Limbic System Retraining and Resources

Welcome to Menopause Rescue I'm Dr. Polly Watson. Midlife women are often caught up in a sea of symptoms. Too often, they're overwhelmed by the lack of support from mainstream health carere inundated with so called experts who are selling solutions which may lack credibility. I'm a menopause Society certified gynecologist with both traditional and functional medicine training I'm here to guide you through this transition and help you decipher the facts from the fads Armed with credible information, I hope you are empowered to rescue and restore your health Making the second half of your life your best Welcome to Menopause Rescue. I'm your host, Dr. Polly Watson. Today I'm so excited to bring on a colleague and a friend, Dr. Amy Doerty. We're going to talk about mass cell activation syndrome x an often overlooked condition that affects nearly every system in the body We'll talk about why symptoms like IBS, migraines, unexplained rashes, dizziness and fatigue And even chronic pain might be connected and how the immune system and histamine pathways play a role in tying all of this together. Dr. Doherty explains how mess cells work, how histamine can affect the gut, brain, heart, skin, and why the nervous system plays such a powerful role in either triggering or calming these responses. If you've ever felt like your symptoms don't quite fit into one neat diagnosis, This conversation will help you connect some important dots and give you a clearer sense of what to do next Thanks so much today for joining us on Menopause Rescue Our guest today is Dr. Amy Doherty She is a doctor of osteopathic medicine and she's done a fellowship in neuromusculoskeletal medicine, which is kind of a new fancy medical terminology for osteopathic manipulation. She's since studied functional medicine and we're so excited to have her with us today to talk about mass cell activation syndrome and understanding how histamine affects us. So I'm so excited to be with Dr. Amy Dorty today. Dr. Amy is going to talk with us about mast cell activation syndrome and We've both been sort of chatting about how in the conventional medical space, mass cells are getting recognized. So Amy, you were just talking about a GI thing and I'd like to chime in with a GYN thing that came up to my awareness this week. Tell me how our friends in conventional medicine are acknowledging mass cell issues Yeah, so it's been really interesting watching this develop with Leonard Weinstock. He was the original gastroenterologist who said, why do all of my IBS patients have Ailerers Danlow's? And why do they all have pOs? right? He's basised out of Stain. Louis, and then he worked with doctors, afron and Moulderings which that's always kind of funny that they're allergists and they chose their boulderings and afron, right? But These three people were the main people to really do the initial research and discovery of this ten years ago while they were going through this initial work, mask cell activation syndrome previously wasn't seen as the spectrum that we know it today. MascA activation was like you are going to the ER needing an EpI pen for almost everything that you encounter, right? So known to be an overactivation of the immune system But what we've learned is that it is on a spectrum. And so there are people who are you're not going to the ER meeting in Epipen, but you just have chronic sinus congestion that you cannot get rid of and all these other things. Now, the reason that the gastroenterologists are so focused on this is because the immune system is highly involved with the GI tract, right? So eighty percent to ninety percent of your immune regulatory cells line the gastrointestinal tract with the mucosa associated lymphoid tissue or malt. So they're getting all these patients that no one can figure out with irritable bowel syndrome right which is more of a symptom than it is a diagnosis. We can't even use it as a diagnosis because we don't like what we do with this thing, right? And they're finally getting some results treating some of the irritable bowel syndrome for what it is which is mascle activation. And so the American Gastroentological Association had a physician paper talking about mass cell activation syndrome, heads and IBS, and that was just in twenty twenty five. The practice guide is AGA clinical practice update on GI manifestations and autoimmune or immune dysfunction in hypermobile Ailers Danlos syndrome, expert review And when I saw that title, I was like, wait, the American Gas Tenological Association is noticing this, you know interplay of the immune system and the joints and just sort of all these like this systems based biology stuff. And that seems like a really great start to these patients getting answers because of the fact that we have, you know mainstream medical being like, yes, let's take a look at this. I love that and I think Oftentimes patients when they have symptoms that hit many different systems, right? So medical training typically has put GI in one bucket, an endocrine in another bucket, an immune in another bucket, cardiovascular in another bucket. And so when someone comes in and they have things that hit across systems were' often historically, at least have been telling these patients, especially when they're women that this is psychiatric, right? This is all in their head. And so from the GYN end of things, Dr. Goldstein who's really big in ishwish and very wonderful advocate for women who have chronic vesibulodenia, chronic vulvar pain syndromes. He is doing a research study right now using a topical antihistamine because we're recognizing the role of histamine in mass cell in chronic bulvar pain, which is fantastic because so many of these women don't have an obvious clinical sign that someone can see their vulva often looks normal. And they're in debilitating pain. So not just not being able to be sexually active, but it hurts to wear jeans and sit down, right? So I love that we are seeing that even in the conventional space, people are putting more things together. And this is something in functional medicine we've been doing for a long time. but it's great as science in general is moving forward. So that's fantastic So If folks aren't familiar maybe we should sort of back up a little bit. We got excited, I got excited about this. Can you just sort of maybe start off with how would someone who's sensitive to histamine or we talked about a spectrum of massell activation syndrome, what does that look What are we talking about? That is very good and I like that question. I didn't want to interrupt you, but I do want to highlight one of the things that you said, which I also feel very strongly about is the The dismissal of patients who are having problems were you noted like its we're told it's all in your head and things like that And I don't think that there is any meanean this when that's done do not attribute you know, like having some type of vendetta if there is a lack of information, right? And so it's like, I think that everyone's doing the best they can But that is oftentimes it brings like I want to start crying when people come into my practice and I say, yes, this all makes sense. This is physiologic. I have a diagnosis. I can you know validate what you're experiencing and they're like, Oh it in my head You know And it's like what that must be like sometimes for years to just have that like, well, there's no explanation for this, It just weird, you know, all those types of things. So sort of dialing down on that that thing that you had mentioned, you know, during that that like, yes, these patients need to be reed and validated because that can actually become part of the disease process where you have lots of anxiety related to this which then brings us back to the pathophysiology, which was the original question, right? Okay. so pathophysiology of mass cactidation syndrome, what is a mask cell R? So masked cells are progenitor cells of the immune system that form in bone marrow, just like all other white blood cells and red blood cells for the most part, right? They are one of the most basic parts of the immune system. So you cannot be born without a mask cell Right There There's disorders where you don't have B cells or T cells, but you cannot be born without a mask cell. And so I'm use my hands when I'm describing this. So you've got histamine, right? And histamine will activate the mask cell And then the mask cell tells the rest of the immune system how angry to get, right? So there's a couple different ways to address this. You If you have really high histamine levels, then that may really activate the mask cell to go nuts But then what if, no matter what your histamine level is, the mask cell is very sensitive or it's not reacting at all histamine, right? So there's both an input and what do you do with that input to consider So in mask cell activation, what's happening is the mask cells are going to react to any type of histamine, right? So there's like basically levels of histamine that people who do not have this are not going to notice at all. So if you have food and it's left out for a while, the bacteria will start producing histamy So for someone who's sensitive to histamine, they may not be able to have leftover food because the change in histamine level from freshly made food to the day after food is going to make a huge impact on their system. Right? And so if you don't know the physiology of this again to that original point of like, Oh it's all in your head. like you can't eat leftover food really, you know. like think of like what that does, right. So there's levels like that. and then also, you know, just, you know, normal you can have like mold, you know, there's been people talking about mold. so it's like two people can live in the same home and then for one person who does not have this, they're not going to be affected nearly as much by the mold and then someone else will just be debilitated by it. again because of the differing way that their immune systems deal with histamine. Another thing that's very important is cell danger response by Robert Navio. That's the main research that we use when we talk about how the unconscious nervous system will affect your immune system And so the unconscious nervous system is one of the biggest levers that we have to pull in medicine that we kind of forget exists, right? And so this is what the POTS patients have to deal with and the mass cell patients and all these things So we've talked about mass cells and how that affects the immune system. Now we're going to talk a little bit about the unconscious nervous system. So in yourconsous we are highly sensitive creatures that are built for survival, not perfection And so some of the stuff that's going on nowadays like If the last hundred years of human history is wildly different than the rest of human history, right? And so we have been built to rise with the sun and go to sleep with the stars and be highly involved in our bodies and be doing physical labor throughout We were not built to rise when our alarms go off and then put on false lighting and groll our phones and have that fight or flight system activated that would normally only be activated if you're running out of food or have a basic need that's not met Right and like have that just going throughout the day and then, you know, going to have food that has been, you know Never do we have to be hungry because There is addictive food everywhere that's literally been engineered to addict you to it, right? So it's like we don't have this awareness of our bodies. and it's a strange thing to recognize that I'm not going to have the same awareness of my body. I have to literally do mindfulness practice Whereas other people lived You know, so there's that aspect of it But this uimesed nervous system that we have was dedicated to survival. And so we have this like flight or flight. And the easiest way to explain this is like if you think of the rabbit going through these normal nervous system things, you have grounded state, which is rabbits just eating food, you know And then the wolf shows up, the fox shows up And then that's fight or flight. So the rabbit starts running and it's got all of its blood flow going to fight or flight. In humans, you can see crazy amounts of strength. L you hear the stories about parents lifting a kid off of their car because they've had the system activated or something, right And so a system like that isn't supposed to be going fororever. Right? That's supposed to be a very short burst like, all right, get your stuff done to survive, save you and your offspring or whatever, right So then what happens is if the rabbit continues to run there comes a point at which it's going to keel over and play dead, right? Like we've all kind of seen that or like the fainting gohats or whatever, where they reach that part of the nervous system where the nervous system says I put all I can in this whole fighter flight thing. it's not working. I'm going to kill over Right? I'm going to play Dad. I'm going freeze Exactly, exactly. and then you're in freeze mode So What this means is that your nervous system is going to instruct every part of your body R? So with the popS people, what they have is that their heart rate and their blood pressure, these basic autonomic functions go crazy because first they're, you know, it seems like their body's like, oh, you're running from a lion,, Let's let's run from a lion. Let's get your heart rate and your blood pressure and everything to go up and that can be in response to, you know a phys like if you cut your arm and it's bleeding and you've got to get somewhere fast, or if you see some you know, like inflammatory work thing going on, you know, that is like gossip or that's going to affect your nervous system the same. Your nervous system doesn't differentiate between, you know, something nasty going on with a family member that's or, you know something that's not life threatening. Your nervous system can't tell the difference, right? So you're going to have these things happen and then if that happens for long enough, then you're going to heel over and have that cop sp thing where you just fall over and have no idea why. but it's a basic automatic function. It's physiology, right? So we can predict this just looking at how the nervous system works Now how this relates to the immune system is that If if you're going fight or flight or you're in a famine, your body may say, you do not have the resources to heal from this right now. or it might say, Oh, we are in trouble. We're being attacked. Let's have the immune system go crazy with inflammation, right? So you get these signals from the outside world that tell your immune system how to act and those signals may not be correct just because of the environment that we're living in. that's a very know strange compared to the rest of human history environment. And I just want to make sure if people are listening that they understand a couple terms. So HOTS is positional orthostasis. So typically people will have fainting or really wild blood pressure swings and It can be very, very debilitating. but if we tie that back to histamine, right? We have histamine receptors in our heart. We have them in our brain. that can be related to refractory migraines. We have them in our gut, like Dr. Amy was talking at the beginning about syndrome, we have them in our skin. we have them in they're all through our body. So this is where that Histamine is touching all these different systems and where some of these folks have gotten dismissed. I just wanted to make sure people understood what POTS was. So yeah, its your immune system isn't able and we have actually seen linkages to autoimmune disease So interesting is that we have almost thirty years of research kind of starting in the nineties talking about all this stuff that's really coming to fruition with some of these explaining some of these diseases that we have. Bessel Vander Kolk wrote The Body keeps the score He's a psychiatrist out of the Netherlands and he has data in there about People like childhood abuse, then drastically increasing your risk of genes turning on for lupus, right So even thinking of that way, even at the genetic level where different types of stresses can cause and different types of traumas can cause change of gene expression, change of immune system function, change of your body's basic on off functions with basic processes like breath, heart rate and blood pressure. So people might be listening to this and think, wow, This sounds like me. I have rable bowel syndrome, I have migraines. I have I get dizzy when I stand up, sometometimes to the point that I've had a couple episodes where I passed out So folks might be wondering if they're interested in learning about Do I have some sort of mass cell activation problem? How do we diagnose this? I think that's really important to kind of talk about because it's tricky And it does get tricky because one thing that is going to drastically help these patients is antihistamine medications. Oftentimes if people just start, you know, alleg or tears,uridity, any effects of any of these, they will notice great improvement in symptoms. So then what that means is that to you're going to reduce your symptoms and it's going to screw with your laps, right And so the main things that we test are histamine Tripace. o tririp Tace is the main lab. Prostagandin, chromagranin, heparin There's some other things produced, you know P Kins and Lukins You can get how many white blood cells are supposed to be per high powered shield in the GI tract. So less than thirteen is normal, greater than twenty per high power field is going to signal the mast cell disorders type of a thing. So oftentimes you need someone to come in in a flare to get a proper test. So that's kind of the issue. is like if you're in a flare, you don't want to go to the doctor's office at that point, right? And then Like it's can be tough to be like, all right now come off of these things that have helped you Right? So for instance, the antiistines are going to lower that histamine level And if you use things, you can use things to help the mask cell be less reactive toorsetin livolence and things like this. So we say, all right, come off of all that stuff so we can see what your actual labs are and get in a flare. It's like sometimes people can't do that. They have to work. They have lives to live Things like that And so oftentimes you can there's actually a questionnaire that was developed by Leonard Weinstock that has some typical symptoms in all the different fields and they have it to the point where they can score it and say, this is your risk of how much your symptoms are due to mast cell activation. So examples and different I'm just reading off of the article that he wrote that and the article that he wrote that's very helpful is mass cell activation syndrome, a primer for the gastroenterologist. They irritable dry cough or need to cough, feeling of shortness of breath or difficultty taking a full breath asthma complaints, burning and or pressure in the chest and heart tests were normal, like EG and stress tests, rapid heart rate, hot flashes that last two to five minutes, nausea, pain in the abdomen, marked attacks of visible bloating or distension within minutes There's like rashes, significant physical weakness or fatigue doing everyday activities. And so they have it for like constitutional and all the different symptoms. And so most of the time because it's like, I have you in the office, you can just answer these questions. I don't have to you know screw with medications or wait till you're in a flare or you know do all these things to put barriers up to you who have already had so many barriers. Oftentimes I'm seing the clinical questionnaire and getting a clinical diagnosis, and then we just start treatment and people are just you know, oh my gosh, I can't believe that I feel so much better and I've been waiting so many years to get results like this, right? So it's like proof is in the pudding. If we can do these kind of more clinical questionnaires and do things that way and get people's results faster, oftentimes I'm doing it that way. If they come in like in a flare then I might do one of those tests, but like depending on insurance coverage, they right? likeike how much this test cost. This is breaking science. so insurance is going to tell you that it's not necessary right? No one's going to cover the testing and it's just like we don't need more barriers for these people. We need less barriers for these people. Right. And I think some of the tests, like maybe trip tase, if I'm remembering correctly Dick Once you get the blood drawn, you have to put it on ice, it has to stay on ice for the whole time. And so sometimes I feel really confflicted about recommending someone get this pretty expensive test If I can't guarantee that it's going to be properly handled, right? Because in my area, this test goes to Mo cllinic. There are a lot of hands that touch that. There's a lot of opportunities for it not to be transported correctly, the results to be incorrect. and then where are we? We just wasted a bunch of money. And so and there's no way for me to know when I get a result Well, is this valid? Was the specimen handled correctly? And so I love this questionnaire and we'll put a link to that. Is that open source or is it behind a paywall or do you? There are some that are behind a paywall and there are some that are open source. I try to find an open source one and put in the show notes because I think that'll be helpful for people Soion syndrome, there's like an actual support group that has open access to this paper that's okay I look bullet fr Oh that's great. Okay. And so you mention some regular pharmaceutical things, regular run of the mill antihistamines. you also mentioned some natural things like quercetin, ludiolen. So let's say someone comes in and they're giving you they've had IBS, maybe they've also had asthma, maybe they also have migraines. they have a lot of sort of autonomic dysfunction, maybe they have a history of trauma, right? capapital T, lowercase T. So you're thinking mass cell. They fill up the questionnaire kindind of looks like everything's lining up in this direction what are you offering that patient? L because I think one of the things that you've alluded to is not just supplements and medication, but also behavioral things we can do to help the nervous system feel calmer because that was sort of the beginning of the problem in the first place. So maybe just kind of walk us through if we're kind of putting three buckets pharmacology bucket, supplement bucket, lifestyle bucket Where are we putting in those buckets to offer this patient that comes in that looks like they've got some mass cell dysregulation? So the first and easiest is going to be avoidance of known triggers, right? So if it heat bothers you, then try to make sure that youve got all the things in place so that you're not No sitting out in the sun in, you know, tropical heat forever right. If cold bothers you, you know, same thing, tryry to avoid that Diet interventions is another thing that's, you know, not going to cost you anything extra as far as medication side effects or things like that. So we talked about not having to leftover food. There's other foods that are higher in histamine, but then that's going to be likeike oftentimes it's like MAOI type things So like ag cheeses or chocolate or just some other things that are like red meats, t fish, unfortunately, tomatoes and spinach are on that list, which I know a lot of us And bas sals we our tomatoes all the time. so yeah That's a tough one to avoid North Carolina. but yeah. Exactly. So yeah, there's those triggers. Then a first line treatment would be like the antihistamine. So taking like benadryl at night you know, secursity effectopenitine or, you know, then you could also do an H two blocker like peepsid The moditing, the editine would be some that could be used. Sometimes I have both an H one and an H two blocker telecast or singular. So another like a lot of things that are used for allergies are also used for this condition to good aect and then the C and Luolin are good ones. I also like making sure that they have proper immune system support because if your immune system is going overboard all the time, then you may be burning through your zinc Vitamin C D, you know, all those typical things that yourour immune system burns through Then you can start getting into chromolin Chromolid has both an oral ingested form and a nebulized form. So I might choose the form based on, you know, hey, they're just unable tolerate food having diarrhea all the time. Let's do oralromolin versus, you know, they're going to get asthma attacks that are pretty bad And like that was really bad with the Canadian wildfires, right? Kind of G gre up in Wisconsins so we noted that a lot. You know, certain times when you have more pollen issues then you can do Hetotoopin and Omlismab are sort of the the last line things that I would use for more recalcitrant cases. So that would be more from the supplementmented perspective This is going to stop the bleeding, right? This is going to make you more functional. But the biggest lever that we can pull is going to be sorting through that unconscious nervous system piece And that's about as difficult as it sounds. How do you access your unconscious nervous system? One problem is that we forget how related our minds are to our bodies, right? And so a lot of the things that we can do is going to be body based therapy So one muscle that I like to work with a lot is the soas muscle He There's three different pathways into the autonomic nervous system And that's places where you have both conscious and unconscious So with the sosoaz muscle, it does gait and posture. Both of those are pretty unconscious, but you can affect them if you want. likeike notice I'm not thinking about walking, but oh, there's like a puddle. so I'll pay attention and I'll take the step, right? Breath work is another way, right? So the diaphragm is a big one where most of the time they can go to sleep at night, notot worry if you're going to forget to breathe because that's not really under your conscious control But then if I start making it under my conscious control, I can start accessing the unconscious nervous system from which it arises Eyes the same thing. I'll walk into a room, my eyes will adjust. I'll look you know across the room and like all that is taken care of me. I walk into a dark room, all that is taken care for me But I feel like you know, looking over there. So again, conscious, unconscious. And in those three body based places, we can start accessing the unconscious nervous system. And so there's lots of eye movement techniques you can do, so as awareness techniques, you can do breathwork that you can do to try to get the body to calm down and have the proper neurologic autonomic input, right And then you can certain remember other tight areas in the body. And I focus more on body based like bottom up rather than top down because many times people do have anxiety and they've had a lot of top down or like, you know, like therapy therapy. And if that hasn't worked Like it's probably not going to work at this juncture. We're missing something. Right I have a colleague who's a mental health expert, and she explained this to me in a way that is just so clear. And she says, you know, the base of your brain is am I safe? The middle of my brain is am I loved? and the front of my brain is can I reason? And so if we're doing cognitive behavioral therapy up in the frontal lobe But our limbic system, the base of our brain, doesn't feel safe, it's not going to work, right? All of that. yes, that's it. And so so I'd love your thoughts on things like primal trust or DNRS or some of these sort of limbic system retraining programs that are online and available for people to sort of do, I mean, probably EMDR might go in that bucket, right? That eye movement desensitization technique. Yeah brain spotting. the base of the brain to feel safe, which kind of goes back to what you've been talking about the whole time is How do we get out of danger, right? How do we get the body to feel safe again so that a normally non noxious stimulus is not interpreted as a threat?ike So when I'm talking to patients about cell danger response, I'm like, it's like your cells have PPSD, right I should be able to hear a car backfire and knock out right think that there's been a bomb going off, right? I should have been like, oh, that was a loud noise. My nervous system should be you know, steady state. and if it's not Something as simple as a glass of really cold water makes someone break out and hives and they come into the doctor and they're told that they're crazy because it's just water. You're made up of water. How could you possibly react to water? But when you're in cell danger response Everything is perceived as a threat because the cells literally don't feel safe. So anyway, I would love your input just because people might be listening and they might be thinking, oh man, this sounds like me. And I think there are a lot of things online for people that aren't gonna hurt anybody Right? So like when you're trying to do limbit system retraining of people, are there online programs that you like that you found your patients really benefit from Yeah, there are a couple but there's the prrime of Trust is one that really gets into the science of it and it's a pretty all encompassing program. They get pretty good response. Sometimes that one can be too much for people though. if they're like, I don't care about the science. I just want something that works right now because that's the place that I'm at then there are ones that just go right into the techniques that you can use and that is the limbic retraining more with like DNRS and GooptA. And what's so interesting to me is that all of these people that created this program is your typical so A lot of times what happens is it's very high performing people that this happens to. because if you're a high performing person, you have been, you know in fight or flight performing for a long time. and So with all the people who created these online programs, it's like this is the type of person that they were before they had their fibromyelology, right which is also kind of on this before they had you know, their like mass cell stuff going on before they had all that And then it was like it brought them to their knees and then they had to learn this lesson of you know, worth is not from works type of a thing. And then they created these programs which is also kind of like the I call it shame two point zero. So one thing I like to warn people of is it's like When we start talking about the most powerful things that we can do for this, it's about making sure that you feel safe. And so then the high performing person is then going to say Why can't I just feel safe then you know, or why why am I the person that, you know, you know, because their whole life they've been shoving their their body symptoms to say, well, that's what the weak people the weak people don't l their body, right? And it's like no, that's not going to help us. We can't do shame two point zero where it's like, you know, and then I sometimes I'll give people the vagal nerve toning stuff and they checked my boxes and I did every singleameor verict and I did all these things. and it's like, no, that's not what we're doing. We're not doing shame two point zero. Like shame one point zero is what got us here. We can't get out of it with shame two point zero. Does that make sense? I think that's so beautiful to hear and so important to say because like, you know, type A girl right here, right? I mean, we're all we're all in this together. And I love that there's so many different online programs. I love that there's a lot of different ways to appach this and it could be vagus nerve work. We've got we're both in a mentorship with Dr. Laura Sellier, who made a great vagus nerve handout. So we'll include that in the show notes. That's a great resource I agree with you. I tried prrimal Trust and You know, I've I've read somatic therapy books. I know the science and I'm like, she dinkps the content where you have to get through hours and hours of science before you get to the thing. And I'm like Can you just let me like why are we being paternalistic? L Don't tell me what I don't know. I've researched this stuff. Let let me just get to the thing. so I hear you. But I think if you're donon't know the science and this sounds like woo and you're trying to around understanding that you're not crazy and this isn't on your head and that there is physiology beforeind it. I think it's really important that resources exist, right. It's just for those of us who are like, let's go, you know, it's a little bit. Ill lot to get through Anything you want to leave folks with because I think this has been great. I love I love not putting shame two point zero on it. I can tell that you are You have worked with highly sensitive patients and are just really gifted at anticipating how they're going to respond and do that with grace. So it's delightful to hear how you're framing this conversation Yeah, thank you. I would just say this is one of the you had put out the call like who loves this? And it's like, I do love this topic because these are the people who often get ignored, denied, you know, it's all in your head. And you know, they're sitting there like, I will I will do anything. I will do anything. And it's like, you know, oh, it's you're crazy. It's like to me, that's such a tragedy, right And so to be able to talk more about it and just the results and what people go through when they're like, you know, being feel like they're being gaslicked by the medical system when they go there for help. I think that that's something important to just recognize sort of that institutional trauma and, you know, I don't think anyone I don't like to place some blame or shame. I don't think anyone's at fault. but I do think it's something that we should all be working to change with, you know, podcasts like this one where you're getting the word out think people understand that. Thank you, dor. Amy. this was really fun. So I'm going to include in the show notes the Veagas nerve handout, links to Bupta, DNRS, and prrimal Trust. We're going to look for the Leonard Weinstock questionnaire and see if we can find that mass cell activation primer for the gastro neurologist. So if it's behind a paywall, we're not allowed plish it but we can at least publish the abstract. so it'll at least help people find where to find it. Any other resources that you would want me to throw in that? There is like actual support groups of people with mast cell activation. so mass cell action So or a UK based one Oh also the other one I like is the Beendy Bodies podcast So one Yeah. so it's an anesthesiologist who has hypermobile EDS and she wasn't able to continue being an anesthesiologist. L she was a, you know, all the things you can't do with EDS. So she was a ballerina, She had to give that up and she was an And' Al is, but right now she has this like hundreds of podcasts, you know, talking to Leonard Weinstock, talking to experts in the field about both Mas Cell and EDS and is a great resource for and's actually you can divide it into where is the maskCell, you know podcasts. And they'll be like, oh, here's this expert in the field, Here's that expert in the field And so she was really able to just take off as far as you know, working in that field with the way that life took her in her pathways. That's awesome. So if folks aren't familiar, EDS is Ellers Danlow syyndrome and it is a genetic condition where folks have hypermobility, but they often have pOots, they often have Histamine sensitivity or mast cell activation syndrome, it's a whole constellation. And again, it's another one of those areas where there are so many symptoms systems that are related that are affected, that don't initially appear to be related, if yout aren't thinking about the broader pathology, that these folks are often not diagnosed in a timely fashion and it can be a really challenging condition All right, so we'll put all that on so that folks have these resources. Thank you so much for sharing your Knowledge, but also your heart with us. I just really feel your compassion for your patience and that comes through beautfully. 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