Jen Lyman:
Welcome to Cerebral Palsy Health. I'm your host, Jen Lyman. And this is going to be another conversation that counts with experts who care. This month is Disability Employment Awareness Month. And we have two guests, David stoner, and Sarah Storck, who I'm very excited about. And they're going to help us better understand issues surround disabilities and employment, especially as it relates to vocational rehab, Ticket to Work, support during employment and mechanisms to help ensure that you can keep your benefits even while earning an income. So I hope you guys enjoy the show.
Jen Lyman:
Welcome to the Cerebral Palsy Health Podcast. We dive deep into health topics that impact people with cerebral palsy, such as stem cells, genetics, neuroplasticity, exercise and fitness, nutrition, accessibility, issues that could be confusing or controversial and those that offer hope, but might not live up to the hype. I'm your host, Jen Lyman. Join me in stations with leading experts as we separate fact from fiction, tackle tough to understand topics and try to shed light on how best to maximize and optimize health, participation and quality of life for those with cerebral palsy.
Jen Lyman:
So I'd like to welcome Sarah Storck and David Stoner. Sarah Storck is the Founder of Next Step Success, LLC. She is a certified rehabilitation counselor since 2019 and a certified work incentive specialist since 2015. She has been in the field of vocational rehabilitation since 2013, and worked as a job coach and benefit specialist with private companies and as a job placement specialist with a state vocational rehabilitation agency. Welcome Sarah. And I'd like to welcome David Stoner. He's a contributor and content curator for cerebralpalsyresource.org, a product of the Cerebral Palsy Foundation. David received his bachelor's degree in journalism and digital communications from the University of South Florida in 2018. David was born with cerebral palsy and has used a wheelchair along with other adaptive technology to make sure that he remains active and lives life to the fullest. And I have the privilege of working with him at Cerebral Palsy Foundation, and I enjoy it tremendously. David, welcome to the show.
David Stoner:
Thank you for having me.
Jen Lyman:
I'm thrilled to have you on the show and I'm thrilled to have you too, Sarah. So Sarah, why don't we just jump right into it? Because kind of the reason why we did this show is because David came to Cerebral Palsy Foundation through a program that was through vocational rehabilitation and it was such a neat process that, it made me think, "Gosh, we really need to tell other people about this and about how all this works, so that other people can benefit from this." So can you first begin by telling us a little bit about what is vocational rehabilitation?
Sarah Storck:
Sure. Well, thank you so much for having me today. First of all, I'm excited to be here as well and happy to share some of my experience with you all. So vocational rehabilitation is really a broad term for the process of helping folks with disabilities to obtain and maintain successful and meaningful employment, whatever that might look like for them. It can involve career counseling and exploration, goal setting and service planning, vocational evaluation and assessment, education and training, job searching and placement services, job accommodation planning, benefits, and work incentives advisement, self advocacy, support, and referral for, and coordination with other services, and the list kind of goes on. Some common places you might see vocational rehab, voc rehab, VR. You might hear it called many different things, but some really common places to see that service is in state agencies, veterans agencies, workers compensation departments, schools, and even in private organizations. So it can be for folks who've never worked before, or folks who might be reentering the workforce at another point in time.
Jen Lyman:
Can I ask a follow up question? How is it funded? Is this a free service for people?
Sarah Storck:
Good question. So that is going to depend greatly from state to state, and from company to company. There's a couple of different ways that someone can access VR services, but it really just depends.
Jen Lyman:
Okay.
Sarah Storck:
Sometimes it's funded by federal, or state, or local funds or grant funds. Sometimes there is a pay percentage for folks, but that really is in my experience, pretty rare occasion.
Jen Lyman:
All right. So David, can you tell us a little bit about your experience with vocational rehab?
David Stoner:
Well, my experience with VR really came from, I graduated at college and really had no idea how I was going to work. And my girlfriend at the time, now fiance, has great experience with VR and she told me, "You need to get involved with this service, they can provide you technological influence to work, they could help you find your job. And I did. And ever since, I've been working with Sarah, who's also my job coach and she found me the job with CPF through the service that VR provided.
Jen Lyman:
So what did that process look like for you, David? What did you and Sarah do to identify what you wanted to do, what your skillset was, and then identify the organization that you wanted to work with? How did that look? What was that about?
David Stoner:
I started by just writing samples of what I could do for Sarah, so she can get an idea of what I was capable of. And then we just started sending those out to companies and organizations I was interested in working for. And I just happened to write a piece about me and my girlfriend's dual CP relationship and sent it to the Cerebral Palsy Foundation. And you guys loved it, and we went from there.
Jen Lyman:
Exactly. It was a fantastic article. I really did love it. And I still love it. I'm looking forward to follow up to that one that we talked about yesterday.
David Stoner:
Yeah.
Jen Lyman:
There was another piece to that process that I recall you telling me about that VR helped you with, and I think there were some technological components perhaps that VR was able to help you with?
David Stoner:
Yes. VR supplied me with a iPad Pro and a mount system that I do most of my work on, that the iPad through the mount system, can mount right to my wheelchair. And actually I have another request out to VR as we speak for voice recognition software, so I can type out my articles more on my own. So that's ongoing.
Jen Lyman:
I see. And as far as that process goes, is it pretty quick, or does it take a little bit of self advocacy on your part?
David Stoner:
It takes a little bit of self advocacy. Like I'm probably going to give it another week and then email my counselor. VR can be a slow process. So the old adage, "The squeaky wheel gets the grease," really applies here. My advice to anybody engaging in the VR process is, be vocal for yourself, say what you need and keep on your counselor to make sure you get it when you need it.
Jen Lyman:
And is this stuff for free? Are you getting the... Was the iPad Pro and the mount and this new software all free to you?
David Stoner:
Yes. It's all paid for through VR.
Jen Lyman:
So David, can you tell me about your early experience with VR? I think in the past you said that your fiance actually accessed VR a little bit earlier than you did. And I was hoping that you might be able to shed some light on that for me.
David Stoner:
Well, the problem that I had is VR didn't really explain themselves and what they're capable of for people. They came to my high school and said, "He's eligible for VR." But didn't really say what it could do, what it was capable of. They just said, "Get on it." And me and my parents were sitting there thinking, "Why did he need vocational rehab? He's just in high school." We were about five, six years away from a job. We had no idea what it was capable of for me. I could have gotten my books paid for, for college. I could have gotten my college paid for, but VR doesn't really advertise what they can do. So my best bet, and I could've done this when I was back in high school, it's do as much research as you can and find out what VR can do.
Jen Lyman:
That's great advice for people. So Sarah, what are, kind of moving forward, and I've got a follow up question for David, but I'm going to ask you first. What are some of the benefits for employers to hiring individuals with disabilities?
Sarah Storck:
That's a really great question. And I think hopefully I can provide a little bit of a unique approach to answering this question because not only have I been a workforce development specialist working with employers, trying to help them understand what it means to hire someone with a disability, what can they do, how can they attract the talent, things like that, working with the individuals with disabilities to help them identify employment that's going to be satisfying to them, that matches their knowledge and skills and abilities and all that good stuff, but I'm also now an employer who hires people with disabilities. So I kind of can see it from all sides of the proverbial coin. But I think that some of the benefit are of course, that you have a really talented workforce, right? People with disabilities are people too, and they have unique experiences and knowledge and background, and can bring a lot to the table in general.
Sarah Storck:
Diversifying a workforce in my personal opinion is always a good idea. The more kind of variety you have at the table, chances are, the better off things are going to be ,I think. You have different opinions and different lived experiences that can all create a really cool environment and hopefully put out really good work for whatever your business is. And then of course, if you want to get really technical about it, there's a lot of benefits for employers, with things like the taxes, or whatever. There's some incentives from the government and things like that for employers to hire diverse candidates. So there's those kinds of things too.
Jen Lyman:
And can you tell me what industries or fields you've seen that have been kind of the most open to hiring individuals with disabilities?
Sarah Storck:
That one's kind of more hard to answer. I feel like of course federal, state and even local agencies tend to be very open to it partially, because they have a certain requirement or incentive too, federal contractors as well. But also, I really can't say specifically because I've seen so many industries be open to it. And I think in my personal experience, of course, I can't speak for everyone, but it really more depends about the people than the industry. It's more about folks being open to listening and folks being open to trying something possibly that's a little bit different than they've tried before. I will say, in my experiences, VR as a field kind of tries to market to the high growth industries, of course. Manufacturing and logistics, healthcare, information technology, those are kind of some of the really big industries and fields that are ever growing, at least here in the US.
Sarah Storck:
And so I think a lot of the, sorry what's the word I'm looking for? A lot of the boots on the ground are going after employers. But also on a broader level, most state agencies have like business development specialists that are constantly working with employers, maybe they're attending round tables with a bunch of companies in one field, they're attending chamber of commerce meetings, and trying to help educate and help people see the benefits of hiring folks with disabilities. So I think it's kind of growing everywhere, hopefully
Jen Lyman:
That's great to hear. From a personal perspective, I haven't seen as many people with disabilities in the educational field and in the healthcare field. And I feel like they're the ones who actually work with a lot of people, are educating children with disabilities and are taking care of individuals with disabilities. But then from an employment perspective, I never see people with disabilities actually as the educators, or as the physicians, or the therapists. And that seems a little odd to me. So I would love to see growth in those fields. That seems like it would be what a great role model to the children with disabilities growing up to have a teacher who's a wheelchair user, or who has cerebral palsy. I just think that would be so incredible to have more role models in these areas where the kids are spending a lot of their time with those kids with children or children with disabilities are spending so much of their time. So do you have any suggestions for employers perhaps? To get people with disabilities or hire people with disabilities? Any tips?
Sarah Storck:
At the risk of making maybe people laugh? Don't be scared. I think there's so much fear and understandably for everyone. Of course people, traditionally, research has shown that employers often think, or fear that maybe there's some sort of liability there, or that maybe they won't be able to give and the accommodations that they need, or that it will cost their business a lot of money, or like people just don't have experience with it, so they don't know. And of course, like most things in life, sometimes the best way to learn is by doing, and there's a lot of support for employers out there too, just like there is for the individual with the disability themselves. So employers are absolutely also able to access vocational rehabilitation providers and get some education and training from them. There's almost always a team, or at least a person, but often a team that has already ready trainings to give to entire businesses, or cohorts of CEOs, or whatever the case may be. But I just always think education is important, and giving things a try is important, but yeah.
Jen Lyman:
I'm with you. So, David, what are some of the barriers to employment that you've experienced?
David Stoner:
Well, I was so focused on school and getting through school that I dictated all my papers and stuff to my mother and other people. When I got done with school, I was so hyperfocused in that scholastic mode that I was like, "Okay, well, that way I did my school probably isn't going to work in the work role. So how are we going to do this?" And getting an iPad, and amount and voice recognition software is expensive. Probably not something that I could afford on my own. So I was like, "How am I going to go about getting all this stuff I need?" And luckily when I'm at Shelby, my girlfriend, she was like, "Dude, you need to get on VR. VR can pay for all this stuff you need." And then that burden of not knowing how I'm going to work was significantly lessened.
Jen Lyman:
Well, that's good to know. That's great to know.
Sarah Storck:
Could I jump in on this?
Jen Lyman:
Absolutely.
Sarah Storck:
If that's okay.
Jen Lyman:
Yeah.
Sarah Storck:
So I've heard you both talking a little bit about VR being able to help pay for some costs. And of course, that's true, but one of the rumors, or misconceptions that we often have to fight as VR professionals is that, you're not just going to walk in and get that thing, whatever it is that you want. Yes, of course, that's the point of VR, is to help folks be able to have what they need to be successful in employment. But number one, it usually has to be tied to employment. So I think that's important for people to hear. But also, every case is different, the rules and regulations are different. It depends on the need for the thing, it depends on the cost for the thing. So I just want to add that little grain of salt that it is a process, it's not just, and I don't think that either of you think that, but just important to note that it doesn't necessarily just automatically mean you can get all of the things that you want necessarily, it's a process.
Jen Lyman:
Yes. Thank you for that clarification, Sarah.
David Stoner:
Like for example, when I needed the tech, VR sent a vendor from the University of South Florida Technology Program, Adaptive Technology Program, and they sat down with me and basically said, "What are your employment goals? And what do you need to fulfill them?" So I basically said, "I'm a writer. I would like to get my writing out as independently as I could. What can help me with that?" And that's how we came upon the iPad Pro and the mount system. So like Sarah was saying, I didn't just say, "Hey, I need an iPad." I had to sit down with somebody and prove that I needed an iPad.
Jen Lyman:
Exactly. So why don't we shift gears for a little bit because the other part of all of this is that, there's a lot of people who have misconceptions about their ability to work and they think that if they actually are employed, they're going to lose their benefits, or they can't work because they're disabled for some reason. And Sarah speaks so eloquently about all of this. And I can't wait to shift gears and talk about this. So I didn't know which you'd like to start with, perhaps the WIPA projects, or would you like to talk about Ticket to Work first?
Sarah Storck:
Either way, but if you see my face just lit up like a kind a candy store, because this is-
Jen Lyman:
I know.
Sarah Storck:
... this is my favorite topic, and this is actually, kind of the meat of what my company does, is talk with folks about their benefits and working and all of the intricate stuff they need to know there.
Jen Lyman:
Exactly.
Sarah Storck:
And so I might answer a couple of your questions in one potentially. But the Ticket to Work is a program through Social Security, for anyone who gets either SSI, which is Supplemental Security Income, or any of the types of SSDI, which is Social Security Disability Insurance. Anyone ages 18 to 64, who wants to work, can access services through the ticket to work. So earlier you were asking about like funding sources, Ticket to Work is one of the funding sources that allows an approved employment network to provide services to an individual with a disability to help them prepare for, obtain and maintain employment.
Sarah Storck:
And that can involve a lot of the things I mentioned earlier, it can be through any of those providers, state, public, private, nonprofit, the list goes on. And some of the services under Ticket to Work include those benefits and work incentives and financial counseling. So you asked about WIPA projects, so there's a lot of terms just like there always is, it's alphabet soup, right? So WIPA projects are a cooperative agreement with Social Security directly. They're a community based provider of work incentives, counseling, coordination, whatever you want to call it.
Sarah Storck:
So anyone who gets benefits or who's trying to apply for benefits possibly, could access services through them, no cost to the individual, of course. And those are kind of standalone, there's usually one or two, maybe three a state, depending on how big the state is. And those are separate kind of on benefits, counseling services, you might access through the Ticket to Work or through VR. Okay?
Jen Lyman:
Okay.
Sarah Storck:
So there's like a lot of different funnels. Possible and a lot of it crosses over. So it's almost like you need a map, a little spider web map to keep things straight.
Jen Lyman:
Got it. And with Ticket to Work, once you are employed and I understand that there's certain thresholds of how much money you can make in different states have different thresholds, but can you give us some ballpark figures and [crosstalk 00:25:25]
Sarah Storck:
No, I can't.
Jen Lyman:
No? Okay.
Sarah Storck:
I can't, because number one, you're right. Things can potentially vary state to state, but also it truly is such an individualized answer that it wouldn't really be fair of me to give a broad answer and keep perpetuating the myths that are out there.
Jen Lyman:
Okay.
Sarah Storck:
One of my least favorite things that I hear people say is, "Well, I can't work more than in 20 hours, or I'm going to lose my benefits." Frankly, it has nothing to do with the hours that you work.
Jen Lyman:
Hours. Yeah.
Sarah Storck:
It has everything to do with the dollar amount of money that you make, it's different for SSI versus SSDI, they get affected differently by employment, they have different safety nets around them. So generally speaking, there's things like a trial work period, there's things like a student earned income exclusion for folks who are in school and working and get SSI. There's so many things that people don't always know about, usually don't know about, that make accessing benefits counseling really important. I'm a hundred percent on a soapbox about it. So definitely, an important thing to access.
Jen Lyman:
Got it. All right. So the next question, I know you love this one, is can you tell us a little bit about ABLE accounts?
Sarah Storck:
Yes. ABLE accounts are definitely some of my favorite things. So one of the problems with benefits, or most folks would consider it a problem, is that there's resource or asset limits associated with them. So SSI, Medicaid health insurance, Medicaid waiver services, food assistance, housing assistance, all of these public benefits programs of course, have income limits, how much money comes in each month, but then they also have resource or asset limits, how much money do you have access to at any given time, whether that's cash, or in a bank account, or in investment accounts or in property, aside from your primary home or vehicle.
Sarah Storck:
So for most of those, that's $2,000 for an individual or $3,000 for a married couple. And unfortunately that figure hasn't changed in decades. Like 30, 40 years, at least those numbers haven't changed. So they've not necessarily adjusted with inflation, or rising cost of living, or wages or anything like that. So unfortunately, if you have some of those benefits and you have $2,001, you might have those cutoff. So ABLE accounts are a solution to that potential problem, in that, money in those accounts doesn't count towards those resource limits for those programs. So people can actually save money, they can invest money, they can spend money with, without it affecting that resource limit or eligibility for those really critical programs that they need. So hopefully, it allows people to have a little bit better financial stability, and really be able to make some progress in their goals, I guess. [inaudible 00:28:42].
Jen Lyman:
So how much money can you put into an ABLE account every year?
Sarah Storck:
Really good question. So most states have an ABLE account program. And so the numbers vary a little bit depending on the state's program. But generally speaking, anyone can contribute to an ABLE account. So the individual with the disability, their family, their friends, a scholarship, a grant, wherever the money might come from, inheritance, like that can contribute up to 15,000 per year. Okay? If that individual with the disability is also working, they can now, this just recently changed, they can now contribute a little over $12,000 a year on top of that $15,000 a year.
Jen Lyman:
So you could basically direct deposit your paycheck into your ABLE account?
Sarah Storck:
Sure. Can direct deposit your paycheck, your Social Security benefits check, if you receive one...
Jen Lyman:
That's a great way to save money.
Sarah Storck:
Mm-hmm (affirmative). Absolutely.
Jen Lyman:
And the money in the ABLE account, what can you spend it on?
Sarah Storck:
So, that's a really good question. And the answer's kind of vague, and I think that's on purpose. So you can spend the money on any qualified disability expense.
Jen Lyman:
Oh.
Sarah Storck:
And I put that in little air quotes. Because it's really not specifically defined. But it's anything that is going to help promote the health, and wellness, and quality of living for the individual with the disability.
Jen Lyman:
That's great.
Sarah Storck:
So that could be basic living expenses, housing, clothing, toiletries, stuff like that. Could be education and training, transportation, health, wellness, medical stuff, could be assistive technology, really pretty broad.
Jen Lyman:
So there's not, I'm sorry to interrupt you. There's not a caveat in there, where if somebody has a Medicaid waiver, and has Medicaid, for example, and Medicaid will pay for an adaptive toilet in their home, or some sort of home modification, then the ABLE account's not allowed to pay for that. It can-
Sarah Storck:
No. Not as far as I know.
Jen Lyman:
Okay. I know there's some... I've read with special needs trust that sometimes that occurs. That if Medicaid would pay for it, then the special needs trust is not allowed [crosstalk 00:31:05].
Sarah Storck:
Right. So I don't know if you want me to tackle that question or if you want-
Jen Lyman:
I would love for you to tackle that.
Sarah Storck:
Yeah, it shows.
Jen Lyman:
Because I know that's on my list about the...
Sarah Storck:
Yeah. So, ABLE accounts and special needs trusts are very different. They do have some similarities in that it's a, it's a place to protect money, right? Without it removing the person's eligibility for benefits in the meantime. Special needs trusts are really complex legal agreements with Social Security and the individual and whoever kind of the benefactor is. I will be honest, I don't have a ton of experience with special needs trust for that reason. That's not something that we as benefits practitioners would necessarily handle. We of course, know a little bit about it, but they're all so different and so specialized, but essentially it often involves like what happens to an estate, or money, or property after someone passes? If they're leaving it to an individual with a disability? So there's a lot of rules about when, and where, and how that money can be used.
Sarah Storck:
There's sometimes rules about what happens to that money in the account, in the event that the individual passes or things like that? Can Medicaid take the money to pay back, or whatever. And all of that is a little out of my realm of expertise. So I certainly don't want to talk too much about it, but where they differ from ABLE accounts is probably largely in their flexibility. So ABLE accounts have that really broad qualified disability expense title, but the individual gets a debit card and they can link bank accounts to it, and they can autopay their bills with it. And so it's really flexible and they have access to that money when they want it and when they need it. So-
Jen Lyman:
That's exciting.
Sarah Storck:
... that's probably the biggest difference.
Jen Lyman:
That's really exciting. And David, I know you've had an ABLE account for a while, and I wanted you to chime in a little bit about your experience with it.
David Stoner:
So I've had it for about two and a half, maybe three years, and we just been filling it and I haven't touched it. And the reason for that is well, our goal is to have enough money in there to when I need my next wheelchair accessible van, I have enough money to pay for the van out of my ABLE account.
Jen Lyman:
And I think that's fantastic. I love it.
David Stoner:
What ABLE account means to me is rather than as my van now have my dad's name on the account, because my name is on ABLE account, therefore the money came from me, therefore, the fan title's in my name, so I can have whatever caregiver I need to drive it without having my dad be liable if there's an accident.
Jen Lyman:
That's really cool. That's pretty awesome. And way to make use of that money.
David Stoner:
It gives me a sense of ownership and a sense of, "Wow, I did this for myself." And that's really meaningful.
Jen Lyman:
Absolutely. Well said.
Sarah Storck:
Yeah. That's awesome. And David, thank you for sharing that. I always love to hear, I guess, testimonials or success stories, or whatever you might want to call them. And I would encourage everyone to go online to the able national resource center, or to your specific state. You can look up the ABLE provider in your specific state. I don't think every state has one quite yet, but you don't necessarily have to have residency to get a state's ABLE account, but there's so many stories like David's, or of course, different from David's too, but about how folks are using these ABLE accounts, what means to them, how it's helped them. So I can't encourage people enough to learn more about those.
Jen Lyman:
Absolutely. And Sarah, how can somebody contact someone like you?
Sarah Storck:
Yeah, that's a really good question too. So I wear a couple of different hats, so I'm going to talk about a couple of different things people might access. So if someone's looking for VR in general, vocational rehabilitation services, a pretty good place to start is by looking up your state agency and contacting them, or if you're someone who's in school, of course, talking to your student disability services department or whatever it might be called, if you're an individual who gets Social Security benefits, you can go to the find help directory on the Ticket to Work website, which is choosework.gov I believe. Going to misquote myself there on that. And then-
Jen Lyman:
I'll make sure it's in the show notes.
Sarah Storck:
... it's choosework.ssa.gov.
Jen Lyman:
Got you.
Sarah Storck:
There we go. And then if you're looking for a benefits counselor, specifically, you could of course, access the WIPA project through Social Security, or you can find a benefits and work incentives advisor through your VR provider. You can always ask your VR counselor or other case manager type of person for benefits services. And I'm, again, just can't encourage people to do that enough, I really think knowledge is power.
Jen Lyman:
Absolutely.
Sarah Storck:
As cliche as that phrase might be, it's pretty true in this case.
Jen Lyman:
And I will make sure that all of those resources are also attached to the show notes and on the CP resource.org website. And then I've got a final question for each of you. What do you think will have the biggest impact on employment for people with disabilities in the future? Sarah, you go first.
Sarah Storck:
So this is a big question, of course. And I'm sure David, or I could both go on for a pretty long time with thoughts and ideas about this. But I think the biggest impact probably is going to be just continued conversation. We've mentioned it a lot throughout this conversation that knowledge is important, and understand is important, and individual individualization is important. So just folks continuing to learn, and ask questions, and talk about all of these opportunities, I think. Whether that's individuals, providers, employers, all of the above.
Jen Lyman:
Awesome. David, what do you think?
David Stoner:
Just be aware that you can work, be aware that there are these infrastructures set up to where you can get gainful, fulfilling and lucrative employment and still keep all the benefits that you need. I was scared. That was one of the things that was scary to me, because I knew I had this boatload of money that I had to have through my state, the State of Florida, to pay for my care. And I was like, "How am I going to work and feel productive and be able to keep all that?" Well, there's programs like, Social Security, like VR, that can show you the way and show you the path to do so. So just because you have disabilities, if you're capable of working, get out there and try to work.
Jen Lyman:
That's awesome advice. Thank you so much. Thank you both so much for being on this show. And I hope everybody found this to be a conversation that counts with experts who care. And I want to thank my producer, Greg Tilton, who makes us sound a little smarter and a whole lot better. Have a great day everybody.
Jen Lyman:
Thanks for listening to the Cerebral Palsy Health Podcast with me, Jen Lyman. If you enjoyed the show, please subscribe wherever you listen to your podcast and follow me on Twitter and Instagram. You'll find the links in the show's description. Please feel free to email me with comments, questions, and topics you'd like to learn more about at jblyman@mac, that's M-A-C.com. This podcast is for educational purposes only. This podcast is not a substitute for a medical doctor or any other medical provider. This podcast is provided on the understanding that it does not constitute medical advice or services. We encourage all of our listeners to have an open, honest discussion about the topics presented on this podcast and, or any other medical concerns with their person medical team. (silence