Interview with Dr Amy Small

Dr Amy Small, a GP in Scotland who is raising awareness about long COVID and PoTS kindly agreed to answer our questions about living with long COVID and developing PoTS as a result. 

Please can you tell us a bit about you/your background? 

I’m Amy, I’m a mum of two boys married to a Frenchman and I’ve been a doctor for 17 years and a GP for the last 13 of those. I originally trained and worked in London before moving up to Scotland in 2010. I worked as a partner in a deprived mining village in East Lothian until 2020 when I caught COVID and subsequently developed long COVID. 

How has this affected your work? 

PoTS and long COVID meant that I lost the job that I loved. I worked in a community for 10 years, knowing the staff, my partners and my patients very well. I was very lucky to work in an environment that I loved and the loss of that was devastating. I’m seeing others affected by PoTS who needs support in their workplace and I’m getting better at advising folk in how to manage this illness.   

How did you find out you had PoTS? Did a healthcare professional tell you or did you work it out for yourself? 

I found out a bit by accident that I had PoTS. I had the last meeting with my partners where I was going to find out if I lost my job or not and I knew it was going to be stressful.  I had some out-of-date betablockers that I had been prescribed when my father was dying and I thought it might help to calm me if I took them prior to the meeting. The meeting did not go in my favour but I noticed that I felt much less breathless than I had been for months after taking the betablocker. I called my GP and said that I had heard of others with long COVID being diagnosed with PoTS and wondered if it accounted for my fast heart rate, breathlessness, brain fogs, myalgia, fever and other symptoms. She kindly agreed to trial me on a course of tablets to see if would help.  A week after my job ended, I was well enough to start working again, this time as a locum GP and I put most of that down to my PoTS medication. This really highlights the importance of increased education and awareness about PoTS. If patients were diagnosed more quickly, they would be far more likely to receive the treatment/advice they need in order to manage this condition better. At the moment, many patients wait years and years to receive the correct diagnosis. 

How common do you think PoTS is in long COVID? 

I think PoTS in long COVID is very common. I’m picking it up in patients that I’m seeing who have been misdiagnosed with anxiety. I’ve had patients who have been repeatedly seen in A+E and by cardiology and others, all commenting on the fact that they are tachycardic but because all their other investigations reveal normal results it’s put down to anxiety or unknown causes.   

Was it easy to access NHS help for diagnosis or treatment?   

I am lucky that my GP has a good knowledge of PoTS and was happy to try me on a betablocker. When I developed side effects from the betablocker, in the form of depressive symptoms, I asked if I could try ivabradine. She was not familiar with using it for this illness, we usually use it for patients with angina, so she agreed to write to the cardiologists for advice, asking if it would be ok to try it and they agreed. It has worked really well for me. Now that I’m so much better I’ve been able to start to exercise and this means I’ve even been able to reduce the dose of my medication as my body seems to be able to cope with the PoTS a lot more now.  I know I am lucky to have a GP with a knowledge of PoTS and this isn’t the case for so many people. The PoTS UK website is so full of useful information for both patients and healthcare professionals alike. I strongly recommend my colleagues to go and have a look at it to learn more about this illness and how you can help your patients! 

What is the worst aspect of long COVID for you? 

I think in the early days of long COVID, it was not knowing at all what the future held. My husband also suffers from long COVID and at the time I lost my job, his salary was about to halve, our roof was leaking and we were in the middle of re-mortgaging. It felt like my world was collapsing. I caught a bug at work during a pandemic and I never thought it would have these sequelae.  

Are you aware of other people with similar experiences? 

I’m part of a doctors with long COVID support group and so many of us have PoTS. Several of us have lost our jobs. Many of us have young children that we have tried to care for whilst being sick ourselves and unable to get any support due to the pandemic. It’s been a pretty harrowing time but I’m lucky that I’m coming out the other side of it now and have new opportunities as a result of all that has happened.  

What would you like to see change/improve? 

I would love to see an increased awareness of PoTS and dysautonomia by medics. I think it needs to be taught at medical school. We need to learn to think outside the box and remember that not all tachycardia, breathlessness, palpitations and dizziness equals anxiety. I cringe to think of the number of cases that I’ve missed over the years through my own ignorance.