It hits Aspen Hermann ‘27 when he’s walking up the stairs to math. His ears start to ring, his legs start to feel weak. As he walks up the two flights, his heart beats faster, faster.
He knows it’s coming — it usually happens once a week, sometimes more. He makes it to math, sits down at his desk and puts his head down as the darkness takes over.
“It is what it is,” he said.
Hermann is one of around one to three million Americans with postural orthostatic tachycardia syndrome, also known as POTS. POTS affects the body’s ability to regulate heart rate and pump blood.
Typically, the body regulates blood pressure and heart rate. The heart pumps blood throughout the body at a steady rate. While that rate increases with movement, specifically exercise, the body is able to adapt and regulate, even if the rate is higher.
But in people with POTS, their ability to regulate is impaired. Blood vessels don’t respond properly when hormones send the signal to tighten. This means the longer that a person is upright, the more blood will pool in the lower half of their body.
The main symptoms of POTS are lightheadedness, dizziness and fainting. There are a variety of other symptoms, from headaches to fatigue to nausea.
Hermann was diagnosed his freshman year after realizing he felt “off” when he stood up. To get the diagnosis, doctors monitored his heart rate and blood pressure while lying down, sitting up and standing up. These tests showed that his body wasn’t regulating his heart rate correctly.
“My autonomic nervous system doesn’t regulate my heart rate. So if I stand up, my heart will just beat faster and faster because it won’t be harder,” he said.
POTS symptoms can change over time. When he was first diagnosed, Hermann had not fainted, but that changed during Theatre West’s production of “Chicago” during the fall of 2024.
“My first time fainting was in tech week of ‘Chicago,’ and I don’t know what led up to it. I think it was bouncing back and forth because during Chicago, I was only in set [crew] and it was just a really busy time, and I was hungry, I was tired and I was like, ‘Whoa, I don’t feel right.’ And so I got on the ground, and then I blacked out for a while, and then that just kind of became a common thing,” Hermann said.
POTS has no known cure. Instead, people with POTS focus on physical activity and diet to manage symptoms.
Many people with POTS, including Hermann, take salt pills because they increase blood volume; raising sodium concentration causes the body to retain more water to dilute the excess salt.
For Hermann, POTS symptoms often get in the way of his daily life. He has to be extremely mindful of his movements to prevent fainting and know when he needs to take a break.
His two main activities are theater and show band. Because both of these activities require physical activity, he has to monitor his health while participating.
“With theater, it’s a roadblock. If I’m trying to lift stuff in set I have to frequently pause and make sure that I don’t go down,” he said. “I have a couple people who know what to look for and know to get me on the ground and stuff in school.”
On top of theater, Hermann experiences difficulty with marching band. The band practices in the late summer and fall when the Iowa heat gets intense. During performances, they are required to wear uniforms with long pants and sleeves, which adds to the heat.
“It’s hot, and heat definitely impacts me. I have to use a lot of air and controlled breathing, and I’m upright, and there isn’t really an opportunity to sit down or anything,” he said. “Sometimes there are times where I have to sit performances out because it’ll be dangerous if I’m on the field, or I’ll have to sit out during rehearsal just to regulate sometimes, which is a bummer.”
Elise Fesler is an eighth-grader at Northwest Middle School who also has POTS. She is also in theater, and, like Hermann, said her condition can get in the way of her performances.
“I’m a performer, so I want to be able to do show choir stuff like that,” she said. “It gets really stressful if I’m out there going to show choir camps, and I stand up, and I get faint and I have no water.”
Activities that require performances like this can be difficult due a lack of time to rest and drink water. During Fesler’s first 2025 performance, she said she started feeling faint right before she went on stage.
“I can’t leave and sit down and get water, so I just sat on the floor backstage, and then I just got up, and I just pushed through it, even though I was still faint, because there’s a dancing number right after that,” she said. “But I think mostly what I’m just telling myself is just like to breathe and just don’t really think about it, because then it’ll go away on its own.”
Fesler didn’t receive a diagnosis until last summer, despite having symptoms for years. Her first experience with POTS symptoms was when she was mini golfing with her family in the hot summer air.
In the middle of golfing, the heat started to get to her. All of a sudden, her vision blacked out.
“It was really weird, because it’s never happened before, and my ears were ringing, I got really faint, and I started crying, because I was like, ‘what’s going on?’”
It was her first time with that experience, but not the last. When she tried to seek help from a doctor, medical professionals attributed the symptoms to a lack of water and told her she would “grow out of it.” But the symptoms never went away.
“It was really stressful because my parents knew I was drinking enough water, because I was drinking like, gallons of water,” she said. “So then I got tested again, and then they diagnosed me last summer.”
Experiences with POTS vary person by person. Some have rapid-onset symptoms while others ebb and flow. Some, like Hermann, faint regularly, but others, like Fesler, don’t faint at all.
Hermann’s symptoms not only changed from the time of initial diagnosis, but they also fluctuate in much shorter time periods. He calls them his “flare-ups”: times when he is typically under high stress and his symptoms worsen, specifically his fainting.
“Sometimes I’ll go a month without fainting, sometimes it’ll be a daily occurrence,” he said. “Sometimes it’s weekly. It just depends on those external factors.”
There is a common misconception that all people with POTS faint. But the disorder is, like many things, a spectrum; the severity of symptoms vary person by person.
“When people hear POTS, they think, ‘Oh, it’s a fainting disorder.’ You stand up, and you fall down and you’re passed out,” Fesler said. “But honestly, POTS is a lot of other things. It comes with a lot of other side effects, like nausea, fatigue, all this other stuff.”
While she doesn’t lose consciousness completely, Fesler’s vision will black out when her symptoms are more extreme. But outside of that, POTS still affects her daily life.
“POTS can really affect your day-to-day life, especially if you’re a student,” she said. “I mean, getting through a five-day school week is really hard for me, since I have fatigue and I’m nauseous.”
Both Fesler and Hermann have their ways of managing symptoms while at school.
Fesler has a health plan that allows her to leave class four minutes early. She doesn’t use it often, but is there as a safety net if she needs it. On a more regular basis, she monitors her salt intake, taking salt and electrolytes if needed.
Hermann has more extreme symptoms, but doesn’t have a formal health plan. Instead, he has had conversations with some of his teachers, such as his band directors, who need to know about his condition.
He went on medication a few months after his diagnosis, after he started fainting. He is currently on a medication that helps increase blood pressure. Along with his prescription, he will also take salt pills that he purchases on Amazon and drink sports beverages like Body Armor or Propel because they contain electrolytes.
Even though he faints, Hermann also wishes more people were aware of the spectrum of POTS symptoms.
“I am one of the people that faint. But there’s also a lot of people that don’t faint that still need accommodations,” he said. “And then there’s people that faint way more than I do who need more accommodations. I think there’s like a baseline in people’s minds where it’s just like, ‘Oh, if you don’t faint, you’re not able to be accommodated.’”
Because POTS has no cure, Hermann and Fesler have accepted it as a part of their lives. Fesler deals with some of her symptoms with a “push through it” mentality, where Hermann approaches it with humor.
“I have just accepted it as a part of my life,” Hermann said. “I like to approach it with humor, like, ‘Oh, there I go once again,’ or something like that. I think it’s fine to mock it and stuff because it’s out of my control. So why not have fun with it?”
