Katie: Hi, my name is Katie. I am 39 years old. I was diagnosed with HS when I was 33 years old. I am a chapter director and patient advocate for Hope for HS, and I'm here to share my story with you. I noticed my symptoms first starting when I was around puberty age. I noticed that I started getting boils under the arms, under the breasts, and in the groin area.

Katie: And then, when I was about in my thirties—childbearing age—I started noticing more symptoms where the boils were now turning into these huge infections. I started getting more fatigue, more pain, joint pain, bone pain. And then there were times when I didn’t even want to get out of bed. The lesions would then leak and rupture, and then they would grow back.

Katie: They would shrink. Then there were several periods of time when they would go through that whole process.

Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. If you or a loved one has been living with hidradenitis suppurativa, or HS, a chronic and often misunderstood skin condition—

Pathak: You probably know that the treatment journey can be complicated. Maybe your treatment regimen worked for a while, but something shifted and now it seems as if your HS flares are no longer under control. Perhaps new symptoms or side effects are appearing, or you're considering alternative treatment options.

Katie: So, a new flare-up is—I experience redness in the area, and then they grow into the boils or the big lesions, and then it's just so painful. Sometimes I can't even lift my arm to put deodorant on underneath the arm. There are times when I don’t want to get out of bed, when I don’t even want to go out or get dressed sometimes because of the pain and the lesions that are leaking.

Katie: It has put a damper on me wanting to go out and socialize with others because of me being worried about the smells coming from the areas. I know that's put a damper on some relationships where my friends would say, “Let's go out for lunch,” and I'm like, “Well, no, I'm not feeling good,” or I come up with an excuse and have to explain to them, “Hey, look, these lesions are really painful.”

Katie: I can't do as much as I want to, which just—my body feels like it prevents me from doing the things I want to do. I had to cancel going to someone’s wedding, and I felt so bad, but I just couldn’t move. It was so physically draining, emotionally draining, and I was afraid that thing was gonna just erupt like a volcano.

Pathak: We'll be right back.

Pathak: With more insight on HS. We are back, so let's continue the discussion.

Katie: I've had several challenges with trying to find care. In the beginning of this year, back in March, I went to have a consultation with a general surgeon, and this general surgeon came in, met me, and then he went back.

Katie: He came back in with a full gown on, masked up, gloves, the face shield. I was really confused, and he’s like, “Well, the condition you have is contagious, and I will not be able to work on you because you are a bigger person, and this is just not something that I would be comfortable doing.” And I kind of had to give him a little education that, hey, HS is not contagious. It is not due to my hygiene. And so I walked out of that doctor's office really upset and said, “I don’t wanna see that person again.” So that’s been a challenge—that there’s not a lot of doctors who know about HS. So I know there are a lot of barriers that need to be addressed through education.

Pathak: How do you know when it’s time to escalate or change treatment, and if your treatment needs are not being met, how do you find a care team that truly understands this chronic condition?

Katie: I work extensively right now with my primary care doctor for things that I need immediately, like pain medication. I work with my dermatologist.

Katie: I also see a rheumatologist. I also work with hematology, as well as a mental health therapist, because this does take a toll on the psyche. So it’s just kind of finding the right care team—which just takes a multi-team approach rather than one doctor treating the skin condition. It takes a toll on everything in your body.

Katie: I believe I find the most support in being an advocate for myself, knowing what I need, and trying to communicate that with the insurance company, the dermatology team, or the doctors I work with who are taking care of me. I make it an effort to try to at least tell two people a day about my HS, and then also challenge them to tell two other people.

Katie: So it’s just kind of been a concept of trying to grow and get away from the stigma of what HS is. So if someone just got diagnosed, I would tap them on the shoulder and say, “Look, you are more than HS and you can get through this. It’s not because of your hygiene. It’s not because of what you eat or what you do.”

Katie: HS affects everybody from all walks of life—young and old, from whatever religion, from whatever race you are. It affects everybody—men and women as well. Just kind of giving them advice: you are more than your HS, I believe, would help them through.

Pathak: Today, we'll walk through what HS escalation looks like, how to recognize when your current treatment plan is not working for you, and how to navigate the difficult but sometimes necessary decision to switch your healthcare provider.

Pathak: Today's episode will offer helpful insights for anyone navigating this condition. First, let me introduce my guest, Dr Chris Sayed. Dr Sayed is a professor of dermatology at the University of North Carolina Department of Dermatology, where he’s director of the Program of Clinical and Research Excellence in HS.

Pathak: He's the secretary of the HS Foundation and an investigator for clinical trials and NIH-funded translational research for HS. Welcome to the WebMD Health Discovered Podcast.

Christopher Sayed, MD: Thank you so much. Very excited to be here and to have a chance to talk about HS.

Pathak: Well, we are very excited to have you and to continue our discussion around HS.

Pathak: But before we jump into the questions I have for you, I'd love to ask about your own health discovery—whether that's through your research or your work with patients—what was that aha moment for you, maybe around questions that they were asking, that you realized really needed more research to answer?

Sayed: I think I can answer this in a couple of different ways. Around clinical care, I can remember pretty starkly during residency training, times where patients would come in and they'd be on something like doxycycline. At the end of the conversation, they'd be on something like minocycline when they walked out the door, and it was like—is that it?

Sayed: And that was probably the question that stuck with me the most—like, is that really all you have to offer, another antibiotic, and not something that’s more thoughtful or tailored to this condition? So that always stuck with me and sort of pushed me, as I developed a clinical niche once I was an attending in our department, to really try to push new directions, offer new treatments, and find different ways of approaching things.

Sayed: And from a research standpoint, I think one thing that really drove me was that a lot of patients—you know, it’s often young female patients or younger patients who develop disease—they're starting to grow their families and say, “What happens to my kids? Are they gonna grow up and have HS too?” And that pushed me into the area of genetics research, where I’ve been able to team with other people at UNC and start to try to answer some of those questions too. So a lot of what we do is driven by what we notice with patients, what patients ask us, and I think that's very much been the case with my course.

Pathak: That’s a really powerful insight, so thank you for sharing that. In a recent episode, we took a step-by-step approach to understanding the first signs and symptoms of HS, how to obtain a diagnosis, and some potential treatment options. Today we’d like to explore what to do when symptoms worsen. We want to take a look at the different treatment options that are available now, how to determine if it’s time to switch treatments, and what new and emerging treatments are most exciting from your standpoint as an HS clinician and researcher.

Pathak: So let's take a little bit of a step back and help us understand—what does it mean when there are escalations of symptoms in HS? How do patients recognize that?

Sayed: I think that can be in a number of different ways. It may be a new area that gets involved. Somebody's only ever had it in their armpits in the past, but all of a sudden now it's in the groin area and buttocks, and it's influencing how they pick clothing or how they can do their job in a much different way.

Sayed: All of a sudden, it may be in the cadence of how lesions develop, as opposed to once every few months, something that was somewhat disruptive from time to time to a nearly constant stream of new lesions. They can't work on a day-to-day basis and their job is suddenly in jeopardy. There’s also just, in general, how much scarring is being produced and how much of the tunneling lesions are present.

Sayed: A lot of that damage is irreversible, and so that can be a real key as to when to escalate therapy, because you miss a window of opportunity to do something if you just keep waiting for more of that damage to develop. So that's a big trigger to move on to new therapies.

Pathak: So then for that patient that has been on somewhat of a stable regimen and now all of a sudden they're having an exacerbation on treatment, can you help us understand the process of switching treatments?

Pathak: And we know that can be an undertaking. There's a concern that you have been okay on this regimen, you're fearful of trying something new. There are potential insurance issues, and then just the mental and emotional impact of now stepping again into the unknown. How do you talk to your patients when it's time to consider a new treatment option?

Sayed: I totally agree. This can be a difficult conversation sometimes, especially when a patient is maybe partly responding to something, or they have had a year or two of pretty good response and it's been slowly waning over time. I think there's this threshold where all of a sudden they're developing in new areas.

Sayed: Areas that were previously relatively dormant are active again and seem to be expanding in terms of how much area they're covering. And so the minute we start losing ground and seeing irreversible changes develop that the medicine is not holding steady enough, that, in my mind, is a reason to have that conversation.

Sayed: Do we add something, or do we make a bigger change overall? But very often we're in a position where, you know, we either have to increase the dose or change to something else. For patients who were really miserable before that treatment, the idea that they might go backwards with a change—they might be better on the next thing, or they could be way worse very quickly.

Sayed: So I always feel like it's a gamble to address that. I have a pretty low threshold to overlap treatments to some extent, which can sometimes be a little bit of a tug-of-war with the insurance—of, yeah, we're gonna try to stop what they're on now and not have them on two things forever. But in the short term, I want to make sure to bridge them and make sure they start heading the right way before I totally pull the rug out from under them.

Sayed: I have pretty low hesitation and sort of worry about risks. It's not totally well-characterized, but I think that's safer than letting them fall apart and then playing catch-up for the next six months, or they end up in the emergency room.

Pathak: And just listening to you, it's very clear that this type of shift needs a very thoughtful approach and really a care team where they're taking all of these things into consideration, recognizing that there might be a little bit of a back and forth with insurance companies as you're titrating, changing, shifting, so that a patient is not left scrambling. So before the whole idea of changing regimens, if you are with a healthcare professional or a team and you don't feel like they may be taking this very nuanced, stepwise approach, how do you encourage them to advocate for themselves and then potentially seek other care options?

Sayed: Sure. I think there are different scenarios where this comes up, where maybe not enough is being done in figuring how to adjust around a partial response or an inadequate response.

Sayed: It's not always straightforward. I think the most obvious thing is that if you are developing new lesions, new locations, and the disease is not, at minimum, stable—communicating the idea that, “Look, I'm watching things get worse over the last six months, and I have new scars and areas that are chronically draining that weren’t there before.”

Sayed: Like, I'm really not holding even steady at this point. So I feel like, to me, it's worth it to make a change. And I'm nervous because I know I'm better than what I was. So if it's possible to have some sort of bridge or sort of temporary coverage to make sure that transition is as smooth as possible—

Sayed: Because I know it could be worse. I think, hopefully, a provider would listen to that very clear expression that, “Look, things are moving in the wrong direction. We have to course-correct in some way.” The other scenario this comes up in is that for a lot of the partial responses we see in HS, maybe the disease is more stable than it was before, but there are a handful of areas that are just persistent, or that as opposed to constantly draining—

Sayed: You know, every month or two they flare up temporarily, and it's still disruptive. You're 75% better, but who wants to live with 25% of really bad HS? And so figuring out when to incorporate things like surgery—I often tell patients that with really bad HS to start with, it's a journey to get to the endpoint, and that will mean stabilizing things, putting out the fire with medicines, making sure we at least stop things from getting worse.

Sayed: There are going to be some of the remodeling types of changes in the skin that have happened that may require a surgical procedure or time to be the best you can be. You know, if you're happy enough that things are improved with medication and more stable, that's great. And if you have an excellent response, maybe that's all we need.

Sayed: But for a lot of patients, there is this next step towards a few surgical procedures to target those worst areas. I think explaining to providers who maybe don't know where that threshold is—if you've seen, again, disease stability but specific areas that you just wish weren’t there, and you're not developing new areas anymore, you’ll make progress with surgery.

Sayed: I think initiating that conversation of, “Look, I'm not afraid to have these areas dealt with. I've had wounds and drainage and done this my whole life. It could be worse in the short term if I'm better in the long run.” So I think some providers might be hesitant to initiate that conversation, thinking the surgery's going to be tough, the patient doesn't want to do that.

Sayed: But I think a lot of HS patients, unfortunately, have been conditioned to deal with things like surgical recoveries by their disease over time. And a wound that heals in six weeks—or even 12 weeks for a really big wound—is better than a wound that feels like it’s never healed.

Pathak: That’s really, really helpful.

Pathak: More on HS when we return. We’re back. So let’s continue the discussion. Do you also have advice on where people can seek out information about providers that really understand management of HS—expectation management, referrals that will need to be made? Where can they find this type of information?

Sayed: Sure. My favorite resource is the HS Foundation, where they have a clinic finder page where you can filter by state and find providers who have applied to be on that clinic finder. They have declared their interest in HS, they’ve typically been vetted and reviewed by other HS experts on the HS Foundation Board, and they’ve typically either trained with one of us or come to our meetings and done sort of bootcamp-style sessions to really learn HS well and how to troubleshoot it.

Sayed: Then the other great resource is that there are really amazing HS support groups that are patient-run, and they often make their own lists or are great places where you can look on forums across the country—and across the world, really. Even there, you’ll be able to find other patients who have good providers they've worked with that they can, by word of mouth, hopefully point you in the right direction at least.

Sayed: So I would definitely encourage patients to lean on those resources and talk to other patients who've had good experiences.

Pathak: That's really helpful. I'd love to then kind of come back to a point you made earlier, which was that in the early days it was sort of switching around different antibiotic choices.

Pathak: We've talked about surgery, so tell us a little bit about the additional treatment options you now have in your arsenal. What are some of these treatment options, and how do they work mechanistically?

Sayed: Yeah, it has been a very rapidly changing landscape over the past several years. You know, when I was in residency—

Sayed: Only a dozen years or so ago, there were no FDA-approved options. So all the antibiotics and things like that we used were off-label. There were some drugs out there for psoriasis, a couple of which are approved now, that we had these initial thoughts like, “Maybe they’re going to be somewhat helpful,” but they were very hard to access at that point.

Sayed: And in 2015, one of the first biologics—that was adalimumab, a TNF inhibitor—got approved. And once there was success seen there, where they saw how frequently prescriptions were being written and how big that need was, it was like all the other pharmaceutical developers took notice of that and very quickly came running. I shouldn’t say quickly-- because at that point there was this lull of a couple years to recognize that need, but then an explosion after that where they announced success with that drug, and it was, okay, there's something here we have to do something about. And it is really hard to predict, unfortunately, like which patient does the best with which drug.

Sayed: None of them are perfect. The fact that we have three FDA-approved options in addition to all the off-label antibiotics and other things we use is revolutionary compared to 10 years ago. And I fully expect, you know, to see more because there's so much in development right now.

Pathak: So you mentioned some of the targets of some of these medications.

Pathak: So how do they work in terms of what the underlying pathophysiology is or what we understand of the underlying pathophysiology for the development of these lesions?

Sayed: Yeah, it's an excellent point to think about because our understanding of HS has shifted drastically over time. If you ask people a couple decades ago what causes HS, they would've said there’s sweat gland infection or things like that.

Sayed: And that played into all these myths that we saw around the disease for a long time. All of these drugs that are approved now and most of the ones in development specifically target inflammatory pathways. And so these drugs have all been approved for other indications first, and it was recognized that with HS seeming more and more like an inflammatory disease, that should be targeted that way.

Sayed: That's where a lot of attention got paid to these drugs and sort of expanding them into HS. I think the next phase of that will be, as we understand HS better, there’s also things like disruption of hair follicle homeostasis. You know, we often see cysts and comedones and dilated follicles, and these tunnel-like structures probably recapitulate sort of an overlap of typical epidermis and hair follicles not forming naturally the way that they should.

Sayed: And so I think we'll have different targets along those pathways to potentially hit over time, maybe particularly in earlier-stage disease. But as of right now, the main framing is that HS is an inflammatory condition that centers around hair follicles.

Pathak: Yeah, that's really helpful. So we've talked about some ways that these newer medications work. Can you help us understand some of the side effects you counsel patients around when they get put on some of these treatments?

Sayed: Yeah, there are some nuances between 'em. They all affect the immune system, and so it's—we mentioned there is some potential risk for a slight increase in atypical infections.

Sayed: So we screen for things like tuberculosis and hepatitis B and C before we start drugs like that. But you know, the real risk of those things is probably exceptionally low. But it certainly can sound scary to patients. They can all sometimes trigger rashes that kind of mimic psoriasis or eczema. And so that probably happens in less than 5% of patients.

Sayed: But when it happens, it can be pretty frustrating. We end up having to change treatment sometimes. Then there are warning labels on there about theoretical cancer risk, at least particularly when used in combination with other immunosuppressive medicines. But that's probably going to be an exceptionally low risk overall across all of these drug classes.

Sayed: The main message I drive home to patients is that when we frame risk, we have to think about the risk of the medication, but also the risk of not treating the disease. And with HS, there are huge risks associated with it when it comes to what the disease itself does—the impacts on physical and mental health and professional life, social relationships—compared to very low risks of those similar types of things happening as a result of being on a medication.

Sayed: And so, in my mind, the benefits typically far outweigh the risks. If the medicine works well, you get much more out of it than the risks that you put into it. You know, if it does cause a problem, you stop, you move on to something else.

Sayed: Or if it doesn't help, you also are gonna move along 'cause the risk-benefit balance is not there. So, and I think in the big picture, things like cardiovascular risks that go along with inflammatory diseases—there's some evidence that you modify and reduce that risk some by treating an inflammatory disease well and controlling that inflammation with different biologics.

Sayed: So when I think about what makes your quality of life better on average and hopefully leads to less mortality or lengthens your life on average—both quality and quantity of life—it means controlling your HS well and using the medications that we know can do that.

Pathak: I wanna come back to what we were talking about earlier, which is clear communication with your provider. Given that we all know the realities—you get about 15, 20 minutes with your healthcare professional, your clinician, to talk about all of these things—and you really shared a lot of nuance around some of what drives your decision-making about what option you're gonna choose.

Pathak: How would you advise people to come in prepared to their visit? What information do you want from them? We can think about that in several sort of buckets of information. So one is just around their own symptoms and how it's impacting their lives. Two, potentially family history, other comorbidities that they might have.

Pathak: And three, as a primary care provider, I'm always sort of asking, what are your fears? What is it that you are hoping to achieve, and what is it that you're scared you might not achieve? So those are kind of how I frame some of my questions. How do you advise people to come in with all of this optimal information so that you can then help them make this treatment decision?

Sayed: Yeah, there is a lot of information that's good to discuss with patients because I think it lets them tell their story and fill in a lot of the background. I think the key pieces of information for decision-making are: is your disease feeling relatively stable versus getting a lot worse over time?

Sayed: In which case we may need to jump in and sort of be more aggressive right off the bat, rather than easing into options that maybe feel less risky to you. I'd rather not lose time and ability to sort of staunch the disease before it gets worse. I'd like to know things very much so about what have the previous treatments been and have they helped or not, because some of those things we might go back to and combine with new treatments if they were helpful. Or if they're things you didn't tolerate, I'm gonna make sure to avoid those things.

Sayed: And then views around things like surgery and certain types of medications. I think some patients come in and just have a lot of fear around things like biologics, or the idea of surgery is just a non-starter. And so it's good to kind of set those expectations too. That doesn't mean I'm not gonna talk about those things at all, because I'm gonna want to address what it is that makes patients hesitant for those things.

Sayed: But it helps me lay out that risk-benefit balance for all those approaches in a way that is appropriate for that patient. They say, “Look, I'm ready for surgery today,” I don't need to talk about it maybe in as much depth as somebody who's very hesitant and feels like they don't have much understanding around it.

Sayed: So I think it helps to lay out where disease is in terms of its activity and acceleration, what has and has not worked in the past, and sort of willingness and eagerness around certain types of treatments.

Pathak: That's great. That's really helpful. What treatment options are you most excited about on the horizon?

Sayed: This is gonna change rapidly, and so I think, um, there are probably close to a dozen different agents in clinical trials right now—some of which work very similarly to what we already have on the market, and some of which will be very different. The probably next closest thing, if I had to guess for FDA approval, um, just 'cause of where it is in its phase three cycle on announcing data, that sort of thing, is probably a drug called sono umab, which is very similar to BIM XX in a lot of ways. So having, you know, another option even in that same path will be helpful because, you know, we know from other diseases that just because a patient fails one TNF inhibitor, for instance, it doesn't mean they can't do great on another.

Sayed: And so just having variety is gonna be helpful. You know, beyond that, there were a couple of JAK inhibitors in clinical trials, which would be the first oral options we have that are FDA approved. And, uh, there are two different ones—probably one called Vacin that will be the first to market, and then, uh, upci nib, which is approved for things like eczema already, will probably be after that. But I think we're gonna see over the next five years probably at least five new drugs and probably four to five, you know, different pathways targeted, which means we're gonna have a lot of variety—a lot of ways to troubleshoot when the options we have right now just don't do well enough.

Pathak: Really. So it sounds like a very exciting time in terms of just tools for your toolkit. One of the themes that emerged in our previous discussion with HS providers and experts was the importance of community connection, advocacy, and information sharing. How do you advise people to leverage community connection, other sorts of resources around advocacy organizations and information sharing so that they can make the most of all of these already available or coming-soon treatment options?

Sayed: Yeah. Being plugged into the community is a huge help because, as you said, it helps you sort of know what's coming. A lot of things like patient support groups have very active online footprints, whether it's on social media—things like Instagram or Facebook—and so they're constantly posting updates. HS Foundation, again, as I mentioned, we're a provider-driven group, also often posts things like research summaries and other updates, so there is a lot that's available online or through social media to get us a pulse on what's happening in the community. And if you're, as a patient, interested in doing things like advocacy and raising awareness, HS Connect is probably the largest and most influential right now, and Hope for HS is another large group I've been involved with for a long time.

Sayed: So there is this really big push to have dialogue in the community about HS, 'cause it has been so hidden for so long that people are hesitant to even talk to family members and friends about it. So it's a disease they suffer with silently. But the more we talk about it, the more we help patients recognize it earlier. Because just like a patient gets a rash and they think about eczema or psoriasis—that’s in their vocabulary somewhere—HS has to be in people's vocabulary associated with, "Oh yeah, that's that thing where people get those painful bumps under their arm," right? So I think the more people get plugged in with that, the more it helps future patients get diagnosed and recognize things earlier.

Pathak: And so, kind of pulling on that point, do you have tips for caregivers or loved ones who want to better support someone in their life with HS?

Sayed: Absolutely. I think patients feeling comfortable talking about it with those family members goes a long way. And those family members being somewhat informed goes a long way. So I think pointing some family members to those same resources, bringing a family member who's interested in providing support to the appointments with them—if they're okay with it—including them, I think, helps start that dialogue and give them some education. Being part of the Hope for HS support groups—there was a time that having that person in a room with all these other patients with HS, like, brought this level of understanding that let them connect on a much better level rather than, again, buying into some of those same stigmas that are a reflex for a lot of people.

Pathak: Yeah, that's really powerful. I'd love to end by seeding time to you in our final moments together. Anything you wish I had asked you, or any message you'd like to get to someone listening today that you think would be critical in their care?

Sayed: I think I'd just like to end on a bit of a hopeful tone—that things have changed dramatically for HS over time. A lot of patients probably have not had a chance to explore much out there when it comes to connecting with other patients or understanding what's happening from a research or treatment standpoint. There has been an explosion in the last 10 years. It is a much different world now, and it's gonna be a much different world 10 years from now—from an awareness standpoint of commercials that are on TV about it, patients with big followings on social media, right? So there is way more dialogue than there used to be and a lot more in terms of resources flooding toward awareness and treatment options.

Sayed: So if you've been frustrated in the past as a patient five to 10 years ago, I think it is worth finding another provider at this point because there are new things to offer, and I think more willingness among providers to stick with patients 'cause they feel like they've got better tools to treat them. So we did a study once looking at patient perceptions of how they've interacted with providers and how much it influenced 'em just to stop seeking care because they were shamed and told the wrong things, and they've kind of hidden away from care for a long time. Again, if you've had a bad experience in the past, I wouldn't let that be an indication that you'll never find somebody who's interested in supporting and advocating for you. So, uh, if you've been shying away for a while, it's maybe time to try again.

Pathak: Thank you. That is a wonderful way to end the episode. Thank you so much for your time.

Sayed: Of course. Very happy to be here.

Pathak: Thank you so much for being with us today. As we wrap up our episode, there are a few important takeaways from my conversation with Dr Christopher Sayed. First, if your HS symptoms are changing, it may be time to speak with your healthcare provider about escalating treatment. These changes may include new flares, possibly in new areas of the body, and may include worsening pain. Early action can prevent irreversible damage and help you return to a stable baseline.

Pathak: Second, switching treatment or care teams isn't a failure on your part. It's a part of navigating a chronic condition. If your current treatment regimen is no longer working, or your care team isn't taking your concern seriously, it's okay to seek out an HS specialist who understands the full spectrum of treatment options.

Pathak: And finally, you don't have to walk this journey alone. From HS specialty clinic finders to online support groups, there is a growing community of specialized resources and healthcare providers who can all offer expertise, encouragement, and advocacy. To find out more information about HS and Dr Sayed, make sure to check out our show notes.

Pathak: Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you are interested in or questions for future guests, please send me a note at [email protected]. This is Dr Neha Pathak with the WebMD Health Discovered Podcast.