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.

3. 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.

4. 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

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

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

Click Here to Download this Blog Post –  Ehlers-Danlos Syndrome (EDS) Prelude – Part 2

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

Overview of Ehlers-Danlos Syndromes (EDS)

Ehlers-Danlos Syndromes (EDS) are a group of 13 heritable connective tissue disorders, which means that you can get it from your parents.

The conditions are caused by genetic changes that affect connective tissue, which is tissue that connects, supports, binds, or separates other tissues or organs. Each type of EDS has its own set of features to identify it.

Core Features Seen Across All EDS Types

Some features are seen across all types of EDS, including joint hypermobility, when joints move beyond their normal range, often due to loose ligaments; skin hyperextensibility, a condition where the skin can be stretched beyond its normal limits because of a problem with the body’s collagen and elastin proteins; and tissue fragility, excessive weakness and susceptibility of tissues to tearing, bruising, and injury.

Hypermobility Spectrum Disorders (HSD)

Patients not meeting strict criteria for EDS may have hypermobility spectrum disorders (HSD) which are connective tissue disorders that cause joint hypermobility, instability, injury and pain.

Additional Symptoms and Related Conditions

Other disorders such as fatigue, a feeling of weariness, tiredness, or lack of energy that can interfere with daily life; headaches, GI problems, a wide range of conditions affecting the digestive tract, with symptoms like abdominal pain, bloating, heartburn, nausea, and changes in bowel habits; and autonomic dysfunctions, a condition where the autonomic nervous system, which controls automatic bodily functions like heart rate, blood pressure, and digestion, doesn’t work properly are often seen as part of EDS/HSD [Ehlers Danlos Society].

Understanding Autonomic Dysfunction in EDS/HSD

Symptoms of EDS and hypermobility may be traced to the parasympathetic, a division of the autonomic nervous system that promotes “rest and digest” functions, counteracting the “fight or flight” response of the sympathetic nervous system; and sympathetic nervous system, a part of the autonomic nervous system that triggers the body’s “fight-or-flight” response to stress or danger; or oxidative stress, an imbalance between the production of free radicals and the body’s ability to detoxify them through antioxidants, leading to cellular damage; and all are treatable.

Clinical Approach to EDS & HSD

As a practicing Clinical Internist, I am always prepared to diagnose a patient with numerous “somatic complaints”, physical symptoms, like pain, fatigue, or dizziness, that cause significant distress or interfere with daily life, with a syndrome rather than to attribute them as psychosomatic, physical symptoms caused by mental factors like stress, anxiety, or emotional disturbance, which is always easier to do and which the majority of physicians prior to a patient’s visit with me have done. Such applies to patients who present with undiagnosed Ehlers-Danlos Syndrome (EDS) or Hypermobility Spectrum Disorder (HSD).

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