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Janassa spent over a decade as a Certified Registered Nurse Anesthetist, reading heart rate, blood pressure and blood flow moment to moment in operating theatres — including a paediatric trauma centre with a Level IV NICU. That work gave her a close, physiological view of the autonomic nervous system under stress, knowledge she now brings to biio. for patients living with it day to day, not only under anaesthesia. Recently relocated to Melbourne from the United States, she listens closely, particularly to symptoms already dismissed or left unexplained elsewhere.
POTS and related autonomic dysfunction disrupt how the body regulates heart rate, blood pressure and blood flow when upright, producing symptoms that shift hour to hour. Assessed one reading at a time, in one specialty, the underlying pattern is easy to miss. Janassa draws on years spent reading real-time haemodynamic data under anaesthesia to interpret how these systems behave together — tracking symptoms against posture, exertion, hydration and time of day. The aim is a plan built around how the body actually behaves, not a single reading.
Mast cell activation frequently coexists with dysautonomia, each amplifying the other — flushing, gut symptoms and cardiovascular instability that vary week to week. Treated one system at a time, the connections are often missed and flares put down to anxiety or deconditioning. Janassa maps how triggers and symptoms cluster across systems, sequencing investigation and treatment carefully in bodies that react to almost everything, working with the wider team where prescribing is needed. The aim is fewer, more predictable flares.
Hypermobile connective tissue changes how blood vessels behave under pressure, and joint instability adds a constant metabolic cost to ordinary movement — both of which can worsen autonomic symptoms already in play. This overlap is often missed when hypermobility and dysautonomia are assessed separately. Janassa reads the two together, weighing how joint instability, connective tissue and vessel tone interact in the same body, and coordinates with physiotherapy where the overlap needs shared management. The aim is a plan that accounts for both, not one at a time.
Hormonal shifts across the menstrual cycle, pregnancy and perimenopause alter autonomic tone directly, so dysautonomia that has settled can destabilise again at each transition. Managed separately from hormonal care, these flares are often read as a worsening primary condition rather than a hormonal one. Janassa looks at where symptoms sit against the cycle or transition, and works alongside women's health specialists to time investigations around it. The aim is for hormonal change to become a known variable in the plan, not an unexplained setback.