EDS Medical Gaslighting, MCAS & Migraine with Dr. Ina Stephens

[00:15] Dr. Linda Bluestein: EDS does not start necessarily when you hit adolescence, okay? Younger patients can have many, many other symptomatic comorbidities besides just being hypermobile. And if it's not diagnosed or managed properly, even starting at a young age, it can lead to further problems down the road.
[00:49] Welcome back to Bendy Bodies with the Hypermobility MD. I'm your host, Dr. Linda Bluestein, and today I'm joined by my friend, colleague, and guest co-host, Dr. Ina Stephens. Dr. Ina Stephens is Associate Director of the UVA Health EDS and Hypermobility Disorders Center, which we are so proud to partner with to bring you conversations that connect cutting-edge science with practical, compassionate care for our community.
[01:10] This conversation includes so many topics, including fermented foods and MCAS and histamine, Munchausen's by proxy, medications and supplements for migraine, why diagnosis matters in children, and what to do while you're waiting to get assessed for a possible hypermobile EDS or HSD diagnosis. This podcast is for education only, and it's not a substitute for personalized medical advice. Stay to the end for a hypermobility hack. Here we go.
[01:37] Well, I am so excited to be back with my friend and colleague, Dr. Ina Stephens. How are you doing today?

[01:44] Dr. Ina Stephens: I'm doing well, Linda. It's so great to be back here again. Thanks again for having me.

[01:49] Dr. Linda Bluestein: Of course. Well, I'm thrilled to get to chat with you because we get so many questions from our amazing listeners, and I love getting to discuss them with my brilliant colleagues. So I'm really excited to chat with you today about some of these really fantastic questions. And I want to just right away tell people that if they go to bendybodiespodcast.com to submit their questions, that is by far the best way. We know then that we have your permission to use your question on air. So please do that so that we can address your questions. So are you ready to start?

[02:23] Dr. Ina Stephens: I sure am. Yeah.

[02:26] Dr. Linda Bluestein: Okay, fantastic. So the first question is from Tanya about fermented foods and MCAS. She comments, "Great episode. I too am curious about the fermented food recommendation." I think she was commenting on one of your episodes. "I'm aware that fermented foods are rich in probiotics, but are also very high in histamine. How do patients with MCAS get appropriate amounts of probiotic support without causing histamine flares?"

[02:53] Dr. Ina Stephens: Wow. Okay. So, Tanya, I'm so glad that you asked this because I think the question is really not about how do I get the probiotic-enriched foods in, but how do I support and create a healthy microbiome, which is really what you're doing with the probiotic-enriched foods. That's a great way to improve your microbiome, but there are other ways to do it as well. A lot of it has to do with other foods and other lifestyle practices.
The probably two most important food groups that you could eat besides fermented foods are dietary fiber — especially with a very big diversity. There are some studies that say the more diverse that you can get, the better. Up to about 30 different types of plants or fiber-enriched foods over a period of about a week. But this doesn't all have to be plants or veggies or fruit. It includes things like spices. It includes things like coffee. You wouldn't believe what actually has a lot of fiber in it. And what the fiber has — mostly prebiotic fibers, things that we call fructans and galactooligosaccharides — what happens is that your bacteria in your GI tract, whether they're the best of the microbiome or not, whatever bacteria is there is actually going to utilize that fiber and is going to make the short-chain fatty acids.
The short-chain fatty acids, which include compounds like butyrate and acetate, actually help feed more bacteria and help the growth of your microbiome for the more healthy microbes in your GI tract. They also feed the colonic cells. The colonic cells use the butyrate or the short-chain fatty acids to basically produce more energy. So it's hugely important that you have the fiber to basically feed the microbiome that's there and to enrich it.
[04:54] The second most important food group is what we call the polyphenol-enriched food group — berries, again coffee, spices, cruciferous vegetables. This is where chocolate comes in. Dark chocolate can be really, really helpful. And these foods are also very high in omega-3 fatty acids like EPA and DHA. Those also help increase the production of short-chain fatty acids for the microbiome. So between high dietary fiber and polyphenol-enriched foods, you don't necessarily have to eat all the sauerkraut or all the high-histamine fermented dairy foods.
In addition, there are some lifestyle changes that I would recommend. This includes — and I think we talked about this on another episode — exercise. People don't believe this, but there are a number of studies that show how exercise and physical activity really alters your gut microbiome. It decreases some of the more unhealthy bacteria, things like Clostridium, and some of the other Enterobacteriaceae that tend to cause more dysbiosis and even SIBO. And it increases the bacteria that we really want, like Lactobacillus, Bifidobacteria, something called Faecalibacterium, Akkermansia — which has a lot of data behind it, but you really want to produce your own Akkermansia, not necessarily take it in, and exercise will do that.
[06:40] But with all this said, I think the most important thing that you can do is avoid disrupting your microbiome. And I say this with my infectious disease hat on: avoid antibiotics that are not necessary. A lot of people and a lot of physicians will just say, oh, let me just take that antibiotic for this or for a longer period of time. Antibiotics are hugely important — they have saved lives by the thousands. However, if you don't need an antibiotic, they can actually cause some major disruption and problems to your microbiome.
[07:29] So my advice is always to question the use of an antibiotic if you're being prescribed one. Ask your physician if there's any way to maybe shorten the antibiotic course if possible. And use the most narrow-spectrum antibiotic that you can possibly use to treat the infection. For example, if you have strep throat, maybe just use penicillin. It will work beautifully and it will take care of strep. You don't need what we call a third-generation cephalosporin, which will treat the strep but also can remove and kill the other microbes that may be healthy in your GI tract and oropharynx. Going for the most narrow spectrum is really, really important.
[08:14] And just other things to avoid disruption of the microbiome: smoking, alcohol, stress, and getting the appropriate sleep. Your circadian rhythm also can alter your microbiome, and there are a lot of studies that show that too. A disrupted sleep pattern can alter your microbiome and further dysbiosis. So really working on all those things can be helpful. If you can't have fermented foods, pick and choose.

[09:01] Dr. Linda Bluestein: Okay. So I feel like we could literally spend the entire episode talking about this question, because I just wrote down several follow-up questions related to this. The first one is: does the type of exercise matter? Are you talking about aerobic exercise, strength training?

[09:18] Dr. Ina Stephens: That's a really great point. Most of the studies have been done with some cardio — some form of cardio with or without resistance training. I actually don't know if I've seen a study that is just on resistance training. I'd have to look into that. I think it's mostly based on cardio.

[09:43] Dr. Linda Bluestein: Okay. The second point I wanted to make: I was doing a literature search the other day and I came across a study looking at nutrition in people with hypermobile EDS and HSD. It was so interesting because they were talking about how in that group of people, they were eating high amounts of protein generally speaking, but they were eating really low amounts of fiber. So it's really interesting that you pointed that out as one of the things that can contribute to dysbiosis, because I don't think a lot of people think about that — even though when I had Lorna Ryan on the podcast, she brought that up as a factor.

[10:20] Dr. Ina Stephens: And I think just to mention that sometimes that can be a double-edged sword, because patients who have slow GI motility, maybe gastroparesis or some aspect of gastroparesis — high fiber foods are difficult to digest. So that's why I'm mentioning a whole number of other things that can possibly be done besides the high fiber, besides the high polyphenol. Maybe it's just going to be exercise. You do what you can do. You can't rob Peter to pay Paul.

[11:00] Dr. Linda Bluestein: Right. Yeah, absolutely. And speaking of antibiotics — let's say you don't have a choice, you need antibiotics. What, if anything, can you do? Do you suggest that people taking antibiotics then take an oral probiotic? And how much do you recommend that they separate them by, or wait until they're done with a course of antibiotics and then take probiotics? What are your thoughts about that?

[11:23] Dr. Ina Stephens: So glad you asked this. The only recommended oral probiotic that actually seems to be worth the while — studies have proven that it helps in replenishing the microbiome — is Lactobacillus GG. And that's in Culturelle. So Culturelle is what we would recommend, and Lactobacillus GG can help replenish the microbiome.
[11:43] So usually what I do is tell the patient, first of all, if I put them on antibiotics, I tell them to eat as much of the probiotic-enriched food as they can. If they cannot, then I do put them on Lactobacillus GG during the course of antibiotics, and I usually continue it for another two weeks after that — sometimes a little bit longer, depending on how long the course of antibiotics is. Lactobacillus GG is the probiotic that really has the proven science behind it. People ask me all the time, what about this probiotic in this jar? Number one, I don't know if that's right for you. And sometimes it actually could be harmful, because even if it's a quote-unquote good bacteria, it may react in your body abnormally or cause even more dysbiosis. So I usually don't recommend that. I recommend what's been studied and tried and true.

[12:53] Dr. Linda Bluestein: And I love that you said that about Culturelle, because I have a dietitian sister-in-law who's really brilliant — she actually wrote the chapter on nutrition in the book Disjointed. And that's what she recommends: Culturelle.

[13:06] Dr. Ina Stephens: And that's because the studies have been done. There have been studies also with Lactobacillus GG in patients with inflammatory bowel disease and how that has been very beneficial. I think that's worthwhile if you need it.

[13:08] Dr. Linda Bluestein: Okay. And last follow-up question before we get to question number two — the mention about circadian rhythm. I totally believe you, so important. But we know that a lot of our patients really struggle with this. They finally get a little burst of energy in the afternoon or the evening, so they end up going to bed at 4 in the morning because they finally started to feel a little bit better. Do you think there are some recommendations you can share with people who are really struggling with their circadian rhythm?

[14:04] Dr. Ina Stephens: Oh boy. Yes. The first one — and there are a lot of studies on this — is: well, first of all, if you have a completely skewed bedtime pattern, let's say you go to bed at 4 o'clock in the morning fairly routinely, or 2 o'clock in the morning fairly routinely, and you sleep till noon or afterwards, what I recommend is to see if you can shift it by one hour and do that for a couple of days, then shift it again by one more hour. Go to bed at 1 o'clock in the morning instead of 2 o'clock, then do that for a week, then do midnight, and kind of move it very, very gradually. That's number one.
Number two, when you wake up in the morning, the number one thing to help set your circadian rhythm is getting bright sunlight to the back of your retina. And I think you've had people talking about this before, but there's a lot of science behind it. The back of your retina has cells that literally go right back through your optic nerve, right to your brain, right to your hippocampus — everything that's telling your brain 12 hours later, please start making melatonin. So your body will naturally start making melatonin 12 hours later if it got that signal. If you could wake up and within the first half hour that you're up, get some direct sunlight — and if it's a freezing cold day, you live in Iceland and you can't do that, get one of those SAD lights, those seasonal affective lights, and have some bright light hitting the back of your retina. That can be really, really helpful.
[15:41] A lot of people like to stay in the dark. They wake up and the first thing they do is look at their phone. That's actually one of the worst things you can do for your circadian rhythm. The light from your phone is sending blue light back into the back of your retina, and it kind of does the opposite in terms of melatonin production. So natural sunlight is really, really helpful.

[16:05] Dr. Linda Bluestein: Let's move on to question two from Diane. "Recently on Substack, you encouraged a mom of a 17-year-old who had an inconclusive evaluation at a major medical center to ask about how to get a definitive diagnosis and how to know where to get this. We also need to know where patients — kids with complex disease — are at risk of losing their child to CPS due to Munchausen's by proxy, or where adults are likely to be labeled Munchausen's and placed in protective custody." And I think the terminology has changed about that, so we'll get to that.
[16:32] And I want to also point out, this is not at UVA. "A patient of mine with MCAS, POTS, EDS, epilepsy, multifactorial headache, celiac disease, and more ended up running to the airport to escape what they perceived as a possible upcoming CPS investigation. It is hard enough for the patient, the family, and caring physician to manage without disbelieving medical centers deciding someone is too sick to be believed. Perhaps we can discuss how to deal with that severe level of distrust as well as the medical PTSD many of us have."
[17:06] So this is a retired child neurologist who worked especially with complex patients, and is asking this really excellent question.

[17:16] Dr. Ina Stephens: Right. And I want to start by thanking Diane for bringing this up. This is a really complex issue. And I just want to start out by saying that I can't offer an opinion on an individual case like this. I don't know the details of the case, and in general it's kind of dangerous to give an absolute opinion about what's going on with a patient if I haven't seen the patient. So I want to preface it with all that.
[17:42] With that said, I am terribly sorry to hear that this family has gone through that kind of struggle, that kind of suffering. That is almost inexcusable. If that was really the case, that is really not fair, and I'm really sorry to hear that.
[18:03] I think the issue goes to the problem that we're seeing with the medical community not understanding EDS, hypermobile EDS, any of the types of EDS, MCAS, POTS, any of the comorbidities. I hate to use the word ignorance, but it's sort of been ignorance. They learned a little bit about this — and even recently, I'm going to give an example. I was recently in the emergency room with my son and the young physician who was probably just a few years out of residency mentioned EDS and basically said, oh, I saw like one picture of that when I was in med school. And that is pervasive and that is very, very problematic.
[18:54] So what is concerning is perhaps the providers that we're seeing, even at a major medical center — and I have seen this happen at major medical centers — looking at what is the diagnosis here and really not understanding. They potentially are giving the wrong diagnosis, some diagnosis in error. This happens all the time. And what can happen is that not only does the patient get the wrong diagnosis, but potentially a dangerous therapy or maybe a dangerous referral, like referring them to CPS, which really should not have happened if that was truly the case. That could be very dangerous — referring a parent or a family to CPS for no reason, or because the disease entity was not really understood.
[19:51] So to me, the answer to this question is really education. I think that we really need to meaningfully and effectively address what I feel is a pervasive ignorance among the medical community. If they don't really understand this disease entity, the syndrome, and the comorbidities, it's not fair. So I think educating and teaching providers about hEDS, HSD, all the monogenic types from the ground up is essential. And we're taking this very seriously at UVA.
[20:31] We're starting with undergraduate students coming to shadow us in the clinic. We're teaching the medical students. We're getting medical students into rotations, into their first and second years, into the classroom, teaching them about all the connective tissue disorders — not just EDS, but all the other connective tissue disorders, including Marfan's and Loeys-Dietz, where maybe they had one sentence about this in their entire four years. We're creating rotations for the residents. We're giving presentations like grand rounds to the faculty in multiple different departments. We're having our EDS symposium where we are inviting faculty from all over the place.
[21:19] So I think that's sort of the answer, because it's hard to teach people that are already out there and not necessarily part of the community that's listening. They may not be going to these CME events. And that's kind of the part two of this question: where do you go? My answer would be to look up the EDS Society and see where the Centers of Excellence are, maybe reaching out to people at the Centers of Excellence if you live very far away and asking for recommendations of physicians that may be closer in their area. I have had that experience numerous times — people will reach out to me and say, I cannot come to UVA, I live way too far away, but do you know somebody in X state? And I could at least do what I can to help them, give them a recommendation of somebody that I trust.
[22:26] Again, I can't really offer a perfect opinion on this individual case, but it's a real shame and I'm very sorry to hear about this. It happens.

[22:41] Dr. Linda Bluestein: Yeah. And your point is an excellent one. First of all, thank you for the education that you all are doing, because that is so, so important with the medical students, et cetera. Even letting undergraduates come and rotate is really fantastic. There's such a huge leap from "we don't understand this person's illness" to "somebody is fabricating the illness." That's such a huge problem. And I also wanted to mention that I think the American Academy of Pediatrics is now using "caregiver fabricated illness in a child" and DSM uses "factitious disorder imposed on another." Most of us know Munchausen's by proxy, but I just wanted to point that out.
[23:24] We know that medical trauma comes in so many different shapes and forms. I feel badly for every single person that has had experiences like this, but I'm also very hopeful for the future because of things exactly like what UVA is doing.

[23:38] Dr. Ina Stephens: Yeah. Thank you. Thank you.

[23:40] Dr. Linda Bluestein: Before we go to the break, I just have a practical question, and then we're going to tackle question three after the break. When a patient has accumulated six, eight, ten or more diagnoses and a huge medical record, what can families and their treating physicians do to communicate the case in a way that increases credibility rather than inadvertently increasing suspicion?

[24:07] Dr. Ina Stephens: I think, first of all, if you do have multiple different comorbidities and you have individual subspecialty recommendations, I would print them out. In the age of electronic medical records, most people are now able to get the after-visit summary and including the entire note. For example, at UVA, you can see my entire note — the patient's history, how I took it, what questions I asked, what my exam findings were, and my reasoning, why I think this patient has this. When I send that to another doctor, they understand my reasoning. They can follow it through. They're like, wow, this is something that I don't know about potentially, or I can agree with or not agree with. But for the most part, when a subspecialist does that, it's because they believe in it. They're not usually making something up.
[25:05] So if you can get that after-visit summary, that full statement from the subspecialist — from the physician that was treating that particular comorbidity — print it out, keep it in a notebook file. You can have this all in a big folder when you come see another physician. I think that's very helpful.
[25:30] And it's nice, as a physician, to get that before the visit. Sometimes that's not possible — sometimes I get it right then and there and I look at it while I'm talking to the patient. But sometimes it's a little bit more helpful than hearing the patient just say, I had this and this, and that doctor recommended such and such. Here, I have it right in front of me. I see what the physician recommended, and it makes sense to me. I could either agree with it or not, or maybe change some of the recommendations, but I don't usually question very much of what's going on. I don't say this person has made it up.

[26:09] Dr. Linda Bluestein: Yeah, I couldn't agree more about the full encounter note versus the summary. The summary is usually so much less helpful than the full encounter note. And I was fortunate to give a grand rounds last week for Kaiser. I was so happy to get that invitation, because it's a group of internists that wanted to know more about EDS and HSD and how to work with these patients. I mentioned the binder, and I encourage patients to have that kind of a binder — but not to be afraid of it. Hopefully they'll be coming in with different records that you can ask them to find, so you don't feel obligated to look through the whole thing, because that's just not practical in most people's fifteen-minute visit. But at least then the person has the records so that if you ask for something, they can hopefully find it fairly quickly. And then you get the level of detail that you're talking about — if you actually see someone's clinical reasoning, it really changes things.

[27:13] Dr. Ina Stephens: Right. And I think just to mention that a lot of times it's helpful to know, you know — when patients come to me with pages and pages of labs or imaging, maybe they're normal or not, it takes too much time to go through that. But if I have the summary from another physician that said liver function studies are all normal, I don't have to go fishing and find that, and I feel comfortable about it. So those kinds of things are very helpful — that summary, that entire encounter where the physician probably either ordered or went through that study and has the results there already interpreted for me.

[27:55] Dr. Linda Bluestein: Right. So rather than sharing, for example — some people do this in preparation for a visit with me — they'll share their last twelve CBCs, and it's like, if you had one done recently, that saves me ordering one perhaps. I know you don't have anemia as part of the problem. Of course, we also like to look at ferritin. But share the most recent one. I don't need all twelve.
[28:18] So we are going to take a quick break, and when we come back, we are going to address the third question from one of our listeners. Put your feet up, get something to drink, give yourself a little break, and we will be right back.

[29:34] Dr. Ina Stephens: I am back with the brilliant Dr. Ina Stephens, and so happy to be here with you. We'll tackle some more questions now if you're ready.

[29:43] Dr. Linda Bluestein: Oh, I'm all excited.

[29:45] Dr. Ina Stephens: Okay, great. The next question was submitted anonymously, and they asked about thoughts on the use of Botox for migraines for people with hypermobile EDS and craniocervical instability — if it could impact them negatively. They would also be happy to hear our thoughts on the multitudes of migraine medications that are out there, and they asked about supplements as well.

[30:06] Dr. Linda Bluestein: Okay, great. So Botox, or botulinum toxin, can be very, very helpful for migraine headaches if it's used in the right situation and for the right patient. It is not frontline therapy — just putting that out there. It is absolutely not frontline therapy, and other regimens should be tried first. I can talk about what regimens I like.
[30:31] But a patient who has craniocervical instability — I would actually avoid using Botox. The recommendations are generally not to use it, and every patient's different, but for the most part you shouldn't, because it can actually worsen the neck instability and increase headache pain.
[30:53] So my kind of go-to migraine medications, supplements, and protocols — I have my regimen in stages. It depends on how often the patient is getting a migraine. If the patient's getting a migraine a handful of times a month, one regimen may be better than if they're telling me they literally have a daily migraine and some days they're so incapacitated they just cannot get out of bed. That's a completely different patient.
[31:34] In terms of what I like, first I like to try to prophylax a migraine headache rather than to treat. And I tend to use supplements — I feel that most neurologists now are using supplements because they are very, very beneficial, they can be very helpful, and they have very few side effects. First try to do something without the adverse side effect, because then we get into more trouble.
[32:00] My favorite supplements to prophylax — and again, these don't treat, they prophylax — is a combination of basically three, sometimes four supplements. The first supplement is magnesium glycinate. I use a high dose of magnesium glycinate, usually 400 or even sometimes 500 milligrams. Magnesium glycinate — this form of magnesium actually goes straight to the blood-brain barrier. It quiets down nervous excitation. It can be a muscle relaxer, a smooth muscle relaxer. It can help quiet down blood vessels. And it's great for sleep. So you always take magnesium glycinate going into sleep.
[32:46] It works best in combination with usually two other supplements, which I actually recommend in the morning because they can tend to be a little energizing. The first one is high-dose riboflavin, which is vitamin B2, usually in a dose of about 400 milligrams. And then I combine that with coenzyme Q10. We've talked about coenzyme Q10 before — it is a mitochondrial supporter. It helps the mitochondria work to make ATP in the electron transport chain, but it actually also helps prevent a migraine headache by quieting down nervous excitation. So the combination of magnesium glycinate, riboflavin, and coenzyme Q10 can be very powerful. The dose of coenzyme Q10 is usually on the higher side, also about 400 milligrams.
[33:39] There's another supplement that also can be helpful, and sometimes I recommend this in addition or sometimes separately. It's called feverfew, which not many people know about. Feverfew is a natural compound from a plant — actually a flower. The active component in it inhibits prostaglandins. During a migraine, the blood platelets release serotonin and a lot of prostaglandins. The active compound in feverfew, which is called parthenolide, will inhibit prostaglandin production. So I like that for prophylaxis.
[34:27] In terms of prophylactic medication, the first two that are sort of go-tos are topiramate, or Topamax, and occasionally a beta blocker like a low dose of propranolol. That's not my favorite — I feel like it can interact with some medications, and it can affect autonomic dysfunction because it blocks epinephrine, and it can sometimes alter what you're trying to do if you're also treating autonomic dysfunction. But both of those medications can be used for prophylaxis.
[35:12] In terms of treatment, I also have my kind of regimen of what to go to first and where I go next. First, you try something that's going to block prostaglandins — high-dose NSAIDs, ibuprofen 600 to 800 milligrams if the patient can tolerate NSAIDs, or naproxen sodium, usually at a dose of about 500 milligrams. Sometimes that can just abort the headache as it's starting and can be very helpful.
But if the patient has graduated from that and those are not working, there are two other classes I tend to go to before I even go to Botox. These are the triptans, which can be used as a rescue medication — usually if used within the first 10 to 20 minutes of the headache, a triptan will work. Triptans kind of mimic serotonin, and they will block a serotonin receptor, specifically the 5-HT1B receptor. What this does is it helps to constrict the blood vessels. That can be very helpful. But there are some side effects and some issues with the triptans.
[36:37] So actually my real new favorite are the CGRP inhibitors — the calcitonin gene-related peptide inhibitors. These medications are great. One issue is that you often need prior authorization from insurance. They're very expensive. They're not approved in some of the younger age groups, so it's kind of hard to get this for a younger teenager, maybe a 14 or 15-year-old — I've had to fight to get them. But they can be very helpful. These medications include ubrogepant — Ubrelvy — Nurtec, Ajovy. What they do is block the secretion of something called substance P and the calcitonin gene-related peptide, which are released from the blood vessels and lead to continuing swollen blood vessels. So it kind of blocks that whole pathway. I find those extremely effective in most patients. That's sort of my migraine regimen. If they're not doing well, then I would consider Botox. And some people want it first — there's nothing wrong with Botox, but I would try these others first, or at least some of them.

[37:55] Dr. Ina Stephens: Okay. A few follow-ups here. First of all, when you're talking about potential contraindications with Botox and CCI, we also know that CCI or craniocervical instability is a big spectrum, right? So you're probably talking about somebody who has significant CCI — not just mild, but maybe on the more severe end.

[38:17] Dr. Linda Bluestein: Yes. But I think if they're coming to me, they have the diagnosis already. It's been a concern. I probably would not go to the Botox. If it's in my differential but doesn't seem to be causing them too many problems, it may be something to discuss. But I try to avoid it if I'm worried about that.
[38:40] One thing to also mention about Botox: it can be very helpful if the migraine is coming from a very tight jaw — like a bad TMJ — and there are just muscle contractions up and down the face and into the neck and coming over the head. Botox can be very helpful for that kind of pain-induced migraine from TMJ. So I was just thinking about that when talking about the joint.

[39:07] Dr. Ina Stephens: Yeah. I had a very interesting experience with Botox for my TMD. I went in to see my dentist and I was in so much pain. I was in terrible, terrible pain that day. They injected the Botox and I felt like I had gotten IV Dilaudid. I got this surge of endorphins and I said, I feel like I'm going to pass out. I really thought I was going to lose consciousness because it was such a powerful response. I'd had Botox before and I'd never had this kind of reaction. And I asked him, was there anything else in there besides Botox? And he said no. But it was so interesting. I said, don't anybody touch me, because it was just this wave of relief. It was really fascinating.

[39:54] Dr. Linda Bluestein: I have not heard that before.

[39:57] Dr. Ina Stephens: Yeah, he hadn't either.

[39:59] Dr. Linda Bluestein: Wow. Okay. Good to know.

[40:02] Dr. Ina Stephens: I wanted to thank you for the recommendations about magnesium glycinate, riboflavin, CoQ10, and feverfew, because the first three I have definitely used for migraine prophylaxis myself. I used to have horrible, horrible migraines and I was on topiramate for a while, which we often refer to as Dopamax because it contributes to brain fog. So a lot of times when I see people on that and they're not taking magnesium — which can help with pain and sleep and central sensitization — I agree those supplements are really, really great.
[40:42] I was curious to ask a follow-up question about feverfew. I feel like maybe I was recommended to take that when I was breastfeeding. Does it help make more breast milk, or am I completely wrong about that?

[40:53] Dr. Linda Bluestein: I don't know that — I would have to look it up. I've never heard that before. I mean, it blocks prostaglandins, but I don't know. I'd have to totally look that up.

[40:56] Dr. Ina Stephens: Okay.

[41:08] Dr. Linda Bluestein: Just to also mention, there is a medication or supplement that you can buy over the counter called MigraRelief, and that is magnesium glycinate and riboflavin both in doses of 400 with feverfew. It just doesn't have the coenzyme Q10. So you can get it that way already pre-compounded. I'll have to look that up about breastfeeding, though.

[41:29] Dr. Ina Stephens: Yes. Oh, that's one of the things I was going to ask you — what dose of feverfew you recommended.

[41:36] Dr. Linda Bluestein: It's 100 milligrams.

[41:38] Dr. Ina Stephens: Okay. And that's taken in the morning?

[41:40] Dr. Linda Bluestein: Yes. And that's actually the dose that's in MigraRelief — 100 milligrams.

[41:44] Dr. Ina Stephens: Perfect. Then the other question I had was regarding medication overuse headaches and with the NSAIDs — if there's a certain period of time. I remember this was happening to me, when I was having all this head pain and I was using NSAIDs and acetaminophen, obviously trying whatever you can, especially when you're working and you can't have a more cloudy head. How does a person know? And I know there's no magic answer for this, but with the NSAIDs and the fact that people can get medication overuse headaches — do you have any magic tips about that?

[42:25] Dr. Linda Bluestein: That is a really tricky question. The only thing that I've ever seen anybody recommend, including neurologists, is to stop the NSAIDs completely and see what happens to your headache. And sometimes you can differentiate — like if there's a real migraine, maybe with an aura, maybe it's unilateral on one side, maybe there are some other feelings along with it, comorbidities like nausea or vomiting or anything else. But then your headache kind of changes while you're on the NSAIDs, and it's just this horrible headache. It may be that it's medication-induced and actually not a migraine. So stopping it and seeing if that different type of headache goes away — and then maybe you're still just dealing with the headaches that seem to be much more migraine-related — then I would go to another regimen. That's when we have to change the approach.

[43:28] Dr. Ina Stephens: And when it comes to the CGRP antagonists, have you noticed any difference with people's other areas of pain when you've started those for migraine? Have you made any observations about that?

[43:39] Dr. Linda Bluestein: That's a really good question. I tend to use ubrogepant — Ubrelvy — which is my favorite of the CGRP inhibitors. The reason for that is that some of the other ones have to build up in the system, or they're injectables. Ubrelvy is an oral medication. It comes in two doses, 50 and 100 milligrams, and it can be given literally as a rescue right at the onset of the headache, 10 to 15 minutes as the headache is starting.
[44:10] I have had people that I've put on Ubrelvy say that they just feel so much better. I have attributed that to the fact that when they get a migraine, they're having so many other comorbidities — they're nauseous, they're exhausted, everything else is hurting them, the migraine can lead to almost like occipital neuralgia-type pain. And all of that quiets down. That's the feedback I've gotten. I don't know about other pain in other areas — let's say from a bad hip or something like that. I have not had that feedback, but I can start asking. So I don't know.

[45:04] Dr. Ina Stephens: Okay, excellent. So this is probably our last question. This question is from Amanda and she wants to know about the benefit of a hypermobile EDS diagnosis in a child or adolescent. This is probably not a neurologic question, but it fits here better than some others. She writes: "I am a 49-year-old mom with hypermobile EDS with multiple bowel obstructions and surgical complications in recent years, ortho issues and complications. My 14-year-old son is hypermobile in the lower extremities and his feet. He's tall, thin, has a very wide arm span. Should I have him evaluated for EDS? What would be the benefit of knowing, and who should I see for this?"

[45:41] Dr. Linda Bluestein: Wow. So this is probably my favorite question today. That's because I'm a pediatrician and I take care of these kids and I have seen these kids from the ground up. And I could actually talk for the rest of the hour plus another hour about that, but we won't do that today.
[46:00] First of all, Amanda, my answer is yes, I would have your 14-year-old evaluated, for numerous reasons. And before we get to your 14-year-old, I want to tell people that I see patients in my clinic coming to me — not just to the EDS clinic, but to some of my other subspecialty clinics for diagnostic dilemma issues or other issues — and they're at a much younger age with many other comorbidities, and I've diagnosed them. The thing to remember is that EDS does not start necessarily when you hit adolescence. A lot of people don't remember that, or pediatricians don't think that it's important. But younger patients can have many, many other symptomatic comorbidities besides just being hypermobile. And if it's not diagnosed or managed properly, even starting at a young age, it can lead to further problems down the road.
[47:05] So the number one thing I want to say is that you want to prevent these comorbidities from worsening the best you can. But I think one of the greater issues I want to bring up is that if you can get an early diagnosis — let's say at the age of 7 or 8, even if it's not a full diagnosis but a suspicion that this child is hypermobile, they may have some comorbidities, there's been a significant family history like you're telling me about — that can be relayed to their pediatrician, who can learn about it, and to every subspecialist that child may be seeing in the future. It is on their radar.
[47:51] Because if it's not, what ends up happening is what we're seeing so much of now. We're seeing the 20-year-old or the 30-year-old who has had years of subspecialty fragmented care — the right hand is not listening to the left hand. And that person just ends up asking, why do I have so many diagnoses? What's going on with me? The subspecialist goes back to our first question about almost the factitious — the subspecialist is like, why do you have so many of these problems? And that leads to what we call medical gaslighting, the PTSD of having a doctor say, oh, here you're coming in with another problem, instead of connecting the dots and putting it all together.
[48:42] So if we can have a medical professional who's caring for a child put the dots together for that child, it's only going to be in that child's best interest. Even if the child comes in with a regular problem that's outside of EDS, they still have EDS on their radar. They can say, oh, you have strep throat today, that's okay, we'll take care of that. That may have nothing to do with EDS today, but this other issue does. And so they're on a little bit of a higher alert when they see that patient.
[49:20] And a lot of these issues can start very early on. Children as young as 3 and 4 can start having orthopedic problems. I see these children coming in with signs of hypermobility and ligamentous laxity — they are clumsy, they were hypotonic as toddlers, they were late to walk, they are falling down, they have problems with proprioception, they are sitting in positions that are not appropriate for their body, like constantly sitting in the W position, which leads to more orthopedic problems like femoral anteversion. It can lead to problems with their knees — genu valgum or varus. It can lead to problems with their ankles — ankle pronation, and then pes planus.
[50:09] Then the next thing we know, we have a teenager whose entire lower body is literally causing them problems from the ground up. So if I can address this in a 5-year-old or 7-year-old, get them into a pair of good arch supports, maybe some AFOs for their ankles, into physical therapy, working on femoral anteversion stabilization, core conditioning, I may prevent all these problems later on in adolescence.
[50:41] And this goes all the way up the spine. We see problems with scoliosis. I see patients at the age of 20 and I always look at the back. Sometimes I see a scoliotic curve, and they were never told about it because after the age of 12 or 13, if they didn't have a major problem with scoliosis, nobody looked at their back again. But in a patient that's hypermobile, that needs to be part of the annual exam for a generalist or a pediatrician who's evaluating that child. So if the diagnosis is there, they will potentially remember to continue looking at that back. It can change. It's hypermobile. It can cause back problems later on in life.
[51:25] I also think that the issues of chronic pain and chronic fatigue are just as prevalent in kids as they are in adults. That can present in many, many different ways. Sometimes it presents as chronic pain and the child is up all night with growing pains, or they're sitting on the sidelines and they don't want to do sports because of either pain that they're not really even able to express, or they're fatigued, but they're missing out and they're not keeping up with their peers.
[51:56] And I think this very much can lead to a huge issue that I really want to bring up, and that's psychological issues that we see in young children with hypermobile spectrum disorders, HSD, and EDS. There's a really interesting study that came out in March of 2025 by William Black at Nationwide Children's Hospital and his group. It looked at the prevalence of anxiety, depression, and other psychological disorders in children that are hypermobile, and it is so much more prevalent than in the general population. A lot of that also can lead to issues later on with PTSD.
[52:55] And so to help prevent the mental health issues — the anxiety, the depression, the chronic pain — that's only going to build them up for more success. Remember, a child who's anxious, depressed, chronically in pain, chronically fatigued is missing school. They're not able to keep up with their peers. They may have school failure. Once you start setting up a child for school failure as a second grader, third grader, or fourth grader, it's hard to catch up. So you want to build the best ground layer for a child. I think that's our job as pediatricians and as parents.
[53:49] So I think that having a child diagnosed, if there are warning signs, needs to be done. That's my answer for Amanda. I would bring her son in. And if she's not in an area where she has easy access to somebody who understands EDS, as I said at the beginning, bring it up to your pediatrician. Say, I have this, I think my child may have this, please help me. And that's the job of a good pediatrician or a family practitioner taking care of children.

[54:27] Dr. Ina Stephens: And I'm going to hand you a magic wand right now with unlimited powers and unlimited financial resources. From a screening perspective, treatment, et cetera — what would you start doing if you had all this money and power?

[54:57] Dr. Linda Bluestein: Oh my gosh. Well, first thing I would do is really study the outcomes and what's going on with these children that get early intervention — what types of intervention work, looking at different lifestyle changes versus medication. We try to minimize the use of medication the best that we can, especially in children, but building the ground up, strengthening the body, getting them into physical therapies.
[55:26] I would put money into helping the therapists, getting these kids stronger, teaching the coaches. So many parents — if I had a magic wand — it would be teaching the coaches. So many parents come to me and say, oh, the gymnastics teacher is so excited. My child can do this split and that split, and is making her do this and this. And she comes home at night and her back hurts. Well, that's a warning sign. That coach needs to understand how to coach a hypermobile body. So I'd want that. I'd want the ballet teachers — and we could talk ballet for a long time, Linda.

[56:16] Dr. Ina Stephens: Yes, we could.

[56:16] Dr. Linda Bluestein: We're both ballet dancers. But to have a teacher pushing a child into toe shoes too early, or pushing that extension, or overstretching just because they can — that is not in the best interest of that child. So I'd really want to teach and educate the community that is caring for children. This includes school teachers, school nurses, school phys ed teachers. So yeah, that's a little money magic wand.

[56:55] Dr. Ina Stephens: Okay. I love it. And for the parents listening right now, when you talk about kids sitting in the W position and things like that — we're both parents, so we get this — it can be hard to balance letting your kid be a normal kid and also knowing, oh, this is something they maybe shouldn't do. Do you have any suggestions for parents who are struggling with that, especially when they're really young? Like if you have a 4-year-old or a 5-year-old and they're doing pretty well, but you are making these observations — how do you walk that fine line? Because we don't want to overmedicalize, but if we can prevent some complications, that would obviously be really important.

[57:41] Dr. Linda Bluestein: That's a great question. And I think the number one thing is to make it fun for the child. When they're sitting like that, be like, "crisscross applesauce!" — and just give it a more fun name. Open their hands differently and sit differently. Make it so that it's not a negative of what they're doing, but a positive. And just even changing the name of it, I think, can be helpful. That's just one example that comes to mind.

[58:14] Dr. Ina Stephens: I love that. That's brilliant. And if you have that kind of a cue that you can just quickly say, whether they're with friends or not, rather than going into this lengthy explanation about their hips and their knees. Okay.
Another quick follow-up before we wrap up — and I love the idea of doing a ballet episode with you. So again, people who are listening right now, please submit your questions to bendybodiespodcast.com. Every time I talk to you, I have pages and pages of scribbled notes because I love talking to you and love diving into these things really deeply. Please let me know what other things you want me to discuss with Dr. Stephens.
[59:17] I want to make sure that people know what ages you and Dr. Sarah Cohen-Solomon can treat at UVA.

[59:28] Dr. Linda Bluestein: Okay, great. We will see anybody who really would want to be seen, but I think it's most beneficial if we're seeing a child usually over the age of 3 or 4. That way I can communicate more with the child, ask about symptoms. A 4-year-old can tell me about pain. They can, and you can really watch them walk, run, stand up. You can really look at their body.
[1:00:01] I have had referrals for children younger than that — I've had an 18-month-old coming in with some hypotonia, not quite walking. I think the trick there is that the differential is so much larger at that young age. I want to make sure I'm not missing a neuromuscular or genetic problem. Why is this child maybe hypotonic or not sitting up properly? So the differential is just so much bigger. And usually by that point, 18 months of age, the child is undergoing an extensive evaluation if they're really hypotonic. So I like to see that evaluation be a little more complete and then see the child when they're a little bit older. It's not that I won't see them, but I think it's most beneficial at around 3 to 4 years of age.

[1:01:05] Dr. Ina Stephens: Okay. And what about on the other end of the spectrum?

[1:01:10] Dr. Linda Bluestein: In our center at UVA, pediatrics for Ehlers-Danlos syndrome will go all the way up to the age of 35. And we have another pediatrician starting in September, part-time.

[1:01:26] Dr. Ina Stephens: Congratulations.

[1:01:27] Dr. Linda Bluestein: Thank you. Dr. Jim Nataro. So he'll be starting.

[1:01:31] Dr. Ina Stephens: That's great news.

[1:01:32] Dr. Linda Bluestein: Yes. We're really trying to grow and build so that we're able to help more people. With that said, a huge number of the patients that are on our waitlist and seeking diagnoses tend to be the older adolescents up to about the age of 35 or 40, which is one reason we go up to 35. But then Dr. Dacre Knight and Angie Kinane, who are working in the adult sector as well, will see down to the age of 16. So we have a lot of providers seeing 16 to 35-year-olds.

[1:02:15] Dr. Ina Stephens: Yeah, that's fantastic. And I want to mention — because I talked to Dr. Cohen-Solomon about this when I interviewed her recently, and I also talked to her about it at the EDS Society conference — a lot of times I'll hear from people, "but the waitlist at UVA is so long." And she pointed out, or maybe you pointed out at one point, still get on the waitlist. Because number one, you're hiring more people, and two, it helps demonstrate the need and it starts the clock going. Do you have any other tips for people who are encountering that?

[1:02:52] Dr. Linda Bluestein: That's actually really important. And this is probably a tip for anybody who's even thinking of starting this kind of clinic — maybe they're at an academic center and trying to get support. Let me give you a little anecdotal story about when I started this clinic.
[1:03:13] I had been seeing these patients for a while and I received a donation to start a clinic. I had to go to hospital leadership — EVP and all of hospital leadership — to start a new clinic like this. I wanted to hire immediately. And the first question I was asked was, "Dr. Stephens, do you think you'll be able to see at least 30 new patients a year?" And I said, well, I think so. That was actually a major threshold. I had to prove I would be able to see more than 30 new patients a year to make it beneficial for the hospital.
[1:04:01] And before we even opened our door, we had hundreds of patients on the waitlist. That immediately gave feedback to hospital leadership: wow, this is actually a huge unmet need. The more patients that were on the waitlist, the more that sparked the interest of hospital leadership. These patients are out there, they need to be seen. This is a bigger deal than we thought it was. And we got more support. This is why I have been able to hire. This is why we're going to be able to have a larger space than was initially allocated to our clinic — that space is no longer even viable, they're looking at larger spaces because of this waitlist. So the more need out there, the more that we're able to hire and grow.

[1:05:04] Dr. Ina Stephens: Great. And I do want to also point out that this donation came because you helped somebody really improve their quality of life. You're such a humble person. But one of these times when we're talking, I would love for you to — to the extent you're able to share — dive a little bit deeper into that origin story. I think it's so important for people to have hope that they actually can get better, or to hear stories of people who have been able to make significant improvements. If you don't have hope, it's really hard to keep going.

[1:05:43] Dr. Linda Bluestein: It is hard to keep going. And it's frustrating for a lot of patients, and we try to address all of that. I say to every single patient: this is not easy. We're going to come with all different kinds of recommendations to treat you, but also to help you heal your body and work and live in this body. We don't have a cure for EDS of any kind — hypermobile, HSD, monogenic type, we don't have a cure. And until we have a cure, what we can do is really work with what we have and make you as healthy and as vibrant as you can.
[1:06:29] When they hear that, and then they hear that we want to encourage them to have those tools, I think they feel more hopeful. That's how I felt. It just gave me something a little bit more tangible to work with.

[1:06:49] Dr. Ina Stephens: Most definitely. And you know that our listeners love hearing our hypermobility hacks, so it's time for a hypermobility hack. If you don't have one readily available, I have a suggestion for one that you might — I love hearing your suggestions.

[1:07:07] Dr. Linda Bluestein: Go ahead.

[1:07:10] Dr. Ina Stephens: One of the things that I know we were hoping to talk about and we didn't get to was low-dose naltrexone, and talking a little bit about how it affects inflammation and the immune system and things like that. Do you have any kind of an LDN-related hack? And then maybe we can actually get more into the science of LDN later, or if you have a different hack, that's totally okay too.

[1:07:31] Dr. Linda Bluestein: I think that's a really important point. So LDN — there are so many ways that LDN actually works in the body that we don't fully understand. We know a couple of the receptors that it works on. We know that it works at the mu receptor and it helps the body build its own natural endorphins. We know that it combats inflammation by working at the natural killer cell level and blocking the pathway — the TRPM3, I think.

[1:08:14] Dr. Ina Stephens: TRPM3, I think.

[1:08:15] Dr. Linda Bluestein: TRPM3. Yeah. So it blocks that pathway. It actually decreases inflammation and allows the natural killer cells to work more effectively. We know it's a mast cell stabilizer. How is it a mast cell stabilizer? I don't know if we really know that yet. There's a lot of research going on there.
[1:08:34] But I think my take-home message for patients is that it takes time to work. And I know that can be very frustrating. Patients who are in pain, who are inflamed, who are feeling bad — and we've all been there — you want something that's going to help now today. I want to be able to sleep well tonight. And when I talk about low-dose naltrexone and talk about its benefits and how it can work, and then I say it's not going to work tonight, it's not going to work tomorrow night, it may not work the next night — you have to build it up in the body. We have to let the body acclimate. We have to let the body build its own natural endorphins, we have to heal the natural killer cells. This can take weeks.
So my take-home point is: please try to be patient with it. We can possibly use other things while we're waiting for the low-dose naltrexone to really start working in the body, but it can take weeks for this medication to start working properly. Once it really starts taking effect, I think patients are going to feel a lot better. I don't know if that's been your experience with your patients, but that's what I see with mine. And it's that frustration of "it's not working yet" that can be difficult.

[1:10:00] Dr. Ina Stephens: Yeah, I see both ends of the spectrum. I feel like I see people who say within three days they feel better. I've definitely had a number of people who feel like they've really noticed a difference. And they also feel a difference when they have to go off for surgery or some other reason. So I definitely see both ends of the spectrum, because I also see people who are like, okay, it feels like it's taking a long time. Being patient is hard after you've been suffering for a long time.
[1:10:33] And speaking of being patient — I know you do have quite a long waitlist, but I also want people to know where they can find you and where they can learn more about your amazing work.

[1:10:45] Dr. Linda Bluestein: Thank you. I just want to mention one more thing about our long waitlist and some of the things we're doing to help the patients that are on it. One of our patients in our patient advisory group has taken a leadership role. What she has done, along with some help from some of our undergraduate students, is put together a number of different resources for the patients on the waitlist — including the Bendy Bodies podcast, but also a number of other resources just to learn about EDS, everything from the EDS Society to Bendy Bodies to Maggie Buckley's book that she put together for patients. You may have mentioned this on another episode about Maggie's book — I think she presented it at the Global Learning Conference in Dallas, which I wasn't able to get to. But just a lot of different resources, and also resources on some of the comorbidities. Like, this is what autonomic dysfunction looks like. Here are some of the things you can start doing even before you meet your doctor at UVA. Just giving all these resources out, I think it's going to be really helpful for the patients on the waitlist.
[1:12:07] And that's Danielle King — so I'm giving a shout out to Danielle, who's one of our patient advisors in our patient advisory group.

[1:12:13] Dr. Ina Stephens: That's amazing.

[1:12:13] Dr. Linda Bluestein: She's amazing. And that's been hugely appreciated. The other thing that we're planning on starting is some more group sessions, particularly for follow-ups for patients that have similar comorbidities — talking through how to heal the body, obviously not addressing individual problems and individual medications, but just kind of talking about how to heal the body.
[1:12:44] And we are putting together what we call a patient empowerment day on how to educate the patient. We're going to have how to deal with some pain, how to work with our pain psychologist, working with our RN coordinator, Jessica, who has studied Empowered Relief —

[1:13:11] Dr. Ina Stephens: Empowered Relief.

[1:13:11] Dr. Linda Bluestein: Empowered Relief. Thank you.

[1:13:14] Dr. Ina Stephens: Thank you.

[1:13:14] Dr. Linda Bluestein: Do you know Jessica?

[1:13:17] Dr. Ina Stephens: No, I got to meet Dr. Beth Darnall. First of all, I interviewed her for the podcast, as you may know. And I also got to meet her at the AAOP conference in Orlando in May. It was great to finally get to meet her in person. Empowered Relief is a great program.

[1:13:35] Dr. Linda Bluestein: Yes. Jessica has gotten herself certified in Empowered Relief and is going to be offering that to our patients — patients that are on the waitlist as well as patients that have already been seen. So we're really trying to not just tell those patients on the waitlist, "hang in there, we'll see you whenever we can get to it." I think we owe it to them to be able to help and support. So that's what we're doing.
[1:14:29] Some really nice chair yoga videos, which I think are very accessible for patients that are even in wheelchairs. They can be sitting there and work their upper body. They can practice deep diaphragmatic breathing as part of it. Just using your body and moving your body — even if you feel like you're lying in bed or in a wheelchair, you can still get some benefit from these kinds of interventions.

[1:15:03] Dr. Ina Stephens: Amazing. We will be sure to put links to those things in the show notes so people can have that information. Well, Dr. Stephens, I could talk to you the entire day, but I know I need to let you go. Fortunately, we will be talking again soon. I'm looking forward to that conversation, and thank you so much again for sharing your vast knowledge with us.

[1:15:25] Dr. Linda Bluestein: Absolutely. I always have such a blast doing this. I love talking to you and I'm looking forward to our next session too. Thank you.

[1:15:31] Dr. Ina Stephens: Thank you for listening to this week's episode of the Bendy Bodies Podcast. If you'd like to go deeper, I share additional education, clinical insights, and resources in my newsletter, the Bendy Bulletin, which you can find on Substack at hypermobilitymd.com. You can also help us spread the word about connective tissue disorders by leaving a review, sharing this episode, or sending it to someone who needs it. These small actions truly make a difference in raising awareness about these conditions that are still widely misunderstood.
[1:16:03] Don't forget, full video episodes are available every week on YouTube at Bendy Bodies Podcast. As many of you know, my passion is helping people better understand and navigate symptomatic joint hypermobility. In addition to my clinical and educational work, I offer one-on-one coaching, professional mentorship for healthcare professionals, and expert witness services. If you'd like to learn more, please visit the services page at hypermobilitymd.com. You can find me, Dr. Linda Bluestein, on Instagram, Facebook, TikTok, X, and LinkedIn, all at Hypermobility MD.
[1:16:35] As part of our collaboration with the UVA Health EDS and Hypermobility Disorders Center, for questions or appointment inquiries, you can contact them at [email protected]. That's the letter R — [email protected]. Or call 434-243-8200.
[1:17:01] Our incredible production team is Human Content. You can find them on TikTok, Instagram, and Facebook.

[1:17:05] Dr. Linda Bluestein: And if you're watching this on YouTube and Instagram, @humancontentpods.

[1:17:07] Dr. Ina Stephens: We love bringing on guests with unique perspectives to share. However, these unscripted discussions do not necessarily reflect my views or opinions. Furthermore, perspectives expressed within Bendy Bodies media, including this podcast, do not reflect the views or opinions held by Human Content Inc. Although we may share healthcare perspectives on this podcast, no statements made on Bendy Bodies should be considered medical advice. Listening to or watching this podcast does not constitute a doctor-patient relationship. Please always consult a qualified healthcare provider regarding your own care.
[1:17:38] For information about the Bendy Bodies program disclaimer and ethics policy, submission verification and licensing terms, HIPAA release terms, or to get in touch with us, please visit bendybodiespodcast.com. Bendy Bodies Podcast is a Human Content production. Thank you for being a part of our community, and we'll catch you next time on the Bendy Bodies Podcast.