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Speaker 1: Ruby.

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Speaker 2: Life sometimes has a way of blindsiding you with a

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Speaker 2: feeling of being overwhelmed at the worst possible time. That's

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Speaker 2: why you have your self care, your coping strategies, That's

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Speaker 2: why you have us. I'm Norah Mcinernie and this is

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Speaker 2: the head start Embracing the Journey, a podcast where we'll

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Speaker 2: be taking all those things you usually say for your

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Speaker 2: friend group out into the open so we can all

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Speaker 2: find a bit of optimism for those battling chronic migraine.

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Speaker 2: These conversations are going to be even more helpful and relatable,

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Speaker 2: so definitely stick around. This show is brought to you

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Speaker 2: in partnership with ABVI, So first let's hear some important

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Speaker 2: safety information and stay tuned to the end of the

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Speaker 2: podcast for more.

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Speaker 3: Indication. Botox on a bochulinum toxin A is a prescription

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Speaker 3: medicine that is injected into muscles and used to prevent

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Speaker 3: headaches and adults with chronic migraine who have fifteen or

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Speaker 3: more days each month with headache lasting four or more

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Speaker 3: hours each day in people eighteen years in older. It

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Speaker 3: is not known whether botox is safe and effective to

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Speaker 3: prevent headaches in patients with migraine who have fourteen or

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Speaker 3: fewer headache days each month, or episodic migraine. Important safety information.

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Speaker 3: Botox may cause serious side effects that can be life threatening.

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Speaker 3: Get medical help right away. If you have any of

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Speaker 3: these problems any time hours to weeks after injection of botox.

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Speaker 3: Problems swallowing, speaking, or breathing due to weakening of associated

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Speaker 3: muscles can be severe and result in loss of life.

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Speaker 3: You are at the highest risk if these problems are

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Speaker 3: pre existing before injection. Swallowing problems may last for several months.

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Speaker 3: Spread of toxin effects. The effect of botulinum toxin may

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Speaker 3: affect areas away from the injection site and cause serious

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Speaker 3: symptoms including loss of strength and all over muscle weakness,

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Speaker 3: double vision, blurred vision, drooping eyelids, coarseness or change or

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Speaker 3: loss of voice, trouble saying words clearly, loss of bladder control,

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Speaker 3: trouble breathing, and trouble swallowing. Please stay tuned for additional

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Speaker 3: important safety information within this podcast. Today's guest Evalise Rivera Salgado,

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Speaker 3: is an actual botox patient who was on prescribe therapy

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Speaker 3: when she shared her story. Changes in therapy status may

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Speaker 3: have occurred since that time, Evilise was compensated by ABVI

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Speaker 3: for sharing her story.

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Speaker 2: Welcome back everyone for season three. Yes, I said, it's

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Speaker 2: season three, fourteen episodes of great stories.

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Speaker 1: Later.

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Speaker 2: If you are new here, we have two seasons ready

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Speaker 2: for you to go back in Binge. But today we

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Speaker 2: are talking about health, wellness and what it means to

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Speaker 2: live a soft life in a hard world. I am,

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Speaker 2: as you may know, a recovering girl boss. For many years,

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Speaker 2: I thought that more was more and more was required.

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Speaker 2: I had to work more, do more, be more. I

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Speaker 2: had to be perfect. I treated myself like a machine

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Speaker 2: that should have maximum output with minimal input. Sleep was optional,

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Speaker 2: food was an afterthought. Working out was essential, but only

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Speaker 2: because I needed to be thin, because thin was a

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Speaker 2: form of perfection. Of course, don't worry, I am fully

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Speaker 2: rolling my eyes at that now. I kept my days

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Speaker 2: filled to the max with back to back to back

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Speaker 2: meetings and projects. I woke up at five, I went

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Speaker 2: to the gym, I came home to get my kids

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Speaker 2: ready for school. I worked a full day and then

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Speaker 2: opened up my laptop to keep working once they were

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Speaker 2: in bed. From the outside, things looked pretty good. On

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Speaker 2: the inside, they did not feel good. I did not

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Speaker 2: feel good. I was scattered and stressed. I was not

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Speaker 2: connected to my body or really to myself in any way.

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Speaker 2: It is hard to slow down, but if you have

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Speaker 2: chronic migrain, you know that the body keeps the score

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Speaker 2: and the body also calls the shots. It can make

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Speaker 2: you slow down even if you don't want to. It

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Speaker 2: took a lot of time for me to deprogram and

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Speaker 2: reprogram myself for exercise to become a part of my

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Speaker 2: day that makes me feel good instead of just something

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Speaker 2: I do to look good to feed myself like I

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Speaker 2: am a beloved friend, because I should be a beloved

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Speaker 2: friend to myself. We all should. This is one reason

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Speaker 2: why I'm so excited to share this conversation with you

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Speaker 2: today because today's guest is a star in the health

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Speaker 2: and wellness space. But she's not the type to tell

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Speaker 2: you that you need to rise and grind and squeeze

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Speaker 2: the most out of your day. She's not here to

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Speaker 2: punish you, or judge you or tell you that you're

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Speaker 2: doing it wrong. She is here to encourage you to

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Speaker 2: live a softer life, and especially if you're living with

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Speaker 2: chronic migraine, like our guest, your body deserves every bit

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Speaker 2: of extra grace and attention that you can give. Today's

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Speaker 2: guest is Evalise Rivera Salgado, and I cannot wait for

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Speaker 2: you to hear our conversation. But first, a familiar voice

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Speaker 2: of the show. Guys, he's back, my good buddy and

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Speaker 2: the headache specialist who has been guiding us through all

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Speaker 2: of these episodes with his perspective and his advice, doctor

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Speaker 2: Christopher Ryan.

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Speaker 1: It has been a while, Hei, Nori, it's Grady be

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Speaker 1: back on the show. I'm excited to listen in to

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Speaker 1: the conversations that you have with Evelise. I don't think

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Speaker 1: we've talked about the important and oftentimes challenging relationship between

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Speaker 1: fitness and chronic migraine, So I'm looking forward to this one.

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Speaker 2: All right, Well, let's meet Evalise Evealise. Great to finally

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Speaker 2: meet you.

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Speaker 1: Nora.

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Speaker 4: I just want to say, like, I am so happy

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Speaker 4: to meet you. It's such an honor to be here.

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Speaker 4: And you know, this is my first little podcast and

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Speaker 4: I can't wait to share my story and my experience

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Speaker 4: with everyone.

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Speaker 2: Me too. I have seen your recipes, the things that

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Speaker 2: you make, the things that you suggest, They're not just beautiful,

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Speaker 2: but really good for you. I am not a cook.

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Speaker 2: I did bake bread earlier this week.

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Speaker 4: Oh, so you're a chef.

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Speaker 2: I am not the person in my family who cooks,

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Speaker 2: but my husband cooks. So what are recipes that you

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Speaker 2: would suggest, things you've made recently that are easy enough

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Speaker 2: for a busy person who has a wife who can't

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Speaker 2: cook and children.

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Speaker 4: I'm gonna go with the burger bowl. I love a

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Speaker 4: good burger bowl. I love the fact that the only

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Speaker 4: thing you truly have to cook is the meat. Like

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Speaker 4: I do frozen fries, I'm not doing the from scratch,

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Speaker 4: So I just pop in some frozen fries and the

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Speaker 4: air fier simultaneously start cooking the meat, and then you

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Speaker 4: just assemble it with the lettuce and the tomato and

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Speaker 4: the onion, and there you have it. You're a chef.

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Speaker 2: Okay, this is why you're popular, because you're making it easy.

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Speaker 4: No see, I think you know. I was born with

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Speaker 4: the what is the quickest way possible, the easiest way

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Speaker 4: possible for me to get this done. I think it's

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Speaker 4: because I have a mom who she loves to make

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Speaker 4: things from scratch. She's made everything my whole life from scratch.

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Speaker 4: Prom dress we had we had chickens, she would make bread.

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Speaker 4: I witnessed the extra steps and I'm like, I'll just

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Speaker 4: go to the store. So I like the shortcuts. I

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Speaker 4: like to do things quick and easy.

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Speaker 2: Okay, you say that, but you are also a person

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Speaker 2: who has done so many impressive and difficult things, like

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Speaker 2: you were an athlete, you served in the military, which

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Speaker 2: thank you for that, thank you for that, your support.

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Speaker 2: All of that is like so physically demanding, so mentally

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Speaker 2: demanding in so many different ways. What do you think

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Speaker 2: it is about fitness, nutrition, wellness and how you talk

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Speaker 2: about it that resonates with people.

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Speaker 4: When I first started my journey on social media, I

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Speaker 4: was just doing like little vlogs, like just silly things.

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Speaker 4: But within the past couple of years, I started to

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Speaker 4: become a little bit more open about my health journey

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Speaker 4: or what I was struggling with, and that's when I

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Speaker 4: found that people really started to connect with me. I

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Speaker 4: was shocked because I do this thing where I think

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Speaker 4: that I'm the only person in the world that is

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Speaker 4: dealing with how do I start my fitness journey? And

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Speaker 4: then when I started to talk to the camera, talk

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Speaker 4: to social media like I would talk to my Diarrye

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Speaker 4: or talk to my friend. That's when I found that

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Speaker 4: people would resonate with me. I mean, I got a

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Speaker 4: message from somebody that said, hey, I followed you because

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Speaker 4: you were funny, used to post funny vlogs, but you

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Speaker 4: started posting your fitness and your wellness and it motivated

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Speaker 4: me to start my health journey.

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Speaker 2: Yeah, isn't that incredible. It's you're in Dallas and you

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Speaker 2: were a part of people's lives around the world.

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Speaker 4: Yeah, it's crazy.

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Speaker 2: Going back to your experience in the military, when you

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Speaker 2: are in the service, you are on a schedule, somebody

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Speaker 2: else is making sure you're doing everything. What made you

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Speaker 2: want to share your you know, civilian fitness journey with people,

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Speaker 2: especially the part that intersects with that chronic migraine journey.

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Speaker 4: Well, I love that question. And you know, when I

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Speaker 4: was in the military, Yeah, it was people controlling my schedule,

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Speaker 4: and you know, they're like, you have to wake up

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Speaker 4: at five am you're running ten miles, or you wake

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Speaker 4: up at five am you're doing push ups, and I

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Speaker 4: don't naturally want to do that at five am. So

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Speaker 4: I really wanted to share my journey because most people

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Speaker 4: couldn't really relate to like the being forced to work out.

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Speaker 4: When I was active duty military, that's when I first

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Speaker 4: started getting my migraine attacks. It made me hate fitness.

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Speaker 4: Sometimes I would have to work out with a migraine,

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Speaker 4: and especially with something that is an invisible disease. This

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Speaker 4: is an invisible illness and so there's no physical manifestation

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Speaker 4: of what's happening to me right now, So you know,

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Speaker 4: people would think I was being dramatic, so I would

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Speaker 4: try to like push through. It Actually made me hate

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Speaker 4: fitness at first because it it was a trigger for

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Speaker 4: me actually like running, which was devastating for me because

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Speaker 4: I used to be a huge runner. I used to

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Speaker 4: run a lot. I used to love running.

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Speaker 2: What are your chronic migraine triggers?

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Speaker 4: Well, I have a bunch, but to name a few.

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Speaker 4: For me, like my my triggers would be getting really hot,

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Speaker 4: So that was like working out. Like most workouts, you're

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Speaker 4: gonna get really hot. Which is why I when I

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Speaker 4: was actually actduty military, I started doing pilates before it

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Speaker 4: was cool, before it what's cool, you guys, I was

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Speaker 4: to do pilates.

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Speaker 2: It was developed as a military exercise.

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Speaker 4: Wait was it for?

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Speaker 2: After World War One? For disabled veterans to like build

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Speaker 2: up their core strengths that they could like live independently.

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Speaker 4: Yeah, and I'm about to tell everybody that, yeah it

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Speaker 4: was a hospital workout. Wow, that's actually I actually love that.

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Speaker 2: Look a up Joseph Pilates. He was like, I got

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Speaker 2: to do something for disabled veterans and I got to

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Speaker 2: get them like feeling good and capable, and it's all

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Speaker 2: about your core.

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Speaker 4: And it is.

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Speaker 2: And meanwhile, I go to pilates and I'm I'm a

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Speaker 2: danger to myself and others at pilates. What does fitness

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Speaker 2: and wellness do for you now with your chronic migraine?

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Speaker 4: Yes, I love that question. I don't know how to

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Speaker 4: describe it. Like, on the days where I do have

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Speaker 4: a migraine attack, I will tailor my workout to be

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Speaker 4: less intense. I'll do something in the ac, i won't

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Speaker 4: go outside. I'll walk on the treadmill, I'll do a

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Speaker 4: light walk. Because to me, it's not really about the

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Speaker 4: intensity of the workout. It's more so keeping that consistency

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Speaker 4: and making sure that I am a dependable person to

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Speaker 4: myself because I've learned that, you know, sticking to your

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Speaker 4: goals and actually doing what you're saying you're going to

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Speaker 4: do it actually makes you trust yourself, so that that

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Speaker 4: has helped me a lot.

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Speaker 2: It's that soft living you talk about.

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Speaker 4: Soft living is being kind to yourself but holding yourself accountable.

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Speaker 4: For me, it's like doing little tasks that I said

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Speaker 4: I would do. If I say I'm going to make

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Speaker 4: my bed in the morning, I do. If I say

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Speaker 4: I was going to go to the gym, I do.

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Speaker 4: And you know, it's the small tasks like that that

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Speaker 4: make you feel like you can trust yourself. That that's

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Speaker 4: what adds up. So every single time I say what

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Speaker 4: I say I'm gonna do, that's building trust within myself.

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Speaker 4: And just like slowing down.

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Speaker 2: It's hard to slow down. It's hard to slow down,

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Speaker 2: especially in a culture that wants you to do more.

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Speaker 2: That's such a beautiful way of saying it, and such

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Speaker 2: a beautiful way of like being gentle with your and saying,

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Speaker 2: you know, I'm trying to make sure that I'm a

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Speaker 2: person I can trust. And if walking on the treadmill

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Speaker 2: is what I'm doing today, then that's what I'm doing

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Speaker 2: and that I'm doing. Yeah, that's great. You mentioned heat

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Speaker 2: is your trigger. What are your other triggers.

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Speaker 4: Perfume, really really strong perfume or strong sense loud, abrupt noises.

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Speaker 4: So if I'm like sitting on the couch reading a

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Speaker 4: book and my dog barks, a migraine attack will come on.

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Speaker 4: And those are triggers that I really can't control, Like

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Speaker 4: I don't know when my dog is going to just

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Speaker 4: randomly start talking. So perfumes, yeah, and since like those,

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Speaker 4: I kind of can tailor my life around them. However,

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Speaker 4: I will say I've been to places where people just

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Speaker 4: love cologne and they love perfumes, and I'm not.

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Speaker 2: Madild Yeah, I'm not mad at it. I do. It

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Speaker 2: does bring me back to like my middle school days

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Speaker 2: where I was like if one spray is good.

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Speaker 4: I used to go to like the stores in the

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Speaker 4: mall and I'd have like all the colors, like the pink,

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Speaker 4: the blue, the purple. And it's just crazy because I

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Speaker 4: had no idea that something like that would affect somebody

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Speaker 4: in such a negative way. But now that I'm living

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Speaker 4: with chronic migraine, I am very aware of those kind

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Speaker 4: of things.

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Speaker 2: After the break, I'll be back with doctor Ryan. So

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Speaker 2: stick around, Welcome back to the head. Start embracing the journey,

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Speaker 2: Doctor Ryan, I want to bring you back in your

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Speaker 2: being the first episode of this season. Can we go

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Speaker 2: over some common terms and definitions that often come up

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Speaker 2: when we're addressing chronic migraine. I think it would be

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Speaker 2: helpful for the listeners and also for me. First, let's

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Speaker 2: just define what chronic migraine is and how it's different

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Speaker 2: than episodic migraine.

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Speaker 1: Let's do it so. Chronic migraine is defined as fifteen

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Speaker 1: or more monthly headache days, and eight of those days

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Speaker 1: meeting the criteria for a migraine headache. Those headaches need

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Speaker 1: to last for four hours or more. Less frequent would

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Speaker 1: be considered an episodic migraine. To help put that into

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Speaker 1: context of people's actual lives, it's important to look at

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Speaker 1: the number of headache free days that you've had per month,

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Speaker 1: and not just the number of migraine attacks per month.

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Speaker 1: Many times people don't have a true count for their

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Speaker 1: headache date, confusing those two things. For example, you may

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Speaker 1: have only counted four headaches or migraine attacks last month,

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Speaker 1: but when you look at the actual number of days

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Speaker 1: you didn't have a headache or migraine attack, it could

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Speaker 1: have been only a few, So getting a clear picture

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Speaker 1: of the headache days you have each month is key

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Speaker 1: to helping your doctor or understand what you're experiencing and

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Speaker 1: making the right diagnosis.

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Speaker 2: Okay, that's an important difference to point out. So we

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Speaker 2: have chronic migraine, which is a distinct disease associated with

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Speaker 2: frequent headaches and migraine attacks. What are some common triggers

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Speaker 2: for the symptoms of chronic migraine?

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Speaker 1: So important to talk about triggers, Nora, So let's get

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Speaker 1: into it because it's a huge deal. Triggers can include

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Speaker 1: increases in stress, changes in hormones. There can be external

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Speaker 1: triggers that can set off those hormones like barometric pressure,

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Speaker 1: changes in weather changes like extreme heat or cold. There

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Speaker 1: can be even triggers like specific smells. Sometimes folks have

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Speaker 1: a hard time with things like cleaning agents or particular perfumes.

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Speaker 1: There are different types of light exposures or sound exposures

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Speaker 1: that can set off migraine attacks, and so understanding those

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Speaker 1: triggers is really critical.

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Speaker 2: Thanks doctor Ryan. Let's get back to evilise for our listeners.

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Speaker 2: Can you describe vibe how your migraine attacks feel, How

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Speaker 2: do they come on? What is the experience like for you.

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Speaker 4: For me, the most recent one that comes to mind

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Speaker 4: was for my mom's fiftieth birthday. We were at a

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Speaker 4: theme park and it had all the triggers for me, heat, smells,

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Speaker 4: you know, loud noises, you know. I was having fun,

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Speaker 4: and all of a sudden, the migraine attacks started coming on.

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Speaker 4: I started seeing floaters like little specks in my vision,

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Speaker 4: and it just progressively starts to get worse for me.

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Speaker 4: I'll get like indications that it's coming on, and that's

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Speaker 4: when I'll like know, like, okay, I need to go

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Speaker 4: sit down, I need to try to cool off, but

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Speaker 4: at that point, like it's coming. I ended up having

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Speaker 4: to leave the theme park early. My family was still

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Speaker 4: there like they're enjoying their time, you know. Like I

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Speaker 4: completely separated myself, and I felt when I had the

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Speaker 4: floaters in my vision, I stepped away because I'm like,

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Speaker 4: I don't want them to see me like this. I'm

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Speaker 4: not trying to ruin the birthday. But I had to

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Speaker 4: separate myself and I had to go back to the

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Speaker 4: hotel and have my migraine attack by myself. And usually

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Speaker 4: when I do have those and I'm able to get

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Speaker 4: to a room. I make it dark, I make it cold,

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Speaker 4: but I do like to get under the covers or

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Speaker 4: like have something waited on me, maybe for like the

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Speaker 4: the comfort of it, and I'll just be in the

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Speaker 4: dark waiting it out.

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Speaker 2: That means you're missing out on things, right, You're missing

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Speaker 2: out on life moments of your own and you know,

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Speaker 2: with people you love, how do you manage that emotionally?

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Speaker 4: At first, I didn't. I didn't manage it emotionally. I

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Speaker 4: had no tools in my toolkit to make myself feel better.

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Speaker 4: But as time went on, I'd learned to be kind

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Speaker 4: to myself and learned to give myself grace and also

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Speaker 4: learning to be transparent with people, because at first I

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Speaker 4: didn't want anybody to know that I had crownic migraine.

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Speaker 4: I really tried to keep it a secret for a very,

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Speaker 4: very long time because I was, for lack of better words,

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Speaker 4: like embarrassed. As somebody who was always fit, active, upbeat,

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Speaker 4: life of the party. I did not want to be

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Speaker 4: the person with a disability. But that's the thing about

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Speaker 4: disabilities and invisible illnesses like chronic migraine. They don't discriminate

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Speaker 4: like it could happen to anybody and it happened to me.

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Speaker 4: So just managing it mostly just like being transparent with

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Speaker 4: people and saying, hey, this is something that I deal

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Speaker 4: with because letting them know that, Like if I have

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Speaker 4: to cancel plans last minute, they'll be understanding. But if

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Speaker 4: they have never had knowledge of me having these chronic

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Speaker 4: migraines before, I feel like they might think that I

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Speaker 4: was lying or something if I like randomly canceled last minute.

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Speaker 2: Yeah. Yeah, it's like building that empathy for yourself, I

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Speaker 2: think also helps you extend that to other people.

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Speaker 4: Absolutely.

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Speaker 2: When were you officially diagnosed?

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Speaker 4: I was officially diagnosed when I was twenty years old

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Speaker 4: my chronic migraines first started and twenty fifteen, and I

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Speaker 4: didn't get officially diagnosed by a neurologist until twenty sixteen,

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Speaker 4: like I had an inklink. But of course, something about

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Speaker 4: getting that diagnosis, like something about it. I just left

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Speaker 4: feeling so seen, so empowered, ready to tackle this disease,

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Speaker 4: like ready to tackle it.

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Speaker 2: Yeah, I'm assuming there's kind of a journey to finding

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Speaker 2: the right treatment. What was your journey.

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Speaker 4: Like, Well, I will say that for me, like the

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Speaker 4: whole treatment journey taught me being resilient I had never

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Speaker 4: experienced something so mentally and emotionally taxing and draining in

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Speaker 4: my life. Because when I first started seeing a neurologist,

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Speaker 4: I'm like, Okay, maybe we'll get along, like maybe she'll

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Speaker 4: listen to me. And she's like, okay, we'll try this.

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Speaker 4: So I tried a medication, didn't work, and she's like, okay,

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Speaker 4: we'll try this one. I tried, it didn't work, And

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Speaker 4: I tried so many different medications and at one point

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Speaker 4: just wanted to stop because I was getting side effects

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Speaker 4: from these medications in addition to still getting my migraine attacks.

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Speaker 4: After that, I remember showing up to my exa appointment

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Speaker 4: being like, I need something else, and I actually ended

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Speaker 4: up looking for another doctor, And I think that that's

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Speaker 4: really important to because I felt bad at first. I

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Speaker 4: was like, man, I don't want her to be mad

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Speaker 4: at me, which is so ridiculous. Thinking back, you know,

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Speaker 4: that's so ridiculous, Like yeah, I'm like, I didn't want

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Speaker 4: her to have her feelings hurt, but just looking back, ridiculous.

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Speaker 4: Because it's my job to make sure that I get

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Speaker 4: proper care.

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Speaker 2: Figuring it out feels like so isolating, which is also

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Speaker 2: so heartbreaking, and I think that's why it is so

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Speaker 2: generous of you to be here with us and be

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Speaker 2: sharing this experience with us, because there is somebody listening

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Speaker 2: to this who is feeling that way, who needs to

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Speaker 2: know like it's not just them. So it's thank you

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Speaker 2: for that.

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Speaker 4: Absolutely.

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Speaker 2: Yeah.

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Speaker 4: But I got a new doctor and I remember walking

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Speaker 4: into his office and he's like in the military, just

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Speaker 4: like me. He looked at me and he's like, well,

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Speaker 4: have you heard of botox for chronic migraine?

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Speaker 2: I am curious. I want to hear your take on

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Speaker 2: the treatment procedure itself.

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Speaker 4: The neurologist's office was three offices down from where I

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Speaker 4: worked because I was a radiology text so I would

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Speaker 4: schedule my appointment and then I would just be like, Hey,

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Speaker 4: I'm going to go get botox from my chronic migraine.

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Speaker 4: I'll go to the appointment, I get thirty one shots.

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Speaker 4: It takes about ten minutes, and I get to go

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Speaker 4: back to work. I don't have to worry about taking

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Speaker 4: something every day. I don't have to worry about, you know,

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Speaker 4: when when's the next refill?

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Speaker 2: Yeah, and you just sit down, they do it and

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Speaker 2: I go back to work, So tag me back in

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Speaker 2: doctor Ryan Evelise his share bared how botox has helped

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Speaker 2: reduce her headache days. Can you tell us more about

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Speaker 2: botox as a treatment option for chronic migraine?

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Speaker 1: Absolutely, and I've been familiar with botox for a long time.

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Speaker 1: In fact, botox has been an FT approved treatment for

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Speaker 1: chronic migraine for around fifteen years now. It may not

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Speaker 1: be what you initially think of when you hear botox,

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Speaker 1: but it's been a part of our arsenal as a

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Speaker 1: preventative treatment option for a long time. Botox is a

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Speaker 1: prescription medicine injected into muscles and used to prevent headaches

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Speaker 1: and adults with chronic migraine, which is fifteen or more

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Speaker 1: headache days per month, each lasting for four or more hours.

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Speaker 1: Botox is not approved for adults with migraine who have

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Speaker 1: fourteen or fewer headache days per month. Effects of botox

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Speaker 1: may spread hours to weeks after injection, causing serious symptoms

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Speaker 1: and so you want to alert your doctor ride away

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Speaker 1: as difficulties swallowing, speaking, breathing, eye problems, or muscle weaknesses

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Speaker 1: can be a sign of a life threatening condition. Patients

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Speaker 1: with these conditions before worth the injection are at higher

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Speaker 1: risk of those effects, and side effects might include allergic reactions, rash,

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Speaker 1: breathing problems and dizziness, neck and injection site pain, and headache.

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Speaker 1: Don't receive botox for chronic migraine if there's a skin infection,

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Speaker 1: and tell your doctor your medical history, muscle or nerve

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Speaker 1: condition history like ALS which is Lukeriic's disease, mysenea gravis

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Speaker 1: lambored eaton syndrome. Any medications, including other bochulinum toxins that

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Speaker 1: you might be utilizing as they may increase the risk

436
00:24:32,720 --> 00:24:35,280
Speaker 1: of these serious side effects. It's important for you to

437
00:24:35,280 --> 00:24:37,960
Speaker 1: talk to your doctor or headache specialist about the important

438
00:24:37,960 --> 00:24:41,280
Speaker 1: safety information you'll hear throughout this episode and in the

439
00:24:41,359 --> 00:24:42,760
Speaker 1: link to the product information.

440
00:24:44,240 --> 00:24:47,120
Speaker 2: Evelise was able to see some changes with the number

441
00:24:47,160 --> 00:24:51,080
Speaker 2: of headaches eventually becoming manageable about six months into her

442
00:24:51,119 --> 00:24:55,280
Speaker 2: botox treatments. How does botox help prevent headaches and chronic

443
00:24:55,359 --> 00:25:00,159
Speaker 2: migraine and how important is that dedication to treatment for

444
00:25:00,240 --> 00:25:02,800
Speaker 2: feeling the full effects of the botox treatment.

445
00:25:03,680 --> 00:25:06,120
Speaker 1: Awesome question and it's one that I get all the time, Nora.

446
00:25:06,240 --> 00:25:08,640
Speaker 1: In the data that was presented to the FDA, botox

447
00:25:08,720 --> 00:25:12,320
Speaker 1: prevented on average eight to nine headache days and probable

448
00:25:12,320 --> 00:25:15,000
Speaker 1: migraine days a month at twenty four weeks versus six

449
00:25:15,040 --> 00:25:18,320
Speaker 1: to seven with placebo. Patients may see results as soon

450
00:25:18,359 --> 00:25:20,840
Speaker 1: as four weeks, but the full effect should be evaluated

451
00:25:20,880 --> 00:25:24,840
Speaker 1: after two treatments six months, So the botox experience is

452
00:25:24,880 --> 00:25:27,280
Speaker 1: going to be different based on the patient. This is

453
00:25:27,280 --> 00:25:29,000
Speaker 1: one of my favorite things to do with patients because

454
00:25:29,000 --> 00:25:32,679
Speaker 1: there's such a preconceived notion around what botox is and

455
00:25:32,760 --> 00:25:36,000
Speaker 1: what the process is to go through with botox. The

456
00:25:36,040 --> 00:25:37,639
Speaker 1: first thing we need to understand when it comes to

457
00:25:37,680 --> 00:25:40,520
Speaker 1: botox for chronic migraine is that there is a fixed

458
00:25:40,560 --> 00:25:44,159
Speaker 1: injection protocol. So we talk to patients about that experience.

459
00:25:44,280 --> 00:25:46,080
Speaker 1: We let them know that they're going to be seated

460
00:25:46,080 --> 00:25:48,840
Speaker 1: in a clinical setting. Maybe it's a procedural suite like

461
00:25:48,880 --> 00:25:51,000
Speaker 1: I use here at the hospital that I work out of,

462
00:25:51,320 --> 00:25:54,439
Speaker 1: or maybe it's your physician's office. Botox is injected in

463
00:25:54,480 --> 00:25:57,200
Speaker 1: thirty one sites into seven muscle groups that the FDA

464
00:25:57,320 --> 00:25:59,760
Speaker 1: is approved. Those areas are going to be in the

465
00:25:59,800 --> 00:26:02,679
Speaker 1: head and neck. You start with two treatments and those

466
00:26:02,720 --> 00:26:04,639
Speaker 1: are going to be twelve weeks apart, and then we

467
00:26:04,680 --> 00:26:08,600
Speaker 1: continue every twelve weeks. Thereafter, we do this every three months,

468
00:26:08,640 --> 00:26:11,320
Speaker 1: four times a year, for about ten minutes each when

469
00:26:11,359 --> 00:26:13,040
Speaker 1: you come in for a session. We try to fit

470
00:26:13,080 --> 00:26:15,840
Speaker 1: treatment into people's busy schedules as much as possible.

471
00:26:16,280 --> 00:26:19,199
Speaker 2: All right, So one last thing that I need your

472
00:26:19,240 --> 00:26:23,720
Speaker 2: pov on doctor Ryan. There is sometimes hesitancy and misconception

473
00:26:23,960 --> 00:26:27,520
Speaker 2: around botox. What is the usual response when you first

474
00:26:27,600 --> 00:26:30,720
Speaker 2: bring it up as a treatment option for your appropriate

475
00:26:31,000 --> 00:26:32,400
Speaker 2: chronic migraine patients?

476
00:26:32,920 --> 00:26:36,080
Speaker 1: Understandably, patients always have a bit of hesitance to you

477
00:26:36,160 --> 00:26:38,720
Speaker 1: when I first bring up botox. Patients are going to

478
00:26:38,720 --> 00:26:42,080
Speaker 1: ask what's the experience, Like how effective is that therapy?

479
00:26:42,520 --> 00:26:44,720
Speaker 1: Cost tends to be a hurdle for some patients, and

480
00:26:44,760 --> 00:26:48,560
Speaker 1: oftentimes they're surprised to hear that most insurance providers, as

481
00:26:48,560 --> 00:26:51,639
Speaker 1: well as Medicaid and Medicare programs, do cover botox for

482
00:26:51,720 --> 00:26:55,439
Speaker 1: chronic migraine. I'd advise patients interested in botox to contact

483
00:26:55,440 --> 00:26:58,560
Speaker 1: their insurance providers. I think it's really important for patients

484
00:26:58,600 --> 00:27:01,400
Speaker 1: to know that providers are not allow to contact insurance

485
00:27:01,840 --> 00:27:06,080
Speaker 1: on their behalf to find out costs or benefits associated

486
00:27:06,080 --> 00:27:09,960
Speaker 1: with a particular therapy botox or otherwise. Additionally, there are

487
00:27:10,000 --> 00:27:13,040
Speaker 1: patients support programs like the Botox Savings Program, which I'm

488
00:27:13,040 --> 00:27:16,359
Speaker 1: a huge fan of. This helps eligible, commercially ensured patients

489
00:27:16,400 --> 00:27:18,840
Speaker 1: to save uncertain out of pocket costs related to both

490
00:27:19,040 --> 00:27:21,919
Speaker 1: botox medicine and the injection procedure.

491
00:27:22,320 --> 00:27:25,479
Speaker 2: All right, I'd imagine the fear of needles comes up

492
00:27:25,480 --> 00:27:28,320
Speaker 2: for some people too, right, Is that a common concern

493
00:27:28,400 --> 00:27:31,360
Speaker 2: or is that just my own projection.

494
00:27:31,200 --> 00:27:33,320
Speaker 1: Not projection nour I have a lot of patients that

495
00:27:33,359 --> 00:27:35,639
Speaker 1: have the same concerns as ev being nervous about the

496
00:27:35,720 --> 00:27:37,800
Speaker 1: needles when coming to their first treatment, But some of

497
00:27:37,800 --> 00:27:40,880
Speaker 1: my patients describe the injections as feeling like tiny pinches,

498
00:27:41,280 --> 00:27:43,399
Speaker 1: and from what I've seen with my patients, most people

499
00:27:43,440 --> 00:27:46,280
Speaker 1: get comfortable with the process after the first treatment.

500
00:27:46,119 --> 00:27:48,480
Speaker 2: Doctor Ryan, Thank you as always.

501
00:27:49,200 --> 00:27:51,880
Speaker 1: Thanks Nora. Really excited to be here, Excited to talk

502
00:27:51,960 --> 00:27:54,040
Speaker 1: some more with this new season that we're kicking off.

503
00:28:03,560 --> 00:28:06,800
Speaker 2: All right, one last question for you, Evalise. Why do

504
00:28:06,840 --> 00:28:10,119
Speaker 2: you love fitness and wellness so much the.

505
00:28:10,160 --> 00:28:12,240
Speaker 4: Way that I express myself. It's an outlet for me.

506
00:28:12,840 --> 00:28:16,480
Speaker 4: It's a celebration of what my body can do. I'm

507
00:28:16,600 --> 00:28:18,920
Speaker 4: so grateful that I'm able to walk on the treadmill.

508
00:28:18,960 --> 00:28:21,520
Speaker 4: I'm so grateful that I'm able to lift twenty pounds.

509
00:28:21,560 --> 00:28:24,960
Speaker 4: I'm so grateful that I'm able to squat whatever. You know.

510
00:28:25,040 --> 00:28:27,240
Speaker 4: That for me, when I put it in that perspective,

511
00:28:27,240 --> 00:28:29,800
Speaker 4: it's like, Okay, get up and go work out, Get

512
00:28:29,840 --> 00:28:31,520
Speaker 4: up and go move your body, because there are people

513
00:28:31,600 --> 00:28:33,919
Speaker 4: right now dealing with something that would just love to

514
00:28:33,960 --> 00:28:37,040
Speaker 4: trade places with you. And I feel like it's foolish

515
00:28:37,040 --> 00:28:40,720
Speaker 4: of me to understand that perspective and then not move

516
00:28:40,760 --> 00:28:43,840
Speaker 4: my body. If you are somebody that's struggling with your

517
00:28:43,880 --> 00:28:47,160
Speaker 4: health or chronic migraine right now, just keep going through

518
00:28:47,200 --> 00:28:49,000
Speaker 4: the motions. If you have to chop your day up

519
00:28:49,040 --> 00:28:52,120
Speaker 4: into little segments, do that, but you'll get through it.

520
00:28:52,800 --> 00:28:54,960
Speaker 4: You have to have the rain to see the rainbow.

521
00:28:56,160 --> 00:29:00,120
Speaker 2: Oh that was beautiful. That was really beautiful. Do you

522
00:29:00,160 --> 00:29:03,880
Speaker 2: see what I mean about this conversation about her energy?

523
00:29:04,600 --> 00:29:10,760
Speaker 2: Evelise in one conversation made me feel so much better.

524
00:29:11,000 --> 00:29:14,880
Speaker 2: I sat down to this conversation in quite a frantic week,

525
00:29:15,040 --> 00:29:20,840
Speaker 2: on quite a frantic day, and her calm energy softened me.

526
00:29:21,440 --> 00:29:24,920
Speaker 2: And what makes her even more incredible is her story.

527
00:29:25,400 --> 00:29:28,840
Speaker 2: She started out in the military stepping into active service

528
00:29:28,920 --> 00:29:32,320
Speaker 2: with so much dedication, and when life threw her a

529
00:29:32,360 --> 00:29:35,760
Speaker 2: big challenge, chronic migraine, she didn't let that stop her.

530
00:29:35,800 --> 00:29:39,240
Speaker 2: She kept going, She kept advocating for herself, She kept

531
00:29:39,480 --> 00:29:45,400
Speaker 2: showing up. She is an inspiration and I hope that

532
00:29:45,480 --> 00:29:50,760
Speaker 2: it gave you permission and encouragement to live a softer life.

533
00:29:51,480 --> 00:29:55,280
Speaker 2: To be softer with others, of course, but also with yourself.

534
00:29:57,760 --> 00:30:01,040
Speaker 2: Thanks for listening to the Headstart Embracing the Journey. We

535
00:30:01,160 --> 00:30:04,040
Speaker 2: hope you've found something worthwhile here with us today. A

536
00:30:04,080 --> 00:30:08,240
Speaker 2: new coping strategy, a relatable story, the comfort of knowing

537
00:30:08,480 --> 00:30:12,160
Speaker 2: you're not alone. I'm so happy to be a part

538
00:30:12,200 --> 00:30:16,000
Speaker 2: of creating this community for all of us, and especially

539
00:30:16,040 --> 00:30:19,040
Speaker 2: for people living with chronic migraine. If you haven't found

540
00:30:19,040 --> 00:30:21,800
Speaker 2: a treatment plan that is working for you, please do

541
00:30:22,080 --> 00:30:25,680
Speaker 2: reach out to your headache specialist to explore your options.

542
00:30:26,760 --> 00:30:28,760
Speaker 2: I truly hope this has helped you find a bit

543
00:30:28,800 --> 00:30:32,960
Speaker 2: of comfort and maybe a smile. Maybe see a next

544
00:30:32,960 --> 00:30:39,840
Speaker 2: episode and stay tuned for more important safety information. The

545
00:30:39,880 --> 00:30:43,760
Speaker 2: head Start Embracing the Journey is hosted by myself Norah McNerney,

546
00:30:44,000 --> 00:30:47,080
Speaker 2: executive produced by yvon Shehan, our head of post production

547
00:30:47,280 --> 00:30:50,600
Speaker 2: is James Foster, our researcher is Sierra Kaiser, and our

548
00:30:50,640 --> 00:30:54,480
Speaker 2: writer is John Irwin. The show is mixed by Michael Hardman.

549
00:30:54,960 --> 00:30:58,400
Speaker 2: Original music by Soundcat Productions and art List.

550
00:31:04,040 --> 00:31:08,040
Speaker 3: Important safety information continued. There has not been a confirmed

551
00:31:08,160 --> 00:31:10,840
Speaker 3: serious case of spread of toxin effect away from the

552
00:31:10,880 --> 00:31:14,040
Speaker 3: injection site. When botox has been used at the recommended

553
00:31:14,080 --> 00:31:17,280
Speaker 3: dose to treat chronic migraine. Botox may cause loss of

554
00:31:17,320 --> 00:31:21,400
Speaker 3: strength or general muscle weakness, vision problems, or dizziness within

555
00:31:21,520 --> 00:31:24,680
Speaker 3: hours to weeks of receiving botox. If this happens, do

556
00:31:24,840 --> 00:31:28,680
Speaker 3: not drive a car, operate machinery, or do other dangerous activities.

557
00:31:28,880 --> 00:31:31,640
Speaker 3: Do not receive botox if you are allergic to any

558
00:31:31,680 --> 00:31:35,440
Speaker 3: of the ingredients in botox, see medication guide for ingredients.

559
00:31:35,600 --> 00:31:38,680
Speaker 3: Had an allergic reaction to any other botchu linum toxin

560
00:31:38,760 --> 00:31:45,040
Speaker 3: product such as myoblock rhymobochelinum toxin B, disport abobochelinum toxin A,

561
00:31:45,600 --> 00:31:51,240
Speaker 3: zeomin incobotchel item toxin A, JEVO probochul item toxin AXVFS,

562
00:31:51,520 --> 00:31:56,000
Speaker 3: daxify daxibotchelinum toxin A l A n M or lettibo

563
00:31:56,400 --> 00:32:00,560
Speaker 3: lettibotchel item toxin AWLBG. This may not be a complete

564
00:32:00,560 --> 00:32:03,880
Speaker 3: list of all botulinum toxin products have a skin infection

565
00:32:04,000 --> 00:32:07,440
Speaker 3: at the planned injection site. The dose of botox is

566
00:32:07,560 --> 00:32:11,760
Speaker 3: not the same as or comparable to another botulinum toxin product.

567
00:32:12,000 --> 00:32:17,880
Speaker 3: Serious and or immediate allergic reactions have been reported, including itching, rash, red,

568
00:32:17,960 --> 00:32:22,840
Speaker 3: itchy welts, wheezing, asthma symptoms, dizziness or feeling faint. Get

569
00:32:22,880 --> 00:32:26,520
Speaker 3: medical help right away. If you experience symptoms, further injection

570
00:32:26,600 --> 00:32:29,920
Speaker 3: of botox should be discontinued. Tell your doctor about all

571
00:32:29,960 --> 00:32:33,120
Speaker 3: your muscle or nerve conditions, such as ALS or lou

572
00:32:33,200 --> 00:32:37,520
Speaker 3: Garrig's disease, Myasthenia gravis, or lambert Eton syndrome, as you

573
00:32:37,560 --> 00:32:40,640
Speaker 3: may be at increased risk of serious side effects, including

574
00:32:40,680 --> 00:32:44,960
Speaker 3: difficulty swallowing and difficulty breathing from typical doses of botox.

575
00:32:45,200 --> 00:32:48,360
Speaker 3: Tell your doctor about all your medical conditions, including if

576
00:32:48,360 --> 00:32:51,120
Speaker 3: you have or have had bleeding problems, have plans to

577
00:32:51,160 --> 00:32:54,440
Speaker 3: have surgery, had surgery on your face, have weakness of

578
00:32:54,480 --> 00:32:58,200
Speaker 3: forehead muscles, trouble raising your eyebrows, drooping eyelids, and any

579
00:32:58,200 --> 00:33:02,080
Speaker 3: other abnormal facial change are pregnant or plan to become pregnant.

580
00:33:02,160 --> 00:33:04,840
Speaker 3: It is not known if botox can harm your unborn baby.

581
00:33:04,960 --> 00:33:07,600
Speaker 3: Are breastfeeding or plan to. It is not known if

582
00:33:07,600 --> 00:33:11,040
Speaker 3: botox passes into breast milk. Tell your doctor about all

583
00:33:11,080 --> 00:33:15,320
Speaker 3: the medicines you take, including prescription and over the counter medicines, vitamins,

584
00:33:15,360 --> 00:33:19,200
Speaker 3: and herbal supplements. Using botox with certain other medicines may

585
00:33:19,240 --> 00:33:22,480
Speaker 3: cause serious side effects. Do not start any new medicines

586
00:33:22,600 --> 00:33:24,880
Speaker 3: until you have told your doctor that you have received

587
00:33:24,920 --> 00:33:27,840
Speaker 3: botox in the past. Tell your doctor if you received

588
00:33:27,880 --> 00:33:31,080
Speaker 3: any other bochulinum toxin product in the last four months.

589
00:33:31,240 --> 00:33:37,880
Speaker 3: Have received injections of bochulinum toxin such as myoblock, disport, zamin, Jevo, Daxify,

590
00:33:38,200 --> 00:33:40,760
Speaker 3: or Letibo in the past. This may not be a

591
00:33:40,800 --> 00:33:44,280
Speaker 3: complete list of all bochulinum toxin products. Tell your doctor

592
00:33:44,520 --> 00:33:48,480
Speaker 3: exactly which product you received. Have recently received an antibiotic

593
00:33:48,520 --> 00:33:52,600
Speaker 3: by injection, Take muscle relaxance, Take an allergy or cold medicine,

594
00:33:52,640 --> 00:33:56,120
Speaker 3: Take a sleep medicine. Take aspirin like products or blood thinner.

595
00:33:56,360 --> 00:33:59,720
Speaker 3: Other side effects of botox include dry mouth, discomfort or

596
00:33:59,720 --> 00:34:03,560
Speaker 3: pain at the injection site, tiredness, headache, neck pain, eye

597
00:34:03,640 --> 00:34:07,040
Speaker 3: problems such as double vision, blurred vision, decreased eye sight,

598
00:34:07,160 --> 00:34:11,560
Speaker 3: drooping eyelids, swelling of your eyelids and dry eyes, drooping eyebrows,

599
00:34:11,680 --> 00:34:15,680
Speaker 3: and upper respiratory tract infection. For more information, refer to

600
00:34:15,719 --> 00:34:18,560
Speaker 3: the medication guide or talk with your doctor. You are

601
00:34:18,680 --> 00:34:21,719
Speaker 3: encouraged to report negative side effects of prescription drugs to

602
00:34:21,800 --> 00:34:26,920
Speaker 3: the FDA. Visit www dot FDA dot gov, slash MedWatch,

603
00:34:27,160 --> 00:34:30,640
Speaker 3: or call one eight hundred FDA one zero eight eight.

604
00:34:31,320 --> 00:34:35,200
Speaker 3: Please see Botox full product information, including boxed warning and

605
00:34:35,280 --> 00:34:39,000
Speaker 3: medication guide by clicking the link provided in the podcast description,

606
00:34:39,239 --> 00:34:44,320
Speaker 3: or by visiting www dot RXABV dot com slash pdf

607
00:34:44,480 --> 00:34:48,640
Speaker 3: slash Botox underscore PI dot pdf. If you are having

608
00:34:48,719 --> 00:34:51,880
Speaker 3: difficulty paying for your medicine, ABV may be able to help.

609
00:34:52,080 --> 00:34:55,880
Speaker 3: Visit ABV dot com slash Patient Access Support to learn more.