More Than Sick of Salt

All Posts in Category: EDS

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The “Soft Skeleton” Problem: How Faulty Collagen Disrupts the Body in hEDS

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Click Here to Download this Blog Post – The “Soft Skeleton” Problem (Part 7)

By Dr. Nicholas L. DePace, M..D., F.A.C.C – Cardiologist specializing in autonomic dysfunction, Ehlers-Danlos syndrome and POTS.

Heritable Connective Tissue Disorders (HCTDs) are caused by the body making collagen incorrectly.

  1. Collagen is the Body’s “Glue” Collagen is described as the body’s “soft skeleton.” It is found in every organ, blood vessel, and nerve. It gives your body its shape and holds your organs in place. When your body creates faulty collagen, it leads to disorders like Marfan syndrome, Stickler syndrome, and the most common one: Hypermobile Ehlers-Danlos Syndrome (hEDS).
  2. Ruling Out Danger It is critical for doctors to figure out exactly which disorder a patient has. While most patients have hEDS (which is painful but not fatal), there are rare types (like Vascular EDS) that can be life-threatening. Doctors need to rule those out first to ensure the patient is safe.
  3. The Name Matters Less Than the Treatment There is currently no genetic test for hEDS. Doctors often argue over labels—whether to call it hEDS, Hypermobility Spectrum Disorder (HSD), or the older term “Joint Hypermobility Syndrome.” The specific label doesn’t matter much because the treatment is the same: focus on relieving the pain, fatigue, and functional issues.
  4. The “Hallmark” Symptoms For most patients (especially young women), the biggest clue isn’t just flexible joints—it is Autonomic Dysfunction. This means the body’s automatic systems are out of sync. Common symptoms include:
  • POTS: A racing heart when standing up.
  • Chronic Fatigue: Feeling exhausted all the time.
  • Thermoregulatory issues: Sweating too much or trouble controlling body temperature.
  • Easy bruising.

In short, while flexible joints are a sign, the internal symptoms (like heart rate and fatigue) are often what bother the patient the most and lead to the diagnosis.

It is important to seek out a clinician with expertise in EDS to make an accurate diagnosis and create a treatment plan. One of the nation’s leading centers is Franklin Cardiovascular Associates, under the direction of Nicholas DePace, MD, FACC. They are located in Sicklerville, New Jersey. franklincardiovascular.com, (856) 589-6034

About the Author

Nicholas L. DePace, MD, FACC is a board-certified cardiologist and Medical Director of Franklin Cardiovascular Associates. A graduate of the Mount Sinai School of Medicine, Dr. DePace has decades of clinical, academic, and research experience and has held faculty appointments as a Clinical Professor of Medicine, becoming one of the youngest full professors in Philadelphia at the time of his appointment.

Dr. DePace specializes in the diagnosis and treatment of autonomic nervous system dysfunction (dysautonomia), including POTS, autonomic dysfunction associated with Ehlers-Danlos syndrome (EDS), chronic fatigue, and anxiety-like conditions that are frequently misdiagnosed. He is nationally recognized for his work on parasympathetic and sympathetic (P&S) nervous system imbalance, a core mechanism underlying many complex chronic disorders.

In addition to treating patients from across the United States, Dr. DePace is a prolific clinical researcher and author of multiple nationally distributed medical textbooks published by Springer and W.W. Norton, focusing on autonomic dysfunction, mitochondrial disorders, cardiovascular disease, and mind–body medicine.

👉 View Dr. DePace’s professional profile
👉 View medical books by Dr. DePace

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Hypermobile Ehlers-Danlos Syndrome (hEDS): The Invisible Condition Behind Chronic Pain and Fatigue

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Click Here to Download this Blog Post – The Invisible Condition (Part 6)

By Dr. Nicholas L. DePace, M..D., F.A.C.C – Cardiologist specializing in autonomic dysfunction, Ehlers-Danlos syndrome and POTS.

Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are conditions that often go unnoticed (“invisible”) for decades because they are difficult for doctors to spot.

Here are the key takeaways in simple terms:

  1. What are Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD)? hEDS and HSD are very similar conditions where the joints are too flexible (hypermobile) and unstable. While they used to have different names, they both result in the same problems: loose joints, muscle pain, frequent injuries, and eventually arthritis. Doctors diagnose this by checking how flexible you are using a checklist called the Beighton Criteria.
  2. The Main Symptom: Chronic Pain The biggest complaint from patients is widespread, long-lasting pain.
  • When does it start? For most people (75%), pain starts in their teenage years. However, for some, it doesn’t start until they are in their 50s or 60s.
  • Why does it hurt? The pain is usually linked to how unstable the joints are. The looser the joints, the worse the pain tends to be.
  1. Exhaustion and Poor Sleep Patients are often constantly tired. This isn’t just laziness; it is caused by:
  • Nervous system issues (P&S dysfunction).
  • Physical disruption: Joints can actually slip out of place (sublux) just by rolling over in bed, ruining sleep quality.
  1. The Cycle of Misdiagnosis Because the condition “hides,” patients are frequently misdiagnosed before doctors realize they have loose joints. Common wrong diagnoses include:
  • Chronic Fatigue Syndrome
  • Fibromyalgia
  • Depression
  • Hypochondriasis (being told “it’s all in your head”)
  • Malingering (being accused of faking it)

Conclusion Over the last 30 years, experts have realized that this is not just a joint problem. It is a whole-body condition that affects many different systems, causing significant suffering that often goes untreated for years.

It is important to seek out a clinician with expertise in EDS to make an accurate diagnosis and create a treatment plan. One of the nation’s leading centers is Franklin Cardiovascular Associates, under the direction of Nicholas DePace, MD, FACC. They are located in Sicklerville, New Jersey. franklincardiovascular.com, (856) 589-6034

About the Author

Nicholas L. DePace, MD, FACC is a board-certified cardiologist and Medical Director of Franklin Cardiovascular Associates. A graduate of the Mount Sinai School of Medicine, Dr. DePace has decades of clinical, academic, and research experience and has held faculty appointments as a Clinical Professor of Medicine, becoming one of the youngest full professors in Philadelphia at the time of his appointment.

Dr. DePace specializes in the diagnosis and treatment of autonomic nervous system dysfunction (dysautonomia), including POTS, autonomic dysfunction associated with Ehlers-Danlos syndrome (EDS), chronic fatigue, and anxiety-like conditions that are frequently misdiagnosed. He is nationally recognized for his work on parasympathetic and sympathetic (P&S) nervous system imbalance, a core mechanism underlying many complex chronic disorders.

In addition to treating patients from across the United States, Dr. DePace is a prolific clinical researcher and author of multiple nationally distributed medical textbooks published by Springer and W.W. Norton, focusing on autonomic dysfunction, mitochondrial disorders, cardiovascular disease, and mind–body medicine.

👉 View Dr. DePace’s professional profile
👉 View medical books by Dr. DePace

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Ehlers-Danlos Syndrome (EDS): One Root Cause Behind Many Symptoms

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Click Here to Download this Blog Post – Ehlers-Danlos Syndrome (EDS) The One Root Cause for Many Symptoms (Part 5)

By Dr. Nicholas L. DePace, M..D., F.A.C.C – Cardiologist specializing in autonomic dysfunction, Ehlers-Danlos syndrome and POTS.

Our research suggests that a wide variety of confusing medical conditions—ranging from anxiety, depression, and ADHD to physical issues like fibromyalgia, heart rate problems (POTS), and stomach issues—may all stem from a single root cause: dysfunction of the autonomic nervous system (P&S system). This dysfunction is particularly common in patients with Ehlers-Danlos Syndrome (EDS) or Hypermobile Spectrum Disorder (HSD).

Autonomic nervous system dysfunction in Ehlers-Danlos syndrome affecting blood flow

Here is how this dysfunction connects these seemingly unrelated symptoms:

  1. The Core Problem: Poor Blood Flow The main issue is that the nervous system is failing to regulate blood flow properly. This leads to “poor perfusion,” meaning not enough oxygen-rich blood is reaching the upper body and the brain.
  2. Why You Feel Pain (“Coat-Hanger Pain”) The text explains that pain in the neck and across the shoulders (often called “Coat-Hanger Pain”) is actually caused by the muscles being starved of blood. This lack of blood flow makes the muscles stiff and tight, leading to tension headaches.
  3. Why You Feel Anxious or Distracted Symptoms often labeled as mental health issues—like panic attacks, ADHD, OCD, or “brain fog”—may actually be the body’s survival mechanism.
  • When the brain realizes it isn’t getting enough blood, it panics.
  • It triggers “Adrenalin Storms” to force the heart to beat faster and push more blood upward.
  • Hyperactivity (like in ADHD) may be the brain’s attempt to keep activity high to demand more blood flow.
    1. The Treatment Approach The text concludes that doctors should focus on treating the nervous system dysfunction first. In many cases, once the blood flow regulation is fixed, the “anxiety,” “fibromyalgia,” and “attention disorders” disappear. If symptoms remain after that treatment, only then should they be treated as separate, standalone diseases.

It is important to seek out a clinician with expertise in EDS to make an accurate diagnosis and create a treatment plan. One of the nation’s leading centers is Franklin Cardiovascular Associates, under the direction of Nicholas DePace, MD, FACC. They are located in Sicklerville, New Jersey. franklincardiovascular.com, (856) 589-6034

About the Author

Nicholas L. DePace, MD, FACC is a board-certified cardiologist and Medical Director of Franklin Cardiovascular Associates. A graduate of the Mount Sinai School of Medicine, Dr. DePace has decades of clinical, academic, and research experience and has held faculty appointments as a Clinical Professor of Medicine, becoming one of the youngest full professors in Philadelphia at the time of his appointment.

Dr. DePace specializes in the diagnosis and treatment of autonomic nervous system dysfunction (dysautonomia), including POTS, autonomic dysfunction associated with Ehlers-Danlos syndrome (EDS), chronic fatigue, and anxiety-like conditions that are frequently misdiagnosed. He is nationally recognized for his work on parasympathetic and sympathetic (P&S) nervous system imbalance, a core mechanism underlying many complex chronic disorders.

In addition to treating patients from across the United States, Dr. DePace is a prolific clinical researcher and author of multiple nationally distributed medical textbooks published by Springer and W.W. Norton, focusing on autonomic dysfunction, mitochondrial disorders, cardiovascular disease, and mind–body medicine.

👉 View Dr. DePace’s professional profile
👉 View medical books by Dr. DePace

Read More
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Ehlers-Danlos Syndrome (EDS): Undiagnosed Patient Case Study, Symptoms & Autonomic Dysfunction After COVID-19

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Click Here to Download this Blog Post – Ehlers-Danlos Syndrome (EDS) The Undiagnosed Patient (Part 4)

By Dr. Nicholas L. DePace, M..D., F.A.C.C – Cardiologist specializing in autonomic dysfunction, Ehlers-Danlos syndrome and POTS.

 

  1. Case Summary: The Undiagnosed Patient

    Patient History: Lifelong Symptoms and Unexplained Health Issues

    The Patient’s History A 48-year-old woman visited a doctor due to worsening dizziness, heart palpitations, and “brain fog” when standing up, which intensified after a mild case of COVID-19. She had a lifetime history of unexplained health struggles. Since high school, she suffered from constant exhaustion and body aches (originally blamed on gymnastics). Her symptoms were diverse, including:

    • Joints that would frequently “pop out” or dislocate.
    • Easy bruising and stretch marks not related to weight gain.
    • Digestive issues (constipation) and heavy menstrual cycles.
    • Anxiety, sleep trouble, and migraines.

    The Medical “Odyssey”: Years of Misdiagnosis

    Over her lifetime, she saw more than two dozen specialists. Because her symptoms affected so many different parts of her body, doctors failed to connect them. She was misdiagnosed with anxiety, depression, and fibromyalgia, often being told her pain was psychological rather than physical.

    The Clinical Examination: Signs of Autonomic Dysfunction

    During this visit, the doctor noted that her heart rate spiked significantly when she stood up (a sign of autonomic dysfunction). The doctor also performed a Beighton score test, a standard method for measuring joint hypermobility.

Why Expert Evaluation Matters in EDS Diagnosis

It is important to seek out a clinician with expertise in EDS to make an accurate diagnosis and create a treatment plan. One of the nation’s leading centers is Franklin Cardiovascular Associates, under the direction of Nicholas DePace, MD, FACC. They are located in Sicklerville, New Jersey. franklincardiovascular.com, (856) 589-6034

About the Author

Nicholas L. DePace, MD, FACC is a board-certified cardiologist and Medical Director of Franklin Cardiovascular Associates. A graduate of the Mount Sinai School of Medicine, Dr. DePace has decades of clinical, academic, and research experience and has held faculty appointments as a Clinical Professor of Medicine, becoming one of the youngest full professors in Philadelphia at the time of his appointment.

Dr. DePace specializes in the diagnosis and treatment of autonomic nervous system dysfunction (dysautonomia), including POTS, autonomic dysfunction associated with Ehlers-Danlos syndrome (EDS), chronic fatigue, and anxiety-like conditions that are frequently misdiagnosed. He is nationally recognized for his work on parasympathetic and sympathetic (P&S) nervous system imbalance, a core mechanism underlying many complex chronic disorders.

In addition to treating patients from across the United States, Dr. DePace is a prolific clinical researcher and author of multiple nationally distributed medical textbooks published by Springer and W.W. Norton, focusing on autonomic dysfunction, mitochondrial disorders, cardiovascular disease, and mind–body medicine.

👉 View Dr. DePace’s professional profile
👉 View medical books by Dr. DePace

Read More
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Ehlers Danlos Syndrome

Ehlers-Danlos Syndrome (EDS): Hypermobility Diagnosis, HSD vs hEDS & Treatment Approach

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Click Here to Download this Blog Post –  Ehlers-Danlos Syndrome (EDS) Hypermobility Diagnosis and Treatment (Part 3)

By Dr. Nicholas L. DePace, M..D., F.A.C.C – Cardiologist specializing in autonomic dysfunction, Ehlers-Danlos syndrome and POTS.

Understanding Hypermobility: HSD vs hEDS

Our clinic treats patients with hypermobility (being “double-jointed” or “bendy”), which mainly fall into two groups:

  • Hypermobility Spectrum Disorder (HSD)
  • Hypermobile Ehlers-Danlos Syndrome (hEDS)

Both are complex and affect the whole body. It’s easy to get lost in the details of diagnosis, but the most important thing to remember is that the treatment for both HSD and hEDS is often identical.

Patients want a diagnosis, but what they need most is a plan to manage their symptoms and feel better.

Our 3-Step Approach to Hypermobility Diagnosis & Treatment

Therefore, our clinic’s process is clear:

  1. Safety First: Immediately rule out the one life-threatening type, vascular EDS (vEDS). All other types, like hEDS and HSD, are not life-threatening (they just impact the quality of life).
  2. Get a Diagnosis: After confirming it’s not vEDS, we run tests to accurately diagnose which hypermobility disorder the patient has.
  3. Create a Treatment Plan: We then build a plan focused on relieving the patient’s symptoms, improving their quality of life, and increasing their productivity.

Why Expert Evaluation Matters

It is important to seek out a clinician with expertise in EDS to make an accurate diagnosis and create a treatment plan. One of the nation’s leading centers is Franklin Cardiovascular Associates, under the direction of Nicholas DePace, MD, FACC. They are located in Sicklerville, New Jersey. franklincardiovascular.com, (856) 589-6034

About the Author

Nicholas L. DePace, MD, FACC is a board-certified cardiologist and Medical Director of Franklin Cardiovascular Associates. A graduate of the Mount Sinai School of Medicine, Dr. DePace has decades of clinical, academic, and research experience and has held faculty appointments as a Clinical Professor of Medicine, becoming one of the youngest full professors in Philadelphia at the time of his appointment.

Dr. DePace specializes in the diagnosis and treatment of autonomic nervous system dysfunction (dysautonomia), including POTS, autonomic dysfunction associated with Ehlers-Danlos syndrome (EDS), chronic fatigue, and anxiety-like conditions that are frequently misdiagnosed. He is nationally recognized for his work on parasympathetic and sympathetic (P&S) nervous system imbalance, a core mechanism underlying many complex chronic disorders.

In addition to treating patients from across the United States, Dr. DePace is a prolific clinical researcher and author of multiple nationally distributed medical textbooks published by Springer and W.W. Norton, focusing on autonomic dysfunction, mitochondrial disorders, cardiovascular disease, and mind–body medicine.

👉 View Dr. DePace’s professional profile
👉 View medical books by Dr. DePace

Read More