Hi r123,

I don't have a lot of knowledge about masto and I just received a diagnosis for MCAS recently (although my symptoms have been in a constant flare for almost two years).  

First of all, you have a HUGE stresser in the fact that your grandmother is so ill and dying.  Even though you may be ready to accept her passing, it still changes a lot in your world and the world of your extended family.  This may be putting more pressure on you than you realize and thus may also be preventing you from getting a good nights sleep.  Do you take any meds to help you sleep?  Can you take something to help you get the rest you need?  If you don't have anything on hand, please call your Dr. and ask for something.  Loosing sleep can compound ANY and ALL symptoms of masto.

Second, can you dress in layers so you can wear very lose fitting and light weight clothing on the train.  Otherwise maybe a small ice pack positioned on a part of your body may help.  I know some of the 'experts' on this site use some kind of cooling vests...the information is on one of the links on this site....

I tend to get very shaky when I have not slept well or eaten as much as I should.  Also...STAYING HYDRATED WILL HELP MORE THAN ANYTHING!!!  It seems so easy for us to become dehydrated....especially if you also have an autonomic dysfunction or POTS along with your masto.  I carry a bottle of cold water EVERY where I go...most of the time I drink around 100 oz. of water a day.  If I don't, I get dizzy, shaky, and feel like I am going to pass out.  

As far as the heat in most places in NY, maybe you could use a humidifier at least at home if you have the same type heat. At work and other places you could even use a small hand fan if you needed to but I would still check into the coolant vests as well. Getting too warm just activates everything and makes you worse!  

By all means...tell your boss about your health issues, especially about different smells that cause you so many problems.  How would you feel if you could help someone feel better by just NOT wearing some perfume!?? That's a simple request and your boss should know of your medical condition anyway, especially if you would need help at work.  If you are not aware of the link about an emergency protocol, is it listed on this site as well.  It's just as important for you to feel safe at all times! That helps to reduce stress too!  You can't do that if others don't know how to help you. OK?  It's also important that your boss knows that it is NOT your job that is causing you not to "look well".  OK?

I also find it very helpful to use a small amount of Xanax or Ativan when you are approaching a difficult situation.  It usually doesn't take much but it certainly can ward off a full blown attack.  (And this of course is our goal each and every day).  If you are more comfortable, perhaps increasing your H1 H2 blockers when you are going into a stressful situation would be better for you.  And when I say stressful, that can mean ANY situation (or place) where YOU feel you could have a mast cell flare up.  Maybe some of the experts on this site can respond to my suggestion.....I don't want to give you incorrect information.  

Hope this little bit of knowledge helps some....The very best to you....keep us posted on how you are doing.

Hugs, Lynda