Diving into the Septad: POTS and MCAS

Neurologist Dr. Ilene Ruhoy outlines the evolving “Septad” model—an approach recognizing that many patients present with overlapping conditions (e.g., POTS, MCAS, ME/CFS/long COVID, pain and neurocognitive syndromes). The framework helps clinicians prioritize care by starting with the patient’s most disabling symptoms while keeping common comorbidities in view. Dr. Ruhoy highlights individualized plans that blend conventional and integrative tools, attention to potential triggers such as infections, mold/water-damaged buildings, and tick-borne illness, and stepwise treatment to reduce physiologic load. She emphasizes collaborative, multidisciplinary care and patient-centered pacing to improve function and quality of life, offering a practical roadmap for both new and experienced clinicians working with complex chronic illness.