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Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Fei Li Kuang, MD, PhD, an allergist and immunologist, at Northwestern Medicine, about receiving two APFED HOPE on the Horizon Grants. Disclaimer: The information provided in this podcast is designed to support, not replace, the relationship between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:50] Co-host Ryan Piansky introduces this episode, brought to you thanks to the support of Education Partners GSK, Sanofi, Regeneron, and Takeda. Ryan introduces co-host Holly Knotowicz.   [1:14] Holly introduces today's topic, two APFED HOPE on the Horizon Pilot Grant Projects and today's guest, Fei Li Kuang, MD, PhD, an Assistant Professor in the Division of Allergy and Immunology at Northwestern University Feinberg School of Medicine in Chicago, Illinois.   [1:42] Dr. Kuang is a physician-scientist who takes care of patients with eosinophilic disorders and also performs laboratory research on these disorders in her lab, often using patient samples. Holly thanks Dr. Kuang for joining us.   [2:05] As a child, Dr. Kuang always wanted to be a scientist. She is so grateful to live out her childhood dream, and it's because of the amazing people who have supported her, most importantly, her parents.   [2:29] In graduate school, Dr. Kuang studied B cells. When she went on to do an allergy fellowship, she thought she would study B cells and care for patients with B cell problems. Instead, she fell in love with allergy and eosinophilic disorders.   [2:50] Dr. Kuang is here, in part, because of the different mentors she has had, and in large part, because of the patients she has met along the way.   [3:20] Dr. Kuang had the opportunity to work with Amy Klion at the NIH in a clinical trial to treat patients with a drug that gets rid of eosinophils. She says it was a dream come true after her training.   [4:02] She says she learned so much about eosinophils, their unusual biology, and the mystery behind what they are here for. She got hooked.   [4:15] Dr. Kuang thinks the patients you meet in a clinical trial in a special place like NIH occupy a space in your heart that makes you want to keep working on the subject area.   [4:34] Patients in a clinical trial have given up a bunch of their time to travel to Bethesda, Maryland. For the trial Dr. Kuang participated in as a Fellow, it was a good year of their time to come out and do it.   [4:47] Dr. Kuang felt there were so many interesting questions, from an intellectual point of view, but there was also a real need from patients with chronic conditions. It was a beautiful opportunity to marry scientists with physicians in training.   [5:36] Dr. Kuang shares some knowledge about eosinophils. They are white blood cells that are in all of us. They have little pink packages or granules that "jumped out" in the light microscope almost 200 years ago, when we first identified them.   [6:00] Dr. Kuang says that animals, dating back to reptiles, and different species of dolphins, all have eosinophils. A veterinary scientist, Dr. Nicole Stacy of the University of Florida, has taken photos of eosinophils from all these different species.   [6:21] They've been around for a long time. What are they good for? What we know is that they are associated with disease conditions, such as asthma and others, including leukemia. Those were the classic first studies of eosinophils.   [6:42] Now, we have a different mindset about eosinophils from work by the late James Lee at Mayo Clinic, Arizona.   [6:58] Dr. Kuang credits Dr. Lee with suggesting that eosinophils not just cause us problems but also help treat parasitic infections, maintain tissue homeostasis, help wound healing, and tissue repair. That's a new area we are beginning to appreciate.   [7:41] Dr. Kuang says we need to be open-minded that in some circumstances, eosinophils may be helpful or innocent. Now we have tools to start to understand some of that. We need to collect information from patients being treated with medicines.   [8:10] Ryan tells of being diagnosed as a kid. Doctors explained to him that eosinophils fight parasites, but in some people, they get confused and attack the esophagus. That's EoE. That was easy to understand, but he knew that the researchers knew more.   [8:53] Ryan is grateful to the patient population around eosinophilic esophagitis, and is proud of APFED's support of patients and caregivers with HOPE Grants. APFED has the HOPE on the Horizon Research Program, entirely funded by community donations.   [9:13] To date, APFED has directed more than $2 million toward eosinophilic disease research initiatives through various grant programs. As a patient advocacy organization, APFED works with fantastic researchers who submit innovative research ideas.   [9:32] These research ideas go through an extensive and competitive peer-review process, supported by researchers and clinicians in the APFED community.   [9:42] Today, we're going to discuss two different projects supported by HOPE Pilot Grants with Dr. Kuang.   [10:00] Dr. Kuang thinks there are two ways these grant programs are important to patients. One is advancing research by nurturing seedling investigators. Dr. Kuang got her first grant when she was a Fellow. It was an incredible opportunity.   [10:25] These grant programs also nurture seedling ideas that don't have enough evidence yet to garner the larger NIH grants, and so forth. There are other sources for grants: pharmaceutical companies. The grant programs are for seeds.   [10:49] Patients need to know that there are new things that are given some chance of being tested out. Research takes some time, and the FDA process of getting a drug approved is long.   [11:04] For the newly diagnosed patient, it can feel overwhelming. It feels like there's a loss of control. Sometimes, participating in something like APFED, being part of a community, gives back a sense of control that is lost when you're handed a diagnosis.   [11:45] For patients who have had it for a long time, when they participate in research and become engaged in organizations like APFED, they know they may not directly benefit today, they may benefit later, but they hope future patients will benefit.   [12:21] That gives them a sense of control and hope that things will be better for the next generation. We all want that, especially in medicine, in something that we don't have a very deep understanding of.   [12:58] Dr. Kuang received two HOPE Pilot Grants, one in 2018 and one in 2022. The first grant was awarded when she was a Fellow at the NIH.   [13:05] That first grant explored some effects of eosinophilic depletion of pathogenic lymphocytes in hypereosinophilic syndrome and overlaps with EGIDs. Ryan asks for a broad overview of that research.   [13:25] When Dr. Kuang was a Fellow at the NIH, they were doing a Phase 2 clinical trial, looking at "blowing up" eosinophils in patients who have a lot of them, hypereosinophilic syndrome patients.   [13:39] They included patients who had eosinophilic GI disease, often beyond the esophagus. They may have esophageal involvement, but sometimes their stomach is impacted, sometimes their large bowel is impacted, with related symptoms.   [13:57] What Dr. Kuang and the team noticed in the trial was that just within that little group of patients, there were people who did well, and people who did much better than before, but would have recurrent symptoms, and with no eosinophils in their GI tissues.    [14:16] The researchers wanted to know what was causing these problems for the patient. If you take eosinophils away, what other factors will impact the immune system of the patient, semi-long-term?   [14:32] Their focus was on these groups of patients who had different responses. They looked at the white blood cells that had been previously described as being the responsible, "bad" T cells that lead to eosinophils in the gut.   [14:49] They found that the patients who had recurrent flares of the disease had more of the bad T cells, and the patients who responded well and never complained again about symptoms did not.   [15:03] That allowed researchers to identify that there were subsets of patients with the disease that they were calling the same thing.   [15:18] Dr. Kuang says that work also led them to find that those cells were being reported in patients who had food allergies for which they needed an epinephrine auto-injector.   [15:27] The researchers were curious whether that was just a food allergy issue, or only applied if you had food allergies and eosinophilic GI disease. That HOPE project allowed them to do a pilot study to look at food allergy patients, too. They did, and published it.   [15:45] They published that in patients who have a food allergy and have these T cells, the insides of those cells make different messages for the immune system than the ones that the researchers had previously described.   [16:01] In looking for why there were differences in those responses, they accidentally found that there were differences inside these cells in a completely different disease, which also had these T cells.   [16:21] Dr. Kuang says that the finding was kind of a surprise. If they had found anything in the eosinophilic GI disease patients, that would have been good. They also looked at the epithelial cells and the structure of the GI lining.   [16:42] Even though there were no eosinophils in the GI lining in the patients who had been treated with a biologic that depleted eosinophils, their GI lining still looked like the GI lining of patients who had eosinophilic GI disease.   [16:55] Dr. Kuang asked what was creating those spots. Our gut lining sheds, so there should have been an opportunity for the GI lining to turn over and look new. Something was there, making signals to create these spots. They did a different publication on that.   [17:21] The data from the HOPE Pilot study allowed Dr. Kuang to apply for larger grants. It allowed her to propose to the company that made this drug, when they did the Phase 3 trial, to insert into that special study the study on eosinophilic GI disease.   [17:48] Do patients with eosinophilic GI disease do better or worse on this drug, and how do the T cells look in that trial? That HOPE Grant gave Dr. Kuang the data to ask the drug company to give her money to study it in an international cohort of patients.   [18:17] There were only 20 patients in that first NIH trial, who gave a year of their life, coming to NIH all the time. They continued to be in the study until the drug was approved for asthma.   [18:28] Dr. Kuang says the main reason the company did the Phase 3 trial, which is expensive, and the market share is not huge because it's a rare disease, is that two of the patients went to bat for this disease population.   [18:47] The two patients went and showed the business people what they looked like before, what the drug had done for them, and how their lives had changed. It wasn't the doctors or the great paper from the trial, but the patients who convinced the company.   [19:01] Dr. Kuang says she was so floored by that and moved by what they did for the community. She is grateful.   [19:24] Since the Phase 3 trial, Dr. Kuang and the other researchers realized they had not fully studied the eosinophils. They had studied them in part. They found differences in response. This inspired the second APFED HOPE Pilot Grant.   [21:19] In 2022, Dr. Kuang received a two-year APFED HOPE Pilot Grant to examine how blood eosinophils in Eosinophilic Gastrointestinal Diseases differ from those of other eosinophilic diseases and how T cells in EGIDs differ from those in food allergies.   [21:49] Dr. Kuang says normally, the biggest place of residence for eosinophils is the GI tract. That's where they are normally seen in people who do not have eosinophilic disorders.   [21:59] People who have eosinophilic disorders that attack other parts of the body, asthma, and rarely, the heart. Dr. Kuang was curious to know why one person and not the other?   [22:15] Patients who have eosinophilic GI disease often ask, How do you know this high level in the blood is not going to attack my heart or my lungs in the future? Dr. Kuang does not know.   [22:29] Dr. Kuang says, looking at the cohort at the NIH, that for many patients who have both GI organ involvement and some other space, when they first went to see a provider, their first complaint was a GI condition.   [22:54] If the doctor had only diagnosed a GI condition, nothing else, that would have been wrong. Those patients may not have been monitored as well. A third of the patients originally presented like that.   [23:11] What that meant was that we should be paying attention to patients who have GI disease who have lots of eosinophils in their blood. Moving forward, if there are new complaints, we need to investigate. We can't forget they have that.   [23:27] Dr. Kuang asks, Wouldn't it be great if we had a better tool than needing to wait? Wouldn't it be great if we had a biomarker that said the eosinophils have switched their target location and are going somewhere else?   [23:41] One way to do that is to take different groups of eosinophils and look for differences between those that never target the GI tract and those that do. In patients who have EoE, the eosinophils only target or cause problems in the esophagus.   [23:58] Are their eosinophils any different than those of a healthy person, with none of these conditions? That was the goal of that study.   [24:10] T cells are another type of white blood cell. They contain a memory of foreign things they have encountered, which allows them to glom onto flu, COVID, peanuts, pollen, that kind of thing. They remember.   [24:32] Dr. Kuang says they learned that T cells, at least in the mouse model, are required in the development of eosinophilic esophagitis. The mice in the old study, where mice were forced to develop EoE, did not get EoE if you removed their T cells.   [24:50] In the first APFED HOPE grant study, Dr. Kuang found T cells in the blood and tissue of both EGIDs and food allergy patients, but the insides of the T cells were different. The food allergy patients were children recruited by a pediatric allergist.   [25:19] In the second APFED HOPE grant study, at Northwestern, Dr. Kuang recruited her adult food allergy patients. That was a way to validate what they found in the first study and move further to better characterize those T cells in the two different diseases.   [25:47] Dr. Kuang says we're at a point where we've recruited a lot of people. She says it's amazing what people are willing to do. It's very humbling.   [26:06] Dr. Kuang's team in the lab is really great, too. To accommodate patients, they would see them after work, if that's what they had to do to isolate eosinophils. So they did that, and now they are in the process of analyzing that data. It's really exciting.   [26:28] What's exciting is that they are seeing results that show that eosinophilic GI disease patients have circulating eosinophils that are different from the eosinophils of people who don't have GI involvement, and from people who have EoE.   [26:46] The EoE patients have eosinophils different from those of healthy donors. Dr. Kuang says there's a lot of promise for perhaps unique signatures that could help define these conditions; maybe someday without biopsying, but that's a long time away.   [27:16] Dr. Kuang says they will focus on some candidate targets and try to recreate some of that in a dish with eosinophils from healthy people.   [27:26] What are the signals that lead eosinophils to do this, and can we translate that back to available drugs that target certain cytokines or other pathways, and maybe give some insight to develop drugs that target other pathways for these diseases?   [28:17] Ryan thinks it's exciting that this research is narrowing in on not only the different symptoms, but also how the eosinophils are acting differently in these populations.    [28:44] Dr. Kuang is super excited about this research. You could imagine that all eosinophils are the same, but you don't know until you look. When they looked, using the newest technology, they found there were differences.   [29:33] Dr. Kuang says it is thought that T cells respond to triggers. We don't think eosinophils have a memory for antigens. T cells do. That's one of their definitions. When T cells react to a trigger, they give out messages through cytokines or by delivery.   [30:20] Those are the messages that recruit eosinophils and other cells to come and stir up some trouble.   [30:28] In the mouse model, where you don't have the T cells, and you don't get eosinophilic esophagitis in the particular way they made it happen in a mouse, that middle messenger is gone, so the eosinophils don't know where to go.   [30:44] With drugs that take out eosinophils, you think that you've gotten rid of the cell that creates all the problems. It shouldn't matter what the message says because there's no cell there to cause the damage.   [30:58] What Dr. Kuang learned is that, at least in certain eosinophilic GI diseases, that's not true. You erase the eosinophils from the picture, but that message is still coming.   [31:10] Who's carrying out the orders? Or is that message maintaining the wall of epithelial cells in a certain way that we didn't appreciate because the eosinophils were also there?   [31:24] It's important to study both, because one is the messenger and the other is one of the actors. Whether all of the actions taken by eosinophils are bad, or maybe some of them were meant to be good, we have yet to learn.   [31:40] At the moment, we're using it as a marker for disease activity, and that may change in the future, as we learn more about the roles of these cells in the process.   [31:50] We have drugs now that target eosinophils and drugs that target T cells. Dr. Kuang thinks it's important to study both and to study the impact of these drugs on these cells.   [32:02] You could theoretically use these drugs to understand whether, if someone responds to it, what happens to these cells, and if someone doesn't respond to it, what happens to these cells, and how this disease manifests in this flavor of patients.   [32:54] Dr. Kuang says, Often in science, we take a model. We think this works this way. Then, if this works this way, we expect that if we remove this, these things should happen. We did that with the first clinical trial, with NIH patients.   [33:10] It didn't quite happen the way we thought, so we had to go looking for explanations. These were unusual setbacks. Sometimes you have unusual findings, like the food allergy part.   [33:24] When Dr. Kuang went to Northwestern, she saw different cohorts of patients than she saw at NIH. She saw people who were seen every day, which is a different spectrum than those who are selected to be enrolled in a study protocol at the NIH.   [33:42] That broadened her viewpoint. It's maybe not all food-triggered. They were seeing adults who'd never had food allergies or asthma their whole life, and they had eosinophilic esophagitis suddenly as a 50-year-old. There's a significant group of them.   [34:10] What Dr. Kuang learned and tries to be open-minded about is that where you train, what sorts of patients you see, really shape your viewpoint and thinking about the disease process and the management process.   [34:24] Dr. Kuang says she was so lucky to have experienced that at a quaternary care referral center like the NIH and at an academic center like Northwestern, where there are fantastic gastroenterologists who see so many of these patients.   [34:56] Dr. Kuang and an Allergy Fellow knew they were going to get a wonderful data set from the NIH patients they had recruited, so they thought they had better look deeply at what had been learned before with older technology, with mice and people.   [35:13] They decided to gather previous research, and that ultimately got published as an article. From that research, they learned that people did things in many different ways because there was no standard. They didn't know what the standard should be.   [35:28] Different things you do to try to get eosinophils out of tissue impact how they look, in terms of transcript, gene expression, and what messages they make to define themselves as an eosinophil.   [35:43] They also learned that because eosinophils are hard to work with, they die easily, and you can't freeze them and work on them the next day; you can introduce issues in there that have to be accounted for.   [35:59] They learned that as an eosinophil research community, they ought to come up with some standards so that they can compare future studies with each other. Dr. Kuang says it was impossible to compare the old studies that used different premises.   [36:50] Dr. Kuang says we need to be proactive in creating the datasets in a standard way so that we can compare and have a more fruitful and diverse community of data. It's hard to use the old data.   [37:57] Dr. Kuang says they get fresh blood from patients, and because eosinophils are finicky, they need to be analyzed within four hours, or preserved in a way to save whatever fragile molecules are to be studied.   [38:19] If you let it sit, it starts dying, so you won't have as many of them, and they start changing because they're not in the body. Dr. Kuang experimented with putting a tube of blood on the bench and checking it with the same test every two hours. It changes.   [38:38] Four hours is a standard to prevent the eosinophils from dying. Patients need treatment. If a patient is hospitalized and needs treatment, Dr. Kuang's team needs to be there to get a sample before treatment is started.   [39:03] The treatment impacts it, changing the situation. Much of the treatment, initially, is steroids. When you give lots of steroids, the eosinophils go away. It's no good to draw their blood then.   [39:27] Dr. Kuang also gets a urine sample. The granules of the eosinophils can get into the urine. As they study people with active disease, they want to capture granule proteins in the urine as a less invasive way to monitor activity in different disease states.   [40:04] The patient just needs to give Dr. Kuang either arm and a urine sample.   [41:04] Dr. Kuang explains, you can count your eosinophils after four hours, but to study them, they have different flags of different colors and shapes. Those colors and shapes may mean that it's an activated eosinophil, or they may have other meanings.   [41:41] Dr. Kuang focused on markers that look at whether it's going to spill its granules and some traditional markers of activation.     [41:50] Everyone chooses a different marker of activation. So they decided to look at as many as they could. One marker is not sufficient. They seem to be different in different conditions. The markers are on the surface; you need to analyze them right away.   [42:20] Then, Dr. Kuang breaks open the eosinophils and grabs the messenger RNA. They preserve it to do sequencing to read out the orders to see what this eosinophil is telling itself to make. RNA chops up messages.   [43:00] When you open an eosinophil, a protein you find is RNA, which chops up messages, destroying parts of the cell. You want to save the message. There's a brief time to analyze the eosinophil. Dr. Kuang works to preserve and read the message.   [44:04] Dr. Kuang hopes someday to run a tube of blood, look at the flags on the eosinophils, and say, "I think your eosinophilic GI disease is active," or "You have a kind of eosinophilic GI disease we need to monitor more frequently for organ damage."   [44:38] If another patient doesn't have those flags, Dr. Kuang could say, "I think the chances that you're going to have involvement elsewhere are low." That can give reassurance to folks who are worried.   [45:15] Dr. Kuang hopes that someday we can understand better why some people have food allergies vs. eosinophilic GI disease. They both have T cells, but the T cells have different packages inside with messages to deliver.   [45:34] Every day, Dr. Kuang has to tell patients she doesn't have that answer. Someday, she hopes she can tell a patient she does have that answer.   [46:35] Dr. Kuang tells about an NIH grant she's excited about and the patients she recruits after therapy, or elimination diets, to examine eosinophils and T cells, to see the impacts their treatments or diets have had on eosinophilic GI disease.   [47:18] Dr. Kuang believes there will be predictors of who will respond to an elimination diet and who will respond to steroid therapy. She hopes one day to have that, rather than going through rounds of six to eight weeks followed by a scope.   [47:34] If you have an elimination diet for six to eight weeks, every time you add back a food, you have to do a scope. Dr. Kuang says it would be great if you could be more precise ahead of time for therapy.   [47:48] Dr. Kuang says these wonderful drugs selectively take out parts of the pathway in the immune system. They provide real-life opportunities to ask, why is this important in human biology and the human immune system?   [48:15] Dr. Kuang finds the knowledge itself fascinating and useful. She hopes it informs how we choose future drugs or therapeutic avenues to get the best we can out of what we've learned, so we have more targeted ways of treating specific diseases.   [48:48] Ryan is grateful for all the research happening for the eosinophilic disease community and all the patients participating in the research. He asks Dr. Kuang how a patient can participate in research.   [49:12] There are lots of ways to be involved in research. Dr. Kuang says her patients come away from participating in research feeling good about having done it.   [49:22] Answer a survey, if that's what you have bandwidth for. Where therapies are changing, being a part of a community is good for the community, for the future, but it's good for you, too. It's healing in ways that are not steroids or biologics.   [49:58] Being part of a community is healing in ways we all need when we feel alone and bewildered. You're not alone.   [50:12] There are many ways to participate: APFED, CEGIR, individual institutions, and clinical trials. They all have different amounts of involvement. It's worthwhile to participate, not only for future patients but for yourself. They're fantastic!   [50:56] Dr. Kuang talks about the privilege as a physician of working with APFED and other organizations to do this work.   [51:09] Holly thanks Dr. Kuang for sharing all of this research and exciting information.   [51:25] Dr. Kuang is excited about what her group is doing and is hopeful. Besides showing up for this disease, we have to show up for research, in general, in this country. It's a dark time for NIH research funding.   [51:55] Dr. Kuang asks the young listeners who are thinking of choosing a field to see the potential and get into it, study this, and believe that there's going to be a future with a more nurturing research environment.   [52:36] Dr. Kuang would hate to lose generations of scientists. She says that once she was a little girl who was trying to be a scientist. Her parents had no connections with scientists or doctors, but she was able to get into research, and she thinks you can, too.   [53:48] As a graduate student, Ryan has always been interested in trying to improve things, and he sees hope on the horizon. He's very grateful to the APFED community for supporting these research HOPE Pilot Grants.   [54:17] Ryan is very grateful to Dr. Kuang for joining us today.   [54:22] For our listeners who want to learn more about eosinophilic disorders, we encourage you to visit apfed.org and check out the links in the show notes.   [54:28] If you're looking to find a specialist who treats eosinophilic disorders, we encourage you to use APFED's Specialist Finder at apfed.org/specialist.   [54:37] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections.   [54:57] Dr. Kuang thanks Ryan and Holly and says she enjoyed the conversation. Holly also thanks APFED's Education Partners GSK, Sanofi, Regeneron, and Takeda for supporting this episode.   Mentioned in This Episode: Fei Li Kuang, MD, PhD, Allergist and Immunologist, Northwestern Medicine   Grants and publications discussed: Apfed.org/blog/apfed-announces-2018-hope-apfed-hope-pilot-grant-recipient/ Apfed.org/blog/fei-li-kuang-hope-pilot-grant-award/  Pubmed.ncbi.nlm.nih.gov/39213186/ Pubmed.ncbi.nlm.nih.gov/37487654/   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections apfed.org/research/clinical-trials   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of GSK, Sanofi, Regeneron, and Takeda.   Tweetables:   "I think the patients that you meet in a clinical trial, especially in a special place like NIH, occupy a space in your heart — I don't mean to be all too emotional about this — that makes you want to keep working on the subject area." — Fei Li Kuang, MD, PhD   "When I was a Fellow at the NIH, we were doing a Phase 2 clinical trial, looking at, for want of a better word, "blowing up" eosinophils in patients who have a lot of them, hypereosinophilic syndrome patients." — Fei Li Kuang, MD, PhD   "We're at a point where we've recruited a lot of people. I've had patients drive from the northern part of Illinois … come down and give me blood. It's amazing what people want to do and are willing to do. It's very humbling, actually." — Fei Li Kuang, MD, PhD   "You erase the eosinophils from the picture, but that message is still coming. Who's carrying out the orders? Or is that message maintaining the wall of epithelial cells in a certain way that we didn't appreciate because the eosinophils were also there?" — Fei Li Kuang, MD, PhD   "We need to be proactive in creating the datasets in a standard way so that we can compare and have a more fruitful and diverse community of data." — Fei Li Kuang, MD, PhD   "I think it's worthwhile to participate [in a clinical trial], not only for the future people but for yourself." — Fei Li Kuang, MD, PhD   Guest Bio: Fei Li Kuang, MD, PhD, is currently an Assistant Professor in the Division of Allergy and Immunology at Northwestern University Feinberg School of Medicine in Chicago, IL. She is a graduate of the Albert Einstein College of Medicine Medical Scientist Training Program with both a PhD in Cell Biology/Immunology and an MD.  She completed her Internal Medicine Residency at Columbia University, New York Presbyterian Hospital in New York City, she did her Fellowship in Allergy and Immunology at the National Institute of Allergy and Infectious Disease (NIAID) in Bethesda, Maryland. She is a physician-scientist who takes care of patients with eosinophilic disorders and also performs laboratory research on these disorders in her lab, often using patient samples.

Welcome back to another episode of the Allison J. Taylor LIFT Podcast. What does it take to succeed as a product manager? It's not just about building great products, but also about leadership -- piloting people, processes, and change. In this episode, Alison J. Taylor speaks with Chris Naunheimer about building and making the product and also about selling the product so that it's profitable because it fulfills an unmet need.   They explore the topic through the lens of their new book Power Up Product Management, a quick-start guide that includes stories, practical exercises, and ready-to-use templates, designed to help product managers thrive in the first 90 days of their product management journey. In their conversation, Allison and Chris discuss common misperceptions about product management and share practical advice for new and seasoned product managers. They explore why success is not purely about the product, why the process is rarely linear – more chaotic, and why emotional intelligence (EQ) matters as much as IQ. They also delve into the customer, whoever is going to either use, buy, or influence the product and how critical it is to manage those stakeholders.    Finally, they discuss the often-overlooked skillset that product managers should have – emotional intelligence. The reality is that you must sell people on your idea and to convince people to invest – whether it's with their physical money, emotional energy, or time and effort. Their book delves into what product managers need to know to perform successfully – the tools and the people management. Tune in now!   Key Points from This Episode: •    Discover why product management is about more than just the product itself. •    Explore why stakeholder mapping is a critical skill for product managers to learn. •    Learn why product development is rarely linear and the importance of embracing flexibility. •    Find out what a common misperception is surrounding the Agile framework and how Agile may be more disciplined than the Waterfall framework. •    Unpack why EQ and persuasive communication are essential skills. •    Hear ways technology has impacted the development of products and processes. •    Learn how AI can be a tool within product management and what it cannot replace. •    Hear a real-world example of a simple tool that delivers great value and how. •    Find out what Chris and Allison hope to achieve with their book.   Chris Naunheimer   Guest Biography:   Chris Naunheimer is an adjunct faculty member and a capstone project advisor in the Masters of Product Design and Development Management program at Northwestern University.   Along with a Master's of Product Design and Development Management, Northwestern University, and a bachelor's in mechanical engineering, University of Illinois, Chris has more than 20 years of experience at multi-national Fortune 500 industrial companies with leadership roles in engineering, R&D, strategic marketing, new product ventures, and user-centered design. Chris holds 25 patents and brings this innovation and continuous improvement mindset to teaching. This mindset, coupled with his user experience, design education, and industry experience, brings a broad cross-functional skill set to his roles at Northwestern University.   Chris is passionate about design and has a deeply held belief that we can use design to develop insights and solutions that can change people, cultures, and the world. Tweetables:   “One of the most common misperceptions about product management is that product management is all about the product.” — Chris Naunheimer [0:01:59]   “The user, the customer, or whoever is going to either use, buy, or influence the product; those stakeholders are critical. And if you want to be a good product manager, that's part of what you have to manage.” — @allisonthought [0:05:01]   “Product and product development can be very, very chaotic. It doesn't always follow a linear path.” — Chris Naunheimer [0:06:45]   “Agile adds complexity as much as it is helpful for pivoting in smaller increments.” — @allisonthought [0:12:54]   “One of the motivations for us even writing this book is to be able to help other people. And that's why we created it. I like tools like that.” — Chris Naunheimer [0:26:50]   “We put the stakeholder map in the book to make sure product managers were aware of what potential bumps could occur. Who is the team that you're going to work with and make sure they're inspired, they're understanding why, and they're motivated, not just informed.” — @allisonthought [0:15:20]     Links Mentioned in Today's Episode: Chris Naunheimer on LinkedIn Thought Marketing LLC Power Up Product Management Strava Kool Stop Email Listener feedback to info@thoughtmarketing.com Allison J. Taylor on LinkedIn Allison J. Taylor on X  

Tweetable quote from Matias"Humans are literally the neurons of the sympathetic system of the brain of a planet."SummaryIn this episode, Dr Espen is joined by a leader and teacher in the health awareness and consciousness space, Matias De Stefano. They dive deep into the realms of consciousness, evolution, and the universe.. Known as "The Rememberer," Matias shares his profound insights on the nature of existence, the mistakes that led to our current reality, and the journey of remembering our true selves. Matias also introduces his "Yosoy" movement, a year-long initiatic path designed to help individuals reconnect with their true essence and purpose.About our guest:Matias De Stefano is a Consciousness Educator known as "The Rememberer" for his ability to recall life before birth. Born in Argentina in 1987, his lifelong memories of other dimensions have shaped his teachings on the origins, identity, and destiny of humanity.Since 2009, he has shared his vision globally through lectures, workshops, and transformational journeys across more than 40 countries. Matias is the founder of the Arsayian Foundation and the creator of projects like Harwitum, YOSOY, and The Dragon's Path. His story was featured in the series The Rememberer on National Geographic.

Tweetable quote from Fr. Seán“Life is a dream that the ego is having, the ego is a dream that the soul is having, and the soul is a dream that spirit is having.”SummaryJoin us for a profound conversation as we explore the depths of spirituality, faith, and the teachings of Christ with Fr. Seán ÓLaoire. He introduces the concept of Christ consciousness as a recognition of the inner divinity present in all beings. The dialogue explores the importance of small, supportive communities in spiritual growth, the significance of understanding sacred texts through a mystical lens, and the transformative power of personal experiences in healing and self-discovery.About our guest:Fr. Seán ÓLaoire, PhD, born in Cork, Ireland, holds a BSc in Mathematics and a PhD in Transpersonal Psychology. Ordained as a Catholic priest in 1972, he spent 14 years serving in East Africa and is fluent in six languages. He is a licensed Clinical Psychologist, author, and researcher focused on the effects of prayer. Fr. Seán is Co-Founder and Spiritual Director of Companions on the Journey, a non-hierarchical spiritual community that honors personal experience, interfaith wisdom, and the divine in all.

Tweetable quote from Jerry“We're physical beings, but we have a metaphysical kind of foundation.”SummaryIn this episode, Dr Espen is joined by Jerry Sargeant, a globally renowned healer and transformational alchemist. Jerry shares his incredible story of overcoming a tumultuous past filled with challenges. Discover the power of Star Magic Healing, a unique approach that taps into our dormant DNA and helps activate our superhuman potential. Jerry explains how this living, breathing technology resides within each of us, waiting to be unlocked.About our guest:Jerry Sargeant is a transformational alchemist and globally renowned healer who is redefining what it means to live in full-spectrum health and sovereignty. As the founder of Star Magic Healing and creator of Infinity, the world's leading Ascension Platform, Jerry has guided millions across the planet into deeper states of healing, expansion, and personal mastery.He is the author of four transformational books, including Maximum Wealth, Into the Light, Healing with Light Frequencies, and his latest, Activate Your Superhuman Potential: The Ultimate 5D Toolkit. His mission is crystal clear: to awaken human potential, unify humanity, expand consciousness, and elevate Earth into a new era of love and power.With over 75 countries reached, thousands trained in Star Magic Healing and millions more activated around the globe, Jerry is now building his first healing center in the mystical Transylvanian Mountains of Romania. His workshops, online activations, and the Infinity App (available on Apple and Android) are portals of frequency, freedom, and remembrance.Jerry Sargeant is here to activate a sovereign and unified world!

Tweetable quote from Paul“If you have a big enough dream, you don't need a crisis.”SummaryIn this episode, Dr Espen is joined by a world-renowned expert in stress management, holistic wellness, and integrative lifestyle, Paul Chek. Together, they explore the profound themes of awakening, the nature of love and God, and the role of pain in personal growth. Paul Chek discusses the concept of the 'Pain Teacher', introduces his Four Doctors model and shares insights about his Spirit Gym program.About our guest:Paul Chek is a world-renowned expert in the fields of corrective and high-performance exercise kinesiology, stress management, holistic wellness and integrative lifestyle management. For over forty years, Paul's unique, integrated approach to coaching and education has changed the lives of many of his clients, his students and their clients. By treating the body as an integrated system of systems and finding the root cause of a problem, Paul has been successful where traditional approaches have consistently failed. Author of numerous books, videos and professional development courses, he is the creator of Spirit Gym, founder of the CHEK Institute, and the host of the popular Spirit Gym with Paul Chek podcast.

Tweetable quote from Zach“There's no such thing as free will. But the human being is gifted with the infinite free will to decide how it's going to experience its reality.”SummaryIn this powerful conversation, Dr Espen is joined by Zach Bush, MD, an internationally recognised educator and thought leader. They discuss the profound connections between gut health, the microbiome, and our relationship with Mother Earth. Zach emphasizes the importance of holistic medicine,  emotional aspects of health, how unresolved emotions can manifest as physical ailments and the importance of reconnecting with nature for healing.About our guest:Zach Bush, MD is a physician specializing in internal medicine, endocrinology and hospice care. He is an internationally recognized educator and thought leader on the microbiome as it relates to health, disease, and food systems. Zach Bush, MD founded *Seraphic Group and the non-profit Farmer's Footprint to develop root-cause solutions for human and ecological health. His passion for education reaches across many disciplines, including topics such as the role of soil and water ecosystems in human genomics, immunity, and gut/brain health. His education has highlighted the need for a radical departure from chemical farming and pharmacy, and his ongoing efforts are providing a path for consumers, farmers, and mega-industries to work together for a healthy future for people and the planet. His work in for-profit and nonprofit arenas is creating avenues for collaborative action for all stakeholders in our global community for a regenerative future of health for the planet and our children.

Tweetable quote from Guy"Every decision is an emotional decision."SummaryIn this episode, Dr Espen is joined by the renowned psychologist, Guy Winch. They discuss the critical importance of emotional health, the dangers of chronic loneliness, and the impact of childhood experiences on emotional patterns. Throughout our conversation, they explored the nature of emotions and their role in shaping our lives.About our guest:Internationally renowned psychologist Guy Winch advocates for integrating the science of emotional health into our daily lives. His science-based self-help books have been translated into 30 languages and his 3 TED Talks have garnered over 35 million views. He is the author of the Get Wrong Do Right Emotional Health Newsletter and the Dear Guy column for TED, and he is the co-host of the Ambie Nominated Dear Therapists podcast from iHeartRadio.

Tweetable quote from Lee“Heart energy is the currency of the future.”SummaryIn this episode, Dr Espen had a conversation with intuitive channeler and healer, Lee Harris. With over 20 years of experience, Lee shares his insights on the concept of channeling, the role of guides, and the transformative power of grief. Together, they explore the essence of channeling, Lee's journey of discovering his guides and the significance of the heart in our healing and awakening processes.About our guest:Lee Harris is the author of The Future Human and several other titles. A gifted energy intuitive and channeler, he leads a vibrant online community that reaches 1 million people every month. His acclaimed online events and members community, which is called The Portal, are adventures into the deepest aspects of living, loving, and awakening. Lee is also an accomplished music producer and singer-songwriter whose acclaimed albums have charted as high as No. 1 on the iTunes and Amazon New Age charts.

Tweetable quote from Dr. Nelson"We're living in an age where the consciousness level of the world is expanding a little bit more every single day. And it's never going to return to where it was."SummaryIn this eye-opening episode, Dr Espen sits down with Dr. Bradley Nelson, creator of The Emotion Code and expert on natural healing methods. Dr. Nelson reveals how trapped emotions can cause physical pain, disease, and emotional struggles. Tune in to discover practical tools to improve your emotional and physical wellbeing by tapping into the body's innate healing abilities. This conversation will change how you think about emotions, health, and healing.About our guest:Dr. Bradley Nelson is a holistic chiropractor, medical intuitive, and best-selling author known for his groundbreaking work in energy healing. He is the creator of The Emotion Code and The Body Code, systems that help people identify and release trapped emotional energies that contribute to physical and emotional pain. With over two decades of experience, Dr. Nelson has trained thousands of practitioners worldwide and is a leading voice in the field of natural and energy-based healing. His mission is to empower individuals to heal themselves and live healthier, more fulfilling lives.

Tweetable quote from Dr. Jeff“You can't fabricate something you don't have the capacity to do.”SummaryIn this episode, Dr Espen sits with Dr. Jeff Spencer, a world-renowned chiropractor and elite performance coach. With a remarkable history as an Olympian cyclist and a career dedicated to helping individuals reach their highest potential, Dr. Spencer shares invaluable insights on achieving excellence in all areas of life—physical, mental, emotional, and even spiritual.About our guest:Dr. Jeff Spencer is a world-renowned chiropractor, elite performance coach, and former Olympian. A 1972 Munich Olympics cyclist, he later earned a master's in sports science and became International Sports Chiropractor of the Year. He developed The Champion's Blueprint, helping clients like Tiger Woods, Sir Richard Branson, and U2 achieve peak performance. His coaching has led to over 40 gold medals and eight Tour de France wins. Beyond coaching, he's an author, speaker, and glass-blowing artist. Dr. Spencer continues to mentor high achievers in sports, business, and life.

Tweetable quote from Lee“Qi is not for hurting people. It's for healing.”SummaryIn this episode, Dr Espen has the pleasure of welcoming back Lee Holden, a renowned Qigong teacher and a personal mentor of mine. Their conversation dives deep into the concept of chi, prana, or life force energy—an essential element that connects us all and influences our well-being. Lee also discusses his new book, "Ready, Set, Slow," and how active relaxation can lead to greater efficiency and joy in life.About our guest:Lee is an internationally recognized master of Qigong, licensed acupuncturist, herbalist, and bestselling author. Known for making ancient wisdom accessible to modern life, he has helped tens of thousands of students improve their health, vitality, and well-being through Qigong. Lee's teachings have been featured on PBS stations across the U.S. and Canada, and he offers classes, workshops, and a teacher certification program. His work empowers individuals to heal from injury, slow the aging process, and enhance their energy and quality of life.

Tweetable quote from Sheleana“Sometimes the people who are the best for us are going to feel the worst for us when our nervous system is dysregulated.”SummaryIn this episode, Dr Espen sit down with Sheleana Aiyana, founder of Rising Woman, to explore the power of conscious relationships. They dive into self-trust, emotional awareness, and the role of personal responsibility in building deeper connections. Sheleana shares insights on recognizing red flags, navigating breakups, and embracing ritual and spirituality in relationships. If you're seeking to transform your approach to love and connection, this episode is a must-listen!About our guest:Sheleana Aiyana is the founder of Rising Woman, a global community with over 3 million readers dedicated to healing, self-discovery, and conscious relationships. An international best-selling author, Sheleana's work is informed by her training in somatic healing, inherited family trauma, and Imago couples therapy. As a writer, mother, and wife, she weaves her own transformative life experiences with the wisdom of nature. Her teachings guide others toward deeper intimacy, self-awareness, and connection with the natural world, inspiring them to heal old wounds and cultivate love in all areas of life.

Tweetable quote from Charles“Let's not predict it. Let's declare it.”SummaryIn this episode of The Dr Espen Podcast, host Dr Espen is joined by Charles Eisenstein, a visionary author, speaker, and philosopher. Together, they explore the shifting narratives that shape our society and individual lives.About our guest:Charles Eisenstein is a teacher, public speaker, and author who examines the unspoken narratives that direct our society and our lives. His work covers a wide range of topics, including the history of human civilization, consciousness, economics, spirituality, interdependence, ecology, and how myth and story influence culture. He is the author of The More Beautiful World our Hearts Know is Possible, Sacred Economics, and The Ascent of Humanity.

Tweetable quote from Jeff“Chronic disease is the result of chronic ease.”SummaryIn this episode, Dr Espen is joined by Jeff Krasno, co-founder and CEO of Commune. They discuss the power of good stress and its benefits for our physical and mental health, the importance of deliberately placing ourselves in discomfort and practical tools and strategies for building emotional resilience, including meditation, breathwork, and engaging in difficult conversations.About our guest:Jeff Krasno is the co-founder and CEO of Commune, a masterclass platform for personal and societal well-being and co-creator of Wanderlust, a global series of wellness events. He hosts the Commune podcast, interviewing a wide variety of luminaries from Deepak Chopra and Marianne Williamson to Matthew McConaughey and Gabor Maté. His latest venture expands Jeff's personal story and protocols into a book,Good Stress: The Benefits of Doing Hard Things (Hay House, March 2025). The book dives deeper into the concepts from the course, distilling insights from over 400 podcast conversations Jeff has conducted, along with his personal experiences applying these ideas to transform his own health. It explores deliberate, self-imposed behaviors that promote social, psychological, and physical well-being, offering both a philosophical exploration of true wellness and practical steps to achieve it.

Tweetable quote from Dr. John“If you perceive happiness as a pleasure without pain, a happy without sadness, a positive without a negative, it's only going to teach you that it doesn't occur.”SummaryIn this episode, Dr Espen welcomes back the renowned Dr. John Demartini, a world-leading expert in human behavior and personal development. Dr. John shares his transformative insights on the nature of happiness, the importance of understanding our own behaviors and judgments and revealing how they often reflect our internal struggles. Through the lens of the Demartini Method, he provides practical tools for achieving emotional balance and self-awareness.About our guest:Dr. John Demartini is a polymath and a world-renowned human behavior expert. He has over 4 decades of research across multiple disciplines. His work has been described by students as the "most comprehensive body of work", "an extensive library of wisdom" and ""wisdom of the highest and most valuable order."Dr. Demartini's mission and vision is to share knowledge and wisdom that empowers you to become a master of your own life and destiny.He's an internationally published author, a global educator and the founder of the Demartini Method, a revolutionary tool in modern psychology.His education curriculum ranges from personal growth seminars to corporate empowerment programs. He shares life, business, financial, relationship and leadership empowerment strategies and empowerment tools that have stood the test of time.

Tweetable quote from Suzy“Be what you want to receive and sit in that beautiful place of harmony and coherence so that your body can live the best possible life ever.”SummaryIn this episode, Dr Espen is joined by the founder of Bottoms Up, Suzy Wilson. Together, they discuss how water can be a powerful ally in your health journey and learn why regular colonics may be essential for maintaining optimal well-being. Suzy shares fascinating insights from her 25+ years of experience, including client success stories and cutting-edge research on water.About our guest:Suzy Wilson is a passionate advocate for individuals on their healing journeys, employing a range of holistic approaches to foster well-being. With a solid background in counseling, Suzy has dedicated her career to supporting children and families impacted by trauma, offering compassionate guidance and deep understanding.In addition to her counseling work, Suzy has developed a distinctive method for enhancing gut health through closed colonics, called the Rojas technique, skilfully blending ancient wisdom with modern practices to promote overall wellness. She draws inspiration from the healing properties of water, recognizing its vital life force.Having personally navigated significant health challenges, including a recent journey with cancer, Suzy has honed effective strategies for healing on physical, emotional, and spiritual levels. Her insights and practical advice empower others to take charge of their health, reminding them that they possess the innate ability to heal themselves, should they connect to their bodies' wisdom.

Tweetable quote from John“If you build the right habits, the right habits then build you.”SummaryIn this episode, Dr Espen is joined by renowned mindset and success expert, John Azaroff. They dive deep into the power of mindset and how it can transform your life. John shares his incredible journey from being broke to building five multi-million dollar companies, emphasizing the importance of empowering habits and self-talk. Discover practical tools and techniques that high achievers use to enhance their mental fitness, including the revolutionary app, Innercise, designed to help you train your brain for success.About our guest:John Assaraf is a world renowned mindset and success expert who has appeared numerous times on Larry King Live, Anderson Cooper, and The Ellen DeGeneres Show.He has built 5 multimillion dollar companies, written 14 books including 2 New York Times best sellers and appeared in 16 movies including the blockbuster hit “The Secret” and “Quest For Success” with Richard Branson and the Dalai Lama.He is passionate in helping people tap into their brain's superpower so they shatter limitations and achieve their fullest potential.John founded MyNeuroGym.com which is revolutionizing mindset coaching and mental fitness training. His powerful “Innercise app” helps people rewire their brain for unstoppable success.

Tweetable quote from Nicole “Your nervous system perceives your repressed emotional world as a greater predator to your life than your physical symptoms.” Summary In this episode,Dr. Espen dive deep into the world of mind-body medicine with the incredible Nicole Sachs. She is a passionate advocate for mind-body medicine and healing from chronic pain. Nicole shared her personal journey, which began at the age of 19 when she was diagnosed with a severe degenerative spinal condition that left her in debilitating pain. After discovering the work of Dr. John Sarno, she transformed her life through mind-body medicine, ultimately eliminating her chronic pain and reclaiming her health. About our guest: Diagnosed with a degenerative spinal condition, Nicole Sachs faced a future of debilitating pain. After discovering Dr. John Sarno's work in her mid-twenties, she reclaimed her life through Mindbody medicine. She transitioned from Sarno's patient to his colleague, lecturing with him at NYU, supporting his patients through her private psychotherapy practice, and continuing his work. For over 20 years, Nicole has researched chronic conditions and guided many to freedom from chronic illness. Her Mindbody approach delineates the brain science behind chronic illness and explains how our physical, mental, and emotional systems are working together to keep us safe. As she lays out in clear and relatable stories and steps, most chronic conditions result from a dysregulated nervous system stuck in long-term fight or flight - a misguided attempt to protect us from our inevitable repressed emotions and trauma. 

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Tweetable quote from Nick “Your brain's for having ideas, not holding ideas.” Summary In this episode, we dive deep into the world of business efficiency with Nick Sonnenberg, entrepreneur, best-selling author of "Come Up For Air," and founder of Leverage. After experiencing a challenging business partner breakup and nearly going bankrupt, Nick discovered the importance of operational efficiency and effective communication in the workplace. Nick shares valuable insights on how to create systems that allow teams to work together seamlessly, ensuring that everyone is aligned and focused on their unique strengths. Whether you're running a small startup or a large corporation, this episode is packed with actionable advice to help you run your business like a well-oiled machine. About our guest: Nick Sonnenberg is an entrepreneur, Inc. columnist, guest lecturer at Columbia University, and the WSJ bestselling author of Come Up for Air: How Teams Can Leverage Systems and Tools to Stop Drowning in Work. He is the Founder and CEO of Leverage, a leading operational efficiency consultancy that helps companies implement his CPR® Business Efficiency Framework. This is the culmination of Nick's unique perspective on the value of time, efficiency, and automation which stems in part from the eight years he spent working as a high-frequency trader on Wall Street. The CPR (Communication, Planning, and Resources) Framework consistently results in greater output, less stress, happier employees, and the potential to gain an extra full day per week in productivity per person—just by using the right tools in the right way, at the right time. Nick and his team have worked with organizations of all sizes and across all industries, from high-growth startups to the Fortune 100.

Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. Margaret Collins, a professor of pathology at the University of Cincinnati and a staff pathologist at Cincinnati Children's Hospital Medical Center. Dr. Collins was a member of the task force that produced the Guidelines on Childhood EGIDs Beyond EoE. In this interview, Dr. Collins discusses the guidelines and how they were created and shares some of the results, including an algorithm for diagnosing non-EoE EGIDs. She shares why she specialized in EGIDs and what her hopes are for the future development of the guidelines. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron, and co-host, Holly Knotowicz.   [1:13] Holly introduces today's topic, guidelines for childhood eosinophilic gastrointestinal disorders (EGIDs) beyond eosinophilic esophagitis (EoE).   [1:27] Holly introduces today's guest, Dr. Margaret Collins, a professor of pathology at the University of Cincinnati and a staff pathologist at Cincinnati Children's Hospital Medical Center.   [1:38] Dr. Collins specializes in the pathology of pediatric gastrointestinal disease, especially EGIDs, and is a central pathology reviewer for the Consortium of Eosinophilic Gastrointestinal Researchers (CEGIR), as well as a member of APFED's Health Sciences Advisory Council.   [2:11] As a pathologist, Dr. Collins examines biopsies microscopically. For EGIDs, she determines the peak count of eosinophils per high-power field, or reports the numbers of eosinophils in multiple high-power fields, and analyzes the tissue for additional abnormalities.   [2:33] Dr. Collins then issues a report that becomes part of the patient's medical record and is provided to the patient's doctor.   [2:41] The biopsies Dr. Collins examines may be the first biopsies for a diagnosis, or follow-up biopsies to determine response to therapy, or as part of ongoing monitoring to determine if inflammation has returned even if the patient has no symptoms.   [3:07] Dr. Collins was inspired to specialize in EGIDs after speaking with patients with EGIDs. She used to give tours of the pathology lab at Cincinnati Children's Hospital. She met affected children and their caregivers. Their courage and gratitude moved her.   [3:43] Ryan mentions the wonderful patients and their families in the APFED community. Holly says that as a patient, it's fascinating to meet a pathologist. Pathologists are generally behind the scenes.   [4:42] Dr. Collins specializes in GI pathology, including eosinophilic-related conditions in the GI tract. EoE, eosinophilic gastritis, eosinophilic enteritis, and eosinophilic colitis.   [5:16] In January 2024, “Guidelines on Childhood EGIDs Beyond EoE” were published in the Journal of Pediatric Gastroenterology and Nutrition. Dr. Collins served on the task force that prepared the guidelines.   [5:35] Non-EoE EGIDs affect all sites of the GI tract except the esophagus. All sites of the GI tract except the esophagus normally have eosinophils in the mucosa, which complicates the diagnosis.   [6:03] Like EoE, the diagnosis of non-EoE EGIDs is made after known causes of tissue eosinophilia are excluded.   [6:28] Consensus guidelines help bring attention to best practices and encourage uniformity of practices.    [6:50] This is especially important for rare diseases and for centers that see fewer patients with rare diseases than the more specialized centers. Guidelines based on the best information available help these centers.   [8:03] The best distribution of guidelines is to publish them in the medical literature and sometimes in multiple journals to target audiences of allergists, gastroenterologists, and pathologists. Guidelines may be presented at national meetings to increase awareness.   [8:36] Several specialties are involved in the care of patients who have EGIDs. If patients or caregivers learn of published guidelines, they can also inform their providers.   [9:23] Insurance is a big issue for so many patients. Getting coverage for both diagnostic and treatment options can be complex.    [9:50] The guidelines may be helpful to insurance companies to accept that a certain drug is needed by a patient with a certain condition. However, if the sequence suggested in the guidelines is not followed, there may be difficulty getting coverage in the U.S.   [11:11] Patients can advocate for themselves with insurance companies by explaining that the order of testing is not important but getting the recommended tests done is important.    [11:55] The greatest challenge the task force faced was the lack of large clinical studies and quality research reports. We're making progress in this field but we're at the beginning. Dr. Collins is hopeful that progress will be made in the next two to three years.   [12:24] When there were knowledge gaps, the task force filled them in with their published research and their own experiences. It's always reassuring to have a well-conducted clinical study that verifies that your thinking is correct.   [13:29] How long did it take the task force to create these guidelines? Longer than they wanted it to take! The years they put into composing these guidelines were greater due to the interruption caused by the [COVID] pandemic. They all felt good when they finished.   [14:18] The guidelines were written by 26 authors from five continents. These are international guidelines.   [14:44] Dr. Collins highlights the pathology. The guidelines state that non-EoE EGIDs should be considered clinicopathologic diagnoses, as EoE is, meaning that biopsies from the affected site in the bowel must show excess eosinophils.   [15:10] The guidelines, for the first time, recommend threshold eosinophil values for a diagnosis in the parts of the GI tract other than the esophagus. For a diagnosis of EoE, a threshold value of greater than or equal to 15 eosinophils per high-power field.    [15:36] The guidelines now recommend that for a diagnosis of eosinophilic gastritis, a threshold value of greater than or equal to 30 eosinophils per high-power field is present.   [15:48] For a diagnosis of eosinophilic duodenitis, a threshold value of greater than or equal to 50 eosinophils per high-power field. For a diagnosis of eosinophilic ileitis, a threshold value of greater than or equal to 60 eosinophils per high-power field.   [16:03] For a diagnosis of eosinophilic colitis in the right colon, a threshold value of greater than or equal to 100 eosinophils per high-power field. For a diagnosis of eosinophilic colitis in the transverse and descending colon, a threshold value of greater than or equal to 80 eosinophils per high-power field. [16:12] For a diagnosis in the rectosigmoid, a threshold of greater than or equal to 60 eosinophils per high-power field.   [16:18] These numbers may change over time. One or more thresholds will likely change as we gain more experience with these diseases. The pattern won't change.   [16:29] Several studies have shown that the normal pattern of eosinophil presence in the mucosa in the GI tract is that the number increases from the stomach to the right colon and then decreases throughout the colon to the rectosigmoid.   [17:40] When giving tours of the hospital, Dr. Collins found that people understood better when they knew the numbers and could see the slides of their biopsies.   [18:48] Dr. Collins found literature reviews that suggested that the GI mucosa was often normal in non-EoE EGIDs. She believes that in the next few years, as we publish more and gain more experience, we will realize that is not the case.   [19:14] There is already a method for scoring the mucosa in the stomach in eosinophilic gastritis (EoG) and there are abnormalities found in a majority of patients. We have to work on the rest of the GI tract.   [19:35] Dr. Collins was surprised that there's not very good information about the use of proton pump inhibitors (PPIs) in eosinophilic gastritis and eosinophilic duodenitis. There haven't been studies about that. We need to work on that, too.   [20:47] Dr. Collins isn't sure we can recognize misconceptions about non-EoE EGIDs at this point. It might be premature to label any belief as a misconception. We thought that eosinophils were responsible for all symptoms in EoE, but we know now that is not true.   [21:10] Dr. Collins thinks we need to wait a bit before we decide that we know for sure all about non-EoE EGIDs. Ryan is excited to learn what the research will show us next.   [21:44] Holly loved learning about the algorithm in the guidelines.   [22:01] Dr. Collins says this is the first effort to create uniformity in the way in which non-EoE EGIDs are diagnosed. This algorithm can change over time. It provides signposts for the diagnosis, based on the information we have currently.   [22:20] The diagnosis of non-EoE EGIDs should rest on symptoms and the detection of dense eosinophilic inflammation in the mucosa by biopsy and the absence of evidence of other diseases, such as parasitic and other diseases, that might cause dense eosinophilic inflammation in the GI tract.   [22:46] The algorithm suggests that the particular anatomic site or sites in the GI tract responsible for the symptoms should be determined, for example, eosinophilic gastritis or eosinophilic colitis.   [23:03] The algorithm also suggests that the involved part of the wall in the involved anatomic site should be identified.   [23:13] For example, if the symptoms are suggestive of mucosal disease, without deeper mural or wall involvement, the clinical investigation can proceed directly to endoscopy.   [23:26] However, if symptoms suggest partial or complete bowel obstruction, which is typical of deep muscular involvement, then imaging studies should be considered before proceeding to endoscopy, to confirm or refute that there is a bowel obstruction.   [23:47] If the obstruction is identified, a full-thickness biopsy of the bowel wall may be indicated, possibly requiring a non-endoscopic surgical procedure. If obstruction is not identified, then the investigation can proceed to endoscopy.   [24:05] If there is abdominal distension, suggestive of fluid accumulation, consideration should be given to sampling the fluid, using a needle to pull some fluid out to determine if there are numerous eosinophils in the fluid that would indicate eosinophilic ascites, with the eosinophilic inflammation involving the outer lining of the bowel wall.   [24:41] The signposts are a little involved. They are a reasonable way to approach working up a diagnosis of non-EoE EGIDs.   [25:34] How is EoE ruled out before using this algorithm? It's sometimes difficult to distinguish symptoms that are relevant only to the esophagus and symptoms that are relevant only to the stomach.   [26:26] Someone with upper tract symptoms only will have an upper tract endoscopy, especially if that person has mucosal symptoms that seem to be relevant to the mucosa only. The best thing is to take biopsies of the esophagus, stomach, and duodenum to be sure where the eosinophil infiltrate is.   [27:06] If the person has lower tract involvement only, such as diarrhea and lower abdominal pain, and no upper tract symptoms, a transnasal endoscopy could be used to determine if there is EoE in addition to the non-EoE EGIDs. Each case is different.   [29:12] As a pathologist, Dr. Collins has seen the guidelines for treating eosinophilic conditions evolve. They've become more specific as our knowledge of the data concerning the disease has increased. PPIs are now considered a treatment for EoE.   [30:12] Dr. Collins says we need clinical trials testing therapies in children and adults with non-EoE EGIDs. We need to determine which patients have single-site disease and will only have single-site disease, and which patients may develop multi-site EGIDs.   [30:42] Those aspects will be addressed in the next version of CEGIR, if it's funded.   [30:49] Ryan tells Dr. Collins it's been fantastic having her on the show. This has been a good overview of non-EoE EGIDs and the new methods clinicians are looking into to help people get a better diagnosis and treatment.   [31:11] Dr. Collins says we don't have validated instruments yet to measure symptoms, evaluate the mucosa, and evaluate the biopsies under the microscopes. We need to create those validated tools to help us determine the significance of our findings.   [31:31] Some data strongly suggest that eosinophilic colitis is different from the rest of the EGIDs; certainly from the upper tract EGIDs. We need to move more deeply into what eosinophilic colitis actually is.   [32:05] For our listeners, feel free to check out the article we've been mentioning in the show notes. We'll include a link to it.   [32:11] For those of you who would like to learn more about eosinophilic disorders, please visit APFED.org and check out the links in the show notes.   [32:18] If you're looking to find a specialist who treats eosinophilic disorders, we encourage you to use APFED's Specialist Finder at APFED.org/specialist.   [32:27] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections.   [32:36] Ryan thanks Dr. Collins for joining us today for this great conversation. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron for supporting this episode.   Mentioned in This Episode: Margaret H. Collins, M.D., A.G.A.F., Director, Gastrointestinal Pathology Division of Pathology ML 1035 Cincinnati Children's Hospital Medical Center “Guidelines on Childhood EGIDs Beyond EoE,” Journal of Pediatric Gastroenterology and Nutrition.   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “The best distribution of guidelines is accomplished by publishing them in the medical literature; sometimes in multiple journals to target audiences of allergists, gastroenterologists, and pathologists.” — Dr. Margaret H. Collins    “Guidelines may be helpful to insurance companies to accept that a certain drug is needed by a patient with a certain condition.” — Dr. Margaret H. Collins    “It's always reassuring to have a well-conducted clinical study that verifies that your thinking is correct.” — Dr. Margaret H. Collins    “This is the first effort to create uniformity in the way in which non-EoE EGIDs are diagnosed. This algorithm can change over time. It provides signposts for the diagnosis, based on the information we have currently.” — Dr. Margaret H. Collins   “We don't have validated instruments yet to measure symptoms [for non-EoE EGIDs], evaluate the mucosa, and evaluate the biopsies under the microscopes. We need to create those validated tools to help us determine the significance of our findings.” — Dr. Margaret H. Collins  

Tweetable quote from Jillian “You have to let go of what you thought life was supposed to be like.” Summary Are you ready to unlock the secrets to self-love and transform your relationships? In this episode of the Dr Espen Podcast, I sit down with Jillian Turecki—certified relationship coach, author, and host of Jillian on Love—to dive deep into the emotional roots of love, connection, and self-worth. Jillian shares her journey from yoga teacher to relationship coach, revealing how the mind-body connection shapes our emotional and relational well-being. We explore the true meaning of self-love, which Jillian defines as self-acceptance, and uncover why embracing our imperfections is key to building healthy connections. About our guest: Jillian Turecki is a certified relationship coach, teacher, author, and host of the Podcast, Jillian On Love.  Fueled by an insatiable curiosity about what makes a relationship thrive, Jillian has helped thousands over the last 20 years through her teachings, courses, and writing to revolutionize their relationship with themselves so that they transform their romantic relationships. Jillian is sought out for her compassionate, direct, and very authentic style of coaching, teaching and writing.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate special guests discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, Pastor Ric and a few special guests discuss things unrelated but related to the message from Sunday.   Check out Transformation Church in Español at https://www.youtube.com/@transformationpensacolaespanol

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Jason Ingraham, an adult living with eosinophilic fasciitis (EF), and Dr. Catherine Sims, a rheumatologist at Duke University and a Health Services Research Fellow at the Durham Veterans' Affairs Hospital. They discuss Jason's experiences living with EF and Dr. Sims's experience treating EF. They share Jason's journey to diagnosis and the importance of working with a group of specialists. They share tips on medication and physical therapy, how to communicate with your medical team, and manage your activity and mindset. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:50] Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron, and co-host, Holly Knotowicz.   [1:14] Holly introduces today's topic, eosinophilic fasciitis, with guests, Jason Ingraham and Dr. Catherine Sims.   [1:25] Jason is an adult living with eosinophilic fasciitis (EF). Dr. Sims is a rheumatologist at Duke University and a Health Services Research Fellow at the Durham Veterans' Affairs Hospital.   [1:52] Dr. Sims explains what EF is. Patients may present with symptoms of large plaques on their skin, edema of arms and legs, Raynaud's Phenomenon, contractures of arms or legs, limited mobility, or loss of the ability to do tasks they used to do.   [2:42] EF, as with most eosinophilic disorders, doesn't follow the textbook. Some people will present with one symptom and some with multiple symptoms. There is a disconnect between how we diagnose conditions like EF and how patients present.   [3:01] There are major and minor criteria for the diagnosis. As in Jason's case, it takes time for the symptoms to present. Things develop over time. It took multiple specialists to diagnose Jason.   [3:38] Eosinophilic conditions are incredibly different from each other. When Dr. Sims sees a patient with high eosinophils, she thinks of three major buckets: infection, autoimmune diseases, and cancer.   [4:12] Patients will often see many different specialists. In Jason's case, they had done a skin biopsy that wasn't as helpful as they hoped. That led him to get a deep muscle biopsy to collect the lining of the muscle.   [4:47] Fasciitis is the inflammation of the muscle lining or fascia. A sample of the fascia can demonstrate under the microscope if there is a thickening, swelling, or inflammation of the lining of the muscle.   [5:24] Dr. Sims as a rheumatologist treats a number of rare diseases. Eosinophilic fasciitis is an ultra-rare disease.    [5:43] Jason had a local primary care doctor and a rheumatologist who both did a really good job and referred him to Dr. Sims. She had the benefit of their hard work to guide her next steps. Because EF is so rare, she has pitched Jason's case twice in rheumatology grand rounds sessions.   [6:18] During one of these sessions, Dr. Sims was advised to get the fascial biopsy that ultimately led to the diagnosis. She benefited from the intelligence and input of dozens of doctors.   [6:59] In the Fall of 2022, while hiking on vacation with his wife, Jason was extremely fatigued, and his forearms and lower legs swelled. His socks left deep impressions. It was difficult to reach his feet to put socks on. He spent a lot of time uncharacteristically resting.   [8:09] Jason's primary care doctor ran lots of blood tests. He thought it might be a tick bite. Jason started seeing specialists, having tests and hospital visits.   [8:57] Jason worked with a rheumatologist in Wilmington, an infectious disease doctor, and a hematologist/oncologist who reached out to a Duke expert. He also saw a pulmonologist and a dermatologist. He got the referral to Dr. Sims for March of 2023.   [9:57] The first diagnosis Jason received was after his first hospital stay in January of 2023, when he had bone marrow biopsies, CT scans, ultrasound, and other tests. He was deemed to have idiopathic hypereosinophilic syndrome (IHES).   [10:30] It was only a few weeks before his local rheumatologist said his panels were back and one tipped it from an IHES diagnosis to eosinophilic granulomatosis with polyangiitis (EGPA). He joined the Vasculitis Foundation and researched EGPA.   [11:03] Dr. Sims told Jason that EGPA was a working diagnosis but he didn't check all the boxes. There was the underlying thought that maybe it was something else. He had a second flare when he came off of prednisone in June of 2023.   [11:48] Dr. Sims scheduled Jason for a muscle biopsy while he was off steroids. That's how he got the diagnosis of eosinophilic fasciitis (EF). Jason says the disorder is hard for him to pronounce and he can barely spell the words.   [12:52] Jason's wife Michelle encouraged Jason to track his symptoms and medications and keep track of data. Going from specialist to specialist, the first thing he did was give the history.   [13:31] Jason found it helpful to create a spreadsheet of data with blood test results, meds, how he was feeling each day, his weight, and even notes about when he had difficulty putting his socks on. Jason is an advocate of owning your continuity of care as you see different doctors.   [14:42] Jason says the doctors at Duke talk very well between themselves.   [14:49] Jason likes to look back at that spreadsheet and see how far he's come, looking at the dosage he was on during and after flares and the dosage he's on now, or zero, on some of the medications. That's a little bit of a victory.   [15:16] Holly works at a private hospital without Epic or CareEverywhere so she gives physical notes to her patients to give to their doctors. She comments that a great PCP, like the one Jason had, can make all the difference in the world.   [16:18] Jason's PCP, Dr. Cosgrove, referred Jason to Duke for a second opinion. That was where he met Dr. Sims. He's glad to have both Dr. Sims and his PCP accessible.   [17:35] Jason says the number of questions you have with this type of thing is immense. When you look up EF, you find very little and the literature isn't easily digestible by patients. Being able to reach out to your doctors for a quick question is super helpful. [17:56] Jason has been able to do telehealth follow-ups and not always have to travel or take off work, which has been extremely helpful. He has been at Duke a good handful of times for various things but remote follow-ups are helpful.   [18:52] Dr. Sims says people just don't know about EF as it is an ultra-rare diagnosis. Even physicians don't understand what causes it. It's lumped in with all other eosinophilic conditions but these disorders don't all present the same way.   [19:19] EoE doesn't look like EF, even though they're both driven by the same immune cells. Dr. Sims says the first need is educating providers and patients on what the diagnosis is; awareness in general when a patient is having this swelling of extremities.   [19:44] Dr. Sims says at his baseline, Jason is very active with multi-mile hikes. When Dr. Sims met him, he was off from the baseline of what he was able to do. Being aware of your baseline and changes from that is very informative for doctors.   [20:07] Dr. Sims talks about the patient being a liaison between multiple specialists. Bringing data to your subspecialist always helps facilitate care and come up with a bigger picture of what's happening.   [20:23] Jason first went to Dr. Sims with the diagnosis of EGPA. She said, let's treat the EGPA and see what happens but they kept an open mind. With ultra-rare diseases, sometimes it's difficult for patients not to have a label for their condition.   [20:45] Dr. Sims explains to her patients that sometimes we live in the discomfort of not having a label. She keeps an open mind and doesn't limit herself to just one diagnosis. She seeks feedback from providers who have seen this before and know what works.   [21:07] Just as Jason described, you will go through multiple diagnoses. Is this cancer? Is it a parasitic infection? Where did you travel? You will see many subspecialists. It's extremely anxiety-provoking.   [21:31] When Dr. Sims did her grand rounds, she gave a third of the presentation, and the other two thirds were presented by an infectious disease doctor and a hematologist. In these cases, you need more than one subspecialist to complete the workup.   [22:10] Dr. Sims says there are a lot of misconceptions that the patient will get the diagnosis right away and the right therapy and get better. There are multiple therapies, not just medications. There are lifestyle and work modifications; it's a gradual process.   [22:22] One of Dr. Sims's goals for Jason and Michelle is to get back to doing the things that they enjoy, tennis and hiking. That's a measurement of the quality of life that a patient has.   [22:34] Talking to your doctors about how you're feeling and how you're functioning is huge. It may be that this is your new normal, but it may also be that we can make adjustments to maximize your quality of life.   [23:00] There are misconceptions about the journey of diagnosis and treatment. Have a close relationship with your subspecialist. PCPs have a high burden of expectations. As a rheumatologist who treats rare diseases, it's helpful to take on a part of that burden.   [22:31] If you don't have good communication with your providers and they aren't listening to you, you can always go get another opinion. The provider relationship is life-long.   [23:43] It's important for your provider to take what's important to you into consideration when they make treatment decisions.   [25:00] As a rheumatologist, steroids are a first-line therapy for Dr. Sims. Their role is the quick control of inflammation. The goal is always to get you off of the steroids as soon as possible, in the safest way possible.   [25:17] When Jason came to Dr. Sims, he was on mepolizumab for the working diagnosis of EGPA. Mepolizumab is one of the primary therapies for EGPA. They talked about not making treatment changes as they were navigating what was happening.   [25:40] They didn't want to make a change of medication and then have that be mistaken for disease activity. They didn't want too many variables moving at once.   [25:47] Typically, the first-line therapy is steroids, meant to help with the swelling, pain, and tightness that patients will get lining their muscles and give them a bit more functionality and decreased pain.   [26:00] Long-term, Dr. Sims gives immunosuppressant medication. She prescribed methotrexate for Jason. In EF, the immune system is overly activated, attacking the lining of the muscles and causing the symptoms.   [26:51] If you suppress the immune system activity, that leads to decreased inflammation and symptoms in the patient. Steroid use, over a few months, is detrimental, with low bone density, weight gain, high blood pressure, and diabetes.   [27:14] Dr. Sims starts with prednisone and folds in medications like mycophenolate or methotrexate.   [27:19] Mepolizumab is an interleukin 5 blocker. Interleukin 5 is part of the immune system and is necessary for eosinophils to grow, function, and multiply. The goal of using mepolizumab is to lower the eosinophils that are contributing to the disease symptoms.   [27:48] Methotrexate, prednisone, and mepolizumab can work synergistically or independently. Most rheumatologists start with methotrexate or mycophenolate which have fewer side effects and have been around longer. We know how to manage those.   [28:08] If there is no response, we may add something like mepolizumab. As Jason was already on mepolizumab, Dr. Sims added methotrexate.   [28:20] IVIG, an infusion of immunoglobulin, has also been used as a quick way to control inflammation. It is used in other autoimmune diseases like myositis, which is inflammation of the muscle itself.   [29:08] With untreated eosinophilic fasciitis, the lining of the muscle may continue to be inflamed and can lead to fibrosis, damage that cannot be reversed. The patient can become very disabled. Contracture is one result of this.   [30:16] Jason says when he tried a new medication, he monitored if it was a good fit and if the side effects were less impactful than the underlying disease. Dr. Sims adjusted his dosages or tried to get off certain medicines as needed.   [30:59] After his muscle biopsy from his left calf, it took about a month to get back to walking easily. He was already in physical therapy, going many times for a variety of things. He had back pain, potentially related to his EF. His physical therapist was great.   [31:56] The stretches alternated between upper and lower body. Jason bought tools to do the stretches at home. When he's not feeling as well, he goes back to some of those same stretches. When he was on steroids, he took long walks to strengthen his bones.   [32:39] Jason started making phone calls to supportive family and friends on his walks and started listening to podcasts related to his condition or medications. Getting back to tennis and hiking is important to Jason. He's happy to be out there.   [33:20] Jason was open with his employer about his condition. Some of the weekly meds can make him not feel well. His employer gives him some flexibility. He has good days that far outnumber the bad days. He doesn't have to think about EF too much now.   [34:33] It's nothing like when he was in a flare, especially when he was in a flare before being diagnosed. What gets him through a bad day is giving himself some grace and understanding while he waits for his meds to catch up. He rests more than he wants to.   [35:33] Low-impact exercises like walking help Jason. He's trying to find a support network that gets EF. That led him to APFED, to find anyone experiencing something like what he was. He saw a conference that included a session on EF.   [36:09] Jason signed up for the conference and there he met Ryan's mother who has EF. They were each the first person the other had met with EF. They decided to connect after the conference. They talked on the phone for about an hour.   [36:39] She told Jason how she got into APFED and talked a lot about her son who had eosinophilic diseases. Soon after, Jason talked to Ryan as a primer for this podcast.    [38:15] Having a community to relate to, even if it's one person, is massive. It can make you feel less isolated.   [38:42] Holly says it's hard having a chronic illness. She thanks both Jason and Dr. Sims for sharing so much information and their journey and she asks for last words.   [38:58] Dr. Sims believes finding a community is critical. She interviews a lot of patients for research and isolation is a frequent theme. Even the doctor doesn't know what it's like to live with the condition you live with daily. As Jason said, give yourself grace.   [39:33] Dr. Sims tells her patients that they're different from the general population because they have to spend so much time and energy managing their condition that they can't do x, y, or z today, and that is OK. She says to stay motivated and positive.   [40:12] Find what works for you. Walking is good for your physical and mental health. Have the goal of getting back to what makes you happy. Take initiative and find non-medication ways to recuperate. You have control over ways you can feel better.   [40:43] Connect with others and share your story, like Jason did today. It may make someone's journey a little easier and make them feel less alone. Utilize your condition for good, for a bigger purpose.   [41:04] Jason had wished he could meet someone who could tell him what EF would be like over the years. He says to stay positive and find out what you have control over. Jason believes the future is bright for being able to do many things for a long time.   [42:26] For our listeners who would like to learn more about eosinophilic fasciitis, please visit APFED.org and check out the links in the shownotes.   [42:33] If you're looking to find a specialist who treats eosinophilic disorders, like Dr. Sims, you can use APFED's Specialist Finder at APFED.org/specialist.   [42:43] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections/.   [42:55] Ryan thanks Jason and Dr. Sims for joining us for this excellent conversation. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, and Regeneron for supporting this episode.   Mentioned in This Episode: Dr. Catherine Sims, rheumatologist Duke University Hospital Durham VA Medical Center   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, and Regeneron.   Tweetables:   “EF patients may present with large plaques on their skin, edema of arms and legs, Raynaud's Phenomenon, contractures of arms or legs, limited mobility, or loss of the ability to do tasks they used to do.” — Dr. Catherine Sims   “Steroids are … first-line therapy. Their role is the quick control of inflammation. The goal is always to get you off steroids as soon as possible, in the safest way possible.” — Dr. Catherine Sims   “Methotrexate, prednisone, and mepolizumab can work synergistically or independently. Most rheumatologists start with methotrexate or mycophenolate which have fewer side effects and have been around longer.” — Dr. Catherine Sims   “Stay positive and find out what you have control over. The future is bright for being able to do many things for a long time.” — Jason Ingraham

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Pastor Ric discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and a few special guests discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Pastor Ric discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Pastor Ric discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and John discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, Nate and Kyle discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Kyle discuss things unrelated but related to the message from Sunday. Resources: Total Forgiveness by R.T. Kindle

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Justin, Pastor Brad, Nate, and a special guest discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Justin, Pastor Ric, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Pastor Ric discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Welcome to the Transformation Church Message Re-Cap Podcast! Each week Executive Pastor Justin Oswald and Lead Pastor Brad Livingston follow up, break down and discuss the week's Sunday message. Join them in their conversation of each message preached at TC. You'll gain deeper insight into the message and may even experience the occasional mind-shattering, face-melting, lip-quivering, Tweetable, quotable, mic-drop one-liner! Enjoy.   This week, Pastor Brad, Pastor Justin, and Nate discuss things unrelated but related to the message from Sunday.

Exploring AI's Role in Legal Research, Data Analysis, and Client Management Tanner Jones, your host and Vice President of Business Development at Consultwebs, welcomes you to another episode of the LAWsome Podcast by Consultwebs. In this episode, he is joined by Karl Seelbach, an attorney, founder of Skribe.ai, and expert in legal marketing. They discuss the evolution of AI in the legal field and how AI tools have transformed legal research, data analysis, and legal marketing. Karl shares his experiences with different AI tools and the challenges of implementing them. They also explore the role of AI in decision-making, client management, and running a law firm. Karl provides insights on how to get started with AI in the legal field and emphasizes the importance of testing and evaluating different tools. Key Takeaways: AI tools have revolutionized legal research, enhancing efficiency and enabling natural language interactions with software. Implementing AI tools in the legal field can present challenges, such as choosing the right tool and addressing risks like hallucinations. AI can assist in decision-making by analyzing large data sets, spotting inconsistencies, and assessing exposure or potential jury verdicts. AI tech can also be leveraged to improve client management, from intake processes to chatbots and AI-powered phone support. Staying ahead in the legal tech space required resting and evaluating different AI solutions, considering cost-benefit analysis, and attending legal tech conferences.  Timestamps: 00:01 - Introduction to Karl Seelbach 01:45 - Evolution of AI in Legal Research 03:49 - Challenges of Implementing AI in Legal Research 04:10 - Leveraging AI Tools for Legal Research 08:10 - AI in Data Analysis and Case Evaluation 11:26 - Using AI for Assessing Jury Verdicts and Risk 12:07 - Starting with AI in Legal Practices 14:15 - AI in Medical Record Analysis 15:15 - AI in Client Management and Intake 18:22 - The Future of AI in Legal Marketing 19:14 - Ethical Considerations and Deep Fakes 21:35 - Introducing Scribd AI 22:43 - Speed and Efficiency in Legal Practices 25:25 - Staying Ahead with Legal Tech 27:20 - Final Thoughts and Advice Best way to contact Karl:  https://www.linkedin.com/in/kwseelbach/  Tweetables and Quotes:  “If you're not online, you're invisible to potential clients. A strong digital presence is no longer optional, it's essential.” @consultwebs “ SEO is about making sure your law firm is found by those who need your services. It's about visibility and relevance.” @consultwebs “Content marketing is about providing value. If you can educate and inform your audience, you'll build trust and credibility.”  @consultwebs “Social media is a powerful tool for law firms. It allows you to engage with your audience and build relationships.”   @consultwebs “PPC advertising can be a game-changer for law firms. It's about reaching the right people at the right time.”   @consultwebs   Do you want to find ways to connect with other lawyers whose practice areas align with your cross-referrals? This podcast is for you: To keep up with issues, trends, and problems in their clients' industries To meet and interact with current clients, former clients, potential new clients, and referral sources To connect with other lawyers whose practice areas align with theirs for cross-referrals To earn continuing legal education (CLE) credits To get away from the office and de-stress Subscribe to LAWsome by Consultwebs on Apple Podcasts, Google Podcasts, and Spotify   Learn more about Consultwebs Digital marketing for Lawyers and Law firms: Digital marketing SEO Web design PPC Local Services Ads Email marketing Search engine marketing Content marketing Social media marketing Video marketing Email marketing   Digital marketing Case studies for Law firms Marketing Resources for Lawyers   Consultwebs 8601 Six Forks Rd #400 Raleigh, NC 27615 (800) 872-6590 https://www.consultwebs.com  https://maps.app.goo.gl/p99f5Q2V2HeoYDmYA