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Podcast, Provider Interviews

How to Track Symptoms Without Getting Stressed & Overwhelmed, with Dr. Millie: Episode 97 of Arthritis Life Podcast

11 months ago
56 min read
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Summary:

Have you ever been overwhelmed with how to track your symptoms? In this episode, Dr. Millie Lytle (ND) and Cheryl share their best tips to make symptom tracking more manageable. They also discuss the importance of qualitative data and how symptoms affect participation in daily activities. They explore what it means to be a naturopathic doctor and how Dr. Millie’s work at Mymee aims to personalize patient care for people living with symptoms resulting from autoimmune rheumatic disease and long-COVID. Unpredictability is hard, but being open to change for things that are controllable, accepting things that can’t be controlled, and practicing self-compassion can help you cope.

Video of conversation

Episode at a glance:

  • What is a naturopathic doctor? Naturopathic doctors use a holistic approach to patient care. They often include nutrition, mind-body medicine, exercise, and natural approaches to their treatment. Naturopathic doctors must take professional board exams in order to be licensed to practice.
  • Mymee: Mymee aims for personalized care for people with autoimmune rheumatic disease and symptoms resulting from long-COVID, aiming to track variables that may make symptoms better or worse. 
  • Symptom Tracking 101: With Mymee, tracking pain focuses on quality vs quantity – so it’s not just the average 1-10 pain scale. The importance of context and ability to participate in activities is taken into consideration.
  • Coping with unpredictability: Part of being human is dealing with the unknown. Control can also be a double-edged sword: it can be empowering, but also overwhelming if obsessed over and freeing to let go over. 
  • Tips for exercise & fatigue: Overexertion can be trigger, so pace your movement! Incorporating snacks with your exercise may help with fatigue, and calisthenic exercise can be beneficial for strength training with the bonus of having minimal equipment requirements.
  • Words of wisdom: Some things aren’t modifiable / controllable, but be open to possibilities for the things that can be controlled. Practice self-compassion and take care of yourself, first! You don’t have to know it all.

Medical disclaimer: 

All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Episode Sponsors

Rheum to THRIVE, an online course and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. See all the details and join the program or waitlist now! 

Speaker Bios:

Dr. Millie Lytle is a licensed naturopathic doctor, epidemiologist and nutrition specialist dedicated to innovatively preventing and reversing the epidemic of chronic disease. She earned her 4-year post grad ND from the Canadian College of Naturopathic Medicine and a Master’s in Public Health (MPH) in Hamburg, Germany. 

In addition to 15 years of private practice, At Mymee, Dr. Lytle manages the coaching program, including all care delivery. She merges her education, clinical practice and research experience in the fields of naturopathic medicine, functional nutrition and chronic disease epidemiology to supervise client consultations, develop coaching protocols, collect and review real world evidence, participate in research and collaborate internally to build and execute program strategy.

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for nineteen years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.

Episode links:

Full Episode Transcript:

Interview between Speaker 1 (Cheryl Crow) and Speaker 2 (Dr. Millie Lytle)

Cheryl:  00:00

I’m so excited to have Dr. Millie Lytle here today to talk about how to track your symptoms without getting stressed and overwhelmed. Welcome! And can you just let the audience know a little bit about yourself, you know, where you live, and what is your relationship to arthritis and autoimmune disease?

Dr. Millie:  00:19

Sure. Well, I’m the head of coaching at Mymee, and we are a program that provides support and help to people and in identifying their triggers. So, I’ve been doing this full-time for the past three years and prior to that I was working in practice as a naturopathic physician. For those of you who did not know what a naturopathic physician is, I went to — I did my pre-med, and then I went to a four-year postgraduate private medical school that focuses on holistic medicine. So, in addition to studying Medical Sciences, how to assess the body, physical, clinical diagnosis, I also learned about treating the body with nutrients, nutrient deficiencies, supplementation, or homeopathy, clinical nutrition or orthomolecular medicine, diet therapy, as well as acupuncture and kind of the whole gamut of the of the holistic world we covered. And so, depending on what state the naturopath is residing in, they might have gone through the four-year postgraduate or they might have taken an online program. So, not every state licenses naturopathic doctors. If you want to find out, you know, how your naturopath was trained, if they’re licensed, and it really does depend on the state. Not only that, naturopaths go by different nomenclatures or titles depending on what state they’re living in, they might refer to themselves as a naturopathic physician or NP. Personally, I’m licensed in DC. So, in DC, I am an NP. Whereas I usually refer to myself as an MD because where I went to school, that’s how we refer to each other. But then there’s also NMDs, natural medical doctors, and it’s the same training. But if you’re in Arizona, that’s how they refer to them there. So, it is very confusing when you’re shopping around for a holistic team, because you really do want to investigate a little bit more what people’s backgrounds in education are. But I can say that if you want to know nationally which state licenses naturopaths, you can go to the AANP — not to be confused with the American Association of Nurse Practitioners — the American Association of Naturopathic Physicians. 

Cheryl:  02:24 

No, that’s super helpful. I honestly think especially when you’re newly diagnosed, a lot of people refer to it as a time of like alphabet soup, you know, where you’re like, there’s all these shortenings for the conditions. There’s like PSA for psoriatic arthritis, or RA for rheumatoid arthritis. But then, some people refer to it as rheumatoid disease or it’s a rheumatic disease, but it also inflammatory arthritis, but it’s also autoimmune arthritis. And then, there’s — you don’t even wanna start with all the spondyloarthropathies, like axial, you know, radial spondyloarthropathy, or there’s non-radiographic axial spondyloarthropathy, you know. So, yeah, that’s just the conditions. And then, there’s the different kinds of providers, you know, there’s physical therapists, and then there’s physical medicine and rehab doctors. So, anyway, not to go on too long about that. But just thank you for that overview. Because yeah, I think it’s an area of confusion when you hear naturopath. It sounds like what you’re saying, there’s definitely a variety of training and a variety of degrees people could have done and a variety of different legal abilities they could have in state to state. I know in Washington State, I live near, actually, Bastyr University, which is like a great, you know, holistic training facility for — what am I, why can’t I just call it, like, what am I trying to call it? You know, it’s a school for people to become naturopaths.


Dr. Millie:  03:50  

A naturopathic school. 


Cheryl:  03:51

Yeah. 


Dr. Millie:  03:52

It’s the first naturopathic school, actually, it’s the first one.


Cheryl:  03:55 

Oh, wow. Yeah. And then, in our state, you know, it’s definitely that that could be your primary care person is a naturopathic physician in Washington State. So, you have to know, it sounds like, you know, look up on the AANP — not the nurse practitioner one, but for the naturopathic practitioners. Thank you for that overview. And yeah, I think —


Dr. Millie:  04:17

Absolutely.


Cheryl:  04:18

Yeah, oh, anything else you wanted to say?

Dr. Millie:  04:19

Currently, I am — oh, I just wanted to say where I am. I’m in Florida. I live on the Gulf Coast of Florida. And this is an unlicensed state. So, naturopathic doctors aren’t licensed in Florida. I came from New York, which is an unlicensed state. And so, that’s why I do keep my license in the District of Columbia because they, you know, they have a good license, we’re licensed by the Department of Health. And so, it’s kind of integrated into the medical system there, so to speak. And I came from Canada where we’re licensed there as well. So, you know, depending on where I move, I find that I’ve had to change my interpretation of what I am and what I do and what I can do. So, now, I just practice remotely. It’s all remote now, so.

Cheryl:  04:58

I know, that is — yeah, that’s one of the great, you know, I mean, trying to find silver linings in the pandemic, you know, the increased access to remote care has — in virtual care — I mean, it’s helped on many levels for me, just even the logistics of planning, you know, okay, I have to, I see a doctor, I’m in the suburbs, and I see the doctor in Seattle. Oh, I have to plan my trip and, you know, the parking and the, oh, if my appointment runs late, I need to arrange childcare for my child. Now, it’s like, you know, it’s a lot of those logistical barriers have been removed with telehealth, so that’s helpful. Yeah.

Dr. Millie:  05:40

Yeah, I mean, it’s yeah, it’s pros and cons. You want to see somebody in-person sometimes, you want to have somebody look at you physically. 

Cheryl:  05:46 

Oh, yeah. 

Dr. Millie:  05:47

But it is very convenient to be able to call somebody, so.

Cheryl:  05:51

Yeah, yeah. Especially with like ongoing chronic conditions where you might just need that check-in or maybe questions about, you know, side effects or whatnot, but I definitely have gone in-person numerous times to my rheumatologist, especially with, I need her physical exam, you know, she could really tell the difference between different degrees of swelling and stuff even more than me. It’s hard to self-assess your own body sometimes, because even the way you touch yourself, you’re feeling that feedback, right, from the inside out and the outside in at the same time, I personally find it. It’s kind of like how you can’t really tickle yourself, you know? It’s hard. You need an outside perspective, sometimes. But okay, I gotta keep myself on track. This is why I do it outline before each episode, believe it or not, those listening, I do an outline. And I think symptom tracking as somebody who’s lived with a chronic condition — numerous chronic conditions — for 20 years now, it’s definitely something that is so helpful to make sense of why things, why your symptoms maybe are a certain way in certain conditions and a different way in other conditions. But sometimes, it can be overwhelming. But in general, can you explain to somebody maybe who isn’t familiar, like, what do you mean symptom tracking? What is symptom tracking, and why is it important?

Dr. Millie:  07:17

So, you might find that, whether you’ve just been diagnosed, you’ve been struggling for a long time, or you have not been diagnosed as of yet, there are symptoms that you have pretty much day in and day out; they seem constant. Some of your symptoms might only appear at a specific time. So, first thing in the morning, you know, to a lesser degree throughout the day as you’re up and moving around, or after you’ve been moving around you might find your symptoms appear more. And then, other symptoms might appear sporadically. So, there is a difference of when it comes to symptom presentation as to whether, you know, you might want to consider tracking those symptoms or not. And so, not every symptom presents the same. And that can give us clues into helping ourselves deal with some of those symptoms or even kind of drilling down into triggers or maybe what’s causing that symptom or how to anticipate that that symptom might come about. That’s kind of what we start with at Mymee, is looking at symptoms that are not constant, because if you are going to track — now, you did ask me to explain what tracking is. The tracking is just logging, essentially, when you’re experiencing that symptom. And you can use any method of your choice that’s reliable to log. You can do pen and paper, you can mark it on a calendar, in a journal, or you can draft your own spreadsheet and become very meticulous. And of course, now there are numerous apps that allow you to track your symptoms or your day, day-to-day experience. And not just your symptoms, but more as well. So, it’s essentially just capturing the time, the place, the symptom itself, or any detail around it as to what you’re experiencing so that you can puzzle piece for yourself. So, you can kind of be a detective and identify, oh, this is happening now, this happened last week, or this happens everyday at this time. Isn’t that interesting? I didn’t realize before that it happened always at this time, or always in this place, or it’s very random that this happens. And so, I really want to try to understand if I can find — I want to see if I can find out any more information about when this is happening. So, I’m going to track it and see if it correlates with anything else in my life. 

Cheryl:  09:36

Yeah, and I think the first thing people usually anchor everything around is time or this day, that day, this time of day. And then, you go on to track, write down whatever it is that’s important to you that you want the outcome to be, you know, is it pain, is it fatigue, and you also track different kinds of activities that you think maybe contribute to that symptom. Like, let’s say I’m concerned into that, every time I eat dairy, I might be experiencing bloating and joint pain, then you would just kind of say, okay, [Time] ate this, bloating, X amount, right? Is that kind of — am I describing example correctly in your mind expertise?

Dr. Millie:  10:19

Yeah. Yeah, you can start with a hypothesis. So, it is good to have a goal with your tracking. So, the reason that I’m going to track now is to understand if anything that I’m eating, or anything that I’m doing, or anywhere I’m going is contributing to this symptom. And then, you start to track all the details that you can think of kind of around that symptom happening. And if you can narrow in on the time frame between having done something and having experienced the symptom, then you can kind of start to recognize patterns. So, it is good to have, you know, a reason or a goal in mind as to why you’re tracking. Some people just might want to start tracking, they’re just interested, they want to quantify themselves. So, but, you know, it does, if you’re going to do that in the long-term, it takes a lot of coordination and patience and persistence. You know, it’s a lot, it’s a lot to track, especially if you’re tracking everything. Or the more details you track, I think it can become really quite stressful, potentially, especially if you’re wanting to keep yourself accountable to tracking everything without knowing what it is is actually participating in that symptom. And if you’re even on the right track towards finding it or if you’re, there’s something else that you just haven’t thought of, or are missing. So, having a goal, having a goal is a is a good idea. I think you can have a hypothesis, or you can not have a hypothesis, that you can have already had an idea or a hunch that, yeah, I do think that dairy is a problem. Now, maybe it’s some dairy, maybe it’s not all dairy, or maybe it’s an amount of dairy, it’s not any dairy. So, there’s also thresholds that come into play. So, I can eat, you know, a serving of milk a day and not feel pain. But if I then eat three servings of milk, then I’m in trouble. That might be a hypothesis, or you just might be like, okay, I want to know if every time I eat milk or eat dairy, if I’m going to have pain or not. And just follow yourself until you kind of find some patterns. But you can also start without a hypothesis and really not know what it is, like, “I have no idea what is causing this pain. I wonder if it’s associated with anything that I’m doing,” and just try to leave yourself really open and curious about finding out what it could be.

Cheryl:  12:41

Yeah, yeah. And I think, in that case, the goal could simply be communication with your providers or your medical team to kind of say, okay, you know, because that’s, I think some chronic illness patients in the beginning, they kind of get taken aback when they’re asked to rate, you know, in the last three weeks, or the last week, how has your pain or fatigue have been on a scale of 1 to 10. And it’s like, wait, I don’t know. We have — and then we kind of have this like, recency bias, right, where we’re kind of more likely to share information that we can easily retrieve from our memories in the last couple of weeks. So, being able to have a bit of data to go from can help you either, even if you’re not sure about variables correlating, if you just kind of kind of capture your overall progression of your disease, or, you know, I think a lot of times with medications, this is also something where it’s helpful to say, okay, you know, I’m starting to think that maybe my medication plan isn’t enough. I’m feeling more stiff, let me kind of — if you have that baseline to go from, like, yeah, when I first started the medication, or lifestyle factor, whatever it is, my intervention, I was feeling like a 2 out of 10 on stiffness, and now I’m kind of more like a 4 or 5. And I know it’s, those listening will know I’ve said this before, but it’s very, very, very hard, I think, to put numbers on these phenomena in general. So, moment of empathy for anyone who’s like, how — like, I’ve joked before, I think even on the podcast, I can’t remember, but saying like, you know, if someone asked me to rate my pain on a scale of 1 to 10, it’s like asking, like, what color is love? Like, I don’t even — like, those numbers in pain, like, it’s hard. So, anyway, I guess, question for you is, yeah, like, how do you — do you help people, or have any tips for people to conceptualize, like, how to quantify some of this stuff?

Dr. Millie:  14:32

Yeah, we absolutely help people quantify by suggesting they qualify it, because the pain intensity scale — and I’ll talk about it — the pain intensity scale is a tool that’s used by every single rheumatologist and most doctors and, you know, it’s a necessary part of an exam. If your physician is trying to examine you and understand how much pain you’re in, they’re gonna ask you to rate your pain from 0 to 10, or 0 to 100, with 100 being, you know, 10 being the most pain you’ve ever experienced, and 0 being no pain. But if you’re experiencing, and similar to what I was thinking of when you were speaking, was that if you’re in a level 3 pain constantly, then that pain is all of a sudden going to escalate. Because I can tolerate a level 3 for a short period of time if it remains a level 3, but if you’re on a level 3 pain for 48 hours, or you know, 148 hours without relief, then that’s not a level 3 pain anymore. And because there’s no relief from it. And so, anything that there’s no relief from, that’s why that’s not going to be a low-grade pain. It’s going to be a chronic pain, and you’re going to experience it as unremitting, or relentless, even. So, then all of a sudden it becomes a much bigger deal in not just your mind, but your body as well, and the way you experience that. 

15:57

Because pain intensity is also, the level of intensity we experience is also over duration, it’s not only just in that acute moment. And if you’re in pain in that acute moment that the physician is asking you, then it’s going to be different level than if you’re not in pain in that moment, as well, because you’re clouded by the pain that you’re currently experiencing. And then, there might be other, you know, other things about just relating to physicians, which are difficult, which also might make us answer those questions in a way, that’s not always — if it’s not an objective question, it wants to be an objective question, but it’s not an objective question. Because our 0 to 10 pain scale does not always remain the same, because we are human beings. So, some, sometimes, actually, an 8 might be a lot more than an 8. And other times, just depending on a whole lot of other factors, that might be discomfort in other ways. 

16:55

And so, at Mymee, what we do is we have clients qualify their pain. So, for instance, what does an 8 mean to you? What does a 3 mean to you? And so, if you’re thinking about, okay, well, sometimes I have mild pain, sometimes I have moderate pain, sometimes I have severe pain. So, even if you break down the pain scale into three areas — mild, moderate, severe — what is that mild pain? Like, if you have a good pain day, and it’s a mild pain, you know, because maybe you don’t have, you’re never without pain, possibly, hopefully not, that you do you have no pain days. But if you’re having always pain days, what does that mild day feel like to you? Versus, and maybe that feels like an inability to do certain things, like maybe an inability to do exercise, for instance, on a mild pain day. Or maybe that feels like, you know, aches and certain areas of your body, like in your joints, but it doesn’t extend to the full body. Or maybe it includes, you know, maybe it doesn’t include rashes, or any other kind of exacerbating symptoms, whereas a moderate might feel like it occupies like half of your body or you feel it inside and outside. Or it’s not only an ache, but it’s also a shooting. So, this is for everybody to get more specific. I’m not telling you what a moderate is for you, this is something that you can come up with on your own, that you’re really honing in on what that 5 is to you, or what that 6 or 8 is for you. So, then you can attach that number, if you will, to the actual experience of, you know, in a kind of objective way. You are creating an empirical value from an experience of qualitative experience. Whereas, you know, on a 10 day, you might not be able to get out of bed and your body just doesn’t move. So, that’s kind of how we approach it and I think it’s a really helpful way.

Cheryl:  19:03

Yeah, it’s really, really congruent with my training as an occupational therapist. Like, we are all about the like, what is the client, the person’s ability to participate in daily activities and required daily tasks. And when you look at participation, it’s informed and participation is just the doing of stuff, you know, whether that’s walking the dog, making food, eating food, taking care of children, and pets, I’m thinking of my pet right now, and you have a puppy, too. It is informed by the contextual supports. It’s not just — you know, if I have severe, you know, moderate to severe pain, but I have maximum supports, environmental supports, in terms of people that can help me, let’s say, perform cooking tasks so I don’t have to or help me with childcare, then my participation is not going to be as limited as maybe if I had mild to moderate pain, but zero environmental supports. I don’t have help with childcare, I don’t have help with household management, I don’t have help with financial, just finances, that’s a huge part. So, if you just have, you know, looking at, yeah, what is my pain on a scale of 1 to 10, it kind of tells you practically nothing about my ability to function in daily life, other than on a very gross level. Like, typically somebody who’s at a 2 is not going to be able to function as with as much ease — or is going to be able to function with more ease as somebody on like, an 8 or 9. But I feel like there’s just that entire gray area between like a 2 and lower and an 8 and higher is like, practically — sorry, I feel like I don’t want this to become a soundbite or someone’s like, Cheryl says it’s like pointless to write your pain. But it is — it’s just so limiting in terms of if your goal is to improve your quality of life, then you can’t just look at an abstract number that there’s like, there’s zero interrater reliability anyway, if you’re looking from a statistical standpoint, right. Because no one will ever know what the 5 feels like to you, other than you. So, I love your idea of, you know, okay, let’s start there then. What does it mean? What can you — I don’t know if this is what you’re getting at, but I know some people in occupational therapy, or they’re just patients on their own who figured out, “Let me just say what I can and can’t do due to my pain and fatigue. So, right now, I can’t do X-Y-Z.” That’s actually what I tell people sometimes, or advise people to communicate to their doctors. Say, you know, “I can’t,” people come to me and say, “I can’t do my bra. I can’t, you know, tie my shoes,” so, I’m like, tell your doctor that because maybe your pain or your stiffness is, only in your head, you’re saying it’s a 3 or 4 out of 10, but it’s preventing you from functioning in daily life. And they’re, your care team will want to know that. That’s a severe limitation on your ability to kind of function, right. So, sorry.

Dr. Millie:  22:04

Yeah, exactly. And there are — no, absolutely. And that is definitely one way to think about pain and/or stiffness or mobility issues. And anchoring that to a number, if you wish. I mean, you don’t have to anchor it to a number, but it is a way of saying, you know, “On a 3 day, I can take care of my children, whereas on a on a 6 day, you know, I can’t even feed my, you know, I can’t even take care of myself, I need somebody to help me.” And so, whatever that means to you. So, and you can you can look up abilities, questionnaires, or you know, activities of daily living and kind of like see what the medical profession considers like that, that list, you know, are you able to do household chores, are you able to feed yourself, are you able to dress yourself, able to bathe yourself. And some of these questionnaires tend to go into kind of the geriatric fields a lot, or in even injury. But in any case, because it can be really, I think, instrumental just in being aware as to what those abilities and inabilities are for you when it correlates to a certain level of pain. And the physical function as well, which is also a type of, you know, questionnaire, just the direction of — is another way to think of, you know, can I move around the way that I want to, can I do my shopping, can I sweep my house, can I vacuum, can I walk the stairs, things like that. So, tying that to pain, I think, is really, can be really helpful. And even just, yeah, and what you said. So, communicate with your doctor as well just to be aware of yourself, anchored in yourself. Because that’s another, you know, maybe a prime reason to track is to grow, build your own body awareness. Obviously, you’re very aware, most people are very aware of their body, you know, feeling like crap. It can be — but the subtleties around that and when it feels better and worse, you know, can really inform you a lot about how your body’s behaving that day.

Cheryl:  24:09

Yeah, I think like, this is where I get a little bit, in a little bit of circles, but maybe just me sharing the circles will help other people who are struggling. Because I have actually worked in therapy as the patient with psychologists on being able to accept that sometimes I have done — like, my academic mind has reached the point where I’ve done everything I can to try to understand this. I’m jumping ahead, right, so maybe advanced levels of tracking where you are like, okay, I’m using all my hypotheses that are informed by my life experience and my understanding of my condition. And then, there can be times, right — and maybe tell me if you disagree — but where you just, I like to joke, like, a butterfly flaps its wings, you know, in Asia, and then I get a flare up. Like, sometimes there is a randomness to it that I have found it useful to, like, from just a peace standpoint and acceptance standpoint to say like, okay, this, like — forgive my French — but like, shit happens, you know. And I can actually say okay, well sometimes I’ll get my expectations set to where, like, you mentioned the word curiosity earlier. Like, I’m approaching the symptom tracking from like a curiosity. And I find that more mentally healthy than what I’ve seen other people do, and myself at the beginning do, which is this anxiety and almost obsession of like, “Okay, I just got to check everything, and I gotta get everything written down. And then, I’m going to find all the variables, correlate them, and then my life will be better.” And do you see people go through that kind of evolution? Or, I don’t know if there’s a question in there, I’m just sharing how it can be a double-edged sword, let’s put it this way. Super empowering to find your triggers, and then also disappointing. It can be disappointing. You make a beautiful hypothesis, or even maybe it works for three years, and then your body changes, you know. For me, my body changed a lot after having a baby. And then, you’re like, but I had it all figured out before. Ugh, I’m so frustrated. So, what do you think about all that?

Dr. Millie:  26:15

I don’t think that we are machines. I mean, we have a lot of mechanistic and nationalistic structure, and, you know, so we can compare ourselves to a car and a robot, you know, up until a certain point, and then it’s not predictable. Not everything is predictable. Not everything is understandable. Not everything is solvable, or at least is not solvable right now. So, absolutely, I do think that there, I mean, being human is also, you know, having to deal with the unknown. And absolutely, if you’re, you know, a chronic illness patient, there’s a lot of unknown, and there’s a lot of unpredictability, and I don’t think that approaching tracking from a control perspective, even though having a sense of control is very important, also, for people at times, but if you’re trying to conquer it, or then that can also get you into a problem with just with yourself and with the process of tracking, because it can kind of be more stress than it’s worth. So, you know, at Mymee, the coaches are always trying to protect their clients from having to experience this tracking overload. We really try to finesse the tracking process, as opposed to conquer the tracking process. And, people, you know, think, you want to think, you think. Well, if I do, you know, that it’s that whole concept of if I do a little bit, then that’s good, but more is always better, and more is just not always better. We, and I hope, I mean, we’ve probably all realized that on some scale to some extent, at some point in our life, but yet, we still might think that if I can do it faster, or if I can do it more, then it’s going to be better for me, but it actually might be worse for you. Because there is such a thing as burnout. And there’s is such a thing as overwhelm. And those are real things that can hurt the process. Certainly during the COVID pandemic, you know, we work with long COVID patients, and there was certainly like an influx of tracking, you know, by certain kinds of cultures within the COVID. And those, and COVID patients, long COVID patients, have a lot of symptoms, like we’re talking, you know, upwards of 200 symptoms that have been identified now as long COVID. And some of those symptoms are rheumatic, and some of those symptoms are vascular and circulatory, and some of those symptoms are digestive. And so, it can be, it’s like an overwhelming number of symptoms. And so, just by tracking your symptoms is not a solution for your issues, either. And so, there is a limit to all knowledge. I absolutely believe that. There’s a limit to knowledge. I mean, we can’t know everything nor does driving to know everything solve all problems, because there still will be unknowns, like, more unknowns will appear every time we ask a question, there’s another question asked, do you know what I mean? And so, the most important thing is to be patient and to be compassionate with yourself. 

Cheryl:  29:35

Oh, my gosh, yes.


Dr. Millie:  29:36

When it comes to the process. I mean, I think, in everything that you do as a chronic illness patient, a person with chronic illness, you know, a person who now is going on this journey of trying to learn things about yourself, and trying to contribute to your own well-being, and do what you can, compassion for yourself is like the most important thing.

Cheryl:  30:05

Oh my gosh, you’re completely speaking, yeah, speaking my language. And I hope that, you know, I think there’s a variety of people that are listening to this right now. There are some like newly diagnosed and then there’s people who have kind of been through the wringer like me where it’s like you do sometimes — you mentioned burnout. I’ve never really thought of that phrase in terms of like, burnout of the job of being a chronic illness patient. But yeah, it is burnout, because it’s a job to talk to insurance companies, it’s a job to track your symptoms, it’s a job to manage the day-to-day, you know. So, being able to, you know, I’ve certainly gone through stages of burnout. And I think that burnout can lead people to also denial, you know, “Oh, it’s not that bad. It’s not, it’s not that that,” you know, or, and kind of a blinders, like, ostrich put your head in the sand, like, I’m just, if I don’t think about this, then it won’t be real, you know. So, I just think it’s great, what you provide at Mymee. I’m not saying that — I’m not getting paid to say this. I just choose interesting people to come on to this podcast. It’s not like, I would, by the way, anyone listening, I will always be upfront, if there’s somebody on the podcast that I have any sort of financial relationship with them, you know, I’m not going to be like, I’ve heard that some of the big podcasts, people are like, “Oh, they only went on there to like, promote their movie.” I don’t know how that works for like the, you know, the million people podcast. But I think what you’re providing Mymee is so great, because you’re kind of helping — it’s like the Serenity Prayer, right? It’s like, help me to control — this is my version of the Serenity Prayer in summary. It’s like, control what I can, let go and accept and find peace with what I can’t, and the wisdom to know the difference between those two, you know?

Dr. Millie:  31:45

And that’s it. I mean, I really think that that’s the solution to everything. But it is, but it is, I mean, it’s extremely difficult. I mean, when you have so few energy reserves, and you’re focusing all of your energy, you know, more energy than you actually have, just to solve for your health condition. I mean, it’s very easy to either go into denial or to, I mean, any mental escape that you want to or need to take during that time is absolutely justified; it’s completely understandable. Which is why it’s so important to have people helping you. Because it’s just so difficult. It’s so difficult to navigate all of this whole world, like whatever, at whatever point you’re learning about yourself, the specialties, your care team, the diseases or any condition, or chasing down a new one, or you’re between diagnoses, or all of these things. I mean, it takes so much mental energy, especially if you apply yourself in that way towards it. So, I mean, again, I’m just looping back around to that’s why support is so important. That’s why speaking to people who do have answers you want to hear is really important. Because if we’re constantly surrounding ourselves — and this is people, you know, our family, our friends, our coworkers, our care team, everybody, if everybody is constantly telling us that you’re not right, or if that’s what you’re hearing, “You’re not right. It’s not that, it’s this,” then that in and of itself is harmful, stressful, it’s inflammation creating, exhausting, fills reserves that, you know, you don’t have already. You know, if you’re like, though, you feel like you’re the one person trying to get to the top of this, so that you can see off the mountain. And everybody’s saying, “No, you can’t do that.” So, it’s extremely important to find people who are saying, “Yes, you can do that, that is completely allowed and justified and understandable. And you’re right about that.” And so, that doesn’t have anything to do with tracking so much as just —

Cheryl:  34:07

Well, the journey. The hero’s journey. That’s not really a hero’s — yeah, yeah. Yeah. 

Dr. Millie:  34:14

Kind of like, yeah. Yeah. It’s not a hero’s journey. I mean, it’s a, you know, it’s a challenging a challenging thing to live through. So.

Cheryl:  34:27

Yeah, I just say it’s not the heroes — or I don’t like to say mine is a hero’s journey. Not that I don’t feel like I’m a hero. Like, yes, we’re all heroes, but the hero’s journey is one that has an end, you know. You climb the mountain, and it has a resolution. And I think it’s been important for me to realize that, like, it’s more healthy to think of my rheumatoid arthritis and other chronic illness management, like having dysautonomia and like anxiety and other issues, you know, GI issues, it’s like this is just going to be a series of mountains that are going up and down, and some are gonna be is steeper, and some are gonna be enjoyable, then I’ll be able to get like a little ride down the mountain on like a fun little, you know, what’s the word I’m looking for? Oh, brain fog. Sled. Sometimes I’ll sled down the mountain, sometimes I’ll fall down the mountain, you know, but it’s not — I think so many people they put — this is another soapbox I go on — but they put their life on hold until they can just, you know, till they can conquer, like you said earlier, to conquer the disease. And it’s not always in your best interest to do that, I would just say. Because thinking of it as an up and down thing is going to prevent that kind of ultimate disappointment a lot of people experience when they realize there’s, it’s an up and down chronic — chronic means chronic. Like, a lot of times we skip over that. We’re like, “It’s chronic, but I’m gonna figure it out,” you’re like, no, chronic means it doesn’t, it’s there. It’s there chronically. But that doesn’t mean you can’t live better with it, you know, and experience a large amount of improvement in your quality of life. And yeah, it’s really a shame that so many people are just basically diagnosed with autoimmune illnesses, and then basically told, “Okay, so this is your team, it’s you and a rheumatologist. And come back in three months, you know, I’ll talk to you for 20 minutes, and then you come back in three months.” So, this is nothing — I love my rheumatologist. She’s literally like my favorite person, and I’ve invited her to my wedding and like, all this stuff. But I’m like, no matter how amazing you are, seeing somebody for 20 minutes every three months is probably not enough. And like, even if it was, you know, a god, you’re like, okay, who’s gonna help me like on the day-to-day, you know. So, having a team, there’s all these amazing professionals out there. There’s occupational therapists — okay, I am biased because I’m an occupational therapist. Physical therapists and naturopaths. There’s, you know, ophthalmologists, other providers that really specialize in the different parts of the body, and then there’s the different psychology, you know, mental health providers. So, anyway, please, if you feel like you’re on your own, there are so many resources and people out there, so check out Mymee today! Sorry.

Dr. Millie:  37:13

No, I think like, you know, so, I mean, setting expectations, managing expectations, being disappointed, and, you know, these are part of it. And it’s okay. It’s okay to also — it’s okay to be disappointed, even though it hurts. I mean, and it’s okay to strive for permanent remission. They’re both okay. It’s okay to — so, I think dealing with the overwhelm of emotions that comes along with the the pain and the fatigue and all the other kind of systematic symptoms, systemic symptoms, you know, you do need support. That’s why you need support, because it is it is challenging.

Cheryl:  37:57

Yeah. And I think, I just, I want to highlight, again, you mentioned that at Mymee, you help with long COVID. And I think that’s really an amazing resource, because it’s so new, right. There’s so much emerging evidence on long COVID. And there’s so few resources out there. So, like your organization works on or focuses on lupus, multiple sclerosis, rheumatoid arthritis, autoimmune illnesses, and long COVID. Am I missing anything else? 

Dr. Millie:  38:25

Right.

Cheryl:  38:26

Yeah, okay.

Dr. Millie:  38:28

Nope. So, you don’t have to be diagnosed in order to use Mymee. Certainly, people who are on the diagnosis journey, you know, we know it takes, it’s taking five to seven years for some people to get diagnosed. And for all of those years, they’re wondering what’s wrong with them, or being told that they’re fine, or that their hormones are, you know. I mean, they’re just being brushed off a lot of times, unfortunately, when they know deep down that there’s something wrong, that there’s really something wrong between how they used to feel and how they feel now, what they used to be able to do and what they can do now. And, you know, we’re there to help those people as well. But to kind of consider, like, the pre-autoimmune, it doesn’t necessarily even mean you’ll ever be diagnosed with an autoimmune disease. But if you’re suffering from like SIBO, or chronic fatigue, or chronic Lyme, or some of these kind of pre-autoimmune conditions, and then tracking and identifying your triggers can help with that, too. And also, you know, being supported, as I keep mentioning, by health coaches who have been through it. I mean, all of our health coaches have their own autoimmune condition.

Cheryl:  39:30

Oh, I didn’t know about that. All of your coaches have their own autoimmune conditions. Wow. Okay. So, that’s always what people ask me, how do I find a provider who also has lived experience, whether that’s like a health coach or a, you know, psychologist, that kind of thing. People just, there is that level of understanding when you’ve lived through something, you know, that’s amazing. 

Dr. Millie:  39:53

Yeah, absolutely. I mean, I do not. I mean, there is autoimmune disease in my family, but I’m also not providing direct client care at Mymee. I’m really supporting the coaches in making the recommendations and through the coaching process. And we all work as a team. But each of the coaches who are actually providing the direct client care have gone through their own journey of the ups and downs and finding, looking for their triggers and tracking, and they’ve done the whole thing. And we even actually have one coach who became a health coach. She was an RMP before. She went through Mymee as a patient, and then she, like, as a client, and she has IBD. But then after she went through Mymee as a client, she became a health coach. And then, we hired her on Mymee too. So, yeah, yeah, it’s really a great team. And yeah, so thank you for speaking highly of it.

Cheryl:  40:50

Yeah. And I got to meet in-person at the 2022 American College of Rheumatology Conference, I got to meet Dr. Nicole Bundy, who is so great. And we both went to Bastyr College, we figured out. We have all these interesting similarities, and she’s just a spark in the world. And so, I’m looking forward to having her on the podcast as well. And she has such a unique set of professional and personal experiences, you know, but I’ll leave that as a teaser. You have to listen more to find out.

Dr. Millie:  41:21

Yeah, and tune in to Dr. Bundys podcast with Cheryl as well.

Cheryl:  41:24

Yes, yes. Yes. Tune in. So, it doesn’t exist yet. But it will. And I wanted to just, before we get to the rapid fire questions, do you have time for one more kind of tracking question, or should we move on to the —? 

Dr. Millie:  41:39

Yeah.


Cheryl:  41:40

Okay. I think — so, I know nutrition is a big one. And I’m not even gonna touch it right now, just because I don’t think we have enough time. But just know that at Mymee they have people that can help you with the various variables and tracking for that. But one, I wanted to talk about exercise and fatigue, because this is one of the trickiest ones. Because I know evidence wise for rheumatoid arthritis, like, one of the most, most reliable lifestyle factors that can improve your joint pain and fatigue and quality of life is exercise. But exercise, the word exercise represents — and I’m saying this as a former college athlete, right — a giant variety of things. It could be taking a walk with a dog, it can be running a marathon, it could be power lifting weights, it could, you know, so — and and I think, okay, the question is, a lot of people have a hard time figuring, disentangling the relationship between, let’s just say, cardiovascular exercise and fatigue. I personally find that when I, if I overdo it, if I either push my heart rate too high or push it moderately for too long, I will experience worse fatigue. But a short, like, for me, I’ve kind of found a sweet spot for exercise for cardiovascular that doesn’t induce fatigue. But what are some tips for people that are like, I know a lot of people get discouraged because we’re like, “I know I’m supposed to exercise, but I feel worse when I exercise. Like, what do I do?” So, what are some tips?

Dr. Millie:  43:09

The first tip is to substitute the word exercise for ‘movement’. 

Cheryl:  43:14

Movement. Yeah. Yeah.

Dr. Millie:  43:15 

Because it’s really, it’s really movement that is being called for and its movement at your pace. No responsible prescription recommendation is ever going to be anything that’s over-exertional. Oh, you know, actually, over-exerting is a huge trigger. And this always shocks people, you know, marathon runners, they do HIIT, Pelotoners, and they then they all of a sudden come down with an autoimmune — it’s like, I was so healthy, I was doing this great exercise, and then now I can’t do anything. And it’s very difficult to be in the present where they are given how fit they were. But having maximal fitness like that is extremely stressful and tiring on the body. And I’m not saying that everybody who does engages in the exercise like that is going to get autoimmune disease, but it’s extremely taxing on the adrenal glands. And so, chronic stress, anything that’s over-exertional, I mean, it’s a big trigger. The literature, you know, the research literature is quite scant on over-exertion and as a trigger for autoimmune disease. And yet we know that it’s real, because we hear it all the time. And the same for COVID as well as autoimmune. And so, replace the word exercise with movement, and only do what you feel you can do without needing to rest afterwards. Your exercise should not make you have to, you know, have a daylong nap afterwards. You shouldn’t have to recover, push through. The word ‘pushing through’, you know, we think it’s a champion, and it’s a warrior. And all these things have been, you know, associated with kind of, you know, it’s been branded as a way to cope with an autoimmune disease or rheumatic illness. And that can actually be doing quite a bit of damage for you if you have, if you’re engaging in anything. Even if it feels good at the moment, it’s really just exhausting you too much for it to be worth it for you to do that type of strenuous activity at this time, if it causes you to have to take a day, a week off, you know. Specifically, definitely, if it’s causing joint pain, but even if it’s causing just fatigue, or needing to sleep it off for a long period of time. It’s probably not worth it, especially if it’s something that you’re trying to implement into your, you know, you’re trying to continue to work out despite having, you know, being sick. You do need to treat yourself as a sick person; you need to treat yourself as if you’re your own child in order to properly care for yourself. And by getting ahead of your energy and creating some energy reserves, then you will find that you’ll be able to do those things without having to force it or push yourself to do something that is really not going to be good for you over the short or the long-term, quite honestly. 


Cheryl:  46:19

Right, that’s —

Dr. Millie:  46:20 

That was that was like definitely my take on it and really what we see at Mymee. Like, we’re always working with people’s activity levels, and how much they can do comfortably now, because it’s much more important to be able to do it more frequently than it is to be able to do it hard, you know, that concept that I was talking about before, more is not better, more is not better, more intense is not better. It’s being able to sustain what you want to do day in and day out, that is what gets you to a place where you actually can heal and recover. And, you know, without the need for deep, dark periods of recovery, which, you know, there’s nothing wrong with that, if you need it, you have to do that. So, I definitely recommend you recover if you need to. If you have to get yourself into a place where you have to recover by deliberately putting yourself into some form of intensity that is too much for the moment, I would not recommend.

Cheryl:  47:15

That’s how, yeah. I, once, at one of the trainings for, you know, occupational and physical therapists, the physical therapists brought up the idea of, I think she called them ‘exercise snacks’, you know, like a little snack versus a giant meal, and maybe movement snacks. So, yeah, you know, can you do a little dance break? And, or if you’re, you know, in the moment you are confined to your bed, you know, can you do just some leg lifts from the bed, you know. Moving your body against gravity is exertional. Like, in occupational therapy school, we learned like, you know, manual muscle testing, you know, the grades against gravity versus gravity assisted. It’s a big — moving your body is exertional. And also, the only other thing I want to say is for people to know, in addition to what you’re saying, that you might also have to look into, if you’re trying to even do like moderate activity, moderate movement, and you’re just getting just horrible fatigue, you might want to look into ME or like what used to be called chronic fatigue syndrome, which is now you know, myalgic — and I always pronounce it wrong — myalgic encephalomyelitis. Yeah, yeah, encephalomyelitis. And they, you know, that can be, because that’s the hallmark symptom of that, is post-exertional malaise, you know. So, you would, you’re gonna, if you have that concurrent with rheumatoid arthritis or another autoimmune illness, you might need to modify even more, do a much shorter, shorter durations, even. But it’s hard because it can be, yeah, you don’t want to decondition because if you’re deconditioned, meaning you lose muscle mass, then your body doesn’t move as efficiently either. So, it’s definitely a delicate balancing act.

Dr. Millie:  49:03

Yeah. And so, in terms of like practical tips of, you know, if you’re looking to strengthen your muscles, I mean, you can do calisthenics, you can simply flex your own muscles, you don’t have to be lifting weights or lifting anything. You can use your own body for those things. You can do squats without holding anything, you can lift your leg from bed, or just flex your calf muscles or rotate your ankles, anything that feels like it’s a mild slight exertion more than what you normally can do that you can sustain repeatedly over, you know, 10 to 30 repetitions. And, but then you also don’t need to sleep for a long period of time and recover for a long period of time as a result of it. But if you’re absolutely deconditioned, I mean, again, long COVID clients who have been, you know, breathless, not able to come out of bed as well, even just deep breathing and strengthening our diaphragm, compressing our diaphragm, you know, for 10 deep breaths, that can be exertional and much more than what you’re doing already. So, these small movements, walking, you know, walking is the best exercise. And again, a five-minute walk is better than zero, than no walking. And then, you can do five minutes, you can do five minutes, you may get to five minutes twice a day, you might get to five minutes three times a day, you might be able to extend to 20 minutes at once. And you build it up gradually. And that’s really the key to conditioning yourself back to a place where that you’re happy and comfortable. So, it’s a gradual, just like everything, it’s best to move and be gradual, and be with yourself how you are now.

Cheryl:  50:38

Oh, gosh, yeah. I’m reminded of my husband — not my husband, my cousin. I was gonna say, I don’t know why I said husband. My cousin ended up getting hospitalized. He had that thing that happens when you try to exercise too fast, where your kidneys, your muscles break down and hurt your kidneys. I forget what it’s called. But yeah, he was like a former big athlete and tried to just jump right back and like, “I’m getting into shape this year.” And I’m laughing but it’s actually a really, really serious condition that he ended up getting. So, it’s yes, start low, go slow. I think those are great. Those are great tips. And yeah, people always think about strength training as needing weights and you’re certainly right, you know, doing, you know, a wall sit, chin, strengthen your quads, you know, doing calf raises just against gravity or on a step, you know, there’s so many things you can do with what’s around your home,

Dr. Millie:  51:32

Chair pose, boat pose, like mild yoga movements, slight Pilates movements, you know, I mean, you can — there’s access on YouTube to all of these things, you don’t have to have to pay to get access to small movements. And so, small movements, I would say, is key, especially if you’re highly debilitated at the moment, you know, and you can build up from there.

Cheryl:  51:53

Yeah, something I remember learning in OT school, I don’t know if maybe you can tell me this is wrong, but is that you’re born with all the muscle fibers you’re going to have, it’s just that they get bigger or smaller. So, that’s kind of like a beautiful thing to think about. Like, okay, even if I’m deconditioned meaning like, my muscle strength is lower at the moment than I’d like it to be. I’m like, well, you can always — you have the fibers are there, we just need to kind of work them a little bit, you know, they didn’t disappear, I think. Hopefully, unless you had like a major injury.

Dr. Millie:  52:24

Yep. And muscle fibers tear and repair, right, that’s how they get stronger. So, small stretching and contraction movements to stretch them and tear them a little bit, and then they repair stronger than they were before. And you can get reconditioned very quickly also, you know, if your body allows for it, so.

Cheryl:  52:46

Yeah, well, thank you. That was helpful. So, just a few last rapid fire questions before we wrap up. What are some words of wisdom you have for people maybe newly diagnosed with an autoimmune illness or similar challenge?

Dr. Millie:  53:05

I always go back to taking care of yourself first. I mean, I think it’s you can spend so much energy looking outwards and trying to find answers and solutions and that can be important and a good task to take on over the long journey, but you really want to be checking in with yourself all the time and asking yourself if you have the energy to do this right now or, and, and speaking to yourself kindly, you know. You really want to take care of and be the nurturer for yourself. You really need to be a nurturer for yourself if you’re just diagnosed and it’s extremely important. And, you know, no matter who you are, you need to speak to yourself kindly and compassionately.

Cheryl:  53:43

I love that. I love that. And do you have a favorite mantra or like inspirational saying, either for you or for your patients?

Dr. Millie:  53:58

You don’t have to know it all. You don’t have to know it all. You know, you can accomplish a lot without — you don’t need to learn the next thing. You know enough now in order to do yourself good. Yeah, I think, continually striving for knowledge. I mean, I’m a person who did spend a good portion of my life continually striving for knowledge and thinking, “Oh, if I just knew that, or if I just took this course I went to that school, or if I didn’t —” you know, you can stop at some point to rest and just collect what you have right now and it’s good enough to help yourself. And I think sometimes just tuning into the wisdom that you do have is more important, actually, than learning what that person has to say or what that person has to say.

Cheryl:  54:43

I love that. And what’s something that’s bringing you joy right now? Could be something in your life, or it could be a book, or a show.

Dr. Millie:  54:53

My puppy. I mean, he is a handful. He had chronic giardiasis since I got him but he’s like, we’ve had — yeah, so we’ve had to manage, you know, chronic diarrhea. And he’s eight months, but he is the best like little guy to wake up with. And so, he definitely brings joy.

Cheryl:  55:17

Oh, my gosh, yeah. My dog just turned four years old and I still call my puppy. And he still brings me joy.

Dr. Millie:  55:25

They are so fun. 

Cheryl:  55:26

Yes. What — this is kind of like a meaning of life question. But what does it mean to you — okay, what comes to mind when I say the phrase, like, ‘Thriving with rheumatic disease’ or ‘Thriving with autoimmune disease’? What does it mean to thrive with those things? 

Dr. Millie:  55:49

What I hear from patients is that they continually have epiphanies about their experience. So, when they know they’re on the right track towards finding, you know, just answers for themselves or getting to know themselves better, or, you know, something’s improved. There’s always like a light bulb moment, and people can have repeated light bulb moments. So, I think when you’re having light bulb moments, you’re living well. You’re learning about yourself. Yeah.

Cheryl:  56:18

Little epiphanies. Yeah. Awesome. And is there anything else you want to share before we conclude?

Dr. Millie:  56:28

Well, I just want to say that the world of tracking, you know, it’s very big and there is a way to get better at it. And it can be — there are a whole lot of factors in autoimmune disease that are not controllable, you know, and not modifiable. Some things are not modifiable, like maybe we can’t clean up our environment. Maybe we, you know, the train spill, I mean, people are sending me so many articles on the train spill and the chemicals that have been released. And, you know, we can’t do, we can’t, we are impacted by our environment and our immune system is impacted by our environment. But all the modifiable things, whether it’s the way we move, the way we sleep, the way we breathe, the way we talk to ourselves, the way we think about our life, the way we engage socially, who we choose to have around us, you know, what we do for work. Like, all of these things are modifiable. And by opening ourselves up to new possibilities, even if it’s hard to break through, is how epiphanies are created for people. It’s keeping an open mind as opposed to thinking like, “I can’t do this,” like, you know, there’s so much ‘I can’t do this’ and so, we keep ourselves and kind of imprisoned by our thinking. And so, when we are feeling inspired by what our tracking is showing us, then we’re on the right track. It’s not about being perfect with tracking or tracking everything or tracking every moment, but it’s about following the threads that are informing us that, you know, we’re feeling better, and we’re getting, we got an answer, we got a good idea there, we, you know, and then that was satisfying. And so, those satisfying moments are really important when you’re trying to empower yourself towards improving your symptoms, and hopefully going into remission when you have an autoimmune disease.

Cheryl:  58:22

Yeah, yeah. I love that. I often talk about the things that are like controllable or outside our control. But I like that idea of modifiable because it kind of suggests degrees, right. Because something can be modifiable, you know, to a certain degree. And it’s just, I like it. So, I’m glad that you introduced me to that concept of modifiable variables, and yeah. 

Dr. Millie:  58:50

Yeah, because it’s not all or nothing. I mean, that’s, you know, and even food, food reductions, elimination, food triggers, all these things. We know everybody’s afraid of them. They’re scary. You don’t want to, you know, lose your favorite foods. But sometimes it’s just tweaks. It’s not, you know, the whole, you know, shebang. Or if it’s the whole shebang, it’s temporary, you know. So, you can get to a place, you can build on successes, you can build on wins and get to a better place. And so, I do want to encourage people that there are people who are who are doing that, and you can do it too.

Cheryl:  59:22

Yeah, absolutely. And I will post the links to Mymee and to your social media, and to the Mymee page. I love what is shared on the Mymee health, you know, Instagram, and I’m just really grateful for your time. I know you’re very busy being the head of coaching at Mymee. So, thank you so, so much for tackling this topic with me today.

Dr. Millie:  59:47

Thanks for having me, Cheryl. It was fun.

Cheryl:  59:49

Yay. Okay, bye-bye for now. 

Dr. Millie:  59:52

Bye.