POTS, MCAS, and the Veins Medical School Forgot | Dr. Alexis Cutchins
Your dizziness when you stand up is real. Your pelvic pain is real. Your fatigue is real. And there's actually a connection between all of it that most doctors were never taught to look for.
In this episode, I sit down with Dr. Alexis Cutchins, a cardiologist who treats POTS, mast cell activation syndrome, and pelvic venous disease. We discuss how POTS gets diagnosed, why so many of these patients also have venous insufficiency, and what mast cell activation has to do with all of it.
She explains why the venous system is overlooked in medical training even though it holds 70% of your blood volume, and how treating venous problems can dramatically improve symptoms. Whether you're a clinician trying to understand these complex patients or someone who's been dismissed for years, this episode gives you real answers.
What You'll Learn:
You don't need a tilt table test to diagnose POTS; simple office-based or at-home tests can help identify it.
First-line POTS treatment includes volume expansion (drink water, eat salt), compression stockings, and treating comorbid MCAS.
About 80% of POTS patients have venous insufficiency treating it can dramatically improve or even cure symptoms.
70% of your blood volume is in your venous system at any time, yet it's completely overlooked in medical training.
Pelvic venous disease is diagnosed with MRV (not CT) and treated with stenting by interventional radiologists.
Left iliac vein compression (May-Thurner syndrome) can cause pelvic pain, back pain, headaches, and IBS symptoms.
Women's heart attacks can present as abdominal pain, neck tightness, or jaw pain, not just chest pain.
These conditions run in families; mothers and daughters often share the same constellation of symptoms.
Mast cell activation syndrome often coexists with POTS, and treating it helps even without classic allergy symptoms.
Venous ablations can improve fatigue and cognitive function, not just cosmetic vein appearance.
If you've been dismissed for POTS, MCAS, pelvic pain, or any constellation of symptoms that don't fit into a neat diagnostic box, this episode validates what you've been experiencing. These conditions are real. They're treatable. And more doctors are finally starting to listen.
Make sure to subscribe to the podcast so you don't miss upcoming episodes on related topics, and share this with anyone who needs to hear that their symptoms matter.
00:00 Intro
04:32 Dr. Cutchins' Origin Story
10:17 What is POTS and How to Diagnose It
17:16 POTS Symptoms and Associated Conditions
22:16 Mast Cell Activation Syndrome Explained
29:14 The Venous System: The Lost Organ
35:45 Pelvic Venous Disease and May-Thurner Syndrome
42:01 Diagnosing and Treating Pelvic Venous Disease
48:47 Pregnancy and Stenting Concerns
52:28 Women's Cardiovascular Health
58:05 Microvascular Disease and Coronary Vasospasm
59:33 Opening a Practice in New York
