23. Empowering Patients with Multisystemic Diseases with Jill Schofield, M.D.

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00:00:00 

Jennifer Milner 

I'm Jennifer Milner, co-host of the bendy bodies podcast here with host Dr. Linda Bluestein. We're speaking  once again with Dr. Jill Schofield, founder and director of the center for multisystem disease.  

00:00:29 

Jennifer Milner 

In our last discussion, we talked about auto-immune disorders, looking at the links between EDS MCAS APS  and more. Today we're trying to dig deeper into multisystemic diseases and how to get help. You are the  founder and director of the center for multi-system disease in Denver, Colorado. Can you tell us why you chose  that name?  

00:00:52 

Jill Schofield 

Well, it shows that name. I mean, it speaks for itself. These I'm targeting the patients who have symptoms and  problems in multiple organ systems. They tend to be bounced from physician to physician and whose, specialty  has kind of a narrow lens looking at the GI tract, looking at the skin, looking at the heart. Patients who truly  have multi-system disease, like MCAS tend to fall through the cracks because nobody's looking at the big  picture. It's like, what's that? elephant, the big elephant where you have the tail. Yeah. That's why I named my  practice that in hopes of increasing awareness, that there is no care currently, and there is no training currently  for multi-system diseases. Nobody really thinks about them, and nobody is equipped to take care of them. The  insurance companies don't recognize the complexity and the time that it takes to care for patients with  multisystem diseases. 

00:02:04 

Jennifer Milner 

What do you want patients to know about multisystemic diseases?  

00:02:09 

Jill Schofield 

I guess that you really have to be your own advocate, and if you've gone to a provider and you feel like they  haven't addressed your situation or taking you seriously, you have to keep looking and looking. There aren't a lot  of us out there who do this work, unfortunately, as we already said, most of us don't take insurance because the  insurance companies don't reimburse you to take care of, spend the hours it takes to actually delve in and try to  sort out these problems. The internet has been a godsend and helping patients get the care that they need. A lot,  most many patients with these conditions have really had to educate themselves, unfortunately, to figure out  where to get care and to understand and recognize that what they're being told by certain providers is incorrect  model in their head. That's unfortunate because not all patients have the ability to do that,  

00:03:16 

Jennifer Milner 

Right? So people around the world are experiencing this now, experiencing the symptoms, at least of it. Like  you said, having the trouble, getting the healthcare that they need, what are some things people can do to try to  get better care for themselves? And is there anything they should avoid doing.  

00:03:34 

Jill Schofield 

Well? It's I think it's a really, difficult to get the right care. I think you have to educate yourself. I think this new  book disjointed is valuable. I think Dr. Afrin’s book never bet against on MCAS is invaluable. I think all of the  patient forums are invaluable for patients to see where they're falling into and to try to get to a provider that is a  

good match. I think the, one of the silver line linings of the COVID pandemic is that telemedicine has  restrictions have been relaxed, and that is hugely valuable because I've been able to see people in New Zealand  who now didn't have to fly here were too sick to fly here, and it's outrageously expensive to fly here. Even just  people five states away, it's still a big deal, right? So that I hope is going to, I hope those relaxations are going to  stay because everybody in the medical community has found that invaluable and the patient community  invaluable.  

00:04:40 

Jill Schofield 

I think it's going to be hard to go back to the way it was. Hopefully that will only make it so much easier for  people to get an appointment with somebody who matches up with the research that you've done, that shows  would be a good match for your case. I mean, I do think that a lot of people can get diagnosed and treated  reasonably well. In the kind of silos of medicine, I call it, like if you have pot, you think you have pots, you can  go to cardiology. You want to go to a cardiologist who actually knows about POTS, because a lot of  cardiologists sometimes don't even seem to know what their criteria are because it's not their area of interest.  You want to try to get to somebody who knows about it. A lot of people, the simple treatments really help them.  I think it's a people with more complex disease that really do need to see somebody who specializes in these  conditions, who actually looks at knows about pots, knows about mast cell, knows about EDS, knows about our  community.  

00:05:48 

Jill Schofield 

There aren't that many people out there who do that work, but there are more and more now, as I said, there was  no training program. There, who does this work, has learned about it on their own, to the conferences pays their  own way to the conferences. We're all we have a physician listserv of over now over 200 physicians who treat  these multi-system diseases all over the world to incredible dialogue that goes on every day. We all learn from  each other, very complicated. We learned from our patients. We tell each other, I saw this patient with this, and  everybody joins in, and there's an incredibly broad expertise, so many specialties. One day it's going to turn into  a training program. I have no doubt about it. There will be insurance companies that recognize that patient, these  complex patients, these patients are complex and they need more time. 

00:06:48 

Jill Schofield 

That provider needs more time to see them, right. It doesn't help to have 10 different people to spending a rush  job. You know, it needs to be okay. We have time to educate you how to treat these, go through all the  possibilities that might be leading to your symptoms, et cetera.  

00:07:03 

Jennifer Milner 

One day we will have codafide specialty for this right. Yet until then they're going to have to do the hard work  themselves and do the research and see what they can find out there.  

00:07:15 

Jill Schofield 

I'm really bad about that. On the other hand, we are light years ahead of where were five years ago. We are light  years ahead. Just with, dysautonomia international, I think Lauren styles, who's the president of dysautonomia  international. She single handedly changed the face of the management of dysautonomia by just, she had the  skillset where she was able to educate patients. She was able to generate money. She was able to bring all these  great researchers together and make them compete for grants and, provide, make this conference and publicize  the videos. And, and just in a matter of like no time, like people actually know what pots is now. 

00:08:00 

Jennifer Milner 

That's true. Well, and as we have seen caregivers like yourself increasing in numbers, and as we've seen the  research starting to come out, we, it also seems like we're seeing an increase in the prevalence of multisystemic  diseases. Do you think we're just starting to identify them? Or do you think that they are becoming.  

00:08:17 

Jill Schofield 

More commonplace as well? That's a great question. I mean, I definitely think MCAS is exploding because our  environment, our food supplies, a joke. Yeah. The people with MCAS are like the Canary in the coal mine.  They are sensitive to all the chemicals in our environment, which are just rampant. And, the sad diet, the  standard American diet has absolutely no nutritional value. That's riddled with chemicals, all the teenagers eat  fast food all the time and blah, and process food. Nobody has time to, make real food. If you walked down an  elementary school classroom today, they're like signs all over. We got all these food allergies, we got asthma.  We got to, and you can't bring any food into the classroom. That's not tell you exactly what the ingredients are. I  mean, that is just completely different. Even when my kids who are 16 and 18 were in elementary school.  

00:09:18 

Jill Schofield 

That right there, I think that tells us it seems to be exploding, but it hasn't been studied. Obviously there  definitely is more awareness or way more awareness about EDS and there's way more awareness about pots. So  I can't answer that for sure. I think the increase awareness is playing a huge role in it. I think there's so many  people it's just great. When you see a patient who doesn't didn't know anything about EDS pots or mass cell, and  they come in and they have obviously all three and it's so validating for them to say, Oh, I actually, they just  said, thought all those things were normal, their whole life. Right. You start to go through, cause I go back to the  beginning of their, from the time of birth, right. Ask, do you have this? And the auto-immune patients will often  say I had one girl who said I was the healthiest kid that ever lived.  

00:10:12 

Jill Schofield 

Until I went to Haiti and I got this bit by something, and then I I've been the sickest kid that ever lived since  where the mass cell and EDS patients will be like, I had this and I had that and then I had this and then I had  that. And you're just like, Oh my God. You just hear the same story over and over again. It's just, for them to go  through all of that and have no, just be told they have nothing right on with them. So it's great that people are  getting diagnosed earlier. People are, the awareness is exploding mainly in my opinion, secondary to social, the  internet and social media.  

00:10:53 

Jennifer Milner 

I would agree with that. It's awesome. Yeah, it is. I would say having seen so many of my dancers go through  dealing with their own auto-immune issues and EDS and stuff, just being validated for spending your whole life  being told there's nothing wrong with you. Being told, Oh no, there's this and this. God bless you for having  lived with it this long.  

00:11:14 

Jill Schofield 

Yeah. It read about it and you see there's other people yet incredibly validating. Also, the thing about MCAS is  it's extremely treatable. It may be complex and it may take a lot of time and education, but it's extremely  treatable. So, and it goes with EDS and, so most people were able to help significantly once we, if we can have  the time and write them and evaluate them properly,  

00:11:43 

Jennifer Milner 

Right. Once what you're looking at well, then talk about, you were mentioning diagnosis earlier and it's so hard  for a lot of these people to be diagnosed, in disjointed book, chapter auto-immunity and hypermobility, you  discussed a lot of the challenges with autoimmune disorders and hypermobility. One of which is the diagnostic  criteria. Can you, can you explain the general pros and cons of more lenient versus more strict diagnostic criteria  for a given disease and then more specifically for auto-immune disorders and hypermobility?  

00:12:17 

Jill Schofield 

Yeah. I think it's a very difficult issue because there are pros and cons on each side that is making the box bigger  and making it smaller. Right. It really depends upon the condition. The paper that Dr. Afrin was the first author  on that was just published on the global consensus. Two criteria for MCAS, has a criteria that creates a much  bigger box for MCAS. The other group to consensus, we call it the consensus one criteria. I think having a  bigger box in that case is so important because those patients with MCAS, there can be simple things that just  dramatically turn around their life, like changing their diet and over the counter medications, like H1 blockers  and H2. If we're making the box so restrictive and the person doesn't think they have it, then they're missing out  on easy life changing treatment.  

00:13:21 

Jill Schofield 

Now, when we're dealing with auto-immune disease and we're talking about treatment with things like, immune  suppressant, medications or IVIG or rituximab or TNF inhibitors, these very expensive right, carry more risk,  then I think it's appropriate to make the box more narrow. However, when there are like antiphospholipid  syndrome, as were talking about, there are also relatively simple treatments that can be a game-changer and just  the awareness of the presence of the antibodies, even if, to reduce the risk of getting a blood clot, important. So,  it's complicated. I think patients just have to educate themselves. I like it, especially in antiphospholipid. I arm  my patients with a lot of papers and I have them read it and be aware of the issue so that when they have a  doctor tell them you shouldn't be on Plavix, they can, show them why they're understand and advocate for  themselves.  

00:14:26 

Jill Schofield 

Most of the patients in that group who have had everyday disabling headaches, who find they go away with  lavatory, even anticoagulation will, bite off any doctor's head and tries to tell them.  

00:14:39 

Jennifer Milner 

To try to take their Plavix.  

00:14:41 

Jill Schofield 

Them to have a there's one paper written by Dr. Hughes who described APS called heparin antiphospholipid  antibodies in the brain. It's one page. I love that paper. They can give it to a doctor and here read this and it  opens their eyes as to this is not just blood clots in pregnancy complications are more symptoms are treatable. They are treatable. It's, I think it's the bane of my existence. These, these criteria. Yeah. It sounds to have them,  we have to ask.  

00:15:11 

Jennifer Milner 

Right. It sounds like if we can have the more lenient criteria, that's larger, like a bullseye, it gives people kind of  a safe place to say, Oh, well maybe if I might have maybe I should try an elimination diet or something nice,  like an easy way. As you start to narrow it down, more and more at that requires more specialist care more yeah.  More stringent criteria to appropriately,  

00:15:34 

Jill Schofield 

Right. To give the big gun drugs, like, right. Yeah. Like Xolair or Gleevec, these more expensive drugs with  potentially greater risk. Yeah. I mean, I don't really consider any of the drugs we use in MCAS all that great  risk, but Xolair would be the highest one, the highest risk one I would consider. Right. So, yeah, we want to be  sure. Also the insurance companies rightfully so, should require meeting a certain level of diagnostic criteria  before they're going to pay for these really expensive drugs. Right. But yeah. MCAS is my favorite example of  one where I just think, I believe, the group, Dr. Moldings and, the university of bond, I think has estimated  about 17% of the German population is on the spectrum of MCASs. And that's probably true. These are people  who have things like asthma, eczema, fives, food allergies, environmental allergies, recurrent sinus trouble, you  can recognize those people immediately.  

00:16:47 

Jill Schofield 

There are people like, I don't have any of those things, what I mean? So there's about 15% of the people that got  some or all of those things. And then there's 85. We don't have any, and these 15%, they're the ones sensitive to  all these chemicals and just changing up the diet and taking simple things that quiet down the mass cells and  understanding the condition can just like open up, figuring out what's triggering them. Right.  

00:17:12 

Jennifer Milner 

Right. It's so helpful and empowering, but they feel like they can do something to help themselves feel that.  

00:17:18 

Jill Schofield 

MCAS patients, I feel like most MCAS patients can, if they educate themselves and learn about all this and see  one of us one time, even to educate them and go through their story, most people can take charge and manage  their case independently because almost everything. Many of the things are over the counter. Yeah.  

00:17:39 

Jennifer Milner 

Well, speaking of MCAS, you have also published peer reviewed scientific articles on mass cell activation  syndrome. In 2019 you wrote recognition and management of excipient reactivity in patients with mast cell  activation syndrome with Dr. Lawrence Afrin and in 2020 diagnosis of mass cell activation syndrome, a global  consensus to now with doctors, Lawrence Afrin, Dr. Bluestein, and an impressive list of colleagues. What would  you like patients to know about MCAS? And if they suspect they might have it, what would you encourage  them to do?  

00:18:13 

Jill Schofield 

Well, Dr. Afrin deserves like all the credit for that second paper and that has to do with, and it was just like an  incredible amount of work and he's brilliant. He has single-handedly like move forward in the field of MCASs.  And, I am, most of us are grateful for his generosity of time and his brilliance and figuring these things out, but  the other paper. Maybe that's that paper is focusing on what box size we should be using and argues that the  consensus one criteria that they didn't call it, the consensus one, they just called it the consensus eight, call it a  consensus one. And these are the, of the consensus. One is like shrinking tiny box. The consensus two is a  bigger box and right. We've gone through the pros and cons of that. I just, most of us in the trenches, seeing  patients who have helped people with simple things, feel so important to have a bigger box for MCAS, but the  excipient paper, that's another one of my passionate interests because we have found that chemicals not only in  the diet and personal care and cleaning products, the chemicals are, these are also in medications. 

00:19:28 

Jill Schofield 

A lot of people are not aware of that. They're in also sometimes supplements. Although the supplement industry  is more in tune with the concept and they tend to have cleaner products in general. There still are companies  who make dirtier products, but the pharmaceutical industry, Oh my God. I mean, you can go and you can go out  of your way, just like super clean organic non-processed diet. Someone gives you these medications and they're  filled with toxins that were in the mast cells. That was a paper it's posted on my website center for multi-system  disease. That talks gives a lot of patient examples about, the importance of knowing what excipients or fillers  are not inactive ingredients. Those are all synonyms are in the medications you're taking. There are usually  alternatives that don't have. Those are ways to work around it. Can take some creativity. That's another thing  that the patient has to educate themselves on and take ownership of, the NIH, FDA daily med website.  

00:20:35 

Jill Schofield 

I think the URL is in that, paper. You can find the ingredients in any medication and you can do a lot of your  own research on there and make sure you're not making yourself with medications.  

00:20:49 

Jennifer Milner 

Right. Right. Even just the same medication, but, different companies, generic version of it. Okay.  

00:20:56 

Jill Schofield 

Well, it doesn't cost that much with the brand versus the generic because the brand could be even worse than the  generic, it just has to do with what the ingredients are. Cause the active ingredient is the same then everything  else in the brand is not superior to the generic, it can be, the generic can better than the brand. You just have to  know what you're dealing with, right.  

00:21:23 

Jill Schofield 

That's the most important clue that you have an excipient problem by death? I saw a patient yesterday, took this  oxycodone, helped her should this one made her sick. That by definition is an excipient problem. You just have  to, you got to find out what are the chemicals in this one? And what are the ones this one? And you make,  sometimes you have to make, well, I encourage people to make a spreadsheet because unfortunately most of the  drugs have many excipients, so it can be kind of complicated. The two categories that have risen to the top in  my experiences, the most likely would be the dyes like DNC red, number five, yellow and blue. And there's also  green and black. Anything that says alcohol, polyvinyl, alcohol, benzyl, alcohol, those tend to really activate  mass cells and people with M pass. They may have no effect at all people without it.  

00:22:18 

Jennifer Milner 

Yeah. It sounds like people with MCAS have to do a lot of their own research and advocating, even if they do  have a doctor on their side who.  

00:22:26 

Jill Schofield 

Is also worked with them. Yeah, absolutely.  

00:22:28 

Jennifer Milner 

That is a lot to navigate. 

00:22:31 

Jill Schofield 

There are resources to help people, these patient forums, Dr. Afrins book, there are other books and it does take  a lot of reading and people with everybody with MCAS is different. You have to also be aware of that. If you're  reading on patient forums or you're reading a book that this might not apply to you, but then you read this  person's story and it opens your eyes. Oh, that might be what's triggering me? So that's where you just got to read a lot. People figure things out really quickly when their eyes are open to the diagnosis. That's why we are  such, we in a consensus to group are such big advocates for making that diagnostic criteria looser,  

00:23:16 

Jennifer Milner 

Looser. Yeah. That makes a lot of sense. I know that you have also written about HPV syndrome. What can you  tell us about HPV syndrome?  

00:23:25 

Jill Schofield 

Well, the HPV vaccine, I don't see a lot of this, but I do believe that it can be a trigger of, auto-immune pots,  CRPS, and MCAS, That paper is also posted on my website, the whole paper, any vaccine can trigger an  autoimmune disease. I mean, not that's well recognized. It's one of the many triggers, so they can probably  trigger MCAS. The thing unique about the HPV vaccine is that there's three, it's a three vaccine series. I think  now it's maybe a two vaccine series, but it used to be a three vaccine series. Many of us saw patients who they  got the first one and they developed everyday headaches. They didn't have before pretty quickly, right after that  vaccine within days. They didn't get the next one until nine months later. Right after getting that one, now they  have, their headaches are even worse than I have pots.  

00:24:28 

Jill Schofield 

It was this, it's a very controversial area because you can't, it's very hard to prove causation between a vaccine  and an illness. People would say people getting this vaccine are all young females and that's, and so, but because  of that temporal association, that many of us have seen, I believe it's a real link. And, the patient that I described  in that paper has had a great response to IVIG. I mean, the patient, a few patients that I've seen, they have auto immunity and severe MCAS. I didn't really talk about the MCAS piece in that paper because it was still early  days with MCAS, but that patient does have severe MCAS too. Another patient I've seen with a severe case that  had also MCAS. So, it's just a controversial area, but the, and sometimes it, like I said, the triggers are hard to,  it's always hard to know for sure what a trigger is.  

00:25:31 

Jill Schofield 

Probably there are more than one trigger that needs to occur. The controversy is always just because nobody  wants to speak negatively about vaccines because vaccines have done so much for medicine and we're running  the risk of infectious diseases and with COVID, but I mean, the HPV vaccine doesn't reach that threshold  because we can already prevent cervical cancer. The patients that I've seen with this all have a family history of  auto-immune disease, or a personal history of auto-immune disease. I just recommend to my patients who are in  that age group, who have a family history of pots, a personal history of pots, a family history of auto, a personal  history, a lot of immunity to consider not getting that unnecessary vaccine. It's not a necessary vaccine.  Interesting. What about other vaccines destroy people's lives to the best that we can tell? what I mean, as far as  prove the causation? well, that's a big one.  

00:26:40 

Jill Schofield 

I mean, MCAS patients, there's a subset who seem to react to vaccines and there, they seem to generally react to  vaccines. A lot of them don't get vaccines because it rubs up their mass. We don't know, it seems like a  reasonable thing to do to, pre-medicate like, it's a really important vaccine. You want to get this COVID-19  vaccine, right. Two vaccine when it comes out. You react to vaccine, so you might load up on your mass cell  therapy before we don't know if that's helpful, but seems like a reasonable thing to do.  

00:27:19 

Jennifer Milner 

Are there other precautions people can take, if they've reacted adversely to a vaccine in the past before they get  another one that's missing.  

00:27:26 

Jill Schofield 

You know, just what I said. Yeah. If you were to say, take like a really high dose of steroids and you probably  wouldn't respond adequately to the vaccine. Right. If you're just taking, anti-histamines and things like higher  dose of anti-histamines, that shouldn't really prevent your responsiveness to the backseat. If I had MCAS and I reacted to vaccines and I wanted to get the SARS cov two vaccine, that's what I'd do. I would load up on  whatever drugs were helping my empty house before I got it. That's the same concept that we recommend,  before somebody with MCAS has surgery or has a procedure, there are peri-operative, recommendations that  Dr. Bluestein has published about. They're very important to reducing the risk of having a horrible flare of the  MCASs. Right. I've seen people just, I've been really shocked over the years at the severity of a flare that a  person with MCAS can have from simple things, like an AGD that you wouldn't think would be that big of a  deal.  

00:28:25 

Jill Schofield 

I really recommend people pre-medicate for those procedures or surgeries. Right.  

00:28:33 

Jennifer Milner 

That's so interesting. Thank you. Vaccines can have, preservatives too, right? Like, so you could get a thigh  Marisol free. Like I always request a thimerosal free flu vaccine for them. Yeah.  

00:28:46 

Jill Schofield 

Yeah. I don't know if those patients are reacting to chemicals in the vaccine, or if their muscles are just being  revved up by, as I mentioned, the Agilent that is present in the vaccine, which is something that rubs up your  immune system so that you actually, your immune system actually responds to the piece of right. That's in there.  If you just have the piece of the micro, the immune system response is weak. It's not going to be enough to like,  create this like sustained immune response. Yeah. That, like I said, people with MCASs are way over here on  the bell-shaped curve of how your immune system is. Those people just like those people way over here. I don't  even know if my hand is in the, are going to, like they're more sensitive to chemicals. It makes sense that some  of those people might be more sensitive to just their immune system just exploding from that Agilent.  

00:29:41 

Jill Schofield 

Sure.  

00:29:42 

Jennifer Milner 

Yeah. That makes a lot of sense.  

00:29:44 

Jill Schofield 

There's no guide. There's no good guidance for that. I mean, people have most people have a gut feeling about it  and some people are just flat out. I'm never getting another vaccine and other people are like, I really want to get  this one. I'm going to pre-medicate for it. I mean, you really have to think carefully about what vaccine it is. I  mean, the flu vaccine, the efficacy is really not that good. The meningococcal vaccine, that's a really important  vaccine for kids going off to college. That would be one that I would make a higher priority. All the ones  infancy, all bets are like most important. It's just, I think the HPV vaccine is the one that stands out as an  unnecessary vaccine, in my opinion. I've seen it destroy the lives of more than one person. I just think it makes  sense if you know that one, if you have a personal and family history of misconceptions that get kicked off, you  might want to think about just getting pap smears instead.  

00:30:46 

Linda Bluestein 

Do much about the Shingrix, the, for the post-herpetic neuralgia, because I'm thinking about again with chronic  pain and, do much about the efficacy of that one?  

00:30:57 

Jill Schofield 

Oh yeah. Those, those vaccines are very efficacious and then those are in older patients. I think it's 65 and older  or 60. 

00:31:04 

Linda Bluestein 

They're recommending it over 50 now.  

00:31:06 

Jill Schofield 

Okay. Over 50. Yeah. I think you're right. Yeah, those are highly efficacious vaccines and they're one time and  yeah. The people who get post-herpetic neuralgia, that's a terrible problem. The herpes viruses can cause a lot of  trouble. For sure. I think the chicken pox vaccine is worth getting to yeah. Yeah. It just becomes a tricky, you  got away. I mean, it's just true, right. Genetic testing, and we'll be able to say, okay, you saved for this and  you're not safe for that, but we're a long way off. And, and that's the way we'll be testing for N CAS, one day  too.  

00:31:49 

Jennifer Milner 

Yeah. So until then we are just doing educated guesses and we try to educate yourself as best that we can. Yeah.  Well, we try to read a lot. Right. Make guesses, find good doctors to help us make good guesses. I appreciate  you answering all of our questions. There anything you wanted to add to what we talked about today?  

00:32:13 

Jill Schofield 

I don’t Think so. I think there was a massive amount of info.  

00:32:16 

Jennifer Milner 

That was a massive amount of info, but I loved every minute of it. Probably listening to myself.  

00:32:22 

Linda Bluestein 

I do have a question because of the Corona virus stuff. Are you open for, consults to other States? We talked  about telemedicine last time.  

00:32:40 

Jill Schofield 

Yeah, absolutely. Okay. Right now you can, even if they can't fly out to see you or whatever, so, okay. They  should just contact your office, then take. It from there. So, yep.  

00:32:45 

Linda Bluestein 

Perfect. Excellent. Once again, where can people find you a center for multi-system disease in Denver,  Colorado, you can just Google it.  

00:32:50 

Jennifer Milner 

In Denver, Colorado. Excellent. Thank you so much. We really appreciate all of that. You have been listening to  the bendy bodies with the hypermobility MD today. Our guests has once again been Dr. Jill Scofield, founder,  and director of the center for multisystem disease. Dr. Schofield, thank you so much for taking the time to come  on the bendy bodies podcast and for sharing your knowledge with us today. Thanks for having me.  

00:33:14 

Linda Bluestein 

Thank you for joining us for this episode of bendy bodies with hypermobility MD, where we explore the  intersection of health and hypermobility for dancers and other artistic athletes. Please leave us a review on your  favorite podcast player. Remember to subscribe so you won't miss future episodes. Be sure to subscribe to the  bendy bodies, YouTube channel as well. Thank you for helping us spread the word about hypermobility and  associated conditions. Visit our website, www.bendybodies.org. For more information, for a limited time, you  could win an autographed copy of the popular textbook disjointed navigating the diagnosis and management of  hyper mobile Ehlers Danlos syndrome and hypermobility spectrum disorders just by sharing what you love about the bendy bodies podcast on Instagram, tag us at bendy underscore bodies and on Facebook at bendy  bodies podcast. The thoughts and opinions expressed on this podcast are solely of the co-hosts and their guests.  

00:34:16 

Linda Bluestein 

They do not necessarily represent the views and opinions of any organization. The thoughts and opinions do not  constitute medical advice and should not be used in any legal capacity whatsoever. This podcast is intended for  general education only and does not constitute medical advice. Your own individual situation may vary, do not  

make any changes without first seeking your own individual care from your physician. We'll catch you next  time on the bendy bodies podcast.