DYSAUTONOMIA & MCAS
When the systems that should run in the background stop regulating.
Naturopathic telemedicine for dysautonomia, POTS and mast cell activation. Looking at regulation, reactivity and the patterns connecting them.
Standing up makes your heart race. A meal, a smell, heat, exertion or a change in environment sets something off. You may feel lightheaded, flushed, shaky, exhausted, short of breath or suddenly unable to tolerate things that never bothered you before.
When symptoms move between the cardiovascular, nervous, digestive, immune and other systems, they can be difficult to fit into a single diagnosis and are sometimes attributed to anxiety. I look at the broader regulation of these systems and what may be increasing the body's reactivity in the first place.
Why these patterns get missed
The autonomic nervous system manages what you never think about: blood pressure when you stand, heart rate, digestion, temperature, sleep and wake. Mast cells do something comparable for the immune system, monitoring the environment and releasing mediators when they register a threat.
When either becomes dysregulated, the result is rarely one symptom in one place. It is a shifting set of symptoms across several systems that can look different from one week to the next. Taken individually each can seem minor or unexplained, which is why the underlying pattern is so often missed.
Related conditions
What I look at
Rather than treating each symptom separately, I look at the systems that are supposed to be doing the regulating:
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Orthostatic response, what happens to heart rate and blood pressure when you stand.
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Autonomic regulation across sleep, digestion, temperature and recovery.
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Patterns around onset and potential triggers, including major physiologic stressors, medication or vaccination history, joint hypermobility, hormonal changes, environmental exposures and other changes that preceded the onset or worsening of symptoms.
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Mast cell mediator patterns, where testing is appropriate and likely to be informative.
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Patterns of reactivity, what sets symptoms off, how quickly, and how long they last.
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The foundations regulation depends on, including light exposure and circadian rhythm, sleep, hydration and nutrient status, nervous system regulation, movement and appropriate pacing, environmental exposures and other sources of physiologic stress.
I also don't view MCAS as the end of the conversation. Mast cells release mediators as part of the body's signaling and defense systems. When that response becomes excessive or poorly regulated, the question becomes not only how to quiet the reaction, but what may be repeatedly signaling threat or stress to the system.
What testing can and cannot tell us
Mast cell testing can be difficult to interpret. Mediators can fluctuate, testing may need to be timed around symptoms, and some specimens require careful collection and handling. When an upper endoscopy or colonoscopy has already been performed, existing biopsy tissue can sometimes be reviewed with additional mast cell staining, although mast cell counts alone do not establish MCAS. I look at testing in the context of the symptom pattern rather than treating any single marker as definitive.
When conventional evaluation comes first
Some symptoms in this area need conventional assessment, and some need it urgently.
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Symptoms suggesting anaphylaxis, including throat tightness, difficulty breathing, or swelling of the lips or tongue, are a medical emergency. Call 911.
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Fainting during exertion, chest pain, or a family history of sudden cardiac death should be evaluated by a cardiologist.
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Formal diagnosis of POTS usually requires specific orthostatic testing, which your doctor or a specialist will arrange.
This practice is designed to work alongside cardiology, allergy and immunology rather than in place of them.
How treatment works
Care follows the same four phases used across the practice, described in full on the My Approach page:
1
Clarify & stabilize
Map your history and your triggers, and steady whatever is limiting daily life most.
2
Investigate
Use history, prior results and targeted testing when useful to better understand what is driving the dysregulation.
3
Rebuild resilience
A personalized plan to improve tolerance and reduce reactivity, introduced gradually and adjusted as you respond.
4
Maintain
Protect your progress and widen what your body tolerates over time.
Is this you?
Heart racing or pounding on standing
Flushing, hives or itching without a clear cause
Symptoms that began after an illness, injury or other major stressor
Lightheadedness, or nearly fainting
Reactions to foods, smells or temperature change
Told it was anxiety, when it does not feel like anxiety