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Podcast

Becoming Immune Confident with Sjogren’s Disease and MCAS, with Dr. Kara Wada

3 days ago
63 min read
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https://youtu.be/O7_Z3tH62l4

Summary:

Feeling overwhelmed by autoimmune symptoms like Sjögren’s and MCAS? You’re not alone — but you can become “immune confident.” 

In this empowering conversation, Cheryl  and Dr. Kara Wada explore what it means to take charge of your health with conditions like Sjögren’s Disease and mast cell activation syndrome (MCAS). Dr Kara shares how her experience as a patient with Sjogren’s taught her things she never learned as a allergist-immunologist doctor

They discuss practical strategies for rebuilding trust in your body, the critical role of understanding your core values, and how to find the right support — whether through programs like Rheum to Thrive or events like the Virtual Sjögren’s Summit. 

Together, they show how education, advocacy, and mindset shifts can help patients move from fear to confidence in managing their immune health.

Episode at a glance:

  • Sjogren’s and MCAS 101: what is Sjogren’s and MCAS? 
  • Dr. Kara Wada’s personal journey: Sjögren’s IDsease and mast cell activation syndrome (MCAS) and how it shaped her mission to empower patients.
  • Understanding “Immune Confidence”: learning to trust your body again after autoimmune and allergic disease diagnoses.
  • The importance of patient advocacy and education: how Dr. Wada supports patients across multiple states through educational visits.
  • Healthcare system issues: why are complex patients being given the short end of the stick, and what are some creative solutions?
  • Upcoming events and opportunities: the Virtual Sjögren’s Summit and Cheryl’s evolving focus with Rheum to THRIVE.
  • Finding balance between personal life and professional advocacy while living with chronic illness.

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 Kara Wada

Quadruple board-certified allergist, immunologist, lifestyle & functional medicine physician bridging conventional and integrative care. With 14+ years experience, I uncover root causes and driving factors of misbehaving immune systems (allergies, autoimmune, inflammation) and empower holistic healing. Personal experience with Sjogren’s and dysautonomia drives my compassionate, patient-centered, trauma-informed approach, blending science with personalized strategies for lasting results.

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 Crow: Hi everyone. I’m so excited to have Dr. Kara Wada here to talk about becoming immune confident with Sjogren’s MCAS and more. Welcome, thanks for 

[00:00:14] Dr. Kara Wada: being here. Thank you so much. I have been looking forward to this afternoon on my calendar for like weeks. 

[00:00:22] Cheryl Crow: Yay. Me too. Well, and what’s really interesting is I was taking a look back and realizing our, the first time I had you on the podcast was two full years ago, but that one episode is my most watched and frequently commented on YouTube video on my entire channel.

[00:00:39] So, we really, struck a chord that one was called, “It’s not just dry eyes,” delving into Sjogren’s. So you’ve been doing really wonderful work.

[00:00:48] I’ve just noticed in, in the five years since I started Arthritis Life, I honestly, if you had asked me in 2020 what Sjogren’s is, I wouldn’t know what to tell you.

[00:00:59] I knew something about dry eyes. Ah, but now there’s a lot more general awareness and I think you’re doing amazing work in this area. 

[00:01:07] Dr. Kara Wada: Thank you. I mean, I think what was so humbling, to share a little bit of backstory for those, who maybe are newer to the podcast and haven’t gone to the deep cuts.

[00:01:17] Mm-hmm. But I think what was so humbling with my diagnosis was realizing how much of what I’ve learned has come from my fellow patients and did not come from my medical education and an education that even had a focus on the immune system and many of the symptoms that are affected by Sjogren’s.

[00:01:37] And even, yeah. Even in spite of all of that, I learned so much more from the community and it, it’s kind of been with that, that i’m driven to make as many people aware, whether it’s been residents or medical students that have rotated with me colleagues at, our green rounds and also just anyone and everyone who will listen.

[00:02:05] Cheryl Crow: Yeah. Yeah. I love that. And well, yeah, you anticipated my first question, which is, what is your relationship to Sjogren’s and Rheumatic disease? And, can you also let the audience know where, where do you live and what is your medical specialty? Yeah. 

[00:02:19] Dr. Kara Wada: So, I, I am based out of Columbus, Ohio area.

[00:02:24] I’m a lifelong mid-westerner, originally from the not Chicago part of Northern Illinois where it’s like cornfield mm-hmm. And all that sort of thing. Yeah. Yeah. I am board certified in allergy immunology lifestyle medicine, and I am over three quarters way done through functional medicine training too.

[00:02:45] Wow. I see both kids and adults. I did both pediatric and adult training, like general training before my fellowship. And the really cool thing about allergy immunology is a field is no matter if you’re a pediatrician or an internist or both, you get to learn how to take Wadae of immune system problems in people across the age spectrum.

[00:03:07] So I didn’t 

[00:03:08] Cheryl Crow: know that that, 

[00:03:09] Dr. Kara Wada: yeah, I did not know That ones a few specialties that allows for that. And I think as someone who has a, a background of what’s called med peds, so both pediatrics and internal medicine mm-hmm. It was a really great fit because I love seeing people across the lifespan. I also knew though that I didn’t have what it took to be a really great.

[00:03:28] Primary Wadae doc which is a lot and they don’t get enough credit for it. 

[00:03:32] (Both Speaking): No. 

[00:03:32] Dr. Kara Wada: That I wanted to focus in on the immune system. I, I of, I’ve always nerded out in like immunology class and, and those sorts of, and biology, how cells talk to one another. Like that stuff excites me. And that is the nitty gritty of the science that I am trying to think about as I am talking with a patient and really trying to get an understanding of their lived experiences.

[00:03:59] So I was diagnosed with Sjogren’s disease coming up on was in 2019, so coming up on my sixth year Wow. Anniversary soon. And. It was within about two weeks of my daughter, my second born at the time having an anaphylactic reaction to egg. We don’t have any family history of food allergy. We didn’t have any, any real family history of, of connective tissue autoimmune conditions.

[00:04:29] I had a couple cousins with inflammatory bowel, but, but you know, this was all pretty out of, seemingly out of left field, what I know now. Maybe it wasn’t.

[00:04:39] (Both Speaking): Yeah, 

[00:04:40] Dr. Kara Wada: and it, that really has been a, a huge turning point in both my, my personal life at home, but also my professional life, as things have evolved.

[00:04:52] Cheryl Crow: Yeah, I, I totally, i, I can relate to being able to connect the dots in, in the past, like mine also, when I was diagnosed with rheumatoid arthritis in 2003, it felt like I came outta nowhere. But then I realized my great aunt, her, her nickname was Flea, and she got that from the fact that she had such bad knee pain as a child, she had most likely juvenile idiopathic arthritis.

[00:05:17] Back then they just called it juvenile arthritis. And she would jump around on the beach. Instead of being able to walk, she would kind of hop. And my grandpa said she was like a, a, a sand flea. So they called her Flea, that was her nickname. But hers went completely away once she had her first pregnancy.

[00:05:33] So we know that the immune system can, can change things up. Mm-hmm. But anyway, initially it still felt out of nowhere and then, but you can kind of connect the family dots maybe. Yeah. But back, back to your story you mentioned you had, were diagnosed with Sjogren’s. Can you tell people who might not know?

[00:05:49] No. What. What is Sjogren’s? How is it diagnosed and how does it, ’cause this podcast is about, typically I talk about inflammatory rheumatic diseases that cause arthritis, which actually little known fact, but you know, Sjogren’s does cause, can cause joint inflammation. But so we, we have mostly talked about rheumatoid arthritis, psoriatic.

[00:06:13] Yeah. And so yeah, can you let, basically give us the, what is Sjogren’s? So 

[00:06:18] Dr. Kara Wada: Sjogren’s, when you see it written out, it is going to look like it’s the name of a chair at Ikea because it’s, it is named after a Scandinavian eye doctor who first described it. It is one of the most common autoimmune connective tissue diseases, but it’s also one of the least.

[00:06:39] Likely to be diagnosed. So, one of the ways that I, that I say that a little more succinctly is it’s not rare, it’s rarely diagnosed. It actually is thought to effect about one out of every 100 people which is the same rate as something like Celiac. And it, 90% of people it affects are female.

[00:07:02] So it does have kind of that, that difference in more often affecting women but not always. It also tends to occur in adulthood, but there absolutely are people who are diagnosed in their in childhood. And there’s pediatric sjogren’s often, what’s taught and what is taught to physicians in training, all the way up through rheumatology trainees.

[00:07:30] Is that it’s a condition that always has dryness associated with it. Dry eye, dry mouth. We don’t talk about it as much because it’s hush hush, but vaginal dryness, dry skin, hair stuff. The reality is though, when you survey patients and you ask them what are the symptoms that are really most bothersome, fatigue and body pain are at the very top of the list.

[00:07:59] And you know what I realized in my clinical work and as I, as I thought about my own story, I peeled back the layers of the onion with symptoms. Most of the initial things I brought up to physicians over the years. They weren’t related to dryness. Yeah, there was dryness. I couldn’t wear masWadaa anymore.

[00:08:21] I wasn’t able to wear contacts. The dental hygienist said something that’s actually what pushed me to, to, to ask for an evaluation. But those were small potatoes compared to the like, overwhelming fatigue. And for me, the body pain has shown up as stiffness in my low back. And it always got better when I was pregnant, which was weird.

[00:08:43] Cheryl Crow: Well, and that’s that’s puts the ding, ding, dinging, ding for autoimmune ding. 

[00:08:47] Dr. Kara Wada: And that’s where I had that like little kind of whisper in my ear of or this underlying gut feeling that I just wasn’t ready to face for a long time. I, I will joke, I was like an ostrich with my head in the stand.

[00:09:00] You’re 

[00:09:00] Cheryl Crow: not the only one though. Yeah. And the fact that it was after the birth of your second child, right? 

[00:09:06] Dr. Kara Wada: Yeah. Everything kind of hit the fan. 

[00:09:08] Cheryl Crow: Yeah. But if you’re fatigued and you’ve just had your second child 

[00:09:12] Dr. Kara Wada: Yeah. And you’re a brand, a relatively new attending physician, and your spouse is also in medicine and you’re, you don’t have any family around and it’s really easy just to try to blame it on life, stress life.

[00:09:27] Cheryl Crow: And I mean, when I Little quick, quick, quick side note back then back to your story, but I, yeah. When I, I had postpartum anxiety and postpartum, I guess I would call it postpartum depression, falls under the umbrella, but I didn’t feel sad at all. I felt just very not myself and constantly irritated and agitated, but also tired and.

[00:09:45] I remember the, one of the questions is do you find, are you not finding pleasure and formerly pleasurable things? I’m like, I don’t know, dude. I didn’t have a baby a year ago. I don’t know what’s, I’ve never had this before. Right? I don’t like that question is irritated me. Which again, it was a symptom.

[00:10:01] My therapist eventually told me irritability is a symptom of anxiety potentially, which I didn’t know, but that’s so not me. Like I’m such like a happy go lucky person that even the fact that I was getting so irritated by this whole thing was like, this was, yeah, but anyway, you don’t know. You’ve never had two kids before.

[00:10:16] You don’t know what’s the normal amount of tired. 

[00:10:19] Dr. Kara Wada: Yeah. And that’s what I’ve chalked up, like the brain fog and stuff. You always hear about oh, I have mommy brain, mom brain, that sort of stuff. I also had had, some pretty longstanding digestive shenanigans, for lack of a better term, things in the IBS spectrum, but also certain foods that really would set off some pretty terrible symptoms. And those actually I had some flareups of those postpartum after my first pregnancy too.

[00:10:47] So again, kind of this fluctuation with those hormonal changes. And then the one other, so GI issues typically with motility IBS, but it can be kind of across the board.

[00:10:59] And one of the other big symptom kind of broad brush strokes that you’ll hear. And there, there’s thankfully been a really big increase in awareness. And, and educational efforts around this, but its impact on the nervous system.

[00:11:13] So, Sjogren’s is the number one autoimmune cause of things like POTS or the over umbrella term of dysautonomia.

[00:11:23] And increasingly we’re realizing that some of those dryness symptoms, like the dry eye associated with POTS may not be inflammatory. For some people it is, and things like Restasis are helpful, but in a lot of cases it’s actually a nerve issue. And the nerve impulse that should be helping you secrete tears is not working correctly.

[00:11:47] And so that can result in symptoms of heat intolerance or not being able to sweat. The dryness symptoms that I mentioned feeling like you, I don’t have POTS, but if I change position really quickly, especially if I’m not well hydrated or it’s hot out. I’ll get kind of like, Ooh, I gotta like, so I, I have what’s called orthostatic intolerance.

[00:12:08] My body doesn’t like when I change positions too quickly. 

[00:12:11] Cheryl Crow: Yeah, me too. 

[00:12:12] Dr. Kara Wada: Yeah. And then often that’s associated sometimes with gastric motility issues and and can be associated with that body pain. So it’s thought to be some of the driving factors in a fibromyalgia like process. So often what I’m listening for when I’m talking with patients is looking for, or listening for signs and symptoms that maybe were attributed to fibromyalgia, IBS those sorts of things.

[00:12:40] And like labs were normal. This is my one other little factoid I’ll add in. Only 60 to 70% of people with Sjogren’s have lab markers that are, like the lab markers we’re taught about. So about 30 to 40% of folks are considered seronegative or more normalish blood work. And that’s where I think we have a huge gap in recognizing, and doc and doctors, frankly for lack of a better term, kind of pussyfooting around with the diagnosis, not wanting to give that diagnosis or not wanting to treat.

[00:13:17] It’s been taught that it’s just a nuisance and it’s not, when you look at the data on how it affects quality of life, the symptom burden it’s the opposite. Anyways, that’s my soapbox. Yeah, 

[00:13:29] Cheryl Crow: no, and that’s, I think that’s extremely important for patients to know about. That was, I mean, my next question is, what advice do we have for people who think they might have Sjogren’s?

[00:13:37] And similar to rheumatoid arthritis, it’s very similar numbers. Seven- 60 to 70% of people with rheumatoid arthritis, especially at initial diagnosis are seronegative. Some become sero positive over time, which means their blood work starts showing rheumatoid factor, but, and other anti CCP and stuff like that, but point being like, I think I’m such a rule follower that, like initially if someone had told me like, well, so they did tell me because they didn’t run every possible blood work.

[00:14:01] They first, when I was first presenting with symptoms, they’re like, your blood’s normal. Like your, yeah, your blood work’s normal. You don’t, you’re fine. And then a month later when I had more symptoms, they’re like, they ran more blood work. They’re like, oh, your blood work is now, everything that we looked at is like off the charts, like you have rheumatoid arthritis.

[00:14:17] And I was like, wait, so that what you were calling my blood work, first of all is not like one monolithic thing. And that’s what patients don’t know. I’m like, oh, well they did the blood work, the blood work, like capital T, capital B, like you just don’t. So knowing that you can advocate for yourself to get absolutely looked at, and I, I wouldn’t know if I was presenting with vaginal dryness, dry eyes, dry mouth, maybe fatigue.

[00:14:42] I wouldn’t know To also mention, oh, by the way, I have all these digestive issues and fatigue. Because if you don’t know the, the symptoms. And 

[00:14:50] Dr. Kara Wada: you have 10 minutes if that Totally of FaceTime with your doc and they’re trying to get through that checklist as well. Yeah. And so like you really have to be pretty strategic about what you’re mentioning, right?

[00:15:03] Mm-hmm. And have kind of an agenda to that’s a great be heard within, within an insurance based system. 

[00:15:10] Cheryl Crow: Yeah. Yeah. And I think the only other thing I would add that, that’s come up a lot in like My Rheum to Thrive support groups for the patients, people that have Sjogrens is this swallowing Yes.

[00:15:20] Swallowing issues. And that can, that overlaps with rheumatoid arthritis. ’cause there’s a joint in your throat. Crico retinoid, is that how you pronounce it? I just know how to read it. Uhhuh. Yeah, yeah, yeah. That’s great. I could feel that sometimes it sometimes actually clicks on my right side. If I’m a little bit inflamed.

[00:15:34] That could also just be like postural. But and if that’s inflamed, it could be inflamed from rheumatoid arthritis, like that overall inflammatory type pain. Or it could be having, you could have issues from swallowing due to Sjogren’s. ’cause you don’t have enough lubrication. Right. Or neurologically.

[00:15:51] Yep. It’s those impulses, like you mentioned, are not being sent accurately. So you have the sensation of food being stuck on the throat, which, how could you not be anxious, by the way, if that happened, I would freak out. Like it’s absolutely, yeah. So, yeah. So know that if you’re having a lot of swallowing issues and some of these other systemic issues that, that it could be Sjogren’s.

[00:16:13] Is there anything, any other advice you have for somebody who might be who, who’s suspicious that they might have Sjogren’s? No. I 

[00:16:19] Dr. Kara Wada: think, so a few things really critical to do a bit of homework before your appointment and kind of get your get your ducks in a row in regards to just sit down with a pen and paper or typing, whatever, however you get information out and organize it.

[00:16:40] And I think it’s really helpful to let your doc know from the beginning of the visit or even when you schedule the visit. These are my goals for this appointment and are you able to partner with me on those or not? That’s super helpful. And there also are some really great resources that our Sjogren’s community has kind of come together and put together.

[00:17:07] So, Dr. Sarah Scheffer. I just, I can’t say like enough wonderful things about her. She and Bey, Dr. Bessy, Lobo run Sjogren’s advocate website. They have some incredible one page resources that if you are getting pushback from your doc, she’s a, Dr. Sarah is a physician herself. And so she wrote it kind of from that dual perspective as well of here’s the evidence.

[00:17:32] It’s all cited, but it’s also very concise. It’s one page knowing that a doc doesn’t have the time to do a big lit review. So I think having, that’s helpful and kind of having your story and thing together. It’s also helpful just to know and to know that you can ask this when you call to schedule an appointment, you can ask how long are these appointments scheduled for?

[00:17:59] Do you double book. Is there any way I could ask for a longer appointment? Become friendly with that receptionist or scheduling person as, as best you can. Knowing that one, they’re talking with a lot of humans all day who generally are not nice to them, them. So, little honey goes a lot, a lot better than vinegar.

[00:18:24] Yes, yes. And and just kind of trying to, to tease that out. I think those are all helpful tips that I’ve, that I’ve passed along. 

[00:18:35] Cheryl Crow: Those are so helpful. And I will definitely put a link in the show notes to the sjogren’s advocate.com. Yeah. Resources. They even, I mean, so well organized. There’s even a page that just says self-advocacy for diagnosis.

[00:18:48] I’m like, 

[00:18:48] Dr. Kara Wada: yeah, it’s so great. And so I actually ended up. Putting together, like what I call the, the sjogren, I think I call it the Sjogren’s Superhero Starter Kit. It’s like this free resource. Right. And the first things I linked to were Dr. Sarah thing. So it has like a pre-appointment like little workbook for people to think through, answer some of those questions on their own and then links to all those resources.

[00:19:13] Because it was pretty silly for me to like reinvent the wheel. Mm-hmm. I think there’s so much work to be done and we need, we need to be like coming together, lifting each other up and. There’s so much healing in that community. So if I can connect the people, it’s great. 

[00:19:33] Cheryl Crow: Yeah, no, that I just, I just got back from an arthritis foundation, like volunteer summit event.

[00:19:39] That was so great and it just, it really reinforced to me as well the importance of community in the patient, in the patient experience. We’re all on the same team. We’re all trying to get good Wadae, and actually we are on the same team as our doctors now. Insurance companies might be different.

[00:19:53] It was actually funny, there was one insurance. Representative though in the room, I realized, oh, okay, gotta be. But they’re trying, they’re trying to work to make the system better. ’cause sometimes you have to work within the system anyway, but yes. Yeah. I think these are extremely helpful, helpful pointers and I think a lot of them apply for people seeking like a rheumatoid arthritis diagnosis as well, to really organize yourself as much as you can ahead of time.

[00:20:17] Really pay attention to the pattern of your symptoms, what makes them better, what makes them worse. Is there any kind of rhyme or reason that can really, ’cause you can kind of almost anticipate the questions that doctors might be Yeah. Asking you. So I, 

[00:20:31] Dr. Kara Wada: I, we try to be detectives. 

[00:20:33] Cheryl Crow: Yes. Yeah. And it’s like you mentioned partnering with your doctor, that is, you’re not an adversary, or if the doctor feels like an adversary, they’re kind of like, oh, you’re just tr trying to like shop, doctor, shop to get a diagnosis then, might not be the right doctor for you.

[00:20:49] So, yeah. Yeah. I, I was gonna ask also, just, I know the whole, the main focus that we’re leading up to in this episode really is like, what does it mean to be immune confident? I really love that phrase that you, you have a whole program now about becoming immune confident, so we’re gonna get there, but I wanted to have, have a one more minute to, or one more little section on MAS Mass Cell activation syndrome because two of the past people who’ve shared their stories on this podcast have had that condition, but we haven’t really delved into it from like, how to doctor explain what is it?

[00:21:26] What causes it? Yeah. 

[00:21:28] Dr. Kara Wada: So mast cells are white blood cells or infection fighting cells that are responsible for helping our body determine if we are safe or not safe in our environment. A, they do that along with our nervous system, like our sensory nerves, and they are found in the same locations, so they are working together and there’s a lot of crosstalk between these mast cells and our small fiber nerves.

[00:21:57] These cells are found in all the places in our body where our body is going to interface with the outside world. So our barriers, our skin, our respiratory tract, our gut, our genital urinary tract, they’re also like those, those barrier tissues also are our connective tissues, right? Most of them. And they’re also found near blood vessels.

[00:22:19] So they’re kind of helping with this, this crosstalk between all these different systems in our body. And as allergists, we’ve been interested in mast cells for quite some time because we realized that they are responsible for. Essentially all the symptoms we attribute to allergy, itchy, sneezy, hives, wheezing, anaphylaxis which are those whole body reactions.

[00:22:43] As allergists, though, we have been a little preoccupied with the fact that a specific protein or antibody that we can create called IgE functions as a receptor on the surface of these cells. So if you’re someone who’s allergic to your puppy dog or you’re allergic to peanuts, you make a specific IgE protein that recognizes peanut or puppy dogs.

[00:23:09] And when you inhale puppy dog dander or eat peanut protein, that triggers those mast cells to release all these chemicals that are pre-made inside of them. It also gets some machinery going for some later actions. But some of those preformed little packets of chemicals include histamine, tryptase, prostaglandins, leukotrienes, whole bunch of things that then tell our body danger, danger.

[00:23:43] There’s a problem and it’s in this it and triggers inflammation, but it’s in this allergic flavor of inflammation. What we’ve neglected to put much emphasis on, like we’ve known that this happens, but we, it hasn’t been a real emphasized aspect and hasn’t been super well researched, is that these cells don’t get triggered only by those allergy proteins.

[00:24:12] They have dozens, if not hundreds of other types of receptors on their surface. That also can trigger them. So we’ve known for a long time that some people are more sensitive to opioid pain medicine. If they have a surgery and they get morphine, they get super duper itchy and Hy-Vee more than the average, maybe more than the average person, though.

[00:24:35] There’s a specific receptor on those cells called the MERG receptor that that medicine like works through, or, heaven forbid you have a bad infection and you need an IV antibiotic called Vancomycin. We’ve known that if you infuse vancomycin too quickly, that a lot of people will get a histamine reaction.

[00:24:56] They’ll turn red and get really itchy. And or with contrast for a CAT scan with contrast, another irritant for those mast cells. Some people, if you, if you Google, it’s a long term, but dermato RAFs, it means writing on the skin. Some people just that pressure or scratching on their skin, that physical disruption will cause hiving.

[00:25:18] So folks with mast cell activation have an abnormal increased response to stimuli that their body shouldn’t be responding to. The big problem right now is that there are two main camps of healthWadae professionals, doctors that have differing views on what those diagnostic criteria should be and how we should be taking Wadae of these patients, and they don’t get along very well.

[00:25:53] And so as a result, the Wadae for folks with these conditions, for a multitude of other reasons too. They’re, they can affect you from head to toe and typically patients will pay play the schema, hot potato getting referred from doctor to doctor. They’ll go see the allergist. The allergist will do their allergy testing, which won’t be super helpful ’cause usually it’s not true allergy that’s driving the process.

[00:26:18] And it, it’s a mess frankly. But patients are really suffering and we’ve seen a, a pretty significant uptick in the number of patients we’ve seen with the, this constellation of symptoms in recent years. And we think covid probably added lighter fluid to this whole situation like it did with other autoimmune conditions too.

[00:26:40] So it’s not specifically an autoimmune condition. I consider it, in my mind, an autoinflammatory process. So it’s still inflammatory. There is often. Some sort of internal increase in the set point. But typically there aren’t necessarily those antibody proteins that are triggering it, which is often the distinction between autoimmune and autoinflammatory.

[00:27:07] Cheryl Crow: That’s, that’s really helpful. I actually think there, there’s, I was gonna ask would it be correct to say, ’cause I often have to stop and remind myself what the difference is that autoimmune is like you’re making antibodies to your own tissue versus autoinflammatory is there’s inflammation happening, but it’s not Yeah.

[00:27:24] Towards your own tissue. Okay. 

[00:27:26] Dr. Kara Wada: Yeah. And well, often it’s driven by more of the innate immune system, which is kind of the part, the part we all like almost all beings have. Seven, eight. Your innate immune system doesn’t necessarily. Learn in the same way over time as your adaptive immune system. Okay. But again, this gets really muddy really fast, but those are the broad brush strokes.

[00:27:48] Cheryl Crow: And then, no, that’s very helpful because I’ve been hearing more about it. And I, again, another condition that even though I really had started specializing in rheumatoid arthritis, I hadn’t heard of it. Even though it has a, it’s one of those ones that if you have one autoimmune or autoinflammatory condition, you’re more likely to have another.

[00:28:05] So it’s good to know about. 

[00:28:07] Dr. Kara Wada: Absolutely. And I do, so it’s interesting. There is absolutely zero research to back up what I’m going to say. So that is my disclaimer. I strongly suspect, based on what I’m seeing and hearing clinically, that there is a relationship between a Sjogren’s disease and mast cell activation, 

[00:28:28] (Both Speaking): similar 

[00:28:29] Dr. Kara Wada: to how we will sometimes and suspect we’re seeing the same overlap with hypermobility and.

[00:28:37] Autoimmune or mast cell issues. And dysautonomia, Sjogren’s is, I talked about a lot of dryness at the barriers, right? So if you have a breakdown at the barrier where that that interface of the bodies insides and outside, you know mm-hmm. Is more permeable or leakier there’s more opportunity for those mast cells to be seeing more of the outside environment and frankly, freaking more out.

[00:29:06] Cheryl Crow: Yeah. It’s, it’s such a fascinating concept that what these systems are designed to protect you and keep you safe. What happens when they go haywire? And there’s, it’s kind of an interesting parallel to, even for me living with anxiety, I, it’s a similar thing, right? You’re like, your anxiety is there to protect you, but when it gets too out of proportion to the actual threat, that’s when it’s not helpful or adaptive anymore.

[00:29:32] Dr. Kara Wada: Well, and here is kind of the you know this, I always tried very Wadaefully with patients because so often our anxiety, especially as women, is weaponized against us. Yes. Yeah. But our brains and our bodies are not separate. Yeah. And so there is some data to suggest that. There can become an abnormal feedback loop where if your brain is sensing that you are not safe, like those, that lizard part of your brain is like, not safe.

[00:30:06] Not safe, that that is priming your immune system to be We’re hypervigilant. 

[00:30:13] (Both Speaking): Yeah. And so often 

[00:30:15] Dr. Kara Wada: when I’m talking with patients about kind of taking a, holistic approach, we’re talking about some of this, mind body medicine and getting a sense like. How comfortable do you feel with this?

[00:30:27] Does that sit, sit? Well, I’ve had a few patients say, Hey, no, this just feels like gaslighting. And I’m like, cool, we’re gonna stay away from that. That’s fine. Mm-hmm. But can be helpful. 

[00:30:37] Cheryl Crow: Yeah. And I think it’s all in, I’ve thought a lot about this too because yeah, I have, I would say, been medically gaslit when it came to my initial diagnosis where they said, you’re just anxious, you’re not sick.

[00:30:48] As if it’s impossible to be both anxious and sick. And also as if it’s not rational to be anxious if your body’s like breaking down and you have no reason why. But anyway, but it is if, because of that I was so resistant to therapy or addressing my mental health because I had felt so I, the example I used is I felt like my body was on fire and I went to the firemen and they were like, or fire people.

[00:31:11] And they were like, you have a disorder called like person who thinks their body’s on fire. But it does. It’s not. And then two days later it’s oh, actually your body’s on fire. We believe you now. I didn’t change, you change, anyway, it’s hard not to feel defense. So 

[00:31:24] Dr. Kara Wada: I have a little bit of kind of maybe explanation, I think why that happened so much.

[00:31:30] Like why we put so much stock in labs. 

[00:31:34] (Both Speaking): Mm-hmm. When we’re 

[00:31:35] Dr. Kara Wada: in a system that expects us to see a new patient every 10 ish, 15 ish minute, depending on eight minutes, depending on what field you’re in. You have to start defaulting and kind of making some of these cognitive like shortcuts, right? Yes, yes, yes.

[00:31:54] In order to get through your day and not just be like, and get bogged down. And so we have grown up and had our training in a time where we’ve had this incredible increase in our availability of blood work lab tests that give us black and white answers. And I think we’ve become very over-reliant on that and don’t allow ourselves to give as much stock to the patient’s lived experience.

[00:32:25] Yeah, yeah. And take the time to actually let that sink in. And use our history taking and physical exam skills like we initially were taught. That’s still what’s emphasized in your first, first few. Courses right? In med school, but when push comes to shove and you turn up the speed of that conveyor belt, all that goes out the window and you focus on that black and white because that’s what’s in front of you, and that’s what can get you to the next room faster.

[00:32:54] Cheryl Crow: Yeah. 

[00:32:55] Dr. Kara Wada: And survive your day as a human being too. 

[00:32:59] Cheryl Crow: Yes. Yeah. I think, yeah, it’s just like with like medical errors with, with gaslighting, it’s really critical not to see it as like an individual bad actor situation. It, there’s systemic factors, there’s huge systemic pressures and, 

[00:33:16] Dr. Kara Wada: and of course there are some bad apples in every group.

[00:33:19] Yeah, yeah. But yeah, there, I think what drives it more than anything is, whatever we wanna call it, burnout or moral injury. What, yeah, what have you. We kind of talked about. I was talking, actually, I was talking with a patient this morning about the medicine I’m practicing now and then I’m aiming to continue to practice, is the type of medicine I signed up for when I went through all that I did to get into medical school and to to graduate.

[00:33:49] That is not where I was four months ago. 

[00:33:55] Cheryl Crow: Yeah. Well and that, okay, so this is perfect segue. I wanna talk, I wanna give you a chance to explain kind of the origin story of what, of your work now. And you said, I know you and I are both, I don’t wanna be projecting, but similar, like a little bit of used to be, perfectionistic or wanting to be the, the good girl in class wanting to get a gold star, it’s kind of from past conversations, we’ve had success and you’ve spoken in about it, on, trying to be just goody, not goody cheat, but like a, rule follow Oh no. That would very 

[00:34:26] Dr. Kara Wada: be very accurate.

[00:34:27] Cheryl Crow: Okay. Yeah. I’m like, I am so good at following the rules. Oh, that’s the time rules. I’m gonna follow the rules harder than everyone else in the class. Yeah. And, and now, you have said recently you want a doctor who is a bit of a rebel. Yeah. And what, what does that mean for you? Why is that?

[00:34:43] Yeah. 

[00:34:43] Dr. Kara Wada: And, and I think a bit is that you don’t want someone who is like so out on left field that you’re like, oh gosh, do they like know the science? Are they like mm-hmm. Mm-hmm. Making some real crazy recommendations. Mm-hmm. But I think when we are trying to function within a system that is.

[00:35:02] Frankly a dumpster fire. It is the healthWadae 

[00:35:05] Cheryl Crow: system. The health is what Yes, 

[00:35:07] Dr. Kara Wada: yes, yes. For both patients. And I would say, and also very much for healthWadae professionals as well. Not just physicians, but for nurses and medical assistants, like across the board. It can really, I think, help to find someone who is pushing back against the overwhelming, pressures to see more people in less time.

[00:35:33] And that’s kind of where I’m coming from, from that rebel, someone who is willing to and able to take that time to one. I, and I say this for any healthWadae professionals listening, realize the importance of their own health. How that influences the health of their patients or clients. Because I can say when I was not taking Wadae of myself, I was not able to take Wadae of my patients to the best that I would want.

[00:36:09] And they deserved in regards to my own ability to listen, to take on their lived experience, to think with curiosity and creativity and how we’re going to make a personalized plan for them to meet their experiences with compassion and empathy. Like you can’t do that if your own cup isn’t at least halfway full.

[00:36:35] And the current system requires a rebel in order to, to do that almost across the board. So essentially things kind of came to a tipping point last fall. When I got word that my salary was going to be cut again and I went to leadership and just said, Hey, second most senior in the department, I really love Wadaing for patients with complex immune system problems.

[00:37:05] These patients take longer to see in the office. Kind of made my case. And unfortunately with how medicine is reimbursed and reimbursements from insurance have not kept up with inflation and other things. And that’s 

[00:37:22] Cheryl Crow: across the whole board. I can say that’s across 

[00:37:24] Dr. Kara Wada: ational therapists.

[00:37:25] It’s for all therapies. 

[00:37:27] Cheryl Crow: All specialties. Yeah. And 

[00:37:28] Dr. Kara Wada: when you look at the increase in healthWadae costs, there’s a really nice chart that’s kind of gone viral. It is not cost driven by physicians or other healthWadae professionals. It’s the cost of doing business, it’s cost of administration. That’s really middlemen.

[00:37:45] Yeah. And that’s a lot of the issues. I was, I, when I was in a larger organization, I had no control over my overhead the cost of rent or, how much staff I had or, supplies and all those things. And so, I made kind of the really tough decision to leave a job that I genuinely love.

[00:38:07] I love the people I work with, I love my patients. I loved having the ability to help teach future physicians both kind of across the, the spectrum of their training. And to embark on doing things a bit differently. And so I opened what’s considered a direct specialty Wadae practice.

[00:38:29] So what does that mean? It means I I’m out of network with insurance. I contract directly with my patients. Patients are able to if they have out of network benefits, they are able to submit some documentation with the hope that they might get some reimbursement. That was a tough decision for me to make because I realize how expensive it is to be sick and to have a chronic illness.

[00:38:59] I also realized that the extra cost it was going to entail for me to have more staff to make sure I was getting paid for the work I was doing within an insurance based system was going to put me back on this treadmill of having to see more people in less time. And I, I could not. I could not do that any longer.

[00:39:26] So today I saw three patients. Yesterday was a busy day. I saw five patients. In my prior life, I would’ve seen 12 to 14, which even like within my field is actually like on the low side. More often in a private practice allergy office, they’re gonna see summer 20 plus patients a day. So I, I’ve had an hour, hour sometimes two hours with those new patients because that’s what it, you need when you’re talking about multi-system issues that, affect people from head to toe.

[00:39:59] When you’re talking with people who have had they’ve seen how the sausage is made on a healthWadae and they just need to get that off their chest. Like that, that in itself is really therapeutic. Just having that witnessed and to be able to set up a practice that I, I preface every initial visit with.

[00:40:17] I want you to feel safe and respected in this space. And whatever I can do to help support that I, to my abilities let’s do it. Because the system is supposed to be healing, it’s not supposed to be harmful. And when I finish schooling, you take that oath to essentially do no harm, right?

[00:40:36] And, and it came to a point where I needed to rethink the system that was not only doing it was doing harm to me and it was doing harm to my patients. And so this is the best I’ve come up with so far. 

[00:40:51] Cheryl Crow: No, and I think it’s very commendable and I think, I’ve tried to highlight the work of people like you on who are really trying to figure out creative ways to better serve patients.

[00:41:05] I mean, it’s just, it is just beyond tragic that you are basically told in the conventional. HealthWadae system that, that, because you wanted to see is, let me know if this is right to say, because you were specializing in seeing patients with more complex issues. You were each year being told you, okay, because you’re choosing to see these difficult to treat quote unquote patients, we’re gonna give you less and less money.

[00:41:33] That is so opposite. It feels like the people who are well, because from 

[00:41:37] Dr. Kara Wada: a system standpoint, they make the system less money. Why I’m not generating, I’m not putting them on allergy shots, I’m not doing skin testing. Like those are things that are the bread and butter of an allergy practice and essentially keep the lights on.

[00:41:54] Cheryl Crow: So, so in every new patient, and, and actually this, this happens with occupational therapy too, where the new patient evaluations, an hour and a half, I would spend an hour and a half within pediatrics doing a new patient evaluation that was charged at a much higher rate. ’cause I did have to do a bunch of paperwork afterwards and think through their treatment plan.

[00:42:12] But then the hour long appointments were at a, a lower rate. Okay. So it’s like these evaluations and then you’re submitting for, but that’s just so, it’s just lo like logically and in my heart, it’s just what a horrible message to send to these patients. That that’s, 

[00:42:28] Dr. Kara Wada: I mean that’s how, it’s how in general though, one of the big issues, global issues with how healthWadae in the US is reimbursed specialties that are more, quote unquote co cognitive, that are evaluation and management or ENM type visits that are non procedural visits are billed at a much lower rate.

[00:42:51] Than generally procedural based things. And that’s that, that’s no greater reflected than in the huge pay disparity for our general pediatricians. Our family practice docs, our general internal medicine, primary Wadae docs they are, I, I give so much credit to those who have stuck it out and have the passion to serve their patients because the system is just really left them up a creek without a paddle.

[00:43:25] Cheryl Crow: It’s so, yeah, and I think that. That there’s no other choice than to say, okay, we have to subvert the system. I mean, my own therapist, he’s a psychiatrist, he’s, he does the same thing you do and it’s becoming super popular in occupational therapy, physical therapy too. You just, it’s direct Wadae. Like you said, you, you, I pay my doctor outta my credit Wadad.

[00:43:47] So I get the miles I get the, get the credit Wadad points and then I submit to my insurance and they cover his services. So psychotherapy at the out-of-network rate. So he charges X amount of money and I get that. Reimbursed into my bank account from, from, and it only takes a few minutes for me to upload a super bill.

[00:44:05] I always thought a super bill was like this big thing. It’s like one, two pages from my doctor, my receipt and my super bill. At least this is for psychiatrists. Yeah. I guess maybe more straightforward ’cause it’s just like I saw her and to, to Yeah. Helped her. But it’s, it’s becoming more common because because of how draining and, and inhumane the, the, a lot of the health, the traditional systems are.

[00:44:28] Yeah. And you can get it, you can get stuff covered, so, yeah. I, I don’t know in your case how often it is, but that’s just for you, for people to know when you’re paying your monthly premium on your insurance in the United States, they, if you look into the details, you can find out that out of network rate means that, they’re still, you’re still paying for that option for them to pay to reimburse you for these out-of-network providers.

[00:44:55] Dr. Kara Wada: Always helpful to check ahead of time. 

[00:44:57] Cheryl Crow: Yes. Yeah. Yeah. And so I love, I mentioned earlier, so tying back to something I said 30 minutes ago about becoming immune confident yeah. You’re calling it the immune confident, confident approach, right? 

[00:45:11] Dr. Kara Wada: Yes. And the, the practice is the Immune Competent Institute.

[00:45:15] I love that. That’s a theme here. One of the things that I realized upon reflecting in my own illness journey 

[00:45:23] (Both Speaking): mm-hmm. 

[00:45:23] Dr. Kara Wada: Was how defeated I felt like just that overall change in. For lack of a better term, my energy. It, it’s like I went from, feeling confident, doing my thing to doubting myself, not listening to my body, kind of this erosion over the years of that illness manifesting itself.

[00:45:51] And I kept hearing echoes of that same process, patient after patient, after patient, like indecision, not knowing what the next best step is. Not trusting in their, in their sensations, in the things they feel in their own body. Not trusting the medical system, right? Understandably. And so I came back to this idea of, gosh, as I’ve started feeling better and as I started.

[00:46:22] Keeping promises to myself and like kind of went through this evolution, one of the things that came back has been my confidence. And with that now my ability to be a rebel or be a little more rebellious. And in, in immunology there’s this term called immune competence, which means your immune system is working well, you’re able to make responses to your vaccines and your infections and fight ’em off.

[00:46:48] And so there was this little play on words that was an inside joke to me. But also, this idea of something greater than just the physical immune system health, but also the, our own psychological social wellbeing. And it probably comes a little bit along this path. I got my life coach certification, so there’s probably a little bit of that kind of thrown in there too.

[00:47:13] Cheryl Crow: You have been busy. She also had another baby, by the way. 

[00:47:16] Dr. Kara Wada: Yeah. Three 

[00:47:17] Cheryl Crow: kids 

[00:47:18] Dr. Kara Wada: has been maniac. 

[00:47:20] Cheryl Crow: He’s so fun. Do you sleep 

[00:47:22] Dr. Kara Wada: three, by the way? Do you sleep? And he’s just oh my gosh. He’s so full of energy. Yeah. Yeah. A meeting with the dayWadae this week. ‘Cause he’s expressing his himself and using his handily for hugs, so.

[00:47:36] Cheryl Crow: Yeah. Yeah. Oh, I’m sorry. That is okay. That’s hard. Yeah. But I love that. I actually didn’t know that Immune Confident was a play on words for immune competence. But I, I think that’s beautiful. I think that’s, I’ve had a similar experience with my own journey is like what I want to feel at the end of the day or what, what’s required for me to feel like I can quote unquote, thrive or make room to thrive with.

[00:47:59] Yes. My multiple chronic conditions, which does include dysautonomia and gastroparesis and stuff like that, is like feeling that I have. These tools to cope with what is happening to me. And one set of those tools is the fixing tools or making the pain get better or ma controlling my disease.

[00:48:18] And then the second set of tools is the coping and accepting what are the things that are, that I don’t have control over. I think that therein, the de delta between those and figuring out which bucket, which one goes into feels to me like the source of stress for a lot of people. If you assume that every single part of your health is going to be fixable under your control, you are gonna be chronically, extremely disappointed, but without a guide person, with, without, if you, all you have is a doctor every three months for 10 minutes to ask your questions to how are you supposed to feel confident, in differentiating between what you can and can’t control.

[00:48:54] Yeah.

[00:48:55] Dr. Kara Wada: The other piece is, kind of how we have things set up on, on in this clinical practice is. Certainly had the ability to see people once and, do that consultation and get them some recommendations to follow up with their Wadae team. But I also felt really strongly about leaning into a membership model and having some flexibility there where one, all of our members have the ability to contact me between visits, kind of using a, essentially a text app.

[00:49:31] It’s called Spruce. It’s super user friendly. 

[00:49:34] Cheryl Crow: Is this like concierge type? Yeah. It’s kind 

[00:49:37] Dr. Kara Wada: setting it up with that, but also trying to keep our, our price. Like I’m, I’m trying to do that in a way that keeps the lights on. Yeah. And allows us, to grow and and serve people, but also. Allow them to feel safe.

[00:49:54] And especially with our, especially with our folks with mast cell issues and you’ve, you have certain things in your environment that will trigger symptoms. Having that safety net makes a huge difference. Yeah. And so having that ability for folks to reach out to us to know that, they’re gonna see me at least quarterly and depending on the plan, some folks wanna see me twice a month.

[00:50:16] So that we have that flexibility. Mm-hmm. And, and just trying to be ultra transparent with pricing. ’cause I think that is what drives, has driven me up a wall as a patient and as a physician is not knowing what things are gonna cost me or my patients. And don’t nickel the 

[00:50:34] Cheryl Crow: clapping for those listening to audio.

[00:50:35] Audio. Do you not nickle 

[00:50:36] Dr. Kara Wada: and dime me? Like it just drives me bonkers. Oh, if I, if I set it up where people were like, oh, every 15 minutes of my time is X amount of money. It’s harder to budget like, ’cause you don’t know how much you’re gonna have to reach out to me and I don’t want you holding off on reaching out to me because you’re worried about how much it’s gonna cost.

[00:50:57] That just adds another stressor to the system. 

[00:51:00] Cheryl Crow: Yeah. 

[00:51:01] Dr. Kara Wada: Anyways, I tried to be thoughtful about all this. 

[00:51:04] Cheryl Crow: No, me too. When I first started, my. First, very, very first. Actually it was exactly five years ago. Because I, I knew it was around it was April, but I just, yeah, I just saw one of my, like Facebook’s memories, but come up and I had done these, I had really dig in or dug in and figure out like how to start a business and how, even do I make it a nonprofit or a for-profit, all that stuff.

[00:51:27] So I structured it as a business, LLC and I, I did all these trainings and one of them was so scammy that I obviously did not follow it, but it was like, don’t tell them what it costs until you get them on the phone. I was like, how 

[00:51:41] Dr. Kara Wada: much of that, it, that just makes me feel icky. 

[00:51:44] Cheryl Crow: That does not align with my values whatsoever.

[00:51:46] And I actually, it made me, I got on the phone with somebody where that was required for me to talk to them and I really felt like it was disrespectful of my time. ’cause when she told me what her service cost, I said. Honestly, if I had just known that I wouldn’t have wasted your time or my time because it doesn’t matter how great you are, I literally cannot afford this.

[00:52:05] And I don’t want to basically be subject to you explaining to me that I actually can when I, I, I, I don’t, I don’t want to afford this. This is not, this is not where my money needs to go right now anyway, so I’m appreciate that about your model. And I’m very transparent about pricing for my programs too.

[00:52:22] I think it’s, 

[00:52:24] Dr. Kara Wada: yeah, I do. This is why we get along so well. I know 

[00:52:27] Cheryl Crow: we were saying before we started recording that we, we, we were both you and 

[00:52:30] Dr. Kara Wada: her 

[00:52:31] (Both Speaking): sisters. Yeah, yeah. 

[00:52:32] Cheryl Crow: We were speaking at a conference and I was like, are you sisters? It was so cute. I was like, thank you. I mean much. There’s so much more to talk about.

[00:52:39] I am putting a link to the immune, becoming immune confident, website and where you can learn more. Just dr Wadata.com. We kind of simplified it all. Good. Yeah. In your simple, maybe you’ve tried to, you’ve iterated over the last, trying, trying to be creative. That’s good. Right. You just don’t wanna, you won’t want things to be stale or whatnot.

[00:53:00] You wanna make, you might wanna change things according to the needs of the people that you’re meeting. The last thing, if you have time, I would love, I know you’ve been talking about your clinical trial you’re participating in for Sjogren’s. Yeah. What is kinda the latest in Sjogren’s treatment? Yeah, 

[00:53:14] Dr. Kara Wada: so Sjogren’s currently, as of April 2nd, 2025, there are no FDA approved treatments for Sjogren’s disease.

[00:53:24] That being said, there are multiple medications that are in phase three clinical trials, which is like the last step before approval. One of them actually was just granted kind of fast track. Approval or status, so not approval, but fast track status. That’s Johnson and Johnson’s and I honestly don’t know how to pronounce the name of it.

[00:53:47] That particular med essentially helps the immune system cut down on how much it recycles those antibodies. And by cutting down on the recycling it should drop theoretically the antibody levels and decrease probably then how many of those auto antibodies are floating around. So that’s that one.

[00:54:11] I am in between month eight and month nine of the Oasis trial. Which is dabe it is a 90 minute infusion that I get every four weeks. When you participate in a clinical trial, you have a chance of getting placebo versus the active medication. In this particular trial, there are actually two arms that have the active med and one placebo because they were trying two different dosing.

[00:54:40] Like ramp up dosing. I’m pretty sure I’m getting active medication because I have seen more tears than saliva and other kind of symptom improvement. I’ve also had a little whiff of side effects, but nothing that would prevent me from being like. Me. I do have to drive an hour each way because the the location is not in my city.

[00:55:05] It’s out in Dayton. Which I’m very thankful I have the ability to do that and the flexibility in my work to do that. One of the other benefits, so, one of the questions it’s asked about participating is why would you wanna participate if you could be driving out there for a year and be getting sugar water in your veins or salt water?

[00:55:29] My, how, my thinking is, and this is just my thinking, there’s something at the end of the trial called Open-Label Extension. And so as I was weighing those pros and cons, what I really thought about was, would I be okay or would I be, it wouldn’t be ideal, but if I got that placebo for a year, I still would have access to the actual drug.

[00:55:52] Probably at least a year sooner than, just a random Jane patient. And to me, that felt okay. But every, everyone has to make that decision on their own. 

[00:56:07] Cheryl Crow: Yeah, I think that that’s such a great thing that most people don’t know about unless you’ve. Looked into clinical trials that if you don’t end up getting the active medicine and the medicine ends up being safe and effective, then ethically they do feel it’s, it’s necessary and important, which I agree to give, so that you’re not giving preferential treatment to people just through random assignment.

[00:56:28] You’re saying, okay, well you didn’t, you got the, the salt water, but now we’re gonna give you the meds. I think that makes a lot of sense and I, I think it’s really exciting to hear that there are more, treatments. It’s, and there’s 

[00:56:41] Dr. Kara Wada: more in the pipeline too. It’s, yeah, it’s what you’ll see, so this is like the crystal ball is you’re gonna see a big increase over the next probably year of disease awareness initiatives.

[00:56:58] Mm-hmm. So this is what pharma does. 

[00:57:00] (Both Speaking): Mm-hmm. 

[00:57:01] Dr. Kara Wada: Pharma will start talking more about the condition getting more of the word out. Usually about a year or so before the treatment is approved. Mm-hmm. And then they’ll start advertising the treatment. Now, we’ll see this may change with some of the changes in all that’s going on in the world.

[00:57:17] But that’s typically how things have played out. 

[00:57:20] Cheryl Crow: I mean, it makes sense, especially, it’s such a circular problem when you have a condition that people might even not even know that they have. That that, that, that you need to get the word out about it. That’s, yeah. I know that for those who also might have like lupus or rheumatoid arthritis, there’s a lot of clinical trials going on right now in Wada T cell therapy.

[00:57:38] I know they are for Sjogren’s as well. 

[00:57:40] Dr. Kara Wada: Yeah, they’re mostly in treat. First patient, I think, was treated up at EW, Wisconsin. 

[00:57:44] Cheryl Crow: Oh, that’s so funny. We have a little rivalry because I live near U dubs. W 

[00:57:49] Dr. Kara Wada: yeah. 

[00:57:50] Cheryl Crow: So, no, she, but that’s, yeah. No, that’s, that’s really exciting. ’cause that’s leading to the possibility of a long-term drug-free remission, which, of course is so cool.

[00:58:01] Would be ideal. It would be effectively like a cure if people are saying so. I’m excited for that. 

[00:58:06] (Both Speaking): Oh, 

[00:58:07] Cheryl Crow: yay. I’ll definitely be sure to come back and I can update the show notes when you find out whether you had Yeah. The placebo or not. 

[00:58:18] Dr. Kara Wada: Maybe it’s about a year long trial, so, okay. Yeah, maybe midsummer, I think.

[00:58:23] Okay. I’ll try 

[00:58:25] Cheryl Crow: to remember those, those listening. Keep me accountable. I’ll, I’ll, if you’re listening to this in summer 2025, remind me, remind me. Yeah. And so I thank you so much. This has been so great. It’s, oh, I, we always feel like we have so many more things we could talk about, but timewise I wanna give you time to get to your kiddos and me and my all are gonna come 

[00:58:44] Dr. Kara Wada: busting in and yeah.

[00:58:45] Cheryl Crow: Probably come join the show. Aw, that’s okay. Yeah. What is some of your best words of wisdom for somebody who might be listening, who’s newly diagnosed with maybe Sjogren’s or MCAS or a similar condition? I. 

[00:59:02] Dr. Kara Wada: As best as you can. Try not to get stuck in the overwhelm. I think just take a deep breath and a pause and then think about what is that next best step I can take, like little baby step, don’t feel like you have to, I’m gonna use all the cliches.

[00:59:23] Rome wasn’t built in a day do not do what I did, which was, excuse the expression, balls to the walls, trying to make everything perfect. Leaning into that perfectionism, stuff I ended up like frying my liver temporarily. That’s I think, in the free first episode, like what is the next best step forward, baby step.

[00:59:46] Treat yourself with some compassion, and it’s okay. It’ll be okay. 

[00:59:52] Cheryl Crow: Yeah. I, I love that and I, I really appreciate, yeah, I definitely encourage people to listen to the previous episode because not a lot of people talk about, experiences with, negative experience with supplements and stuff like that.

[01:00:04] Mm-hmm. And it’s so common. It’s so common, but it, there’s just not talked about ’cause people feel ashamed. So I think it’s so important that you share that story. What does it mean to you, this is kind of the $10,000 question to live a good life and thrive with Sjogren’s? 

[01:00:23] Dr. Kara Wada: I think one of the things I keep coming back to and I think has been some of the most powerful kind of quote unquote internal work I’ve done is taking the time to figure out what my core values are and making decisions in alignment with those.

[01:00:40] And I think that has steered me towards better understanding what a good life is overall. And a good life living with Sjogren’s and Dysautonomia. And for me, it’s really been leaning into connection with other humans and those that I love, leaning into curiosity. Like I love learning. I, I, being that detective and, and getting to know other people and and transparency.

[01:01:07] I, I am who I am, you, you get what you get with me. And and trying to lean in, not to put on, just to be authentic me, but also in what we were talking about with pricing stuff and all of that. And I think that has really just helped me better know who I am and what I stand for.

[01:01:28] And that’s made the biggest difference in really perceiving this as being a good life and thriving. 

[01:01:34] Cheryl Crow: That’s to, that’s so beautiful. And I love that it’s. I think, well, I hope not to give away my own agenda, but one of the things I’m hoping that when people listen to many of these episodes and hear how different people think through this question is that I think when you first get diagnosed, the presumption people have is that what it means to thrive and live a good life with this is to conquer it and make it go away.

[01:01:59] And I cure or make it cure it or make it, I’m gonna, I, I have really listened to these, messages that are given out by really well-meaning people say, oh, how did you conquer your arthritis? How did you conquer your Sjogrens? And it’s not, it’s about living, what you’re saying, living according to your core values and your, your conditions are coming along for the ride, potentially versus, yeah.

[01:02:23] I just like, yeah, 

[01:02:24] Dr. Kara Wada: putting yourself back in the driver’s seat. 

[01:02:27] Cheryl Crow: Mm-hmm. And also not holding 

[01:02:30] Dr. Kara Wada: onto the wheel. 

[01:02:31] Cheryl Crow: Yes. Being, I mean, I think that’s this is like a perennial topic from done. Yeah. The, the acceptance piece has been, I was dragged kicking and screaming into acceptance. But once I got there, once I opened myself up to the possibility of, of accepting that not everything’s under my control in particular, it was such a gift to be able to let go of control, but it felt impossible.

[01:02:57] It felt like there’s no way I’m gonna be happy with that. There’s no way I’m gonna be okay with not being in control. And then once I did, it was like, oh. Like that what you hold holds you. I was being held back by the idea that I just need to control everything. And now the world is more open to me.

[01:03:12] Anyway, that’s my story. But this is so great and I, I love values work. It’s funny, when I first made the Thrive acronym for the Room to Thrive program, the VI struggle with what the V should be at first. ’cause I, I had the ideas of what I wanted to teach and what I knew was helpful, but I want, and I really was, I was like, I want this to fit into the Thrive.

[01:03:32] I want it to spell out Thrive. Yeah. And, and I was like, V is gonna be, I know I wanna talk about values, but I was like, is it gonna be exciting enough to people like values? Are they gonna just be like blob? What? Like why does that have to do with arthritis? But it’s everything to do with.

[01:03:47] Quality of life. And if you don’t know what your core values are, then you’re constantly gonna be changing the goalposts, and just going with the whims of what other people say is important. So I just, anyway, I love that you have that in there. And then is there anything else that, now that your kids are trickling in?

[01:04:03] In my, my dog, I, I told ‘

[01:04:05] Dr. Kara Wada: em they can watch the tv, so they’ll be excited for a little bit. Oh, that’s, yeah, yeah, yeah, because I, I, now that they’ve been a, a bit of a stay at home mom with them after school, I, I’ve tried to anyways find that balance. But I think the only other thing I wanted to make sure folks know is, although I’m located in Ohio.

[01:04:24] I am licensed in a whole bunch of states, so that list is being kept updated over on my website, dr Wadata.com. And even if I’m not licensed in your state, I still can meet with you for educational visits. So I can’t do meds or do labs or things, but can be there as, kind of that advocate, that sounding board if you would find that helpful.

[01:04:47] So 

[01:04:48] Cheryl Crow: that’s so helpful to know. And again, that’s one other part of the healthWadae system people might not know about. Yeah. Is that we’re all anyone who’s licensed as a health provider is licensed in the number of states that they are licensed in. And that dictates where you people can, and yeah, 

[01:05:03] Dr. Kara Wada: the only other thing that I kind of put you on the spot beforehand, but every summer, this’ll be the fourth year that we are hosting the virtual Sjogren Summit.

[01:05:14] And I can’t remember the exact. Title of our theme, but in general, it’s like building your network. And so we’re hoping that Cheryl can join us this year. Oh, yes. Calendar allows. Yes. But it’s a really great it, it’s free to attend live and then if you there are some paid options too, but a really great place to connect with others in the community, learn more about the condition, and hopefully make an impact.

[01:05:43] Cheryl Crow: That’s, that’s huge. No, I, I would be honored to, to present at that. And it reminds me that I had never exactly announced that I was, I was not doing the Arthritis Life hack extravaganza for 2025, and no one’s asked. So, I mean, people are maybe just kind of like whatever she does stuff I’ll show up if I can, but yeah.

[01:06:03] And we did an Arthritis Life hack Extravaganza event 2022, which you spoke at 2023 and 2024. And I just, I really had a need. Yeah, I needed to really take a step into the 20,000 point view foot view and really assess like, where does my energy need to go? And, and I’m redoing some things or improving some things with the Room to Thrive program that I’ll be announcing later in the spring.

[01:06:26] So anyway, again, it’s funny ’cause you think, oh my gosh, who’s, they’re all gonna be so disappointed. Literally no one has asked. So it is on a little hiatus, but that, that’s my program. It just, I’m maybe think of that, but maybe you can 

[01:06:40] Dr. Kara Wada: scratch the itch over at the VS and 

[01:06:43] Cheryl Crow: Yes. Yes. To not have to 

[01:06:45] Dr. Kara Wada: deal with all the headaches that go with putting on a fence.

[01:06:49] Cheryl Crow: Oh man. Yeah. No, I really appreciate that, that you’re continually doing the, the virtual show Sjogren’s Summit. And just appreciate you taking the time today. Pleasure and keep up the awesome work. I wish I was closer to Ohio, then I would give you a real hug. I know. 

[01:07:03] Dr. Kara Wada: Well, 

[01:07:04] Cheryl Crow: we’re gonna 

[01:07:04] Dr. Kara Wada: meet up one of these years.

[01:07:05] Cheryl Crow: Yes. Well, I forget how far Columbus is from Chicago, but I will be in Chicago in October, 2025 for the rheumatology conference. The 24th through 27th, I think it is. Yeah. 

[01:07:16] Dr. Kara Wada: Okay. I’ll see what I can do. Yeah. Maybe I’ll plan a visit to grandma. 

[01:07:20] Cheryl Crow: Yeah. Oh, is Grand Grandma’s still in? He’s in the 

[01:07:23] Dr. Kara Wada: suburbs, yeah. Okay.

[01:07:24] Her birthday’s tomorrow in 94. 

[01:07:28] Cheryl Crow: Oh my gosh. Oh, three of my four grandparents live to 94. Fun. Fun fact. So I’m like, well, I hope that those, I hope that those dreams come, come down. I Happy birthday to your grandma. Thanks. So sweet. All Cheryl. Take.

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