What if your body keeps sending distress signals, but every test keeps saying, “You’re fine”? That question stayed with me while reading Upright. Peem Lorvidhaya’s book takes the often confusing world of POTS and dysautonomia and brings it down to earth—not by oversimplifying it, but by explaining what may be happening inside the body and, more importantly, how it can affect everyday life. As I read, I found myself thinking less about medical labels and more about the person trying to get through an ordinary day.
Understanding POTS and Dysautonomia Without the Medical Jargon
Dysautonomia can be difficult to understand, particularly when someone is experiencing very real symptoms while routine tests appear normal. Upright: A Cardiologist’s Guide to Living with POTS and Other Dysautonomias addresses this problem from the very beginning.
What I liked immediately was the author’s conversational approach. Instead of making the book feel like a medical textbook, Lorvidhaya explains complicated ideas through simple comparisons. One of the most memorable is his explanation of the autonomic nervous system as an accelerator and a brake that are no longer working in sync.
The book also encourages readers to look at patterns rather than labels. Symptoms such as dizziness, racing heart, fatigue and brain fog can become much easier to understand when you look at when they happen, what triggers them and what makes them better. The second chapter, for example, focuses heavily on tracking symptoms and identifying patterns instead of simply saying, “I feel terrible all the time.”
A Practical Guide to Managing POTS Symptoms
This is probably the part of Upright I found most useful. The book doesn’t stop at explaining what dysautonomia is. It spends considerable time discussing what patients and clinicians can actually look at next.
One of the central ideas is the Five Levers Model, which looks at volume, venous return, conditioning, autonomic tone and heart-rate control. I found this particularly interesting because it moves away from a one-size-fits-all approach. Two people may have the same diagnosis but have very different reasons for struggling.
The book then explores practical areas such as fluids and salt, compression, muscle pump exercises, meals, reconditioning and lifestyle changes. I especially liked the emphasis on consistency rather than heroics. The author explains how small, regular movements and gradual strengthening can help improve the muscle pump and orthostatic tolerance.
That practical mindset runs through the book. Readers are encouraged to make one change at a time, observe what happens and use that information rather than changing everything at once. It makes the process feel much less overwhelming.
The Human Side of Living With Chronic Illness
For me, this is where Upright becomes more than a medical guide.
The author doesn’t focus only on heart rate, blood pressure and testing. He also talks about something that can be much harder to measure: what it feels like to live with an illness that other people may not understand.
The book discusses the frustration of not being believed, friendships that change, lost independence and the grief that can come with losing parts of your old life. I appreciated that the author doesn’t treat emotional struggles as proof that physical symptoms aren’t real. Instead, he makes room for both realities.
I also liked the fact that the book looks beyond the doctor’s office. Later chapters cover work, pregnancy, surgery, travel, mental health, relationships, intimacy, children, family and working with healthcare providers.
That makes Upright feel like a guide to living with dysautonomia, rather than simply a book about diagnosing it.
My Final Thoughts on Upright
I went into Upright expecting a fairly technical medical book. What I found was something much more approachable. Yes, there is plenty of medical information here, but it is broken down with patient stories, everyday examples and a fair amount of humour.
What stayed with me most was the book’s focus on function. The goal isn’t presented as chasing a perfect number on a smartwatch or eliminating every bad day. Instead, the focus is on gradually getting back to the ordinary things that make up a life—working, studying, parenting, exercising, sleeping and simply being able to participate in everyday activities.
I would recommend Upright to people living with POTS or dysautonomia, caregivers, and anyone who wants a clearer understanding of these often misunderstood conditions. It is also a useful reminder that a normal test result doesn’t necessarily explain everything a person is experiencing.
One important point: the book itself states that it is meant for education and is not a substitute for individual medical advice. It encourages readers to use the information to have better conversations with their healthcare providers rather than making treatment changes on their own. If this is something of interest to you, you can grab your copy of the book on Author’s website or Amazon.
About the Author
Peem Lorvidhaya is a cardiac electrophysiologist who cares for patients with dysautonomia and heart rhythm disorders. He wrote Upright to give patients and clinicians the same plain-language framework he uses in his clinic—understanding what is happening, why it is happening, and which practical levers may help restore function.
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