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Managing Hypermobility Dr. Linda Bluestein’s guide to Ehlers-Danlos syndrome

Managing Hypermobility Dr. Linda Bluestein’s guide to Ehlers-Danlos syndrome

Do you ever wish someone would break down the complexities of joint hypermobility, sexual pain, and how they connect to your overall health? Well, that’s exactly what we dived into in this episode!

🎙 We were honored to have Dr. Linda Bluestein, a former dancer-turned-physician specializing in hereditary disorders of connective tissue, join us to share her personal journey with hypermobile Ehlers-Danlos Syndrome (EDS). Her insights show how a combination of approaches, not a single solution, can lead to better health outcomes.

Highlights:

1. Multifaceted Approaches to Health:

   – Dr. Bluestein underscores that managing health issues, particularly joint hypermobility and its symptoms, often necessitates a combination of methods—ranging from medications and supplements to lifestyle changes and psychosocial support.

2. Joint Hypermobility in Dancers:

   – Did you know a stunning 90% of ballet dancers experience generalized joint hypermobility? We explore how joint hypermobility can lead to symptomatic conditions affecting dancers’ performance and quality of life.

3. Sexual Pain and Pelvic Floor Disorders:

   – Learn about the prevalence and management of sexual pain and pelvic floor dysfunction, emphasizing these common issues as part of nearly every treatment plan Dr. Rahman and Dr. Bluestein encounter.

4. Mast Cell Activation Syndrome (MCAS):

   – Unpack how mast cells and their potential hyperactivity cause distress and inflammation, and how managing triggers like food and exercise can significantly impact health outcomes.

5. Mind-Gut Connection:

   – Hear about the essential mind-gut connection in addressing abdominal pain and bloating, and why treatments like acupuncture are recommended based on individual preferences and experiences.

6. Empowerment and Self-Advocacy:

   – Dr. Rahman emphasizes the importance of not giving up, seeking reliable information, and making use of resources like this podcast to become your own best health advocate.

🙌 How You Can Get Involved:

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Go to my website and sign up for our newsletter for more insights and updates! 

Questions or Comments?We love engaging with our listeners! Drop your questions or comment on my Instagram page, and let’s keep learning and advocating for better health together.

Connect with Dr. Bluestein:

Website

Instagram

Get in Touch with Dr. Rahman:

Practice

Instagram

Youtube

Transcript

Dr. Sameena Rahman [00:00:01]:

Hey, y'all. It's doctor Samina Rahman, Gyno girl. I'm a board certified gynecologist, a clinical assistant professor of Ob GYN at Northwestern Feinberg School of Medicine, and owner of a private practice for almost a decade that specializes in menopause and sexual medicine. I'm a south asian american muslim woman who is here to empower, educate, and help you advocate for health issues that have been stigmatized, shamed, and perhaps even prevented you from living your best life. I'm better than your best girlfriend and more open than most of your doctors. I'm here to educate so you can advocate welcome to gyno girl presents sex, drugs, and hormones. Let's go.

Dr. Sameena Rahman [00:00:51]:

Hey guys, welcome to another episode of Gyno Girl presents sex, drugs, and hormones. I'm doctor Samina Rahman, Gyno girl. Talk to you guys about everything you want to know about sex, drugs, hormones and more. So please like and subscribe to my channel here and my podcast and let me know what you guys want to hear about. I just finished an interview that you guys are going to hear now with doctor Linda Bluestein. Amazing. She is the hypermobile MD on Instagram. She is also a board certified anesthesiologist and an integrative medicine and pain specialist and now located in Colorado.

Dr. Sameena Rahman [00:01:25]:

She's licensed in Wisconsin and Colorado and she has her own podcast called the Bendy Bodies. She's a former ballet dancer who was going to be this wonderful ballet dancer, internationally renowned, and she has hypermobile EDS, Ehlers Danlos syndrome, which is a connective tissue disorder that can lead to a lot of myofascial pain, joint laxity, hypermobile Ehlerler Danlos syndrome. EDS is really a common subtype of the Ehler Danlos syndrome. It's a group of inheritable connective tissue disorders. Signs and symptoms include hypermobile joints, hypermobile back back pain, neck pain, easy brewing, soft velvety skin, stretchy skin, sensitive skin, allergies, hives, gastrointestinal syndrome, dizziness, dysautonomia, hernias, prolapse, atrophic scarring. They often have myofascial pain and muscle over activity to compensate for the joint laxity. It's strongly associated with MCAS, which is mast cell activation syndrome. Mast cells are part of your white blood cell system, your first line of defense against infections and inflammation.

Dr. Sameena Rahman [00:02:32]:

When they become overactive and doing things they shouldn't, they cause problems for people such as vestibular pain in the opening of the vagina provoked vestibular denia, neuroproliferative vestibulodynia, pain with sex and pelvic floor dysfunction. It's also associated with postural orthostatic tachycardia syndrome, Potts syndrome. The symptoms are a wide spectrum and it's really sometimes hard to get diagnosed. We know it's associated with sexual pain and pelvic floor dysfunction. Patients with endometriosis often have this as well, and they have severe pain with their menstrual cycle. People with IB's irritable bowel syndrome often have underlying Ehlers Danlos syndrome or hypermobility disorders in that spectrum of disease. So doctor Linda Bluestein is a patient of this herself, but she's also a patient advocate. She treats patients for this, like I said, in Colorado and Wisconsin.

Dr. Sameena Rahman [00:03:25]:

And you're going to learn a lot about what she does to help her patients. And please check out her podcast, hypermobilemd on Instagram and her podcast, Bendybodies. And so you please. I hope you enjoy this episode as much as I did because we know there's a link where we've seen it for the last few years and we're going to get to the bottom of it. We're going to eventually help patients before they have all these problems, and this is the way to do it by collaboration. So please enjoy this episode.

Dr. Bluestein [00:03:54]:

Thanks.

Dr. Sameena Rahman [00:03:56]:

Hey, y'all, it's me, doctor Samina Rahman. Gyno girl. I'm super excited to have a very special guest today on this episode of Gyno Girl presents sex, drugs and hormones. Today I have this distinct honor and pleasure to introduce you to doctor Linda Bluestein. She is a world renowned expert at hypermobile spectrum disorders and Erlos Danlos syndrome. She has been practicing medicine for over 20 years and has helped countless people in their lives deal with the risks of hypermobility disorders. She also is an integrative medicine physician and certified and performed arts medicine. And she has a unique approach to evaluation and treatment of this highly specialized population.

Dr. Sameena Rahman [00:04:39]:

She's received her doctor of medicine from the University of California, Los Angeles, as well as completed an anesthesia residency at Mayo Graduate School of Medicine and Border certified in anesthesiology as well as she does integrative pain management for patients in Colorado. Right?

Dr. Bluestein [00:04:57]:

Yes.

Dr. Sameena Rahman [00:04:58]:

Yes. So I'll let her further introduce you and then I'm going to tell you guys why I thought it was so important for you to hear about. Oh, she also has her own podcast, Bendy Bodies. Right?

Dr. Bluestein [00:05:09]:

Bendy bodies with a hypermobility MD. Yeah, I'm super excited to chat with you because I feel like we have so many connections and crossovers, and so, yeah, I'm super excited to be here.

Dr. Sameena Rahman [00:05:20]:

Yay. So that's doctor Linda Bluestein, one of the reasons I reached out to her, because she has this wonderful podcast on bending bodies, and she's known as the hypermobility MD on Instagram, her social media. And one thing in the world of sexual medicine and pelvic pain disorders that we often see, and we've noticed over the last few years, the trend has been to see more patients that have hypermobile EDS, Ehlers Danlos syndrome related to either vestibulodynia or painful sex, pelvic floor dysfunction, myofascial pain syndromes. And there was actually a study that was just conducted and presented at Ishwish in March of 2024 that demonstrated at the center for revival Vaginal Diseases. They reviewed over 200 patients, screened them for hypermobile EDS or hypermobile disorder, and basically found that about a third of their patients had screened positive for hypermobile EDS or hypermodal spectrum disorders. And of those that screened positive, almost every single one had provoked vestibular pain or vestibulodynia. Painful sex was like 98% and 67% have pelvic floor dysfunction. So we've known this connection.

Dr. Sameena Rahman [00:06:40]:

And there was also a study recently published by doctor Erwin Goldstein about mast cell apparent mast cell activity and how it's related to when he did surgery on a number of patients that had provoked vestibular pain. It was thought to be neuro proliferative in origin and basically stain them for a stain specific for mast cell disease, and found the majority of them had positive stains for mast cell activation, which is very cutting edge research here. So we've known about this connection. We need to learn more about it. We need to learn how maybe treating eds better or hypermobile disorders may help prevent this in the future. We don't know. There's so much we don't know. But let's talk about it.

Dr. Sameena Rahman [00:07:19]:

Doctor Bluesting, tell us a little bit about, you know, your journey about, if you want to just restart with telling us, like, what is eds? What is this hypermobile disorders that we hear about all the time or see in our clinics with our patients or any of the patients listening, that may have it.

Dr. Bluestein [00:07:35]:

Right? Right. So I think a good way to start is to think about joint hypermobility just by itself. That that means that a joint or a group of joints has greater than expected range of motion. And some people that have joint hypermobility will be just fine, asymptomatic throughout their entire lives. They will not develop chronic pain or any other symptoms related to having hypermobile joints. But a lot of people do develop symptoms, and the symptoms can be multisystemic. So if that's the case, then we call that symptomatic joint hypermobility. And of those patients, there's going to be a subset of people who have one of the hereditary disorders of connective tissue, and meaning that their connective tissue, they have a genetic alteration.

Dr. Bluestein [00:08:18]:

And so the way their connective tissue is made is different than the quote unquote, normal person. And so of those hereditary disorders of connective tissue, the Ehlers Danlos syndromes are one of the more common forms, and specifically, the hypermobile type is the most common type of eds. So we think that probably 80 to 90 or maybe even more percent of the cases of eds are actually hypermobile eds. What's tricky about hypermobile eds is we don't know yet the genetic marker or, you know, the causative gene for this condition. So it's a clinical diagnosis. So we have certain criteria that we look at, and one of them is, you know, does the person have generalized joint hypermobility? Because you can have, like, you know, hypermobile shoulders, for example, but not other hypermobile joints, or you can have lots of hypermobile joints. So when people have lots of hypermobile joints, that's generalized joint hypermobility. And there are specific criteria for that.

Dr. Bluestein [00:09:15]:

And before we started recording, you and I were talking about, like, the five point questionnaire, which, by the way, I love that questionnaire. Those are really, really great questions. You know, it starts with, you know, can you now? Or could you ever bend your thumb to touch your forearm, for example? Can you now? Or could you ever put your hands flat on the floor without bending your knees? And then, you know, as a child, could you amuse your friends or twist your body into strange shapes or do the splits? Like, these are some of the questions. And so it gets to, are you now or were you in the past hypermobile? And what I like about that, as compared to the bite and score, is a lot of people, they were hypermobile in the past, but they're not anymore. So by the time they develop symptoms, if they're not hypermobile anymore, using a tool like the five point questionnaire can be really, really helpful.

Dr. Sameena Rahman [00:10:00]:

Wonderful. Yeah, because I think that's the big hiccup that I see with some patients, is, like, getting the appropriate diagnosis and what that means, I guess, really just improving their quality of life. But, and I see it a lot in my patients who are dancers. And I think that that's one of your histories, too, right? You're a former dancer.

Dr. Bluestein [00:10:17]:

Yes. I really, really wanted more than anything in the whole wide world to be a professional ballet dancer. And my own joint pain and different problems definitely made me have to come up with a plan B, which was to go into medicine. And then I practiced as an anesthesiologist for over 20 years in the operating room. And then my health started to catch up to me again, and that's when I pivoted to plan C, which was to actually have a clinic devoted to caring for this population of people. And then I also have my podcast because I want to make the information as accessible as possible. So, of course, if I see someone one on one, that's the most, you know, specific and, you know, they can really, really get customized information, whereas the podcast is, you know, one to many. So it's, you know, more general information.

Dr. Bluestein [00:11:05]:

But it's a lot of people have said that the podcast has been just hugely transformational for them listening to it.

Dr. Sameena Rahman [00:11:12]:

Yeah, yeah. I actually oftentimes referred now to my patients, to your podcast as well, because I do see a lot of patients either with that diagnosis or potential diagnosis, and I'm like, well, you know, check out Doctor Linda vlust and you'll learn a lot from her. So they've gained a lot of that as well. What was your journey like? When did you get the diagnosis? Or, you know, for yourself?

Dr. Bluestein [00:11:32]:

Like, I was in my forties, actually. So it was a long, long time. And, you know, as a kid, it's funny, because I didn't know the connection between mast cell activation syndrome and eds until much more recently. But as a kid, I had terrible asthma, allergies, eczema. I remember telling my mother that I wanted to die because my allergies were so bad. I was just, like, allergic to life, you know, it was horrible, absolutely horrible. And then I started developing migraines, irritable bowel syndrome, you know, pelvic floor problems. I've actually been a patient of Doctor Goldstein's, Doctor Erwin Goldstein.

Dr. Bluestein [00:12:09]:

So, yeah, he's amazing. And ishwish is, like, I think, a fantastic organization. So I'm super excited about this because likewise, I have a lot of patients that have questions about hormones and pelvic floor function and sex, painful sex and things like this. So there's a lot, a lot that is, you know, the hypermobility affects the way we are able to do certain activities, you know, intimate, intimate activities. And likewise, those things are definitely, you know, really, really relevant. And it's important for people to know, though, that there is hope. And that's why I do the podcast. It's why I still see patients even though, you know, I'm in this, like, later stage of my career, because I want people to feel hopeful.

Dr. Bluestein [00:12:54]:

And I, you know, that's something that, like, Doctor Goldstein gave to me when I saw him. I was feeling really, really hopeless. And so it was huge that I saw him, and he was able to help me with some things.

Dr. Sameena Rahman [00:13:04]:

Yeah, I think that's. That's one of the big keys is that because I think patients suffer for years or a lifetime even. Like, we see the connection with, like you said, mast cell activation. We think that maybe now that patients that have that, you know, initial pain with penetration, or they've always had that pain with penetration, that leads to even more of that myofascial tension in the pelvic floor, you know, then they might seem like they do have a barren mass cell activity. And so I think that it's really important to know that, you know, we're discovering more and we're trying to look for preventative ways to deal with this. But, you know, trying to deal with the whole picture is very important when it comes to, you know, sexual medicine, we always talk about the biopsychosocial approach, and I think that is something that, you know, is very relevant. Tell me a little bit about, like, when you see patients to come to you, like, because you really give them unique, you know, patient care plans and this kind of thing. Like, how does that visit look like? What does that look like?

Dr. Bluestein [00:14:02]:

So I'm licensed in Colorado and Wisconsin. So if someone lives in the United States and they can come to Colorado or Wisconsin to see me in person and they want to become a patient, I can establish with them that way, or they can establish with me that way. We can establish the doctor patient relationship that way. I also do coaching for people who live out of the country or cannot come to see me in person. And that is more general suggestions. Although we do get into pretty specific things. But I write it like I'm writing it in a book. So I don't say you should do XYZ.

Dr. Bluestein [00:14:34]:

Cause I'm not making a diagnosis. Instead, I make it. You know, these are some things that can be helpful for people with XYZ. So when someone comes to see me, though, as a patient, what I usually do is I create a comprehensive treatment plan. Once I have done the normal history and physical exam, right. And done an evaluation and determine what I think is most contributory to their pain or what other symptoms they want me to address. And I generally use an acronym for my treatment plans. That's men's pmms.

Dr. Bluestein [00:15:09]:

And the letters stand for movement, education, nutrition, sleep, psychosocial modalities, medications, supplements.

Dr. Sameena Rahman [00:15:18]:

Wow, wonderful.

Dr. Bluestein [00:15:19]:

Medications and supplements are at the end because there's so many other things that we can do. And I feel like most people, when they come to see me when I was having terrible pain, they've made the same mistake, if you will, where they're looking for the one thing that's going to make them better and give them their life back. And instead I found in my experience, both personally and professionally, that it's usually a combination of things. And also it takes time, right? It takes, you have to make some changes and then you have to allow some time and you have to just keep at it. But in many, many cases, most of the time can really, really improve their quality of life and their functional capacity. I really don't ask much about, you know, pain scores, because for me, it's about function. You know, there was a point in time for me where, you know, my pain was a zero most of the time, but I couldn't open a door because I was having so many problems with my upper extremities. So it's really, really important to think about what are the functional limitations that a person has.

Dr. Bluestein [00:16:17]:

And working on those, I imagine you.

Dr. Sameena Rahman [00:16:20]:

Work probably closely with all types of physical therapists and. Yes, all right, they're on your speed dial as they are on mine. What? I mean, so what percentage of patients do you think like, dancers or other? Because, I mean, obviously, to be a ballet dancer, you do have to be a little more mobile than the average or hypermobile, I guess. Do we have statistics on that just to know what percentage of ballet dancers are performers? Yeah, yeah.

Dr. Bluestein [00:16:47]:

And the interesting thing is, you know, there's been studies done over the years looking at, you know, contemporary dancers or, you know, ballet dancers, different types of, and styles of dance. Of course, I bet you now, if we were to do another study looking at what the prevalence is of generalized joint hypermobility and, for example, the pre professional ballet population, or, you know, amongst professional dancers, I bet you it's going to be even higher because hypermobility has become even more valued. And, you know, when I was dancing, of course, it was very important to be able to get your leg as high as possible in the air. But I feel like it's become even more so with the competitions, dance competitions, social media, you know, it's. The emphasis also has changed to a certain extent. But there are studies that show that amongst ballet dancers, like, 90 plus percent have generalized joint hypermobility.

Dr. Sameena Rahman [00:17:40]:

So over 90% of dancers of any type likely have hypermobile disorder. Hypermobility disorder.

Dr. Bluestein [00:17:49]:

So, yeah, so I just want to clarify that. So I'm talking about ballet dancers. Ballet dancers, like, looking at contemporary dancers or other forms of dance, most of the studies have little lower percentages. Ballet is a form of dance where, you know, the lines are very, very important, and the aesthetics of the, you know, the hyperextended knee is considered, you know, the. The absolutely desired look. So, amongst ballet dancers, studies have shown that, like, 90 plus percent. Some studies have shown that, like, 90 plus percent of them have generalized joint hypermobility. Now, that does not mean that they have a hypermobility disorder.

Dr. Bluestein [00:18:26]:

That means that they have, at least now we say, five or more joints that are hypermobile. The tricky thing about this is that the nosology and how we define things and everything has changed so much over time. So we're kind of, like, using newer terminology and looking at older studies. I mean, it's probably true in every field of medicine, but I feel like some are harder than others because there's been a lot of changes in terminology amongst those. We don't really know what percentage have symptoms and have symptoms related to their joint hypermobility. But I will tell you, based on talks that I give at valet schools, I believe that the percentage is extremely high, because, you know, they'll come up to me and talk to me about different symptoms that they have. I work with a lot of dancers, and, you know, so I think the percentage that have symptomatic joint hypermobility is quite high. How many have EDS is another story that's gonna be significantly less.

Dr. Sameena Rahman [00:19:26]:

Less. And of those patients that you see in your office and your clinical scenarios, how many do you think are struggling with either sexual pain or some form of pelvic floor disorder? Like, if you had a ballpark it, do you think that, like, it's part of. It's part of the overall treatment plan for almost every patient that you're dealing with or so.

Dr. Bluestein [00:19:46]:

So, you know, we're not talking about just dance the dance population at this point. We're talking about the whole population. I would say it's. It's 90 plus percent. It's extremely.

Dr. Sameena Rahman [00:19:56]:

Yeah, yeah. And the same thing. When you were saying that you had all these struggles with allergies and things growing up with mast cell activation, do you find that that's consistently seen among your patient population as well?

Dr. Bluestein [00:20:09]:

Oh, yeah. It's really, really huge. And I didn't appreciate it in the beginning. I didn't realize that it would be that significant. I mean, when I wrote my first paper about eds in 2017, I did not appreciate the relationship. But now I've really noticed. It's really, really incredible. And once you actually address the mast cell activation and you kind of factor that into your treatment plan, I've noticed that the outcomes are a lot better.

Dr. Sameena Rahman [00:20:37]:

Wonderful. And what does that usually entail? Does that. I mean, people talk about low histamine diets and, you know, different, which I think is very difficult for most patients to. But, you know, or even, like, you know, talking about antihistamines, is that of, you know, in your repertoire of things you recommend or.

Dr. Bluestein [00:20:53]:

Oh, definitely. Yeah, yeah, definitely. So. So we address it on multiple different levels. We think about, well, what are the triggers that are happening in the environment? And the goal isn't necessarily to remove all triggers, because that isn't always possible. Like, one of the triggers that a lot of people experience is exercise. We need to exercise. If we.

Dr. Bluestein [00:21:11]:

As soon as we stop moving or we aren't moving enough, that causes a whole another set of problems. So we want to figure out what the triggers are, and we figure out how we can manage those triggers. And you're right, food can definitely be a trigger. But I also encourage people to be very, very careful not to limit, limit. Limit their foods. And then they start getting more and more anxious around meals, which causes activation of the sympathetic nervous system. It causes digestion to slow down, and.

Dr. Sameena Rahman [00:21:40]:

Then that hypertonic pelvic floor don't redevelop.

Dr. Bluestein [00:21:43]:

Yes, yes, exactly. Exactly. So then you eat and you don't feel good, and so you think, oh, eating causes these problems, and then it turns into a vicious cycle. So I think that it's really important to be thinking about, okay, just like, be an observer. You know, I tell people, be like a reporter, try to just pay attention to these things and notice, oh, when I eat this particular food at this particular time, I have this type of a reaction. And so maybe right now, that's something that I should avoid, but maybe in the future, I can put that back in my diet. Because we want people to, you know, basically, we want their mast cells to calm down and stand down. We don't want them to just avoid, avoid, avoid, and then run into more and more problems.

Dr. Sameena Rahman [00:22:26]:

Right. And for listeners out there, your mast cells are part of your white blood cells system that are supposed to be the forefront to help, you know, fight infections and inflammation and all that stuff. But sometimes they can get a mind of their own and become hyperactive or overactive and cause, you know, their own distress and inflammation. And I think. Do you see a lot of the pots syndrome, too? The postural?

Dr. Bluestein [00:22:52]:

Yeah, yeah, tons, tons. So. So pots falls under the category of dysautonomia or dysfunction of the autonomic nervous system. So your, you know, fight, flight, or freeze versus your parasympathetic nervous system, which is the rest. Digest, restore, basically controlling all the. I know you know this, but just for the listeners, like, all the automatic functions in the body, right. Heart rate, blood pressure, pupil size, temperature regulation, et cetera. And so I see a tremendous number of people that have some degree of dysautonomia.

Dr. Bluestein [00:23:20]:

Maybe they have orthostatic intolerance, but don't quite meet the criteria for pots. But it's. Yeah, I would say it's a huge percentage. It's the majority. It's by far the majority.

Dr. Sameena Rahman [00:23:30]:

The majority. And then, you know, the whole, in the gyn world, we see all that associated also with endometriosis and have painful menstruation, the inflammation around bloating and the sexual pain. All of that sort of linked together. And we know that patients that have mast cell activation syndrome can also be seen with those patients with endometriosis who have introidal pain with sex, too. So it's a very interesting link. I think that there's obviously something, a genetic predisposition to some of this, that environmental factors can then cause a whirlwind of problems for different patients, depending.

Dr. Bluestein [00:24:10]:

Yeah, yeah, definitely.

Dr. Sameena Rahman [00:24:12]:

And so typically, when you see a patient in your office, you kind of look through lifestyle modifications. Are there specific medications that you're thinking of prescribing? Depending. I mean, I think you and I both don't practice cookie cutter medicine. Right. We look at, as an individual, we are all about precision based medicine based on what their historical findings are, their history, their genetic predisposition, all that stuff. But is there any, like, medication or other treatment plans that you would incorporate other than sort of lifestyle modifications and just being aware, physical therapy, all of that stuff. Right, right.

Dr. Bluestein [00:24:50]:

So I prescribe lots of medications. You know, lots of times, too, when people come to me, they might already be on lots of medications and supplements. And sometimes I look at that and I say, well, I wonder if some of the excipients or the quote unquote inactive ingredients that are in some of these medications and supplements are actually part of the problem. So rather. So with some people, rather than adding more medications, we start with taking things away, and we say, and I look at that, I look at their list, and I say, okay, well, you know, I start picking things off the list. I say, do you think this is really making a difference for you? And if not, let's try eliminating it and see if that makes a difference or not. So that's the first thing that I often think about. Otherwise, if mast cell activation is a significant part of the picture, then, yes, antihistamines definitely are one of the mainstays.

Dr. Bluestein [00:25:41]:

Sometimes leukotriene antagonists like Montelucast definitely can be helpful. And also chromolin sodium, which might be administered either before meals orally. So that would have more of an effect on the GI tract. It can be administered as eye drops, kind of hard to get nowadays, but that is a possibility and also can be used as a nasal spray. So there's a variety of different ways that that can be used. I do sometimes actually give people instructions to do a chromolyn sodium douche for menstrual pain. And, you know, there's no one right way to do that. But I do have a set, like, chart, part set of instructions for people to try that or to try a douche with, with Benadryl.

Dr. Bluestein [00:26:25]:

It's another. Yeah. Is another thing that. Yeah, there's a paper published by some of my colleagues on, on that for, you know, heavy menstrual bleeding and painful periods and things like that. So, so those are some of the things that, that I prescribe for medications. I do often prescribe supplements as well. So one of the ones that I really like is called qucertin, and it's spelled q u e r c e t I n. So I use that.

Dr. Bluestein [00:26:49]:

I use that one a lot. Vitamin C can be very helpful. I check vitamin D levels a lot and often prescribe vitamin D and, or getting outside and getting some sunlight. So there's a variety of supplements with.

Dr. Sameena Rahman [00:27:03]:

The mind gut connection as well.

Dr. Bluestein [00:27:05]:

Yes, yes, exactly. And, yeah, and that's the thing, too, with a lot of people. They have abdominal pain, bloating, et cetera. And that definitely that mind body, that gut brain connection is very, very important.

Dr. Sameena Rahman [00:27:19]:

Have you seen, I mean, I haven't looked at this, like, from a study's perspective, but, like, the use of, like, acupuncture or, you know, sort of like any of the eastern medicine that you've looked at. Have you seen any impact, clinical studies or relevance in terms of that?

Dr. Bluestein [00:27:35]:

I do recommend acupuncture quite frequently. A lot of times, by the time people come to see me, they've tried a lot of things, including acupuncture. So a lot of times they're, you know, kind of resistant to that. So I start where they are, and like you said, it's totally customized, individualized. So you look to see, well, what all have they tried and what are their feelings about some of those different things? Because sometimes they're really open to trying them again, and other times they're not. Acupressure. There's some great studies on acupressure and persistent pain and things like fibromyalgia, where they've seen some really good results with that as well.

Dr. Sameena Rahman [00:28:13]:

Oh, wonderful. Well, I so appreciate you being here. Just for an introduction to this, I'm going to have you back. We can have a further discussion, but I think that, you know, just understanding how the relationship exists between my world and your world is so important so people can access both to help improve their overall quality of life. Obviously, we're here to educate so they can advocate for themselves. If you had one piece of advice to, to give, you know, someone listening who was like, oh, my God, I've always had that, you know, Bendy situation with Wonderland or destroy, like, what would you tell them in terms of, you know, next steps or, you know, how to access the best care they can?

Dr. Bluestein [00:28:52]:

I guess what I would say is never give up. I feel like everyone that I've seen, I've at least had some ideas of things that they could try, and I see all the time. In fact, I saw something really recently on social media where someone was talking about their hypermobile eds and said that their doctors have said that within five years they're going to be completely bed bound. And I don't think that has to be the case. I think that it's possible through improving again. The gut is kind of, to me, like the be all and end all, which I was a very mainstream medicine trained physician. But if your gut's not working well, you're not absorbing your nutrients well, you're not going to make strong tissues, you're going to have all kinds of problems. Like, that just is so, so important.

Dr. Bluestein [00:29:41]:

And I feel like for some people, if they're really, really struggling, they're having a lot of joint dislocations, joint subluxations. You know, they start to get really discouraged. And maybe they're having, like I said, the GI symptoms are having constipation or, you know, abdominal pain, bloating, gerd whatever it might be. But it seems like usually there are things that we can do in order to improve someone's quality of life. So I would say never, never give up. Try to get as much information as you can, even if you can't afford to see me one on one or something like that. Listen to the podcast. There's now 94 episodes, so that could take you a while to listen to all of them.

Dr. Bluestein [00:30:20]:

And in the beginning, it was more dance medicine focused than it has been more recently. But I've had lots of non dancers tell me that they've learned a lot from the dance specific episodes. You know, that's free to the listener, right? The podcasts are free to the listener, so absorb as much of that as you can and start trying some of the things that we talk about in the podcast, but don't give up.

Dr. Sameena Rahman [00:30:43]:

Wonderful bendy bodies. That's the podcast. And Doctor Linda Bluesteen is hyper mobile md on social media platforms. So please, you know, check out her content as well. And thank you so much for being here today. Just to, you know, illuminate this range of disorders and how it impacts, you know, not only your ability to move your joints and mobility in general, but just your whole life in general, from how you feel about your gut health to your sexual health. So if you guys have any other questions or comments, please leave them in the in the comments section. I'm here to educate so you can advocate for yourself.

Dr. Sameena Rahman [00:31:19]:

And please tune in for the next episode of Gyno Girl presents sex, drugs and hormones. Thank you.

Dr. Sameena Rahman [00:31:25]:

If you have a second, please subscribe to this podcast. I'd love for you to be a follower and learn as much as you can about the things that we're going to talk about with all the people on our journey. Please review us on Apple or Spotify or wherever you listen to podcasts. These reviews really help review us. Comment tell me what else you want to hear to get more information. My practice website is www.cgchicago.com my website for Gynell Girl is www.gynegirltv.com. my Instagram is Gynell girl so please follow me for some good content. Additionally, I have a YouTube channel, Gynel Girl TV, where I love to talk about all these things on YouTube.

Dr. Sameena Rahman [00:32:08]:

And please subscribe to my newsletter, Gyne Girl News, which will be available on my website. I will see you next time.