Dr. Kate Herts 00:00:00 The Teaspoon podcast is part of the practice of the Practice Network, a network of podcasts seeking to help you market and grow your business and yourself. To hear other podcasts like am I okay? Imperfect. Thriving and Thursday is the new Friday, go to woo dot practice of the practice.com/network. Welcome to the teaspoon podcast. I’m so happy you’re here. Hi, I’m the teaspoon doctor Kate Hertz, a queer millennial health psychologist with ulcerative colitis. I’m here to dish out all the hottest tea about living a connected and meaningful life with chronic illness. I’ll cover everything from how to wear a bikini with scars, to what it feels like to be too sick for a chronic illness camp. Get comfortable on the couch, grab your furry friend, and let’s get cozy because we have some hot tea to sip on today. Hi everybody. Welcome to the Teaspoon podcast. I’m your host, doctor Kate Hertz, a health psychologist who specializes in treating teens and young adults with chronic illness and also a spoonie living with ulcerative colitis. I’m really excited to introduce you to my guest today, who is going to help me spill the really hot tea. Dr. Kate Herts 00:01:33 I’m thrilled to have Doctor Karin Carter Zoli. She is a clinical psychologist and the co-director of Behavioral Health Integration and Innovation, and an assistant professor of psychology in clinical psychiatry and pediatrics at Weill Cornell Medicine. Karen Doctor Carter Azoulay oversees mental health services embedded across all pediatric medical settings and has expertise in pediatric integrated care program development and specializes in treating anxiety disorders and working with youth facing acute and chronic medical illness. Today, I’m going to talk to Doctor Carter Azoulay about the very childhood experience of chronic illness and how parents and therapists can help. If you’re a spoonie listening today, this is one to send your mom, your dad, your therapist, your friends. Karen, thank you so much for being here today. I’m thrilled to have you. Dr. Corinne Catarozoli 00:02:26 Thank you so much for having me, Kate. I’m excited to be here. Dr. Kate Herts 00:02:29 Yeah, it’s really exciting for me because we’ve been friends for a long time. And Corinne actually supervised me way back when I was on internship and working in some pediatric inpatient settings. So this is really a thrill. Dr. Corinne Catarozoli 00:02:42 So full circle. Yeah, totally. All right. So yeah, to kick. Dr. Kate Herts 00:02:47 It off, I think it would be really helpful if you could just tell us what you’ve been seeing commonly across kids and teens with chronic illness, what are some of the mental health concerns that come up a lot in your experience? Dr. Corinne Catarozoli 00:03:00 Absolutely. The most common thing that I see across the board, trans diagnostically, no matter what the medical illness is, is anxiety. And that makes a lot of sense, because when you think about the experience of being a child and adolescent and a young adult with a medical illness. There is this hallmark confrontation of danger and threat that you’re constantly facing. Dr. Kate Herts 00:03:28 So, and it’s like an internal threat right from your heart. Dr. Corinne Catarozoli 00:03:32 It could be it could be pain. It could be various physical symptoms. It could be, frequent medical procedures. You know, we work with kids who are going through, you know, having MRIs or injections, endoscopy. These are distressing. So you’re constantly being faced with these, sort of anything ranging from just awful to even life threatening, issues that become really, really, really challenging. Dr. Kate Herts 00:04:06 Absolutely. And, you know, I remember when I was 8 or 9, I didn’t know how to swallow pills. I didn’t know how to get a blood test. I was afraid of getting blood tests and getting shots. And suddenly when I was diagnosed with colitis, I had to do that all the time, like pills every day and, blood tests all the time. And colonoscopies were terrifying. But I don’t think anyone at that time told me. And I think what I heard from a lot of my patients who had childhood chronic illnesses that not a lot of doctors are talking to kids about anxiety and talking to parents. So I’m I’m curious. A couple things like one is how does anxiety show up in younger kids if it’s not like the traditional if maybe a teenager can tell you they’re worried, but what about like an eight year old or ten year old? What might you look for as a parent? Dr. Corinne Catarozoli 00:04:56 That’s a great question. You know, the signs and symptoms of anxiety really do present differently across the lifespan. Dr. Corinne Catarozoli 00:05:03 So sure, an adolescent or a teenager young adult might be able to really verbalize what worries they’re having, or that they’re spending a lot of time ruminating, or what their fears are. In younger kids, it often looks like crying, clinging difficulty separating. It can even look oppositional at times. Imagine a little kid who is terrified, or they’re in the hospital facing something really scary and unpredictable. It can even look behavioral at times and be mistaken for that. So, any really change from baseline sleeping, eating, separating those things are can all be warning signs that there’s some anxiety there. Dr. Kate Herts 00:05:48 That’s really helpful. So we’re looking we’re trying to figure out like okay what is my kid like day to day. And since we started going to the doctor and having these things, is that changing in ways that are not attributable to maybe the medical effects of the illness? Dr. Corinne Catarozoli 00:06:04 Yeah. And I also just want to normalize that. It totally makes sense that a child would be experiencing this change from their baseline in the context of a medical illness, because think about the massive inability to control your environment when you’re in a hospital or in a medical setting. Dr. Corinne Catarozoli 00:06:22 Anybody who’s spent time there knows people walk in and out of your room all day long unannounced. You never really know what’s going to happen or when. So there’s this total unpredictability that comes along with it, not to mention just the unpredictability of having a medical issue where you’re uncertain whether symptoms are going to exacerbate disease will progress, and illness will recur. It is really the kind of mark having a chronic illness. So those are all really the enemies of anxiety. That unpredictability, the unknown unfamiliar. So of course our kids are experiencing this. Dr. Kate Herts 00:07:02 No. It’s so I’m so glad you said that. And it is so important to normalize it, because I think that it’s actually a very reasonable reaction to what’s happening. Let’s say if you’re diagnosed, getting diagnosed with cancer, you’re getting diagnosed with type one diabetes or something that’s going to really change your life even if you’re five, six, three. You know that it’s not normal for you to be in the hospital with your mom while your brothers at school, and that might not be like something you process and fully understand until later, but it still disrupts that routine that really helps kids not have anxiety. Dr. Kate Herts 00:07:39 So I almost think, I don’t know, I feel like having no anxiety with chronic illness would also kind of make me think twice. Like what’s going on in there? We really. Dr. Corinne Catarozoli 00:07:49 Robots. Dr. Kate Herts 00:07:50 We’re not robots. Yeah, exactly. And that is borne out in the research. I know that up to a third of patients with chronic illness have like clinically diagnosed anxiety disorders, but that that other and that’s high that’s much higher than the general population. But that other 70%. That doesn’t mean they don’t have subclinical. Typical levels of worry and anxiety and yeah. Yeah. And I think that also because little kids don’t have great ability to regulate their emotions to communicate, that’s all really helpful to normalize. And yeah I think it might be helpful to and I know that you have worked in inpatient settings and outpatient settings at the hospital. What are some of the different illness presentations that you’ve seen that show up? More so in childhood or like early adolescence? And how should parents be looking differently at, depending on the symptoms or the illness the child’s experiencing for mental health issues? Dr. Corinne Catarozoli 00:08:51 So just like you said, an adjustment reaction sometimes I don’t even categorize it as a reaching diagnostic criteria for an anxiety disorder is really typical. Dr. Corinne Catarozoli 00:09:02 And that’s probably the most common that we see in the context of an acute stressor, like a hospitalization or, being in the pediatric ICU or receiving a new diagnosis. So, I typically kind of categorize those as an adjustment disorder, and those can come along with anxiety, with depression or mood issues as well as behavioral issues. So that kind of behavioral, regression that we sometimes see. And then with adolescents, especially those who are managing chronic illnesses, where maybe they’ve had them since they were young children, and it requires frequent procedures, maybe daily medication. We often see a stage where they reach this level of burnout, and that can come along with depression or other mood issues where they’re just over it, and we can sometimes see some non-adherence or non-compliant medication behavior come along with that. because they’re sick of it. They’re sick of having this every day so relatable. Dr. Kate Herts 00:10:09 And I see that so much in my patients. And definitely when I was 12 or 13 and no medication had worked for me that I had taken, except for prednisone, which any parents who’s ever had a kid on prednisone, all these bunnies been on prednisone? No, 1213 year old girl is going to be like, yeah, this is awesome. Dr. Kate Herts 00:10:27 I’ll keep taking Ferguson. So sorry, Mom and Dad. I definitely a couple times took it to school and threw it out like you’re just. Mostly I took it, but, like, it was not easy. And so adherence is a really important topic I think that you bring up and I’m wondering, how can parents or therapists, even how can we help kids navigate that? Because I’m also I also have seen that there’s certain vulnerability periods, especially like freshman year of college during the transition to adulthood where mom’s not giving you your medicine or wine. So how do we set kids up for success from the beginning and sort of a medical adherence sense? Dr. Corinne Catarozoli 00:11:08 Parents facilitating their child’s independence starts really young. So I think it’s so important for parents to have really honest, open dialogue with their child about their medical illness. And that’s going to shift over time. The language that you’re going to use to explain symptoms or treatment to a two year old is going to be quite different than a ten year old and then a 16 year old and then a young adult. Dr. Corinne Catarozoli 00:11:34 So it evolves over time. But I talk with parents about starting to layer in information as kids get older, so nothing ever comes as a surprise for them. There’s never a big scary moment where you sit down and learn something about yourself that you didn’t previously know kids should know, starting at whatever age they, you know, start to develop language that, you know, I have this thing called diabetes, or I have this thing called epilepsy. And their understanding of that will evolve as their cognitive capacity evolves. But that’s a really huge part in parents being open and honest and then ultimately kids being able to take ownership of some of that management themselves as it becomes age appropriate. Dr. Kate Herts 00:12:21 There’s so much there that I’m so I have a couple of questions, because I think both things are really important that you’re saying. But then the honesty and openness from a young age, like you mentioned, as young as, you know, to your developing language, maybe you talk about that in kid terms or read a book or something. Dr. Kate Herts 00:12:39 I think that for a lot of parents, that’s and I know from my parents that’s a little bit counterintuitive. Like parents want to really shield their children such a natural inclination. Right? I don’t want you to be scared. So don’t worry about this. Like everything’s going to be okay, but then it’s not. And how do we balance that desire to shield our kids and reassure them and make sure that they know will take care of them with the honesty of a really scary situation, like a serious illness. Dr. Corinne Catarozoli 00:13:10 The interesting thing is that it’s so well intentioned when parents try to shield or protect their child from anything that might feel scary or unknown or dangerous, but what we find is that it’s counterproductive. Kids are smart, and they can sense when there’s something that they’re not being told, when they’re, you know, being asked to leave the doctor’s office and the parents are talking to the physician alone. They’re not being totally upfront and honest about what’s going on. And then kids actually can invent things in their head that are worse than reality. Dr. Corinne Catarozoli 00:13:45 So, so it’s a really well intentioned, idea, but it ends up backfiring and it makes kids more anxious in the long run. It also can make them mistrustful of their parents or even of their doctors, which obviously is not a dynamic that we want to set up. So, Dr. Kate Herts 00:14:05 Yeah. So do you recommend that, that parents see the doctor without the child? Or should kids always like at what age should kids be present for any conversations? Because I know a lot of parents with younger kids will say, okay, go play in the waiting room. I’m going to talk to the doctor about what we’re doing. Dr. Corinne Catarozoli 00:14:23 Yeah, I think it’s reasonable for parents to have some alone time with the doctor if they have questions that they don’t feel yet prepared to discuss with their child, And it it’s helpful just to give their child some context for what’s going on when they’re not in the room. But certainly as kids get older into adolescence, we want them present. We want them having the opportunity to ask their own questions. Dr. Corinne Catarozoli 00:14:49 We even want them having an opportunity to meet with their physicians without their parents present, so they can discuss any questions that they have on their. Dr. Kate Herts 00:14:58 Asking. Yeah. Dr. Corinne Catarozoli 00:15:00 Yeah. So it’s scaffolding right. We’re we’re training and teaching them to have some role in their own illness management. So then when they do launch and go to college, it’s not suddenly their first time where they are trying to manage all of this on their own while also adapting to a new environment and, a new social scene. We really want that to be built up over time. Dr. Kate Herts 00:15:25 I think that’s such an important, incredibly important point. And I definitely have seen in a lot of my work that freshman year of college is a particularly vulnerable situation for kids, especially as they leave home. Maybe they’ve had type one diabetes since they were eight years old and they’ve managed it. But mom always called the insurance company, and maybe they’re in college in Boston and they grew up in New York, so they’re not near their provider. And it actually, in my experience, I did some research a while, actually, in college, in my senior year, where I looked at loneliness levels among freshmen with chronic illness versus their healthy peers, and their loneliness levels were way off the charts higher. Dr. Kate Herts 00:16:08 And in qualitative interviews, I found that a lot of them had relapses. So if it’s an illness that can have exacerbations like maybe their agency would get more out of control or their blood sugars weren’t as normal. maybe you’d have a, we call it a flare in colitis. Maybe you’d have worse migraines than normal. Because what happens in young adulthood and especially freshman year of college, okay, you want to be a normal kid, right? So you want to drink. You want to stay up all night? You want to eat pizza, and all of that is totally fine if you’re 18 and healthy and has a different effect. Unfairly so. But factually, if you have a chronic illness. So I that scaffolding is such so so important. Yeah. Dr. Corinne Catarozoli 00:16:50 Yeah I think there’s I tell parents there’s an age appropriate way to explain anything. Let’s take surgery for example. You might be tempted, a parent might be tempted to just, sort of not go into the details or explain what a surgery is. But, think about not having that information and how that will feel to a child who’s kind of unprepared, and explaining that what’s going to happen. Dr. Corinne Catarozoli 00:17:21 And again, the level of explanation will depend on their cognitive abilities. But there’s I’ve yet to find something that we can’t put into kid terms. Dr. Kate Herts 00:17:30 That’s awesome. That’s so that’s like, maybe that should be like a bumper sticker that you hand out, because I think that’s like such a big fear and it’s so incredibly important. Yeah. Dr. Corinne Catarozoli 00:17:41 And the things that kids can understand. So it’s not like one day you just sit down on the couch and have this big discussion about this medical diagnosis that they have, connecting it to a medication. They have to take a doctor’s appointment that they had an experience that they remember. Remember the time we went to the hospital because your belly was hurting? That did it. And it continues from there. Dr. Kate Herts 00:18:06 That’s awesome. Yeah. And, you know, I think that the I something that’s like coming up for me is I know that I worried about so many things that I never talked to my parents about as a, as an adolescent and young adult. And I think that a lot of times when I treat parents now, I will hear, well, I don’t want to introduce the idea that they could need surgery because then it will create a worry in their mind. Dr. Kate Herts 00:18:29 Whereas if I talk to the teen, they’re saying, I think I’m going to have surgery and die, and that’s my real problem. But I can’t tell my parents because I don’t want them to worry I’m going to die. And so I my take on it and I’d be curious their thoughts on this and my take on it, is that if you’re thinking of it, they’ve thought of it. And there’s nothing that’s off limits to talk about. Yeah, but we’re not going to. Dr. Corinne Catarozoli 00:18:52 Plant worries in kids heads, especially kids that have access to Google. And when they do, we usually know more than I do about the potential treatment pathways for any given disease. So it’s, they’re gonna find out what’s out there. And, we want them to trust their parents. So if they’re parents, if they say, you know, I was diagnosed with diabetes, is this going to get better? And if their parent says, yeah, maybe it’s even though we know that it’s going to be around for their life, their whole life, that is going to later kind of come back to haunt that relationship, to feel like they weren’t honest. Dr. Corinne Catarozoli 00:19:40 And I see a lot of young adult or even adult patients now who have that experience of my doctors didn’t tell me the whole story, or my parents didn’t tell me the whole story. And again, it’s all so well intentioned because nobody wants to give upsetting news to a young child or an adolescent. but really, the idea here is that this is part of building resilience, building their complete knowledge of their own body and medical history and their own wellness. So even though it might feel harder in the moment, in the long term, it’s definitely in service of their wellbeing. Dr. Kate Herts 00:20:19 Yeah, I think that’s so reassuring and so, so helpful for everybody to hear. And, if parents want more resources around this, where should they go to learn how to put it into kid terms or learn how to aid that transition? Do you have any resources you can share? Thoughts about how they could connect with you or your team to learn more about them? Yeah. Dr. Corinne Catarozoli 00:20:42 Yeah. So our team here often meets with parents only to do these sort of consultations and to provide guidance. Dr. Corinne Catarozoli 00:20:50 I’ve met with many parents across our different medical divisions to help them practice and figure out what language they want to use, and I’ll meet with them for time. So I might start when their child’s a baby and help them thinking about adjusting to this diagnosis. And then when there’s a child, when their child’s too, we start to layer in some information about, you’re taking this medication every day to help your heart. And then when there’s terms for we, talk about what that means a little bit more and just keep developing their understanding. So, parent guidance and consultation on this is so important and just parents managing their own anxiety because I think they often catastrophize about the reaction of being worse than it really is. and, and underestimate their kids ability to cope. Dr. Kate Herts 00:21:49 Totally. No, I think that’s that’s an incredible service that you have. And, at Weill Cornell, where where you are, where you’re, you have a whole team there doing this that you’re heading, which is incredible. how someone access those services, are they automatically built into the care for illness? Are they something you have to say? I need to see a psychologist or direct me to doctor care solely. Dr. Kate Herts 00:22:13 How can they find this? Dr. Corinne Catarozoli 00:22:15 So any patient that’s seen here in any of our pediatric medical subspecialties. So these are divisions like endocrinology, cardiology, neurology, gastroenterology, on and on. Has access to visits with our psychologists so they can ask a physician. Oftentimes physicians directly refer families who they feel like will benefit. Families can request it themselves. We have certain clinics to like our clinic, where we just have a psychologist on site to see patients who are coming in for chemotherapy on the day that they’re getting treatment. So it’s sort of a one stop shop and makes access really easy and available for them. and same with our inpatient units. Any child that’s medically hospitalized here on any of our units, on our ICU, in our ICU, we have psychologists who are available to come bedside and to work with the patient, work with their families. Wow. Dr. Kate Herts 00:23:10 That is that definitely does not exist when we were growing up. So I’m so excited to hear about that. And I’m sure that other hospitals are starting to do this too. Dr. Kate Herts 00:23:20 I know that if you’re not in New York City and you go to another hospital, always ask at your appointment, like, is there a psychologist or a mental health provider I can talk to? I have these questions about for my child or for myself. And I think that, you know, you and I created are trying to to get this everywhere. And I know a lot of other people are working on this too. So if you don’t know, you can’t ask. So I hope that this, that this will help you guys really find amazing services like this and current. I want to pivot us if it’s okay, to speaking to the therapists out there, because I know that a lot of psychology trainees that I’ve worked with, other psychologists that we’ve both worked with, who are therapists that we both work with, who don’t specialize in treating patients with chronic illness, have, I think, some fear around it and will tend to refer those cases to us instead of seeing them themselves. And the results, I think, is there are a lot less providers who are willing to do this work. Dr. Kate Herts 00:24:17 So what advice do you have if a psychologist who’s maybe a generalist or treats anxiety disorders but doesn’t specialize in chronic illness, if they have a patient come in with a chronic illness, how do they decide whether they need to refer out or not, and how do they help that patient? Dr. Corinne Catarozoli 00:24:35 That’s a great question, and I think this does happen a lot. I will often get referrals, for patients who have epilepsy or Crohn’s or a concussion because of the medical piece of it. And truthfully, I always tell psychologists that if you have background in cognitive behavioral therapy, if you can treat an anxiety disorder, you can treat this too. So really this is all about adapting our tried and true CBT interventions and just tweaking them a little bit to have our target be medical, whether that’s a physical symptom, pain, worries about disease progression or symptom flares versus maybe a, you know, good old fashioned social anxiety worry. So it’s really the same approach, but we’re just changing a little bit what we are targeting, what our target symptom is. Dr. Corinne Catarozoli 00:25:34 So I really encourage this, sort of trans diagnostic model where you don’t need to be an expert in any one disease category in order to treat a patient who has that condition. Dr. Kate Herts 00:25:49 I could not agree with that more. And I think that that’s been actually the most powerful part, not just of my own illness experience, but also of my professional experience as a health psychologist is seeing that over and over and over again, that patients and parents feel so alone and so siloed and like very few people can understand their experience or help them with their experience. And I think the world of support, whether it’s a psychologist or friends or other parents, is actually so much bigger if you think of it trans diagnostically and truthfully, if you have a kid with type one diabetes who’s ten, you have a lot more in common with the parent of a kid who has Crohn’s disease in his ten, then you think you do almost everything. Actually. Dr. Corinne Catarozoli 00:26:34 Yeah, I think there are universal themes and experiences that patients and families go through. Dr. Corinne Catarozoli 00:26:41 You know, themes of feeling different, feeling alienated, feeling excluded, depending on the visibility of an illness. Themes about anxiety around appearance. And so all of these constructs are things that any CBT therapist or CBT provider, can address in the same way that they would treat panic disorder or social anxiety disorder or OCD. You know, we have a real focus on functioning, and we use cognitive restructuring and exposure therapy just in the same way that we would with another condition. Dr. Kate Herts 00:27:19 I think that’s so helpful, and I’m so glad that you’re getting the word out. And I could not agree more. And I want to get your take on just one thing that I do in my practice that I’m that is a little more acceptance based, and maybe we can talk a little bit about the acceptance side or the like, okay. Balancing the cognitive restructuring around the fear that is too high or that is not relevant versus true threat of I have to have a lung transplant. And that is scary and it’s appropriate to have that threat. Dr. Kate Herts 00:27:52 I’m thinking particularly of a lot of patients that I see in their 20s or their 30s, who have had the experience of being repeatedly invalidated about pain they’re experiencing and told they’re kind of a hypochondriac or they’re, overly anxious. They’re quote unquote crazy. I hate that word. But patients say it all the time. that understandably. Because that’s what they’re going into the doctor and saying I’m in tremendous pain and they’re saying, go see a therapist. Dr. Corinne Catarozoli 00:28:23 Yeah. Dr. Kate Herts 00:28:24 And what’s the therapist do if there’s no medical diagnosis? But your tummy hurts, right? Yeah. Dr. Corinne Catarozoli 00:28:30 Unfortunately, this is such a common experience with pain where if there is no biomarker that a physician can point to as an etiology, it becomes this is psych or this is not medical. And there is sort of an old school way that pain used to be talked about. And I think it’s changing, which is promising, but it would sound something like this is not medical. Go to psychiatry or psychology. This is in your head. You’re doing this to yourself or even, you know. Dr. Corinne Catarozoli 00:29:07 And what is intentioned is more good news. Great. This is wonderful. Your test for normal and which. Dr. Kate Herts 00:29:15 We hate to hear, right? Like, it’s like if my tests are normal, how are you going to help me? And my tests are normal and I’m in so much pain. But you’re sending me to a therapist? Dr. Corinne Catarozoli 00:29:26 Yeah. So what happens with that kind of language is patients feel misunderstood. They feel like they’re not being listened to. They feel like they’re being questioned. So they either will go try to find another physician or go without care. and it it it doesn’t help them in any way. So I’ve been really helping sort of thinking about shifting the dialogue towards my what I’m calling the new school way of thinking, which is more about believing patients and validating your pain is real. Your symptoms are real. They sound extremely disruptive and distressing. And we have a non-pharmacological treatment for these symptoms called cognitive behavioral therapy. Now imagine if you’re a patient receiving that information. Which way feels more hopeful? Which way feels more promising? Which way? Which way do you feel more understood? You know, being told that there’s actually an option for this is so much more hope. Dr. Corinne Catarozoli 00:30:33 Inspiring. It’s true. We have. We have good evidence based treatment for pain. Dr. Kate Herts 00:30:39 I think I love this new school way of thinking, and I think that that is just exactly the words you said are so important, right, I believe you. You are in tremendous pain. There is a I’m sure there’s a biological source. I do not think this is just anxiety. Medicine has not figured out what it is yet, but I believe you and I’m going to help you figure it out. What it is. And I’m also going to treat the co-occurring anxiety that you have so that your experience of this is less fraught emotionally, which is so different than saying, well, it’s all in your head. So we need to like, help you not believe that in just know that you’re healthy because everything’s been disproved. Yeah. Dr. Corinne Catarozoli 00:31:24 Yes. I think we need to align with patients complaints and what they’re coming in with, the symptoms that they’re experiencing, whether it’s a migraine or abdominal pain or pain following a, you know, persistent pain following a concussion. Dr. Corinne Catarozoli 00:31:40 We need to believe them and understand that what they’re experiencing is real. And I think presenting CBT as a non-pharmacological option, we obviously have non firm options for a lot of we do. yeah, a lot of medical conditions. If you go see a neurologist about migraines, they’re going to talk to you about medications, but they’re also going to talk to you about hydration and sleep and yes, stress. So let’s add this to the repertoire of options. Dr. Kate Herts 00:32:10 And evidence based. Right. We know that this helps. We know that this will do this for you. We know. And you know I think that if if our audience has one takeaway as therapist and even as parents and friends and loved ones and spoons, believe yourselves, I think that it’s believe patience because more. There’s no harm in believing somebody’s lived experience. So thank you so much for being here. And I think that’s like the note I would love to end on, because I just think it’s so incredibly important. And you’ve really given so much incredible information here today. Dr. Kate Herts 00:32:49 And I’m just so grateful to get to have this conversation with you. And yeah, thank you. I hope that you’ll come back and talk to us again. Dr. Corinne Catarozoli 00:32:57 Absolutely. Thank you so much, Kate. I’m so excited you’re doing this podcast. This is going to be such an amazing resource to so many families. Thanks for having me. Dr. Kate Herts 00:33:05 It is totally my pleasure and my honor. Okay guys, so that is our hot tea for today. I hope you really enjoyed speaking with Doctor Karen Carter as much as I absolutely did. And so we will put in the show notes and on our website a few resources to help with transitions, with talking to kids that doctor N will put. How to get to Cornell if you’re interested. So I hope that you all just gives you some food for thought. Send this to your loved ones, anyone you think should hear it and have a great week. We’ll see you next time. Thanks for listening. I’m Doctor Kate Hertz, and for further details on today’s tea, be sure to check out the show notes. Dr. Kate Herts 00:33:56 To stay connected or carry on the conversation, head over to my website at the teaspoon.com or drop me a DM on Instagram at the teaspoon pod. Tune in next week for another serving of piping hot tea. I’ll catch you then. This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical or any other professional information. If you want a professional, you should find one.