13. Healing the Brain Holistically with Ilene Ruhoy M.D., Ph.D.

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00:00:00 

Linda Bluestein 

Welcome to bendy bodies with the hypermobility MD. This is your host, Dr. Linda Bluestein here today with  cohost Jennifer Milner. We have the great pleasure of speaking with Dr. Ilene Ruhoy board certified neurologist  with a PhD in environmental toxicology and a graduate of the integrative medicine program fellowship at the  university of Arizona. She is the medical director and founder of the center for healing neurology in Seattle,  Washington, and is the co-editor of integrative neurology an Oxford press book expected to be released at the  end of summer 2020, Dr. Ruhoy was kind enough to have me as a guest on her podcast, healing neurology very  recently, and I highly suggest subscribing to both her podcast and this one bendy bodies Dr. Ruhoy. Hello and  welcome to Bendy bodies.  

00:00:58 

Ilene Ruhoy 

Hello thank you for having me. It's so great to talk with you today.  

00:01:19 

Jennifer Milner 

Hi, Dr. Ruhoy it's nice to meet you. You comment in your excellent blog that you are seeing more symptoms  and disease associated with the brain, and that there has been an increase in stroke incidents in young adults, as  well as an increase in early onset cognitive decline, when and how should we be protecting our brains? We  should start protecting our brains. I think as soon as we are aware of our brains, I think it's hard with me as a  mom of a teenager. I know that she literally has no sense of like her health and mortality and all of that.  

00:01:49 

Ilene Ruhoy 

I think getting her to follow my guidelines or my rules is very difficult to do, but I do suggest that early in life,  early adulthood is actually the best time. There's been a lot of research to show that the things that we do in life  and are in terms of lifestyle choices can have great neuroprotective properties for our brain for years to come.  The sooner we get on top of how we sleep and how we eat and how we move, how we manage stress, I think the  better off we are as we age, because we lose resilience, we lose reserve we're at greater risk for responses to exposures. We have greater risk for certain kinds of chronic disease. The sooner we do it, the better off we are.  But I agree with that,  

00:02:36 

Linda Bluestein 

Dr. Ruhoy would you be willing to elaborate slightly and tell us how we can be protecting our brains?  

00:02:42 

Ilene Ruhoy 

There's a lot of things that we actually know now about the physiology and our brains and the health of our  brains. We do know, for example, take our nutrition choices. We do know that foods can be pro-inflammatory  or anti-inflammatory. The more times that lead to anti-inflammatory foods, the better off our brains are. He has  long connection between the gut and the brain. If we reduce inflammation or reduce inflammation in the brain,  there's a lot of crosstalk that goes on the brain axis is a real thing. In fact, an altered microbiome is very much  associated with neurodegenerative diseases like Alzheimer's and Parkinson's, and some of the other  neurodegenerative diseases. We know that there are changes to the microbiomes of the patients who have an  early time diagnosis. We do know that what we eat actually plays a tremendous role. I think that, and I advocate  for plant-based diet.  

00:03:33 

Ilene Ruhoy 

I'm almost militant about it. I also recognize that if you've been eating more of a standard American diet for  many years, it does take baby steps. We don't expect miracles, quickly, but you do have to have every meal is a  chance to make a choice, right? Every meal is a chance to decide I'm going to eat a healthy anti-inflammatory  meal today. I often recommend starting the morning off with juicing. I think that it's very hard to sit down and  eat three bunches of kale, but you can do three bunches of kale and you can add an Apple than a lemon and  make it taste good. In the morning is so it's so naive. I refer to it as, because we fasted all night long. There are  there's, there isn't the presence of work. There isn't the acid and the enzymes. You drink just a pure homemade  juice with lots of healthy vegetables and fruits, it's just so quickly absorbed.  

00:04:25 

Ilene Ruhoy 

It's really a great way to start the day. The cells just uptake all of those nutrients and compounds, and it starts in  anti-inflammatory state at the beginning of the day. I think that I learned that late in life after my brain surgery  and radiation, I learned that juicing actually made the biggest difference in terms of my recovery of my brain. I  

wish I had started a lot earlier now. I find myself reaching out to anyone who will listen basically. I think that  the food we eat is a very important part of our lifestyle choices that we can make that protect our brain later on. I  also think that the way we exercise, I think we need to move every day. That doesn't mean obviously to climb  Mount Everest or, to be a triathlete. It just means we need some form of movement. Our bodies are meant to be  in motion.  

00:05:09 

Ilene Ruhoy 

Sitting all day at a desk, obviously, and on the screens, which is what a lot of our culture does, I, does not  provide for good blood flow that obviously includes all organs, but specifically the brain. It also doesn't help to  reduce some of the pro-inflammatory mediators that are released based on just exposures that we have nothing.  We have really, we have very little control over. I think that we have to try to find ourselves moving every day.  In fact, studies show that if you just go out for walks or hikes out in nature, everyday nature has a very,  important effect on our brain and our central nervous system in general. I always tell patients those so combined  exposure to nature with some exercise, and again, it can just be a nice brisk walk, at least out in nature, a nice  hike out in nature, and have very positive effects on the brain.  

00:05:59 

Ilene Ruhoy 

How we sleep is so important. We know that the glymphatic system of the brain is most active during the night  when we're sleeping during restorative stages, the glymphatic system, of course, being the lymphatic system of  the brain, where it rids itself of the metabolic waste byproducts. That is much more active while we sleep. The  

amount and quality of sleep is super important. That's a whole topic of in and of itself. I recognized, and we can  talk a lot about sleep hygiene, in ways of really improving that sleep. I will say that I think our, the way we live  these days, our culture really lends itself to us, having altered sleep patterns. I always talk about trying to go to bed at the same time each night, trying to wake up at the same time each morning, try to have a routine during  the day because sleep is, the sleep wake cycle is not only sleep, but it's the wake portion.  

00:06:47 

Ilene Ruhoy 

During that wake portion can actually help set you up for success during the sleep cycle. I go through all the  different kinds of great sleep, wake hygiene options that you can incorporate into your life that will only be  really beneficial for your brain. So those are some options. I mean, obviously I can go on and on.  

00:07:08 

Jennifer Milner 

Basically you're saying to eat well and exercise and sleep well, right. Huge groundbreaking right here.  

00:07:21 

Ilene Ruhoy 

There was just an article that just came out in one of the neuro immunology journals that talked about the spinal  cord injury and the standard American diet, the Western diet there. It showed that actually injury of spinal cord.  I'm sorry, healing of spinal cord injuries was much more robust with a plant-based non westernized type of diet.  So basically anti-inflammatory diet. So wow. That to have an inflammatory diet, there's so much more damage  

to our bodies, especially in when about our bodies need to be in a state of healing. I would argue that just  because of the things in our air and our water, in our food, I would argue that we're always in a state of healing,  especially as we're aging, right? So maybe not the 18 year olds as much, but definitely the 40 year olds, and then  the 50 year old and the six year and so on.  

00:08:09 

Ilene Ruhoy 

I think we're always in a state of healing. I think that our bodies are constantly degenerating and regenerating.  The more that we can support that regeneration, I think the healthier we will be for a much longer period of  time.  

00:08:21 

Jennifer Milner 

Well, and it's a great point of view to say our bodies are constantly in a state of healing to have people  understand that our body is constantly in a state of breaking down and also healing. If we can look at it as do we  want to constantly be turning towards breaking down, or do we want to be constantly working towards one of  these directions and both in some way are going to be happening. If they're going to be happening, we might as  well encourage it. Rather than waiting until, Oh, I've had a spinal cord injury. Now I shall change my diet and  my lifestyle. Right.  

00:08:56 

Ilene Ruhoy 

It's exactly right. I absolutely a hundred percent agree, a hundred percent. We need to support the regenerative  aspect. Right. And that's what our body is mean. If you think about the bones, right? The osteoblasts and  osteoclasts turnover. That goes on throughout our bodies throughout our lives. We want to support the  regenerative aspect and as we eat that needs more support. That's what we should all be designed to do on a  daily basis, as much as we can. Listen, I recognize these are the, this is hard, right? I mean, I think changing  human behaviors is a notoriously difficult, right? It's very challenging. That's why we say the sooner you can  start the better off you'll be, but it's never too late is what I always say, never too late. Even if it's just baby steps  at the beginning, but we should as supporting regeneration. Yeah.  

00:09:42 

Jennifer Milner 

I love that. Supporting regeneration. These are steps that pretty much anybody can take, like speaking to a very  general population. We are in general, the podcast provides information to patients and healthcare professionals  about hyper-mobility disorders and its related conditions. Can you start out telling us what conditions you treat  that affect this bendy population?  

00:10:09 

Ilene Ruhoy 

I treat MCAS mast cell activation. I treat a lot of dysautonomia is we do a lot of autonomic testing and I find many of these patients have a history of hypermobility. We see a lot of different dysautonomia is including the  very commonly seen, POTS as well as, intolerance. We find some other kinds of dysautonomia is as well. We  treat, small fiber neuropathy, which I find again, a lot of times as a history of hypermobility. And then we treat  

chronic fatigue syndrome. As you probably know, that is very much associated with the hypermobile  population. In fact, I often see, a CCI kind of picture cranial, cervical instability, and it's because the ligaments  are so lax that they are creating that over chronic fatigue, which ultimately I think stems from some form of  chronic inflammation. If you're already starting at a baseline with ligamentous laxity, just from your genetics,  and then you add chronic inflammation on top, then I think that you are a greater risk of some of the,  comorbidities we see with the hypermobility population.  

00:11:15 

Ilene Ruhoy 

I treat most of all of that. I don't treat the hypomobility per se. I certainly don't call myself a hypermobility  expert as Dr. Bluestein is. We definitely treat MCAS, small fiber neuropathy, POTS, dysautonomia, a lot of  gastrointestinal dysfunction. We see SIBO as well as other kinds of gastroparesis and constipation. Again, we  see a lot of that because of the gut brain axis. It's like, it's, the people will come because they have a  neurological manifestation, but we ask a lot of gut questions and we find that there's a whole history there as  well. So that's what Jillian does. She's a gut to my brain kind of. We see all of those kinds of different, diseases  and, or, and symptomology that we help treat.  

00:12:00 

Jennifer Milner 

It really goes beyond if somebody is hypermobile and they think, well, I'll go see my neurologist about my  migraines. They may find a host of other things that you can help address that they may not even understand.  

00:12:12 

Ilene Ruhoy 

Yeah. In fact, very often I get patients who come in who have been told to have fibromyalgia and I met, it's not a  true fibromyalgia, but more that they have hypermobility and now they have headaches and they have joint and  muscle pain. All we can argue about what does fibromyalgia specifically mean because it can fit under the,  under its proposed definition. Certainly there's clearly a lot more going on there because of their hypomobility,  which wasn't initially identified.  

00:12:40 

Jennifer Milner 

Right. Right. Well, and, there is a fair amount of people with hypermobility who have migraines and chronic  headaches, and that does seem to be a big piece that goes along with it. What should patients and providers,  what should they know about headaches, migraines and fascial pain in bendy people, in bendy bodies?  

00:13:03 

Ilene Ruhoy 

I think it, I think it happens a lot. I haven't done, epidemiology to give, appropriate statistics, but I, I see it more  often than I don't see it, frankly. It's, I think there's a very common ideology there. I think that when you have,  any kind of, connective tissue disorder, it leads to myofascial pain just because the body isn't held together well.  There's inflammation in the connective tissue and so inflammation in the fascial planes and that ultimately, will  hold up the neck and the head and you often have neck pain, which then leads to headaches. If there's a  predisposition for migraines that can evolve into migrainous types of headaches, they're not always migraines.  Sometimes they're just headaches and people like to label everything is in migraine, but migraine has actually  has a very specific definition. I think because a lot of the drugs are very, they're targeting more of the migraine  physiology.  

00:13:58 

Ilene Ruhoy 

That sometimes is the case without question and hypermobile patients very often, there's a migraine history, not  only personal, but family history and they are having migraines and some of the newer drugs have been very  effective for them. I think that there's an overall pain picture is my point. I see a lot of what we've heard was  cutaneous allodynia. Like the scalp, you know, is painful. There's a lot of cervicalgia where the neck is painful  and, they have a lot of trigger point issues. I think it's just because the connective tissue holds it all together. If  it's if it's not strong enough and it's, and if it's got, reasons to be lax, then you are ultimately set up for a lot of  this type of pain syndrome. 

00:14:41 

Jennifer Milner 

Yeah. That's so interesting to me. Because it, like you said, migraines are a very specific type of headache. You  see people who suffer with these chronic conditions. Dr. Bluestein and. I share someone who has one of those,  and you see people who have had headaches for years or whatever it might be going on, and without addressing  

the fascial component of it and trying to address that and that the chronic pain that comes from it's really  difficult to try to be successful with dealing with the headache.  

00:15:10 

Ilene Ruhoy 

I completely agree. I'm actually shocked at how many patients headaches are abated with a mast cell type of  treatment, which I don't think was intentional. Sometimes you can go down the list of all the headache and  migraine medications that we know of. Then, and not really get any kind of relief, but you start treating a mast  cell concern that may only present as headaches, frankly, in some patients. You start treating it as a mast cell  problem, and they finally get relief. It's interesting to me, and, it's because of the brain, as the central nervous  system has H3 receptors, which are not really found anywhere else. We all know about the H1, H2 receptors and  everyone's on antihistamines for that, but the H3 receptors are very unique, and are ubiquitous throughout the  central nervous system and not necessarily elsewhere. I think that there's some relation there to mast cell  degranulation and these headaches and hypermobile patients.  

00:16:02 

Ilene Ruhoy 

I don't often just jump to a mast cell treatment if there's no obvious other reason to think mast cell, but when I'm  not getting relief from headaches with patients who have tried the gamut of things that we have, including nerve  blocks, which might give transient relief, the trigger point injections, even some of the other, vagal nerve  stimulators, not getting permanent kind of in sustained relief. I will go down a mast cell route and will often not  always, but often get relief from their headaches.  

00:16:32 

Jennifer Milner 

That's so interesting and encouraging too. Something else that we see just in the general, well, I have all these  weird things going on with me because I have a bendy body, is the whole brain fog thing. I'm wondering how do  you work up and treat brain fog and, or other cognitive complaints.  

00:16:52 

Ilene Ruhoy 

So, I think the words, brain fog patients like perception of what they're experiencing. I'll often just do a  cognitive assessment initially, just to get objective data as to where their cognition sits. There a true cognitive  concern? but I also think that the brain fog experiences related to the dysautonomia that is very often seen with  hypermobile patients, recent study that was just published that talked about changes in position that provoked  the autonomic nervous system resulted in changing cognition and changing awareness. When I read that, I  thought that's exactly why I tried to pin down patients as to what their brain fog experience is like. That is  exactly how they describe it. Like their environment seems different, their interaction, they feel slower. They  can't process things as easily or as quickly. There are studies that support that the autonomic nervous system,  when is engaged in an accurate manner, as it's so often is in hypermobility.  

00:17:53 

Ilene Ruhoy 

They can have alterations in awareness and mentation and cognition that can be, that is usually transient, until,  so it things settled down, I think it's I think that's a piece of that puzzle with regards to the brain fog. Also I think  that the whole, cranial cervical instability, actually, we do know that, things like tethered cords and things like  craniocervical instability does, result over time, obviously not acutely or initially necessarily, but over time does  result in some hypoperfusion of the cord and or the brainstem. I think that too, so hypoperfusion, so, if you think  about what happens when there's lack of appropriate oxygen supply, I think that too can lead to the brain fog  kind of experience patients have. So I think it's multifactorial. I don't think that science has really pinned down  specifically what it is, but that is exactly how I approach it, because that's how I see it. 

00:18:49 

Ilene Ruhoy 

And, we will sometimes get good results based on that, those kinds of perspectives, and insights. Again, there's  obviously a lot more to it that was so sure.  

00:19:00 

Jennifer Milner 

Yeah, absolutely. I wanted to circle back, you were talking about with migraines that you would, look into the  possibility of mast cell activation syndrome and perhaps treating them with that protocol. What should we know  about mast cell activation syndrome, especially as it pertains to the bendy body population?  

00:19:24 

Ilene Ruhoy 

Well, mast cells are ubiquitous in their body, but we also know that they are lot in large numbers in the  connective tissue. I think it's very easy to understand why there's such a high percentage of MCAS in the  hypermobile population. When they degranulate, so do the mast cells are of course, as part of the innate immune  system. They are poised basically to help us fight off things that assault us, right. In our environment, whether  it's infections or exposures, and so when they're triggered so often, and when they're so exposed as they are in  hypermobile patients, because there are so many in the connective tissue and they tend to get a little trigger  happy, and they tend to degranulate too often or at the drop of a hat kind of thing. They're constantly releasing  their mediators and we're always talking about histamine and yes, histamine does play a large role in a lot of the  symptomology we see, but it has lots of other mediators, most of which are pro-inflammatory.  

00:20:22 

Ilene Ruhoy 

The tryptases and the proteases and the prostaglandins and the Bradykinins, leukotrienes and so on. If these are  being released at a frequent rate in the body, then you're going to have lots of inflammatory mediators that are,  that want to find something to fight basically. With, with these release, it just again, it's, first of all, it leads up to  more potential laxity of the ligaments. More connective tissue issues, more fascial pain issues, and more  headaches. That's why sometimes just by, calming down the mast cell activity, you can actually have a relief of  quite a bit of pain, no matter where the pain is, but again, because we focus a lot on headaches and migraines  here. We do see a lot of improvement in that kind of pain.  

00:21:08 

Jennifer Milner 

That's so interesting and encouraging. Going deeper with, mast cell activation system, what are the symptoms?  What can you tell us about MCAS and meningiomas.  

00:21:20 

Ilene Ruhoy 

Oh, that is so I know where that can deduce. I don't yet have a great answer I'm that I posed it because I haven't  had a personal history of meningioma and the more I read, the more I recognize. So, w in 2013, I, I was not  feeling well. I, I went to a lot of my colleagues, but, it was thought that I was just working too hard and I was  too stressed. The truth is I was working too hard and I was just stressed. I believed it, but I just knew something  wasn't right. I was having more and more headaches. I think because I, I have a personal history of migraines. They have not been frequent in my life, maybe one a year, but I was having them very often. I think that it was  just talked up to stress, was making more migraines. I believed it for a long time, but things just started to get  worse.  

00:22:16 

Ilene Ruhoy 

I was feeling unwell. Despite the fact that everything came back normal, including my labs and my neuro exam,  I had no deficits. Everyone just thought, just, meditate and take a break, which I had already been doing. I, I  kept asking for an MRI and out here in Seattle, at that time, you couldn't order your own MRI, but no one would  do it. Everyone would just say, Oh, too much, you're thinking too much about this MRI. Anyway long story  short, I finally just went to a friend of mine. Who's an internist. Just asked, please order me an MRI. And she  did. I went to the MRI machine and as I come out, the tech, told me to go directly to the ER and I said, why?  And he said, I don't know. Cause the radiologist's telling me, they just told me to tell you to go to the ER, I  thought, okay. 

00:23:05 

Ilene Ruhoy 

I went to ER and, it turns out I had a seven centimeter meningioma that was basically pushing that had grown  into my brain. Pushed my left hemisphere over to my right. It was a lot of swelling around it because of it.  Everyone was shocked that I had no neurodeficit. Everyone was shocked that I didn't have more, symptoms  actually. I think it was because it probably grew insidiously. Regardless it was big and I was admitted right  away, for a surgical resection. I, it recurred a year later. And so then I had brain radiation. The pathology came  back that it was a grade three, which is the worst type to have, which means there's likely, recurrence. And,  anyway, my point being is that it's so because of all of that, I started and I was now in the whole mast cell world,  I had posed the question to leaders in the mast cell world, and asked about, the really I had read about, mast cells  and histamine.  

00:24:10 

Ilene Ruhoy 

Went down that path and I, I don't yet really have, an accurate enough answer for me to counsel other people to  be fair. I think that, we sent off, my tissue because my husband's a pathologist. So, it wasn't really, it didn't, it  wasn't definitive than anything. It was equivocal ultimately in what, how, what kind of role mast cells can play  to be completely honest, but I do think plays a role. I think when I think back to some of the symptoms I was  having, it's actually some of the same symptoms I see my mast cell patients have, which is just not being able  tolerate. I constantly felt nauseous, right? So it was these vague type of symptoms that like, maybe I just eating  the wrong foods, or maybe I'm just not sleeping well enough. Those kinds of those where I couldn't tolerate  meals, I was constantly feeling nauseous and bloated and I felt dizzy often.  

00:25:00 

Ilene Ruhoy 

It very much sounds like my mast cell patients. I do think there's a role, but again, I don't think there's any real  science right now for me to report, but I continue to look and read and research.  

00:25:14 

Jennifer Milner 

Something that would be great to see some research on in the future. For sure.  

00:25:18 

Ilene Ruhoy 

I completely agree. I completely agree.  

00:25:21 

Jennifer Milner 

Yes. Well I could, pick your brain for about 36 hours and that'd be finished, but not everybody has a chance to  sit and talk with you one-on-one. What do you suggest to that people do if they're having difficulty getting help  and what appointment options are you offering patients right now, especially out of state and out of country.  

00:25:43 

Ilene Ruhoy 

So, I think, well, first of all, the options that we offer, we do a lot of telemedicine. Even before COVID-19, were  doing telemedicine, televideo. We have a lot of patients who don't live in Washington state, so we are very  equipped to offer either phone or video. And so that hasn't changed at all. So that's always an option, of course. I  do think that there's a lot of doctors out there that are really learning more and more, and I'm always impressed  by how many more there are in the mast cell world, or at least how many more are that are showing interest and  want to learn. I think there's a lot of literature now, a lot of good literature for patients, and I often will share a  certain resources with them, but there's a couple of things that people can do, anti-histamines are over the  counter, right?  

00:26:26 

Ilene Ruhoy 

You don't need a doctor necessarily prescribed them. So, I w so they can try, on their own, even Claritin and  Allegra, of course, following instructions on the box. Just recognize that it's not, it's a lot a of it is the histamine,  but it may not be the only the histamine cause there were other mediators, but then, and sometimes you really  need mast cell stabilizers, which are really are prescribed by physicians. I think that, but you can definitely say, do you get any kind of relief from the histamines that you can easily buy in a drug store? There are some  supplements that are particularly helpful. Like quercetin is one of my favorites as well as something called PEA.  

00:27:13 

Linda Bluestein 

I just chugged some right before this.  

00:27:15 

Ilene Ruhoy 

Exactly, exactly. I mean, it's a lipid audit coy that has incredible anti-inflammatory effects actually. Actually  what it really is good for is that it helps to, when we have chronic inflammation. If we have mast cell activation,  we have this inflammatory cascade, and we ultimately lose that stop gap, that natural stop gap that our bodies  have to stop that inflammation and stop it in its tracks, actually with regular use, with consistent use of it  actually helps to stop that test gain. It sort of breaks the inflammatory pathways. It's really powerful to get  everything under control. I really, and It worked and there's a synergistic effect with quercetin. I actually love it  together. I find it much more effective than either one of them alone. And I generally just start patients there. I'm  not a huge fan of like putting someone on, 20 different supplements. I feel like that's not really great medicine,  plus you don't know interactions.  

00:28:08 

Ilene Ruhoy 

I think if you are targeting something in specific, I think you find, the four or five that really worked for you. I  always just start patients on PEA. It may add a couple of others down the road. I find that patients do get a  response from it. I, like I said, there was some prescribed medications, like the Chromelin and a low dose  naltrexone, which I'm fans of certainly. But that does require a prescription. Again, more and more physicians  are really coming on board with mast cell kinds of concerns. I mean, it used to be, as you guys know, used to be  either nothing or mastocytosis and the whole spectrum in between. A lot of people fall in that spectrum. I think  that other doctors are actually starting to recognize that. 

00:28:55 

Linda Bluestein 

Which is, which is great, and which is what is exciting to me about both your podcast and this one. I know you  and I also do on social media from time to time when we have spare time, which isn't very often I know for you,  for sure. I love it when a colleague will say, Oh, I learned this and this on your podcast, and they may ask a  question or again, then they start to look for that in their patients, which is, really gets me excited because that  means that we're reaching people that have the ability to influence a lot of people.  

00:29:31 

Ilene Ruhoy 

So I completely agree. That's why I love podcasts actually, because I find that we can reach people that wouldn't  otherwise have access to us. And so I love that really helping other people.  

00:29:44 

Linda Bluestein 

Yes, yes, absolutely. Absolutely. And, and you and I met, in an international group, the mastermind group and  we collaborate there and talk about complex patients and I, I love it. It's such a great place to really learn. Of  course, de-identified, of course I'll all of, any of these conversations that we have. We talk about these  overlapping conditions, including, Ehlers Danlos syndrome dysautonomia, as you've mentioned, mast cell  activation syndrome, autoimmune disorders and, gastrointestinal problems. Can you tell us, in terms of, and I  know some people call that the pentad, cause it happens to be five things, in your practice. Are you seeing a lot  of that overlap of those five things or are you seeing different things? and what approach do you take and you, have you identified any prognostic factors?  

00:30:37 

Ilene Ruhoy 

Yeah. First of all, I, I would call it a pentad I think I'd love to eight fingers. Now there you go, because there is  so much, and you're absolutely right. There is so much. So, I just basically go down the list. I mean, I feel like,  there's no blueprint in my opinion. I mean, I suppose to some extent there is because we know the organ systems  we want to cover, but I just listened to the patient's story. I find that if I just let them start speaking, they will go,  they will tell me about, at least three of the five of the pentad, and then I'll ask the rest of the questions and I'll get them more. I dive deeper and I get other organ systems involvement or other kinds of symptoms that maybe  I hadn't thought about in more conventional kind of pen, Ted presentations.  

00:31:24 

Ilene Ruhoy 

My approach, is that I basically start with a diagnostic workup just so I can really understand maybe where in  that pen tat or octet or Chad, I can start to try to treat, the things that we talked about already, like the piano  histamines and the mastless stabilizers and the supplements I think applies to most. I tend to start that fairly soon  on, but I do autonomic testing. As I said, we do the full breadth of autonomic testing. It's not just the tilt table.  We do the heart rate, deep breathing, the Valsalva or the QSR skin biopsy for the small fiber neuropathy. Jillian  does a lot of gut type of testing. Sometimes I'll even do an EMG nerve conduction study because they described  sometimes large fiber neuropathies. I see CIDP often in this population. When I say often, I don't mean often I  just need more than I would expect.  

00:32:17 

Ilene Ruhoy 

Let's put it that way. Sometimes I'll do a nerve conduction study. We do a lot of labs and I do a large auto  workup because I really do believe so the muscles and the set apart of the innate immune system. They're  chronically triggered and chronically asked to help, heal the body, they eventually get worn out and tired. So they recruit the adaptive immune system. All of our B cells come and start to make these antibodies. At some  point, they might go astray and start making an auto antibody against some protein in our body or some antigen  in our body. So, I do a large auto immune panel and I very often will find, auto antibody and based on what that  auto antibody is, can help tailor treatment or target treatment. I actually do quite a bit of kinds of treatments for  those, I see a lot of very severely chronically ill and I find these auto antibodies.  

00:33:15 

Ilene Ruhoy 

Sometimes just doing symptomatic where we've with different medications, doesn't really get them to where  they need to be. I'll do more systemic kind of immunomodulation kinds of therapies like IVIG. So, and that is  helpful for a lot. Again, not, I mean, there's, again, there's no right. Nothing really seems to help everyone  otherwise, everyone would know the answer, so it wouldn't be to the controversy or a mystery. So I do a lot of  IVG. Sometimes if I'm suspecting a CCI kind of picture and that's anatomical concern, I do the workup for CCI,  which is attraction trial, as well as some imaging of the cervical spine. I work with, a neurosurgeon and I sent  him, the imaging as well as attract and trial. He decides if it's a potential surgical candidate and takes it from  there. I explained that, all of our medications and even all of our fancy treatment alternatives, won't fix  anatomical issue if that's what it really is though.  

00:34:15 

Ilene Ruhoy 

There's some dialogue going on now that, well, if you reduce the inflammation and hone up the ligaments,  perhaps the CCI isn't as much of a concern, which may or may not be true. I don't think we know that yet. We  still lead in learning about CCI itself. I I'll, I might go down that route with regards to potential surgical  intervention for them. We do a whole lot of things is trying and really the root goal is to like reduce the  inflammation in any way we can. Various ways of what you can try to do that. I do a lot of mitochondrial  medicine. I I'm one of them, I call it a hobby, but, and the children's hospital, I do both pediatric and adult  neurology. I used to work in the children's hospital out here, and there was a Mito clinic and I worked there and  I saw a lot of micro disease and then, was also doing it for adults.  

00:35:05 

Ilene Ruhoy 

I realized there's a whole mitochondrial dysfunction spectrum. It's not just about a mutation in the mitochondrial  DNA or the nuclear DNA. There's a spectrum of dysfunction. Of course it makes sense because when there's  chronic inflammation, the electron transport chain just doesn't work as well. Doesn't create as much energy as  the cell needs to continue to either fight or to heal. So, we sometimes we'll work on it. We do mitochondrial  assesses. I do functional assay of my, of the electron transport chain, enzyme complexes to see they're working  and based on whether they're working or not. I I'll tell a treatment. It's really like an all out, I guess, and I, I  always say to patients, I'll do as little as you want, or as much as you want, because we can go down a lot of  routes here, and sometimes I say, and I always say we can stop when we find something and work on that and  just see if that gets us where we need to be. 

00:35:57 

Ilene Ruhoy 

And if so, great. But if not, we'll continue to look. Yeah, so I know it's probably, I think you probably wanted a  more concise answer. 

00:36:06 

Linda Bluestein 

Oh, I know we did not. No we love details. Yes.  

00:36:11 

Ilene Ruhoy 

Yes. Patient just presents like their own story. I mean, that's what Dr. Bluestein and I were talking about earlier,  where everyone just has their own story and that story really, no matter what it is, even if it's early childhood  events, for example, that plays a role in who they are today and how they're presenting and how they're even  tolerating their symptoms. I mean, some people were telling me about all this pain that they have and all these  debilitating symptoms, and some people are not as stoic and just can't tolerate it and just don't want to live this  way kind of, presentation. So it's across the board really.  

00:36:48 

Linda Bluestein 

It's really fascinating because it sounds like you do such a wide range of things for the workup itself, and then also for the treatment from juicing, which is, yeah. I love that. I think that's fantastic. I mean, as you were  talking about like the mitochondrial disorders and things, I'm thinking, probably the more you learned about a  lot of these things and you were taking care of your own, healing after your surgery. Right. How do I get as  many nutrients in my body as I can. That's kind of how you came up with that is that when you got into the  juicing, I, I want you to circle back to that .  

00:37:32 

Ilene Ruhoy 

I did, I started to read about all of the qualities of certain plants, vegetables and fruits, and I was trying to eat  them all and I couldn't, and I read, and, I realized that I couldn't do all of these things. I bought myself a very  inexpensive juicer, and I just started to throw things in the juicer. I found that I played with certain, quantities of  fruits and I was able to make it actually palatable and tastes good, but also have additional nutrients. I just  started using, and within a couple of weeks, we did it every single morning. The first thing I did in the morning,  even before my coffee is everyone who, anyone who knows me, knows that I love my coffee. I did it first thing  in the morning and within a couple of weeks. The difference in my day, specifically in the energy that I had is,  was incredible.  

00:38:23 

Ilene Ruhoy 

I recognize that it was really the only change I had made at that time was the juicing. I was actually in active  recovery from a seven hour brain surgery at the time. I felt like I could do anything. I felt honestly it was such a  huge difference. I've just continued on and that was 2015. I still do it to this day. I mean, I, when I travel,  obviously I don't get to do it every day. I do it to this day and I basically preach it to my patients because I do, I  really am a firm believer that the foundations of health are probably the most important thing that we can do.  Like everything that I add on, I think really, if you're, if the foundations aren't there, it's not going to it's, it may  not be effective at all, but it certainly won't be as effective as it possibly could be.  

00:39:07 

Ilene Ruhoy 

If you're not sleeping well, if you're not eating well, if you're not moving every day, you're not finding ways of  managing your stress. All the treatments, all the meds, all the supplements, all the fancy things that we do, really  are, they might work, but they won't be as sustainable is my right. You've just gotten so far away from what we  can do on our own. We become reliant on I think, medicine. But I think food is our medicine. We should focus  in on that first. Everything we add is just icing on a cake and put no cake,  

00:39:46 

Linda Bluestein 

Not on a regular basis. Anyway. 

00:39:49 

Ilene Ruhoy 

It was my birthday. I had a piece of cake. 

00:39:54 

Linda Bluestein 

Happy birthday. It's just so interesting because then you use things from juicing all the way to IVIG and  working up the craniocervical instability and doing the traction trials and helping people get to the right  neurosurgeon and then have neurosurgery sometimes. So it's the full gamut is,  

00:40:16 

Ilene Ruhoy 

Yeah, we do every, I mean, I won't leave a stone unturned I'm so I, yeah, I put the patient on the journey and  again, it will start with, what are you eating today with, like, I'm going to give you some fancy stuff, and then  I'm going to send you to neurosurgeons and we're going to do lots of systemic treatments and, yeah. So we do it  all.  

00:40:35 

Linda Bluestein 

That's fantastic. Part of what, when I, the more I started understanding what you do, and I thought this is so  exciting because I remember when I went through medical school and residency, and I, I, I have to say, I  thought neurology, that's a field I couldn't do, because there's just not a lot you can do for people, but you are,  you have found a way to help people in a way that is such a unique approach. I'm so excited about this book that  you have been working on. I can't wait for that to come out. I'm going to buy a copy for sure. Share that with  lots of people. I know there's a lot of patients with, that have bendy conditions that have movement disorders  like dysautonomia. I'm thinking of, I'm sorry, not dysautonomia, a dystonia, too many things that start with  DYS. Right. I've had some patients that have really significant, movement disorders, movement abnormalities.  

00:41:32 

Linda Bluestein 

Can you tell us about that and what you see and how you treat those?  

00:41:39 

Ilene Ruhoy 

I think it depends upon the kind of dystonia that they have. I think, I don't really understand the physiology  behind why there's such a large percentage of hypermobile patients who have some form of dystonia, but I do  see it fairly frequent. It's usually very transient when it's, very painful. Obviously I'll use medications.  Sometimes we, if it's, if it happens and it doesn't resolve self resolve on its own, then we do things like Botox  injections trying to release it. Of course, Botox is not necessarily what you want when you're very hyper mobile,  but we do very locally for dystonic kind of posturing of usually it's up the feet, occasionally it's on the hands.  We use some medications that just release the muscles, just so the dystonia is not as painful or as prolonged and  can potentially even prevent it. The physiology behind the connection there is, I'm not completely sure.  

00:42:37 

Ilene Ruhoy 

I was so curious about it that I thought, do they have an underlying dystonia? And I've done genetic dystonia  panels. It was too frequent and getting more and more severe that I thought maybe there's an underlying  dystonia, which there are a lot of BYT genes, gene variants. We did a whole dystonia genetics panel and I've  done it three times and they were all negative. I realized that it wasn't a genetic concern. It was more, again, a  pathophysiologic unrelated to the underlying etiology of hypermobility. I've even done nerve conduction studies  over it, but have not found any abnormalities. It's very, it's a very interesting question and I do treat it, but I don't  completely understand it just yet.  

00:43:20 

Linda Bluestein 

Sure. I mean, do you, well, I'm thinking of one patient of mine in particular and I'm not a neurologist. And I, I  apologize. I may even be using the RA if she has admirable movements. I, in terms of like trying to describe  exactly what, which type of movement it is, I'm not completely sure, but I did treat her initially with, a lot of  CBD and she got a lot better. She couldn't afford it anymore because it's not prescription and your insurance doesn't cover it or anything. The dose that she was needing was, pretty significant. I wrote her a prescription for  epidiolex and she responded extremely well to that. I mean, it went away completely the first time that she had  more like of a shaking type. She's had spinal cord release for tethered cord. My first visit with her the entire, I  think I had a five-hour visit with her and the entire time she was shaking like this, now you can see me people  on won't be able to see what I'm doing, but she was shaking like this the entire time.  

00:44:31 

Linda Bluestein 

I know that from my cause I'd read some, I had read notes from other doctors that she had seen, some of them  accused her of, faking it.  

00:44:40 

Ilene Ruhoy 

Yeah. So just showing me, so that's not dystonia, so, okay. I do see dystonia, which is more of a posturing thing  if you will, locking up a lot, but when you're referring to what I've also seen, sometimes it's tremor, other times  it's myoclonus and the indefinitely with the CCI kind of picture. I see a lot of spinal myoclonus definitely be  treated with Epidiolex. Dystonia, not so much, but kind of myoclonus without question to be queued by of the  dialects. You can also even have central origin of myoclonus. Coming from the brain, as opposed to the spinal  cord. Often when there's a hypermobile patient who has any kind of tremor, myoclonus, it's usually spinal cord,  initial initiation, and would definitely be created with things like CBD. If the guy looks wouldn't be responsive,  I should say, not everyone responds, but I would have, but I see a lot of response to those kinds of medications.  

00:45:32 

Ilene Ruhoy 

Yeah, I see that fairly often and that physiology is more understandable in regards to, just because of the  meningiomas is connected tissue, right. You have kind of, you have a pre and you've had surgical, intervention,  so that there's some manipulation that has been done to the corridor or the brain or the install. You can  ultimately result in abnormal or abyrinth, I should say, signaling pathways, if you will, that result in some of  those movements. Sure. Absolutely treated with CBD. Okay.  

00:46:04 

Linda Bluestein 

Okay. Yeah. Fascinating. And, and I know that we, you had mentioned earlier on small fiber neuropathy, and  this is something that I'm definitely, super interested, I, I think is also very under appreciated in this population  of people with, Ehlers-Danlos syndromes and other hyper-mobility disorders. What, what else can you tell us  about small fiber neuropathy in terms of how you work it up, how you treat it, that kind of thing.  

00:46:29 

Ilene Ruhoy 

I work it up by doing, I do a neuropathy panel in general, which has a lot of things on it, but includes lots of,  like your thyroid and certain nutrient, levels on that can result in any kind of neuropathy. Sometimes I'll even do  like protein electrophoresis looking for blood dyscrasias, even which can usually result in a large fiber type  neuropathy, not necessarily small fiber, but, sometimes you can see small fiber of superimpose on large fiber,  but I see a lot of small fiber neuropathy, with chronic disease. I definitely see it with dysautonomia because the  small fiber is, do have a role in our autonomic nervous system and our autonomic functions. I will definitely see  it with, abnormal, at least an abnormal Q starting out on a testing if not more abnormalities. I further, I usually  then next, especially in this particular patient population that we're referring to in this conversation, I do an auto immune workup for it.  

00:47:24 

Ilene Ruhoy 

I do a sensory neuropathy auto-immune panel. I send out for that, to look auto antibodies that are commonly  known to cause sensory neuropathies. I would say about maybe 10 to 15% of the time I find one of those auto immune antibodies. I think antibodies are interesting. I think we look for what we know. Right. I think that there  are, it seems like every year we're told about new auto antibodies that we identify, I mean, even take the world  of my senior gravis. Like I feel like every year or other year or so, there's another auto antibody associated with  that diagnosis. A we, now we have to check for five different antibodies opposed to one. I think, there are just  antibodies out there that are yet to be discovered. We don't always find antibody, which can sometimes be the  obstacle when you're trying to get insurance approval for IVG of course, I always get happy when I see an auto antibody and not because I'm happy that the patient has an auto immune disorder, because I feel like I can  finally get them appropriate treatment.  

00:48:19 

Ilene Ruhoy 

I do an entire otomy workup for small fiber neuropathy. Then, like I said, the autonomic study, so then I,  depending upon of course what comes back, what's positive, what's negative. If it's very painful, I can use a lot  of analgesics. I think it's often related to mast I'll. I do a lot of masks, all kind of work with them if it is auto immune, like I said, I do a lot of immunomodulation usually, with IVG sometimes with oral modulation. It  depends on the role, the small fiber neuropathy is actually playing, right? Some people don't even know they  have small farm and rapidly until I do a skin biopsy, but it's only because I suspect that based on every other  symptom that they have. I think that it just ultimately depends upon what the etiology and what it's it coexists  with that I base my treatment off of, we do a lot of other things here.  

00:49:06 

Ilene Ruhoy 

We do a lot of so things that are not, but these also responsive to con certain kinds of oxygen therapies. I do  have hyperbaric oxygen, which is very helpful for the symptoms, small fiber neuropathy. We also do the Vasper  system here. I don't know how much about the Vasper system. I think it's incredible. I think everyone should  own their own, except they're super expensive. It's basically a low intensity exercise, bicycles, what it looks like,  but it's not, an exercise bicycle it's and it's with cooling and constriction. You have like basically blood pressure  cuffs on your arms and on your thighs. There's ice water that flows through those cuffs. You have your bare feet  on ice cold plates, and then you have an ice cold thing around your neck. With the cooling and the blood  restriction, it actually helps to increase the delivery of oxygen at an exponential force, so that there's extra  perfusion along with vasodilation from the cooling.  

00:50:01 

Ilene Ruhoy 

This really enhances oxygen profusion, and there are a ton of studies that have shown that it reduces  inflammation, that it improves cognition, that it improves the production of anabolic hormones that help us to  build muscle and to maintain muscle. It's incredible. In fact, we're currently starting a study here on the Vasper  and mitochondria function because it's also known to reduce oxidative stress. My hypothesis is that it'll improve  electron transport chain function, so it'll improve oxidative phosphorylation. So, we're doing a study on that in  the mitochondria. People really have gotten, I mean, I've had some people with true cognitive dysfunction, that,  go on the Vasper and do the program and actually their, even their spouses and their partners and people that  they work with notice a huge improvement in their mental clarity loss of brain fog. It's, I think it's a really great  technology. NASA uses it.  

00:51:04 

Ilene Ruhoy 

The military uses it, a professional sports team uses it because it really aids in recovery. It used to be just very  elite and the very fit. Now it's now migrating into therapeutic and medicinal world because people recognized  the possibilities with this kind of technology. I think that's, that's when it's very hot, it was so popular that we ha  we got a second one. So we have two Vaspers now. Wow it's really incredible. I can't even get on it anymore. I  have to come in on the weekend, you have to make an appointment. We do, we offer that. A lot of our patients,  especially that have Nobel ones who don't really have an easy time exercising as but this is something that  they're completely supported and seated. We even have attachments that it helps them move if they need help.  Like I don't even have ALS patients on it.  

00:51:54 

Ilene Ruhoy 

There are attachments anyone, right? So there's no one who cannot use it. And so I really, I recommended  regularly. We do a lot of auction therapies. We do some ozone injections for joint, certainly cause a lot of our  patients, their joints are degenerating. We do some, we do PRP and prolotherapy and ozone injections. Then, we  do occasionally do STEM cells. I recently gave a talk at the international cell society meeting, about how STEM  cells have been shown to basically transfer their new and naive and young mitochondria to damaged and eight  cells. They basically give these old cells, some baby mitochondria and that really upsets energy game, right. To  heal itself and become a young cell itself. So, we can go as far as that, although usually I, we get a lot of great  response. Well well before that, but so my point is that I've looked at everything. 

00:52:54 

Ilene Ruhoy 

And, and so we have our few favorites, that really seemed to work for a lot of people. And that's really what we  focused on.  

00:53:02 

Linda Bluestein 

I love that about the Vasper, because I'm thinking about, a number of patients that I have seen with EDS that  have very low testosterone levels, like free testosterone, basically undetectable and, testosterone plays a really  important role in pain.  

00:53:20 

Ilene Ruhoy 

Absolutely. Absolutely. There's actually studies about the best friend testosterone increases testosterone levels.  Yes absolutely.  

00:53:28 

Linda Bluestein 

So that's, that is really interesting. Yeah. You do a lot of really fascinating things in your previous and another  one that I wanted you to talk, share with us about is about peptides and well, let's, I'll ask you about the peptides  first. Tell us about peptides, what you're doing with peptides.  

00:53:45 

Ilene Ruhoy 

So, we do a lot with peptides. One of the things in this population that has really been a game changer for a lot  of people in pain is something called BPC 157. And these are physiologic peptides. They're just a string of  amino acids that are the same amino acids we have in our bodies. They're compounded in a pharmacy, they have  a shelf life. They're viable in that regard, but I always say that because I see a lot of things out there on the shelf,  any woman who's like looking for face cream, they see what that tides, but if it's sitting in a jar on a shelf, I'm  not sure how viable they are, but regardless at times that we get from compounding pharmacies, that really  helped to regenerate some cells that had been repaired that have been damaged and need repair. BBC one 57 has  been, and there's a lot of literature on it that has really decreased pain.  

00:54:32 

Ilene Ruhoy 

It either comes in a capsule form. It actually helps a lot of our SIBO patients and our, those with gastrointestinal  distress, especially if it's been chronic. It also helps, for any kind of pain you can do local injections. You can  just do systemic injection that systemic meaning, like just putting the abdomen for a full body kind of effect.  Some patients, we have higher dosages and we put the, have them put them in the joints, they can do it on their  own. Some feel more comfortable having us do it. It's really been really remarkable for patients. There's some  other peptides that I liked that helped to support the immune system like the. I find that, and I do them for three  months at a time, and then we take a break and we just reassess and see how their symptoms are, but I have  found that, and there are a lot of peptides.  

00:55:20 

Ilene Ruhoy 

I would say that here in this clinic, we probably have like five or six that we are really big fans of. There's a  couple that we use for cognitive support, as well as for pain and then for immune support and, anti-microbial  type of activity. We just generally go to this handful of peptides that have really been effective for a lot of  people.  

00:55:44 

Linda Bluestein 

Wow. You do IV therapies also tell us about that.  

00:55:48 

Ilene Ruhoy 

Yeah, we do a lot of nutritional IV therapies. We also do an IV Mito boost, which is the electron transport chain  has co-factors and substrates. We tried, if you feed the electron transport chain co-packers and substrates that it may not have enough supply of it doesn't work as well. We base elect to support the mitochondria as best as we  can with some IB formulations. We do like IV, vitamin C, we do glutathione. We do things that just helped  support the physiology. I don't really build them as curative on any level, but they do what, with regard to what  we're trying to heal and what we're trying to treat. They are supportive. They are supportive therapies and  ancillary therapies that are very effective, when they use it as part of a program. So that's what we do with  therapies,  

00:56:33 

Linda Bluestein 

Fabulous that you have such a range of things that you're treating. I love the fact that although your background  is in neurology, but it's also an integrative medicine. You're treating really the whole patient, although the brain  is the most important thing that we have.  

00:56:55 

Ilene Ruhoy 

That's what I have my surgery lying on the couch and saying to my husband, who am I without my brain? Like,  I can't believe it's happened to me. Like who are we without our brains, most important Oregon. Cause I know  that Portland, Oregon, and I think my specialist friends would get part is just as important, which it is, but the  brain is who we are like literally figuratively, right? It's our personality, it's our emotions. It's our interactions.  It's who we are. I think all we can do to protect it, I think we should. That's what people do who really don't  know how to. Of course, once your body is in a state of, disease of any sort, or inflammation, even you just need  more help sometimes, which is why, again, from the beginning of our conversation, the earlier you get started,  the better off you will be needing lots of interventions in health.  

00:57:53 

Linda Bluestein 

Right. Right. If right now grocery stores are filled with all kinds of things that we really should not be eating. I  mean, obviously, they're there, like you said, it was your birthday yesterday and we don't, we don't need to get  overly restrictive every single day, all day, every day, but what we do need to be mindful. Right. The things that  you talked about in the very beginning about nutrition and about sleep and about managing stress, I mean, those  are so critically important. I agree. Yeah. So, so what else did, is there anything that we didn't cover that you  wanted to share and can you let us know how people can learn more about you and about your practice?  

00:58:39 

Ilene Ruhoy 

I think we covered a lot. I mean, I, I think with Julie and I have built here, I think is really incredible because, I,  I do believe in the gut-brain access, I think that we have found ways of not only, learning about our patients.  Cause I, I think that the patient doctor relationship is super important because I really need to understand the  patient to really understand what they're here for. Right. There's so much that goes into a human being. I, I need  to know, I like to know them, and sometimes it takes more than one visit, unfortunately, just because of the  nature of medicine these days in terms of time. I think that what we've, what we try to do is we really get to  know our patients and their lives and how their symptoms are interfering in their lives. We get to understand  what their biggest concern are because obviously to me, at least their first visit, I want to at least be sure that I  address their prominent concern, the reason that brought them here.  

00:59:32 

Ilene Ruhoy 

Then, but we go beyond that and we ask a lot of questions within, as I've already discussed, we do a lot of  evaluations, a lot of diagnostic workup, and then Julie really helps. She just correct the gut. She's great at like  traumatic experiences life. She's got this, she's a certified aggravated practitioner. She's got this aggravated  wisdom that she brings with it. I focus in, on the brain, the central nervous system, the peripheral nervous  system, the autonomic nervous system. We bring it together and we come up with treatment plans. We do a lot  of, type of, genetic kind of workups that really focus in on certain snips that make each of us individual. It's not  the same direct to consumer kind of snip testing that, 23andme and other kinds of companies offer it really dives  into the different metabolic pathways that go on. Our, as our bodies are just like tens of thousands and hundreds  of thousands of pathways that happen each and every day without us even doing anything.  

01:00:24 

Ilene Ruhoy 

We really focused in on where, any one of those pathways can possibly result in something that we can intervene on that might help a symptom or so we do a lot and that's all part of the workup that we do. We just  come up with different protocols for patients.  

01:00:47 

Ilene Ruhoy 

Beause we find patients actually wanted it that way. I mean, we used to be like, well, a patient will just decide  what is they need, but I think patients really understand it better when it's in a package. And I, I get that. We did  design certain packages for your prominent symptoms and where we're going to start with this package and then  we can go on from there. So I guess I've I, yeah. That's sort of what our clinic does. I think that Julie and I have  to have formed a really good partnership. And then of course we have Dr. David Calspan here, who is the  infectious guru. I mean, he just understands that entire infectious workup. He's amazing. He is incredible. I  wouldn't know what I know about infectious workups if it weren't for him, because obviously that plays a large  role in this patient population with regards to infectious exposures.  

01:01:31 

Ilene Ruhoy 

We also have a psychiatrist here, actually, Dr. Dan Krashen who, works like he's a great pain psychiatrist. He  used to run the chronic fatigue clinic at Harborview medical center, which is a, a large well-known hospital out  here, at least in Washington state. He's a, he's a pain doc in general. He does a lot of pain interventions and he's  a great pain psychiatrist and just a great psychiatrist overall. I feel like our clinic just has a lot to offer people,  just not in terms of peace, but also in terms of the treatment options. Then, yeah, I think otherwise I think we  can.  

01:02:08 

Speaker 4 

Not at all. Oh my gosh, no,  

01:02:11 

Ilene Ruhoy 

I ended up at what we do and so passionate, right? Like I'm in this world where like, I'm finally seeing people  getting better and even if it's, and which is hard and in some specialties of neurology, so it's exciting actually.  And I think we're on the cusp. I think all of us, especially in our group, I think we're on the cuffs of something  

big. I and, I hope that we just continue to contribute to the science and contribute to the knowledge base and  educate other doctors, so that we can move forward and really start making a big difference in people's lives.  

01:02:46 

Linda Bluestein 

I think you're making a big difference already. I mean, it's very exciting and I, I, I loved hearing more, I'm on  your podcast for healing neurology, right? I, I loved hearing your story and hearing from Jillian and her story  with outward bound. Right. She did say that.  

01:03:05 

Ilene Ruhoy 

It's amazing.  

01:03:07 

Linda Bluestein 

She's amazing. If people want to get more information about your practice, where should they go?  

01:03:13 

Ilene Ruhoy 

We have a website, so centerforhealingneurology.com. We have a Facebook page. We have an Instagram page.  I'm not, I really don't know social media, all that. Well we definitely do our best. You certainly find out at least a  lot of information between our Facebook and our website. There's definitely a lot of information there. I very  often will post articles on the Facebook page that I think are of interest to our patient population. Our website  has all the services we have to offer. We are actually planning a reconstruction of that website because we have  added so many different programs and protocols and the past six months that our rep website doesn't necessarily  reflect yet. I still think there's a lot of good information up there actually. That's where I would recommend  people go. 

01:03:59 

Linda Bluestein 

Okay, well, fabulous. Well Dr. Ruhoy I thank you so much for taking the time to chat with us today and coming  on the bendy bodies podcast, this has been such great information and everyone's going to be really excited.  

01:04:14 

Ilene Ruhoy 

I was really happy to talk with you guys. This was really fun. So thank you for inviting me.  

01:04:20 

Linda Bluestein 

Absolutely, absolutely. Well it was great to chat with you, Jennifer, as always. You have been listening to the  bendy bodies podcast with the hypermobility MD today. Our guest has been Dr. Ilene Ruhoy medical director  and founder of the center for healing neurology in Seattle, Washington.  

01:64:39 

Jennifer Milner 

If you've enjoyed this program, please like share, subscribe and leave a review. This podcast is for informational  purposes only, and is not a substitute for medical advice. Please see your own medical team prior to making any  changes to your healthcare. Bendy. Body's original music is by Andrew Savino and sound editing is by Rhett  Gilt. Thank you so much for tuning in, and we will see you next time on bendy bodies with the hypermobility  and beat.