heres the email Your symptoms are quite consistent with a mast cell activation disorder (MCAD), far more likely the prevalent mast cell activation syndrome (MCAS) than the rare systemic mastocytosis (SM). MCAS often afflicts multiple members within a family, though often with different symptoms in different members of the family. This is due to the different members having different mutations in the regulatory elements of their mast cells. It is not presently understood why the mast cell mutations in different members of an affected family are different and acquired post-conception rather than similar and inherited from one generation to the next. It is common for MCAS patients to be diagnosed with "POTS," but there is no way POTS can possibly account for any but a small minority of the full spectrum of symptoms most POTS patients report. Although much research remains to be done in this area, I suspect most patients with "POTS" actually have MCAS as their root problem. Unsurprisingly, treatment targeting the POTS rarely helps the other symptoms which are caused by a problem more fundamental than POTS. I'm happy to see you (the process begins with your contacting our schedulers at 843-792-9300), but let me provide you fair warning on two counts: (1) My schedule is getting increasingly backlogged, and the wait at this point for a new-patient appointment slot may be a few months. (2) For many obvious reasons, it is impossible for me to serve as the primary manager of the acute difficulties suffered by my distantly located patients. Therefore, it is *essential* that you identify a local "physician/partner" who is willing to be your primary manager -- and that physician should know that I am happy to provide prompt consultative input to any physician who reaches out to me for help. Thank you for your understanding on both of these important points. Whatever you decide to do, I wish you the best of luck... -- LBA he says in the last paragraph "For many obvious reasons, it is impossible for me to serve as the primary manager of the acute difficulties suffered by my distantly located patients. Therefore, it is *essential* that you identify a local "physician/partner" who is willing to be your primary manager -- and that physician should know that I am happy to provide prompt consultative input to any physician who reaches out to me for help." What does that mean?