POTS Treatment Using Natural Remedies

POTS Treatment Using Natural Remedies Contents hide

1 POTS treatment 1.1 What is Autonomic Dysfunction 1.1.1 Types of dysautonomia 1.1.2 Postural Orthostatic Tachycardia Syndrome (POTS) 1.1.2.1 Neurocardiogenic syncope (CNS) 1.1.2.2 Orthostatic hypotension 1.1.2.3 Postprandial hypotension 1.1.2.4 Multiple system atrophy 1.1.2.5 Pure autonomous failure 1.1.2.6 Afferent baroreflex insufficiency 1.1.2.7 Family dysautonomia 1.1.3 Dysautonomia symptoms 1.1.4 Specific POTS symptoms 1.1.5 Autonomic Dysfunction causes 1.2 Natural Autonomic Dysfunction and POTS treatment 1.2.1 Lifestyle changes and home remedies for dysautonomia and POTS treatment.

1.2.2 The recommended diet for POTS – an essential part of POTS treatment.

1.2.3 Acupuncture for Autonomic Dysfunction treatment – an ancient Chinese POTS treatment.

1.2.4 Hypnotherapy – Effective POTS treatment 1.2.5 Homeopathy – the #1 natural treatment for POTS 1.3 Natural POTS treatment in Philadelphia

POTS treatment

POTS treatment should be tailored to each individual, as the symptoms and underlying conditions can vary widely. POTS aka Postural orthostatic tachycardia syndrome is the most common type of dysautonomia or Autonomic Dysfunction.

Although there is no known cure for POTS, the condition can be managed in most patients with diet, exercise, and medication.

While POTS is a widespread medical condition population doesn’t have enough knowledge on the subject.

The most common approaches to POTS treatment are: 

Medications such as saline tablets, fludrocortisone, pyridostigmine, midodrine, and/or a beta-blocker may be prescribed to control POTS.

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You may be prescribed thigh-high medical grade compression stockings. These stockings help push blood up your legs to reduce POTS symptoms.

You should get a sphygmomanometer to check your blood pressure and pulse. Blood pressure monitors can be purchased at most drug stores, online, or at a medical supply store. Have your blood pressure monitor checked at the doctor’s office to ensure that the readings from your device match the blood pressure readings from your doctor?

Although the heart is healthy in most POTS patients, you can be evaluated for participation in a cardiac rehabilitation program.

This exercise template uses the cardiac rehab model to recondition and improve health and control POTS. Some of the best data on treating POTS comes from cardiac rehabilitation.

What is Autonomic Dysfunction Autonomic Dysfunction occurs when the autonomic nervous system, which controls the functions responsible for well-being and maintaining balance, is not properly regulated. Autonomic Dysfunction is also known as:   

dysautonomia autonomous failure autonomic neuropathy

The autonomic nervous system controls body functions that occur without conscious control. Although there are several components of the

autonomic system, it can be mainly divided into the sympathetic nervous system and the parasympathetic nervous system.

A simple way to think about the sympathetic nervous system is that it is what allows bodily fear and escape responses to emergencies and stress.

The parasympathetic nervous system lets us relax, sleep, and digest.

Both the sympathetic and parasympathetic systems have central (inside the brain) and peripheral (outside the brain) components and together

these two systems essentially control our heart rate, blood pressure, digestion, temperature regulation, sweating, urination, and sexual function. The two systems have different primary neurochemicals that help with signal transmission.

Due to the complexity of the interaction between the components of the autonomic nervous system and the myriad ways in which the harmony of the system can be disrupted, individuals with Autonomic Dysfunction can experience mild to severe symptoms. These symptoms can affect one or more organ functions. Autonomic deregulation or failure can occur alone or be associated with various other neurological and non-neurological disorders.

In this article, Dr. Tsan will convey his opinion and experience on the subject.

You will find the answer on: 

What is Autonomic Dysfunction?

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What is POTS?

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What is dysautonomia?

What are Vagus nerve disorders?

What are the Dysautonomia causes?

What are Dysautonomia symptoms?

What are the options of Treatment for Dysautonomia?

And how holistic medicine can help in POTS treatment.

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The autonomic nervous system regulates the internal organs of the body, such as heart rate, blood pressure, digestion, and body temperature.

People with an autonomic disorder have trouble regulating one or more of these systems, which can lead to fainting, dizziness, fluctuations in blood pressure, and other symptoms.

Autonomic nervous system disorders can occur on their own or as a result of another disease such as Parkinson’s disease, cancer, autoimmune diseases, alcohol abuse, or diabetes.

Types of dysautonomia

Postural Orthostatic Tachycardia Syndrome (POTS) What is POTS is a very common question my patients ask me when they have Dysautonomia symptoms.

So, what is the meaning of POTS? POTS is an abbreviation that stands for:    

Postural: correlated with the body position Orthostatic: specific for standing position Tachycardia: fast heartbeat Syndrome: a set of signs

POTS is the most common type of dysautonomia, a disorder of the autonomic nervous system. This area of the nervous system regulates functions we can’t intentionally control, such as heart rate, blood pressure, gastrointestinal peristaltic, erection, sweating, and body temperature. The main characteristics of POTS are specific symptoms and an exaggerated increase in heart rate when standing. Postural orthostatic tachycardia syndrome (POTS) is a condition that affects blood flow. POTS causes the following symptoms:   

dizziness, fainting, and an an uncomfortable, rapid heart rate that starts when you get up from a lying position and are relieved when you sit up or lie down.

It involves the autonomic nervous system (which automatically controls and regulates the body’s vital functions) and the sympathetic nervous system (which activates the fight-or-flight response).

POTS is a form of orthostatic intolerance, the development of symptoms that arise when getting up from a reclined position and which can be relieved by sitting or lying down. The main symptom of orthostatic intolerance is dizziness, fainting, and a rapid, uncomfortable increase in heart rate.

Heart rate and blood pressure work together to keep blood flowing at a healthy pace, no matter what position the body is in. People with POTS cannot coordinate the balancing act of blood vessel contraction and heart rate response. This means that blood pressure cannot be kept constant and stable.

Each case of POTS is different. In POTS patients, symptoms can come and go over a period of years. In most cases, a person with POTS will see an improvement in their quality of life through adjustments in diet, medication, and physical activity. And POTS symptoms can subside when an underlying cause is found and treated.

There are different types of POTS. The most common are: 

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Neuropathic POTS: Peripheral denervation (loss of nerve supply) weakens the muscles of the blood vessels, especially in the legs and the core of the body.

Hyperadrenergic POTS: Hyperactivity of the sympathetic nervous system.

Low blood volume POTS: Reduced blood volume can lead to POTS. Low blood volume can cause similar symptoms that may overlap in neuropathic and hyperadrenergic POTS.

Neurocardiogenic syncope (CNS) CNS is the most common form of dysautonomia. This can cause fainting that happens once or twice in your lifetime or several times a day. SCN is also called situational syncope or vasovagal syncope.

Orthostatic hypotension Orthostatic hypotension is a sudden drop in blood pressure that occurs when a person stands up, causing blood pressure to drop when standing.

This leads to a decrease in the blood supply to the brain. The condition usually makes a person feel lightheaded or lightheaded. Sometimes, orthostatic hypotension can cause a person to pass out.

Other symptoms of orthostatic hypotension include fatigue, particularly from exertion; poor eyesight; pain in the back of the neck and shoulders, sometimes called “hanger” pain; or shortness of breath.

Symptoms of this type of dysautonomia worsen when people stand up and improve when they sit or lie down. Usual causes of orthostatic hypotension are:   

dehydration, hot environments, or standing for long periods of time.

Most people feel better by hydrating and resting.

Many people sometimes feel lightheaded or dizzy after standing.

However, for those who feel dizzy or lose consciousness every time they get up, it could be a sign of an autonomic disorder.

Orthostatic hypotension can lead to complications, especially in older people, such as falling from fainting. People with the disease are at risk for bone fractures, stroke due to reduced blood supply to the brain, or cardiovascular diseases such as chest pain or heart failure.

Postprandial hypotension Postprandial hypotension is a sudden drop in blood pressure after a meal caused by changes in blood pressure during the digestion of food. The most common symptoms of postprandial hypotension are:

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dizziness, lightheadedness, or fainting about 15 to 90 minutes after eating.

This medical condition is frequent in mature people over the age of 60 and in individuals that suffer from other autonomic nervous system disorders.

During digestion, excess blood is diverted to the stomach and small intestine, causing the heart to beat faster and stronger as the blood vessels located away from the digestive system constrict. These functions naturally preserve the normal blood flow and blood pressure all over the body. However, in people with postprandial hypotension, the heart rate doesn’t beat as fast and blood vessels don’t constrict as they should, causing blood pressure to drop.

Multiple system atrophy Multiple system atrophy is a rare autonomic disease that usually affects men and women in their 50s and progresses rapidly over 5 to 10 years.

Multiple system atrophy initiates a developing loss of motor functions of the skeletal muscles and sooner or later the need to make use of a wheelchair.

There are two distinct sorts of multiple system atrophy:  

cerebellar type of multiple system atrophy parkinsonian type of multiple system atrophy.

How a person is diagnosed depends on the most noticeable symptoms at the time of his or her evaluation.

People with the parkinsonian type have symptoms similar to Parkinson’s, such as slow movement, stiffness, tremors, and problems with balance and coordination.

Patients with the cerebellar type have a loss of coordination, difficulty swallowing, problems with speech or a trembling voice, and unusual eye movements.

This condition tends to progress faster than Parkinson’s disease, and most people eventually require a walking aid such as a cane, walker, or wheelchair within a few years of symptom onset.

Pure autonomous failure Pure autonomic failure is a rare degenerative disease that causes orthostatic hypotension, sexual dysfunction, reduced ability to sweat, elevated blood pressure when lying down, and changes in gastrointestinal and urinary habits. The condition affects men slightly more often than women and is often found in middle-aged and older adults.

Afferent baroreflex insufficiency Afferent baroreflex disorder is an autonomic disorder that causes fluctuations in blood pressure due to disruption of the blood pressuresensitive nerves that carry information to the brain. As a result, blood pressure is alternately too high and too low. Symptoms include dizziness and fainting, as well as headaches, sweating, and flushing of the skin.

This condition occurs when the blood pressure-sensitive nerves in the neck are damaged after cancer treatment, surgery, or radiation therapy.

This can happen in people who have had a stroke, which affects areas of the brain through which information about blood pressure is transmitted.

It can also be the result of hereditary diseases that affect the development of blood pressure-sensitive nerves.

Family dysautonomia Familial dysautonomia is a rare inherited disorder that affects the development of the autonomic and sensory nervous systems. People with Familial dysautonomia experience unpredictable surges and falls of blood pressure that vary between being too high and too low. They may also have reduced pain and temperature sensitivity and lack of tear flow when crying.

Other common symptoms include difficulty swallowing, profuse vomiting or gastroesophageal reflux, poor muscle tone, excessive sweating, excessive saliva and mucus production, and patchy redness of the skin when fidgeting or eating. People with familial dysautonomia can develop chronic breathing problems due to stomach acid or food reflux. You may also have vision problems due to progressive damage to the optic nerve in your eye.

During times of stress, people with familial dysautonomia can experience high blood pressure and heart rate, accompanied by vomiting or retching. This is called an autonomous crisis.

Dysautonomia symptoms The autonomic nervous system innervates all structures, systems, and organs of the body. That’s why symptoms of dysautonomia may be different depending on the patient’s age, constitution, gender, underlying conditions, and of course the type of dysautonomia.

There are many symptoms of dysautonomia. Symptoms vary from patient to patient. Symptoms may be present for a while and may disappear and reappear at any time. Some symptoms may develop during times of physical or emotional stress or may appear when you are completely calm. Some symptoms may be mild in some patients; in others, they may constantly interfere with everyday life.

A common sign of dysautonomia is orthostatic intolerance, which means you can’t stand up for long without feeling faint or dizzy. Other signs and symptoms of dysautonomia you may experience include: Stability problems

Sound/bright light sensitivity

Chest pain/pressure

Shakiness, faintness, unsteadiness

Continuing tiredness

Visual disruptions

dyspnea

Fluctuations of body and temperature

Trouble swallowing

(blurred vision) Nausea and vomiting, Gastro-intestinal (bower movements irregularity)

Tachycardia or bradycardia, palpitations

Significant fluctuations s in heart rate and blood pressure

Weakness

Cyclothymia

Collapsing, loss of consciousness

Decrease of perspiration or lack of sweat

Insomnia

Hemicrania or frequent headaches

Thirst and general dryness

Impotence in men or frigidity in women

Hypoglycemia

Brain “fog”/ poor memory/a deficit

Recurrent frequent urina incontinence

Physical activity intolerance ( doesn’t change according to level)

Certain conditions and events can produce the symptoms of dysautonomia. These triggers are:     

Alcohol consumption.

Dehydration.

Emphasize.

Tight clothes.

Hot Environments.

Specific POTS symptoms

POTS symptoms can be an uncomfortable and frightening experience. POTS symptoms that patients usually experience fall in two or more of the many symptoms of POTS listed below. Not all patients with POTS have all of these symptoms.    

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high blood pressure/low blood pressure. high/low heart rate; racing heart rate. chest pain.

Dizziness/drowsiness, especially when standing up, standing in one position for a long time, or taking long walks.

Fainting or near fainting. exhaustion/tiredness. abdominal pain and bloating nausea.

Temperature deregulation (hot or cold).

Nervous, jittery feeling.

Forgetfulness and difficulty concentrating (brain fog).

Blurred vision.

Headache and body aches/aches (may feel like the flu); neck pain.

Insomnia and frequent waking up from sleep, chest pain and heart palpitations during sleep, excessive sweating.

Tremors/tremors, especially with adrenaline rushes.

Discoloration of feet and hands. exercise intolerance.

Excessive or absent sweating. diarrhea and/or constipation

Autonomic Dysfunction causes Many health conditions can become dysautonomia causes. Autonomic Dysfunction can also be a side effect of treatment for other diseases such as cancer.

Certain general causes of Autonomic Dysfunction are: 

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Diabetes, particularly when inadequately controlled, is the most frequent cause of autonomic neuropathy. Diabetes can progressively cause nerve damage all over the body.

Abnormal accumulation of proteins in organs (amyloidosis), affecting organs and the nervous system.

Autoimmune diseases, when the immune system strikes and harms parts of its own body, including your nerves. Examples of autoimmune diseases that can cause Autonomic Dysfunction are: o Sjogren’s syndrome, o systemic lupus erythematosus, o rheumatoid arthritis, and o celiac disease. o Guillain-Barre syndrome is an autoimmune disease that develops swiftly and can impact the autonomic nerves.

Another possible cause is an abnormal attack of the immune system that occurs as a result of certain cancers (paraneoplastic syndrome).

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Certain medicines, including some medications, are used to treat cancer (chemotherapy).

Certain viruses and bacteria, such as HIV and those that cause botulism and Lyme disease.

Some hereditary diseases can also cause autonomic neuropathy.

Natural Autonomic Dysfunction and POTS treatment There is no successful POTS Treatment or treatment for Dysautonomia in western medicine, but you can manage the symptoms.

Your doctor may suggest many different therapies to deal with the specific symptoms of dysautonomia.

More common measures for dysautonomia and POTS treatment are: 

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Drinking more water each day. Ask your medical practitioner about the recommended amount of water you should consume per day. Extra fluids maintain blood volume which helps with symptoms.

Add extra salt to your diet (3 to 5 grams per day). Salt helps the body to maintain the correct amount of fluid in the blood vessels, which helps to maintain normal blood pressure.

Sleeping with your head high in bed (about 6 to 10 inches higher than your body).

Take medications such as fludrocortisone and midodrine to raise your blood pressure.

Lifestyle changes and home remedies for dysautonomia and POTS treatment.   

Do not smoke or drink alcoholic beverages.

Eat a healthy diet.

Drink a lot of water. Have a supply of water next to you at all times.

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Add extra salt to your diet. Keep savory snacks with you.

Get enough sleep.

Maintain a healthy weight as a part of your POTS treatment.

Maintain blood glucose levels within normal limits if you suffer from diabetes.

Listen to what your body is telling you it needs. For instance, take time off from work or college if you feel that your body needs rest.

If you feel dizzy, sit, lie down and/or lift your feet.

Get up slowly.

Wear compression stockings and supportive clothing to increase/maintain blood pressure Don’t spend too much time sitting or standing without changing your body position.

Avoid the heat. Take warm or cold baths and showers.

Talk to your doctor before taking any over-the-counter medication or supplement.

Ask your doctor if you can drink caffeinated beverages or eat foods with artificial sweeteners. Caffeine should be avoided if you have an elevated heart rate. Artificial sweeteners can cause migraines in some people.

The recommended diet for POTS – an essential part of POTS treatment.  

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Boost sodium consumption from 3,000 mg to 10,000 mg per day.

Drink 2-2.5 liters of liquid daily. Water is a good choice. Sports drinks are fine, but watch out for the calories and if you have food intolerances to the ingredients in these drinks.

Small, airplane size meals are easier digested and reduce POTS symptoms.

A diet high in fiber and complex carbohydrates can help reduce blood sugar spikes (sugar spikes) and relieve POTS symptoms.

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Keep your diet balanced with protein, vegetables, dairy, and fruit.

Plan meals as POTS sufferers occasionally do not have enough stamina to shop for groceries and prepare meals. Plan meals when your energy is at its highest. If possible, make it a family plan to prepare food and share the responsibility for grocery shopping.

Don’t rely too much on processed foods. Processed foods are easy to prepare and appealing when you’re low on energy but typically have less nutritional value.

Beneficial salty snacks can include chicken or beef broth, vegetable broth, pickles, olives, salted fish like sardines/anchovies, and nuts. Don’t rely too much on potato chips and crackers for salt.

Plan your grocery shopping using a list to ensure you choose healthy foods and POTS (hydration and salt supplements) care. If your stamina is low, ask someone to help you with shopping, carrying, and storing your groceries.

Health conditions can be costly. Make every effort not to compromise nutrition and food choices to save money.

You may need a diet and nutrition consultation ordered by your doctor to help you with your diet. This consultation can be particularly useful for people with celiac disease and other food sensitivities.

Often in the early phase of POTS, patients do not like the way their body feels and looks. Beware of fad diets or weight loss supplements.

Acupuncture for Autonomic Dysfunction treatment – an ancient Chinese POTS treatment.

Acupuncture can help establish normal vagal tone, which appears essential in dysautonomia, POTS, and the disease’s many debilitating side effects. People with dysautonomia have typical symptoms of the

disease, but also have very individual complications. The beauty of acupuncture is that it is a catalyst for the body to do what it needs to do according to each person’s essential health requirements. The inclusion of the Vagus nerve acupuncture point in a patient’s individual acupuncture treatment plan should be seriously considered – for the benefit of a person’s quality of life.

TCM in general and acupuncture, in particular, prompt the body to heal itself. Acupuncture is a clinical medicine that treats diseases, pain syndromes, and inflammations while encouraging the maintenance of our homeostasis or microelements’ balance. For example, the same acupuncture point can be treated for high or low blood pressure and the body will adjust accordingly to establish that happy 120/80 range. Same with a fever or a hot flash – treating a certain acupuncture point can lower body temperature to recover our ideal temperature of 98.6 degrees F. In the case of dysautonomia, gastroparesis with severe pain and vomiting, bradycardia, fainting or fainting, and an inability to sweat are several major complications. Gastroparesis is the result of the underactive Vagus nerve, with delayed gastric emptying and inhibition of peristalsis – an inability to digest food and its vital nutrients. At the same time, an overactive Vagus nerve can cause abnormally low heart rate and vasovagal fainting or syncope due to a sudden drop in cardiac output.

Whether the Vagus nerve is hypo or overstimulated, whether in dysautonomia, treating the Vagus nerve’s acupuncture point encourages the body to homeostasis and function effectively. Since the body naturally tends to maintain homeostasis and function optimally in order to survive, vagal stimulation through acupuncture communicates the corresponding need to increase or decrease vagal function.

Hypnotherapy – Effective POTS treatment The mind is like an onion. The external coating, or conscious mind, deals with intellect, certainty, existence, and logic. The inner mind is connected to emotions, imagination, and memory, as well as the autonomic nervous system, which automatically controls our internal organs (i.e., how we breathe, send oxygen to blood cells, or walk without using the conscious mind). the inner mind operates on autopilot, responding to the demands of the pleasure principle. He seeks pleasure and avoids pain” (Warren, 2003, pp. 175– 176).

It is these characteristics that make hypnosis a highly effective therapeutic tool in the treatment of a wide range of mental and physical disorders. When a clinical hypnotherapist engages in hypnosis, the amygdala is turned off. A clinical hypnotherapist can actually relax the autonomic nervous system by turning off the normal fight, flight, or freeze response and reducing the trigger that triggers pituitary and adrenal secretions.

This gives the body an opportunity to strengthen its immune system and reduce injury (Frank and Mooney, 2002) in many chronic diseases (eg, irritability syndrome, bulimia, cancer, high blood pressure, and Parkinson’s disease). Even The Wall Street Journal (Friedman, 2003) has documented how hypnosis has become mainstream of POTS treatment and uses trance states for fractures, cancer, and burns, and speeds up recovery times.

When a person looks at the world, they are confronted with an overwhelming amount of sensory information – sights, sounds, smells, etc. After being processed in the sensory areas of the brain, the information is transmitted to the amygdala, which acts as a portal to the limbic system regulating emotions. Utilizing feedback from the person’s accumulated experience, the amygdala defines how the individual should respond emotionally. For example, with fear (at the sight of a burglar), lust (at the sight of a lover), or lust. indifference (in the face of something insignificant). Messages cascade from the amygdala through the rest of the limbic system and eventually reach the autonomic nervous system, which prepares the body for action. If the person is confronted by a burglar, for example, their heart rate will increase and their body will sweat to dissipate the heat from the muscular effort. The autonomic stimulation, in turn, responds back into the brain, strengthening the psychological response. Over time, the amygdala creates a landscape of salience, a map that details the emotional significance of everything in the individual’s environment.

Recent brain research shows that it’s possible to talk to the amygdala, a key part of the brain involved with certain emotions. The inner mind deals with emotions, imagination, and memory, as well as the autonomic nervous system, which automatically controls our internal organs. By speaking to the amygdala, a skilled clinical hypnotherapist can relax the autonomic nervous system by shutting down or restricting the trigger that initiates secretion from the adrenal and pituitary glands. This gives the body the opportunity to rebuild its immune system in many chronic diseases making at the same time clinical hypnosis one of the best POTS treatments.

Homeopathy – the #1 natural treatment for POTS The nervous system can encompass so much. Neurology has to do with any dysfunction of the nervous system but generally does not include those conditions traditionally considered psychiatric, such as depression, schizophrenia, and anxiety disorders, which can have important effects on the proper functioning of the nervous system. Homeopathy, of course, has a big role to play in this area, but that is beyond the scope of this article. I will settle for a few remedies or groups of remedies that I find helpful in some of the more well-known neurological conditions, many of which can lead to long-term discomfort or disability. The role

of homeopathy in many of these conditions is not to cure, but in general, to help people cope better with their difficulties and a qualified physician should always be consulted. The homeopathic system of medicine works very well to treat the symptoms of POTS and also to treat the condition. Symptoms such as dizziness, fainting, nausea, vomiting, bloated stomach, the feeling of fullness in the stomach, headache, ringing in the ears, etc. are treated well with these homeopathic remedies. Some known homeopathic medicines indicated for POTS treatment are Aconitum Napelus, Lycopodium Clavatum, Hydrastis, Pulsatilla Nigricans, China Officinalis, Nux Vomica, Bismuth, and Carbo Veg. The most suitable drug is selected individually for each gastroparesis case based on the symptoms.

Scientists also suggest that the Vagus nerve is extremely important for boosting the body’s immunity. Thus, Vagus nerve stimulation (VNS) (both electronically and chemically) is the new buzzword in improving human health. Scientists believe that VNS helps relieve pain, reduce certain diseases such as asthma, anxiety disorders, heart failure, and others. My guess is that homeopathic medicines may chemically assist in this VNS process.

Based on a study, Aconitum Napelus produced a response in heart rate variability (HRV) with a power of 30c and in blood flow variability with a power of 1M. Sulfur 200c and 1M, Gelsemium 200c, and Pulsatilla 200c produced a 62.5% HRV response versus a 16.6% placebo response.

Gelsemium, Phosphorus, and Sulfur produced a response in blood flow variability with a potency of 1M, similar to the response of Aconitum Napelus 1M. Natural POTS treatment in Philadelphia While western medicine doesn’t have a good success rate in POTS treatment we at the Philadelphia Holistic Clinic perform treatment for Autonomic Dysfunction using a combination of acupuncture,

homeopathy, hypnotherapy, reiki, and ayurvedic herbal medicines. Our success rate is way above average in the industry.

To schedule an appointment for an evaluation and discuss with Dr. Tsan the optimal POTS treatment plan for you, contact our clinic (267) 2843085 or use our automatic online application by scanning the QR code below.