Lewy Body Roller Coaster
Lewy Body Roller Coaster
Information About the Syn-one Skin Test part 1
Welcome back everyone.
This week we have a guest question helper as well as Dr. Todd Levine from CND LifeSciences to share with us all information about the new syn-one skin test that can help in diagnosing LBD.
Our good friend Wendy Cogan joined us to help ask the right questions so we get a better understanding of this new test.
This is a three part recording because our interview was well over an hour and a half but we had lots of questions to ask the doctor.
Enjoy part one
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Hello and welcome to our podcast about living on the Lewy Body Roller Coaster a podcast for Lewy Body Dementia patients and their families. Presented by Lewy Body patients and their families.
Speaker 2:You will hear firsthand the ups and downs and twists and turns of Lewy Body Dementia From families directly affected. We'll share our support and experiences on all things Lewy Body.
Speaker 1:We're your hosts, Linda and Curry. I have a loved one with Lewy Body Dementia.
Speaker 2:And I am living with Lewy Body Dementia.
Speaker 1:Let's get started. Welcome back podcast family.
Speaker 2:Yes, welcome back y'all.
Speaker 1:Just another quick shout out to everyone for your continued support and patience. We were good there for like two weeks, curry, they came out on time and then this past week, hiccup, but that's all right.
Speaker 2:Well, this past week I had my doctor's appointment and then I was down a day or two. But yeah, thank you all for being so patient and supportive. Down a day or two, but yeah, thank you all for being so patient and supportive.
Speaker 1:And this week we're going to jump right into the episode and topics because we have a guest helper.
Speaker 2:Wendy, as well as a doctor to share information on a new test. Okay, but first a few quick shout outs to some of our supporters.
Speaker 1:We've got matthew and miriam garaci, marcia treffman, vicky setterberg, bonnie and randy weber, d rickert and wendy kogan and and as a reminder, we are not giving medical advice, but rather sharing our open and honest feelings and thoughts as we live with louis body dementia okay, uh, this is the episode we've been telling y'all was coming with a doctor from CNC Life Science to talk about the SYN1 skin test.
Speaker 2:It's a new test to help in the diagnosis process of LBD. So please welcome to the podcast Dr Ted Levine and also a guest helper, Wendy Kogan, whose husband also has Lewy body dementia. All right, Winnie, can you share a little about yourself and then we'll get right into the questions with Dr Levine.
Speaker 1:Yeah, and I'm just going to. There is a typo. It's CND Life Sciences. That was on me. Sorry, that was on me. I knew it was CND. I know you read it, I just read it wrong. Okay, we're not even 30 seconds in and you messed up already, what the hell. And it's Todd Levine. Does it say Todd, on your paper?
Speaker 2:Oh, yes, it does.
Speaker 1:It's people listening. It's really early recording. So, yeah, but our people are used to us this is the way it rolls. But anyway, wendy, you want to introduce yourself.
Speaker 3:Yeah, yeah, thanks for having me on the show. I really appreciate it. I really appreciate these podcasts. Overall Name's Wendy Kogan and my husband's name is Jeff.
Speaker 3:We live in Kansas City and my husband was diagnosed with Lewy body dementia about two years ago when he was 65. And just a little bit of background on him, and I think, as we do this podcast, you're kind of going to get a feel, for he was misdiagnosed several times, which is often the case with Lewy body dementia. His first symptoms started really in 2007. He had a sleep disorder, periodic limb movement disorder, but in 2012, he got diagnosed with a severe depression and then in 2018, he got diagnosed with bipolar All of a sudden in his 60s. He went on like manic buying and selling sprees for two or three years and this was in his 60s. Really weird when he got that diagnosis because for the most part, bipolar starts, you know, in the 20s. So that was kind of a first clue. Something was wrong. I noticed that he continued to have some mild cognitive impairment and some visual spatial issues. I'd go back to the psychiatrist who was treating him and say, is it more than just bipolar? And the psychiatrist kept reassuring me and saying, no, you know, he's having some additional mild cognitive impairment just because of some of the medications he's on. He was on lithium.
Speaker 3:He had some issues after he had a special treatment called it was a shock therapy where he lost some cognition there too, where he lost some cognition there too. So they kept telling us to wait to see if he gets some of his memory back. He had forgotten, really, our 10-year marriage, our eight-year marriage. We had been together 10 years but anyway it really came to a head in 2019. We had gone to Florida for a month. He had a severe side, a severe drug reaction that put him in full delirium and he was in delirium for about three weeks. I finally said we're going to see a neurologist. We saw our first cognitive neurologist. They ran an MRI, they did an FDG-PAT and came back and said, yep, he's got mild cognitive impairment, but we can't tell you if it's Alzheimer's or Lewy body or what it is, and we probably won't know for several years because right now he's not having Parkinson's symptoms. So you know, we probably. Yeah, you know a lot of families don't want to know what this is anyway and we'll know in, you know, a matter of years.
Speaker 3:Of course, I didn't buy that. I used to be a nurse. I went on you know Google and I was able to watch some of the presentations that Mayo had done for neurologists that talk about different types of dementia and I really thought my husband seemed like he had Lewy body dementia, but he didn't have hallucinations either. He didn't have REM sleep behavior but he had a lot of the other things. So I reached out to Dr Beauvais at Mayo. He did in fact suspect he had Lewy body. We were able to do a virtual appointment. The first appointment was virtual and he suspected it was. Then we were able to go in person. My husband got a DAT scan and was assessed. The DAT scan was positive. Now I thought if you have a positive DAT scan, that means okay, yeah, it's definitely Lewy body or Parkinson's or MSA. But you'll see something a little twist later when we're going through some questions that I also figured out about a DAT scan. It can also indicate a different type of dementia. But in any event we were able to get the testing done.
Speaker 3:He was finally diagnosed with Lewy body dementia.
Speaker 3:He was he's part of their biomarker study.
Speaker 3:So we really like being able to give back to science.
Speaker 3:I had said at the time that really stuck with me is he said people don't just all of a sudden get bipolar in their 60s. I mean, that just doesn't happen. And he said those cases are definitely a result of a neurodegenerative disease like Lewy body dementia or FTD. So that was our first clue that something had majorly been missed. The other thing he said and he did agree with me not all Lewy body dementia patients even show Parkinsonism. Some actually go all the way through their life and don't get that. So we could have been waiting until he died if we were waiting for that particular symptom for us to know what he had. So once we got the right diagnosis, we were able to get him on the right medicine for cognition, for psychiatric, for sleep and, man, he really improved. The delirium totally gone, became functional again and our quality of life significantly improved. So, um man, I'm really excited about being able to have biomarkers that can help others not have to go through all this yeah, and I thanks for sharing that wendy and I.
Speaker 1:I was uh got to meet wendy in person last weekend and and meet her husband and when you hear what he went through and that Curry and I always talk about, the sooner someone gets diagnosed, sure, there's no medicines to cure it, but there's medicines to help the symptoms. So I think that's why the fact that we always hear people taking two to five years to get diagnosed, that's what's driving me and Kari to do this podcast, just kind of shouting at the rooftops and sharing people's stories and thankful. And another reason we asked Wendy to come on is because she, her husband, had the test that the doctor's going to talk about. So thanks for sharing that. Wendy and Dr Levine, can you introduce yourself and tell us a little bit about yourself and your connection with CND Life Sciences?
Speaker 4:Sure, yeah, so I'm Dr Todd Levine. I'm a neurologist based in Phoenix, arizona, where I direct a neurology department for a healthcare system out here. My subspecialty training within neurology actually was not movement disorders or cognitive disorders, but was actually neuromuscular disorders, which is the subspecialty that studies nerve and muscle in the peripheral nervous system, not the central nervous system, in the peripheral nervous system, not the central nervous system. And about 12 to 15 years ago people began to publish information on the ability to see nerves inside the skin to help in diagnosing some of the neuropathy, so people with numbness and burning and tingling and pain sometimes. All of our conventional tests did not really yield a specific diagnosis and so the folks at the University of Minnesota and Johns Hopkins really kind of pioneered this test and so I opened a lab about a decade ago to receive specimens from all over the country to study the nerves, and that lab basically looks at the nerves to say whether they're healthy or not. But it really got me into the concept of how many nervous system structures there are in the skin, so autonomic structures and sensory structures and lots of really interesting nerves in the skin. And then about seven or eight years ago my two other co-founders, chris Gibbons and Roy Freeman, who are both at Beth Israel in Boston. They began to publish some work to say you could not only look at the nerves in the skin but you could actually look inside the nerves of the skin and see what's going on inside of them. And their earliest work really focused on looking at this protein called synuclein and we're obviously going to talk a lot about that during the podcast.
Speaker 4:But what's become clear is that there are a number of diseases which people have traditionally thought may only exist in the central nervous system, like Lewy body dementia, like Parkinson's disease, where now we understand that these are really full body diseases, that the damage that's occurring in the central nervous system is actually occurring throughout the entire body. In the case of Parkinson's disease, it's fairly well accepted now that the first damage may actually be out in the body and it may take years for that damage to move up into the brain. Examples of that may be 10 years before someone has Parkinson's disease, they have constipation because the nerves to their intestines don't work very well. They start to have bladder dysfunction because the nerves to their bladder don't work very well, and so there's this concept in all of these diseases. Are these top-down, meaning they start in the brain and spread out to the body, or are they bottom-up, meaning they start out in the body and then spread up to the brain?
Speaker 4:So with that sort of concept, we began to think that using the skin may allow us to help diagnose these conditions in a much more objective way. And, wendy, you alluded to the term which I use often but then I tell myself I don't want to use, which is the term biomarker. So a biomarker means something that you can measure as a reflection of a disease. What we are able to do is actually see the abnormal form of the protein accumulating in the skin. So it's really pathology. Just like you might look at autopsy in the brain and see a Lewy body, we can look in the skin of a living person and see the same accumulation of the proteins. So with that, we founded C&D Life Sciences about six years ago and we began doing commercial testing throughout the US about three years ago, just under three years.
Speaker 1:Yeah, this is very exciting when we heard about it. We've been telling people in our support groups and posting about the tests anytime we hear about it. Something that's going to help to diagnose we share. So I'm assuming you get that all our listeners are aware that Lewy body dementia is a neurodegenerative disease which is part of a group of progressive conditions that damage the nervous system, and so there we have a lot of people that are seeking diagnosis, that are diagnosed, caregivers and, like Dr Google, we all have been to Dr Google, you know to help. So the reason that we asked Wendy to come on, because clearly she has the medical background but, wendy, I just want to say you have the most amazing way of explaining things you know and because we were in our support group Saturday and she was explaining about what were you doing with your fingers.
Speaker 3:Aricep, I was explaining why that worked. Yeah, why.
Speaker 1:Aricep worked, but anyway. So that's why we brought Wendy, because just her introduction tells you that. You know, when I was with her last weekend, I was just staring at her. She talked because I'm like, give me more, give me more information. She does our homework for us, but anyway. So we're going to ask you some questions about the actual test, Dr Levine, and then we're going to ask you some questions about the actual test, Dr Levine, and then we're going to ask Wendy to help with some additional questions and, for our listeners, we'll post the link to the CND Life Sciences on our pages and in the episode notes, just so you know. So, Dr Levine, here's the thing. We've been telling everybody that this podcast was coming. So can you share with us what the SYN1 test is, as well as the goals of CND Life Science?
Speaker 4:Sure. So what we know in the nervous system is that there is this protein called synuclein, and synuclein is incredibly vital for the normal function of your nervous system. Unfortunately, even today, we still don't know exactly what it does, but we know that mutations in synuclein cause Parkinson's disease. We know that animals can't survive without synuclein, so we know that it's a very, very important protein in the nervous system. What we also know for 100 years is that when you look inside the brains of people who've passed away from Parkinson's disease or Lewy body, what you see are Lewy bodies, which is named after the pathologist Lewy who discovered them. And over the past 40 years years, what became clear is that that hallmark finding contains an accumulation of proteins and not just a nucleon, but the main protein inside of a louis body is synuclein. And what seems to be the difference between a normally functioning synuclein protein and an abnormal accumulation of synuclein is the addition of a little group called phosphorus, so that chemical that you might have heard of phosphorus. If you add that phosphorus group onto the end of the synuclein protein, it causes that synuclein protein to fold incorrectly, and then what we believe is the beginning of that folding incorrectly then causes other proteins to fold incorrectly, and that theory is not just for Lewy body dementia or Parkinson's. That theory is true for Alzheimer's disease or frontotemporal dementia. It's just different proteins. So in frontotemporal dementia it's a protein called TDP43. In Alzheimer's disease, it's two proteins tau and amyloid. So this accumulation of proteins then builds up inside of the nerves and eventually damages the nerves to the point that they die. So that is as best as we understand it in 2022.
Speaker 4:What the SYN1 test allows is the ability to look inside of the nerves and to see if that abnormal protein, the phosphorylated synuclein, is starting to accumulate inside those nerves. We believe that that is a process that doesn't occur in normal people, and so the finding of the abnormal protein, the phosphorylated synuclein, tells us that there is a problem with the synuclein system inside of the nervous system. So the SYN1 test is able to do that by just using a small little skin biopsy, just like a dermatologist might do to look at a rash or whatever. So it doesn't require any stitches. It takes literally two minutes to do and then it's sent to our lab. That's the process, and then we can look inside the skin, inside the nerves in the skin, and see if that abnormal protein is there, so we can tell the difference between a normal nerve that contains normal subnuclein and an abnormal nerve that contains what we call the phosphorylated synuclein, which we believe is pathologic or harmful to the nervous system.
Speaker 1:Well you hear that he's saying you're abnormal, Curry. I know right, it's official, it's official, I heard it right here.
Speaker 2:Yeah, you're right, it's official. I heard it right here. Yeah, you're right, doctor. The webpage states that the SYN1 test provides objective pathological evidence to aid in the diagnostic evaluation of patients with clinical features suggestive of a synucleinopathy similar to what you shared so far synucleinopathy similar to what you shared so far.
Speaker 1:So what's this can you share with us? Uh, specific diseases included in the neuro, neurodegenerative synucleinopathies. That's what it is. Wendy told me this, mike, how do you say that, wendy? She's like opopathy. Sorry, I didn't prep you curry, right um.
Speaker 4:So we think that there are five diseases with the potential actually for a sixth that are all called synucleinopathy. So the most common is Parkinson's disease, the second is dementia with Lewy bodies, the third is a disease called multiple system atrophy, the fourth is a disease called pure autonomic failure and then the fifth is REM behavior disorder. There was a recent paper looking at a rare disease in the Philippines called Lubog, in which people get dementia, parkinson's and dystonia, and it was a small number of patients, but I think 85% of them actually had an abnormal SYN1 test, suggesting that that disease, which again fits into the realm of Parkinsonism and dementia, may also be a synucleinopathy.
Speaker 1:So what does an abnormal test identify, and can this test distinguish between the synucleinopathies you mentioned? And, if not, how would physicians use the results of the SYN1 skin test?
Speaker 4:Yeah. So what the test tells us with certainty is that there is an accumulation of the abnormal form of synuclein, and so that meets the definition of a synucleinopathy. It's a challenge at the moment to say that we can definitively separate out the five diseases, and even more so because, as some of you may be familiar, some of these diseases may evolve into other diseases. So REM behavior disorder is sort of the classic one here, where many people with Lewy body or Parkinson's start with REM behavior disorder five or 10 years before they develop the Lewy body or Parkinson's disease. So you can imagine that if we're looking at the skin biopsy, yes, we see the abnormal protein throughout those five to 10 years, but it's difficult to predict what direction it's going to go into. So we are very actively trying to pursue a number of important clinical distinctions, and we're doing this actually through two multi-million dollar NIH grants that we were fortunate enough to get. So one we call the SYN1 study. That one will be done probably by the end of this year and we think will really allow us in a prospective blinded way to distinguish between the synucleinopathies. And then the second is a very important study that we just received an award in April of this year for that we call the SIN-D study, which is actually looking at mild cognitive impairment in the Alzheimer's group versus mild cognitive impairment in the Lewy body group and asking whether we can tell the difference between those two and then also following them prospectively over a couple of years to say how does the biopsy change, how does the clinical picture change. So we're actively trying to be able to do that. But to answer your question right now, it really is a combination of the clinical features with the biopsy and just like any other x-ray or any other test, even any other biopsy you might do, the clinician always has to put it together with what does the patient look like and can this test then help distinguish between possibilities?
Speaker 4:Where this test is very helpful is distinguishing between synucleinopathies and non-synucleinopathies. So trying to distinguish Alzheimer's disease from Lewy body, alzheimer's disease would be normal, lewy body would be abnormal. Trying to distinguish something like progressive supernuclear palsy from Parkinson's disease, where PSP is due to tau, so the SYN1 test would be normal and Parkinson's obviously due to tau, so the SYN1 test would be normal and Parkinson's obviously due to synuclein. So we are moving in that direction. We can sometimes provide some guidance based on the pathology, but we do believe that the pathology is going to be very helpful. Not 100% black and white, distinguishing between the five. Really, the 100% black and white comes in synucleinopathy versus non-synucleinopathy. Okay, does that make sense?
Speaker 2:Yeah, it does, Dr Levine. What are the advantages of this specific test?
Speaker 4:So there's a few advantages. Again, if we think about what you'd want as a perfect test, right? You'd want to test number one, which is very sensitive and specific, right, so it can pick up most people that have the disease and it's not going is very sensitive and specific, right, so it can pick up most people that have the disease and it's not going to pick up false positives, right? So we believe that our sensitivity and specificity is greater than 95%, which is about as good as these types of tests can get.
Speaker 4:The second is that you'd want it to be easy for the patient. So, for example, any of you that have had a DAT scan know that you have to go to the facility, you have to get injected, you have to wait several hours, you have to get imaged. It's a four, five, six hour process, whereas this test really all in is about 15 minutes. So it's convenient for the patient. And then we'd want it to be affordable patient. And then we'd want it to be affordable, and this test, fortunately, has been well paid for by insurances and by Medicare, so that it's much more affordable. Even the sticker price compared to the sticker price of a DAT scan, it's about one third the price of a DAT scan. So we think those are sort of our main advantages is that it can provide objective evidence for the doctor, it's easy for the patient and it's affordable. So we're happy with those pieces of our test right now it's a pick on curry day because we're up early.
Speaker 1:Um, I'm gonna ask the doctor to explain the steps. Someone would go through to get the skin test, but I want to. Did you hear him curry? He said it's no big deal, just a little prick, and I heard that I know we pick on curry because he's like I'm not gonna have a spinal thingy, um, but anyway, uh, yeah, can you explain the steps? Uh, someone would go through to get this skin test uh.
Speaker 4:So for the most part just that the physician has to believe that there's a reason to do the test, that there's some diagnostic question. And I sort of a little less common, I think, probably for your people that are listening but in the, the Parkinson's world, for example, I like to say you know, sometimes Parkinson's is obvious, right? So a person has a rest tremor and they shuffle and they're slow and you give them the medicine and they get vastly better. You don't need a test, you don't need a DAT scan, you don't need the SYN1 test. The clinicians already made the diagnosis, treated appropriately. We're good. The SYN1 test is really for where there's diagnostic confusion and for where we're trying to provide a little more information for the doctor to make the best possible clinical diagnosis. So if the clinician believes that this is a patient, that's appropriate for that, we usually run an authorization for the insurance just so we can tell the patient and the family what to expect the out-of-pocket to be. They then come into the doctor's office. They don't have to stop any medications, they don't have to do anything special. We take three biopsies, so one from the ankle, one from the knee and one from the shoulder. All three biopsies would take about 15 minutes, and then that's sent off to us the same day by the clinician In the lab.
Speaker 4:The processing is very complex, so it is not like most pathology Just very briefly in most pathology like if you have a breast biopsy, a colon biopsy they take that piece of tissue, they put it in a piece of plastic, they stick it in these amazing machines that are multimillion dollar machines and 20 minutes later you got a beautiful slide with your section and the pathologist can read it. That technique does not work for what we're doing, so it is literally everything is done by hand. It's cut by hand. We literally have little loops that move pieces of tissue that are 1, 20th of a millimeter thick and they have to be stained for days and days and days. The whole process in the lab takes about seven to eight days. So we tell people that it would be about three weeks from the time that you have the biopsy for us to process it in the lab and then read it, issue the report and get it back to your doctor. It's usually a little less, but if you plan on three weeks, then nobody's disappointed.
Speaker 1:Yeah, yeah, we've heard the turnover is about three weeks from people that had the test. So when someone gets the report, can you share with us what the report actually says? And just for our listeners, if you go on the CND Life Sciences, send one page, it'll show you a sample of a report, which is thank you for putting that up there because it's yeah, I thought that was pretty powerful. Just see, I'm a visual learner, so that really helped me.
Speaker 4:Good, good. So the report we basically look at four pieces of information. The first is is the phosphorylated synuclein protein present? That's the pathological form of the protein. If first is, is the phosphorylated synuclein protein present? That's the pathological form of the protein. If that is present, then that is diagnostic of a synucleinopathy. So that's point number one.
Speaker 4:Point number two is we look at the nerves in the skin as well, because we know that some of these conditions, some of the five synucleinopathies, are more likely to be associated with neurodegeneration in the periphery, not just in the brain.
Speaker 4:We know that that's true, for example, in Parkinson's disease at about 80%. So we look at those nerves as well because, again, we think as we finish this study this year it's going to be multiple pieces of information from the pathology that give us the best picture. We also look for a protein called amyloid, as we said, that can be found in lots of these diseases as well. And then we just look at a regular pathology picture to make sure there's no cancer there, rash there, inflammation there as well. We give every report contains the patient's own pictures, so they're not stock photos. So we send back in the report so that the clinician can go over the pathology with the patient and their family, so you can see where this protein is accumulating and you can see whether the nerves are deteriorating. And then we give some specifics about how many nerves, how many sections. That kind of information.
Speaker 2:Did that help Go ahead.
Speaker 1:Yeah, I'll jump in to help Kerry. So you already talked about the cost of the test and covered by Medicare and insurance.
Speaker 4:How would someone without insurance get the test? So we do have a cash price. Um, I can tell you the cash price is about fourteen hundred dollars for all three sites. So it's not cheap, um, but again, compared to a dat scam that might be five to seven thousand dollars. Um, it's cheaper.
Speaker 1:Um, we certainly have payment plans and all kinds of ways to work with people if they're interested in doing that as well yeah, thanks, thanks for sharing that Because I know and this next question we have listeners for the podcast from 71 countries right now to date, and we have people from different countries that attend our. We do one, two, three, four, five support groups now a week. So the people not from the USA want to know is the test available outside the USA?
Speaker 4:Great question, so complicated question. So performing the biopsy is available anywhere. That's easy. There's a couple of challenges in getting it from other countries. So the first is some countries have fairly strict requirements on what we can bring to them so our reagents, our test kits and those types of things, things. So in europe, for example, you have to have something called a ce marking if you want to be able to provide this. We should have that by the end of the year and so we would be able to receive from europe based on customs rules. At that point. Some countries don't have any customs rules and it's no problem whatsoever.
Speaker 4:The second challenge is that when we do this test in the us is that when we do this test in the US and the doctor takes the biopsy, it's put into something called a fixative and that fixative helps fix the proteins. That's what it's there for. But it's harmful to the tissue if it's left in the fixative too long. So when it's sent back to us from the US, it's overnight. We get it in 24 hours. Everything's good. Obviously, that's not going to happen from Asia or Africa or maybe even most of South America. So we are doing research studies in Australia and Europe and little bits of Asia. When that happens, what that means is that the clinician takes the biopsy, they let the biopsy sit in our fixative for 24 hours and then they wash it and put it in something called a cryoprotective. Once it's in the cryoprotective, you can't hurt it. It's great.
Speaker 4:So it's an extra step for the different countries to be able to ship to us and where we don't have to worry about damaging the tissue. And then the third piece would just be the cost, which would be obviously it would have to be cash from other countries because we don't have insurance from there. Now, having said that, in Canada, for example, canada has health provinces and we are a participating provider with some of those health provinces and are looking to become providers with other health provinces where the health province would just pay us directly and, like the Canadian healthcare system, is free to the patient. I think we had one Canadian patient who actually flew down to the US and had the biopsy done in the US and then paid cash. So it's doable.
Speaker 4:What I would say is, if anyone wanted to do this from another country, just contact our lab. We could figure out what the rules are. We could work with them and see if there's any way to do it work with their clinician. So it's definitely doable. I've always hoped that we could provide this worldwide, but there are a few more complicated steps that go into place.
Speaker 1:Yeah, I have faith that it'll work out with other countries, as you guys continue to work hard. So we're going to stop here for a bit and when we come back next week we're going to pick up with Wendy asking some more of the medical-based questions.
Speaker 2:Thank you again, Dr Levine, and to our guest helper, Wendy Kogan. Remember you can email us with suggestions on what you'd like us to discuss on future episodes, or you can ask any questions you have, and we'll sure do our best to help get you the best answer possible.
Speaker 1:And remember that Curry sometimes remembers to add the links. If you're interested in helping us as a volunteer and advocate, please send us an email at louisbodyrollercoaster at gmailcom, because the more people who reach out, the more people we can help and if you'd like to learn how you can be a supporter of the podcast, please see the episode notes, as we post information on that there.
Speaker 2:Well folks, thanks again for joining us until.
Speaker 1:Until next week.
Speaker 2:This is Linda and Curry signing off.