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Podcast, Provider Interviews

Navigating the Shift: From Pediatric to Adult Rheumatology with Dr. Jenna Thomason

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Summary:

Getting diagnosed with inflammatory arthritis in your teens or early 20s comes with a whirlwind of changes—and one of the biggest is shifting from pediatric to adult rheumatology care. In this episode, Cheryl sits down with rheumatologist Dr. Jenna to unpack what that transition really looks like, and explore tips to make it smoother and less overwhelming.

Dr. Jenna breaks down the key differences between pediatric and adult care, and shares practical tips to help you feel more confident and prepared—whether it’s learning how to speak up during appointments, track your symptoms, or build a support system that really gets it.

They also get real about mindset, movement, rest, and how to keep living a full, active life even with rheumatoid arthritis, juvenile idiopathic arthritis or a similar condition in the mix. If you’re feeling unsure about what comes next, this conversation is full of encouragement, clarity, and little ways to start taking charge of your health journey.

Episode at a glance:

  • Why the Transition from Pediatric to Adult Rheumatology Care Matters: Understanding the key differences between pediatric and adult rheumatology care.
  • Common Challenges: Navigating new doctors, treatment plans, and increased self-management responsibilities.
  • Self-Advocacy Tips: How to confidently communicate with your new care team and take charge of your health.
  • Building a Support System: The importance of finding a community, whether through friends, family, or patient groups.
  • Finding the Right Rheumatologist: What to look for in a specialist who understands your needs and concerns.
  • Words of Encouragement: Reassurance that you’re not alone in this transition and that smoother adjustments are possible with the right resources.

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 Jenna Thomason 

I am an Assistant Professor of Rheumatology at the University of Washington (UW), and Associate Program Director of the UW Rheumatology Fellowship Program. My niches include medical education, SLE, derm-rheum overlap conditions, CNO/CRMO, and transitions from pediatric to adult rheumatology care.

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:
Today I am so excited to have rheumatologist Dr. Jenna Thomason on The Arthritis Life podcast. Welcome! 

[00:00:07] Dr. Jenna:
Thank you. I’m so happy to be here. Thanks for having me. 

[00:00:10] Cheryl:
Yes, we’ve been talking about this for a while. And so, could you let everyone know where do you live and what is your relationship to arthritis, however you interpret that question?

[00:00:21] Dr. Jenna:
I live in Seattle and work in Seattle. And I’m a rheumatologist. So, I spend most of my time at Harborview Medical Center. And once a month, I work in a combined rheumatology/dermatology clinic at the UW Roosevelt Clinic. And my clinical niches include rheumatic diseases with dermatologic manifestations, systemic lupus, erythematosus, transitions from pediatric to adult rheumatology care, and also chronic non-bacterial osteomyelitis and the subsets of that, which are chromo and SAPHO syndromes.

[00:01:00] Cheryl:
Wow, I haven’t even heard of those, but that’s what’s wild about rheumatology is there are so many rare — I don’t even know if that’s rare, I just hadn’t heard of it — there’s so many.

[00:01:10] Dr. Jenna:
Yeah, it’s rare, more common in pediatric patients. 

[00:01:13] Cheryl:
Okay. Yeah. And I’m just really excited to have you here. We’re going to talk a lot about the transition from pediatric to adult care, but we’re also going to talk about other helpful things from your wealth of experience. And when we say UW, I always try to like define acronyms and stuff. That’s short for University of Washington by the way. So, if anyone’s listening, “What’s a UW?” I always wondered, maybe the, I wonder if the University of Wisconsin also calls it that. 

[00:01:42] Dr. Jenna:
I think they do. Yeah. 

[00:01:44] Cheryl:
So, so we’re talking about when we say UW, we’re both in the Seattle area talking about University of Washington. So, before we get into the topics of the day, I always like to know what inspired you to become a rheumatologist in the first place?

[00:01:59] Dr. Jenna:
Yeah, so, I would say choosing a medical specialty was really tough for me. I actually published a little essay about that when I was a medical student because I really, really struggled. And I look at it kind of as a series of branch points. When I was a medical student, I was trying to decide between pediatric and adult care because I really, really love kids. But the thing that really drew me to adults was that I really loved hearing people’s stories. And then, I also loved dermatology, but what I really loved was dermatologic manifestations of underlying systemic disease. 

So, I ultimately went into internal medicine and was considering several subspecialty options subsequently, but I was really drawn to rheumatology, for a few reasons. So, as rheumatologists, we’re so fortunate that we develop these really long-term relationships with our patients. And that was something that was so valuable to me. Also, you might say, “Oh, that’s what a primary care doctor does too.” But I think one of those branch points is deciding, do you want to know a lot about one thing or a little about many things? And to me, I really wanted to know a lot about a sort of more narrow area in internal medicine. And then, again, I love the diseases that have derm manifestations and other physical findings. And so, for me, rheumatology was, I think, ultimately a natural choice and I have loved every minute of it and I have not looked back, so. 

[00:03:45] Cheryl:
That’s amazing. I think I was trying to think if you’re, like, you’re somewhere between the 10th to 15th rheumatologist I’ve had on the podcast, maybe even 15 to 20th, and I always love hearing why people are drawn to rheumatology. And it’s usually the mixture of that long-term relationship to really be able to dive deep with your patients and the medical mysteries. 

[00:04:07] Dr. Jenna:
Oh, yeah, getting to essentially be a detective sometimes. 

[00:04:11] Cheryl:
Yeah, yeah. And, yeah, I have a million follow up questions, but I do want to make sure we have time for the day. But I would say one quick question is, I think as a patient and as a support group leader, I think one of the hardest things to cope with is like uncertainty and ambiguity. And I think having a chronic — or having a rheumatological disease like rheumatoid arthritis, which I have — from the start, from the word ‘Go’, it’s actually so much uncertainty. ‘Cause there’s, you have this specific diagnosis, but there’s no, there’s a diagnosis of exclusion, right? Where it’s not like this silver bullet. Like, for diabetes, like your fasting blood sugar was X, you have diabetes. There’s no question, right?

Whereas for us, it can be really hard to wrap your head around. And I’m just — yeah, it’s one of the harder things to cope with, whether it’s uncertainty about even your underlying diagnosis and then also uncertainty about your treatment plan. These meds usually work, but sometimes they don’t, and you might have to do trial and error. How do you cope as a rheumatologist with all that uncertainty? 

[00:05:24] Dr. Jenna:
Yeah, that’s tough. I think we get, I think, as a rheumatologist, you do become a bit more comfortable with uncertainty and living in the gray, which is something that I think all of us have had to learn during our training. And you’re right. There is that, at this point, we’re still living with uncertainty even about what specific treatments will work. And I’ll tell questions about all the time when it comes to choosing the next medicine. I tell them, like, “One day you’ll come into my office, we’ll do a blood test. And it will tell us this is the inflammatory pathway that we should lock, you know, next in Cheryl’s treatment,” or whatever, “And we don’t have that yet.” 

But we have come so far. Another thing I tell people is that, you know, we could — I want to offer, a little bit of hope when they are diagnosed with these conditions because we do have so much more to offer than we have historically. I tell them, if you were being diagnosed with this condition, say, in the 80s or even in the 90s, we just didn’t have, nearly as much as we have to offer today. And so, hopefully that does provide some hope for patients.

[00:06:46] Cheryl:
Yeah, I remember my doctor having that exact conversation with me at my very first diagnosis appointment. And she said — and it really left an impression on me — that this is the best time in history to have been diagnosed with one of these conditions. That was the case in 2003 and it’s even more practically the case now. There’s so many more treatments. So, is there anything else that you wish patients knew maybe either about rheumatologists in general or about your job? It’s just, honestly, I don’t have — I’m not trying to lead you into anything, I’m just curious.

[00:07:25] Dr. Jenna:
Yeah, I don’t know. Yeah, I would say most rheumatologists are like such, well, most of the time, very kind people, and like we were saying, they’re like detectives. They’re typically these very cerebral beings, and interested in not only diagnosing your condition, but figuring out the way to treat it that helps maximize your quality of life, and all those things that are important to you. 

[00:07:56] Cheryl:
Yeah. Yeah. I think that’s true. And I think one thing I tell patients sometimes, I don’t know if you do too, but is that your rheumatologist does not have a crystal ball. Like, they’re doing — but they’re very informed as to their recommendation, but it’s not like they’re — sometimes I think it feels to patients like, “They just don’t want to tell me what’s going to work,” or something like they’re worried that the rheumatologist is being obtuse, but I’m like, no, they literally don’t know. Does that make sense? Are your patients sometimes confused? They’re just like, “Tell me what to do. Tell me what’s going to work.” 

[00:08:29] Dr. Jenna:
Yeah. Yeah. People take — definitely people have different ways that they approach that uncertainty too. I have some patients that are like, “Whatever you decide, that was what I will do.” Whereas other patients, they want to have way more back-and-forth and engagement and negotiation and conversations about where to go. But, yeah, it can be uncomfortable for everybody living with that uncertainty and gray area. 

[00:09:00] Cheryl:
Yeah, and that’s what’s all the more reason to see — the other thing I tell people a lot and then we’ll go to the other questions — but is that your rheumatologist is like on your team, like, on your side. Because navigating medicine can feel like combative to some people because they’re like, “Oh, there’s all these barriers. Like, I can’t get in for three months or six months or eight months.” And it feels like it’s us versus them, which I would say, sometimes it’s the case with insurance. Don’t quote me on that, but yeah, we all know it. 

[00:09:29] Dr. Jenna:
Yeah, yeah. A hundred percent on your side. And it’s so, I think, important to be like really honest about how things are going, like how adherent you are to your medication regimen because like sometimes someone may feel like they’re letting their doctor down or something if they’re not being 100% adherent to their medications. But often there’s things that we want to explore. Are you having side effects from the medications? Are there ways that we can adjust it to make it better? Like, for instance, like methotrexate can be very difficult to tolerate. But we generally have ways that can help people like, like split dosing. So, you take part of your dose in the morning, part in the evening. Or using subcutaneous methotrexate. Or sometimes increasing folic acid. Like, lots of strategies. 

Or say people are not injecting their subcutaneous medicine because they have a needle phobia. Like, maybe we could figure out how to switch to one that’s less frequent or to infusions or oral medicine. Or there’s so many, we’re so fortunate we have so many strategies available to us. So, it’s so important just to lay it all out there and figure out how you together can work to really maximize your treatment plan and quality of life. 

[00:10:49] Cheryl:
Yeah. I mean, I think I’ll say this as like a person who’s been the victim of my own, what I would say, wayward optimism is that it is so important to be — ’cause I would never the kind of person that would be dishonest for a reasons other than like my own denial, you know what I mean? The first time a medication failed me, I didn’t understand what was happening because I was like — insanity is doing the same thing and expecting a different result, right? 

Well, I’m doing the same thing. I’m injecting my Enbrel every week exactly how I always have. And I’m suddenly feeling worse, but I didn’t know why and so I kept thinking, “Oh, this must just be, maybe it’s stress. Maybe I didn’t sleep well enough. Maybe my, oh, this is just I’m getting older,” I’m like 27 [Laughs]. So, then I’m at my doctor and she’s like, “How are you?” I’m like, “I’m fine. It’s like weird that my fingers are like hurting but not really bad. Not a big deal. Not a big deal.” 

And I finally, when I told her, she explained explain that your immune system could change and adapt and create antibodies. Potentially the meds are just, like, the meds can, for whatever mysterious reason of what’s going on in my body, they can decrease in effectiveness. And I was like, oh, if I had known that then — first of all, if I’d just known that to begin with, I would have been more on top of it. But, so it’s all the more reason to have that open communication. So, yeah. 

So, we’re going to talk today about the transition from pediatric care to adult rheumatology care, which is a big, big change for people. So, first of all, just what is the difference? Why can’t I, as an adult, go to pediatrics? Because I like being around kids and they’re fun and their facilities are always bright and colorful and more fun. Or why can’t kids go to the adult rheumatology? Just what’s the difference? 

[00:12:38] Dr. Jenna:
Yeah. There are some important differences. Of course, age being probably the most important one. 

[00:12:48] Cheryl:
Your literal joints are different when they’re, you’re growing. 

[00:12:51] Dr. Jenna:
Yeah. That’s, yeah, that’s so true. Yeah. So, pediatric rheumatologists generally see patients up to typically up to age 18 there. And there are some reasons why patients might transition to adult care earlier or later. Also, the diseases themselves are a little bit different in the pediatric world. Treatments can sometimes be different as well. And then, there’s a lot of important differences kind of like in the, I would say, like, approach in pediatrics versus adult care. And there was this beautiful paper that was written a few years ago by Sarah Bayefsky, Kimberley DeQuattro, and Rebecca Sadun, where they go through the differences between peds and adult care. And Dr. Sadun is a, she’s a med peds doc who’s trained in rheumatology, so she has, this wonderful perspective in looking at the two sides. 

And then, also, I’ll put in a plug for our video that we made, which I think Cheryl’s gonna share, where we, it’s just essentially animated versions of myself and one of my colleagues, Cindy Chiu, where we also talk about differences between pediatric and adult care. So, some of the big differences that we talk about are just like the appearance of the clinic. So, it’s much more pleasant to go to a ped’s room clinic. There’s usually, like, sea creatures on the walls and, like, beautiful and colorful. And then, like you come to our clinic and like literally everything is beige, like, some shade of beige on like the floors, the walls, the curtains. So, that’s the first difference people notice. And then, also in the waiting room, sometimes you might see older patients. Also, the length of visit can be different. So, in the pediatric world, patients generally have longer visits. When they transition to adult care, depending on which clinic you go to, there may be, like, shorter visits. 

So, we’re so fortunate. We have 60-minute new appointments, 30-minute follow up appointments. But often in the adult world, the rheumatologist may only have 40-minutes for a new visit, or even 15- or 20-minutes for follow up visits, which is tough. Also, the approaches to screening are often different in the pediatric versus adult world, and I think a lot of that has to do with, like, once you are in the adult world and you maybe have more ability to express what’s happening with your body, like you’re able to tell us more about what’s going on, and then we generally do certain testing based on symptoms; whereas, in the pediatric world, for instance, systemic lupus patients, regularly, pretty much every year, get an echo, pulmonary function test, and other things. Whereas, again, in the adult world, we’re more focused on evaluating those things if they have, patients have certain symptoms. 

Also, one thing I think is scary for patients is they are sometimes told that in the adult world, we will sometimes tolerate low disease activity. In the peds world, patients are treated very aggressively to stamp out any evidence of active disease. But as patients like get older and older, sometimes the treatments carry a little bit more risk for patients as they get older and maybe accumulate more comorbidities. So, there are times when a patient might have low disease activity and we tolerate that rather than ramping up their disease regimen. 

[00:17:04] Cheryl:
Yeah. And to people who may not, maybe are like the more newly diagnosed, like when we say low disease activity, we mean like you still might have some clinical markers of disease in your blood work or in your tender joints, swollen joint count, or your subjective experience of your disease, like, having some lingering pain or stiffness; versus the remission, trying to give the people the ‘right’, quote unquote, the amount of treatment, which is usually the medications that are going to put you into full remission, where you’re, like, don’t even look like you have the condition anymore. Would that be right to say?

[00:17:39] Dr. Jenna:
Yeah, that’s right. And then, and usually tolerating low disease activity is like usually a shared decision between the patient and the provider, like, generally not letting people have active disease if it’s causing them significant pain or interfering with quality of life. Or more like the patient might — say I might feel some swelling on exam and the patient’s already on meds, and they feel like they’re doing really well. And they’re like, “I don’t want to take more meds. I don’t want to take different meds,” and then, in that case, we’re just monitoring things over time. So, there are a few different scenarios in which that can come up. 

[00:18:22] Cheryl:
And I think — oh, sorry. I was just going to say, ’cause I used to work as a pediatric OT and I think in our occupational therapy evaluations, it’s very much like family system-based in the sense that you’re, you have to, especially depending on how young the child is, you’re asking a lot of questions to the adult to say, okay, let’s say you have a two-year-old that started, that stopped suddenly walking or is limping or is crawling differently. And obviously like the two-year-old can’t be like, “Mum, I have bilateral joint pain,” you know, like, you have to see what the, observable behavior is. And whereas adult, it’s more like a one-on-one relationship with you.

[00:19:03] Dr. Jenna:
Yeah, exactly. I think on the most important difference really is the care is really centered on the patient rather than — and patients are welcome to bring whoever they would like to their clinic appointments, but we’re generally directing questions at the patient. And sometimes, if you are a young patient and you bring a parent with you, then we might even ask them to step out so that we can have so private conversations about things that you may not want to discuss in front of your parent.

[00:19:41] Cheryl:
Yeah, when I was diagnosed was 21 and I had my parent, my mom, at my appointments because I had become so — I was just really sick, and I had lost like over 10% of my body weight, maybe even like 15%. I was just, like, I felt like I couldn’t think clearly like the brain fog and fatigue were so bad and I didn’t know what was happening. So, I really needed her there as an extra brain, you know what I mean? And I needed her emotionally, but also please, like this, these are complex conditions to begin with. And I’m not at my best right now. 

So, I was really lucky that I wasn’t treated poorly by rheumatology for having her there. I was — anyway, listen to Episode 100 if you want to hear the ups and downs of my medical journey, because I interviewed my parents on that episode. They shared that one of the gastroenterologists just said something really weird about how he thought that I was like too attached to my mom or whatever. I’m like, sorry, I have a supportive family. Anyway, that’s my story. But what else were you going to say when I said the thing about like the kind of family-based care? 

[00:20:50] Dr. Jenna:
Yeah, just like also the — you feel the expectations in terms of coming like to appointments on time, and refilling your own medications, and things like that can sometimes feel like a change when you’re transitioning to adult care as well. 

[00:21:17] Cheryl:
I think the other thing that surprised me, I honestly didn’t know this, because I was diagnosed by an adult rheumatologist as an adult. I didn’t know that pediatric rheumatologists, they’re pediatricians. They are pediatricians who are then — this is not obvious to regular people. So, they’re pediatricians who then specialize in Rheumatology. Whereas rheumatologists are adult internal medicine. That is a totally different basis of your training, right? 

[00:21:45] Dr. Jenna:
Yeah, it is. Yeah. Yeah. 

[00:21:47] Cheryl:

So, it’s just good to know that pediatricians are trained in child development and all sorts of other things that are — not that, like, all doctors are trained in like the basics, right. But it’s just, it’s a different, and it’s a different, I would just argue like maybe personality type in the type of physicians or medical students who self-select into pediatrics, like internal medicine. And but I’ve still found that I think rheumatologists are amazing, and but I’m like a big kid at heart. So, I also love pediatric rooms, too.

[00:22:22] Dr. Jenna:
Yeah. Yeah. Yeah. Me too. That’s how I got this gig doing transitions. I actually, when I was a fellow, rheumatology fellow, in my second year, we do several rotations and one of them is going to hang out at Children’s with the pediatric rheumatologist. And so, I got to hang out at Seattle Children’s and I loved it. I loved it so much. And they deemed me a peds, like, adult rheumatologist and they started sending their patients to see me in clinic. And so, that’s how I got this gig, and I love it. I feel so fortunate. 

[00:23:02] Cheryl:
Yeah, well that dovetails perfectly to my next question, which is, yeah, so when patients transition, what, you know, let’s say on average age 18, from going to their pediatric rheumatologist to the adult rheumatologist. Why is that transition hard? Obviously, it’s probably not obvious, but what are some of the things that make that transition hard? And then what are the things we can do to make it easier for them? 

[00:23:29] Dr. Jenna:
Yeah, so, I think it really, the difficulty depends on the patient themselves. Some of the things that have come up there are that some patients with childhood onset rheumatic disease, they may have been diagnosed like when they were super young and we’re asking them questions — they come in for their first visit and we’re asking them questions about their disease, and they may not remember the beginning. And they also, they may have had a lot of help managing medications and stuff like that, and suddenly they’re being asked to manage their own medications and get their refills and that kind of thing. 

So, other things are like just that time in your life, like when you think about when you’re 18, like, you might be like going off to school or starting your new job or having serious relationships or managing health insurance, which is extremely difficult, unfortunately; maybe moving to a new place. So, just there tend to be naturally a lot of transitions during that period. And so, it’s a lot for somebody to also be transitioning their doctor at that time. 

And in terms of things that we can do to help. So, that’s what we’re trying to sort out. And we’ve been doing a little survey study in the past couple of years to try to figure out how we can support young people better. And I will say, the majority of research about pediatric to adult transitions is done on the pediatric side. And we know from that type of work, it’s really good to introduce the idea of transition early on. So, maybe even around ages like 12 or 13, which can sometimes feel early for patients, but it’s good to start thinking about it and gradually letting patients have more autonomy from their family in terms of being the person that is doing the speaking at the visit and taking their own medications and that sort of thing, so that when it does come time for transition that they will feel ready. 

Questions that we’re trying to explore in our survey is are these patients, do they have adequate information about reproductive health in terms of are they on teratogenic medications? Have they had access to contraception if they are capable of childbearing? Also, do they want us to ask about, like, mental health and how that is affecting their life if it’s related to their rheumatic condition. And also, right now, we are offering some transition coordinator support for patients to see how engaged our folks with childhood onset rheumatic disease will be with a transition coordinator to see if that is going to be something long-term that’s going to be helpful to those patients. 

[00:26:42] Cheryl:
I love that idea, having a transition coordinator. 

[00:26:45] Dr. Jenna:
Yeah, just someone that’s available to answer questions about various things. And then, the last thing that I that I personally think is really important is for patients that, because as like a lot of patients are lost to follow up around the time of transition —

[00:27:05] Cheryl:
And lost to follow up means that they don’t continue going to get care, right?

[00:27:08] Dr. Jenna:
Yeah, they don’t continue going to get care, or it may be like a really long time before they seek care in the adult world. One thing I think is really important is as they are arriving at the time in which they will transition to adult care, after they have identified an adult rheumatologist, made an appointment with that person, if that patient is like a higher risk patient — say like they they’re on multiple medications or their disease is active or it might be high risk for social reasons or other reasons — actually making that appointment with the adult doctor, but then making a subsequent appointment with their pediatric doc. And that way, if they don’t make it to that adult clinical appointment, or say maybe it doesn’t go well, it doesn’t feel like a good fit, then they’re still circling back to their peds rheum doc so that we can ensure that we’re keeping them engaged in care.

[00:28:02] Cheryl:
Yeah. That makes a lot of sense. And I think, one thing I read, and I should fact — I should fact check this. But let me just, I’ll just ask you because you can fact check this, is that the case that like juvenile idiopathic arthritis — let’s just take that one condition or that set of umbrella set of conditions — is more likely to go into remission? I know not all childhood rheumatic diseases go into like long-term remission, but isn’t JIA more likely to go into remission than like adult rheumatoid arthritis? 

[00:28:33] Dr. Jenna:
So, yeah, certain types of JIA. 

[00:28:36] Cheryl:
So, I would imagine if you were somebody who was in remission at the time you’re 18, I’ve heard people in my support groups, like people in their 20s or even early 30s, will say, “Well, I thought I was done with this because I had, you know, whatever subtype of JIA, and then, or juvenile ankylosing spondylitis, or juvenile psoriatic arthritis, and then I started — I was feeling better, and just, I thought it was going to never come back, and then it did.” Is that just like freak occurrences that I’ve seen or is that something you’ve seen? 

[00:29:03] Dr. Jenna:
Some kids, yeah, some kids, depending on their type of arthritis, can go into remission. 

[00:29:08] Cheryl:
Yeah, adults can too, that’s what’s cool, too. Obviously, we can go to medicated remission, but some go into like spontaneous remission even unmedicated, right?

[00:29:18] Dr. Jenna:
Yeah, some, depending on your type of inflammatory arthritis. Yeah, less likely, with, rheumatoid arthritis, but some other types of seronegative inflammatory arthritis, reactive arthritis could go into remission. So, yeah, and we hope that’s going to be more of our future is like actually having people go into remission. So, we’ll see. Yeah. 

[00:29:41] Cheryl:
Yeah. Yeah. Sorry. I didn’t mean to take us on derail, but I think that was, that’s a really, I can imagine the idea of being lost to follow up or just not continuing being seen totally could make sense if you’re, like, it’s your first time being on your own, you move to go to college, you have all these new responsibilities, you have your first credit card, you have your first job, you’re managing your college schedule. And you’re like, “Oh, I’ll make this appointment later,” or the doctor says you have all these months to, you can’t do it for X number of months and you’re like, “Oh, my gosh,” so, yeah, So, I know you’ve done lots of research on this, I remember you presented at the Rheumatology Conference last year, which doesn’t seem like that long ago, but it was in November of 2024. And is there anything else you wanted to share, like, just about transition in general, or about the work that you do? ‘Cause it does sound so fascinating to me. 

[00:30:39] Dr. Jenna:
Yeah, it’s, been super, super fun work. And I’m so appreciative to all the patients who have filled out our surveys and told us what they think about all of these things. Because, like I said, historically this work has really been done on typically on the pediatric side and we haven’t heard much from patients after transition. So, I’m so grateful to them. And then, one of the things that came up and in our initial group was wanting to really know more, exactly what you asked me, like the differences between pediatric and adult care. 

[00:31:17] Cheryl:
Yeah. 

[00:31:18] Dr. Jenna:
And so, we actually made, and I mentioned this earlier, we made some videos for patients, that talk about a transition timeline and then also differences between adult and pediatric rheumatology care. And then, we also had one of our amazing patients with systemic lupus who gave us her patient testimonial, which was so wonderful. And I think Cheryl will link to all those, all of those.

[00:31:47] Cheryl:
Make sure to watch the videos. 

[00:31:49] Dr. Jenna:
Yeah. And I guess one other thing, I think, something that I think is important that I’ve heard from others is for that initial visit with your new adult doc, like, generally we aren’t and often should not make a lot of changes on that visit. That’s really more of a visit to get to know the patient and get to know their history and maybe even get to know like where they’re at in terms of independence and managing their health. And generally, we’re not making a lot of changes during that visit, unless there’s something wrong that we need to address. And I think that generally seems to go over better with the patients. Because often they’re on a regimen that they have developed with this other person that they have this like often long-standing relationship with, so it’s really more of a meet-and-greet that first visit.

[00:32:51] Cheryl:
Yeah, that makes a lot of sense. And you mentioned earlier that they might not feel that the first rheumatologist, adult rheumatologist, they meet might not be the right fit for them long term. Like, what’s your opinion on people getting like second opinions? Like, I think some people are say they tell me they’re scared to get a second opinion. ‘Cause they don’t wanna offend the doctor that they saw, or they’re worried they’re gonna be labeled as like a ‘difficult patient’. 

[00:33:18] Dr. Jenna:
Oh, yeah. So, I don’t think that they should. I don’t think they should worry about those things. I don’t want them to worry about those things. ‘Cause it hopefully should be a good fit for them. Again, like, it’s such a delicate time in their life and a lot of transitions, happening. And so, I don’t think that they should feel too concerned about being labeled as those things.

[00:33:47] Cheryl:
Like, it’s okay to get a second opinion, in your opinion, by a different doctor. 

[00:33:48] Dr. Jenna:
Yeah, I think so. 

[00:33:49] Cheryl:
I think so too. I’m just, I want them to hear it from you because I’ve said it before. 

[00:33:54] Dr. Jenna:
Yeah, no, I think so. Just from a logistical standpoint, because there are so many referrals to see a rheumatologist now, it can be difficult to get a second opinion in general, just because of our, you know, in the Northwest, we have a deficit of rheumatologists and a lot of patients, so that can make that aspect difficult. But I think for transitioning patients, it’s a unique situation. 

[00:34:26] Cheryl:
Yeah. Yeah. And I think, like, if it is gonna be a long-term relationship, if there’s — for me, I got so lucky. I had a home run with my first rheumatologist I met and it wasn’t even from any research. It was just the one that my primary care referred me to. It was fresh out of UCSF. So, she was young, relatively young, and I was like, okay, well, you’re like 10 years older than me. So, I’m, like, I’m gonna stick with you forever. But if I didn’t, yeah, if she was like unfortunately — rheumatologists are generally amazing, but some of the stories I’ve heard, sometimes if you’re in a support group leader role, you obviously are sometimes hearing like the best and the worst case scenarios. 

And sometimes if, yeah, if you don’t feel comfortable, or you don’t feel like your doctor is really partnering with you or listening to you, it’s in your best interest to see if there’s another option in your area. Again, there’s not always, you know, if you’re rural or depending on your insurance and all those other things. The other fun question I like to ask whenever I have a subject matter expert is are there hot topics in your field, like in the field of rheumatology, that you are — or just like scientific developments and discoveries that you’re excited about? 

[00:35:39] Dr. Jenna:
Yeah, for sure. Yeah. So, I think everyone’s really excited about CAR T.

[00:35:43] Cheryl:
Okay. Can you tell them what that is? We’ve referred to it before, but not recently. 

[00:35:47] Dr. Jenna:
Yeah, sure. So, the CAR T is, essentially it’s a type of therapy that was first used in treating cancer. And what they do is they take your — or currently what they do, it’s evolving over time — but currently what CAR T is is taking your own cells. And actually, taking them out of your body. And then, actually weaponizing those cells against other cells in your body that are sort causing or an underlying cause of your immune disease. And then, giving you medicine to lower your immune system in general, and then giving you those weaponized cells back into your body. And then — 

[00:36:36] Cheryl:
Oh, sorry, your audio cut out. Oh, sorry, your audio just cut out for the last five seconds for some reason.  So, I got — give you, so you get the, give you the meds to lower your immune system, and then what happens? Sorry.

[00:36:51] Dr. Jenna:
So, they give you, they take your cells. And actually weaponize them against a different type of cell in your body that’s involved in causing your autoimmune disease, give you medicine to lower your immune system for a brief period of time, and then give you back those weaponized cells. And they go in and they basically wipe out any trace of your autoimmune disease. 

So, CAR T is an amazing new therapy on the horizons currently being studied in clinical trials. The strategy of CAR T initially was used in, or has been used in treating cancer. So, what they do is they take patients with an autoimmune disease, typically a severe autoimmune disease. And so far they’ve been studying lupus and myositis and other autoimmune diseases. They take the patient’s own cells, their, T-cells, and they essentially weaponize their T-cells against a different type of cell inside their body that is involved in causing their autoimmune disease. Then they give the patient medicine to lower their immune system briefly for a brief period of time. And then, they give them back those weaponized T-cells and the T-cells go in and they kill off those cells that are involved in causing your autoimmunity. 

So, these patients that have had CAR T therapies so far have done really, really — it’s just been absolutely amazing. It’s given us hope for a cure for severe autoimmune disease, which is just absolutely — it’s really mind blowing when you look at it. Because these patients, their immune system starts to come back in a matter of weeks, but there’s no trace of their autoimmune disease. So, like, all of their antibodies against lupus are gone. 

[00:39:02] Cheryl:
Unbelievable. 

[00:39:04] Dr. Jenna:
Yeah. Their renal disease is halted. So, there’s been a lot of success so far, and there are a lot of ongoing trials to try to make it safer, make it more affordable, because that is definitely an issue, and so we’ll see. But I’m really excited about CAR T-cell.

[00:39:25] Cheryl:
I am too. Gosh, yeah, being able — not being, I mean, being suppressed in the long-term would be incredible, so I’m definitely following that. And I saw so much excitement at the conference, even though it’s outside of my domain as an occupational therapist, of course, because we’re not like doing those kind of interventions. But as a patient, I’m like, I want to learn about this. Yeah. Yeah. And so, oh, there’s a great doctor who I saw on Twitter. He’s a real doctor. So, it’s not like a fake thing. It’s the guy who does The Lupus Encyclopedia. Do you know him? He has a website called like The Lupus Encyclopedia. And he has a thing on his website all about CAR T’s. So, maybe I’ll — oh, it has like an area where you can find out about clinical trials. 

[00:40:21] Dr. Jenna:
Oh, that’s awesome. 

[00:40:22] Cheryl:
So, let me — I’m looking at that right now. ‘CAR T-cell Therapy for Lupus Made Simple: January 2025 Updates’, Dr. Donald Thomas. 

[00:40:30] Dr. Jenna:
Oh, nice. Yeah. The Lupus Foundation has a nice description as well on their Lupus Foundation America website. 

[00:40:38] Cheryl:
Awesome. I feel like with some of these things, I just have to, like, just being honest, like, I’m a smart person of the objectively in some ways, but also I’m like, wait, tell me again? Like that part in Zoolander. Mind blowing! 

[00:40:51] Dr. Jenna:
Like, this might be hard to wrap your mind around that idea. Like, it’s pretty wild. You’re not alone.

[00:40:58] Cheryl:
It’s like too good to be true. So, I’m like, yeah. I am unfortunately, I mean, fortunately in a position to support a lot of people, but unfortunately for them, I’m in touch with a lot of people who have had, who are very treatment resistant disease, who have failed all nine medications for RA in one year. And it’s just, it’s heartbreaking when you feel like you’re getting to the end of the road, like, there’s no new treatments. There are no more treatments to try. But clinical trials are — they’re not, like, a lot of patients I think tend to think of clinical trials as this fringe thing. And honestly, I did, initially. I was like, yikes, I don’t want to go to a clinical trial, they’re going to treat me like a lab rat or something. 

Like, this is the incorrect thing. Like, by the time clinical trials get to human subjects, they’ve been, like, rigorously tested. Yeah. So, it’s obviously human to be scared if you’re trying something that’s maybe not — even the drugs that are on the market, people are still scared to take those, so there’s like an amount of fear that people just have, injecting or putting anything in their body, except for untested supplements. But anyway, let’s not worry about that. That’s just humans. As Dan O’Reilly says, we’re predictably irrational. We’re not always rational. 

But so, we’ll definitely keep an eye out for more on CAR T. CART-T. I keep calling it CART-T. My brain adds an extra T. I can’t believe we’ve gone through 45-minutes and we haven’t talked about Taylor Swift yet. Just so you know, we’re both Taylor Swift fans. So, I’m wearing my —

[00:42:39] Dr. Jenna:
I think we may have been at the concert the same day. We were like so lucky we got to go to the concert. 

[00:42:44] Cheryl:
I know. Now it’s almost two years ago now in 2023, but yeah, for those of you who are also Taylor Swift fans, just I’m going to plug my own episode. I did an episode like all about like Taylor Swift songs that helped me cope with chronic illness. So, that was — I’m going to have to look it up right now, Episode 113. Of course it’s Episode 113, there’s a 13 in there.

[00:43:08] Dr. Jenna:
I also saw one of your episodes where you did some exercises to Down Bad.

[00:43:13] Cheryl:
Oh yes. Yeah, yeah. Yeah. That was on the [Word 43:16].

[00:43:17] Dr. Jenna: 
Yes. Yes, yes, yes. 

[00:43:19] Cheryl:
That was really fun. Yeah, that was really fun. But so, we’re on to the rapid-fire questions. Do you have any best words of wisdom or advice you’d like to give to people who are brand new diagnosed? 

[00:43:34] Dr. Jenna:
Yeah, I guess like more of what we were saying about, just like what you said, this is the best time in history to be diagnosed with your condition, because we do have, we have so much more to offer than we have. And patients often, by the time they receive a diagnosis of say, rheumatoid arthritis, but before they see you, they Googled photos of rheumatoid arthritis and you can see like these horribly destroyed joints. And thing is, like, fortunately, like in our country, it’s unlikely that, patients progress to that point if they’re able to access medical care and medications. It just, it really has changed the trajectory. 

[00:44:28] Cheryl:
Yeah, it’s really, I think when you’re comparing yourself or predicting how your future will be with your condition, you really have to be careful to do apples to apples, meaning like your prognosis as somebody diagnosed in 2025 is very different than somebody diagnosed in like 1985, right? You had years of disease progression because there weren’t any treatments or medications to put the disease in remission back then, so people will often say, “Oh,” or often say, “Is this my life?” And again, not to say that you can’t have a possibility of — I try to maintain the perspective that we can have a good life, even with disabilities and challenges. That’s like, the entire foundation of occupational therapy as like a discipline. 

Philosophically, it’s we’re going to find a way to work around. If you don’t have two hands, we’re going to figure out how to do everything one handed. If you don’t have any hands, we’re going to figure out how to do it with your toes. If you don’t have toes, we’re going to do it with your mouth. We’re going to figure out how to live and adapt. But don’t make it, don’t scare yourself unnecessarily that you’re going to have to suffer in the exact way that someone else did. So, anyway, just building on to what you said. Do you have a favorite mantra, if that’s too strong of a word, or inspirational saying that helps you either as a provider or that helps your patients? 

[00:45:45] Dr. Jenna:
Yeah, I was trying to think of one. 

[00:45:48] Cheryl:
It’s okay if you don’t.

[00:45:49] Dr. Jenna:
Well, so I have one, like, exercise person that I find like very inspirational and she always says, “You don’t have to, you get to.” And I think it’s, I think it’s cool to think about how many things in our lives that we’re thinking like, “Oh, I have to do this,” but it’s oh, if I just reframe it to think, “Oh, I get to do this because I’m able-bodied and I’ve had, so many, good things in my life that have brought me to this point.” So, I think it’s, applicable to your workouts, however many times a week, but also applicable to any other areas of your life. So, and that’s Jess Sims on Peloton, love her. 

[00:46:40] Cheryl:
Oh, what’s her name? 

[00:46:41] Dr. Jenna:
Jess Sims. 

[00:46:42] Cheryl:
Okay, okay. I, yeah, I’ve heard such good things about the Peloton. I have, I’ve only ever used it when — I have one at my husband’s work, which spouses can go to the gym there, which is really a great spouse benefit. And so, I did try a couple workouts just for fun but I don’t like have one at home or anything. 

[00:47:03] Dr. Jenna:
Yeah, I love her. She’s so motivating and she’s great.

[00:47:08] Cheryl: 

That’s awesome. I also have, I have my ‘We can do hard things’. That’s when I like repeat to myself. 

[00:47:13] Dr. Jenna:
Yeah. Yeah, yeah. She’s, yeah, she says that a lot too. And I say that to my kids all the time. Yeah. 

[00:47:18] Cheryl:
It’s so important, like that kind of resilience and yeah. I love it. It reminds me when you’re talking about kids, when you were saying earlier about like giving children and like young adult or young teens — what do they call them, preteens — and teens, like, more responsibility? It was interesting because my son’s about to start middle school and they’ve already started doing these orientations. So, they’ve been saying, like, you need to start now. My kid’s only in fifth grade, but being like, they’re like try to let your kid be in charge. And say you’re in charge of bringing your instrument to school or you’re in charge of your homework, not providing excessive reminders because they have to start now being more accountable and having those experiences which then make them experiences of what it’s like when you forget your instrument, you’re the only one in the band who’s not playing or whatever. 

And then, that will help — as long as it’s in OT, we call it like the ‘Just Right Challenge’. Like, it has to be an appropriate challenge. You don’t tell a three-year-old go zip up your jacket and tie your shoelaces. Like, they’re not able to do that yet. But I think, as a parent, we definitely, the pendulum has swung towards a lot of like helicopter, yeah. I remember — actually, sorry, this is a side note, but I just have to say it because it’s really interesting. There was research coming out of, I think it was Children’s in UW, that the number one most effective strategy for treatment, for childhood anxiety disorders was adult parental coaching. Even more effective than the one-on-one therapy with between a child and a therapist was the parent coach. I know, that was so fascinating. 

Anyway, my therapist, he’s a psychiatrist, but he’s a board certified in both adult and child psychiatry. So, he does see, he didn’t actually talk about that research, but he’s specialized in OCD and specific phobias and anxiety disorders, but I somehow found out about that, and I was like so fascinated, because it just tells you the role of, you know, supports. Yeah, so cool. Okay, do you have a favorite — you may not, because you don’t have arthritis to my knowledge — but do you have a favorite arthritis gadget or tool in your toolbox, physical or metaphorical?

[00:49:35] Dr. Jenna:
Yeah, I do. So, I was actually going to say it, not just because you’re here, but hand OT. Hand OT, so hand OT is amazing. And I tell patients that hand OT is amazing, because I think you guys really think about their whole day, and the challenges that they experience, and what’s on an individual basis, how to overcome those various challenges. And I think it can be amazing for patients. And then, also physical therapy, typically as an adjunctive treatment for other conditions that we’re managing can be absolutely amazing. 

And it’s so wonderful for patients to be able to do, like, certain exercises or movements that resolves some discomfort that — and you’re not having to take a medication that comes with potential side effects and costs and all of these things. So, I love those things. And then also, I frequently recommend slippers with arch support to patients that have trouble with their feet. I wear them and they’re, like, they’re so essential for me and that’s helped a few patients too, so. 

[00:50:55] Cheryl:
I love that. Yeah. I have home slippers. Like, they’re like, or not slippers, sorry. They’re like flip flops, but they’re really, really supportive. And I wear them around the home. And they, and I have really high arches. So, definitely with that base of the foot, those joints that are like these corollary joints to like the MCPs, like, that’s where it tends to get inflamed for me with RA. So, having that support is huge. Just like good footwear in general. Yeah, good footwear in general. So good. Justify your shopping. That’s what I’m here for. Yeah. 

But no, I’m, thank you for the shout out for like occupational therapy, specifically hand therapy is so, so, helpful. I had someone in my support group who, she’s an artist and no one had — she’s a physical artist, like she’s making stuff with paper and, you know, she is using her hands all the time and her doctor had never mentioned this whole discipline of hand therapy. And she was struggling with her hands. And I’ve heard rheumatologists say, “Oh, we don’t have to refer to hand therapy as much anymore because people aren’t having as significant deformities.” It’s like their deformities might not be as visible or huge to you, but it meant they still might have impact on function and quality of life. So, anyway, so preaching to the choir for you. 

And then, this is not on topic of arthritis, but favorite book or movie or show you have consumed recently? I should put music in there too. Book, movie show, music, pop culture. 

[00:52:32] Dr. Jenna:
Yeah. Yeah. So, my kid, I basically, I only watch, I get to watch movies with my kids. So, which is totally fine with me. Because I love watching movies with my kids. But we’ve been like on this 90s sports movie kick. 

[00:52:48] Cheryl:
Oh, my gosh, us too! 

[00:52:50] Dr. Jenna:
Really? Okay, I’ll have to ask you which ones you guys have been watching, but it’s so nostalgic, right? Watching like ‘The Mighty Ducks’, and they’re like really into it, and they’re like on the couch screaming, “Quack, quack, quack!” 

[00:53:05] Cheryl:
That’s so true. ‘Ladybugs’. I don’t know if they’re old enough for ‘Ladybugs’. The gender kind of, there’s issues with it. You kind of have to explain it. 

[00:53:13] Dr. Jenna:
Yeah, sometimes, yeah, watching the 90s movies can be like a little bit of a gamble. But then it gives us an opportunity to talk about it. Also, ‘The Little Giants’. Do you remember that movie? 

[00:53:23] Cheryl:
Ooh, I haven’t re-watched. I remember, but I haven’t re-watched it. 

[00:53:27] Dr. Jenna:
Recommend. Highly recommend. And ‘Rookie of the Year’. They just loved that movie. 

[00:53:33] Cheryl:
Oh, my God, this is so great. I’m getting some good ideas. 

[00:53:37] Dr. Jenna:
And then, they’re also really into musicals. They loved ‘Wicked’, which I loved too. It was so great. And then, we just watched the, there was a 2014 remake of ‘Annie the Musical’. It was so good. We just, we watched that last weekend. So, lots of good movies. 

[00:53:58] Cheryl:
Oh, that’s so great. 

[00:53:59] Dr. Jenna:
Yeah, we’ve been — 

[00:54:00] Cheryl:
Oh, go on. 

[00:54:01] Dr. Jenna:
I was just gonna say, the only sort of new movie that we watched recently was this movie ‘Bookworm’ on Netflix, which was also fantastic. 

[00:54:09] Cheryl:
Oh, I didn’t see that one. Did you watch ‘Flow’? The Oscar nominated, it’s basically a silent animation movie featuring a cat. 

[00:54:23] Dr. Jenna:
No, we haven’t. No, we haven’t. 

[00:54:26] Cheryl:
Yeah. It’s all animals. It’s really beautiful. It won best animated feature at the Oscars. Yeah. Sorry, spoiler alert for those listening, but this was the Oscars from a few weeks ago. And it’s really cute. I think it’s Netflix. Yeah, it’s really, it’s really great. Yeah. I love children’s media. It’s really fun. We’ve been watching, my kids are, my kid is a little older than yours, but we’ve been watching ‘Boy Meets World’. Oh, my gosh. It actually holds up surprisingly well. Yeah. 

[00:54:59] Dr. Jenna:
That’s awesome. 

[00:54:00] Cheryl:
But to be like, we paused, okay, this is what a phone looked like. You had to dial in numbers. It’s really fun to look at that even, like, we’re finally he’s finally old enough to watch some of Jim Carrey, like ‘The Mask’, although we have to fast forward a couple things. But yeah. Oh, yeah, classics. 

Okay, and then back to arthritis. What does — this is a hard one — what does living a good life and thriving with rheumatic disease mean to you? You’ve talked about quality of life a lot in this so far, but what does it mean to you? 

[00:55:36] Dr. Jenna:
Yeah. So, one of my great mentors, who I think you know, Greg Gardner, he had so many wonderful, wonderful things that he would say. But one of them was like, and he was a rheumatologist before we had medications, right? There’s this whole generation of rheumatologists that were treating patients before we had good meds and have been able to live through this new having all the options that we have now.

And he would say to patients, “Our goal is for you to not have to think about your arthritis except for the one day a week when you give your shot,” or whatever. And that’s probably not necessarily true for many patients, but I think it’s, I think it’s a good goal, and I think it’s a real possibility for some people, and we’re so, and we’re really fortunate that we’re in an era where that’s even something that we’re able to talk about. 

[00:57:00]  Cheryl Crow: 

That’s a beautiful thing to not be just — I always tell my doctor, I just don’t, I want my symptoms to be such that I’m not, distracted by them on a daily basis. It’s just, it’s either background noise or it’s not there at all. That’s ideal. And is there anything else? I know we’ve been talking a little while, but was there anything else that you were like, “Oh, shoot, I forgot to say that”? You probably will think about it 10 minutes after we hit —

[00:57:26] Dr. Jenna:
Yeah. Not that I can, not that I can think of. Thanks for linking to the videos that we made, I appreciate that so much and I hope that those are helpful to people. And please leave us comments, if you’d like. 

[00:57:42] Cheryl:
Oh, yes. And is there anywhere else you would want people to follow you online versus other than that? 

[00:57:48] Dr. Jenna:
Yeah, we have, so we have a UW — again, it’s a University of Washington — UW Rheum, Instagram account where we publish or we post things about, like, transition. Sometimes all of our speakers are on there and various other things. And we have, one of our incoming fellows is really interested in transition and is going to make some educational posts for us to put up on there. So, stay tuned for those. 

[00:58:22] Cheryl:
Oh, one last, one last off the cuff question. what was your favorite Era at the Eras tour? Taylor Swift Eras tour.

[00:58:31] Dr. Jenna:
It’s so hard. ‘Cause I feel like it like it kind of, like, it changes over time, right. Because it depends what I’m like going through in my life, honestly. I think as an album, like, as a whole album, I think my favorite is probably Lover, just because there’s so many songs on that album that I just love. But I love her so much and she’s such, like, an incredible breadth of music and genre, and I think she’s absolutely incredible. What about you? 

[00:59:09] Cheryl:
Yeah. Well, my favorite Era of the Eras tour, like her performance, was Reputation for sure. I just love, especially ‘Look What You Made Me Do’, just the way it was visualized with all those like little tailors coming down and strutting around. I just strut to that song like constantly. But I agree. Like, I think ‘The Tortured Poets Department’ set when she added that, like, after we had seen the show was absolutely like incredible as well. But yeah. 

[00:59:40] Dr. Jenna:
I know. I wanted to see it again just so I could see that. 

[00:59:43] Cheryl:

No, I know. It was, yeah, it was really unbelievable how she managed to bring each album, you know, each album to life in different ways. Evermore is one of my favorite albums and it was so cool to see how she, like, had the kind of mystical, like the orbs and everything. So, I love Lover too. It was such a great, perfect one to start the show given that like Loverfest, like, her previous concert had to be canceled. So, yeah. Oh, we’re so fortunate to be so fortunate in the era of Taylor Swift. I was gonna do an obscure quote — sorry, my brain auto filled with an obscure Parker Posey quote, but not even related to Taylor Swift. But yeah, we are very fortunate to be living in the times, the time era of Taylor Swift. 

[01:00:30] Dr. Jenna:
Absolutely. 

[01:00:31] Cheryl:
Well, on that note, thank you so much again. I know you’ve had, like, this is like your fifth meeting of the day. So, thank you for, for being here and sharing all your wisdom. And I hope that, you know, there’ll be people not just today, but in the future listening to this episode and feeling more confident about their transition from kids to adult rheumatology. So, thanks again. 

[01:00:50] Dr. Jenna:
I hope so. Thank you so much, Cheryl. 

[01:00:52] Cheryl:
Yay, thank you. Bye-bye. 

[01:00:54] Dr. Jenna:
Bye.

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