1 00:00:03,800 --> 00:00:20,800 Speaker 1: Rube. I am so delighted today to welcome Dana Famm, 2 00:00:20,920 --> 00:00:23,439 Speaker 1: who has been living with siasis since she was twenty 3 00:00:23,440 --> 00:00:27,120 Speaker 1: one and with soriatic arthritis since her mid twenties, a 4 00:00:27,200 --> 00:00:30,680 Speaker 1: diagnosis that arrived, of all times, on her first day 5 00:00:30,720 --> 00:00:34,360 Speaker 1: of medical school. She is currently a medical student at 6 00:00:34,400 --> 00:00:39,160 Speaker 1: the University of Chicago, a Nationalsoriasis Foundation volunteer and advocate, 7 00:00:39,479 --> 00:00:42,360 Speaker 1: and someone who has written about the patient experience in 8 00:00:42,440 --> 00:00:46,720 Speaker 1: peer reviewed journals. She also leads her school's Disability and 9 00:00:46,800 --> 00:00:50,960 Speaker 1: Chronic Illness student organization, because apparently medical school alone was 10 00:00:51,040 --> 00:00:54,480 Speaker 1: not enough for Dana. What makes Dana's story so right 11 00:00:54,520 --> 00:00:57,080 Speaker 1: for this episode is the way that she moves between 12 00:00:57,080 --> 00:01:00,440 Speaker 1: two worlds. She knows what it's like to be the 13 00:01:00,480 --> 00:01:03,240 Speaker 1: patient in the room, and she is also becoming the 14 00:01:03,240 --> 00:01:06,119 Speaker 1: physician in the room. And she has thought very hard 15 00:01:06,160 --> 00:01:09,919 Speaker 1: about what that means, about stigma, about what gets missed 16 00:01:09,920 --> 00:01:13,080 Speaker 1: when doctors don't listen, and about what it costs people 17 00:01:13,120 --> 00:01:19,120 Speaker 1: when diagnosis takes years. Dana, Welcome to our skin. We 18 00:01:19,200 --> 00:01:21,800 Speaker 1: are so glad you're here. Thank you so much for 19 00:01:21,840 --> 00:01:24,320 Speaker 1: having me that. That's such a lovely intro. I'm very 20 00:01:24,400 --> 00:01:27,479 Speaker 1: impressed by you, so I'm glad that you liked your intro. 21 00:01:28,120 --> 00:01:30,319 Speaker 1: I would love for you to take us back to 22 00:01:30,440 --> 00:01:34,440 Speaker 1: whensoriasis first showed up in your life. I would love 23 00:01:34,440 --> 00:01:36,200 Speaker 1: if you would tell us how old you were and 24 00:01:36,280 --> 00:01:39,480 Speaker 1: what those early years were like of getting to diagnosis. 25 00:01:40,280 --> 00:01:43,240 Speaker 2: I was twenty one, and it was actually crazy because 26 00:01:44,040 --> 00:01:48,000 Speaker 2: sariasis firstly is not a contagious condition. There's like genetic 27 00:01:48,040 --> 00:01:52,520 Speaker 2: predispositions to it, and then there's environmental influences stress influences, 28 00:01:52,880 --> 00:01:55,520 Speaker 2: so we can't really say or like I can't say 29 00:01:55,520 --> 00:01:58,920 Speaker 2: for myself that one thing caused it, but time wise, 30 00:01:59,360 --> 00:02:02,640 Speaker 2: it showed up right after I got home from Coachella 31 00:02:02,720 --> 00:02:07,040 Speaker 2: in my fourth year of college at UCLA, and it 32 00:02:07,120 --> 00:02:10,000 Speaker 2: was like, I mean, when I try to hypothesize about 33 00:02:10,000 --> 00:02:12,000 Speaker 2: it for myself, obviously I'll never get a true answer, 34 00:02:12,040 --> 00:02:14,880 Speaker 2: but like knowing that there's some people in my family 35 00:02:14,880 --> 00:02:17,360 Speaker 2: that I found out later on had psoriasis who developed 36 00:02:17,360 --> 00:02:20,360 Speaker 2: it after me, And like Coachella was like one hundred 37 00:02:20,360 --> 00:02:23,919 Speaker 2: degree heat. We were like partying all day and like 38 00:02:24,080 --> 00:02:26,320 Speaker 2: not drinking enough water, and I don't know, like maybe 39 00:02:26,320 --> 00:02:28,440 Speaker 2: that stress on the body was enough to turn on 40 00:02:28,480 --> 00:02:30,840 Speaker 2: the light switch in me. But like that is not 41 00:02:30,880 --> 00:02:34,480 Speaker 2: a scientific explanation. That's just me hypothesizing. But that was 42 00:02:34,560 --> 00:02:38,640 Speaker 2: like a crazy experience for me coming back from Coachella 43 00:02:38,680 --> 00:02:40,640 Speaker 2: and then getting red dots on my back, but it 44 00:02:40,680 --> 00:02:43,160 Speaker 2: was like seven or eight red dots, and I was like, 45 00:02:43,200 --> 00:02:46,600 Speaker 2: it's probably just bedbugs, because I obviously consulted doctor Google 46 00:02:46,639 --> 00:02:50,920 Speaker 2: who told me it was bedbugs. So then I waited 47 00:02:51,040 --> 00:02:52,840 Speaker 2: because they said the bed bugs would. 48 00:02:52,680 --> 00:02:53,120 Speaker 1: Just go away. 49 00:02:53,200 --> 00:02:55,760 Speaker 3: So I waited and I showered, and then it did 50 00:02:55,800 --> 00:02:56,320 Speaker 3: not go away. 51 00:02:56,800 --> 00:03:00,440 Speaker 2: It did indeed get worse every day, and it's spread 52 00:03:00,440 --> 00:03:03,760 Speaker 2: from like my back to my arms, to my trunk. 53 00:03:04,280 --> 00:03:07,800 Speaker 2: And I saw my PCP at UCLA Student Wellness Center 54 00:03:08,400 --> 00:03:11,919 Speaker 2: and they were first thinking it was contact dermatitis, So 55 00:03:11,960 --> 00:03:14,880 Speaker 2: like maybe I laid in the grass at Coachella, which 56 00:03:14,919 --> 00:03:16,840 Speaker 2: I definitely did, like laid in the grass, lad in 57 00:03:16,880 --> 00:03:19,760 Speaker 2: the sand, and maybe that irritated my skin very fair 58 00:03:20,440 --> 00:03:23,680 Speaker 2: And they put me on like a weak moderate cortico 59 00:03:23,720 --> 00:03:27,239 Speaker 2: steroid topical, but that did not help at all, and 60 00:03:28,320 --> 00:03:29,400 Speaker 2: they sent me with. 61 00:03:29,360 --> 00:03:32,559 Speaker 3: An urgent quote urgent referral to dermatology. 62 00:03:32,600 --> 00:03:34,320 Speaker 2: And I was like, at that point in my life, 63 00:03:34,320 --> 00:03:37,680 Speaker 2: being twenty one, you just don't expect problems to be 64 00:03:37,760 --> 00:03:40,000 Speaker 2: anything outside of a cute. So I just never saw 65 00:03:40,040 --> 00:03:42,640 Speaker 2: that coming and my parents didn't have it, like it 66 00:03:42,680 --> 00:03:45,200 Speaker 2: was not even in the picture for me. And I 67 00:03:45,240 --> 00:03:47,400 Speaker 2: called and I found out that the next available appointment 68 00:03:47,440 --> 00:03:49,320 Speaker 2: for a dermatologist was three months out. 69 00:03:50,040 --> 00:03:52,000 Speaker 3: And I first was. 70 00:03:52,000 --> 00:03:55,440 Speaker 2: Like, what is like this is crazy, But then second, 71 00:03:55,480 --> 00:03:58,040 Speaker 2: like after I looked back, I realized that like a 72 00:03:58,080 --> 00:04:00,800 Speaker 2: ton of people who are on the waitlist also have 73 00:04:01,000 --> 00:04:03,200 Speaker 2: urgent issues like me, and this is just the nature 74 00:04:03,240 --> 00:04:08,280 Speaker 2: of things, and of like we just need more physicians, 75 00:04:08,920 --> 00:04:11,440 Speaker 2: more specialists, and patients are also. 76 00:04:11,200 --> 00:04:14,120 Speaker 3: In need, so you know what, I'll take that one month. 77 00:04:14,760 --> 00:04:19,240 Speaker 2: And so April was when Coachella was and June was 78 00:04:19,279 --> 00:04:22,279 Speaker 2: when my first appointment was, And by that time I 79 00:04:22,440 --> 00:04:26,960 Speaker 2: was quite covered in soriatic disease plaques like my thighs, 80 00:04:27,040 --> 00:04:31,280 Speaker 2: my arms, my trunk, my back, my cabs, my legs, 81 00:04:31,400 --> 00:04:34,800 Speaker 2: and my scalp as well, and everywhere I was walking 82 00:04:34,839 --> 00:04:37,200 Speaker 2: it was like it was snowing because my skin flakes 83 00:04:37,200 --> 00:04:39,960 Speaker 2: were falling off. I didn't know what was happening to me, 84 00:04:40,839 --> 00:04:43,840 Speaker 2: and I didn't even suspect crisis because also at that time, 85 00:04:44,320 --> 00:04:48,039 Speaker 2: maybe it was like influences from the media while I 86 00:04:48,120 --> 00:04:51,040 Speaker 2: was growing up, or maybe just like what the word 87 00:04:51,279 --> 00:04:53,440 Speaker 2: was about csisis at that time, but I thought it 88 00:04:53,480 --> 00:04:57,400 Speaker 2: was a diagnosis for like senior aged people to get 89 00:04:57,520 --> 00:05:00,440 Speaker 2: or like people of paler skin to get. I didn't 90 00:05:00,480 --> 00:05:03,920 Speaker 2: know that a young person of color could get psoriasis, 91 00:05:04,160 --> 00:05:06,919 Speaker 2: Like that was false, but I just didn't know that 92 00:05:07,000 --> 00:05:07,520 Speaker 2: at the time. 93 00:05:08,000 --> 00:05:10,480 Speaker 3: And then they told me the treatment options, and I was. 94 00:05:10,440 --> 00:05:12,359 Speaker 2: Like, wait, like I have to be on treatment for 95 00:05:12,440 --> 00:05:14,240 Speaker 2: this for the rest of my life if it doesn't 96 00:05:14,279 --> 00:05:17,320 Speaker 2: go away, Like what are we talking about here? So 97 00:05:17,440 --> 00:05:21,960 Speaker 2: then I first started on topicals, but then it did 98 00:05:22,000 --> 00:05:25,360 Speaker 2: not treat it. I had forty percent body service area 99 00:05:25,440 --> 00:05:29,400 Speaker 2: involvement and involvement of high impact sites like the genital area, 100 00:05:29,480 --> 00:05:34,719 Speaker 2: the scalp, and it was just so severe for me 101 00:05:34,920 --> 00:05:39,400 Speaker 2: personally that it affected all aspects of my quality of life. 102 00:05:40,160 --> 00:05:43,440 Speaker 2: It was running rampant behind my thighs, and that made 103 00:05:43,480 --> 00:05:46,320 Speaker 2: me not be able to sit down and study for 104 00:05:46,360 --> 00:05:48,600 Speaker 2: more than fifteen minutes. And like as a college student 105 00:05:48,680 --> 00:05:51,320 Speaker 2: also who was studying for the MKT at that time, 106 00:05:51,400 --> 00:05:54,920 Speaker 2: like I could not focus because I was so incredibly itchy, 107 00:05:55,320 --> 00:05:58,080 Speaker 2: especially with living in one hundred degree heat in LA. 108 00:05:58,640 --> 00:06:01,479 Speaker 2: It was going on my face ears, it was starting 109 00:06:01,560 --> 00:06:04,080 Speaker 2: to get everywhere, and it just felt like I had 110 00:06:04,160 --> 00:06:07,520 Speaker 2: no control over it, like I felt truly powerless. Thankfully, 111 00:06:07,720 --> 00:06:13,400 Speaker 2: in August, I received approval for my first biologic, and 112 00:06:13,720 --> 00:06:15,960 Speaker 2: my skin went from head to toe in plex to 113 00:06:16,480 --> 00:06:19,720 Speaker 2: quite literally fully clear within a month, which was the 114 00:06:19,760 --> 00:06:23,560 Speaker 2: power of having access to a medication that could change 115 00:06:23,560 --> 00:06:26,080 Speaker 2: your life so much, not only my skin but my 116 00:06:26,200 --> 00:06:28,760 Speaker 2: mental health. There was just so many other aspects of 117 00:06:28,800 --> 00:06:31,679 Speaker 2: it that made me feel less beautiful, less like myself, 118 00:06:31,720 --> 00:06:34,080 Speaker 2: and less like the twenty one year old cute girl 119 00:06:34,120 --> 00:06:36,760 Speaker 2: that I wanted to be. But after like reconnecting with 120 00:06:36,800 --> 00:06:38,359 Speaker 2: that part of myself, I was so thankful, and I 121 00:06:38,400 --> 00:06:42,360 Speaker 2: reflected on how privileged this access to medication is because 122 00:06:42,600 --> 00:06:47,360 Speaker 2: without insurance coverage or without copay assistance programs coupon cards, 123 00:06:47,720 --> 00:06:50,120 Speaker 2: like these medications run up to like one hundred thousand 124 00:06:50,160 --> 00:06:53,760 Speaker 2: dollars a year or more, so that like is completely 125 00:06:53,800 --> 00:06:56,560 Speaker 2: unaffordable for people who can't access it through those methods. 126 00:06:56,600 --> 00:06:58,800 Speaker 2: And I think about all those people who have struggles 127 00:06:58,839 --> 00:07:01,479 Speaker 2: with accessing it, because I eventually became one of those people. 128 00:07:01,880 --> 00:07:04,599 Speaker 2: And we could talk about that later, but that just 129 00:07:04,640 --> 00:07:07,839 Speaker 2: completely changed my life. And I was thankful for my 130 00:07:07,880 --> 00:07:10,640 Speaker 2: health stability. Later on had to switch medications because I 131 00:07:10,680 --> 00:07:12,040 Speaker 2: developed arthritis. 132 00:07:11,600 --> 00:07:13,120 Speaker 3: But we could talk about that later. 133 00:07:13,440 --> 00:07:15,840 Speaker 1: That's actually the next thing we're going to talk about, 134 00:07:15,880 --> 00:07:18,840 Speaker 1: because just as you're getting all of this figured out 135 00:07:18,880 --> 00:07:20,760 Speaker 1: and at an age when you should be having fun 136 00:07:20,800 --> 00:07:25,120 Speaker 1: and enjoying life, then of course soriatic arthritis enters the 137 00:07:25,160 --> 00:07:28,679 Speaker 1: picture as you're getting ready and applying to medical school. 138 00:07:29,840 --> 00:07:32,240 Speaker 1: So what was it like to have your body change 139 00:07:32,280 --> 00:07:36,160 Speaker 1: on you again at that exact moment when you feel 140 00:07:36,160 --> 00:07:38,240 Speaker 1: like you've got it under control and you're taking on 141 00:07:38,320 --> 00:07:39,640 Speaker 1: a huge new challenge. 142 00:07:40,440 --> 00:07:43,040 Speaker 3: That was a crazy time, indeed. 143 00:07:43,920 --> 00:07:48,920 Speaker 2: So I started developing back pain, and I thought that 144 00:07:49,000 --> 00:07:51,200 Speaker 2: it was just back pain because I was spending twelve 145 00:07:51,240 --> 00:07:53,720 Speaker 2: hours a day, like writing essays, preparing for interviews. 146 00:07:53,760 --> 00:07:54,120 Speaker 3: I don't know. 147 00:07:54,760 --> 00:07:56,720 Speaker 2: And then I went to my PCP in San Diego 148 00:07:56,760 --> 00:07:58,640 Speaker 2: at the time, because that was during my gap years 149 00:07:58,760 --> 00:08:01,920 Speaker 2: applying for medical school, and he was like, yeah, probably 150 00:08:01,920 --> 00:08:04,960 Speaker 2: because of your sententary lifestyle, like you went from working 151 00:08:05,000 --> 00:08:08,800 Speaker 2: out every single day playing volleyball to sitting down all 152 00:08:08,840 --> 00:08:10,720 Speaker 2: the time. So I could see how that cost is 153 00:08:10,760 --> 00:08:13,000 Speaker 2: pain for you. Let me send you to physical therapy. 154 00:08:13,560 --> 00:08:16,160 Speaker 2: Quite frankly, I just got worse, not because of the PET, 155 00:08:16,320 --> 00:08:20,160 Speaker 2: but just because of disease progression without appropriate treatment. So 156 00:08:20,440 --> 00:08:22,840 Speaker 2: I remember going to the mall with my friend and 157 00:08:22,880 --> 00:08:25,760 Speaker 2: having to sit down every fifteen minutes because I could 158 00:08:25,760 --> 00:08:27,480 Speaker 2: not walk for more than fifteen minutes. I could not 159 00:08:27,520 --> 00:08:29,400 Speaker 2: stand up for more than fifteen minutes. And that was 160 00:08:29,440 --> 00:08:32,960 Speaker 2: when I was like, Okay, something is definitely wrong. This 161 00:08:33,120 --> 00:08:35,240 Speaker 2: is not normal for a twenty four year old guys. 162 00:08:35,840 --> 00:08:37,839 Speaker 3: So that was that. 163 00:08:38,760 --> 00:08:43,320 Speaker 2: But then I knew that soriatic arthritis existed, but silly me, 164 00:08:43,400 --> 00:08:45,480 Speaker 2: I didn't know that the back was a joint. 165 00:08:45,920 --> 00:08:46,960 Speaker 3: And there's this thing. 166 00:08:46,840 --> 00:08:49,360 Speaker 2: Called the Past Questionnaire, which helps a lot of people 167 00:08:49,440 --> 00:08:53,640 Speaker 2: connect when like find out signs about soiatic arthritis. But 168 00:08:53,760 --> 00:08:55,720 Speaker 2: it asked about joint pain, and I was like, well, 169 00:08:55,720 --> 00:08:57,120 Speaker 2: my back's not a joint. I just had back pain, 170 00:08:57,160 --> 00:08:59,520 Speaker 2: not joint pain. I think it asked if I had 171 00:08:59,559 --> 00:09:02,520 Speaker 2: like nail changes. I didn't have any nail changes at 172 00:09:02,520 --> 00:09:05,040 Speaker 2: that time. I didn't have any feet pain. I do now, 173 00:09:05,080 --> 00:09:07,600 Speaker 2: but like at that time, I didn't until I got 174 00:09:07,640 --> 00:09:11,160 Speaker 2: to University of Chicago where I'm at medical school, to 175 00:09:11,240 --> 00:09:14,160 Speaker 2: be able to see a rheumatologist which is the doctor 176 00:09:14,160 --> 00:09:18,640 Speaker 2: that specializes in like inflammation and joint stuff. So then 177 00:09:18,679 --> 00:09:20,560 Speaker 2: on my first day at medical school was the first 178 00:09:20,679 --> 00:09:23,640 Speaker 2: day that they had an available appointment, so they booked 179 00:09:23,720 --> 00:09:27,679 Speaker 2: me for that day. Saw my doctor went to orientation, 180 00:09:28,080 --> 00:09:30,199 Speaker 2: got the X ray back around lunchtime. 181 00:09:30,720 --> 00:09:32,720 Speaker 3: X ray said, I have soriatic arthritis. 182 00:09:32,840 --> 00:09:36,000 Speaker 2: Doctor was like, also consistent with your symptoms of like 183 00:09:36,400 --> 00:09:40,640 Speaker 2: morning stiffness and general stiffness and pain and the back 184 00:09:40,720 --> 00:09:44,000 Speaker 2: involvement and stuch. And then I went during my lunch 185 00:09:44,000 --> 00:09:46,480 Speaker 2: hour to my dean's office and then I cried because 186 00:09:46,559 --> 00:09:48,960 Speaker 2: I was like if I cannot At that point, I 187 00:09:49,000 --> 00:09:51,720 Speaker 2: couldn't stand up to brush my teeth because my back 188 00:09:51,800 --> 00:09:54,280 Speaker 2: hurt so bad. I could not walk to school because 189 00:09:54,280 --> 00:09:56,679 Speaker 2: my back hurts so bad. And honestly, I was not 190 00:09:56,800 --> 00:09:59,920 Speaker 2: sleeping more than zero to three hours per night max. 191 00:10:00,640 --> 00:10:03,400 Speaker 2: Because I couldn't even find a comfortable position because my 192 00:10:03,440 --> 00:10:05,920 Speaker 2: body was so stiff that I could not fall asleep 193 00:10:06,040 --> 00:10:08,280 Speaker 2: no matter how tired I was, no matter how much 194 00:10:08,280 --> 00:10:11,760 Speaker 2: melatonin I took, no matter what I was trying, I 195 00:10:11,800 --> 00:10:14,640 Speaker 2: could not fall asleep. And I was like, with all 196 00:10:14,679 --> 00:10:18,080 Speaker 2: of this, like, how could I do a rigorous medical program? 197 00:10:18,160 --> 00:10:20,920 Speaker 2: And study my best to be a doctor, So that 198 00:10:21,080 --> 00:10:24,119 Speaker 2: was what I was grappling with when I first got diagnosed. 199 00:10:24,760 --> 00:10:29,360 Speaker 1: You have spoken so frankly and openly about, you know, 200 00:10:29,440 --> 00:10:32,680 Speaker 1: all of the difficulties and the pain of it. But 201 00:10:32,800 --> 00:10:35,360 Speaker 1: I also want to talk about stigma, because that's really 202 00:10:35,400 --> 00:10:39,120 Speaker 1: at the heart of this entire episode. You have lived 203 00:10:39,120 --> 00:10:42,439 Speaker 1: with a visible skin condition since your early twenties, again 204 00:10:42,480 --> 00:10:44,840 Speaker 1: a time, as I said before, which should be fun, 205 00:10:44,840 --> 00:10:46,720 Speaker 1: And you mentioned you wanted to be that like cute 206 00:10:46,760 --> 00:10:49,880 Speaker 1: young twenties girl, but what does that actually feel like 207 00:10:50,000 --> 00:10:52,120 Speaker 1: day to day to in fact, have the opposite and 208 00:10:52,240 --> 00:10:54,320 Speaker 1: have plaques that you need to deal with that are 209 00:10:54,480 --> 00:10:55,520 Speaker 1: all over your person. 210 00:10:56,720 --> 00:11:01,040 Speaker 2: I think, firstly, there's different definitions of stick, Like there's 211 00:11:01,760 --> 00:11:05,920 Speaker 2: the stigma that I anticipate others to put upon me 212 00:11:06,440 --> 00:11:10,640 Speaker 2: and their stigma that I experience as tangible events. I 213 00:11:10,679 --> 00:11:13,040 Speaker 2: think that for some people they are separate things and 214 00:11:13,040 --> 00:11:16,560 Speaker 2: for other people they are not separate things. But for me, like, 215 00:11:16,600 --> 00:11:18,760 Speaker 2: I always felt like I was being stared at, and 216 00:11:18,800 --> 00:11:22,800 Speaker 2: I was concerned that people thought I was contagious, and 217 00:11:22,840 --> 00:11:25,440 Speaker 2: like looking at surveys, I've seen that like people didn't 218 00:11:25,440 --> 00:11:27,880 Speaker 2: even want to shake hands or carpool with people with 219 00:11:27,920 --> 00:11:31,000 Speaker 2: psoriasis because they thought they were dirty, or because they 220 00:11:31,040 --> 00:11:35,040 Speaker 2: just thought it was contagious, And these ideas and this 221 00:11:35,320 --> 00:11:39,400 Speaker 2: medical misinformation just made me feel like I was a monster. 222 00:11:40,080 --> 00:11:42,520 Speaker 2: I was scared to date at that time, when I 223 00:11:42,640 --> 00:11:46,120 Speaker 2: was fully flaring with mysiasis. I stopped dating because there 224 00:11:46,160 --> 00:11:48,040 Speaker 2: was plaques on my nipples, Like you couldn't even see 225 00:11:48,040 --> 00:11:51,320 Speaker 2: my nipples anymore. How could I prepare a twenty one 226 00:11:51,400 --> 00:11:53,760 Speaker 2: year old man to be seeing that I just was not. 227 00:11:54,200 --> 00:11:54,480 Speaker 3: I was. 228 00:11:54,679 --> 00:11:57,240 Speaker 2: Even if they would be nice, I just wouldn't even 229 00:11:57,280 --> 00:11:59,000 Speaker 2: dare to try it because I was not ready to 230 00:11:59,040 --> 00:12:00,440 Speaker 2: have those conversations. 231 00:12:00,920 --> 00:12:03,800 Speaker 1: It probably also did not make you feel especially sexy 232 00:12:03,840 --> 00:12:04,160 Speaker 1: at that. 233 00:12:04,160 --> 00:12:07,440 Speaker 2: Point, exactly like I didn't even think about feeling sexy 234 00:12:07,440 --> 00:12:09,520 Speaker 2: at that point. I was someone who was really struggling 235 00:12:09,520 --> 00:12:14,120 Speaker 2: with their health, and I think I over compensated with 236 00:12:14,200 --> 00:12:17,520 Speaker 2: that by like trying to act more confident than I was. 237 00:12:17,920 --> 00:12:21,240 Speaker 2: And I wasn't like acting like super confident or anything. 238 00:12:21,280 --> 00:12:23,160 Speaker 2: I was just like acting like my normal self. And 239 00:12:23,200 --> 00:12:25,800 Speaker 2: people were saying that I was so strong and like 240 00:12:25,840 --> 00:12:29,360 Speaker 2: people were so supportive of me, and I'm so grateful 241 00:12:29,360 --> 00:12:31,280 Speaker 2: for that, But that was definitely me trying to just 242 00:12:31,320 --> 00:12:34,480 Speaker 2: convince myself that I was okay, when in reality, like 243 00:12:34,920 --> 00:12:38,200 Speaker 2: me wearing short sleeves made me so insecure, or like 244 00:12:38,240 --> 00:12:42,240 Speaker 2: wearing light colored clothes and seeing my ointments seep through 245 00:12:42,280 --> 00:12:44,360 Speaker 2: the light colors made me insecure as well. 246 00:12:44,960 --> 00:12:46,760 Speaker 1: That's such a lot to go through at that time 247 00:12:46,760 --> 00:12:51,720 Speaker 1: in your life. And now you are moving to the 248 00:12:51,760 --> 00:12:53,840 Speaker 1: other side of the table at least part of the time. 249 00:12:53,880 --> 00:12:57,200 Speaker 1: You're becoming a physician, learning about what it is to 250 00:12:57,240 --> 00:13:01,360 Speaker 1: be a doctor and going through that whole process of education. 251 00:13:02,160 --> 00:13:05,959 Speaker 1: Does that change how you experience or how you perceive 252 00:13:06,120 --> 00:13:10,160 Speaker 1: stigma or you know, even I mean, I'm confident you're 253 00:13:10,200 --> 00:13:14,120 Speaker 1: going to carry that your own experiences into dealing with 254 00:13:14,240 --> 00:13:17,400 Speaker 1: patients when they walk in the door. Tell me about that. 255 00:13:18,440 --> 00:13:23,120 Speaker 2: Honestly, living with psoriasis and sooriatic arthritis has given me 256 00:13:23,280 --> 00:13:28,000 Speaker 2: so much like passion, joy fulfillment in connecting with other people, 257 00:13:28,040 --> 00:13:31,960 Speaker 2: and empowerment as I've found more resilience in this journey 258 00:13:32,600 --> 00:13:36,200 Speaker 2: and with this, I feel like I'm not actively trying 259 00:13:36,280 --> 00:13:39,360 Speaker 2: to translate the qualities of a patient into the qualities 260 00:13:39,400 --> 00:13:42,040 Speaker 2: of a physician, but for me, it just naturally happens. 261 00:13:42,520 --> 00:13:45,880 Speaker 2: So as someone who now understands that there's so much 262 00:13:45,960 --> 00:13:49,560 Speaker 2: more to the chronic illness or disease experience than like 263 00:13:49,960 --> 00:13:53,480 Speaker 2: what is clinically measurable. I love to hear about patient's 264 00:13:53,600 --> 00:13:56,720 Speaker 2: journeys in those measures as well outside of things that 265 00:13:56,760 --> 00:14:01,720 Speaker 2: are like traditionally measured for like the clinic environment. Like 266 00:14:01,760 --> 00:14:05,280 Speaker 2: there was a patient where she had expressed that there 267 00:14:05,320 --> 00:14:07,000 Speaker 2: was a part of her health that people did not 268 00:14:07,160 --> 00:14:10,200 Speaker 2: understand because other people don't know how hard it is. 269 00:14:10,559 --> 00:14:12,679 Speaker 2: And then I resonated with that, and I didn't want 270 00:14:12,679 --> 00:14:14,240 Speaker 2: to make it about me, because that's always a line 271 00:14:14,280 --> 00:14:17,840 Speaker 2: that I'm trying to like not cross. It's always about 272 00:14:17,840 --> 00:14:20,120 Speaker 2: the patient. I'm always prioritizing what the patient is going through. 273 00:14:20,520 --> 00:14:22,960 Speaker 2: My experiences with chronic eunlyssis have given me so much 274 00:14:22,960 --> 00:14:25,200 Speaker 2: for patient care, and it makes me feel so lucky 275 00:14:25,240 --> 00:14:28,080 Speaker 2: to be able to live in both worlds. But it's 276 00:14:28,120 --> 00:14:31,600 Speaker 2: like it makes it hard because the frustrations I experience 277 00:14:31,760 --> 00:14:36,440 Speaker 2: as a patient translate to frustrations that I will have 278 00:14:36,520 --> 00:14:37,240 Speaker 2: as a physician. 279 00:14:37,320 --> 00:14:40,440 Speaker 3: But then I can't do things about it. 280 00:14:40,800 --> 00:14:44,840 Speaker 2: Sometimes, like obviously I do advocacy with the National Services Foundation. 281 00:14:44,880 --> 00:14:47,400 Speaker 2: I go to Washington, DC, and I know that our 282 00:14:47,480 --> 00:14:51,080 Speaker 2: voices have so much power as patients, but like as 283 00:14:51,120 --> 00:14:53,760 Speaker 2: a doctor, I will still be carrying the frustrations that 284 00:14:53,800 --> 00:14:55,800 Speaker 2: I had when I was a patient as well as 285 00:14:55,840 --> 00:14:58,840 Speaker 2: carrying all the frustrations that my patients share with me. 286 00:15:00,000 --> 00:15:03,200 Speaker 1: There are also a Disability and Chronic Illness mentor at 287 00:15:03,240 --> 00:15:06,640 Speaker 1: your school because you built something for students who are 288 00:15:06,640 --> 00:15:09,280 Speaker 1: dealing with exactly what you've dealt with, which is a 289 00:15:09,360 --> 00:15:12,720 Speaker 1: huge undertaking. I imagine what made you want to do 290 00:15:12,760 --> 00:15:15,080 Speaker 1: that and take on even more in your life and 291 00:15:15,400 --> 00:15:18,160 Speaker 1: what do you tell people that come to you for mentoring. 292 00:15:19,000 --> 00:15:21,960 Speaker 2: People often ask to me like how I do the 293 00:15:22,080 --> 00:15:25,000 Speaker 2: advocacy work or the volunteering work, or like the mentorship 294 00:15:25,040 --> 00:15:28,240 Speaker 2: work that I do, But honestly, for me, it's actually 295 00:15:28,280 --> 00:15:31,200 Speaker 2: one of the ways that I cope. So it makes 296 00:15:31,240 --> 00:15:35,360 Speaker 2: me feel like even if there's things that I cannot 297 00:15:35,360 --> 00:15:37,960 Speaker 2: control in my life, at least something that I can 298 00:15:38,040 --> 00:15:41,920 Speaker 2: control is pouring back into the community, sharing the knowledge 299 00:15:41,920 --> 00:15:45,000 Speaker 2: that I have amassed thus far, and being an ally 300 00:15:45,040 --> 00:15:48,200 Speaker 2: to other people who are going through something similar. Because 301 00:15:48,440 --> 00:15:51,080 Speaker 2: when I was first diagnosed, I was not alone by 302 00:15:51,120 --> 00:15:53,200 Speaker 2: any means. I had like my family, my friends who 303 00:15:53,280 --> 00:15:56,600 Speaker 2: loved me, but I only joined the National Stiviceis Foundation 304 00:15:56,720 --> 00:15:58,560 Speaker 2: after I was stable in my health, because if I 305 00:15:58,720 --> 00:16:00,600 Speaker 2: when I was unstable, I could not be like giving 306 00:16:00,640 --> 00:16:02,920 Speaker 2: to other people and I didn't have the capacity to 307 00:16:02,920 --> 00:16:06,240 Speaker 2: even pour into myself. I had a hard time saying 308 00:16:06,280 --> 00:16:08,840 Speaker 2: no to like being asked to hang out, or like 309 00:16:09,080 --> 00:16:12,400 Speaker 2: opportunities or like leaving things early or something. But like 310 00:16:12,440 --> 00:16:15,280 Speaker 2: that's something I have no shame in now. And I 311 00:16:15,320 --> 00:16:17,760 Speaker 2: realized that like with me not having any shame in it, 312 00:16:17,840 --> 00:16:19,840 Speaker 2: like the people who I love, the people who are 313 00:16:19,840 --> 00:16:21,920 Speaker 2: around me just take that as it is, Like if 314 00:16:21,960 --> 00:16:24,000 Speaker 2: I have to leave, leave, that's completely fine. We know 315 00:16:24,000 --> 00:16:26,800 Speaker 2: that you're fatigued, and it's fine. And I think also 316 00:16:26,880 --> 00:16:30,840 Speaker 2: just fostering these conversations decreases the stigma on it. There 317 00:16:30,880 --> 00:16:33,360 Speaker 2: was an event that I had for newly admitted students 318 00:16:33,400 --> 00:16:37,280 Speaker 2: at my medical school to just have a session about disability, 319 00:16:37,440 --> 00:16:39,520 Speaker 2: chronic illness and what that's like as a medical student. 320 00:16:39,520 --> 00:16:41,480 Speaker 2: And I remember they were telling me like that made 321 00:16:41,560 --> 00:16:44,360 Speaker 2: me feel safe to commit to this school, knowing that 322 00:16:44,640 --> 00:16:47,040 Speaker 2: there are people here who have been supported, that there 323 00:16:47,080 --> 00:16:48,920 Speaker 2: are people here who are on that journey with me, 324 00:16:49,040 --> 00:16:50,960 Speaker 2: even though we don't know what the future looks like, 325 00:16:51,240 --> 00:16:53,440 Speaker 2: we know that we are at least here to support 326 00:16:53,440 --> 00:16:57,680 Speaker 2: and that we understand, so fostering that conversation has given 327 00:16:57,840 --> 00:16:59,240 Speaker 2: all of us so much. 328 00:17:00,120 --> 00:17:02,640 Speaker 1: Doing that kind of advocacy At the same time, you're 329 00:17:02,640 --> 00:17:05,560 Speaker 1: doing medical school is a lot. You are also doing 330 00:17:05,680 --> 00:17:08,920 Speaker 1: peer reviewed research, you volunteer, as you said with the NPF, 331 00:17:09,200 --> 00:17:12,439 Speaker 1: you were mentoring students. How do you balance all of 332 00:17:12,480 --> 00:17:15,560 Speaker 1: these things and hold it all together on days when 333 00:17:15,600 --> 00:17:19,240 Speaker 1: your body is also making demands because, as we know 334 00:17:19,320 --> 00:17:22,639 Speaker 1: from doing the show, sometimes your body doesn't care what 335 00:17:22,680 --> 00:17:23,680 Speaker 1: you have on your calendar. 336 00:17:24,200 --> 00:17:27,680 Speaker 2: That's absolutely right, yep. The body often does not care 337 00:17:27,760 --> 00:17:30,399 Speaker 2: what I have on my calendar. And you know, I 338 00:17:30,520 --> 00:17:34,080 Speaker 2: probably rescheduled this podcast like three times, and that's completely fine. 339 00:17:34,320 --> 00:17:36,640 Speaker 2: I am just privileged that the people in my life 340 00:17:36,720 --> 00:17:41,840 Speaker 2: thus far have been amenable to rescheduling, amenable to making 341 00:17:41,880 --> 00:17:45,040 Speaker 2: events on or like giving a zoom option to an 342 00:17:45,040 --> 00:17:47,640 Speaker 2: event if my body is too fatigued to go in person, 343 00:17:48,200 --> 00:17:51,719 Speaker 2: and I've been received very kindly with that. Obviously, there 344 00:17:51,800 --> 00:17:55,080 Speaker 2: is a part of me that's like, before my disability, 345 00:17:55,240 --> 00:17:58,840 Speaker 2: I was on top of things, and I still am 346 00:17:58,960 --> 00:18:02,000 Speaker 2: in a different way, But I honestly still feel guilty 347 00:18:02,119 --> 00:18:05,080 Speaker 2: for like I still meet deadlines, but I struggle to 348 00:18:05,119 --> 00:18:08,680 Speaker 2: beet deadlines or like having to reschedule things or having 349 00:18:08,760 --> 00:18:12,359 Speaker 2: to have more conversations about what a sustainable timeline for 350 00:18:12,440 --> 00:18:16,720 Speaker 2: me looks like for different projects. But the kindness that 351 00:18:16,760 --> 00:18:20,280 Speaker 2: I've received from my mentors thus far has allowed me 352 00:18:20,400 --> 00:18:24,440 Speaker 2: to do everything very sustainably and I feel comfortable canceling 353 00:18:24,480 --> 00:18:27,280 Speaker 2: whenever I need to. And that's really been the hallmark 354 00:18:27,480 --> 00:18:30,280 Speaker 2: of me being able to do everything that I need 355 00:18:30,320 --> 00:18:33,320 Speaker 2: to do to keep myself healthy and also do everything 356 00:18:33,320 --> 00:18:35,920 Speaker 2: that I need to do to fulfill who I want 357 00:18:35,920 --> 00:18:37,919 Speaker 2: to be clinically and who I want to be like 358 00:18:38,040 --> 00:18:40,600 Speaker 2: on a research an extracurricular basis. 359 00:18:41,080 --> 00:18:43,240 Speaker 1: That's so refreshing to know that you get that much 360 00:18:43,400 --> 00:18:46,639 Speaker 1: support and grace from people when you just need to 361 00:18:46,840 --> 00:18:50,639 Speaker 1: change it up. The future physician that you are becoming, 362 00:18:51,400 --> 00:18:54,440 Speaker 1: I wonder, what's the primary thing that you want her 363 00:18:54,520 --> 00:18:58,600 Speaker 1: to do differently than what you experienced as a patient, Because, 364 00:18:58,640 --> 00:19:01,080 Speaker 1: as you said, some things you can't control right there, 365 00:19:01,600 --> 00:19:04,960 Speaker 1: Insurance companies involved, they are all kinds of like scheduling 366 00:19:05,000 --> 00:19:07,760 Speaker 1: issues involved. But what's the thing within your control that 367 00:19:07,800 --> 00:19:08,520 Speaker 1: you would change. 368 00:19:09,440 --> 00:19:14,679 Speaker 2: I remember being frustrated about how I had to seek 369 00:19:14,760 --> 00:19:18,920 Speaker 2: support from so many different people, like the pharmacy knew 370 00:19:18,920 --> 00:19:23,200 Speaker 2: about the pharmacy, the manufacturer knew about the copay assistance, 371 00:19:23,280 --> 00:19:25,760 Speaker 2: the insurance knew about the insurance, my doctor knew about 372 00:19:25,760 --> 00:19:30,840 Speaker 2: my disease. And I wished that there was more of 373 00:19:30,880 --> 00:19:34,399 Speaker 2: a stream blind way for me to get that information 374 00:19:34,960 --> 00:19:37,359 Speaker 2: and be connected with all these programs instead of me 375 00:19:37,440 --> 00:19:40,119 Speaker 2: having to reach out to every single person that I 376 00:19:40,119 --> 00:19:42,200 Speaker 2: needed to reach out to be on hold for an 377 00:19:42,200 --> 00:19:45,160 Speaker 2: hour and advocate for myself and tell my story again 378 00:19:45,200 --> 00:19:47,919 Speaker 2: and again and again. And that was how it was 379 00:19:47,960 --> 00:19:52,960 Speaker 2: at the time, and I've met since then so many 380 00:19:53,000 --> 00:19:59,440 Speaker 2: soriatic disease experts who have expertise in ways to navigate 381 00:19:59,480 --> 00:20:03,960 Speaker 2: insurance coverage, legal mechanisms to go through, ways to specific 382 00:20:04,040 --> 00:20:08,439 Speaker 2: ways to navigate step therapy, and insurance denials. So I 383 00:20:08,640 --> 00:20:12,159 Speaker 2: would love to be a provider that is knowledgeable about 384 00:20:12,160 --> 00:20:15,320 Speaker 2: all the barriers that patients go through in order to 385 00:20:15,600 --> 00:20:19,320 Speaker 2: properly empathize with them and support them through those experiences, 386 00:20:19,800 --> 00:20:24,200 Speaker 2: because I felt like my physicians before were extremely helpful, 387 00:20:24,680 --> 00:20:27,600 Speaker 2: and I think that something that I just want to 388 00:20:27,640 --> 00:20:31,679 Speaker 2: be for myself is someone that understands the things that 389 00:20:31,760 --> 00:20:35,359 Speaker 2: I felt were unseen or unacknowledged. 390 00:20:34,560 --> 00:20:35,520 Speaker 3: By my physicians. 391 00:20:36,119 --> 00:20:39,080 Speaker 2: However, I also just can't blame them for that, because 392 00:20:39,119 --> 00:20:41,320 Speaker 2: the more I'm in my rotations, the more I realized 393 00:20:41,320 --> 00:20:46,080 Speaker 2: that doctor's appointments are scheduled to be like fifteen thirty 394 00:20:46,119 --> 00:20:48,760 Speaker 2: forty minutes, but in that time, that is completely not 395 00:20:49,000 --> 00:20:51,639 Speaker 2: enough time to give the patients the support that I 396 00:20:51,720 --> 00:20:54,840 Speaker 2: want to give them. But I've met people who have 397 00:20:55,080 --> 00:20:57,800 Speaker 2: done it all and have supported their patients very holistically, 398 00:20:58,200 --> 00:21:00,399 Speaker 2: So I want to be that person. I want to 399 00:21:00,720 --> 00:21:04,520 Speaker 2: spend time acknowledging how difficult it is, like how it 400 00:21:04,520 --> 00:21:06,280 Speaker 2: feels like a full time job on top of your 401 00:21:06,280 --> 00:21:09,520 Speaker 2: full time job to have a chronic illness, to be 402 00:21:09,600 --> 00:21:12,600 Speaker 2: navigating these things, and also learn more about what the 403 00:21:12,640 --> 00:21:15,040 Speaker 2: hardest parts are for them, Like I'm a very much 404 00:21:15,119 --> 00:21:18,240 Speaker 2: a holistic care person as well, because how are you 405 00:21:18,240 --> 00:21:21,560 Speaker 2: supposed to advance your health if you are struggling with 406 00:21:21,640 --> 00:21:25,080 Speaker 2: accessing food or accessing housing, Like these things are all connected. 407 00:21:25,680 --> 00:21:27,640 Speaker 1: One of the things that we've talked about a lot 408 00:21:27,680 --> 00:21:30,840 Speaker 1: in this interview is embarrassment and stigma, and I keep 409 00:21:30,880 --> 00:21:34,680 Speaker 1: thinking about the way that embarrassment can follow you even 410 00:21:34,680 --> 00:21:37,800 Speaker 1: when no one's watching you talked about that stigma that's 411 00:21:37,840 --> 00:21:40,880 Speaker 1: in your head of expectations as well, because I think 412 00:21:40,920 --> 00:21:43,000 Speaker 1: a lot of people do assume that stigma is something 413 00:21:43,040 --> 00:21:46,199 Speaker 1: that comes from other people, and what you're describing is 414 00:21:46,240 --> 00:21:48,960 Speaker 1: so much more internal than that and so much harder 415 00:21:49,000 --> 00:21:52,080 Speaker 1: to shake and their levels to it. So I appreciate 416 00:21:52,119 --> 00:21:54,879 Speaker 1: you bringing light to that. Specifically, We're going to take 417 00:21:54,880 --> 00:21:56,879 Speaker 1: a little break, and then after that, I'm going to 418 00:21:56,960 --> 00:22:00,439 Speaker 1: tell you about a Persian physician who understand all of 419 00:22:00,480 --> 00:22:04,400 Speaker 1: that twelve hundred years ago, and Wyatt took Western medicine 420 00:22:04,480 --> 00:22:21,080 Speaker 1: until practically yesterday to catch up to that concept. I 421 00:22:21,160 --> 00:22:25,879 Speaker 1: want to tell you a story preserved in Cheharmakala, a 422 00:22:26,119 --> 00:22:30,520 Speaker 1: twelfth century Persian prose work by Nizami Aruzi that includes 423 00:22:30,600 --> 00:22:34,600 Speaker 1: a discourse on medicine and physicians. In a nineteen seventy 424 00:22:34,680 --> 00:22:39,400 Speaker 1: nine paper, two psychiatrists actually highlighted one case from that text, 425 00:22:39,880 --> 00:22:44,080 Speaker 1: involving a physician named Jasalik and a patient with pariasis, 426 00:22:44,480 --> 00:22:47,320 Speaker 1: reading it as an early example of the link between 427 00:22:47,320 --> 00:22:51,920 Speaker 1: emotional strain and skin disease. The author of Jeharamakalik was 428 00:22:51,960 --> 00:22:56,560 Speaker 1: Ahmad Iben umar ibin Ali, known as Nazami Arusi Samarkandi. 429 00:22:57,119 --> 00:23:00,240 Speaker 1: His exact birth and death dates are uncertain, but he 430 00:23:00,320 --> 00:23:03,560 Speaker 1: was probably born in the late eleventh century, and he 431 00:23:03,640 --> 00:23:07,760 Speaker 1: composed Chahar Makala in eleven fifty five to eleven fifty 432 00:23:07,800 --> 00:23:11,560 Speaker 1: seven ish. The Chahar Makalah is not a medical treatise 433 00:23:11,680 --> 00:23:13,680 Speaker 1: or a text in the modern sense. It's more of 434 00:23:13,760 --> 00:23:17,320 Speaker 1: a catalog of the four professions that a ruler would 435 00:23:17,359 --> 00:23:21,119 Speaker 1: need to have around. Those were, according to this writing, 436 00:23:21,240 --> 00:23:26,280 Speaker 1: an astrologer, a secretary, a poet, and a physician, which 437 00:23:26,320 --> 00:23:29,359 Speaker 1: you know, obviously everybody should have that assortment at hand. 438 00:23:30,520 --> 00:23:36,000 Speaker 1: Chehar Makala is Aurusi's only surviving work. Encyclopedia Ironica notes 439 00:23:36,040 --> 00:23:38,400 Speaker 1: that much of what we know about his life actually 440 00:23:38,440 --> 00:23:42,159 Speaker 1: comes from passages within that text itself, which means that 441 00:23:42,240 --> 00:23:45,320 Speaker 1: this book is a key source for examining the writer's 442 00:23:45,359 --> 00:23:48,399 Speaker 1: own career. He appears to have spent a lot of 443 00:23:48,440 --> 00:23:52,320 Speaker 1: his life moving through Khorasan and Transaxiana, and as he 444 00:23:52,400 --> 00:23:55,760 Speaker 1: traveled he was paying careful attention not just to whether 445 00:23:55,920 --> 00:23:59,360 Speaker 1: a court had a physician, but what sort of physician 446 00:23:59,640 --> 00:24:03,240 Speaker 1: the rule needed. So that also means that the Jeharma 447 00:24:03,320 --> 00:24:06,520 Speaker 1: Kalah is a text with an agenda. It presents what 448 00:24:06,560 --> 00:24:10,600 Speaker 1: Azori thinks is an ideal physician. So this ties into 449 00:24:10,640 --> 00:24:12,520 Speaker 1: what we were talking about a moment ago in terms 450 00:24:12,520 --> 00:24:15,520 Speaker 1: of your goals. So we should, though, because all of 451 00:24:15,560 --> 00:24:20,240 Speaker 1: this is interpreted from a fictional text meant to be didactic, 452 00:24:20,520 --> 00:24:22,000 Speaker 1: you have to take all of it a little bit 453 00:24:22,000 --> 00:24:24,640 Speaker 1: with a grain of salt. But it's also pretty illuminating. 454 00:24:25,520 --> 00:24:28,879 Speaker 1: What seems very very important about Jasalyik, if this person 455 00:24:29,000 --> 00:24:32,280 Speaker 1: really existed as a historical figure and not just a 456 00:24:32,320 --> 00:24:35,960 Speaker 1: literary composite or a fictional creation, is not just the 457 00:24:36,040 --> 00:24:41,680 Speaker 1: diagnoses that he gave. The ideal physician, the text suggests, 458 00:24:42,280 --> 00:24:44,720 Speaker 1: is not just one that treats the body, but someone 459 00:24:44,800 --> 00:24:49,280 Speaker 1: who also treats the mind. In that nineteen seventy nine 460 00:24:49,320 --> 00:24:54,639 Speaker 1: authors interpretation of Azori's story, Jasalyik connected the patient's flair 461 00:24:54,760 --> 00:24:58,199 Speaker 1: to severe interpersonal conflict and treated the case in a 462 00:24:58,200 --> 00:25:02,800 Speaker 1: way that they compared to modern a exploratory psychotherapy. That is, 463 00:25:02,880 --> 00:25:06,000 Speaker 1: of course, a modern reading and a modern interpretation, and 464 00:25:06,080 --> 00:25:09,520 Speaker 1: not a settled historical conclusion. But it is very striking 465 00:25:09,600 --> 00:25:13,600 Speaker 1: because it does suggest that Persian medical writing long ago 466 00:25:14,000 --> 00:25:17,280 Speaker 1: made room for the possibility that illness could be shaped 467 00:25:17,320 --> 00:25:21,480 Speaker 1: by a patients social and emotional world. So that brings 468 00:25:21,560 --> 00:25:24,119 Speaker 1: up the question if a physician understood this in the 469 00:25:24,160 --> 00:25:28,080 Speaker 1: eighth century, why did it take until the late twentieth 470 00:25:28,119 --> 00:25:32,720 Speaker 1: century for Western medicine to accept these ideas. So, Dana, 471 00:25:32,840 --> 00:25:36,040 Speaker 1: I'm curious hearing this what you think as someone who 472 00:25:36,160 --> 00:25:38,720 Speaker 1: is going into the medical field, someone who has a 473 00:25:38,800 --> 00:25:41,679 Speaker 1: chronic illness and you've talked a little bit about this, 474 00:25:41,840 --> 00:25:44,080 Speaker 1: but how do you look at the mind body connection 475 00:25:44,800 --> 00:25:46,560 Speaker 1: in the historical context? 476 00:25:47,200 --> 00:25:49,720 Speaker 2: Shout out to that doctor who was putting us on 477 00:25:49,800 --> 00:25:52,679 Speaker 2: about the mind body connection, because absolutely we need to 478 00:25:52,720 --> 00:25:56,760 Speaker 2: address that. I think holistic and comprehensive care of like 479 00:25:57,080 --> 00:26:00,199 Speaker 2: the mind, the body, of everything that goes in to 480 00:26:00,359 --> 00:26:03,480 Speaker 2: being a patient is so important for us to address 481 00:26:03,520 --> 00:26:07,160 Speaker 2: as doctors to make our patients feel fully sane, so wild. 482 00:26:07,359 --> 00:26:10,119 Speaker 2: And I think that every day we have moments where 483 00:26:10,480 --> 00:26:12,960 Speaker 2: we can improve in that and the improvement process is 484 00:26:13,040 --> 00:26:15,240 Speaker 2: just continuing on how we can best support our patients. 485 00:26:15,800 --> 00:26:18,120 Speaker 1: Yeah, we're going to talk a little bit about that 486 00:26:18,160 --> 00:26:21,560 Speaker 1: process and how slow it's been because Jasa Leek's work 487 00:26:21,600 --> 00:26:24,400 Speaker 1: really matters for the story that we're talking about today, 488 00:26:24,760 --> 00:26:28,439 Speaker 1: which is the long and sometimes frankly torture journey. Western 489 00:26:28,520 --> 00:26:31,760 Speaker 1: medical science has gone on to be where we're at 490 00:26:31,880 --> 00:26:36,160 Speaker 1: in terms of modern care, understanding that something like psoriasis 491 00:26:36,720 --> 00:26:40,280 Speaker 1: can have origins or triggers that are inside of our bodies, 492 00:26:40,720 --> 00:26:42,880 Speaker 1: and it is tied up with our immune system. Yes, 493 00:26:43,000 --> 00:26:48,280 Speaker 1: but all sorts of emotional and psychological components also affectsoriasis. 494 00:26:49,200 --> 00:26:52,440 Speaker 1: We have covered in past seasons, really every single episode, 495 00:26:52,440 --> 00:26:56,000 Speaker 1: it comes up how much people's reactions to a visible 496 00:26:56,040 --> 00:27:01,840 Speaker 1: skin condition can exacerbate that very condition, because stigma makes 497 00:27:01,840 --> 00:27:05,600 Speaker 1: psiriasis harder to deal with for many patients, because it 498 00:27:05,640 --> 00:27:08,320 Speaker 1: makes it stressful. So it's not just emotional, it is 499 00:27:08,359 --> 00:27:13,120 Speaker 1: a physical reaction as well. Hippocrates, of course, centuries earlier 500 00:27:13,160 --> 00:27:18,000 Speaker 1: than this writing, had already linked emotional distress with bodily symptoms, 501 00:27:18,200 --> 00:27:21,480 Speaker 1: and ancient medicine did not assume that the mind and 502 00:27:21,520 --> 00:27:25,879 Speaker 1: body were separate realms. But somewhere in the long march 503 00:27:25,960 --> 00:27:31,400 Speaker 1: towards scientific specialization, something seems to have gotten lost. Medicine 504 00:27:31,440 --> 00:27:37,040 Speaker 1: divided itself into disciplines. Dermatology went one way, psychiatry one another, 505 00:27:37,400 --> 00:27:40,000 Speaker 1: and in the territory between them, the question of how 506 00:27:40,040 --> 00:27:42,960 Speaker 1: the inner life shows up on the skin kind of 507 00:27:42,960 --> 00:27:47,280 Speaker 1: got divided up, so different disciplines were treating each component 508 00:27:47,440 --> 00:27:50,600 Speaker 1: the skin and the mind separately. This also kind of 509 00:27:50,640 --> 00:27:52,720 Speaker 1: calls back to what you were saying earlier about having 510 00:27:52,760 --> 00:27:56,200 Speaker 1: to track down information from a bunch of different specialists. 511 00:27:56,880 --> 00:27:58,919 Speaker 1: We have, of course, at this point, talked about some 512 00:27:59,000 --> 00:28:02,240 Speaker 1: fairly ancient history. So now I would love to travel 513 00:28:02,240 --> 00:28:04,439 Speaker 1: through time a little bit and come to the US 514 00:28:04,520 --> 00:28:07,920 Speaker 1: in the early twentieth century, because in the nineteen twenties, 515 00:28:07,960 --> 00:28:12,439 Speaker 1: a Philadelphia dermatologist named Joseph Klouder wrote that quote, the 516 00:28:12,480 --> 00:28:16,560 Speaker 1: psychological phase of certain skin diseases should not be neglected 517 00:28:16,640 --> 00:28:19,679 Speaker 1: in treatment. And as we've been talking about today and 518 00:28:19,800 --> 00:28:23,520 Speaker 1: really throughout several seasons now of our skin. This is 519 00:28:23,640 --> 00:28:26,080 Speaker 1: not a new idea, and you would think it would 520 00:28:26,160 --> 00:28:29,399 Speaker 1: land well, but it didn't catch on really quickly. In 521 00:28:29,480 --> 00:28:32,920 Speaker 1: nineteen twenty seven, a physician named W. T. Sack wrote 522 00:28:32,920 --> 00:28:36,400 Speaker 1: that quote, there is scarcely a medical specialty in which 523 00:28:36,440 --> 00:28:40,240 Speaker 1: the modern teaching concerning the neuroses has found so little 524 00:28:40,280 --> 00:28:45,680 Speaker 1: application as in dermatology. Dermatology, in other words, was not 525 00:28:45,760 --> 00:28:49,080 Speaker 1: just ignoring this idea, it seemed to be actively resistant 526 00:28:49,120 --> 00:28:52,400 Speaker 1: to it. The nineteen thirties through the nineteen fifties brought 527 00:28:52,440 --> 00:28:55,800 Speaker 1: a surge of interest. Sigmund Freud and many of his 528 00:28:55,880 --> 00:28:59,200 Speaker 1: European colleagues relocated to the United States in the early 529 00:28:59,240 --> 00:29:03,480 Speaker 1: half of the twentieth century, and psychosomatic medicine, the study 530 00:29:03,560 --> 00:29:07,520 Speaker 1: of how psychological states influenced physical illness, had a real 531 00:29:07,560 --> 00:29:11,320 Speaker 1: cultural moment. There were books published about it, Clinics were 532 00:29:11,360 --> 00:29:15,280 Speaker 1: opened that addressed it. Researchers started trying to put clinical 533 00:29:15,360 --> 00:29:19,360 Speaker 1: language around what patients had been describing for centuries and 534 00:29:19,560 --> 00:29:24,720 Speaker 1: ancient didactic texts, but the field remained really fiercely contested 535 00:29:24,760 --> 00:29:28,440 Speaker 1: for a long time. In nineteen forty, a prominent American 536 00:29:28,480 --> 00:29:32,360 Speaker 1: dermatologist named Sulzberger stated, and this is a direct quote, 537 00:29:32,560 --> 00:29:36,440 Speaker 1: that there was quote no proof for nervousness as causal 538 00:29:37,040 --> 00:29:40,280 Speaker 1: in skin conditions. So in the same decade you had 539 00:29:40,320 --> 00:29:44,880 Speaker 1: physicians arguing that connection was real and clinically significant, and 540 00:29:45,000 --> 00:29:49,160 Speaker 1: other physicians arguing that it was completely unproven and possibly irrelevant. 541 00:29:49,160 --> 00:29:53,000 Speaker 1: And the patients meanwhile kept noticing that their skin got worse, 542 00:29:53,480 --> 00:29:57,000 Speaker 1: their conditions got worse, when their lives got harder. It 543 00:29:57,120 --> 00:30:00,480 Speaker 1: wasn't until the nineteen seventies and nineteen eighty, so that 544 00:30:00,600 --> 00:30:05,440 Speaker 1: research on the stress skin connection started accumulating in ways 545 00:30:05,600 --> 00:30:09,760 Speaker 1: that were harder to dismiss for the naysayers. Monographs on 546 00:30:09,880 --> 00:30:15,560 Speaker 1: psychophysiologic aspects of skin disease, clinical studies showing correlations between 547 00:30:15,720 --> 00:30:20,320 Speaker 1: life events and flare timing researchers beginning to map what 548 00:30:20,440 --> 00:30:23,640 Speaker 1: was actually happening in the body when stress triggered a 549 00:30:23,680 --> 00:30:27,800 Speaker 1: skin response, and it was not until nineteen ninety one 550 00:30:27,920 --> 00:30:31,840 Speaker 1: that the Association for psycho Cutaneous Medicine of North America 551 00:30:32,000 --> 00:30:35,480 Speaker 1: was formally established. It was two years later, in nineteen 552 00:30:35,520 --> 00:30:39,360 Speaker 1: ninety three that Europe established it a field of medicine, 553 00:30:39,360 --> 00:30:42,920 Speaker 1: recognizing a connection that was documented all the way back 554 00:30:42,960 --> 00:30:47,120 Speaker 1: in the eighth century, that Hippocrates touched on four hundred 555 00:30:47,240 --> 00:30:50,840 Speaker 1: years before the Common era, that patients had been trying 556 00:30:50,840 --> 00:30:53,360 Speaker 1: to tell their doctors about as long as they had 557 00:30:53,360 --> 00:30:57,000 Speaker 1: had doctors. So here's what we understand now, and it 558 00:30:57,080 --> 00:31:01,640 Speaker 1: is worth understanding because it reframed something very import Stress 559 00:31:01,720 --> 00:31:05,520 Speaker 1: has been reported in forty four percent of soriasi's patients 560 00:31:05,920 --> 00:31:09,920 Speaker 1: before their initial flare. We often hear from our guests 561 00:31:10,000 --> 00:31:12,920 Speaker 1: that going to college or having some big life event 562 00:31:13,080 --> 00:31:17,520 Speaker 1: preceded their first flare and recurrent flares are attributed to 563 00:31:17,640 --> 00:31:22,040 Speaker 1: stress in up to eighty percent of individuals. Eighty percent, 564 00:31:22,120 --> 00:31:24,880 Speaker 1: and that is not anecdotal, that is biological, and that 565 00:31:25,000 --> 00:31:29,920 Speaker 1: is documented data. Does this aspect of siasis stress preceding 566 00:31:29,920 --> 00:31:33,120 Speaker 1: a flare resonate with you as a patient. 567 00:31:33,680 --> 00:31:37,160 Speaker 3: Yes, definitely, and now hearing all the history of it. 568 00:31:37,200 --> 00:31:38,200 Speaker 3: Thank you so much for sharing. 569 00:31:38,200 --> 00:31:40,240 Speaker 2: By the way, I've honestly felt like I've taken for 570 00:31:40,320 --> 00:31:44,880 Speaker 2: granted the stress and like inflammatory connection because to me, 571 00:31:45,040 --> 00:31:47,960 Speaker 2: that was my truth. I didn't realize that this was 572 00:31:48,000 --> 00:31:53,680 Speaker 2: not truth for all before nineteen ninety one or whatever year, 573 00:31:54,240 --> 00:31:56,719 Speaker 2: And it's hard for me to drop out of that 574 00:31:56,880 --> 00:32:01,320 Speaker 2: cycle of like, I'm stressed about my saris insoriatic arthritis 575 00:32:02,000 --> 00:32:06,000 Speaker 2: because i have psoriasis and soriatic arthritis, and because of 576 00:32:06,000 --> 00:32:07,920 Speaker 2: the symptoms of it, and because of the barriers to 577 00:32:08,000 --> 00:32:11,320 Speaker 2: access to treatment and to care, and I'm stressed about 578 00:32:11,400 --> 00:32:14,240 Speaker 2: the cost of it, and I'm stressed about medical school 579 00:32:14,360 --> 00:32:17,000 Speaker 2: and like being a disabled medical student, et cetera, et cetera. 580 00:32:17,280 --> 00:32:21,560 Speaker 2: But then that stress causes made of flares. They're stressed 581 00:32:21,560 --> 00:32:23,760 Speaker 2: about the stress, and then they're stress about the stress 582 00:32:23,760 --> 00:32:26,000 Speaker 2: about the stress, and then I'm flaring even more, and 583 00:32:26,040 --> 00:32:28,800 Speaker 2: then it's just just like a vicious cycle that keeps 584 00:32:28,800 --> 00:32:29,160 Speaker 2: getting me. 585 00:32:29,240 --> 00:32:34,040 Speaker 1: Honestly, and this is actually a well documented mechanism. Basically, 586 00:32:34,160 --> 00:32:37,160 Speaker 1: it works this way when you experience a conflict, a loss, 587 00:32:37,240 --> 00:32:41,120 Speaker 1: sustained pressure, the particular weight of moving through the world 588 00:32:41,160 --> 00:32:43,720 Speaker 1: in a body that sometimes gets stared at or misunderstood. 589 00:32:44,080 --> 00:32:47,560 Speaker 1: When these things are happening, your brain activates a system 590 00:32:47,720 --> 00:32:52,960 Speaker 1: called the hypothalamic pituitary adrenal axis, the HPA axis. That 591 00:32:53,120 --> 00:32:58,480 Speaker 1: cascade triggers the release of cortisol and inflammatory cytokines and neuropeptides, 592 00:32:58,800 --> 00:33:02,720 Speaker 1: and in psyriasis, specif those signals activate the THH one 593 00:33:02,840 --> 00:33:06,960 Speaker 1: and THH seventeen immune pathways, these are the exact pathways 594 00:33:07,000 --> 00:33:09,760 Speaker 1: that drive the overproduction of skin cells. You're nodding because 595 00:33:09,760 --> 00:33:12,600 Speaker 1: I know you're like, I know, I'm in med school, lady. No, 596 00:33:12,640 --> 00:33:14,240 Speaker 1: I'm just like, this is so validating. 597 00:33:14,800 --> 00:33:17,320 Speaker 2: Yes, I feel like I often think about the stress 598 00:33:17,360 --> 00:33:19,760 Speaker 2: of it, and like, yes, the pathways make sense, and 599 00:33:19,840 --> 00:33:22,080 Speaker 2: like we study those and I understand those, But to 600 00:33:22,120 --> 00:33:24,160 Speaker 2: see how it actually connects and to be able to 601 00:33:24,240 --> 00:33:26,720 Speaker 2: verbalize that connection is honestly validating. 602 00:33:26,720 --> 00:33:27,880 Speaker 3: So thank you. So much for doing that. 603 00:33:28,160 --> 00:33:30,400 Speaker 1: Stress does it just change your mood, It changes your 604 00:33:30,440 --> 00:33:35,320 Speaker 1: immune system, and it activates the precise machinery that produces plaques. 605 00:33:35,840 --> 00:33:40,360 Speaker 1: And it's interesting because, as you've experienced, that relationship runs 606 00:33:40,400 --> 00:33:44,120 Speaker 1: in both directions. The skin sends signals back to the brain. 607 00:33:44,360 --> 00:33:48,920 Speaker 1: Living with a visible stigmatized condition, having people sometimes stare 608 00:33:49,000 --> 00:33:52,600 Speaker 1: or even anticipating that. Some people have described things like 609 00:33:52,680 --> 00:33:56,040 Speaker 1: being asked to leave a public pool or watching someone 610 00:33:56,080 --> 00:33:58,240 Speaker 1: move away from them at a party. All of that 611 00:33:58,400 --> 00:34:01,600 Speaker 1: generates a whole other layer of st feeds back into 612 00:34:01,640 --> 00:34:05,960 Speaker 1: the inflammatory system and worsens the condition and generates more stigma. 613 00:34:06,120 --> 00:34:09,280 Speaker 1: It's just like this ever growing concentric circle of misery 614 00:34:09,320 --> 00:34:11,960 Speaker 1: and flair. And researchers have a name for this. They 615 00:34:11,960 --> 00:34:15,799 Speaker 1: call it the neuroimmunocutaneous system, or NICs, not to be 616 00:34:15,880 --> 00:34:19,160 Speaker 1: confused with ncis very different. It's a loop, and once 617 00:34:19,200 --> 00:34:21,759 Speaker 1: you're in it, it's really really hard to interrupt it. 618 00:34:22,440 --> 00:34:26,359 Speaker 1: The anxiety about being visible and being seen, about being 619 00:34:26,360 --> 00:34:28,640 Speaker 1: in a swimsuit like you described, or in a job 620 00:34:28,680 --> 00:34:32,200 Speaker 1: interview or on a first date, that doesn't exist separate 621 00:34:32,200 --> 00:34:34,719 Speaker 1: from the disease. It's part of your life and it 622 00:34:34,719 --> 00:34:37,720 Speaker 1: can trigger the disease. It's something that we talked about 623 00:34:37,800 --> 00:34:41,040 Speaker 1: last episode as well. There were a lot of legal 624 00:34:41,080 --> 00:34:43,960 Speaker 1: battles that had to be one to prove that disability 625 00:34:44,000 --> 00:34:48,200 Speaker 1: for psoriasis is not intermittent, even though plaques might flare 626 00:34:48,320 --> 00:34:52,120 Speaker 1: up and then go into remission, because the stress of 627 00:34:52,239 --> 00:34:57,200 Speaker 1: managing psoriasis can be debilitating too. It's its own problem, 628 00:34:57,239 --> 00:35:00,279 Speaker 1: even if you, according to some people, look fine or 629 00:35:00,320 --> 00:35:02,960 Speaker 1: you look like you don't have a problem. So stigma 630 00:35:03,239 --> 00:35:06,560 Speaker 1: isn't just tied to your feelings. It has a very 631 00:35:06,600 --> 00:35:11,719 Speaker 1: real biological pathway. And when we talk about reducing stigma 632 00:35:11,800 --> 00:35:14,760 Speaker 1: around psoriasis, we're not just talking about people being nicer 633 00:35:14,800 --> 00:35:17,720 Speaker 1: to one another, although that would be lovely. We're also 634 00:35:17,840 --> 00:35:21,600 Speaker 1: talking about medicine and we're talking about interrupting that feedback 635 00:35:21,600 --> 00:35:25,360 Speaker 1: loop that makes the condition harder to manage. So, in 636 00:35:25,440 --> 00:35:28,280 Speaker 1: terms of where the field stands now, you actually reference 637 00:35:28,320 --> 00:35:31,680 Speaker 1: this a few moments ago, right, Psychodermatology is a field 638 00:35:31,760 --> 00:35:36,520 Speaker 1: that's growing. More dermatologists are receiving training in the psychological 639 00:35:36,560 --> 00:35:40,600 Speaker 1: dimensions of skin conditions. Research is being done on cognitive 640 00:35:40,640 --> 00:35:46,360 Speaker 1: behavioral therapy, biofeedback, stress management, all as part of psoriasis care, 641 00:35:46,480 --> 00:35:50,800 Speaker 1: and that research is accumulating. Some clinics are now offering 642 00:35:50,920 --> 00:35:56,160 Speaker 1: integrated models like you describe, dermatologist and psychologist or psychiatrists 643 00:35:56,480 --> 00:36:00,680 Speaker 1: working together for the benefit of their patients. Obviously, as 644 00:36:00,719 --> 00:36:03,000 Speaker 1: you said, not where it needs to be. Studies still 645 00:36:03,000 --> 00:36:06,960 Speaker 1: find that large numbers of dermatology patients have anxiety and 646 00:36:06,960 --> 00:36:09,840 Speaker 1: depression that don't get acknowledged, they don't get diagnosed, and 647 00:36:09,880 --> 00:36:12,960 Speaker 1: they don't get treated. So the training gap is very real, 648 00:36:13,400 --> 00:36:16,640 Speaker 1: but the direction is right. So going all the way back, 649 00:36:16,760 --> 00:36:20,720 Speaker 1: Jasalik's intuition from twelve hundred years ago that the skin 650 00:36:20,800 --> 00:36:24,520 Speaker 1: and the inner life are in conversation has actually now 651 00:36:24,560 --> 00:36:28,120 Speaker 1: been named and mechanized and is increasingly being built into 652 00:36:28,200 --> 00:36:31,160 Speaker 1: how we treat this disease. And for anyone who has 653 00:36:31,200 --> 00:36:33,560 Speaker 1: ever had a doctor look at them skeptically when they 654 00:36:33,600 --> 00:36:36,799 Speaker 1: said their flares get worse when they're stressed, I want 655 00:36:36,800 --> 00:36:39,680 Speaker 1: you to know you were right all along. The science 656 00:36:39,760 --> 00:36:42,640 Speaker 1: just took a really ridiculously long time to catch up. 657 00:36:43,200 --> 00:36:46,200 Speaker 1: So DA knowing all of this and knowing that the 658 00:36:46,239 --> 00:36:51,120 Speaker 1: embarrassment itself actually has a biological story and component which 659 00:36:51,160 --> 00:36:53,839 Speaker 1: you probably intuited and new to some degree, does that 660 00:36:53,960 --> 00:36:57,280 Speaker 1: change anything about how you think about the stigma element 661 00:36:57,320 --> 00:36:59,880 Speaker 1: of it, or about what you would want people to 662 00:37:00,080 --> 00:37:01,800 Speaker 1: understand about it. 663 00:37:01,800 --> 00:37:05,840 Speaker 2: It just puts words and data and history onto something 664 00:37:05,880 --> 00:37:10,359 Speaker 2: that like me and every other psoriasis patient already know intuitively. 665 00:37:10,440 --> 00:37:12,759 Speaker 2: Like you said, but I just feel like it's so 666 00:37:12,840 --> 00:37:16,200 Speaker 2: great to just be learning about these things and validating 667 00:37:16,239 --> 00:37:18,680 Speaker 2: to know that there actually is a connection. And maybe 668 00:37:18,680 --> 00:37:20,759 Speaker 2: that's something that I could use with future patients to 669 00:37:20,800 --> 00:37:22,880 Speaker 2: be able to say, like, in the ways that I 670 00:37:22,920 --> 00:37:24,920 Speaker 2: support patients, I often think about the ways that I 671 00:37:24,920 --> 00:37:29,200 Speaker 2: can be the most validating, whether that's using personal experience 672 00:37:29,400 --> 00:37:33,279 Speaker 2: or data or anecdotes. So I'll definitely be pulling this 673 00:37:33,400 --> 00:37:34,759 Speaker 2: up and I appreciate you for sharing that. 674 00:37:35,120 --> 00:37:38,680 Speaker 1: Listen, you can supplement compassion with hard science, which is 675 00:37:38,719 --> 00:37:43,200 Speaker 1: a great compo. The whole project of this show Our 676 00:37:43,320 --> 00:37:46,040 Speaker 1: Skin is about creating a space to talk about all 677 00:37:46,080 --> 00:37:50,560 Speaker 1: of this openly, because isolation and feeling different is a 678 00:37:50,560 --> 00:37:55,080 Speaker 1: big trigger for autoimmune disease and chronic illnesses like psoriasis 679 00:37:55,080 --> 00:37:57,920 Speaker 1: and soriatic arthritis, so we want to reduce that isolation. 680 00:37:58,800 --> 00:38:01,400 Speaker 1: We are all in this together, so I'm also very 681 00:38:01,440 --> 00:38:03,799 Speaker 1: grateful to you for joining us in that project and 682 00:38:03,840 --> 00:38:07,319 Speaker 1: for all the work you do. Now, I have two 683 00:38:07,360 --> 00:38:10,000 Speaker 1: more questions for you today. This is how we wrap 684 00:38:10,080 --> 00:38:14,120 Speaker 1: up every episode with our guests, so these are easy. 685 00:38:14,239 --> 00:38:17,920 Speaker 1: There's no wrong answer. Ever. The first is what suggestions 686 00:38:17,960 --> 00:38:21,319 Speaker 1: do you have for people who may not have psoriasis 687 00:38:21,360 --> 00:38:24,120 Speaker 1: themselves but they love someone who does. You've talked a 688 00:38:24,120 --> 00:38:27,480 Speaker 1: lot about your support system. What are they doing exactly right? 689 00:38:28,120 --> 00:38:29,480 Speaker 3: That's such a sweet question. 690 00:38:30,600 --> 00:38:37,600 Speaker 2: I think that there is value in understanding that if 691 00:38:37,640 --> 00:38:40,839 Speaker 2: we do not have the capacity to be there, it's 692 00:38:40,880 --> 00:38:45,040 Speaker 2: because we are exhausted and we are going through so 693 00:38:45,160 --> 00:38:48,600 Speaker 2: much health stuff. But that doesn't mean we don't want 694 00:38:48,640 --> 00:38:50,840 Speaker 2: to be there, like the people that keep inviting me 695 00:38:51,160 --> 00:38:54,400 Speaker 2: like that means so much, because I don't want people 696 00:38:54,440 --> 00:38:56,319 Speaker 2: to think that because I keep saying no now, I'm 697 00:38:56,320 --> 00:38:57,920 Speaker 2: going to say no forever, like I still want to 698 00:38:57,960 --> 00:38:58,400 Speaker 2: be invited. 699 00:38:58,440 --> 00:38:59,560 Speaker 3: I don't want to be forgotten. 700 00:39:00,040 --> 00:39:01,759 Speaker 2: It's just that right now, my body is really not 701 00:39:01,840 --> 00:39:05,319 Speaker 2: cooperating with me, and I've had apartment mads b understanding 702 00:39:05,400 --> 00:39:08,480 Speaker 2: when back when my back would hurt. Before I started 703 00:39:08,480 --> 00:39:12,239 Speaker 2: my new biologic, I had trouble like filling my dishwasher 704 00:39:12,320 --> 00:39:15,640 Speaker 2: because bending down was terrible. So like I've had friends 705 00:39:15,719 --> 00:39:18,080 Speaker 2: like be non judgmental when the dishes I put in 706 00:39:18,160 --> 00:39:22,200 Speaker 2: the dishwasher look insane, or like when I have trouble 707 00:39:22,239 --> 00:39:23,920 Speaker 2: with that and they just do it for me. So 708 00:39:24,000 --> 00:39:26,759 Speaker 2: it's little things about being a disability ally being an 709 00:39:26,840 --> 00:39:30,839 Speaker 2: understanding person and realizing what your friends and loved ones 710 00:39:30,840 --> 00:39:33,520 Speaker 2: are going through that allow you to be an understanding 711 00:39:33,520 --> 00:39:34,640 Speaker 2: supporter for them. 712 00:39:35,080 --> 00:39:37,200 Speaker 1: It's interesting because as you talk through that, what I 713 00:39:37,280 --> 00:39:39,600 Speaker 1: was thinking is that it takes mental load off, which 714 00:39:40,000 --> 00:39:43,000 Speaker 1: ties into this whole idea of like reduction of stress 715 00:39:43,400 --> 00:39:46,320 Speaker 1: and putting you in a better place to heal. Last, 716 00:39:46,320 --> 00:39:48,840 Speaker 1: but not least, if you and I know you have 717 00:39:48,880 --> 00:39:51,880 Speaker 1: a ready answer because of your advocacy and the mentoring 718 00:39:51,920 --> 00:39:54,759 Speaker 1: work you do. If you could send one message to 719 00:39:55,360 --> 00:39:58,720 Speaker 1: listeners who might be grappling with their own diagnosis, perhaps 720 00:39:58,800 --> 00:40:01,360 Speaker 1: early on, what would that message. 721 00:40:00,960 --> 00:40:05,120 Speaker 2: Be, You are not alone, even if it feels like 722 00:40:05,239 --> 00:40:09,520 Speaker 2: it take all the time you need to feel whatever 723 00:40:09,520 --> 00:40:10,399 Speaker 2: emotions come up. 724 00:40:10,719 --> 00:40:13,640 Speaker 3: For me, I was grieving my past self, like it 725 00:40:13,680 --> 00:40:17,279 Speaker 3: felt like that past self died and like she just 726 00:40:17,280 --> 00:40:21,080 Speaker 3: doesn't exist anymore, like my non disabledself, my self who 727 00:40:21,080 --> 00:40:25,240 Speaker 3: didn't have back pain and constant body pain and fatigue myself, 728 00:40:25,280 --> 00:40:26,160 Speaker 3: who didn't have to. 729 00:40:26,160 --> 00:40:30,840 Speaker 2: Inject drugs to help me keep my body not super 730 00:40:30,880 --> 00:40:34,279 Speaker 2: inflamed like every month or every two months. Like she 731 00:40:34,400 --> 00:40:37,000 Speaker 2: doesn't exist anymore, and I had to grieve her. I 732 00:40:37,040 --> 00:40:39,160 Speaker 2: just have so much more perspective and resilience now, So 733 00:40:39,200 --> 00:40:40,879 Speaker 2: I'm really proud of the person I am now too, 734 00:40:41,280 --> 00:40:42,919 Speaker 2: but it took me so much time to get there. 735 00:40:43,560 --> 00:40:46,360 Speaker 2: It's okay if you feel shame, it's okay if you 736 00:40:46,440 --> 00:40:52,560 Speaker 2: feel different, but there are spaces that fully understand who 737 00:40:52,600 --> 00:40:55,279 Speaker 2: you are and what you go through. Something I wish 738 00:40:55,360 --> 00:40:58,240 Speaker 2: I did was reach out to the National Stirisis Foundation earlier, 739 00:40:58,440 --> 00:41:00,319 Speaker 2: because I only reached out when I had something to give, 740 00:41:00,440 --> 00:41:02,640 Speaker 2: like when I was healthy enough to be able to 741 00:41:02,640 --> 00:41:05,400 Speaker 2: support other people. But this is also a space for 742 00:41:05,440 --> 00:41:08,160 Speaker 2: people who are newly diagnosed and who are struggling. They 743 00:41:08,200 --> 00:41:11,320 Speaker 2: have a hotline for you to call any time to 744 00:41:11,320 --> 00:41:14,960 Speaker 2: be connected with resources, and in working with them, I've 745 00:41:14,960 --> 00:41:19,359 Speaker 2: felt incredibly seen and incredibly heard, And the people who 746 00:41:19,400 --> 00:41:21,680 Speaker 2: I work with and who I collaborate with, like, I 747 00:41:21,680 --> 00:41:24,319 Speaker 2: don't even have to say it out loud, but I 748 00:41:24,360 --> 00:41:26,320 Speaker 2: want to validate that with size. 749 00:41:26,400 --> 00:41:27,719 Speaker 3: The storiatic arthritis. 750 00:41:27,920 --> 00:41:31,640 Speaker 2: There is a fatigue aspect, there's like a constant burnout aspect. 751 00:41:31,640 --> 00:41:35,160 Speaker 2: There's that disability chronic illness. Tax I understand that in 752 00:41:35,239 --> 00:41:38,440 Speaker 2: our community understands that. So I believe that you should 753 00:41:38,440 --> 00:41:40,040 Speaker 2: have the confidence to say no when you don't have 754 00:41:40,080 --> 00:41:42,239 Speaker 2: the capacity, and be ready to say yes when you 755 00:41:42,280 --> 00:41:45,320 Speaker 2: do have the capacity. But it's okay for your capacity 756 00:41:45,320 --> 00:41:46,120 Speaker 2: to wax and wane. 757 00:41:46,680 --> 00:41:48,719 Speaker 1: I feel like the medical field is going to be 758 00:41:48,800 --> 00:41:51,719 Speaker 1: much improved when you enter it fully as a professional 759 00:41:52,040 --> 00:41:54,880 Speaker 1: and you finish all your studies. I'm so grateful to 760 00:41:54,920 --> 00:41:56,719 Speaker 1: you for spending this time with me today. Thank you 761 00:41:56,760 --> 00:41:58,840 Speaker 1: so much, Dana, thank you so much for having me. 762 00:41:58,880 --> 00:42:01,400 Speaker 2: It's always such a privileged be talking about these things, 763 00:42:01,840 --> 00:42:05,120 Speaker 2: to be spreading awareness and to be speaking with people 764 00:42:05,120 --> 00:42:07,400 Speaker 2: like your team who feel like you're truly trying to 765 00:42:07,480 --> 00:42:10,480 Speaker 2: understand and do your research and really support our patients 766 00:42:10,520 --> 00:42:11,560 Speaker 2: and amplify our narrative. 767 00:42:11,640 --> 00:42:12,520 Speaker 3: So this means so much. 768 00:42:16,640 --> 00:42:20,280 Speaker 1: Our Skin is hosted by myself Holly Frye and executive 769 00:42:20,280 --> 00:42:24,200 Speaker 1: produced and engineered by Ryan Martz. Our executive producer and 770 00:42:24,239 --> 00:42:27,799 Speaker 1: writer is Meredith Barnes. If you enjoy the show, share 771 00:42:27,840 --> 00:42:30,440 Speaker 1: it with your friends. You can also listen and follow 772 00:42:30,680 --> 00:42:34,040 Speaker 1: on the iHeartRadio app, Apple Podcasts, or wherever you get 773 00:42:34,080 --> 00:42:41,279 Speaker 1: your podcasts.