people with Pops long COVID tend to take very big breaths in, so they're over breathing. So just reducing all of that, and that will shift you into the parasympathetic.

Jackie Baxter 32:38

Yeah, because yeah, it's it's the two different sides of it, isn't it? Yeah, yeah. And one will help the other, but you've sort of got to address both of them. So, yeah, you were talking about uh you know, low deep breathing, but not breathing in your chest, because I certainly found to start with that I was getting very panicky as well. In my initial illness, I did have some breathing difficulties, which could well have been what triggered the whole thing off, I guess. And uh it was just like my body thought it was still there.

Lorna Nicholson 33:11

Yeah, absolutely.

Jackie Baxter 33:13

Lower down, slower, and nose breathing was the other thing that made a big difference for me.

Lorna Nicholson 33:18

Yep. So nose nose breathing is is sort of the foundation of good breathing. Uh, and the why why I want to breathe through our nose is it filters out um dust particles, and it's our first line of defence from infection. It um your sinuses produce nitrous oxide, they are a vasodilator, so they open up your blood vessels and um airways. It also the suction or breathing through your nose helps get the air low, so down to the base of your lungs. So the best gas exchange happens at the base of your lungs. So if you're always upper chest breathing, the air isn't getting, you're not getting the oxygen all the way to the base where where we want it to be. So that's some of the key benefits of nose breathing. And I will honestly say, say, I thought, why I'm gonna put this to the test. And the first thing is is awareness of are you breathing through your nose? Most people haven't even thought about it. And when you do go and think about it, you'll probably notice that um there are times when you are mouth breathing. So for me, with any sort of exercise, I would mouth breathe. Um, so I've learned to nosebreathe with exercise, and and I'll honestly say it's improved my exercise tolerance. Um I've had clients who just by nose breathing, they've said, gosh, I can walk to the end of my street without feeling dizzy. It's made an improvement in my symptoms. So just learning to nosebreathe. If you do nothing else, that's a really good start. I would suggest starting when you're sitting down. Um, if you're a chronic mouth breather, just work on it when you're sitting, watching telly, and then add it into a bit of walking around the house, and then when you start to increase your activity levels. Um, most people they go for a walk or something and say, I tried it when I was walking and it was really hard, I can't do it. So you just have to be kind to yourself and think about how you're starting and gradually build it up. And the the more you work on it, the the easier it will get, and also the more your airways open up to make it easier. There will be the feeling of not getting enough air in, but you just have to trust me that you're getting plenty of air, you're getting the oxygen actually more to where you want the oxygen to get to.

Jackie Baxter 35:43

Absolutely, yeah. Um, so I mean we've talked a lot about breathing and how that will help everything because it's awesome. Have you got any kind of general tips for people with lung COVID and or POTS that will just kind of generally help them, whether it's with calming down the nervous system or dealing with other things?

Lorna Nicholson 36:06

There's just a few things is um spending time being mindful. So being in the moment, stopping, doing what you do in a mindful way. That could be eating mindfully, it could be if you're doing some crafts mindfully, so being in the present, not dwelling on the past or looking to the future. Um, I've had a client say that they thought they were being mindful, but when they really realize it, they're their sort of inner chatter, the what's going on in the head was still going on. So it's just putting that aside. So mindfulness meditation. Um, some people find that being in the presence quite difficult. So sometimes just doing the slow breathing, that's a form of mindfulness. Also, thinking about beliefs. What do you believe are the cause of your symptoms? What are your fears? So beliefs are a big part of it. And if you can understand a little bit why do you have these symptoms, where are they coming from, what's driving them? That can make a big difference as well. And there are things that um like gratitude. So keeping a gratitude diary at the end of each day, just look at your day, what are you thankful for on that day? Um, so that's another tool, and and that there's scientific evidence of its benefit in influencing your nervous system. So it's something really simple that will make a difference. One thing that I'm particularly interested in at the moment is is wild swimming. Um so cold water exposure. And I think this is fascinating because to go in cold water, you have to control your breathing. It's really mindful, you have to be in the moment. Um, and there's loads of anecdotal evidence of um the benefits of cold water on the nervous system, reducing inflammation, people who have depression say they feel much more alive. I've met a number of people with POTS and other health conditions that the cold water exposure has made a difference to them. And I'd love to hear from you if any any of you have long COVID or POTS and you have found cold water exposure beneficial, it'll be really interesting to hear your stories. So, again, it's another tool to influence a nervous system. There is a slight warning with that, is if you've never done it before, I would suggest that you um that there are people out there who will take you um while swimming, so teach you how to do it properly and safely. There are risks with it, and I wouldn't start in the winter, it's something to do in the summer. But what you can do now is simple things like splashing your face with cold water, that might be enough. Having a cold shower, and that's something that you can try that will influence a nervous system. Um so that so they're just simple, safe tools that you you could try, and it would be interesting to see how you get on with that. But this is influencing things on a nervous system level rather than sort of cognitively.

Jackie Baxter 39:23

Yeah, fantastic. Um now you you've sent me over a lot of links, so I'll make sure that all of them go into the show notes. So if people want to look up what you're doing or get in touch, they'll be able to do that through them, won't they?

Lorna Nicholson 39:36

Yes, uh that that's right. So the easiest thing is to have a look at my website, see all the different things that I do, um, send me an email. If you have any questions, feel free to email me as well and I'll answer as best as I can.

Jackie Baxter 39:49

Fantastic. So yeah, I'll make sure that all goes into the show notes. And of course, people can get in touch with me and I'll point them in your direction if they're stuck. Great. Well, thank you so much for your time today. It's been an absolute pleasure speaking to you and really, really interesting to demystify pots a little bit. So thank you so much.

Lorna Nicholson 40:06

Thank you for having me.