Clinical Care
orthostatic testing

Michelle Blate APN [left], the Center nurse practitioner, is testing the patient for orthostatic sensitivity- i.e., physiological evidence substantiating complaint of feeling worse while standing. In the Center's protocol, heart and breathing rates, blood pressure and exhaled carbon dioxide are measured every minute with the patient lying on her back and then while leaning for 10 min against a wall [leaning test developed by NASA in lieu of tilt table testing]. The test identifies patients whose heart rate zooms while standing [POTS or postural orthostatic tachycardia syndrome], develop low or high blood pressure [orthostatic hypo- or hypertension] or those who overbreathe while standing [POSH or postural orthostatic syndrome of hyperventilation]. All of these disorders can be treated by Dr. Natelson. While some doctors evaluate patients for orthostatic cardiac problems, the Center is unique in also evaluating patients for breathing abnormalities.

Emphasizing a multidisciplinary approach to treatment, the Pain & Fatigue Study Center's private care practice enables us to deal with the wide range of symptoms and problems associated with CFS and FM.

Dr. Natelson sees new patients for an initial evaluation taking about 2 hours in his offices in the Department of Neurology at the Icahn School of Medicine at Mount Sinai located on the 7th floor of 5 E 98th Street. For nearby parking, consider searching parkwhiz.com.

When you arrive, you will be greeted by Michelle Blate, the Centerís nurse practitioner. She will do a complete physical examination on you as well as determine if you respond abnormally to being upright. Private pay patients will undergo a modified tilt test (depicted on the right) which Dr. Natelson has shown to be the equivalent of formal tilt testing. But since Medicare insurers do not reimburse for this test, he does formal tilt testing on patients with Medicare. Following the time with Ms Blate, the remaining time will be spent with Dr. Natelson. Thus, there is always adequate time for patients to tell him about themselves, how they feel and how all this has impacted on their lives as well as time to discuss any particular concerns and Dr. Natelson's preliminary diagnosis and recommendations to begin on a path towards wellness.

Prior to the initial visit, patients are asked to complete a comprehensive health screening form which Dr. Natelson will use to assure a comprehensive understanding of the new patientís condition and symptoms.

Upon completion and submission of the completed form, new patients receive a call from Dr. Natelsonís assistant to set up an appointment. Be sure to bring copies of any medical tests or reports concerning your medical condition to the visit. Patients are encouraged to ask their physician to order the blood tests that Dr. Natelson usually does on the initial visit and bring the results of those tests to the appointment. Click here for a list of those tests.

Patients return to complete the initial evaluation in the next month to allow further treatment planning. Subsequent visits in collaboration with the patientís primary care provider will be determined based on the patient's individual needs and circumstances.

To learn more about Dr. Natelson's personal approach to patient care, be sure to go to our page Dr. Natelson in the News. There, you can hear his approach to wellness. One important step is to maximize your own potential for wellness.

To read opinions of some patients about the quality of his care, click here.

Currently, the only insurance Dr. Natelson's office accepts is US Government Medicare. For patients with other insurance, the fee for the inital patient 2-hour consultation is $1,230 and $430 for 30-minute follow-up visits. Patients with non-government Medicare will be carged $710- a charge which includes formal tilt testing; the fee for follow-up visits is $175.

Payment is required in full at time of visit. Documentation for reimbursement from insurance companies will be provided to patients.