Kerry Reller 0:29

All right. Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have a very special guest, one of our own, our physician assistant, Soondoos Rasheid Browning. Welcome to the podcast.

Welcome & Meet Soondoos Rasheid Browning, PA-C

Soondoos Rasheid Browning 0:43

Hi, thank you for having me. It's an honor to be invited to be on the podcast this early on in my career. Got me a little bit nervous, not gonna lie, and I did communicate that because I was like, "Okay, do I know enough? Am I smart enough?" Those different things always come into play. As physicians, physician assistants, we always have that imposter syndrome, so

Kerry Reller 1:06

Absolutely. But you are obviously constantly learning and that's part of why I wanted to bring you on the podcast, 'cause you went out of your way to go learn something. But first tell us a little bit about, your background and how you got into being a physician assistant.

Soondoos Rasheid Browning 1:21

My background, initially I started away from medicine. I wanted to go into law school. My parents really did go against that with me, and I

Soondoos’ Journey from Law Enforcement to Medicine

Soondoos Rasheid Browning 1:32

decided to join the military. Went in as a military police officer, then transitioned into law enforcement in the City of Tampa. Moving on, stayed in the military, left the military and said, "All right maybe there is a calling back into medicine." But at the time that I left, I was like, th- med school's entirely too much. There is no way with the fact of my family, my kids just the mindset. I feel like with med school, you have to be sometimes a little bit younger so that you can take on that venture and be a little more into school, because there is a different background with clinicals and residency. So I started looking into PA school about 2018, and just went headstrong, finished off a lot of my pre-reqs, and started applying to PA schools in about 2020. I applied, and I was accepted in my first round of applications, and I started at the University of Tampa. It was a rough start for me too there, because I thought my old study habits would pull through. No way. I used to be one of those people who used to cram before exams.

Kerry Reller 2:49

Mm-hmm.

Soondoos Rasheid Browning 2:50

Figured out real fast that was just not gonna work. So went to PA school, did fairly well in school. I always was one of those overachievers in a lot of ways, and I'd overstudy for everything. One of my favorite subjects in PA school ended up being pharmacology, surprisingly. So that also drives as to why I did attend this conference as well that we're gonna be talking about today. But graduated from PA school in December 2025, took my certification exam two months later, passed that and started interviewing, and had the honor of getting hired on with Dr. Reller. And then a tidbit of information that was new to me, her and I kinda discussed this briefly, was I was shocked that she also had a start in medicine that was later on and came into medicine after doing something completely different. So I was like, wow, it's definitely like that invisible string theory where you meet somebody along the way that has traveled a lot of the same paths, but differently, but then finally that string intersects. So it's an honor to be working with her, though.

Kerry Reller 4:05

Yeah, we're having lots of fun, and I think you were describing PA school. They probably give you like a fire hose of information, just like med school, and it's takes a lot to learn. And f- I, I find it funny that you liked pharmacology. I hated that 'cause it's all memorization, and I'm not a memorizer, so I found that probably pretty challenging. But obviously it's very important, and I think nowadays luckily, when the real world, when practicing medicine, I can look that stuff up, so It wasn't that important to have to memorize everything, but And then I love your non-traditional role into medicine, and yes, I had that too, and I think it just, you bring, you can bring so much more different experiences, and already knowing like your background in military and background in police, like it's already come to use in our practice. We're I think it's definitely exciting to have you with us. But

What Is Collaborative Care?

Kerry Reller 4:56

so tell us about this conference that you attended and why you signed up for it,

Soondoos Rasheid Browning 5:01

so recently I attended the Collaborative Care Conference. It was more so of a summit also. It was through the diversity in dermatology. Essentially what it was covering how different specialties can work with one another to actually treat a patient. Because half the time we're sitting here in primary care as ourselves looking at, oh I'm getting everybody's problems, but usually I refer and then I go back and I review the notes. But not unless you actually meet with a cardiologist, immunologist, an allergist, and study those elements yourself will you really understand what you're seeing. I can see a list of medications and had I not gone into those medications like myself with another partner or colleague, I'd probably just go through them and really not give them a, a second thought process of saying, "Huh, that could be a medication that if I put them on this new medication in primary care, they're gonna counter interact or there's gonna be a contraindication here." So within the summit, I was more so seeing a lot of the same themes of, because there was that like higher end of dermatology coverage where dermatological problems aren't necessarily dermatological. Our skin essentially is a window to what's going on systemically within our bodies. Like you can see a patient with a rash and automatically start thinking, oh what did they come into contact with? Versus could there be some other disease form that they're dealing with IBD or some type of Crohn's disease or their skin can be discolored. Whenever you see a patient who has diabetes, for example, you see the acanthosis nigricans on their skin. Or patients that have have hirsutism and lots of acne can we start looking into another diagnosis that we're supposed to be treating versus just that topical feature? So a lot of our patients come in with these what they see physically first versus what they're realizing is actually happening within. So going to this conference really opens your eyes to that because sometimes we're just treating the symptom rather than the actual problem.

Kerry Reller 7:27

Yeah, you're

The Skin as a Window Into Your Health

Kerry Reller 7:27

right. The skin I don't know what words you just used, but it was fantastic. The opens the window to what's going on systemically, I think that's true. And I think that I liked about the fact that you went to this conference is that it was like a collaborative care place, right? And I think medic- like, most of the conferences I've gone to are like, "Okay, this is family medicine. This is allergy. This is obesity medicine," right? And I

Soondoos Rasheid Browning 7:50

right

Kerry Reller 7:50

been to any of these con- conferences where they're integrating all the disciplines, which is fantastic because that's what I try to do with our practice, right? So we do primary care, we do allergy, we do obesity medicine, we do all sorts of things. But, really it's treating the whole patient and listening to them and figuring out what's going on. And I know, during this conversation we're gonna talk about, certain cases, and I think we tend to attract these types of patients because they wanna be s- heard and listened and, really figure out what's going on with them as well. But I haven't had such a dive into the dermatologic side as, I think you have with the,

Soondoos Rasheid Browning 8:24

you should

Kerry Reller 8:25

education that you've done. So I think this will be, enlightening as well. So I think where should we start? You saw so much. What do you think is, the most important, the, we talked about the message of the overlapping collaborative care, and not just looking at the symptom. What is the symptom telling you? What's going on? And I think that's a huge part of, what we, why I wanted to talk about things today. What's the thing that's standing out to you? Do you think that it's that theory of when you mentioned you saw a patient or you were, they were talking at the conference like, "Hey, I'm itching," right? Or, "I'm

Soondoos Rasheid Browning 9:00

Yeah. Yeah, so

Kerry Reller 9:01

tell us more about what that kind of sparked in going on in your brain there.

Chronic Itching: Treating the Symptom vs. Finding the Cause

Soondoos Rasheid Browning 9:07

Yeah. So in our practice we see a lot of patients who come in with itch, allergy, asthma. And a lot of patients who come to me and they're like, "Oh I just thought I had allergies, why are you telling me I have asthma?" And then I'm just like because everything overlaps. Nothing is just you just have this here, and there's nothing on the opposite end," because we're talking about different receptors within the body that also overlap in creating a histamine response, an itch response. So for example, itch being a great example because that's the first one we always hear in office. We automatically start thinking allergy, histamine, but then the itch can come from something inflammatory in the skin, whether it's a... Even a medication could be causing the itch systemic disease, a nerve dysfunction, which we had a patient more recently with that situation going on. And we start automatically asking ourselves "What can I give for itch?" Because that's the first thought that we're really running to as providers because that's what the patient's complaining about versus, "Why are you itching?" So we're not thinking deep enough, and sometimes it requires multiple visits because it, let's be realistic, a 15 to 20-minute visit never really covers all the 12 problems they came in with. And I find myself trying to solve all 12 right off the bat with everybody, because I want everyone to feel very heard, and that they're seeing me because traditionally the PA profession has always been projected as people come to you because doctors have limited time, but they have more time with you. And I'm like that's not true," because our visits are about the same timeframe. We see a lot of the same patients. There's a ton of overlap. So we don't realistically get that much more time with a patient, but we do get to explain it to them a little bit differently than the doctor does essentially. So whenever I'm thinking about itch, I need to think about distinctions of what's going on with the itch. Is it the itch, like, because they got bit and something, it's oh, it's a bite, so let's treat the itch because it's secondary to the bite, but I still need to do something to treat the bite. So a patient who gets bit by fire ants, for example, starts developing cellulitis. Let me treat that because that's going to help with that itch response as well. Don't just mask everything by giving them a steroid. And you and I have talked a lot about the whole steroids 'cause I'm all about steroid-sparing treatment.

Kerry Reller 11:48

we'll bring that up more too. But, you know what's interesting about itching, it's very disabling, right? Patients, if they have like a, especially a chronic itch, they are just like, they can... I don't wanna use the word goes insane, but it's very disabling. They lose sleep, right? So

Soondoos Rasheid Browning 12:04

Yeah

Kerry Reller 12:04

Types of things I usually, and you d- dive into, like more specifically, like what's causing it, right? You mentioned a histamine pathway, you mentioned a neurogenic pathway. I think, thinking outside the box of what is causing it is very important. I will say sometimes I'm just really wanna control it because they're so frustrated and then they can't, like function, right? So maybe in the beginning, the first visit that's shorter, right? We are obviously getting a good history, but we may be, "Okay, let's control it," right? First, and it's typically, most of the time it's a in- it's a histamine response, so we're giving lots of antihistamines, right? But then, you bring them back, not like months later, like weeks later or so, and then you can dive more into did that help with what's causing it kind of thing. I always invite them, "Hey, come back sooner if this doesn't work for you," right? So what are some other things during this conference that you came across that could be causing, the itching response?

Soondoos Rasheid Browning 13:02

So

Medications, Nerves & Other Causes of Itching

Soondoos Rasheid Browning 13:02

some of the other things that I came across through the conference was that the itch can be caused by medication. So they could be on a specific medication, and they can be developing an itch with a rash, and then you're asking yourself, "Okay what medications are they on?" But more often than not, we're thinking of what new medication is a patient on versus they could have been on a medication for a long time, and there's that delayed latency that could give that rash, itch, and then they're dealing with it. Not saying that we should just stop all these medications, but some of the main medications that were even covered that could cause these rashes, these itches, these problems for patients could be your standard ACE inhibitors, beta blockers. Don't wanna scare people, but diphenhydramine anticonvulsants. So we need to start looking at their medication list more thoroughly. Other things is, we also have bradykinins that can cause these itches and angioedema that we need to take into effect because something could be deeper within the dermis, not just the topical layers. So you're more of an expert on this stuff, so I do relate a lot of this back to you, and I do think, okay, it's important to bring it back to you as well so we can collaborate, because we see a lot of the same patients. So I'm treating now a patient who's had this chronic itch for years. She's been dealing with shingles that she had, I think a couple years back is what she had told me. And while reviewing her overall situation, she's been to dermatologists who gave her clobetasol to treat her itch. Mind you, this patient is elderly and applying clobetasol on already atrophied skin that's thin and falling apart, and when she comes to me, the skin is friable, it's loose, and she's got areas where there are boils and excoriations. So I'm now dealing with wound care-

Kerry Reller 15:17

हम्म

Soondoos Rasheid Browning 15:18

office and on top of that telling her, "I need to discontinue a medication that you love for your itch." And she was distraught not that I wanted to do that to her, but she was so distraught. She was upset and I said, "We can go with a lower potency steroid, something that's lower." But during that time period as well, because she had so many exposed areas, I said, "I can't give you a steroid for those areas. You can go around it and on the areas that are open, I'd like for you to use something that's an emollient, a thick barrier. Keep it covered, make sure that adequate air and cl- no soaps are used." And she was a little bit upset, I'm not going to lie. But I love that she came back because she came back and she was like, "You're right, my skin healed, but I still have the itch." And I said, "All right. So there are other options outside of steroids. Have you ever used tacrolimus? Have you ever used capsaicin?" And she was like, "No, I've never used those." And I said, "Okay. Both of them are terrible to start off with. They sting, they burn, but that's the whole point. We're supposed to try to induce that at first." And especially with the capsaicin, 'cause that was the route in my mind that I felt she has a nerve dysfunction now, so what we need to do is we need to cause the nerves to have less of a response, right? So draining out that substance P, and I explained it to her in the most, humanly understandable way is, "I'm gonna have you be a little bit miserable to start off. It's gonna burn, but along the route of using this medication, eventually your nerves will not feel the pain of the itch anymore, so you will not have the itch. But it's going to take time. But you've lived with this itch and this problem for a long time anyway, so what's the difference of time with a little bit more itch and slight burning, but then finally we get some resolve versus you're still gonna live with this itch?" So she was actually very amenable to it, and I was even like, "Okay. Maybe I can start off with a lidocaine cream to numb her up a little bit before we use the capsaicin." She was like, "No, I don't care. I wanna feel the burn. I want... I'd rather feel anything but the itch." And I was like, "That's interesting." I'll be following up with her pretty soon and we'll see what's going on with her. I'm very hopeful that things will change because her mindset is very different as I've taken a lot of time doing more patient education with her on things.

Why Patient Education Can Change Treatment Success

Kerry Reller 18:04

And those are some of the important, I think, points that you pulled out from the conference too, right? Was that one, actually telling her what's going to happen with this medication that's differently from a different medication that, hey, this is gonna burn. You need to be educating the patient on all the symptoms and side effects that can occur from it, at the same time as, choosing that medication in the first place, 'cause it has been I guess you're as- assuming an, a, a different mechanism of the itch, right? So but she's already been through several steps of that. And then, I think, you even mentioned sometimes insurance having to do with it as well can make it a little more harder to get some of these newer therapies when we're trying to save off of not doing clobetasol and triamcinolone, like those steroid medications. But I think what's interesting is that you're trying this new thing and bringing her back, and you explained to her all of the details of, what could occur, so she's expecting to have that burn feeling, right?

Soondoos Rasheid Browning 18:59

Absolutely, because if I didn't do that, eventually down the road we'd end up documenting capsaicin failed when it wasn't that there was a failure in the capsaicin itself, and it was more so the patient could not tolerate it only because the patient wasn't given the proper education leading up to it. Now, had I just told her, "Yeah, this medication is my recommendation and peace, see you later," and she'll, she'd probably be pissed. We'd be getting messages or something. But I did tell her, "It's gonna be bad. It's gonna burn." this was also something that I went back and forth with a colleague who's in dermatology about who she treats a lot of patients within that age who are suffering with postherpetic neuralgia, and her and I kinda c- came to the treatment plan. Her and I went to school together, so that always really helps. We rely on people we went to school with who went to other specialties. We call them up and we say, "Hey, I had this case today."

Kerry Reller 19:57

Yeah. funny you mention that. I literally yesterday just met a, a cardiologist nearby, and I had just talked to her colleague on the phone about a patient. So once again, we're talking about that collabor- collaborative care approach of, everything in treating our patients. And, it's nice to have, those people to, I guess contact in case, anything comes up where you can, tr- try to hang on to that patient and not necessarily refer them every single time if not really needed as well. Did you have anything more to say on that, that whole experience? 'Cause what you did was, learn something from the conference last weekend or so and already brought it back to, a patient that you're seeing.

Soondoos Rasheid Browning 20:35

Yeah, and I even remember my lecture on Pharm regarding capsaicin. It was funny 'cause Dr. V, she was just like, "Yeah, your patients will never stick with it, so don't even bother." I, and I was like Okay, so what do I use then?

Kerry Reller 20:49

yeah

Soondoos Rasheid Browning 20:50

You know? But uh, I think it's more so the reason why is because as providers, we really don't have that much time in the room to over-explain things, because I can explain something and not until they hear it over and over again do they finally feel comfortable moving forward with a medication. Or if they've seen that no other medication has helped them thus far, they're like, "All right, my hands are tied. You take over at this point." And I can even discuss other patient scenarios where it's the same case, but not regarding itch, more so regarding cholesterol. Yeah. When we discuss cholesterol with a patient, the, they are very resistant to start a statin even after we've gotten the, lipid panel with CardioIQ and it shows that they are at high risk of A- ASCVD risks. They are very resistant, so then I recommend, "All right, so let's go and do the coronary CT scan now." And we move forward to that. We review that, and then all of a sudden, that's that eye-opener. But there is that constant fear and resistance of statins. But statins aren't always the answer for most patients, right? We've all seen that. We can start you on a statin, but you might experience the side effects most commonly known as the myalgias, and more so they talk to a friend and the friend told them, "Oh yeah, you're on too high of a dose. Your myalgias are gonna start," or, "No, it made me feel sick." So what do we do then, and most recently, we we did a training, you and I and a couple of our colleagues at work, and the cardiologist that was speaking with us had recommended to us to start talking to patients about using inclisiran. I've now been talking to patients about that because it's probably an, hate to say, an easier way of treatment, but then it also helps them with that compliance and understanding that it's not an everyday pill that they're having to use now. it's not something that they'll forget. It's starting off three shots and then two shots yearly, and we see a decrease of their LDLs by 50%, and those are big numbers. I know that shifts away from derm, but in the sense of collaborative care, we need to look at the patient as a human, that each body system is interconnected, not, "Hey, I'm sending you to a specialty, but I'm not going to take responsibility of what that specialist said and this specialist," and tie them together because everything ties together.

Kerry Reller 23:34

Yeah, I totally agree. Maybe I don't want to go around the rabbit hole of cholesterol treatment today, 'cause

Soondoos Rasheid Browning 23:39

Yeah,

Kerry Reller 23:40

a very thorough additional conversation of

Soondoos Rasheid Browning 23:43

Absolutely

Kerry Reller 23:43

who should or shouldn't do statins, and if they want or want to. But that's a great point as well. And in case... I just want to clarify, ASCVD is like your risk for heart attacks and strokes in case anybody listening isn't sure what that is. But Is a score that we calculate to know, how we should be treating you essentially. But yeah. So you...

Steroids, Skin Thinning & Steroid-Sparing Care

Kerry Reller 24:02

let's go back to that steroid thing. You were

Soondoos Rasheid Browning 24:05

Yeah

Kerry Reller 24:05

about how you are obviously trying to move away from steroid use, and I know Derm is very much trying to do that as well. Clearly we're trying to do less of that systemically, but tell me why more you're, they're even worried about it, topically.

Soondoos Rasheid Browning 24:20

So topically for use of steroids, what we see is that there's more skin atrophy. So when you have more skin atrophy, we already know as we age we have thinning skin as a problem. So what are we predisposing our patients more to? Tears,

Kerry Reller 24:38

Mm-hmm.

Soondoos Rasheid Browning 24:39

Excoriations, and your typical patient who's 80 years old coming in, their skin has tons of bruises, tears, blisters, wrinkles, and now we're adding something that's going to make that even worse for them. I feel as though when I took on the role of doing medicine, do no harm, right? And essentially I feel as though I would be adding on to that harm in a lot of ways. So I... Yes, using a steroid is great because that's our beginning steps, but using it sparingly is what my thought process is. It's more so I need to find out what is the driver behind the vehicle, right? I can't just think that their itch is the vehicle, and I need to just treat that. I need to treat what the driver is as well.

Kerry Reller 25:31

And how, how difficult it is to figure out those drivers though. We've mentioned this already, and sometimes it's not easy. I think we might use it in the beginning, but I think that your point is it should how long should be continued, right? I know with chronic eczema patients are using lots of topical steroids for a long period of time, and luckily there are new biologics that we can use for those who are very complicated with their eczema. But it's hard to take that away from them when they've had, been doing so well with it and controlled with it. But you're definitely mentioning, that, that lar- older population is very high risk for lots of tears and breaking of skin and, that can induce infection and sepsis. That can be very, dangerous as well. But how do you deal with the patients who have been doing something for so long like that and change their mind? Because sometimes that doesn't work.

Soondoos Rasheid Browning 26:28

Yeah, no. It's so hard, and it doesn't take one visit either. It is multiple visits. Typically my patients that are coming in that have said I've been doing this for X, Y, Z amount of years. I've been using p- just even prednisone. I've been using this steroid. I've gotten this triamcinolone and I always get it filled, and it's always what heals the problem. Always." And nothing wrong with steroids, don't get me wrong, but steroids were the number one way eons ago. Hate to make people sound old. It's not, that's not the case 'cause I'm not young myself. But steroids were the way because there weren't that many new medications. But right now we've got the biologics to help treat things. And granted, not everybody's gonna be a candidate for biologics, whether it's due to, fears of needles or just that they don't actually meet the mechanism of action for the biologic use, like their itch isn't treated by that. Or something as simple as their insurance just won't cover it. So we always have to be cognizant of that. How many times we are treating somebody and the insurance kicks it back and says, "I'm not covering this medication" and then we end up finding out that they paid for it out of pocket. That's devastating to me when a patient comes back and tells me, Hey, this medication that you prescribed my insurance won't cover it. But because I feel like I really need it, and yes, it helped me before when you gave me a sample, I paid $400 for it this time." That breaks my heart because I'm just like, "Nobody's made of that kind of money." And e- even if you're working a lot, you just... Can you imagine needing a medication to be replaced every month and just one at 400 a month. That's insane, to me at least. There's gotta be another way. So I think we need to look at when it comes to itch and using steroids, I'm still very pro steroids. It's not that I hate steroids. Just looking at what haven't we controlled essentially. And yes, that takes a lot of investigation and maybe my, like, old law enforcement side likes the whole investigation part. I like to figure out what's going on versus, oh, I took care of it, now I'll see them at their next annual or something. And then they'll still come back to me and be like, "So by the way, it never treated it, but I don't care anymore."

Kerry Reller 29:06

I wouldn't say pro steroids, right? I don't know if you really meant to use those words, but more like it's good for the skin in the shorter term cir- circumstances. But obviously, we do know what the, steroids can do for people, especially long-term. Even short-term, when we talk about those couple bursts of steroids that we do for asthma, like it

Soondoos Rasheid Browning 29:25

Yes

Kerry Reller 29:26

consequences. But I know what you meant. I just wanted to

Soondoos Rasheid Browning 29:28

Yeah.

Kerry Reller 29:29

that out. But you also... i'm gonna change gears. So you you mentioned some other, like, dermatologic findings that can be signals of things, and I kinda wanted you to go into, the boils and other rashes that may have, what that can mean or how, what made you think differently about that?

Soondoos Rasheid Browning 29:49

Okay. So like as far as like boils, like hives, swelling, things like that,

Kerry Reller 29:54

No, I,

Soondoos Rasheid Browning 29:55

or just

Kerry Reller 29:55

the boils part right now. We've done we'll come back to the hives, I think.

Soondoos Rasheid Browning 29:59

Okay.

Recurrent Boils & Hidradenitis Suppurativa

Kerry Reller 30:00

yeah

Soondoos Rasheid Browning 30:00

Whenever I see a patient with boils, I try to figure out, okay what kind of boils they are. Is it something that I can compress and fluid moves or is it hard? But sometimes there are boils that patients have in sensitive areas that they don't always want to discuss, but finally come in and say, "Hey, I've had this pimple that now looks like a boil and it's in my armpit and I have it in my groin and I have it... I have some in other areas. They're really itchy. They drain. They smell real bad." And then you start thinking let me take a peek," right? And then we start looking and we realize this patient could have hidradenitis suppurativa, and what can we do to help treat this patient? Traditionally, we go through a step approach and in treatment versus where we start with the topicals, and we start with a topical clindamycin on this patient, and then move them up,

Kerry Reller 31:01

antibiotic,

Soondoos Rasheid Browning 31:02

yeah, to an antibiotic that's more systemic, where I start thinking, "Okay, what can I give them systemically?" But then after some time, we realize we need to give them something that's stronger, like a biologic or Something that can block a specific essentially a specific mechanism or pathway that is actually causing these problems for them. Because you treat something topically all day long, you haven't stopped what's going on the inside. I mean-

Kerry Reller 31:33

Yeah, so hidradenitis sup- suppurativa, they sometimes like to call it HS. It's not my specialty or anything like that, but you're getting at it. So these people have, chronic boils, usually in the axilla or groin and things like that. And using the topical antibiotic is a great first-line thing. But usually there can be something more systemically going on, and I think it is, inflammatory as well. That's why you mentioned the other advanced drugs that can be used to treat it. But also surgeons need to be involved and actually, do procedures to, lessen the boil burden. I don't know. But there are s- very, not very many people that specialize in this, I should say. But it is, like surgeon-wise there is clinics, like, devoted to it, right? So it's siloed out. But, as in the primary care role, once again, we're trying to figure out if there's someone that needs that advanced care to maybe have a a dedicated visit for it. But I wanna share something. We have a patient in our office more than one, that has HS, actually a couple, and they have newly begun GL- GLP-1 therapy, and they, these two individuals that I'm thinking of, are doing so much better with their HS already. So I don't know if it's, weight loss and, or decreased inflammation or what, and I'm not in that space where I've looked up the research of GLP-1 and HS, but I don't know. It seems to be really helping these patients. I don't know if you've seen this or... but it's impressive, I think.

GLP-1s, Obesity & Inflammation

Soondoos Rasheid Browning 33:00

So that was an area that was actually covered in the conference space as well, or the summit should I say. The use of GLP-1s for treatment outside of just obesity, because a lot of patients immediately hear GLP-1, they're thinking obesity medicine versus treatment of inflammation. The fact that a lot of people have not been truly educated, and there's this just severe negative stigma of, "Oh, you can just go work out and lose the weight," right? But they're not realizing that adipose tissue carries inflammation, and it c- it is disease at the end of the day that, causes other problems for patients. So the HS, like we were just talking about, or patients who have obesity overlapping with PCOS, for example. I can treat the obesity, release some of that inflammation. Not saying that I've completely forgotten about the, HS or the PCOS or the rheumatological problem, but you have to help in treating some part of the inflammation because that is a driver a lot of the time to the essential problem they're dealing with

Kerry Reller 34:20

Yeah, absolutely. And we know that HS and P- well, now it's PMOS,

Soondoos Rasheid Browning 34:24

the oldest

Kerry Reller 34:25

PCOS, but overlap very much they're very highly correlated with obesity, and the, like you were saying, the fat cells are inflammatory. They give off inflammatory markers, and also I do a lot of talk about asthma overlap with obesity, and it's the same thing. Those patients are diffi- more difficult to treat, right? The steroid inhalers don't work as well. There's a lot of, I guess inflammation going on that's harder to treat and responsible from, it's actually coming from excess adipose tissue. That's why it's e- exciting with the GLP-1s, the weight loss, maybe the decreased inflammation and weight loss. Which one's coming first, don't know. But, it can help with PMOS. It can help with HS, and now we've got a whole vocabulary of all these acronyms. I'm sorry.

Soondoos Rasheid Browning 35:10

I know, because wait till we hit up MCAS.

Kerry Reller 35:13

Yeah. Okay. Why don't we? I think we should. So let's... This is so trendy and on TikTok and on, every social media platform now, and we s- we, in our practice, we tend to attract a lot of patients who are, wan- wanting to know if they have this, right? So I'll help you, but what did you... It was very much covered in the conference, so tell me what you guys discussed about MCAS and what is it? And I think that's a great place to s- wrap up part one. So the big takeaway for me is that sometimes we need to stop and ask, are we really treating the symptom, or are we treating what's actually causing it? In part two, we're gonna talk, take that idea even further. We're gonna talk about MCAS, hypermobility, patients with symptoms that don't fit neatly into one diagnosis, and how we figure out when a pattern is meaningful and when we need more evidence. We'll see you in part two.