The Keiser Clinic

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Chelsea, MI
The Keiser Clinic

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Founder of The Keiser Clinic. Specializing in POTS, dysautonomia, concussion and neurological disorders.

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11/09/2026

When your hands turn red and the veins bulge out as soon as they hang down, and then go back to normal when you raise them, that's pooling. We see it very commonly when the blood vessels lose their signaling and become pressure passive, which basically means the blood goes in the direction of gravity because the vessels can't shunt it around effectively. You'll notice it when your hands or legs are down, and also when you lay down, where your face might flush or you get veins in your head. It's a super good way to understand how to best solve for it.

If you want to learn more about your condition, download our POTS roadmap at the link in our bio.

11/09/2026

Most people working through a POTS diagnosis have heard of the Levine protocol or the CHOP protocol, an exercise prescription for deconditioning that's commonly applied to POTS. The original Levine protocol was built to help astronauts regain capacity after space flight, where being without gravity changes the stimulus on the body and causes symptoms that look like deconditioning or POTS, and when you put them back in a normal environment, exercising works because they were previously healthy. With POTS we're not just taking someone out of a normal context and putting them back, because the way the body adapts to gravity, sending blood flow around, getting the heart to beat right and the blood vessels to constrict right, has physiological errors. So we work through the mechanism that's failing first, and then stack the exercise demands on top of it to regain function and get out of that deconditioned state.

If you want to learn more about your condition, download our POTS roadmap at the link in our bio.

11/07/2026

So many of the patients we see who have been diagnosed with orthostatic intolerance, POTS, or dysautonomia deal with this. If eating makes your symptoms worse, you're way less likely to keep eating, but why is it happening? Anytime someone has a difficult time sharing blood flow around their body, particularly to their brain, eating matters, because the blood has to come down to the gut to pick up nutrients and carry them back through the body. If I'm already having a hard time sending blood flow to my brain and I then pull it down into my gut, I'm not going to feel very well. They already have a hard time getting blood to the brain, and when they eat, pulling that blood down to the gut to grab nutrients pulls it out of the brain, giving them more symptoms.

If you want to learn more about your condition, download our POTS roadmap at the link in our bio.

11/06/2026

Pacing is really a way of managing capacity, because if your body has been compromised, it doesn't just know how to run a marathon again, and walking for 6 minutes can feel like the marathon. We have to find the threshold where I can provide a stimulus, get a positive response on the back end, and still recover from it. So many times we forget that recovery is an active process too, it takes energy, and we can have errors in the way we recover the same way we have errors in the way we perform activities. With post-exertional malaise, recovery is usually the part we're forgetting, so the dose grows a little at a time only when it's provably positive and recoverable.

If you want to learn more about your condition, download our POTS roadmap at the link in our bio.

11/06/2026

Live Q&A with Dr. Nathan Keiser

11/05/2026

I know they want you to pass out on this test. But the point of the tilt table test is not to make you pass out. If you're someone with POTS, you probably shouldn't be passing out, because the diagnosis says your heart rate can keep up enough to prevent you from passing out, and your blood pressure doesn't drop. If someone has orthostatic intolerance, orthostatic hypoperfusion, they may pass out. But here's where it's useful to see what's going on, because if you are passing out, what we want to measure is what's failing. If someone passes out on the tilt test, number 1, it isn't dangerous. You're strapped to a table, and all we do is gently bring you down. A lot of times, before we even see someone pass out, we can see what's happening physiologically and understand it. It's really important to know: is the blood flow to my brain failing first? Is it my blood pressure dropping? My heart rate and my blood pressure dropping? Is my breathing starting to change? Are my CO2 levels starting to drop? Whichever one of those happens first in the sequence and leads the train tells you what to target to fix it. So the goal isn't to make you pass out. The goal is to understand what's happening physiologically when you stand up, so that if you do it long enough, the system starts to break down. For some people that will be passing out, but for most people with POTS, that isn't what it is. So try not to be too afraid of it. Ultimately, you want to be with someone who you feel has your back and your best interest at heart while you're doing the test, and all they're trying to do is capture some data to figure out how to help you.

If you want to learn more about your condition, download our POTS roadmap at the link in our bio.

11/04/2026

When people hear dysautonomia, they assume something in the autonomic system is failing, not kicking on. But POTS is the opposite form, the hyperactive form, where the system is working at an exaggerated rate to compensate for a problem somewhere else. Almost all of the physiology of POTS is the system working too much, not too little. That subtle framework change matters, because the next question becomes what it's compensating for, and that is the problem to solve.

If you want to learn more about your condition, download our POTS roadmap at the link in our bio.

11/03/2026

Cerebral hypoperfusion comes up all the time, so it's worth defining how we actually measure it. We use transcranial Doppler ultrasound on the middle cerebral artery on both sides, and we do it in a dynamic way, which means we change the context and compare the blood flow in the brain from one to the next. The main one we start with is a tilt test, measuring lying down and then upright, and we're looking for not a huge change, because the brain should be able to calibrate and maintain its blood flow even when you're upright. We also look at what happens when you turn your head or move your arms, your trunk or your body, so if the positions that give you symptoms line up with a real change in perfusion, we can start working backwards toward the source of the problem and then toward a solution.

If you want to learn more about your condition, download our POTS roadmap at the link in our bio.

11/02/2026

For some people with POTS, the problem is right where your neck meets your skull, because that's where all of these vessels and wires have to pass through. At that junction you basically have to line up two holes, and if they don't line up perfectly we start to shrink the size for all of those tubes and wires. Compressing the tubes that carry blood can reduce how blood flows from the head back to the heart and make it harder for blood to push up, so your heart works harder and you may get palpitations, pressure in your ears, ringing, or puffiness in your face. It's worth looking beyond just heart rate at that craniocervical junction, because conservative care can open up a whole new path of treatment for a lot of people.

If you want to learn more about your condition, download our POTS roadmap at the link in our bio.

Address

400 N. Main Street Suite A
Chelsea, MI
48118

Telephone

+17347075105

Website

http://www.keiserclinic.com/fb

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