Hair Transformations and an Intro to Hidradenitis Suppurativa - Feminist Survival Project

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[00:00]
Emily
Foreign.
[00:14]
Sarah
Before we do anything else, I just want to comment for the record that yes, I did cut my hair into a mullet. That is something that happened and I have no regrets. Something I read all the menopause books, Right. And a thing I still did not manage to hold on to, even though I knew that the texture of gray hairs was going to be different from my naturally colored hair, just the color that I had the rest of my life. I did not know that due to hormonal changes, both estrogen and thyroid changes, the shape of a hair follicle would change and therefore my whole head's hair texture was going to change. And I now have quite wavy into full ringlet curls when my hair has mostly been just barely wavy. And so I cut my hair into a mullet to make the most of my perimenopause curls. Just for the record, I want people to know that that is a thing that I made real in my life. It's my first ever mullet. The age of 48.
[01:22]
Jessica
That's important. It's a big step.
[01:24]
Emily
Yeah.
[01:25]
Sarah
I have been asking for months, should I get. You have bangs. I've been like, for months, should I. Should I cut myself bangs? Should I cut myself bangs? And you're like, no.
[01:32]
Jessica
That's because when I have cut bangs, I've always wanted there to be someone to say no to me and remind.
[01:39]
Sarah
Me, but you did cut yourself bangs.
[01:41]
Jessica
I. And I regret it. I am instantly already growing them back out. You regret your bangs?
[01:47]
Sarah
I don't regret my bangs because they are. I just a full part of the mullet situation.
[01:53]
Jessica
It's. I don't regret the bangs. I just don't want them anymore. And it takes so long.
[02:00]
Sarah
It does.
[02:01]
Jessica
To undo.
[02:01]
Sarah
Half an inch a month is all I get.
[02:04]
Emily
Yeah.
[02:05]
Sarah
Anyway, we're not here to talk about my hair. I just. I just needed to be transparent with the listeners that you are currently who deserve to know that they're listening to.
[02:14]
Jessica
Somebody who was a mullet, who currently has a mullet, who gave themselves a mullet.
[02:19]
Emily
Yes.
[02:19]
Sarah
I did it to myself at the tail end of a migraine. I had taken a number of medications.
[02:29]
Jessica
But it does actually look pretty good.
[02:32]
Sarah
It's all right.
[02:32]
Emily
Yeah.
[02:33]
Sarah
It's very easy.
[02:35]
Emily
Yeah.
[02:36]
Sarah
Anyway, so what are we actually here to talk about?
[02:40]
Jessica
I really feel an important need to talk about hydratonitis suppurativa because we talk about long Covid, which is millions of people who have long Covid. We talk about autism, which is millions of people who have autism and autism is only 1 or 2% of the population.
[02:55]
Sarah
Yeah.
[02:55]
Jessica
And we.
[02:56]
Sarah
We did a whole episode on my dizziness, for fuck's sake.
[02:58]
Emily
Yeah.
[02:59]
Jessica
Hidradenitis suppurativa is an auto.
[03:02]
Sarah
This is a disease you have.
[03:03]
Jessica
It's a disease I have, and it's.4% of people have it.
[03:06]
Emily
That's a lot.
[03:07]
Jessica
It's an auto inflammatory disease, which means it's like. It's not an autoimmune disease because there's no, like, autoimmune marker that you look for to test for it. But it is just a condition that occurs when your immune system overreacts to something that someone with a, you know, typical immune system would not overreact to and there would be no, like, big problem. But since my immune system is made of cottage cheese and chicken wire, it overreacts to things that it doesn't need to overreact to. And that happens in my skin when a hair follicle gets too much keratin in it, which might result in, like, you know, a pimple for somebody. For me, it results in. And for 4% of the population, it results in a huge boil, incredibly painful, large breakout.
[04:07]
Sarah
What specifically is a boil?
[04:11]
Jessica
It's like a cyst. It's like when there's this excess keratin in the hair follicle. The hair follicle can close up and, like, become clogged, but the immune system reacts and sends all of this, like, you know, inflammatory reaction to it and fills that follicle with stuff with more keratin, with puss, with, you know, body things.
[04:41]
Sarah
So people who have this, what they will notice is on the outside of their body, there'll be a fairly large red lump. That is hard.
[04:53]
Jessica
Yeah, it's often hard. And like a. Like a pimple, it can, like, kind of come to a head and burst. That is not the ideal situation. Ideally, the. The matter inside the follicle will eventually break down and be broken down and eliminate.
[05:09]
Sarah
Processed by the lymph system.
[05:11]
Jessica
Yeah, yeah, that would be ideal because when it bursts open, it's much more likely to become infected. And also it's hugely painful if it doesn't break open. And it's even more painful if it does break open, at least temporarily.
[05:24]
Sarah
But so it's painful. It's not just a visible heart.
[05:28]
Jessica
It's incredibly painful.
[05:29]
Sarah
The reddish inflamed lump. It hurts.
[05:32]
Jessica
Dermatologists acknowledge that it is the most painful skin condition.
[05:35]
Sarah
Oh, my God.
[05:36]
Emily
Yeah.
[05:37]
Sarah
The more painful. I mean, you've had shingles, and that hurts a lot.
[05:41]
Jessica
The Thing about HS is that it is considered to be a progressive disease, that it starts for a lot of people, like puberty. Not always. It can start at any time in your life. But the most common presentation is it starts in puberty when the hormones go bananas. And I have had it since I was at least 19 because I went to a gynecologist. I remember.
[06:08]
Sarah
Oh, God, this story. I hate it so much.
[06:10]
Jessica
And I'm laying there on the table, legs out for the world. Not the world. It was. It was the gynecologist. I'm like, or your doctor. Yeah, from a doctor. And she pokes at a. At a lump on my, like, inner. Inner. Inner thigh. And it's a really hard. Like a little bit smaller than a golf ball, but about the same texture. And she kind of rubs it and goes, what's. What's this? What is this? And I was like, I don't know, babe. You tell me. And I have seen half a dozen gynecologists, none of whom clocked it. I even asked. Like, I have these. I thought maybe it was herpes or something, because it. It comes and goes in waves.
[06:53]
Sarah
So herpes look really different from that, though.
[06:56]
Emily
Yeah.
[06:57]
Jessica
Well, so what I'm talking about, this here that I'm describing is, like, stage one of hydratonitis suppurativa, which I'll just call hs.
[07:05]
Sarah
Say the full name slowly, if people want to Google it.
[07:08]
Jessica
Hydratonitis suppurativa. And it will be spelled out correctly in the episode title. Okay, so that's stage one is when there's, like, an occasional kind of lump bump, open sore, open wound. Stage two is when the wounds kind of add up on top of each other. There's multiple at the same time so that they create tunnels between each other. They get so large that they connect under the skin. Under the skin. That's stage two. When there's still healthy tissue between the tunnels. That's stage two. Stage three is when there is no healthy tissue and, like, a whole big mass of skin. Like, for example, your entire armpit is just a mass of tunnels and abscesses. That's stage three. None of these is a measurement of severity. These are just the stages of the disease as it progresses. Severity. It can be extremely severe at stage one, which is to say you can have an abscess that is huge and immensely painful and debilitating, but only one. But it, like, stops you from living your life because it's so intensely painful. And these things generally occur. They can occur anywhere. You have hair Follicles, but in general, they tend to appear in places where your skin folds. So armpits and crotches, armpits, groins, under boob. So for example, an entire armpit, that's stage three. But if you have. But that might not be very painful, it might be like on its way to being healed. And like, no. And like, feel okay, but probably not. Probably. It hurts like mother frickin hell. Okay. So I mentioned that it's 4% of the population. 4% of the population, I said. And it also, one of the things it has in common with autism is that people face challenges getting a diagnosis because of stigma and lack of options. And I think one of the reasons is that it's three times more common in AFAB folks in the US Although there are regions in the world where it's more common in male people. And I think asking for help is a thing that, you know, women in the US don't do. Especially when you do ask for help and your doctor fingers a big old abscess in your thigh and goes, what's this? Sorry, I'm just really curious. Anyway, it's reportedly more common among smokers, fat people, people with highly melanated skin, but it's also vastly underreported. Like I did. I had it for decades.
[09:49]
Sarah
And yeah, as you're, as you're talking about it, I am recognizing that that's an experience. So when I was cycling long distances and, or very frequently, I would get them, I would get things like this red pretty hard, sort of oblong shaped things that if I squeezed it, it got dimples. Like a golf ball. In my inner thigh.
[10:10]
Jessica
Yeah, it's possible.
[10:11]
Sarah
Specifically, like the crease of my inner thigh.
[10:14]
Jessica
It's possible. There's no research that shows that like, activity would add. Would make it worse.
[10:21]
Sarah
So it had to do with irritation of hair follicles?
[10:26]
Jessica
No, just the natural process of keratin being deposited into a hair follicle goes wrong.
[10:34]
Sarah
Just goes wrong.
[10:34]
Jessica
Yeah, there's no, there's nothing you can do to prevent it is the thing. There's no, oh, if I avoid this. I mean, if you engage in behaviors that reduce inflammation overall, you can potentially reduce this kind of inflammatory reaction, because that's what it is. It's an inflammatory response. It has nothing to do with hygiene. It's not communicable. It is, there's no reason that there would be stigma attached to this, except that it happens in, like, your private areas, in your dirty areas, you know, most commonly, because those are the parts where the skin folds, and that's really, I guess, if the skin folding is it.
[11:20]
Sarah
But it doesn't happen because of a lack of hygiene.
[11:22]
Jessica
No, no, no, no. In those areas, it might is be more likely to get infected if the area isn't clean. But in general, people with HS shower more than regular people because when it does ooze, when there are open tunnels, it'd be gross. It oozes and it stank. So another overly inflammatory thing that my body does is mast cell activation syndrome. Mast cells are cells that are involved in the immune system, and when they become overly activated, you get a. This is the thing that was killing people at the end of COVID When it first came out was the cytokine storm. Not the coughing, not the that. But like, the overreaction of the immune system. So mast cell activation is related to that, and that is much more likely in autistic people. And I wonder if HS is more common in autistic people because of the likelihood that our immune systems are more kind of fragile than typical anyway. So the locations of these cysts and boils are, like. They feel private. You know, it feels like places where you don't want to go ask a doctor. So one of the reasons I never got a diagnosis, I do have some in my armpit, but they're very, very minor, and they never bothered me. But the ones that are in my gynecological region were never recognized by a gynecologist. And I've never been to a dermatologist. Cause I've never had, like, a serious skin thing that I wanted to talk to a dermatologist about. But even if I did, would I be, like, laying on a table with my legs in stirrups for a dermatologist? Is that how you get that diagnosed?
[13:09]
Emily
I don't know.
[13:10]
Jessica
Yeah, right. So I think a lot of people miss the diagnosis because it is in a place where regular doctors aren't gonna just, like, casually be like, oh, yeah, I see that thing on your sk. That's blah, blah, blah.
[13:20]
Emily
Yeah.
[13:21]
Jessica
I want to talk about what kind.
[13:22]
Sarah
Of pain it is, okay.
[13:25]
Jessica
Because there is the achy lumps, like I was talking about. But it can also just cause the kind of, like, raw burning, like, surface level, like, friction. Because, like, the feeling of an open wound, and when the abscesses become big enough, there's like, a sharp, stabbing pain. It's like walking around with a knife stuck in wherever it is. And if that place is in a place where it's affected by your legs moving, it makes walking really difficult. If you have to use your arms and it's in your armpit, that becomes extremely difficult to, like, raise your arms because there's a knife in your armpit. So even the unburst blisters and because people don't know anything about it, when you go to, like, urgent care and you're like, I have this abscess and the pain is debilitating, what do I do? What they're going to do is they're going to drain it. They're going to poke it open and they're going to drain it. And that, it turns out, is like the worst thing you can do. It's just going to make it more likely for another abscess to come back in that location. The treatments that you can only get really, at some dermatologists is to deroof an abscess that's really bad. To completely remove the skin on the top and just leave it completely open. Not to just poke a little tiny hole that's gonna, you know, close up and leave an, you know, an empty abscess behind all ready to be filled in, but rather just to deroof the whole thing. I mean, and that in the end is the.
[14:58]
Sarah
That sounds agonizing.
[14:59]
Emily
Oh, yeah.
[15:01]
Jessica
I mean, from people I've heard talk about this surgery, it is way less uncomfortable than the abscesses themselves.
[15:09]
Sarah
Okay.
[15:10]
Emily
Yeah.
[15:10]
Sarah
And is that like a curative treatment?
[15:13]
Jessica
Potentially, yeah. Only for specifically just the places that have been de roofed. But usually those places are at stage three. I mean, they're not gonna do surgery on you, on you, unless you're having like a very severe situation. So they will remove the surface and it will heal up and it'll be like new skin. But yeah, there's always a chance it could come back in that area. Because again, any place you have a hair follicle can be a location. People get it on their faces, on their heads, on their necks, in perfectly visible areas. There's a TED talk of a kid, not a kid. He's in his, like early 20s, I think, talking when he's like, I have HS and you can see it on his neck, on his face. Because it's not just in the private places, but, you know, so I thought that it's a disease that has a lot in common with all the other, all the other crap we talk about. And I know that it's kind of specific, but Lord, if there's one person who's got the big painful abscesses who's like, what the hell are these? I thought you Know, maybe I'll help one person get a diagnosis faster so they can, you know, just to talk about this is what this is.
[16:31]
Emily
Yeah.
[16:31]
Sarah
If we're going to do that, then we need to talk about effective strategies for going in and talking to a medical provider and not saying. Dr. Google told me.
[16:40]
Jessica
Yeah. Because that is how I found out it was hydratonitis separativa. And then the last. Then the next time I went to a gynecologist, I said, I have hidratinitis separativa. And she was like, oh, yeah, I can see the scars here. It was a new gynecologist, so maybe she would have clocked it on her own. But every gynecologist I'd had so far to date didn't come up with that, even when they could see it in front of them. Nobody was like, wow, hey, this is hidratenitis operativa. Not a single one. But when I said, you know, when Dr. Google, I didn't say it. I just said flat out, I have hidratenitis operative. And she was like, oh, yeah, yeah. That's clear to me that that's what this is.
[17:22]
Sarah
So one way to go about talking to a medical provider about it is just to present it as a fait accompli, something that you have already been diagnosed with, not mentioning in what way you were diagnosed with it. I'm just saying this is a situation that I have. So, you know.
[17:36]
Emily
Yeah.
[17:36]
Jessica
And look, let me tell you, this thing is visually distinctive. When you look at the pictures and you go, yep, I have that.
[17:42]
Emily
Yep.
[17:43]
Jessica
In general, there is a problem of diagnosis on average. And you hear this statistic bended about everywhere. On average, HS takes seven years to get diagnosed. From the time somebody goes, I have a problem till somebody goes, that's hs. Seven years.
[18:00]
Sarah
So if it is visually distinctive, then if you go in and say, so I have this situation, it is so painful. And obviously, I did the thing people do, which is I looked it up online, and I found these pictures that look exactly like what I have, and nothing else looks like this. So I'm wondering if it might be this. And I know we should not have to do this kind of emotional labor with our medical providers, but the reality is they are mostly intensely burnt out, overwhelmed, exhausted, functioning within a profoundly maladaptive. Oh, my God. Yeah.
[18:43]
Emily
Okay.
[18:43]
Jessica
Shelly Cat. Shelly Cat. Just for the record, the cat got.
[18:56]
Sarah
Very quiet very fast.
[18:57]
Jessica
The cat is still alive while Emily is gone, dealing with the cat poopies. I will tell you that there's this conversation about how Body size makes it worse because of, oh, maybe it causes more skin folds. There's really no evidence that gaining weight or losing weight changes your. The severity of the disease. And I will tell you that I have had symptoms since I was six sizes smaller than I am now. And gaining weight has never corresponded to the severity of my symptoms. Never once, you know, what does. Hormones and mast cell activation. Those are the only things I have experienced in my life that make HS worse or better.
[19:47]
Sarah
Anyway, we shouldn't have to do emotional leisure.
[19:50]
Jessica
So another reason that you. So, yeah, you shouldn't have to do this emotional labor. And some of the emotional labor is also like, if they've heard anything about hs, they're going to talk about your weight and they're going to talk about smoking. And both of those things are. Yeah, so. And only as far as inflammation corresponds on a large scale from a systemic level.
[20:11]
Sarah
An emotional labor point of view. If your doctor talks about those things, let them talk about it. And you just water off a duck's back. Just let it be not relevant to your situation and set that information aside because that is not your situation.
[20:32]
Jessica
I have been told that I have to lose weight for treatment for other things. Never for this. I've never been told any treatment for this.
[20:41]
Sarah
It sounds like there is not any treatment for this apart from globally reducing inflammatory processes in your body.
[20:48]
Jessica
Globally reducing inflammatory processes, which no one has ever. Which the one gynecologist who I told directly was like, oh, yeah, well, it was kind of like, there's nothing we can do about that. Or maybe see a dermatologist anyway. Yeah, globally reducing inflammation is the thing you can do. So like dietary changes, potentially, maybe if you eat foods that feel inflammatory and you recognize that, don't eat those foods. So much processed foods and high sugar foods. And we've already done the food episodes.
[21:22]
Emily
Yeah.
[21:23]
Jessica
But like, it's really gonna matter. Vastly. One of the reasons that I, like, we have talked about kind of eating keto, but not really like strictly keto, but just like super low sugar, super low carb, which I don't recommend that anyone else do. It's just the thing that happens to feel the best for me that does reduce the severity of HS outbreaks. It does.
[21:48]
Sarah
And also that way of eating is hugely more expensive than.
[21:53]
Jessica
Hugely more expensive. Hugely more expensive. But as I am progressing through my perimenopause journey and my periods are less and less common, I have fewer breakouts. They were very directly correlated with my menstrual cycle. So they are getting better. Fingers crossed. It is possible that menopause will reduce the breakouts significantly because estrogen is a clear thing that correlates with the severity of the breakouts. But I mean, maybe not. Some people develop HS in their 70s.
[22:31]
Sarah
Well, that's fun.
[22:33]
Jessica
Yeah. So the thing about HS that's more painful than shingles is that it lasts potentially decades.
[22:47]
Emily
Yeah.
[22:47]
Jessica
And comes and goes in flares like herpes. I only have stage two disease, I don't have stage three. So I have not sought extraordinary intervention to this point. If you Google HS treatments, there is some evidence to suggest that possibly laser hair removal that destroys the hair follicle permanently can reduce outbreaks. If you destroy the hair follicle. Because anywhere you have a hair follicle and hey, did you know that burn scars don't have hair follicles? So if you were burned all over the surface of your body, which believe me, is a very, very stupid comparison to make, but if you had burn scars instead of hs, that would be a trade off that I, who have had both. I mean, like, burn scars are like long term scars. They change the texture and the stretchability of your skin and they're painful long term. But is the pain of a burn scar worse than the pain of an HS breakout? Like kind of?
[23:55]
Emily
No.
[23:55]
Sarah
If my sound quality got worse, that's because I just had to turn on a fan.
[24:01]
Jessica
Ew, I can't hear it.
[24:03]
Sarah
Our cat, our cat is 20 and she's having troubles.
[24:09]
Jessica
I did just go on a little diatribe about how burn scars don't have hair follicles. Burn scars are cause chronic pain, but like the toss up, it's a toss up whether I would rather have a burn scar or NHS breakout or even just the potential for NHS breakout.
[24:27]
Sarah
So this is a nice simple topic that will result in a nice short episode, which is great. So could you tell us, just lay it out for us, how knowing about HS helps us with the whole stronger than the fire thing. The world's on fire.
[24:46]
Emily
Yeah.
[24:48]
Jessica
I think that one of the. Okay, look, people with HS are twice as likely to die by suicide. This is.
[24:55]
Sarah
Jesus God.
[24:57]
Emily
Yeah.
[24:58]
Jessica
This is a disease that has pain, chronic pain, stigma, little research. It harms people's social lives, it harms people's abilities to do the things that give them joy. This is a very severe disease. Even though all it is is skin.
[25:14]
Sarah
Condition.
[25:17]
Jessica
It'S uncontrollable in some ways. And so, like, specifically for the 4% of us who actually have this condition, knowing about it and understanding that they're not Alone. And like, we live in a world now where there are multiple podcasts by people who have hs. I think there's a series called the Hydradenitis Supper of Divas of like a couple of women with talking about, like, the science of hs. And it's. It's like you live in a world now where you find a link to that, oh, my God, I'm not alone.
[25:50]
Emily
Yeah.
[25:51]
Sarah
So you, so you, so you don't feel quite so isolated and you don't feel quite so helpless and trapped, which are some of the highest risk factors for not wanting to be alive anymore.
[26:05]
Emily
Yeah, yeah, you're not alone.
[26:08]
Jessica
And you know what? Like, there's no reason to have a stigma about it. Like, I. For me, the main social difference was that I didn't know how to wear a bathing suit in public because I've got red lumps and purple scars around my bikini line, which I have worn, like little skirts. And I now have a little union suit romper type bathing suit that has like shorts with like a 6 inch inseam to cover all of the scars. A lot of people have much worse disease than that, and a lot of people have it stop their lives. And if we're gonna be stronger than the fire, the things that solve this problem are the same things that keep us from burning out just because of how awful everything is. This is just one more thing. But, you know, the things that we do to deal with it and manage it are the same things that we do to deal with and manage everything. Everything.
[27:18]
Sarah
So the baseline kindness and motherfucking compassion. When outbreaks happen, when scars form, you turn toward them. This is the new hotness. You allow them to exist with kindness and compassion and forgiveness instead of berating your body for doing a thing that you can't control and that you do not like, just allow it to be a neutral experience that is part of living in a mammalian body.
[27:49]
Emily
Yeah.
[27:50]
Sarah
And it's not always going to be like that. There are days when you're going to have grief and rage and despair and uncomfortable, unpleasant emotional experiences and just turn toward all those experiences also with kindness and motherfucking compassion. Because it is normal to have those experiences, those emotional experiences in response to situations where you kind of are helpless, but you are not alone with it and you are not trapped.
[28:22]
Emily
Yeah.
[28:24]
Jessica
And there is hope.
[28:25]
Sarah
There are.
[28:26]
Jessica
There's every reason to believe that surgery can work long term. That is, there's evidence to show that that's, you know, probably gonna help. And anybody who has HS is probably like, surgery bring it on. I don't. The pain. I can totally manage that. That's awesome. I'd much rather have. I'd rather. I'd like to get rid of that.
[28:43]
Emily
Yeah.
[28:44]
Jessica
And, like, the change in hormones going on the pill can help. Reducing the sugar you eat can help. Sometimes just taking antihistamines can help. Like, there's so much that could help. You have to know what it is. That's one of the. That's one of the main things is to.
[29:00]
Sarah
One of the main things is knowing that it exists, that that's what it is.
[29:04]
Jessica
You got to know that's what it is. It's. It's not. It's not herpes and it's not.
[29:10]
Emily
Yeah.
[29:11]
Jessica
Or any other kind of. It's not a sexually transmitted disease.
[29:14]
Emily
You.
[29:15]
Jessica
You can't give it to anybody.
[29:17]
Sarah
Not communicable.
[29:17]
Emily
The thing I.
[29:18]
Jessica
One of the things I thought might happen is that we would record this and you would be like, oh, yeah. Well, I guess you did say you kind of have those. Yeah, you get them sometimes.
[29:27]
Sarah
But for me, it's when there's a lot of rubbing very clearly associated with. There's a lot of rubbing. Specifically cycling.
[29:35]
Emily
Yeah.
[29:35]
Sarah
And occasionally, if I use the wrong kind of antiperspirant, it'll impact the clogging of my hair follicles in my armpit, and it'll be a big sore red blob that lasts months to resolve.
[29:56]
Emily
Yes.
[29:57]
Jessica
You just nailed the description of how it starts. That's how it begins. It might be something more like a blackhead, like, in the beginning. That might be the most minor, but the biggest, incredibly painful thing that takes months to heal. So that when by the time you have, you know, another period and it's a month later and you get another one now, they're just. They take so long to heal. They take so long to heal.
[30:19]
Sarah
So I think I almost certainly have a. Just a much less. To a much lesser degree.
[30:24]
Jessica
To a much less degree. And that indeed is true for, like, a lot of the kind of disease things, because I've always been the sickly twin. I was the Danny DeVito to your Arnold Schwarzenegger. I mean, I was always homesick from school.
[30:39]
Sarah
I'm the one with the bad balance and dizziness. I'm the one with the peripheral arterial disease that's been progressing since I was 35. I'm not, like, all set.
[30:50]
Emily
No, no, no.
[30:51]
Jessica
But I do have a longer history. Like, I've had this since I was a teenager, for sure. I've had this since I Was a teenager, fully 30 plus years.
[31:01]
Emily
Yeah.
[31:02]
Sarah
And outbreaks that use have you have been with you for a large proportion of your lifespan, as opposed to like, they come and they go and they come and they go. It's been like they come and they are, like, on their way out when the next round hits. And that's how you get the channels.
[31:18]
Jessica
I. When I was on the pill, I didn't get them as often.
[31:20]
Sarah
And now you cannot get a prescription for the pill because you get migraine with aura.
[31:26]
Emily
Yeah.
[31:27]
Sarah
And there's not a gynecologist in the world who recognizes that. Like, actually maybe the increased but still very low risk of stroke is worth it if it means getting rid of all the other stuff that the pill can manage.
[31:47]
Jessica
Yeah. Like endometriosis, which I also have and.
[31:51]
Sarah
Affects your life, like, every fucking day. But, like, there's an increase, but insurance.
[31:58]
Jessica
Companies won't sanction giving me the.
[32:00]
Sarah
Yeah, I get it.
[32:02]
Emily
Yeah.
[32:02]
Jessica
Because migraine with aura. Although I get a half a dozen migraines a year, not even every month do I have a migraine. And I would happily train a migraine for ahs, assuming that they didn't come.
[32:21]
Emily
Wow.
[32:22]
Jessica
If I had migraines as often as I had HS breakouts, I mean, but the thing is, they last for a month, so how do you trade Whatever. That's just a thought exercise.
[32:33]
Emily
Yeah.
[32:34]
Sarah
Would you have a migraine for months at a time instead of having HS for months at a time?
[32:40]
Jessica
No.
[32:41]
Emily
No.
[32:42]
Jessica
Because most of the breakout is tolerable. There's only a handful of days when the pain is really debilitating.
[32:51]
Emily
Right.
[32:52]
Sarah
Like with migraine, there's only a handful.
[32:53]
Jessica
Of days and it depends on where the location is. Sometimes the location is someplace where it doesn't bother me much until I, like, sit down quite heavily and I go.
[33:08]
Emily
Yeah, yeah.
[33:11]
Sarah
Okay.
[33:12]
Emily
Yeah.
[33:13]
Sarah
We need an episode where I didn't do a lot because I have actually been having a lot of migraines lately.
[33:19]
Emily
Yeah.
[33:19]
Jessica
And you basically had to move house.
[33:21]
Emily
Yeah.
[33:22]
Sarah
For complicated reasons.
[33:23]
Jessica
Which is one of the most stressful.
[33:24]
Sarah
Things that life was. Life was very stressful for a while. On top of our cat being very seriously unwell and.
[33:37]
Emily
Yeah.
[33:38]
Sarah
So my brain has not been great lately. So it was. It was nice for me to have an episode where I didn't have to do a lot of work.
[33:44]
Emily
Yeah.
[33:46]
Jessica
I know.
[33:46]
Sarah
All I had to do was be like, the thing we say all the time. Kindness and compassion. Turn toward the uncomfortable situation. With kindness and compassion.
[33:57]
Emily
Yeah.
[33:58]
Sarah
And.
[33:58]
Emily
Yeah.
[33:58]
Sarah
We have to do emotional labor for our doctors, because our doctors are all burnt the fuck out. And it's not their personal individual fault that the medical system is as bad as it is in the United States. It's not like that everywhere, but it's kind of like that kind of everywhere. Unless you're super wealthy.
[34:17]
Emily
Yeah.
[34:19]
Jessica
And like a lot of the other things we talk about, we're identical twins and we vary who were raised in the same household, and our experience varies dramatically. You have had the same reaction. And anybody can have like a lump where their body overreacts to some keratin in the hair follicle. It's when it's, you know, a chronically recurring problem that it becomes. The thing is that it makes itself.
[34:43]
Sarah
Is it related to kp, the chicken skin on the back of your arm situation?
[34:49]
Jessica
Because that is also a hyper keratinosis thing. I mean, it's the same mechanism to start with, in that there's too much keratin and the thing closes over and it becomes a teeny weeny weeny little dump. But HS becomes a great big giant. So, no, it's not the same because.
[35:09]
Sarah
Yeah, KP is not painful. It's tiny, tiny red bumps. It pretty much is permanent. There is treatment that mostly involves chemical exfoliant applied on a pretty regular basis. That's it.
[35:23]
Jessica
And when it comes down to it, the symptoms of HS are skin symptoms. The mechanism of HS is inflammatory, is auto inflammatory. Okay then, so it's a. I mean, like we now probably should also talk about a little bit of polyvagal theory as related to this, because it's when your body feels unsafe is when inflammation goes extra bananas, when your body is in fight or flight, when you're experiencing stress.
[35:54]
Sarah
Right, sure. So that's why we're turning toward difficult feelings with kindness and compassion.
[35:59]
Jessica
Like you say all the time that when you have a stress response, one of the things that happens is that your skin moves away from blood, moves.
[36:05]
Sarah
Away from the surface of your skin.
[36:06]
Jessica
Your blood moves away from the surface of your skin. So if you get cut, you're less likely to bleed. There are lots of skin things that happen that are activated by the stress response, including your oil glands. And when your hair stands on end, that's a stress response that below the level of conscious awareness. Piloerection can. Yeah, it's called pilo erection.
[36:27]
Sarah
Your hair stands on end.
[36:28]
Jessica
Yeah, your hair stands on end. That's your hair follicles reacting to stress in a very ancient like, make myself look bigger, puff my fur out kind of way. So, yeah, your skin responds to stress. If anybody's ever had a breakout, like, of just regular old acne after a stressful or during a stressful situation, that's because your skin responds to stress.
[36:52]
Sarah
Hives.
[36:53]
Jessica
Hives is another skin condition.
[36:55]
Emily
Yeah.
[36:56]
Jessica
So all of the things that help you move through stress, if stress is a factor that. You know, one of the things with HS is because it's so. It comes and goes in such cycles that are multi weeks, multi months long. It requires tracking to really start to notice what the activators are.
[37:18]
Emily
Yeah.
[37:18]
Jessica
I tracked it for years, and the only thing that would predict it was menstrual cycle. And once, twice, I knew for sure I was having a mast cell activation episode. And HS also got worse at the same time.
[37:33]
Sarah
So, like, so tracking.
[37:35]
Jessica
Tracking over months and figuring out what the triggers are, figuring out what makes it worse, what makes it better. Very much like my brain, unfortunately, this is another one of those things where you are the only person who can be an expert in this. In your. In your own case, in your hs.
[37:52]
Emily
Yeah.
[37:54]
Jessica
Which sucks. That feels so terrible and so frustrating. Like, so goddamn much work, especially if you have other things going on.
[38:02]
Emily
Yeah. Yeah.
[38:04]
Jessica
So it's a. It's a lot of work. It's exhausting. I get why people feel hopeless about it and enter a state of despair because it feels overwhelming, but there is so. There is so much hope. And, you know, you track a thing, you mention it to your doctor like it's a foregone conclusion, and you connect to all the people on the Internet now who are talking about their HS and being mad about the same things.
[38:31]
Sarah
You're mad about it. It's got a subreddit.
[38:33]
Jessica
Doesn't have any. I don't do Reddit, so I don't know, but I completely expect that. Yes, it has a subreddit. So I wanted to talk about this, because this is the thing I deal with, and it's more common than frigging autism.
[38:50]
Sarah
And we are gonna do a shadow episode. It's not like all the episodes are not gonna be like, here's a disease I have. Well, here's a disease I have.
[39:00]
Jessica
But it is funny that this one overlaps so much with the same systemic challenges. It affects women in the US More than men, although that's not true globally. Like, it has this stigma. It's hard to get a diagnosis. It just. It has. It has all. It has all of the ingredients.
[39:24]
Emily
Of.
[39:25]
Jessica
A thing that can make you burn out, because it has all the same, you know, hurdles of A. An unjust medical system.
[39:35]
Emily
Yep.
[39:36]
Sarah
If people want to send us emails about the diseases they have that have used up a lot of bandwidth and have made it more difficult for them to tolerate living in a world of rising autocracy, tell us what they are. Yeah, we'll, like, read a list of like, hey, listeners, you're not alone here. Here is just some of the diseases that listeners are living with.
[40:02]
Emily
Yeah.
[40:02]
Sarah
That's like making life more difficult.
[40:04]
Jessica
Because.
[40:06]
Sarah
A lot of people in the women's wellness space, I say with heavy air quotes, talk about, like, what a joy it is to live in a body and really embracing, like, their internal and like, while, like the pleasures of the body. But, like, we are the ones who consistently are like. All of that is true. And when you can turn toward your internal experience with kindness and compassion, you will be healthier. That's a. That's a reality. And also, let's not ignore or downplay how inconvenient and uncomfortable it can be to live in a body. And there's no way to separate living in a body from responding to and coping with gestures broadly.
[40:52]
Emily
Yeah.
[40:53]
Jessica
All of the everything.
[40:54]
Sarah
All of the Everything that is around us every day, especially if you're paying attention to the news and such.
[41:02]
Emily
Yeah.
[41:02]
Jessica
So if there's one person who had mystery lumps that recurred and is like, oh, oh, that's. I have a name for this thing now.
[41:09]
Emily
Yeah.
[41:13]
Jessica
I hope I helped one person.
[41:14]
Emily
Yeah.
[41:14]
Jessica
Because you have a name for it.
[41:16]
Sarah
You're not alone. There are some things that you can do to help reduce the impact. And certainly you can start tracking and look for patterns.
[41:24]
Emily
Yeah.
[41:24]
Jessica
And you don't have to worry about it being contagious or, you know, because it's your fault. It's not your fault.
[41:31]
Sarah
It's not your fault.
[41:32]
Jessica
Your immune system is just a little freaky.
[41:36]
Sarah
Aren't we all?
[41:37]
Jessica
And you know what? Same.
[41:39]
Emily
Yeah. Yeah. That's it.
[41:43]
Jessica
I think we did it.
[41:43]
Emily
We did it.
[41:43]
Jessica
Roll ukulele.
[41:44]
Emily
Hooray. Cue the ukulele.
[41:55]
Jessica
Just for the record, the cat got very quiet very fast. The cat is still al.

Summary5 min read

Feminist Survival Project: Hair Transformations and an Intro to Hidradenitis Suppurativa

Released on August 14, 2025

Hosts: Emily Nagoski and Amelia Nagoski
Guest: Jessica

Introduction

In this episode of the Feminist Survival Project, sisters Emily and Amelia Nagoski delve into the intricate journey of personal transformation, both physical and emotional. The episode primarily focuses on hair transformations influenced by hormonal changes and introduces listeners to the lesser-known autoimmune condition, Hidradenitis Suppurativa (HS). Through candid conversations and personal anecdotes, the hosts aim to shed light on the challenges faced by feminists who juggle multiple stressors while striving for well-being.

Personal Hair Transformations

Sarah's Mullet Makeover (00:13 - 02:34)
The episode opens with Sarah (likely Amelia) sharing her bold decision to cut her hair into a mullet at the age of 48. She attributes this transformation to the hormonal fluctuations experienced during perimenopause, which altered her hair texture from barely wavy to full ringlet curls.

Sarah (00:13): "I cut my hair into a mullet... it's my first ever mullet. The age of 48."

This personal change becomes a metaphor for the broader theme of adapting to bodily changes and embracing one's evolving self.

Introducing Hidradenitis Suppurativa (HS)

Understanding HS (02:39 - 07:32)
Jessica, a guest with personal experience of HS, introduces the condition, highlighting its prevalence and the struggles associated with diagnosis. She emphasizes that HS affects 4% of the population, making it more common than autism (which affects 1-2%).

Jessica (03:01): "Hidradenitis suppurativa is an auto-inflammatory disease... it results in a huge boil, incredibly painful, large breakout."

Jessica explains HS as a condition where the immune system overreacts to minor follicular blockages, leading to painful cysts and abscesses primarily in areas with skin folds, such as armpits and groins.

Medical Explanation and Stages of HS

Stages of HS (06:10 - 07:32)
Jessica breaks down HS into three stages:

Stage One: Occasional lumps or boils.
Stage Two: Multiple interconnected lesions forming tunnels under the skin.
Stage Three: Extensive mass of tunnels and abscesses without healthy tissue separating them.

Jessica (07:05): "Stage one is when there's an occasional kind of lump... Stage three is when there is no healthy tissue and, like, a whole big mass of skin."

She clarifies that these stages do not measure severity but rather the progression of the disease.

Challenges in Diagnosis and Medical System

Difficulty in Diagnosis (09:49 - 13:20)
Jessica shares her frustrating journey through multiple gynecologists who failed to diagnose her HS, despite presenting clear symptoms.

Jessica (09:49): "I've seen half a dozen gynecologists, none of whom clocked it."

She highlights the lack of awareness among medical professionals and the stigma associated with HS, which often delays diagnosis by an average of seven years.

Jessica (17:43): "On average, HS takes seven years to get diagnosed."

This section underscores the systemic issues within the healthcare system, particularly for women in the U.S., and the emotional labor required to secure a proper diagnosis.

Impact on Daily Life and Mental Health

Living with HS (14:00 - 25:14)
Jessica discusses the debilitating pain and physical limitations caused by HS, comparing it to other painful conditions like shingles.

Jessica (05:10): "It's incredibly painful."

The chronic pain and visible scars significantly impact her quality of life, leading to social isolation and increasing the risk of suicide among HS sufferers.

Jessica (24:55): "People with HS are twice as likely to die by suicide."

This segment highlights the profound emotional and psychological toll of living with HS, emphasizing the need for empathy and support.

Coping Strategies and Treatment Options

Managing HS (20:11 - 29:00)
Jessica outlines various strategies to manage HS, including dietary changes like adopting a low-sugar, low-carb diet, which have personally helped reduce the severity of her outbreaks.

Jessica (21:48): "Super low sugar, super low carb... it does reduce the severity of HS outbreaks."

She also mentions potential surgical interventions, such as laser hair removal and deroofing abscesses, which can provide long-term relief for severe cases.

Jessica (23:54): "There is evidence to show that surgery can work long term."

Furthermore, understanding and tracking personal triggers, especially hormonal fluctuations, play a crucial role in managing the condition.

Jessica (37:17): "Tracking over months and figuring out what the triggers are."

Importance of Awareness and Community Support

Breaking the Stigma (25:14 - 41:55)
The hosts emphasize the importance of raising awareness about HS to reduce stigma and provide solace to those affected. By sharing personal stories and providing a platform for dialogue, they aim to foster a sense of community and understanding.

Sarah (25:14): "Knowing about it and understanding that they're not alone... they don't feel quite so isolated."

Jessica encourages listeners to seek support, connect with others who have HS, and advocate for better recognition and treatment options.

Jessica (41:13): "I hope I helped one person. Because you have a name for it."

Conclusion

The episode concludes with a powerful message of hope and resilience. Emily, Amelia, and Jessica remind listeners that they are not alone in their struggles, whether dealing with physical transformations or chronic illnesses like HS. By fostering kindness, compassion, and mutual support, they believe that individuals can navigate the complexities of their bodies and societal expectations without succumbing to burnout.

Sarah (28:22): "Kindness and compassion. Turn toward the uncomfortable situation with kindness and compassion."

The discussion serves as both an informative and empathetic guide for feminists feeling overwhelmed by their multifaceted challenges, reinforcing the notion that strength lies in understanding, support, and self-compassion.

Notable Quotes:

Sarah on Self-Acceptance (00:13): "I cut my hair into a mullet... it's my first ever mullet. The age of 48."
Jessica on HS Pain (05:10): "It's incredibly painful."
Jessica on Diagnosis Delay (17:43): "On average, HS takes seven years to get diagnosed."
Sarah on Community Support (25:14): "Knowing about it and understanding that they're not alone... they don't feel quite so isolated."
Jessica on Hope (41:13): "I hope I helped one person. Because you have a name for it."

This episode of the Feminist Survival Project not only educates listeners about a debilitating condition but also weaves in personal narratives that resonate with anyone grappling with bodily changes and systemic challenges. Through vulnerability and shared experiences, Emily, Amelia, and Jessica offer a beacon of understanding and solidarity.

Loading summary

Transcript249 lines

[00:00]
Emily
Foreign.
[00:14]
Sarah
Before we do anything else, I just want to comment for the record that yes, I did cut my hair into a mullet. That is something that happened and I have no regrets. Something I read all the menopause books, Right. And a thing I still did not manage to hold on to, even though I knew that the texture of gray hairs was going to be different from my naturally colored hair, just the color that I had the rest of my life. I did not know that due to hormonal changes, both estrogen and thyroid changes, the shape of a hair follicle would change and therefore my whole head's hair texture was going to change. And I now have quite wavy into full ringlet curls when my hair has mostly been just barely wavy. And so I cut my hair into a mullet to make the most of my perimenopause curls. Just for the record, I want people to know that that is a thing that I made real in my life. It's my first ever mullet. The age of 48.
[01:22]
Jessica
That's important. It's a big step.
[01:24]
Emily
Yeah.
[01:25]
Sarah
I have been asking for months, should I get. You have bangs. I've been like, for months, should I. Should I cut myself bangs? Should I cut myself bangs? And you're like, no.
[01:32]
Jessica
That's because when I have cut bangs, I've always wanted there to be someone to say no to me and remind.
[01:39]
Sarah
Me, but you did cut yourself bangs.
[01:41]
Jessica
I. And I regret it. I am instantly already growing them back out. You regret your bangs?
[01:47]
Sarah
I don't regret my bangs because they are. I just a full part of the mullet situation.
[01:53]
Jessica
It's. I don't regret the bangs. I just don't want them anymore. And it takes so long.
[02:00]
Sarah
It does.
[02:01]
Jessica
To undo.
[02:01]
Sarah
Half an inch a month is all I get.
[02:04]
Emily
Yeah.
[02:05]
Sarah
Anyway, we're not here to talk about my hair. I just. I just needed to be transparent with the listeners that you are currently who deserve to know that they're listening to.
[02:14]
Jessica
Somebody who was a mullet, who currently has a mullet, who gave themselves a mullet.
[02:19]
Emily
Yes.
[02:19]
Sarah
I did it to myself at the tail end of a migraine. I had taken a number of medications.
[02:29]
Jessica
But it does actually look pretty good.
[02:32]
Sarah
It's all right.
[02:32]
Emily
Yeah.
[02:33]
Sarah
It's very easy.
[02:35]
Emily
Yeah.
[02:36]
Sarah
Anyway, so what are we actually here to talk about?
[02:40]
Jessica
I really feel an important need to talk about hydratonitis suppurativa because we talk about long Covid, which is millions of people who have long Covid. We talk about autism, which is millions of people who have autism and autism is only 1 or 2% of the population.
[02:55]
Sarah
Yeah.
[02:55]
Jessica
And we.
[02:56]
Sarah
We did a whole episode on my dizziness, for fuck's sake.
[02:58]
Emily
Yeah.
[02:59]
Jessica
Hidradenitis suppurativa is an auto.
[03:02]
Sarah
This is a disease you have.
[03:03]
Jessica
It's a disease I have, and it's.4% of people have it.
[03:06]
Emily
That's a lot.
[03:07]
Jessica
It's an auto inflammatory disease, which means it's like. It's not an autoimmune disease because there's no, like, autoimmune marker that you look for to test for it. But it is just a condition that occurs when your immune system overreacts to something that someone with a, you know, typical immune system would not overreact to and there would be no, like, big problem. But since my immune system is made of cottage cheese and chicken wire, it overreacts to things that it doesn't need to overreact to. And that happens in my skin when a hair follicle gets too much keratin in it, which might result in, like, you know, a pimple for somebody. For me, it results in. And for 4% of the population, it results in a huge boil, incredibly painful, large breakout.
[04:07]
Sarah
What specifically is a boil?
[04:11]
Jessica
It's like a cyst. It's like when there's this excess keratin in the hair follicle. The hair follicle can close up and, like, become clogged, but the immune system reacts and sends all of this, like, you know, inflammatory reaction to it and fills that follicle with stuff with more keratin, with puss, with, you know, body things.
[04:41]
Sarah
So people who have this, what they will notice is on the outside of their body, there'll be a fairly large red lump. That is hard.
[04:53]
Jessica
Yeah, it's often hard. And like a. Like a pimple, it can, like, kind of come to a head and burst. That is not the ideal situation. Ideally, the. The matter inside the follicle will eventually break down and be broken down and eliminate.
[05:09]
Sarah
Processed by the lymph system.
[05:11]
Jessica
Yeah, yeah, that would be ideal because when it bursts open, it's much more likely to become infected. And also it's hugely painful if it doesn't break open. And it's even more painful if it does break open, at least temporarily.
[05:24]
Sarah
But so it's painful. It's not just a visible heart.
[05:28]
Jessica
It's incredibly painful.
[05:29]
Sarah
The reddish inflamed lump. It hurts.
[05:32]
Jessica
Dermatologists acknowledge that it is the most painful skin condition.
[05:35]
Sarah
Oh, my God.
[05:36]
Emily
Yeah.
[05:37]
Sarah
The more painful. I mean, you've had shingles, and that hurts a lot.
[05:41]
Jessica
The Thing about HS is that it is considered to be a progressive disease, that it starts for a lot of people, like puberty. Not always. It can start at any time in your life. But the most common presentation is it starts in puberty when the hormones go bananas. And I have had it since I was at least 19 because I went to a gynecologist. I remember.
[06:08]
Sarah
Oh, God, this story. I hate it so much.
[06:10]
Jessica
And I'm laying there on the table, legs out for the world. Not the world. It was. It was the gynecologist. I'm like, or your doctor. Yeah, from a doctor. And she pokes at a. At a lump on my, like, inner. Inner. Inner thigh. And it's a really hard. Like a little bit smaller than a golf ball, but about the same texture. And she kind of rubs it and goes, what's. What's this? What is this? And I was like, I don't know, babe. You tell me. And I have seen half a dozen gynecologists, none of whom clocked it. I even asked. Like, I have these. I thought maybe it was herpes or something, because it. It comes and goes in waves.
[06:53]
Sarah
So herpes look really different from that, though.
[06:56]
Emily
Yeah.
[06:57]
Jessica
Well, so what I'm talking about, this here that I'm describing is, like, stage one of hydratonitis suppurativa, which I'll just call hs.
[07:05]
Sarah
Say the full name slowly, if people want to Google it.
[07:08]
Jessica
Hydratonitis suppurativa. And it will be spelled out correctly in the episode title. Okay, so that's stage one is when there's, like, an occasional kind of lump bump, open sore, open wound. Stage two is when the wounds kind of add up on top of each other. There's multiple at the same time so that they create tunnels between each other. They get so large that they connect under the skin. Under the skin. That's stage two. When there's still healthy tissue between the tunnels. That's stage two. Stage three is when there is no healthy tissue and, like, a whole big mass of skin. Like, for example, your entire armpit is just a mass of tunnels and abscesses. That's stage three. None of these is a measurement of severity. These are just the stages of the disease as it progresses. Severity. It can be extremely severe at stage one, which is to say you can have an abscess that is huge and immensely painful and debilitating, but only one. But it, like, stops you from living your life because it's so intensely painful. And these things generally occur. They can occur anywhere. You have hair Follicles, but in general, they tend to appear in places where your skin folds. So armpits and crotches, armpits, groins, under boob. So for example, an entire armpit, that's stage three. But if you have. But that might not be very painful, it might be like on its way to being healed. And like, no. And like, feel okay, but probably not. Probably. It hurts like mother frickin hell. Okay. So I mentioned that it's 4% of the population. 4% of the population, I said. And it also, one of the things it has in common with autism is that people face challenges getting a diagnosis because of stigma and lack of options. And I think one of the reasons is that it's three times more common in AFAB folks in the US Although there are regions in the world where it's more common in male people. And I think asking for help is a thing that, you know, women in the US don't do. Especially when you do ask for help and your doctor fingers a big old abscess in your thigh and goes, what's this? Sorry, I'm just really curious. Anyway, it's reportedly more common among smokers, fat people, people with highly melanated skin, but it's also vastly underreported. Like I did. I had it for decades.
[09:49]
Sarah
And yeah, as you're, as you're talking about it, I am recognizing that that's an experience. So when I was cycling long distances and, or very frequently, I would get them, I would get things like this red pretty hard, sort of oblong shaped things that if I squeezed it, it got dimples. Like a golf ball. In my inner thigh.
[10:10]
Jessica
Yeah, it's possible.
[10:11]
Sarah
Specifically, like the crease of my inner thigh.
[10:14]
Jessica
It's possible. There's no research that shows that like, activity would add. Would make it worse.
[10:21]
Sarah
So it had to do with irritation of hair follicles?
[10:26]
Jessica
No, just the natural process of keratin being deposited into a hair follicle goes wrong.
[10:34]
Sarah
Just goes wrong.
[10:34]
Jessica
Yeah, there's no, there's nothing you can do to prevent it is the thing. There's no, oh, if I avoid this. I mean, if you engage in behaviors that reduce inflammation overall, you can potentially reduce this kind of inflammatory reaction, because that's what it is. It's an inflammatory response. It has nothing to do with hygiene. It's not communicable. It is, there's no reason that there would be stigma attached to this, except that it happens in, like, your private areas, in your dirty areas, you know, most commonly, because those are the parts where the skin folds, and that's really, I guess, if the skin folding is it.
[11:20]
Sarah
But it doesn't happen because of a lack of hygiene.
[11:22]
Jessica
No, no, no, no. In those areas, it might is be more likely to get infected if the area isn't clean. But in general, people with HS shower more than regular people because when it does ooze, when there are open tunnels, it'd be gross. It oozes and it stank. So another overly inflammatory thing that my body does is mast cell activation syndrome. Mast cells are cells that are involved in the immune system, and when they become overly activated, you get a. This is the thing that was killing people at the end of COVID When it first came out was the cytokine storm. Not the coughing, not the that. But like, the overreaction of the immune system. So mast cell activation is related to that, and that is much more likely in autistic people. And I wonder if HS is more common in autistic people because of the likelihood that our immune systems are more kind of fragile than typical anyway. So the locations of these cysts and boils are, like. They feel private. You know, it feels like places where you don't want to go ask a doctor. So one of the reasons I never got a diagnosis, I do have some in my armpit, but they're very, very minor, and they never bothered me. But the ones that are in my gynecological region were never recognized by a gynecologist. And I've never been to a dermatologist. Cause I've never had, like, a serious skin thing that I wanted to talk to a dermatologist about. But even if I did, would I be, like, laying on a table with my legs in stirrups for a dermatologist? Is that how you get that diagnosed?
[13:09]
Emily
I don't know.
[13:10]
Jessica
Yeah, right. So I think a lot of people miss the diagnosis because it is in a place where regular doctors aren't gonna just, like, casually be like, oh, yeah, I see that thing on your sk. That's blah, blah, blah.
[13:20]
Emily
Yeah.
[13:21]
Jessica
I want to talk about what kind.
[13:22]
Sarah
Of pain it is, okay.
[13:25]
Jessica
Because there is the achy lumps, like I was talking about. But it can also just cause the kind of, like, raw burning, like, surface level, like, friction. Because, like, the feeling of an open wound, and when the abscesses become big enough, there's like, a sharp, stabbing pain. It's like walking around with a knife stuck in wherever it is. And if that place is in a place where it's affected by your legs moving, it makes walking really difficult. If you have to use your arms and it's in your armpit, that becomes extremely difficult to, like, raise your arms because there's a knife in your armpit. So even the unburst blisters and because people don't know anything about it, when you go to, like, urgent care and you're like, I have this abscess and the pain is debilitating, what do I do? What they're going to do is they're going to drain it. They're going to poke it open and they're going to drain it. And that, it turns out, is like the worst thing you can do. It's just going to make it more likely for another abscess to come back in that location. The treatments that you can only get really, at some dermatologists is to deroof an abscess that's really bad. To completely remove the skin on the top and just leave it completely open. Not to just poke a little tiny hole that's gonna, you know, close up and leave an, you know, an empty abscess behind all ready to be filled in, but rather just to deroof the whole thing. I mean, and that in the end is the.
[14:58]
Sarah
That sounds agonizing.
[14:59]
Emily
Oh, yeah.
[15:01]
Jessica
I mean, from people I've heard talk about this surgery, it is way less uncomfortable than the abscesses themselves.
[15:09]
Sarah
Okay.
[15:10]
Emily
Yeah.
[15:10]
Sarah
And is that like a curative treatment?
[15:13]
Jessica
Potentially, yeah. Only for specifically just the places that have been de roofed. But usually those places are at stage three. I mean, they're not gonna do surgery on you, on you, unless you're having like a very severe situation. So they will remove the surface and it will heal up and it'll be like new skin. But yeah, there's always a chance it could come back in that area. Because again, any place you have a hair follicle can be a location. People get it on their faces, on their heads, on their necks, in perfectly visible areas. There's a TED talk of a kid, not a kid. He's in his, like early 20s, I think, talking when he's like, I have HS and you can see it on his neck, on his face. Because it's not just in the private places, but, you know, so I thought that it's a disease that has a lot in common with all the other, all the other crap we talk about. And I know that it's kind of specific, but Lord, if there's one person who's got the big painful abscesses who's like, what the hell are these? I thought you Know, maybe I'll help one person get a diagnosis faster so they can, you know, just to talk about this is what this is.
[16:31]
Emily
Yeah.
[16:31]
Sarah
If we're going to do that, then we need to talk about effective strategies for going in and talking to a medical provider and not saying. Dr. Google told me.
[16:40]
Jessica
Yeah. Because that is how I found out it was hydratonitis separativa. And then the last. Then the next time I went to a gynecologist, I said, I have hidratinitis separativa. And she was like, oh, yeah, I can see the scars here. It was a new gynecologist, so maybe she would have clocked it on her own. But every gynecologist I'd had so far to date didn't come up with that, even when they could see it in front of them. Nobody was like, wow, hey, this is hidratenitis operativa. Not a single one. But when I said, you know, when Dr. Google, I didn't say it. I just said flat out, I have hidratenitis operative. And she was like, oh, yeah, yeah. That's clear to me that that's what this is.
[17:22]
Sarah
So one way to go about talking to a medical provider about it is just to present it as a fait accompli, something that you have already been diagnosed with, not mentioning in what way you were diagnosed with it. I'm just saying this is a situation that I have. So, you know.
[17:36]
Emily
Yeah.
[17:36]
Jessica
And look, let me tell you, this thing is visually distinctive. When you look at the pictures and you go, yep, I have that.
[17:42]
Emily
Yep.
[17:43]
Jessica
In general, there is a problem of diagnosis on average. And you hear this statistic bended about everywhere. On average, HS takes seven years to get diagnosed. From the time somebody goes, I have a problem till somebody goes, that's hs. Seven years.
[18:00]
Sarah
So if it is visually distinctive, then if you go in and say, so I have this situation, it is so painful. And obviously, I did the thing people do, which is I looked it up online, and I found these pictures that look exactly like what I have, and nothing else looks like this. So I'm wondering if it might be this. And I know we should not have to do this kind of emotional labor with our medical providers, but the reality is they are mostly intensely burnt out, overwhelmed, exhausted, functioning within a profoundly maladaptive. Oh, my God. Yeah.
[18:43]
Emily
Okay.
[18:43]
Jessica
Shelly Cat. Shelly Cat. Just for the record, the cat got.
[18:56]
Sarah
Very quiet very fast.
[18:57]
Jessica
The cat is still alive while Emily is gone, dealing with the cat poopies. I will tell you that there's this conversation about how Body size makes it worse because of, oh, maybe it causes more skin folds. There's really no evidence that gaining weight or losing weight changes your. The severity of the disease. And I will tell you that I have had symptoms since I was six sizes smaller than I am now. And gaining weight has never corresponded to the severity of my symptoms. Never once, you know, what does. Hormones and mast cell activation. Those are the only things I have experienced in my life that make HS worse or better.
[19:47]
Sarah
Anyway, we shouldn't have to do emotional leisure.
[19:50]
Jessica
So another reason that you. So, yeah, you shouldn't have to do this emotional labor. And some of the emotional labor is also like, if they've heard anything about hs, they're going to talk about your weight and they're going to talk about smoking. And both of those things are. Yeah, so. And only as far as inflammation corresponds on a large scale from a systemic level.
[20:11]
Sarah
An emotional labor point of view. If your doctor talks about those things, let them talk about it. And you just water off a duck's back. Just let it be not relevant to your situation and set that information aside because that is not your situation.
[20:32]
Jessica
I have been told that I have to lose weight for treatment for other things. Never for this. I've never been told any treatment for this.
[20:41]
Sarah
It sounds like there is not any treatment for this apart from globally reducing inflammatory processes in your body.
[20:48]
Jessica
Globally reducing inflammatory processes, which no one has ever. Which the one gynecologist who I told directly was like, oh, yeah, well, it was kind of like, there's nothing we can do about that. Or maybe see a dermatologist anyway. Yeah, globally reducing inflammation is the thing you can do. So like dietary changes, potentially, maybe if you eat foods that feel inflammatory and you recognize that, don't eat those foods. So much processed foods and high sugar foods. And we've already done the food episodes.
[21:22]
Emily
Yeah.
[21:23]
Jessica
But like, it's really gonna matter. Vastly. One of the reasons that I, like, we have talked about kind of eating keto, but not really like strictly keto, but just like super low sugar, super low carb, which I don't recommend that anyone else do. It's just the thing that happens to feel the best for me that does reduce the severity of HS outbreaks. It does.
[21:48]
Sarah
And also that way of eating is hugely more expensive than.
[21:53]
Jessica
Hugely more expensive. Hugely more expensive. But as I am progressing through my perimenopause journey and my periods are less and less common, I have fewer breakouts. They were very directly correlated with my menstrual cycle. So they are getting better. Fingers crossed. It is possible that menopause will reduce the breakouts significantly because estrogen is a clear thing that correlates with the severity of the breakouts. But I mean, maybe not. Some people develop HS in their 70s.
[22:31]
Sarah
Well, that's fun.
[22:33]
Jessica
Yeah. So the thing about HS that's more painful than shingles is that it lasts potentially decades.
[22:47]
Emily
Yeah.
[22:47]
Jessica
And comes and goes in flares like herpes. I only have stage two disease, I don't have stage three. So I have not sought extraordinary intervention to this point. If you Google HS treatments, there is some evidence to suggest that possibly laser hair removal that destroys the hair follicle permanently can reduce outbreaks. If you destroy the hair follicle. Because anywhere you have a hair follicle and hey, did you know that burn scars don't have hair follicles? So if you were burned all over the surface of your body, which believe me, is a very, very stupid comparison to make, but if you had burn scars instead of hs, that would be a trade off that I, who have had both. I mean, like, burn scars are like long term scars. They change the texture and the stretchability of your skin and they're painful long term. But is the pain of a burn scar worse than the pain of an HS breakout? Like kind of?
[23:55]
Emily
No.
[23:55]
Sarah
If my sound quality got worse, that's because I just had to turn on a fan.
[24:01]
Jessica
Ew, I can't hear it.
[24:03]
Sarah
Our cat, our cat is 20 and she's having troubles.
[24:09]
Jessica
I did just go on a little diatribe about how burn scars don't have hair follicles. Burn scars are cause chronic pain, but like the toss up, it's a toss up whether I would rather have a burn scar or NHS breakout or even just the potential for NHS breakout.
[24:27]
Sarah
So this is a nice simple topic that will result in a nice short episode, which is great. So could you tell us, just lay it out for us, how knowing about HS helps us with the whole stronger than the fire thing. The world's on fire.
[24:46]
Emily
Yeah.
[24:48]
Jessica
I think that one of the. Okay, look, people with HS are twice as likely to die by suicide. This is.
[24:55]
Sarah
Jesus God.
[24:57]
Emily
Yeah.
[24:58]
Jessica
This is a disease that has pain, chronic pain, stigma, little research. It harms people's social lives, it harms people's abilities to do the things that give them joy. This is a very severe disease. Even though all it is is skin.
[25:14]
Sarah
Condition.
[25:17]
Jessica
It'S uncontrollable in some ways. And so, like, specifically for the 4% of us who actually have this condition, knowing about it and understanding that they're not Alone. And like, we live in a world now where there are multiple podcasts by people who have hs. I think there's a series called the Hydradenitis Supper of Divas of like a couple of women with talking about, like, the science of hs. And it's. It's like you live in a world now where you find a link to that, oh, my God, I'm not alone.
[25:50]
Emily
Yeah.
[25:51]
Sarah
So you, so you, so you don't feel quite so isolated and you don't feel quite so helpless and trapped, which are some of the highest risk factors for not wanting to be alive anymore.
[26:05]
Emily
Yeah, yeah, you're not alone.
[26:08]
Jessica
And you know what? Like, there's no reason to have a stigma about it. Like, I. For me, the main social difference was that I didn't know how to wear a bathing suit in public because I've got red lumps and purple scars around my bikini line, which I have worn, like little skirts. And I now have a little union suit romper type bathing suit that has like shorts with like a 6 inch inseam to cover all of the scars. A lot of people have much worse disease than that, and a lot of people have it stop their lives. And if we're gonna be stronger than the fire, the things that solve this problem are the same things that keep us from burning out just because of how awful everything is. This is just one more thing. But, you know, the things that we do to deal with it and manage it are the same things that we do to deal with and manage everything. Everything.
[27:18]
Sarah
So the baseline kindness and motherfucking compassion. When outbreaks happen, when scars form, you turn toward them. This is the new hotness. You allow them to exist with kindness and compassion and forgiveness instead of berating your body for doing a thing that you can't control and that you do not like, just allow it to be a neutral experience that is part of living in a mammalian body.
[27:49]
Emily
Yeah.
[27:50]
Sarah
And it's not always going to be like that. There are days when you're going to have grief and rage and despair and uncomfortable, unpleasant emotional experiences and just turn toward all those experiences also with kindness and motherfucking compassion. Because it is normal to have those experiences, those emotional experiences in response to situations where you kind of are helpless, but you are not alone with it and you are not trapped.
[28:22]
Emily
Yeah.
[28:24]
Jessica
And there is hope.
[28:25]
Sarah
There are.
[28:26]
Jessica
There's every reason to believe that surgery can work long term. That is, there's evidence to show that that's, you know, probably gonna help. And anybody who has HS is probably like, surgery bring it on. I don't. The pain. I can totally manage that. That's awesome. I'd much rather have. I'd rather. I'd like to get rid of that.
[28:43]
Emily
Yeah.
[28:44]
Jessica
And, like, the change in hormones going on the pill can help. Reducing the sugar you eat can help. Sometimes just taking antihistamines can help. Like, there's so much that could help. You have to know what it is. That's one of the. That's one of the main things is to.
[29:00]
Sarah
One of the main things is knowing that it exists, that that's what it is.
[29:04]
Jessica
You got to know that's what it is. It's. It's not. It's not herpes and it's not.
[29:10]
Emily
Yeah.
[29:11]
Jessica
Or any other kind of. It's not a sexually transmitted disease.
[29:14]
Emily
You.
[29:15]
Jessica
You can't give it to anybody.
[29:17]
Sarah
Not communicable.
[29:17]
Emily
The thing I.
[29:18]
Jessica
One of the things I thought might happen is that we would record this and you would be like, oh, yeah. Well, I guess you did say you kind of have those. Yeah, you get them sometimes.
[29:27]
Sarah
But for me, it's when there's a lot of rubbing very clearly associated with. There's a lot of rubbing. Specifically cycling.
[29:35]
Emily
Yeah.
[29:35]
Sarah
And occasionally, if I use the wrong kind of antiperspirant, it'll impact the clogging of my hair follicles in my armpit, and it'll be a big sore red blob that lasts months to resolve.
[29:56]
Emily
Yes.
[29:57]
Jessica
You just nailed the description of how it starts. That's how it begins. It might be something more like a blackhead, like, in the beginning. That might be the most minor, but the biggest, incredibly painful thing that takes months to heal. So that when by the time you have, you know, another period and it's a month later and you get another one now, they're just. They take so long to heal. They take so long to heal.
[30:19]
Sarah
So I think I almost certainly have a. Just a much less. To a much lesser degree.
[30:24]
Jessica
To a much less degree. And that indeed is true for, like, a lot of the kind of disease things, because I've always been the sickly twin. I was the Danny DeVito to your Arnold Schwarzenegger. I mean, I was always homesick from school.
[30:39]
Sarah
I'm the one with the bad balance and dizziness. I'm the one with the peripheral arterial disease that's been progressing since I was 35. I'm not, like, all set.
[30:50]
Emily
No, no, no.
[30:51]
Jessica
But I do have a longer history. Like, I've had this since I was a teenager, for sure. I've had this since I Was a teenager, fully 30 plus years.
[31:01]
Emily
Yeah.
[31:02]
Sarah
And outbreaks that use have you have been with you for a large proportion of your lifespan, as opposed to like, they come and they go and they come and they go. It's been like they come and they are, like, on their way out when the next round hits. And that's how you get the channels.
[31:18]
Jessica
I. When I was on the pill, I didn't get them as often.
[31:20]
Sarah
And now you cannot get a prescription for the pill because you get migraine with aura.
[31:26]
Emily
Yeah.
[31:27]
Sarah
And there's not a gynecologist in the world who recognizes that. Like, actually maybe the increased but still very low risk of stroke is worth it if it means getting rid of all the other stuff that the pill can manage.
[31:47]
Jessica
Yeah. Like endometriosis, which I also have and.
[31:51]
Sarah
Affects your life, like, every fucking day. But, like, there's an increase, but insurance.
[31:58]
Jessica
Companies won't sanction giving me the.
[32:00]
Sarah
Yeah, I get it.
[32:02]
Emily
Yeah.
[32:02]
Jessica
Because migraine with aura. Although I get a half a dozen migraines a year, not even every month do I have a migraine. And I would happily train a migraine for ahs, assuming that they didn't come.
[32:21]
Emily
Wow.
[32:22]
Jessica
If I had migraines as often as I had HS breakouts, I mean, but the thing is, they last for a month, so how do you trade Whatever. That's just a thought exercise.
[32:33]
Emily
Yeah.
[32:34]
Sarah
Would you have a migraine for months at a time instead of having HS for months at a time?
[32:40]
Jessica
No.
[32:41]
Emily
No.
[32:42]
Jessica
Because most of the breakout is tolerable. There's only a handful of days when the pain is really debilitating.
[32:51]
Emily
Right.
[32:52]
Sarah
Like with migraine, there's only a handful.
[32:53]
Jessica
Of days and it depends on where the location is. Sometimes the location is someplace where it doesn't bother me much until I, like, sit down quite heavily and I go.
[33:08]
Emily
Yeah, yeah.
[33:11]
Sarah
Okay.
[33:12]
Emily
Yeah.
[33:13]
Sarah
We need an episode where I didn't do a lot because I have actually been having a lot of migraines lately.
[33:19]
Emily
Yeah.
[33:19]
Jessica
And you basically had to move house.
[33:21]
Emily
Yeah.
[33:22]
Sarah
For complicated reasons.
[33:23]
Jessica
Which is one of the most stressful.
[33:24]
Sarah
Things that life was. Life was very stressful for a while. On top of our cat being very seriously unwell and.
[33:37]
Emily
Yeah.
[33:38]
Sarah
So my brain has not been great lately. So it was. It was nice for me to have an episode where I didn't have to do a lot of work.
[33:44]
Emily
Yeah.
[33:46]
Jessica
I know.
[33:46]
Sarah
All I had to do was be like, the thing we say all the time. Kindness and compassion. Turn toward the uncomfortable situation. With kindness and compassion.
[33:57]
Emily
Yeah.
[33:58]
Sarah
And.
[33:58]
Emily
Yeah.
[33:58]
Sarah
We have to do emotional labor for our doctors, because our doctors are all burnt the fuck out. And it's not their personal individual fault that the medical system is as bad as it is in the United States. It's not like that everywhere, but it's kind of like that kind of everywhere. Unless you're super wealthy.
[34:17]
Emily
Yeah.
[34:19]
Jessica
And like a lot of the other things we talk about, we're identical twins and we vary who were raised in the same household, and our experience varies dramatically. You have had the same reaction. And anybody can have like a lump where their body overreacts to some keratin in the hair follicle. It's when it's, you know, a chronically recurring problem that it becomes. The thing is that it makes itself.
[34:43]
Sarah
Is it related to kp, the chicken skin on the back of your arm situation?
[34:49]
Jessica
Because that is also a hyper keratinosis thing. I mean, it's the same mechanism to start with, in that there's too much keratin and the thing closes over and it becomes a teeny weeny weeny little dump. But HS becomes a great big giant. So, no, it's not the same because.
[35:09]
Sarah
Yeah, KP is not painful. It's tiny, tiny red bumps. It pretty much is permanent. There is treatment that mostly involves chemical exfoliant applied on a pretty regular basis. That's it.
[35:23]
Jessica
And when it comes down to it, the symptoms of HS are skin symptoms. The mechanism of HS is inflammatory, is auto inflammatory. Okay then, so it's a. I mean, like we now probably should also talk about a little bit of polyvagal theory as related to this, because it's when your body feels unsafe is when inflammation goes extra bananas, when your body is in fight or flight, when you're experiencing stress.
[35:54]
Sarah
Right, sure. So that's why we're turning toward difficult feelings with kindness and compassion.
[35:59]
Jessica
Like you say all the time that when you have a stress response, one of the things that happens is that your skin moves away from blood, moves.
[36:05]
Sarah
Away from the surface of your skin.
[36:06]
Jessica
Your blood moves away from the surface of your skin. So if you get cut, you're less likely to bleed. There are lots of skin things that happen that are activated by the stress response, including your oil glands. And when your hair stands on end, that's a stress response that below the level of conscious awareness. Piloerection can. Yeah, it's called pilo erection.
[36:27]
Sarah
Your hair stands on end.
[36:28]
Jessica
Yeah, your hair stands on end. That's your hair follicles reacting to stress in a very ancient like, make myself look bigger, puff my fur out kind of way. So, yeah, your skin responds to stress. If anybody's ever had a breakout, like, of just regular old acne after a stressful or during a stressful situation, that's because your skin responds to stress.
[36:52]
Sarah
Hives.
[36:53]
Jessica
Hives is another skin condition.
[36:55]
Emily
Yeah.
[36:56]
Jessica
So all of the things that help you move through stress, if stress is a factor that. You know, one of the things with HS is because it's so. It comes and goes in such cycles that are multi weeks, multi months long. It requires tracking to really start to notice what the activators are.
[37:18]
Emily
Yeah.
[37:18]
Jessica
I tracked it for years, and the only thing that would predict it was menstrual cycle. And once, twice, I knew for sure I was having a mast cell activation episode. And HS also got worse at the same time.
[37:33]
Sarah
So, like, so tracking.
[37:35]
Jessica
Tracking over months and figuring out what the triggers are, figuring out what makes it worse, what makes it better. Very much like my brain, unfortunately, this is another one of those things where you are the only person who can be an expert in this. In your. In your own case, in your hs.
[37:52]
Emily
Yeah.
[37:54]
Jessica
Which sucks. That feels so terrible and so frustrating. Like, so goddamn much work, especially if you have other things going on.
[38:02]
Emily
Yeah. Yeah.
[38:04]
Jessica
So it's a. It's a lot of work. It's exhausting. I get why people feel hopeless about it and enter a state of despair because it feels overwhelming, but there is so. There is so much hope. And, you know, you track a thing, you mention it to your doctor like it's a foregone conclusion, and you connect to all the people on the Internet now who are talking about their HS and being mad about the same things.
[38:31]
Sarah
You're mad about it. It's got a subreddit.
[38:33]
Jessica
Doesn't have any. I don't do Reddit, so I don't know, but I completely expect that. Yes, it has a subreddit. So I wanted to talk about this, because this is the thing I deal with, and it's more common than frigging autism.
[38:50]
Sarah
And we are gonna do a shadow episode. It's not like all the episodes are not gonna be like, here's a disease I have. Well, here's a disease I have.
[39:00]
Jessica
But it is funny that this one overlaps so much with the same systemic challenges. It affects women in the US More than men, although that's not true globally. Like, it has this stigma. It's hard to get a diagnosis. It just. It has. It has all. It has all of the ingredients.
[39:24]
Emily
Of.
[39:25]
Jessica
A thing that can make you burn out, because it has all the same, you know, hurdles of A. An unjust medical system.
[39:35]
Emily
Yep.
[39:36]
Sarah
If people want to send us emails about the diseases they have that have used up a lot of bandwidth and have made it more difficult for them to tolerate living in a world of rising autocracy, tell us what they are. Yeah, we'll, like, read a list of like, hey, listeners, you're not alone here. Here is just some of the diseases that listeners are living with.
[40:02]
Emily
Yeah.
[40:02]
Sarah
That's like making life more difficult.
[40:04]
Jessica
Because.
[40:06]
Sarah
A lot of people in the women's wellness space, I say with heavy air quotes, talk about, like, what a joy it is to live in a body and really embracing, like, their internal and like, while, like the pleasures of the body. But, like, we are the ones who consistently are like. All of that is true. And when you can turn toward your internal experience with kindness and compassion, you will be healthier. That's a. That's a reality. And also, let's not ignore or downplay how inconvenient and uncomfortable it can be to live in a body. And there's no way to separate living in a body from responding to and coping with gestures broadly.
[40:52]
Emily
Yeah.
[40:53]
Jessica
All of the everything.
[40:54]
Sarah
All of the Everything that is around us every day, especially if you're paying attention to the news and such.
[41:02]
Emily
Yeah.
[41:02]
Jessica
So if there's one person who had mystery lumps that recurred and is like, oh, oh, that's. I have a name for this thing now.
[41:09]
Emily
Yeah.
[41:13]
Jessica
I hope I helped one person.
[41:14]
Emily
Yeah.
[41:14]
Jessica
Because you have a name for it.
[41:16]
Sarah
You're not alone. There are some things that you can do to help reduce the impact. And certainly you can start tracking and look for patterns.
[41:24]
Emily
Yeah.
[41:24]
Jessica
And you don't have to worry about it being contagious or, you know, because it's your fault. It's not your fault.
[41:31]
Sarah
It's not your fault.
[41:32]
Jessica
Your immune system is just a little freaky.
[41:36]
Sarah
Aren't we all?
[41:37]
Jessica
And you know what? Same.
[41:39]
Emily
Yeah. Yeah. That's it.
[41:43]
Jessica
I think we did it.
[41:43]
Emily
We did it.
[41:43]
Jessica
Roll ukulele.
[41:44]
Emily
Hooray. Cue the ukulele.
[41:55]
Jessica
Just for the record, the cat got very quiet very fast. The cat is still al.