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Podcast, Provider Interviews

Why are Integrative Approaches (like nutrition and exercise) so important for RA? Insights from Dr. Diana Girnita

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61 min read
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Summary:

On this episode of The Arthritis Life Podcast, Cheryl sits down with rheumatologist Dr. Diana Girnita for an in-depth conversation on how lifestyle interventions—alongside medication—can help you manage rheumatoid arthritis.

Together, they break down the science behind why nutrition, exercise, and sleep play a crucial role in managing rheumatoid arthritis. Plus, they share practical tips on incorporating these key habits—along with stress management and social connection—into your treatment plan.

Dr. Girnita also highlights the importance of medication in arthritis management and discusses how lifestyle changes complement traditional treatments. She even delves into exciting advancements like CAR T-cell therapy, a cutting-edge approach that has shown promise in putting some rheumatic diseases into remission without immunosuppression.

Her philosophy? “I don’t treat diseases. I treat people.” This episode is all about finding a care plan that supports you as a whole person—because you deserve nothing less!

Episode at a glance:

  • What are integrative medicine and lifestyle medicine?
  • How does nutrition help RA?
  • Why is exercise important for people with RA?
  • Why is sleep so important for people with RA?
  • Why is stress management important for RA?
  • CAR-T treatment: an exciting new development in rheumatology
  • Dr. Diana’s Empowering Mantra: “I don’t treat diseases. I treat people.” Dr. Diana’s patient-centered approach focuses on treating the whole person, not just the diagnosis.

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. Diana M. Girnita, MD, PhD, is the CEO and Founder of Rheumatologist OnCall, a pioneering telemedicine company that provides quick access to patients with arthritis and autoimmune diseases across multiple states in the U.S. Rheumatologist OnCall was the first telemedicine platform to offer direct care services across multiple states. Dr. Girnita’s groundbreaking contributions to telemedicine and direct care have been featured in the New York Times, Medscape, Kevin MD and other publications. She is also an internationally recognized speaker, author, and educator, with over 13 million views on her popular YouTube channel. As a passionate advocate for patient education and empowerment, Dr. Girnita collaborates with organizations such as the American College of Rheumatology and the National Arthritis Foundation.

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for over twenty 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:

[00:00:00] Cheryl:
Oh, I’m so excited today to have Dr. Diana Girnita on the Arthritis Life podcast. Welcome! 

[00:00:07] Dr Diana:
Thank you so much. It’s such a pleasure to be here. 

[00:00:12] Cheryl:
Yeah, no, and I, we both are very like similarly passionate about, you know, providing lots of education and support and hope for people living with inflammatory arthritis. And so, I’m just really happy that you’ve, that we had the time to meet today. And can you first let the audience know, where do you live and what is your relationship to arthritis? 

[00:00:37] Dr Diana:
We have to stop. There is a [00:38 word?].

[00:00:39] Cheryl:
Oh, oh. I’m so happy you’re here today and I would love to know where do you live and what is your relationship to arthritis?

[00:00:50] Dr Diana:
I am a rheumatologist. I’m primarily based in Irvine, California. I do have a telemedicine practice, but I also have a practice where I see patients in person and it’s right here in Irvine, California. 

[00:01:05] Cheryl:
That’s amazing. Yeah. And I always love asking rheumatologists, why did you pursue this specialty?

[00:01:15] Dr Diana:
It’s a very interesting story that you’re going to hear. I was a cardiologist. I thought that cardiology is the most exciting specialty in the world when I finished my medical school. But then, by accident, I became interested in immunology and I’ve done a PhD in immunology. First, I worked in transplant immunology, where I was dreaming myself to go to help people getting a heart transplant, but then I understood that immunology is much more than transplants, and I found out about rheumatology. 

And initially, you know, I thought that immunology doesn’t apply too much to rheumatology, but then I saw that it is so much connected with what I knew. And I was so impressed that, with the advances that were done about 20 years ago in understanding the immunology part, then I was able to, or we were able to help patients with arthritis to improve their life. And also, to help them even overcome life threatening diseases like lupus or vasculitis. 

[00:02:32] Cheryl:
Yeah. That’s incredible. So, did you have to go back and take, do like a residency in rheumatology, right? Okay. That’s a lot. 

[00:02:41] Dr Diana:
Yes. I had to redo all my training here. I’ve gone through USMLE steps and then I’ve gone through three year internal medicin,e and another two years of rheumatology fellowship. So, it was a long pathway for me to become a rheumatologist, but I do not regret it. 

[00:03:02] Cheryl:
Yeah, that’s incredible. And I think, yeah, I, as a patient didn’t really understand the connection between like immunology and rheumatology because when I was first diagnosed, I didn’t truly understand that it was an immune condition. Even though it’s auto, I, heard it was autoimmune, but in the back of my head I was like, okay, that’s weird because it’s arthritis, what does that have to do with anything? So, it’s definitely something that I think, as you have the disease longer, like, when my first biologic stopped working, because my immune system made antibodies to it, I was like, okay, this really is an autoimmune. But that’s just my story. Anyway, but back to you. I would love to hear, like, what do you love the most about your work as a rheumatologist? 

[00:03:48] Dr Diana:
I do love the most that we connect with our patients. We have that ability, as rheumatologists, to spend probably a little bit more time with our patients, and most of the time is about solving mysteries. A lot of our patients will come to us with a myriad of symptoms, and you just have to connect the dots. And in this way, you get to a diagnosis. And not only that, but every patient is unique. As you probably know, not everyone looks like in the books, and every presentation is unique, so you are never going to get bored. 

And on top of that, when you are able to diagnose someone, you are able to help them, give them hope, not only tell them that you’re going to get better. You know that with the right approach and with the tools that we have, including medications, because people would have to understand that rheumatology made the most important progresses in the last 20 to 30 years, and it’s one of the fields that grew the most in progress compared to cardiology, for example, or gastroenterology. We were able to understand the immune system, modulate the immune system, and we were able to stop diseases from progressing and disabling people, which is extremely rewarding for me. 

[00:05:11] Cheryl:
Yeah. Yeah. And I’m glad you mentioned, the importance of medication because we’re going to talk about today, the majority of what we’re going to talk about is integrative medicine, lifestyle medicine, things you can do in addition to medications. But they’re definitely, for many patients, they’re not a substitute. Like, you’re still, like, for me, my patient journey, the medications are like the foundation, but I can use the lifestyle factors and interventions to improve my symptoms and maybe long-term lessen my reliance on medications potentially. But, it’s definitely, yeah, I think that’s the point you made about all these advances that were occurring in rheumatology in like the late 90s to early 2000s through today, it’s like we’re living in like a — what do they call it? — like a golden age? We’re in a golden age of — 

[00:06:04] Dr Diana:
Yes, we have the golden salts to treat rheumatoid arthritis. But then, we have so many options and we are trying to go even further. We can talk about that to understand our genetics and try to modulate our genetics. So, I think that for this field, we just have to take what is extremely important and we have to breach the advances in medicine and advances that we have done in understanding the immune system, modulating that with the lifestyle, because that’s what we need to understand. We cannot separate them. 

[00:06:45] Cheryl:
Yeah. Yeah. That’s well, and that’s one of the reasons I was excited to talk to you today. You’ve written a book called ‘Thriving with Rheumatoid Arthritis: Your Science-Backed Guide to Conquering RA’. I used to have a speech impediment where I couldn’t say R’s. I comes back every once in a while. I was show a quote — anyway, ‘Science-Backed Guide to Conquering RA‘. And I love the title because, I’m all — thriving is like a my core, thriving and enthusiasm, I think, are like core values I have, or the core, like, what would you call them, like targets I’m trying to reach in my life is a state of thriving. And your book outlines a lot of great evidence-based interventions for lifestyle, someone’s lifestyle clinical or integrative treatments, but before we go into the actual, what are some things that work for people, can you help define, what is integrative medicine and what is lifestyle medicine?

[00:07:43] Dr Diana:
Absolutely. Thank you so much for mentioning the book. The reason that I wrote the book is because I have seen a lot of people getting advice from some others that did not know what is working and what is not. And all my patients will be interested at some point in lifestyle or in integrative medicine. And I think it’s important to understand the difference. And, so much. As far as I have learned, because this is something that you don’t learn in medical school, there is only probably four to eight hours that they dedicate to nutrition or lifestyle in the whole medical training, not only medical school. I have learned from my patients and I have learned by doing my own research what is working and what is not. 

So, lifestyle medicine refers to whatever is evidence-based in our lifestyle that will be able to prevent, treat, and many times reverse chronic diseases, and sometimes autoimmune diseases. And the key pillars are nutrition, physical exercise or physical activity, stress management, and sleep. And I will add something here, the social connection. I think that’s very important for people to understand that they are not alone when they deal with rheumatoid arthritis or an autoimmune disease. On the other hand, integrative medicine combines what we know from the conventional medical treatments, whereas lifestyle and other complementary or what is called alternative medicine — and I do want to include here acupuncture, herbal medicine, meditation, even chiropractic practices — but also, this integrative approach of the whole body, like the mind, the body therapies. 

We, in traditional medicine, we ignore that. Not because we want to ignore it, but because we are not educated to understand those things. But I can tell you from my patients that they do have great results with integrating both worlds. And I’m a strong believer that if you do the right things, medication or traditional medication or traditional treatments, and you combine that with your lifestyle and some of those practices in integrative medicine, your chances to get into remission are better, your needs for medication are smaller, and you can thrive, not only survive. That’s what I tell my patients, because when they come to us, most of the patients are in a lot of pain, in a lot of distress, and they don’t have a hope. And that’s the part that we need to change. 

[00:10:39] Cheryl:
Yeah, and these, it’s important to say that, even though these lifestyle interventions like exercise, diet, sleep, stress management, they’re not covered in-depth in medical school. There are many other — first of all, I will say someone corrected me the other day someone said, don’t say that every medical school only covers four or eight hours of diet because some of the medical schools nowadays in 2025 or 2020s, they have started catching on. And so, I will say caveat, some medical schools cover more than others. But point being, there are also allied health professionals whose entire degrees are in this area. So, in one of these areas. So, there’s doctorates of physical therapy or people with a master’s like me in occupational therapy, where we learn a lot, particularly about the exercise, stress management. We do learn some about nutrition, but I always say, it’s a great idea to pursue, if you’re interested in dietary interventions, pursue like a one-on-one relationship with a registered dietitian, somebody who really can go in-depth and give you that personalized advice. 

So, the American College of Rheumatology, which is like the professional association — I know you know, but for people listening — the professional association for rheumatology and allied, ARP, the Rheumatology Health Professionals, they put out in 2022 the first ever integrative health guidelines for rheumatoid arthritis. And I know it’s just a starting point, but it did, does cover the longer — people just call it the integrative health guidelines usually — but the longer name of it in the Journal article is ‘The American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet and Additional Integrative Interventions for Rheumatoid Arthritis’ and they cover which interventions have the highest evidence. So, it’s not, this is not like, what do you call it? Stuff that’s on the fringe, this is now being recognized by associations, which is awesome. 

[00:12:44] Dr Diana:
We’ve been to the same meeting. I was in the room when we were talking. And then, I was in the room when other physicians, particularly from Italy, they were talking and another physician from San Diego was talking about the role of lifestyle medicine in rheumatology. And after that meeting, they met and they released the guidelines. And I was really excited because for about 10 years — and I was having this book in May, I would say — I was really excited because the evidence is right there. It was right in front of us. But as you said, not every medical school will do a poor job. 

And there are, in our days, some programs, I actually attended a program at Stanford to understand the science of nutrition. And that helped me a lot as a physician. And in that program, it was me and a lot of other, I was the only rheumatologist, but there were a lot of other doctors and other practitioners from many other fields trying to understand the science of nutrition. And on top of that, there is the Integrity of Fellowship at University of Arizona, which also promotes the science behind lifestyle intervention and integrative medicine. And I think that the progress that we’ve made is huge in the last, I would say, five years. 

[00:14:11] Cheryl:
That’s wonderful. I will put links to that Stanford program and the Arizona one as well. I think Dr. Micah, you mentioned the Arizona one when I had him on. And I often refer people who are really interested in getting a starting point for diet and nutrition for rheumatic disease to the UCSF. California has a lot of great resources. The UCSF Osher Center, or Osher Center, I’m not even sure how it’s pronounced, but Center for Integrative Health. They have a really nice, like, in-depth guideline about what anti-inflammatory diet in general and Mediterranean diet, why are these recommended and they even have a section now on lupus as well. So, you know, there are so many great resources. And your book, of course, as well. And my course, hey, I offer my course is I call it, like, the Rheum to THRIVE course is like an orientation manual to not just the lifestyle, but also yeah, relationships and managing your mental health and stress and all that. 

So, there are, a lot of times people feel so alone out there when they get diagnosed, like, no one’s helping me. But there are people like us trying our best on the Internet and in creative methods to give people some guidance around this, because as you said earlier, there is a lot of misinformation out there, unfortunately. So, I think this is a good time to delve into some of the specifics and maybe give you a chance to maybe counteract or bust some myths. What are some of the, you know, two or three most important things you would want someone with inflammatory arthritis, whether it’s rheumatoid or psoriatic or ankylosing spondylitis, to know about the role of like diet and nutritio? 

[00:15:54] Dr Diana:
I think, you know, a lot of people, they misunderstand when it’s about, when we talk about nutrition and just the fact that you mentioned diet, for a lot of people will be something very restrictive. And I try to refrain myself from using ‘diet’, but I know it’s a very popular term. So, I always tell my patients that, and this is promoted in my practice; this is promoted in my videos. I try to promote that everywhere. Because people have to understand that, what you eat is what you are. And if they want to call it ‘diet’, fine. But they have to remember this diet matters, and it matters not only to prevent disease, because that’s the part that a lot of people do not understand. 

If you have someone in your family with rheumatoid arthritis, if you have someone with ankylosing spondylitis, if you have someone with lupus, you are predisposed. I know you are predisposed genetically to develop an autoimmune disease, but it’s going to make a huge difference if you develop that in your 20s or if you develop that in your 40s or if you develop that in your 60s. And sometimes, if you do the right things, you might never, never develop that. And as I say to my patients, we cannot change our genetics, but we can change what we do day by day. And then, if you develop an autoimmune disease, or an inflammatory arthritis, by changing diet, you will decrease the symptoms, you will decrease the amount of flare ups or the severity of a flare up, and it will delay the progression of the disease. 

And this is scientifically proven. It is nothing that I’m telling you that is not scientifically proven. And on top of that, it reduces the need for medications. or changing medication from medication to medication. When I do see patients that they come to me after they change four or five drugs, I know something is behind there. It is not about patients being non-compliant. Because most patients, when they are in pain, they take their medication. But there is something else in their lifestyle that will cause more flare-ups, that will cause this increased need for medication. So, I start my conversations not only about what they have done, but also what do they do day by day. And I ask them about the diet, the exercise, the amount of sleep, or I ask them about the stress that they encounter in their life.

[00:18:36] Cheryl:
Yeah. And I think it is important to just give the caveat that there are people who have, I know people who’ve come into my support groups and said, “Gosh, I was vegan. I had a, you know, I exercised. I did everything right. And I still got this.” Like, there are, if you have that family history, sometimes the environmental trigger that triggers your disease is something totally out of your control, like a virus, right. 

[00:19:01] Dr Diana:
Absolutely. Absolutely.

[00:19:03] Cheryl:
So, it’s not to say that if you have a family history of — I know you weren’t saying this, but just in case people are like jumping to a bigger conclusion on what you were saying — you’re basically trying to stack the odds in your favor, but there’s not going to be a guarantee. Unfortunately, there’s no guarantees of anything in health, right? You just are trying to give yourself a better chance. And I think, just like some people take a medicine and respond really great to it, others don’t. That’s at least been in my experience, the same thing with the nutrition interventions. Has it been your experience, too? But sometimes the first, maybe, nutrition intervention you try isn’t the one that works for your body. You might have to try a couple of things. Okay. Yeah. 

[00:19:48] Dr Diana:
Absolutely. So, what I say to patients is that there is not a recipe or a diet that works for them. We just have to see what are the things that will cause them flare ups or will cause them to feel bad, compared to others that might not have the same problem. So, I think that when we talk about diet or nutrition, we have to look at what are your cultural preferences, the things that you grew up with, the things that you change in time. 

And, like you said, what I’m trying to do is put everything in your favor to help you and not to blame you. I don’t want patients to feel, you know, not to put a label on them because I have had patients that will come to my office and will say, “I’m a lupus patient,” or, “I’m a rheumatoid arthritis patient.” No, you’re not. You are a person with a disease that is manageable and all we have to do is to use our knowledge to have the best outcome that we can. And yes, there are not the perfect drugs. As well, there is not the perfect recipe that will work for you. And everything has to be based on the patient, not on the, on a guideline, as I would say. 

[00:21:16] Cheryl:
Yeah. And I know, you know, Christina Montoya, she’s a registered dietitian I love. And she also, we call ourselves RA twins because we’ve had rheumatoid arthritis the same amount of time. And I really like — yeah, she’s wonderful, right. And she has talked a lot — she’s from Columbia. So, she’s talked about the cultural aspect, which I thought was so, so missed often. But she also has talked about how like, certain examples she has — I thought was really helpful was like dairy, for example, for some patients or people. Dairy is a wonderful source of protein and calcium, and there’s no additional inflammation for them. For other people, they have a sensitivity to dairy, and they notice, gosh, when I eat dairy, my joints flare up, I feel headachy, I feel bloated, I feel fatigued. 

So, it’s not a one size. It’s all, it’s like you use the word ‘detective’ earlier, that’s like rheumatologists are detectives, which I love. And as the patient, I have no problem call myself a patient. It’s just everyone’s different. As a person with lived experience of rheumatoid arthritis, whatever you want to call me, it’s really been in my benefit to look at my — I look at my lifestyle factors as like an experiment and to say, in every outcome, whether it worked or didn’t. I try to look at it as information that’s helpful versus, like, oh, I failed. Because so many patients, like you said, they feel like they, if they try the anti-inflammatory diet or the, there’s so many different — I hate the word diet too. 

Or I don’t, I don’t tend to use — I use the word diet as terms of just like a synonym for like food or nutrition. People will try a really specific diet and they’re like, “Oh, well, I failed at it.” It’s the same. You don’t, you didn’t fail. It’s just, you learned that diet doesn’t work for you. Like, I can’t eat a lot of, I have gastroparesis on top of RA, which means for me eating a lot of highly fibrous foods is the worst thing possible for my stomach. So, eating raw vegetables, soy, legumes like beans; those are all really bad for my body. I feel really bad when I eat those, but someone else, those are like the most healthy foods ever for them. So, it’s like, you know, anyway, nutrition is —

[00:23:25] Dr Diana:
And that’s what I talk in my book — I’m sorry to interrupt you. 

[00:23:28] Cheryl:
No, go ahead. 

[00:23:29] Dr Diana:
In my book, I don’t say that you have to do this, because there is not something like that for patients with rheumatoid arthritis and patients or people in general. Let’s talk about people because in the end, we are all people. We can become patients, all of us, but we are all people. And like you said, there are patients of mine or people that I meet that will have a great sensitivity to lactose. They are lactose intolerant. Actually, 60% of this planet is lactose intolerant, but there are others that could actually benefit from eating yogurt or eating kefir or eating certain things that are not bad for them. 

So, and it matters the quality of the food because there is cheese and cheese, okay. Meat and meat. When you look at the ultra-processed cheese, that’s very different from feta cheese or the cheese that you do in your house, or when you look to, you know, gluten, the same problem. There are people that are sensitive to gluten and there are people that are not, and they will benefit from eating foods that yes, they will have gluten, but like you said, more fibers. So, what I tell to my patients is that it’s a trial. You do a trial, and like you said, you learn from that trial if something is good or bad. And don’t think that, whatever your neighbor or whatever you see on the TV or whatever is advertised, it’s going to work for you because the chances are it might not.

[00:25:06] Cheryl:
Yeah, and I think if we set the stage, talking to somebody newly diagnosed, helping them understand that it’s going to help prevent frustration, because I think a lot of times the frustration comes from, “Well, wait a minute, I tried to follow, Emily’s diet. And it worked for her. And why didn’t it work for me? And I’m so confused.” Instead of being confused or overwhelmed by that, you can say, “Okay, well, I’ve learned that this, you know, this is a trial-and-error process. And you can also change over your lifetime.” My dietitian that I worked with, she said, we know I don’t have Celiac because I was tested a long time ago for that when I was first having stomach issues she’s — and I’ve been, but I’ve been avoiding gluten because it’s it historically has really caused my GI motility to slow down. It doesn’t really have an effect on my arthritis that I could feel symptom wise. But she was like, you know if you’re interested like you can always try slowly reintroducing gluten because just because it was that it didn’t work well for your motility 20 years ago when you went gluten free or 15 years ago, doesn’t mean that it will be that way now. And it honestly blew my mind because I thought to myself, oh, well, this is just my body. This is how it is. But she was like, no, it can change. So, I’ve started slowly experimenting with reintroducing gluten and it’s been okay in small amounts. 

[00:26:21] Dr Diana:
I’m glad you mentioned that, because that’s what I tell my patients. They come with these ideas, “I cannot eat this, I cannot eat that,” and if you introduce things slowly, you might have a chance to enjoy that. And just by restricting people to not to eat so many things, they will be very stressed and the stress doesn’t help the arthritis. 

[00:26:47] Cheryl:
No, a hundred, a hundred percent. And I’m very much against a restrictive diet in general. And so, I think, there’s so many voices out there that are saying, “Oh, you, you should only eat this or you shouldn’t eat all those bad foods.” Actually, I even get these comments. I did a video where I was showing how to use this opening aid, like, as an occupational therapist, “Oh, here’s a little aid I use to help open the container of orange juice,” and then the comment someone left was, “You shouldn’t be drinking orange juice if you have rheumatoid arthritis. That’s too much sugar.”

 And I was like, oh, my gosh. Like, you know, first of all, like every single thing I put in my mouth, for me, it doesn’t, it’s going to be too stressful for me if I think about 100% of my food always being, like, the perfect food. Even my own therapist has said, “I really don’t ever want you to go down that path,” because I have a history of anxiety and that could lead you down disordered eating path of only wanting to be so perfect all the time with your food. So, I’m much more like moderation. Like, all things, yes, I try to overall eat an anti-inflammatory eating pattern. But yeah, I eat donuts. I eat cookies sometimes. I eat things that bring me joy. And that’s part of a full life.

[00:28:00] Dr Diana:
I love that because that’s what I tell my patients. You are not perfect. We are not perfect. And I tell them, I’m not perfect. I’m trying my best on doing a pattern. I’m trying my best to follow a Mediterranean diet. But I’m not going to restrict myself from drinking even a glass of juice from time to time or eating a cookie from time to time, because what is the pleasure of living? I mean, we do have a couple of things that we enjoy doing in our life and eating is one of them. 

[00:28:35] Cheryl:
Yeah. Yeah, yeah. Allow yourself to feel the joy of food even if you’re endeavoring overall to, you know, support your health and have a healthy eating pattern. Maybe I think Emily, we were just talking about her before we started recording, Emily Johnson, who goes by Arthritis Foodie. She recommended or, you know, mentioned that what works for her is like an 80/20 where you’re like, 80% of what I eat is along the lines of food I know that is, supportive of my health. And then, the other 20% or 10% or 15%, whatever it is that day, she lets herself indulge and that’s like a healthy balance. So, I appreciate your perspective on that. And the next topic I want to talk about is, and that you have in your book as well, is the importance of movement or exercise. I know some people also get overwhelmed by the thought of exercise when you have inflammatory arthritis. What are the top things that you want patients to know about exercise and movement?

[00:29:31] Dr Diana:
I know I’m gonna get a lot of heat because when people are in pain, they don’t want to exercise. And they will actually tell me, you know, “Have you ever exercised when you are in pain? And I know because it’s not easy.” But I actually took a quote from your world. I say, “Motion is lotion.” 

[00:29:54] Cheryl:
Oh, and I didn’t make that up. The Arthritis Foundation had a big campaign a few years ago, maybe 10 years ago, motion is lotion. So, I don’t want to take credit for that. But yeah, it’s so hard. 

[00:30:03] Dr Diana:
I do love it, because that opens the mind of people that are more ready towards exercise and, you know, exercise, you can probably talk about this so much better than I can do. But exercise, I know that it improves the flexibility. It improves the strength. And what I learned studying for this book is that exercise is actually great to help decrease the inflammation. I learned that in people with rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis, because of inflammation, their joints are full of these proteins, and that fluid is so, so thick, and those protein will act there and will destroy the cartilage. But when you move, you produce more fluid, and that will expand that cavity with more fluid, and those proteins that are inflammatory, and they are supposed to damage the joints, they don’t have the contact all the time with the joints, so this is the explanation of why exercise will induce more fluid, and you have less inflammation. 

And I also learn from others that exercise improves the mood. And the fact that you have a better mood and you have less pain, if you think more positive and if your mood is better, definitely your pain level will decrease. So, all of that together, I think it’s important for patients to understand that if they start any exercise that they love — dancing, walking, yoga, swimming — I’m a big proponent of incorporating swimming into the plan of a patient with an inflammatory arthritis because I know it brings a lot of benefits.

[00:31:58] Cheryl:
A hundred percent. And the only thing I would add is that not only does exercise like reliably improve pain levels, stiffness, you know, less stiffness, less pain, better mood. It also is associated with less fatigue and better cognition. So, which how few things do we have to directly influence ‘brain fog’, quote unquote, or cognitive dysfunction and rheumatoid arthritis, and other forms of inflammatory arthritis? There’s very few like interventions that really can directly improve it. I don’t know the, like, at the cellular level, what is exactly happening to make it have that positive, make exercise have that positive effect on cognition, other than it’s possible that it’s the same thing you’re talking about with the less inflammation getting up to the brain, as well as less inflammation in the joints. And it feels almost like the one — I remember in my OT program; I don’t know if you can verify this because of your cardiology background as well. But that, cause I’m, I might butcher this, but I remember cause I’m a very visual learner. So, we’re talking about how, when you exercise, you literally, your brain or your blood vessels grow more. What is it? More vessels, right? You get more blood flow. 

[00:33:17] Dr Diana:
Yes, you get more blood flow, correct. You get more blood flow. 

[00:33:21] Cheryl:
Yeah, so, it kind of makes sense. You’re literally bringing more blood and oxygen to your brain, which you’d think would logically cause better brain function, less brain fog. So, I think that’s where a lot of people think about the benefits — this is one of my soapboxes — but that the benefits of exercise are going to be limited to the joints and the muscles. Those are great benefits, but it’s also good for those other reasons; fatigue, brain fog, and mood.  

[00:33:50] Dr Diana:
I did learn somewhere, I did read somewhere that exercise actually also influences our gut microbiome, which is directly connected with our brain. And although the research is right at the beginning, I feel like it’s making a lot of sense. Because not only the food, but also, like you said, the types of things that we add, like the sleep, the exercise, how we modulate the stress, they all influence our gut microbiome. And we understand more and more, we are at that, I think we are scratching the surface right now about our gut microbiome. But the fact that we understand that we are not alone in this equation makes us more knowledgeable, but also gives us reason to implement certain things into our lifestyle. 

[00:34:40] Cheryl:
Yeah, that’s really fascinating. I do know, I remember really early on, like in the early 2000s, before I even had my RA diagnosis, I had a gastroparesis diagnosis. And I remember I was struggling with constipation, and I was reading what are these recommendations for constipation, and what are some natural things I can do along with other things, like, whatever, Miralax, whatever. And it was, I remember just seeing, it was so simple, it struck me that it was just a long walk. It’s like a natural method for helping with constipation. I’m like, could it be that simple? But I did notice, wait, when I’m more active, when I’m, you know, when I either take a long walk or at that point, I was also a runner. So, I would run and I’m like, yeah, my motility is actually better. So, it would make, it makes sense on that level. 

But I know the gut microbiome is more complex than just motility, but it’s just really cool to think that it can have an influence on all your body systems. Yeah, not just, again, not to knock the importance of having adequate musculature around your joints. It just makes — it’s going to reduce your pain because it’s going to support your joints through the movement and have less load on your joints, but there’s many other reasons to do it too. So, one thing I want to give, before we go to sleep, which is our next topic, if you are really overwhelmed with the idea of increasing your movement or physical activity. One of my friends, Dr. Christine Stamatos, she’s a nurse practitioner, she talks about exercise snacks, like instead of a giant three course meal of exercise where you like run and lift weights for an hour, just little bursts throughout your day, can be more achievable then. 

[00:36:21] Dr Diana:
Yeah, I have a friend who is also a physical therapist and she actually taught me about how to encourage patients to approach exercise because, like you said, it could be something giant. It looks like you have to conquer the Everest. 

[00:36:36] Cheryl:
Yeah. 

[00:36:37] Dr Diana:
Not like that, you know. Those people that got and conquered the Everest, they were not conquering it in one shot. They did it in steps. So, that’s what I would encourage my patients to do. And now, because I said about this, let me tell you about a patient of mine with rheumatoid arthritis that I think I closed the book with that story of him. He actually climbed the Everest. And I was so proud of him, and I want to congratulate him if he sees this episode. I’m so proud of him. He did the treatments for rheumatoid arthritis, but then he incorporated the lifestyle changes. And little by little, this patient of mine literally conquered the Everest.

[00:37:23] Cheryl:
That’s amazing. I think he sent me an email and I emailed him back. He’s like, do you want me to share my story in your podcast? And I was like, yeah! 

[00:37:29] Dr Diana:
That would be amazing. I would love to make the connection for you. 

[00:37:33] Cheryl:
Yeah! I think I just need to, I think I emailed him back, but maybe I’ll follow up. We all are really busy, but that’s an incredible story. And yeah. 

[00:37:42] Dr Diana:
And true. It’s a true story. 

[00:37:44] Cheryl:
It’s incredible. Oh, my gosh. The next thing that I want to ask you about is the importance of sleep which I actually had this a t-shirt made that says ‘Sleep diva’ because I tell people with rheumatoid arthritis, it’s like you have to be a diva about your sleep and be like, this is important. I’m protecting my sleep, like, I have needs, and advocate. But people tend to think, often, they’ll be like, “Oh, well, it’s not that important. It’s just sleep.” So, tell, me about why is sleep important in managing —?

[00:38:18] Dr Diana:
I’m fascinated about it. So, I think about four or five years ago, about five years ago, I think, I accidentally met, I accidentally saw a TED talk about the importance of sleep. And then, this is how I learn about Matthew Walker, who wrote a book about the importance of sleep. And the book is called ‘Why We Sleep’. And this is a professor, a neuroscience professor from University of Berkeley who actually, probably for the first time in the world, he brought to the general public the importance of sleep. So, I read about how sleep is connected with pain or how sleep is connected with inflammation. And I learned that more sleep means less pain. And more sleep means less inflammation because during the sleep process, we are like a battery that we recharge. And the same for our immune system, has the power to recharge and fight inflammation or fight what is happening in the body. 

And not only that, you’re going to sleep, and I tell my patients this: Sleep is not laziness. Sleep is recharging. Sleep will help you to fight the disease better and have a better life. And we all know that when we don’t sleep, not only that we don’t feel good and we are more foggy and our interest is low, but people with autoimmune diseases and people with arthritis, they are in a lot of pain after a night that they didn’t sleep. They will experience more pain the next day. So, that’s why I think that incorporating scheduled sleep and sticking to a pattern of sleeping, it’s extremely important for people with rheumatoid arthritis and other types of inflammatory arthritis. 

[00:40:22] Cheryl:
Yeah, I was really, I felt that was so validating when I first learned about that. And I’m glad you recommended that book. It’s been on my list forever. I keep meaning to read it. I haven’t read it yet. So, I want to keep myself accountable by saying it in the podcast that I’m going to read that book. And I really, yeah, one of the people at the rheumatology conference mentioned like — I think it was the University of Michigan researcher, ’cause they have a great like lab there on pain and another one on sleep. And he said, choose, think of your bed as your recharging station, just like your phone. You recharge it, you plug it in, you have to plug yourself in to your bed. And that’s such a great visual to me. 

And I think it is hard culturally, like a lot of people, especially if you’re younger, like I was diagnosed at 21. There’s a lot of — I didn’t have a lot of pressure to like drink alcohol or do drugs and stuff that. Actually, the bigger pressure for me was to stay up late. Because everyone wants to go out and party and stuff and I realized, okay, sometimes I can because I never — anyway, this is just me, but it relates to methotrexate because you’re not supposed to be drink alcohol. I didn’t really drink alcohol before being on methotrexate, but it just gave me a nice excuse not to drink alcohol, but I would like to still go. I always went to the parties and stuff because I’m a soccer player. We would have a big team party and I would just drink water or Sprite or whatever. But the bigger pressure was staying up and, “Oh, don’t go home yet. Don’t go home yet. We’ve got to have fun. You’ve got to have fun.” 

And I think that, for me, part of my strategy around that, even to this day, at age 43, is taking naps on a night when I might be going out later. I’m a swing dancer, and the dances, sometimes they’re from like 8 to 11, other times they’re from like 9:30 to 12:30. And I’m usually pretty tired. I’m like an early bird circadian rhythm. So, I have to take a nap in the afternoon on those days. I have to protect my need for that nap, right. And advocate for myself to get that sleep. 

Or even like when my son was younger, I think the postpartum period can be so hard for people with rheumatoid arthritis, you know, from your patient population you’ve worked with. And there’s just sometimes, if you don’t have help and you’re breastfeeding or something, there’s just nothing you can do like other than you have to just wait get your sleep interrupted. But when we transition to bottle feeding from breastfeeding, that was so helpful for me because I was able to get longer periods of sleep again. So, it’s just, you know, if you’re, if you remember nothing else from this part of the conversation, just know that it’s okay to advocate for your sleep, right? 

[00:42:59] Dr Diana:
And sleep is not laziness. 

[00:43:01] Cheryl:
Sleep is not laziness. Yeah. And it’s doctor’s orders to sleep, okay. 

[00:43:06] Dr Diana:
Actually, it’s recommended to sleep eight to nine hours per night.

[00:43:10] Cheryl:
Yeah. Yeah. 

[00:43:011] Dr Diana:
If you can. Yeah. You should aim there. 

[00:43:14] Cheryl: 
Totally. And I love that earlier on you mentioned, you know, that sleep and exercise both have a good impact on your stress levels and your mental health. And I know a lot of people — I’ll just say, first of all, if you’re like me and initially I was told, “Oh, you’re not sick. You’re just anxious,” like, you just — before I knew I had RA, it can be really hard to hear that your stress management matters. I used to be really stubborn about this and say, when people say that I need to manage my stress there, it felt to me like they were saying it’s all in my head or it’s my fault. And so, if you are like me and you’re like defensive like that or stubborn like that, it’s totally normal and it’s okay. But what I now know from researching and reading your book and many others and experiencing it myself is that it doesn’t mean that you caused your disease or anything by being by having stress, but managing your stress and finding minutes of mindfulness and peace and self-compassion can really go a long way. So, sorry. That’s my spiel on it. What would you want patients to know about that? 

[00:44:24] Dr Diana:
No, I love that you share your spiel on it because it’s so important to see it from someone that has experienced the disease. We, as physicians, we learn about many things in medical school, but we learn even more by working with patients. And that’s the part that I enjoy the most when I interact with a patient. And this is something that I have to share with you. When I interact with the patients, I feel like I learned the most. And me learning about mindfulness was from a patient. 

10 years ago, I met this amazing math teacher who told me that he was doing mindfulness, which not only helped his rheumatoid arthritis, but it helped his marriage. He was ready to divorce. He had a child that was struggling with Down syndrome, and he learned by doing mindfulness to manage his disease and also save the marriage and take care of the child. And I sat there and I listened to the, to this patient. And because I’m a researcher by structure, I went to my computer, and this is literally what I did, and I looked it up, ‘Mindfulness.’ And how could that influence autoimmune diseases? 

I had no knowledge about what mindfulness is. I only knew that mindfulness is something about meditation. I was thinking maybe something like a, you know, sitting there floating above the ground level. That was my understanding about mindfulness. And I started to read about that and how mindfulness can influence chronic pain. And that’s how I discovered John Kabat-Zinn, which is this amazing doctor. He’s a PhD who started the first mindfulness stress-based reduction program in the United States in the 1970s. And I started to read about his program, and I started to read one of his books, and I was so fascinated. How could mind influence our body and our perception about pain? And 10 years later, I went to took his course at the University of Massachusetts because I was so intrigued about how could the mind be so powerful to influence how we react to pain. 

And then, recently I read even more about the role of trauma, childhood trauma, about the stress about, you know, and this is common. I don’t know from my practice, but I can validate that I heard it from other rheumatologists, our patients get diagnosed after they had a divorce, they lose someone dear, they have a change in jobs, they change the house, they get pregnant, they get a baby, okay. So, all these moments in our life, also we cherish some of them, but we also go through them. They will have an impact on our immune system. And like you said, it’s not in their heads. It’s not the anxiety. You know, the fact that you are in pain, you will get more anxious. The fact that you are in pain and you develop an autoimmune disease will get you depressed. So, all these things can be connected. But the fact that stress is inducing autoimmune diseases, I don’t think there is a question at this point. 

[00:48:01] Cheryl:
Yeah. And so, in terms of a stressful event may be that, if we start with that, the theory of there’s an environmental predisposition, or there’s a genetic predisposition and then an environmental trigger that actually triggers your condition, that environmental trigger could be like a virus, or it could be a traumatic event, or it can be maybe some sort of, you know, maybe a lifestyle variable, like smoking, I think, is one. But once you have it, once that trigger is pulled and you’ve developed it, from what I understand and from my experience, the stress reduction techniques in mindfulness are really helpful in not just reducing symptoms like overall, like maybe feelings of pain and stiffness, but also just I really love that you mentioned the effect on the, your patient’s marriage and quality of life. 

That’s what I found too, is my learning about mindfulness and also acceptance-based therapies and self-compassion based therapies has, in addition to doing therapies — I’ve gone to a therapist, which I didn’t even go to until I had a baby, and there’s so much awareness about postpartum depression and postpartum anxiety that I was like, okay, it’s okay for me to go to therapy now because I have postpartum issues. So, I went to her when my son was almost one years old and of course we started talking about adjusting to parenting. And she, it ends up that we talked more about chronic illness because I was in a really bad postpartum flare. 

But she told me something that really blew my mind that I had never considered before because I said, “I’m not depressed. I don’t really feel like anxious.” I’m like, “I’m, what I am is I’m just irritable all the time and I was never like this.” I’m like, I was a happy baby; I was a happy kid. Like, every teacher I’ve ever had would be like, “She’s a pleasure to have in class.” Like, I’m not an angry, irritable person. I was like, what happened to me? And she was like anxiety can manifest as irritability. And that literally blew my mind and I was like, really? But once I labeled it and understood that it was anxiety that I was experiencing, and I was anxious about so many things, right? Is my flare up going to get better? Is my child going to, what should I do for the — just all the minutia of parenting is so overwhelming to me that I was able to then step back and be like, okay, this is what’s happening. And then, I can accept it. 

And that’s a whole other process of leading me through the acceptance-based therapies in addition to mindfulness and self-compassion. For me, that was like the secret sauce that like opened me up to feeling more — it wasn’t just that I felt more at peace with having rheumatoid arthritis and coping with the uncertainties and ups and downs. It was the — it was me feeling like a more not, maybe peaceful isn’t the right word, but it was just easier for me to thrive. Like, if we’re talking about that core thing we’re looking for is thriving, right?

[00:51:00] Dr Diana:
And I think understanding what is the process that you are going through, and like you said, understanding what is happening to you is very important. We all have stress in our life. I don’t think there is anyone on this planet without stress. But the problem is that we don’t know and we are not taught in school or sometimes not even in our family how to manage the stress and what are the techniques that we can use to manage stress. And as I told you, I was so Intrigued by my patient. How could something like this help you? And that’s how I learned about gratitude journaling. 

I learned about stop complaining. Don’t think that I don’t complain. I do complain, but don’t complain about everything. Complain about the big stuff and try to avoid the small things. Try to basically surround you with people that are positive, that will send you a good vibe. Try some breathing exercises. I actually do breathing exercises with my patients. I teach them how to do the square breathing exercise. 

I teach them about the difference between mindfulness and meditation. I learnt, at this point what it is. I also tell them about music therapy, like you said. I tell them about the power of meeting friends, being with their friends. Because just enjoying those moments or enjoying the time for yourself or putting a pause in what you do or prioritizing things will help manage stress better. And there are so many options, but because of I’m not an expert into, I don’t claim that I’m a trainer in mindfulness, but I do tell patients what are the tools. And not everyone is going to do gratitude journaling or not everyone is going to enjoy breathing exercises, but giving people the tools, they can choose whatever they find comfortable to minimize stress.

[00:53:11] Cheryl:
Yeah. Yeah, I think it’s a — it’s, I think, overall about like I have a coping toolbox, right, to cope with whatever life is throwing my way, whether the challenges from, I don’t know, a friend or family situation or whether it’s from my, you know, illness or my condition and it’s just helpful in life. I think that’s what I wish I had someone had told me before; you don’t have to wait to address your mental health until it gets really bad. Like, I was just thinking, well, I, most of my life is going really well. Like, I have all this family support. I have friends support. Like, I’ve never had any psychological trauma. Like, I was very lucky. If my ACE score is like zero, what’s like Adverse Childhood Events, but that doesn’t mean that just because other people have it worse doesn’t mean that you don’t deserve support and deserve to, that you can’t maybe improve your mental state. 

So, that’s my little pitch for getting help. I think the therapy process for me has been really, really amazing. I think it’s so rare that you have someone’s full undivided attention for 50 minutes straight. It’s just whoa, it’s a totally unique experience, like one-on-one therapy or group therapy as well is so valuable. So, whether it looks like that, but whether it looks like learning a meditation from a YouTube video, finding a guided meditation on an app, Calm. A lot of people, and I know like the app Calm, there’s so many ways. So, yeah, we’re just supporting you listeners in delving into that. 

[00:54:47] Dr Diana:
And just the fact that you don’t overwhelm someone that you love with your feelings, it’s so refreshing because when you go to therapy, you can feel free to tell what is on your heart without harming someone. Because most of us, we try to protect the people that we love. I’m not going to go too serious, say to my mom or to my boyfriend that I don’t feel good today, that I’m in pain and I’m going to complain every day; I’m not going to go to tell them that I feel frustrated or anxious. But you can go to your therapist and say all these things. So, just taking those out will be so important for you to release that pressure. 

[00:55:31] Cheryl:
Yeah, I’ve always thought about having there’s different people in your life to talk about different stuff with. Of course you don’t, you’re not going to necessarily tell, your mom everything about your relationship with your spouse or whatever, you know, and yeah, therapy is awesome. And time wise, I just wanted to ask one more question before we get to the rapid-fire. Are there any like hot topics in the field of rheumatology or lifestyle medicine that you’re excited about? You mentioned the microbiome. I don’t know if there’s whatever else you’re interested in. 

[00:56:03] Dr Diana:
Yes, I am excited about the research that is connected with the microbiome. I’m excited about CAR T-cell therapy. You’ve probably heard about that. And I’m excited about gene therapy. I know it started 30 years ago, but I think that in the next 5 to 10 years, things will happen. And actually we will be able to modulate the immune system to the genetic level. And I think that is the next step, which will bring an immense power to us as clinicians to have, or an a great tool for us to have to modulate the genetic system or the genetic, the genetics, to modulate the genetics, to actually make our immune system listen to us. 

[00:56:50] Cheryl:
Yeah, that’s incredible. And actually I’m trying to remember if I’ve covered CAR T-cell therapy. I don’t think I have. So, can you tell the listeners really quickly what that is? 

[00:57:01] Dr Diana:
So, this is a type of immunotherapy, which was developed for patients with cancer. And about, I think, four or five years ago, or maybe even longer, they started to use CAR T-cell therapy for people with lymphoma, and the success was wild. So, what they do, they take T-cells, they actually select type of population, which is a type of immune cells. They modulate it to the genetic level, they introduce certain receptors, and they teach these cells to interact with other cells in our immune system to immunoregulate them or to regulate them not to be so active. So, the idea, it’s also a genetic type of therapy, but the idea is to modulate the immune system not to be so reactive towards, your body. 

And I think that the first study that was published in 2022, which included patients with rheumatoid arthritis and lupus, the results were astonishing because in people with lupus, the remission was amazing, complete for two years after one infusion. And I know the study was short for two years and I’m looking forward to hear more about what happened with these patients because we always want bigger numbers and great results, but the initial results were great. 

[00:58:33] Cheryl:
And if I understand, if I remember correctly, it’s not as immunosuppressive, right? Or it’s not even immunosuppressive. So, that’s like a huge. 

[00:58:42] Dr Diana:
It’s more like modulating, telling the immune system how to act in someone with autoimmune diseases. It’s different, it’s not going to suppress the immune system, it’s going to teach the immune system how to react towards certain types of cells. 

[00:58:58] Cheryl:
And I just realized through looking at it again, I, in my head had pronounced it Cart-T, but it’s ‘Car’, space, ‘T’. 

[00:59:07] Dr Diana:
Yes. I actually have a video on YouTube channel about CAR T-cells, where I explain the role of this, how it works, and what are the studies so far, including in people with lupus and rheumatoid arthritis, trying to make people aware about the novelty that we have in our world.

[00:59:31] Cheryl:
It’s so — that’s perfect. And then make sure people should definitely check out your channel. I’ll have links to it in the show notes. Coincidentally, one of my close friends from high school, her husband works on CAR T-cell therapy here in Seattle. So, it’s definitely a hot topic. 

[00:59:47] Dr Diana:
And a very good friend of mine works in CAR T-cell therapy. He was one of those who promoted — he was the VP of the company who actually did the studies for people with lymphoma. His name is Adrian Bott. I’m very happy that I know him. He’s very smart. He has a wonderful family. I’m very good friends with his wife and him. I’m so excited I know him. I’m trying to get more information from him about what’s coming. 

[01:00:17] Cheryl:
I know they have to be careful. I know my husband works in tech and they have to be careful about they tell. So, yeah, I tell him not to tell me because I don’t want to accidentally spill the beans on what he’s working on. But anyway.

[01:00:29] Dr Diana:
I know they’re working on something new, but I don’t know exactly what they are working on. But I was so excited to hear that CAR T-cell therapy is an option for our patients as well. 

[01:00:42] Cheryl:
Yeah. Oh, and I, this is me literally multitasking as you were saying that I was looking up where Irvine is on the map because I was trying to remember how close it is to Disneyland. Sorry. It’s right here. And I know that there are occupational therapy annual conference is actually going to be in Anaheim in 2026. So, I’ve got to come visit you when I, anyway, when I go there.

[01:01:06] Dr Diana:
We will see each other at the AC. 

[01:01:08] Cheryl:
At the ACR too. Yeah, I hope, I wish why is that never in Anaheim? I’ve never, it’s a, I don’t know why not. Maybe it’s too small of a conference. 

[01:01:15] Dr Diana:
You should come. 

[01:01:16] Cheryl:
Yeah. Yeah. So, back to the rapid-fire questions. Best words of wisdom for newly diagnosed patients, what would you say?  

[01:01:27] Dr Diana:
So, my advice is do not lose hope. Do not let others’ bad experience influence your decisions. And I think finding a rheumatologist who will resonate with what you are looking for, what you are looking for, not what they want, is the best thing that you can do for your, for your health approach.

[01:01:51] Cheryl:
I love that. And do you have a favorite like inspirational saying or quote? 

[01:01:58] Dr Diana:
I have it and I tell it all the time, “I don’t treat patients.” I — no, I say, once again, “I don’t treat diseases. I treat patients.” 

[01:02:12] Cheryl:
That makes sense. Yes, yes, yes. For some reason, my brain knew what you were going for. 

[01:02:16] Dr Diana:
Yes. I actually have it in my, on my website. It’s very clear. “I don’t treat diseases. I treat people.” 

[01:02:26] Cheryl:
Yeah. That’s, beautiful. And that’s what people — I want to be treated like a whole person, not just as like a collection of cells, you know? And now this is — you don’t have arthritis, but do you, do you have a favorite arthritis gadget or tool in the toolbox, nevertheless? 

[01:02:46] Dr Diana:
I love telling my patients about paraffin wax therapy. 

[01:02:50] Cheryl:
Yes. It’s not just for the nail salon anymore.

[01:02:53] Dr Diana:
Exactly. I tell them all the time. Do you know, they look at me and they ask me, “What is paraffin wax therapy?” And I said, do you ever go for the nail salon or do you ever go to a spa where they offer you paraffin wax? And they look at me, it’s like, “Can you do that at home?” Yes, you can. You go on Amazon.com, find one of those devices and you can do it at home and it’s very, very soothing. And, your hands will look great, but your pain will be so much easier on you.

[01:03:23] Cheryl:
Yeah. I love, that. Yeah. I didn’t know that so few people knew about that till I made a video about it on TikTok in 2020, and so many people responded, “Oh, my gosh, I didn’t know they could help with pain.” So, I love that you said that. This is just me loving like pop culture and talking about movies and books and stuff. Do you have a favorite book or movie or show you’ve watched recently? 

[01:03:48] Dr Diana:
As a favorite book, I love Gone with the Wind. 

[01:03:50] Cheryl:
Oh, classic. Yeah. 

[01:03:54] Dr Diana:
Yes, I read that while I was in high school and I think that after reading many other books, I still go back to that and I love the movie as well. But I also love the movie Downtown Abbey. I look at that and I can watch it again and again. I can binge on that. 

[01:04:09] Cheryl:
Oh, my gosh, me too. Oh, it’s so good. I love it. I haven’t rewatched that. It reminds me, I haven’t re-watched it in a while. Okay. That’s a good one to rewatch. 

[01:04:19] Dr Diana: 
Yes. I love Downtown Abbey. 

[01:04:21] Cheryl:
Yeah. Oh, I love it. As a swing dancer, I love that. This is a little bit, before the swing era was like the 1920s to the 40s, and Downtown Abbey is like earlier, but I love some of the stylings, the dresses and all that. So fun. Now, what — this is a big question because you wrote a whole book about thriving with arthritis, but what does living a good life and thriving with rheumatic disease mean to you as a provider?

[01:04:50] Dr Diana:
I think if I’m able to help my patients to understand what they are going through, live a life with grace along their family, their friends, the people that they love, I think that means a life that you just don’t survive and you can thrive through it. We all encounter difficult moments and the fact that you are diagnosed with autoimmune disease, it’s probably a very, very — not probably, it’s for sure a very difficult moment in your life, but you also have to appreciate the things that you have, even the access that you have to get the right treatment, to get the right diagnosis in the beginning. Because you don’t know but outside of the United States, there are many people with inflammatory conditions or autoimmune diseases that are never diagnosed because they are not having access to the right specialist. And even if they have the access, they don’t have access to the treatments. And that’s really important to appreciate, to know that you do have things that others do not have in other parts of the world. 

[01:05:59] Cheryl:
Yeah, that’s — that really hits home because I’ve actually meeting Christina, Christina Montoya was a good example. We were diagnosed at the same time with relatively similar severity, relatively similar age, but because I was put immediately on, well, back then I was put almost immediately on Enbrel. There was no period of having to fail something else first, like I was on, because it was 2003, so it was before all the insurance hoop, laws hoops. And it was put on methotrexate and then Enbrel and went into remission, like complete remission for six years. So, anyway, that’s, I think that’s a really important point. 

[01:06:36] Dr Diana:
And I can tell you that I’m coming from Romania, people that they have access here to JAK inhibitors, they struggle to get access to JAK inhibitors in Romania. It’s much, much better than it was in the 1990s or the 2000s. But even today, a lot of people will not have access to the biologics that we have, you know, yes, with the hoops and loops, but we can go through that with the right approach. You can go through that and you have access here much more than you will have in Brazil or in many other parts of the world.

[01:07:11] Cheryl:
Yeah. Yeah, absolutely. Well, thank you so much for taking the time to delve into these topics. I love hearing your perspective and I’m sorry I got excited a few times and I rambled on a little bit, but thank you for coping with that. Where can people find you? I’m going to put all your links in the show notes, which you can always find on the Arthritis Life website, but where can people find you online if they’re looking to follow you right now?

[01:07:36] Dr Diana:
All right, so I have a YouTube channel, and I’m very excited to use that to educate people about what it means to live with an autoimmune disease. The YouTube channel is called Rheumatologist On Call, or they can Google my name, they will find it. I have an Instagram account, I have a blog that I use every week, I publish a blog almost every week, and I have a website, which is called rheumatologistoncall.com. 

[01:08:04] Cheryl:
Yeah, I’m gonna have, again, I’m gonna have hyperlinks to all of these as well. I just appreciate your work. You’re really helping a lot of patients in the whole, like, the whole patient, not just the disease, like you said, so that’s the more eloquent the way you said it. But thank you very much. And I hope to — we’ll probably have a follow up sometime and chat maybe a little bit more, maybe an Instagram live or something like that. So, but we’ll just say bye-bye for now. And thanks again. 

[01:08:34] Dr Diana:
Thank you very much. 

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