WEBVTT
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Thank you for tuning in to Help for HD Live.
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This podcast is made possible by Teva Pharmaceuticals, Neurocrime Biosciences, Sarepta, Unicure,
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and the Griffin Foundation. I am your host, Katie Jackson.
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And today we have Wes back with us. So in
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our last show, we talked about timing of testing and
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the testing process. But today we are going to get
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a little bit more into the weeds of it slightly.
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So thank you for coming back with us today, Wes.
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Absolutely. Happy to be here.
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Let's talk about personal and family impact. So first question,
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how can knowing your genetic status for Huntington's disease impact
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you personally?
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Yeah, gosh, that's a really great question. And often kind
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of a big driver in making this decision, right, is
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really thinking about how does this information affect you personally
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and your world? So individually, you know, personally, how does
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this affect you? And And I think that there are
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some things to consider as far as emotional effects. There's
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interpersonal effects, whether that's with your partner or your spouse,
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or if that's having to do with your family, but
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really kind of centering on the individual can be really
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heavy information to receive, right? And that's whether that test
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comes back positive or negative, you know, I think there's
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a lot of focus on if that test were to
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come back positive, how heavy that information can be and
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what kind of effects can be there. And kind of
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thinking about the future, what that would look like for
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you and kind of drawing conclusions from lived experiences with
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family members that, you know, maybe have you've watched deal
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with Huntington's disease. That can be especially difficult drawing that
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parallel to your own life and kind of wondering what
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that will look like for you in the future. Additionally,
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receiving a negative result, sometimes people don't expect that to
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be as heavy as it can be. And it really
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can be when, you know, especially heightened by having maybe
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another at risk sibling. And you're kind of thinking about
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receiving these results. And you're feeling this sense of relief
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and celebration. And you're like, man, I don't have to
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worry about this. But then you're reminded of your sibling
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that's still at risk. And that's a challenging position to
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be in. And Do I share this information? Do I
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feel sort of guilty about having this result when they're
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still at risk? Or whenever I have another family member
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that's living with Huntington's disease and experiencing it right now,
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there's just a whole mix of things that can go
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along with receiving your results that really, I think, it
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really highlights the importance of talking it through with someone,
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a genetic counselor or someone who's really specialized with Huntington's
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disease or someone really knowledgeable in the community. Yeah.
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In what ways might test results affect family relationships and dynamics?
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Great question. Yeah. So this can come up in different ways.
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And one of which is, you know, mentioning, thinking about
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the at-risk siblings and thinking about how that can, you know,
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come into play or thinking about sibling who has already
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tested and you're testing and getting your results and maybe
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your results are discordant with theirs, or maybe you know,
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you both tested positive and you're sharing this information with them.
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There's all kinds of things to consider there. There's also,
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you know, when we think about another dynamic, it's sharing
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that information with your parent. And, you know, that can
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be all sorts of different scenarios too, where are you
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sharing this information with the parent that is experiencing Huntington's disease?
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And does that maybe bring up some feelings of guilt
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for that parent or, you know, some resentment or, you know,
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all kinds of different things that can come to surface. Similarly,
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sharing that information with maybe your parent that's not experiencing
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Huntington's disease can be tricky too, because of what they've
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lived with the parent that has lived with Huntington's disease.
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You know, I think one of the important things about
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genetic counseling and why, you know, I recommend folks try
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to talk with a genetic counselor about this decision is
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is exactly this reason. So there's already a lot to
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consider as far as individual effects and how it may
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affect you personally. But beyond that, it's interpersonal. It's thinking
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about how does this affect people other than me, people
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close to me and people I love. Who do I
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wanna know and who do I not wanna know? And
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these kinds of questions I think are really important to ask.
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How do you counsel individuals about the possibility of passing
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Huntington's disease onto their children?
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That's a great question. The short answer is sharing with
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folks that if you've inherited this genetic cause of Huntington's disease,
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if you have this genetic cause of Huntington's disease, any
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biological children that you have will be at a 50-50
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risk of inheriting that genetic cause of ADHD. Unless you
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were to take some biological measures, whether that's IVF and
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genetic testing of embryos prior to implantation and other scientific
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marvels like that, there's a 50-50 risk of each child
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of an affected parent. Beyond that, with the answer being
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a little more complicated, I think is thinking about the
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psychosocial effects, thinking about the emotional side of talking with
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someone about the possibility of them having this genetic cause
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of HD and what that could mean for their children
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and the potential risk there is often a really hard
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conversation to have when we're talking about testing. So when
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we're talking about these family dynamics, like I was earlier
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with siblings or parents, When you think about it from
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the perspective of the individual already having children and they're
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thinking about this potential risk for them, that can be
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a really tough conversation.
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It came out of so left field for us. And
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I remember like learning that it was like more scary.
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I think for my husband that he was thinking he
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was testing to see if his kids were at risk. Right.
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And like, cause that's when we started doctor Googling and learning,
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we thought, oh my gosh, they're at risk too. When
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we started learning, if someone finds out their genetic status,
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How might their information directly reveal the status of untested
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family members, such as a parent who hasn't been tested?
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Yeah, this does come up. So sometimes, like, let's talk
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about this is something that comes up called 25% risk,
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where let's say there's an individual who is curious about
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genetic testing for Huntington's disease. They know that their grandparent
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is affected by HD or has passed from HD, but
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their parent, so the kind of middle generation there, their
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mother or their father has not tested, but they are
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at risk of Huntington's. They're at the 50-50 risk. But
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that parent's child is the one who's curious about testing.
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Maybe they're in a stage of family planning. Maybe they're
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wanting to think about having their own kids or maybe
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they just want to know for themselves. They're just sort
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of in a position where they're like, I want to
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know if I'm at risk for Huntington's. And maybe they
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talk to their parent and they say, hey, if you
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test and you test negative, I don't have to worry
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about it. But that parent just does not want to know,
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which is fine, right? That person seeking testing, if they
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were to test positive, that would of course mean that
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their parent is also positive. And that can be a
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really difficult situation, especially if that parent really doesn't want
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to know their own status. So this is definitely something
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to explore before you undergo testing is thinking about, you know,
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thinking ahead and thinking about, is this information that I
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share with them or do I have a way that
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I keep this to myself or me and my spouse
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or kind of keep it away from them and as
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healthy of a way as possible? what does that realistically
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look like? Cause sometimes people approach it and they say, well,
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I just want to know. And they haven't really thought
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about that. And they've sort of thought about it like, well,
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I want to know, and I'm going to find out.
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And when I find out, I guess they're going to
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find out, take, take a breath on that one, you know,
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like maybe think about it a little more and just
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kind of approach it with an intention and, Thoughtfulness, you know,
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that's not to say that's not your information to learn, right?
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Of course, you have your own life, you need to
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do your own things. But maybe just thinking about that
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parent that's at risk and how to approach that. Sometimes,
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this might be helpful to share. Sometimes what people will
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do is they will approach this conversation with their parent as, hey,
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I am really thinking about testing. Like, I'm really thinking,
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I think I'm going to do it. Is that information
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that you want to know or not? Like, should I
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not share it with you or should I? And just
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have that direct conversation. You could have already tested at
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that point, and maybe you know your answer, but you're
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gauging them to see if that's a comfortable conversation, that
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they are open to receiving your information. And if they are,
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then maybe that's a different conversation. You guys talk about it.
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if they're very much against it and they put up
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their guardrails and they're like, I don't want to talk
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about this, then you know that that's something that maybe
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you guys don't talk about. And maybe you're like, well,
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I'm glad I didn't bring up that. I've tested, you know,
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so just food for thought.
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Yeah, for sure. What about identical twins?
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Identical twins is really tough. Yeah. That, that's come up too.
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If they are truly identical twins, then that means you're
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testing and And if you get your results, you're finding
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out for your twin as well. And this is very
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similar to that situation with the parent that maybe wants
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to know, maybe doesn't want to know. It's very important
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to have a clear conversation with your twin and say,
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here's the situation. I want to know this information. If
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I find out, it's basically like testing you too. Is
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this information that you want to know or not? Or
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how do we navigate this? I think it's, you know,
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a matter of just being intentional and having these open conversations.
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Yeah, absolutely. It's so, to me, it's so crazy because
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like for an identical twin, you know, we hear in
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clinics that they won't test siblings together. So they'll make
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them test like X amount of time apart from each other.
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We won't give you your, you can test the same time,
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but we won't give you the results within a room together.
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We hear that often.
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Yeah.
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But like an identical twin, you almost feel like that
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has to be an exception to the rule. I mean,
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why would you not tell them together if they both
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want the knowledge? Because they're going to tell each other
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and find out anyways. It's like, it's such a different,
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I mean, I know it's rare, but it's there, right? Yeah. Yeah.
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That's a tricky one. I would say, you know, sometimes
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the way I always try to approach it the way
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that I described, which is, you know, essentially you're going
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to get that result. It's going to inform everything. the
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other person's result, but when the other twin does want
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to test for themselves, I always leave open the possibility
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that maybe they're not identical twins.
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Let's get into a little bit about supports and counseling.
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What emotional and psychological support resources are available and what
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should individuals consider when undergoing testing?
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Yeah, I think that that's something important to focus on
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if you're thinking about diving into the consideration of testing
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is think about your support network. And I think that
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that term sometimes can get thrown around, but it's true.
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Think about who do you want to go on this
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journey with you? Is that a spouse or partner or
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is it a close friend that you've confided in through
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this process? Is it someone just, you know, someone that
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comes to mind when you think about, I want to test,
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you know, what does this look like? I think it's beyond.
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So that's, that's sort of your personal world when you're
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thinking about your support network and, and how to go
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through this journey of testing beyond that. Think about like, okay,
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but what else? Like what, whenever I'm, having tested and
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I'm sort of ready to turn to other folks, maybe
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professional help. I think it's important. I'm always a big surprise,
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but I'm a big champion of therapy and talking to
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a therapist. And sometimes I think that gets tied up
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with folks feeling like they have to be depressed or
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anxious or something like that to have a therapist. And
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that's not necessarily true. So just in life in general,
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it can be helpful to have a therapist. So it's
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especially helpful if you're trying to make a big decision
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like this, such as undergoing testing for HD and what
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life looks like after that. So genetic counselors are there
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to help you through this process and help talk you
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through what it looks like and things to consider. But
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a therapist, like an actual psychotherapist or counselor, can be
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a really good resource to lean on about all of
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your inner world, your interpersonal world with your family dynamics
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and how you think this might affect your life and
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your work and all these sorts of different things. So
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it's a really good idea maybe to get connected with
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these things. Sometimes people get hung up on feeling like,
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I want a therapist, but I want a therapist that
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already knows about Huntington's disease. Because I don't want to
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have to explain it to them and, you know, they
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should just know about it. And I hear where you're
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coming from, if that's you. I do also wish that
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that was the case. But more important than anything is
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try to find a therapist that you truly connect with
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and you feel like is someone that you can confide
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in and you feel like has your back and is
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in your corner. Because, you know, more likely than not,
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that person is going to be the one that you
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want in your corner and that you want having your
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back and is willing to learn about Huntington's disease and
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really kind of trying to get in there. And if
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you're listening to this and you're thinking like, well, I
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do have a therapist, they don't know about Huntington's disease,
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send them my way. I'm happy to talk to your
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therapist and educate them about Huntington's disease. Send them to Katie, Katrina,
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send them to Help4HD.
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Com.
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They are going to find this information to help you. So, yeah,
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I think that that's really important. And social workers, too.
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Always keep a lookout for social workers. You can connect
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with Help for HD, of course, with Jamie. You can
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go to your HDSA center of excellence. They generally have
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a social worker tied to their clinic that is, you know,
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knowledgeable about that local or regional space.
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So my kids, I listen, even though I go to
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all these guys, we host these conferences. I actually sit
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and listen to almost every session and I take notes
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because I'm an HD family. So, you know, and one
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thing that we talked about early on was, was counseling
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for my children. So I had my children established at like,
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for instance, my, my oldest Madison, she was established with
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a counselor at 15 and she's kept that counselor her
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whole entire, now she's 23 and she still has that
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same counselor. So even though she doesn't know, yes, about
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Huntington's disease directly, she went through her dad's, you know, journey,
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her dad passing all of these milestones, Madison, you know,
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starting college, Madison finishing high school. me getting remarried, right?
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All these different things that went on in Madison's life, um,
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she's followed. And then, so Madison, as she goes, you know,
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as she's going through the testing process, she has that support, um,
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to be able to go and see this very, you know,
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so I'm so glad that I started that really young
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and I know it's expensive. I know like it, But,
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you know, it's and it's hard to get a counselor.
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Let's all be honest. You know, you call mental health
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services on your insurance and you sit for six months
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waiting for someone to have an opening on their schedule.
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But yeah, it's so important. I really do believe it's important.
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And sometimes an outsider that knows nothing about you, she
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isn't a bad thing either.
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Absolutely. That is a really great point, Katie. Sometimes just
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getting that outside perspective of someone that's not all wrapped
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up in it can be really, really helpful. So, yeah, yeah. Yeah.
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I think it's anyone that understands like grief and those things.
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And most counselors do, right? Yeah. So we'll wrap up
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with reproductive choices. So, yeah. What options exist for family planning,
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such as pre-implantation? You say it for me.
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It's a crazy one. Pre-implantation genetic testing. Yeah.
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Yeah. prenatal testing for people who are at risk for
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Huntington's disease.
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Absolutely.
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Yeah.
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It's funny that, you know, getting into this whole world,
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the world that we're in, I still have trouble saying
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neurodegenerative and it's, oh my gosh, it comes up. Oh
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my gosh. Anyway, options, family planning options. There are a
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number of options. The first option that I always want
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to make sure that people consider, and sometimes they feel
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a certain way about, but you know, that's up to
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you to each their own. Again, it's just the good
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old fashioned way. You can just have kids if you
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want to, you know, I think that there's a lot
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of judgment sometimes about, you know, knowing your HD risk
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and having kids, but this is truly your decision, you know,
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and I think it's something to think about, right? When
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we're weighing out all the options, let's consider all the options.
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And if that is your choice, and that's the way
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you're going, That's okay. That's your choice. But when we're
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talking about ways of mitigating risk or, you know, lowering
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or eliminating risk of Huntington's disease risk for family planning
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and pregnancies and these kinds of things, there are a
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number of options. So sometimes what folks will do is
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look into adoption. First of all, maybe adopting kids is
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the route to go. I have Personally, a lot of
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friends that were adopted, they're really lovely friends and come
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to mind whenever I think about adoption. So I think
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it's really excellent to be a parent adopting. There are
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also situations, so depending on which parent is at risk,
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you can have donor egg or donor sperm. If, you know,
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having biological children is important to you and you want to,
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you know, have half of the DNA be from one
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parent and that kind of thing, that's a possibility. There
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is also, as Katie mentioned earlier, this possibility for what
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we call, well, the name always changes, but generally it
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kind of revolves around IVF-PGT, which is essentially in vitro
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fertilization and pre-implantation genetic testing, meaning genetic testing of embryos.
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so the sperm and the egg combined, genetic testing of embryos,
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and then implanting those embryos that are free of risk
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of Huntington's disease. And this process, this can actually be
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done through something called non-disclosure testing, meaning if you personally
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don't want to know your own genetic status, you don't
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want to know if you've inherited that genetic cause of
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Huntington's disease, but you want to move forward with family
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planning and having pregnancies free of risk of HD, you
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can do that. You can have IVF, PGT through non-disclosure
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testing where they essentially, the fertility clinic identifies those embryos,
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only implants those embryos free of risk of HD, and
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they don't tell you if they found any embryos that
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are actually at risk of HD. That way, you don't
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have to learn your status before you're ready. And that's
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something that a lot of people don't know is possible.
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And further, if that is something that you're interested in,
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I would just caution you to reach out to that
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fertility clinic directly and just be very, very straightforward, direct
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and open about it and say, here's the situation. I
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do not want to know my own genetic status for
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Huntington's disease, but we want to make sure we have
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pregnancies that are free of risk of HD. That way
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they don't accidentally somehow put it in your record. I
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would just not be afraid of just overstepping and being
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as clear as day about it, if that's what you're
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concerned about, just to be really, really safe and sure.
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So there's a number of options, but yeah.
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Right. I, we, I just had a friend, well, this
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is a couple of years ago. I had a friend
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and she, I'm so glad this is why I just
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love Wes. He just said, Hey, look, there's just like
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the old fashioned way that don't, you know, there's judgment
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in this. And I think the people that judge the
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most are the people within the HC community. They're the
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worst at this. And I, I, I had a friend
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and her, her child had passed from JT and her, her, um,
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she was pregnant, um, by her and her and her
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husband were having another baby who was symptomatic. And she
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came to one of our events and she was like,
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I was kind of embarrassed to come here. Cause I
377
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know people are looking at me and I was like,
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you're having a baby.
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That's a beautiful thing.
380
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Like it's, you know, I remember Mike was fully symptomatic
381
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when I delivered Macy.
382
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I put him, put her in his arms and, Yeah.
383
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He gave her, I swear he lived a couple more
384
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years because of her and loved her. And he was
385
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a wonderful father, even symptomatic with Korea and everything. He
386
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was an amazing father. Macy is an amazing human. So
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I don't, the judgment is just, it's, but yes, I
388
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do believe this is, I love what you said. This
389
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is your journey. So yeah, completely. So let's finish with
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how do you help patients discuss genetic risks and reproductive
391
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choices with their partners?
392
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Yeah, that's a good question that comes up. So I
393
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would say, you know, it's, it's really important to have
394
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these conversations. And it's really important to, if you're having
395
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children together to really find common ground and really decide
396
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what it is that you want to do. You know,
397
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one thing is, Well, one thing that comes to mind
398
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is when we talk about IVF and pre-implantation genetic testing
399
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and this option that's available, I think sometimes it can
400
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get tossed around like it's just this easy option when
401
00:23:21.619 --> 00:23:25.640
it is extremely difficult on the prospective mother to undergo
402
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these rounds of IVF and egg retrieval and these things.
403
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And it's also not a guarantee. It's really... the chances
404
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of having successful egg retrievals and successful implantation and pregnancies
405
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from IVF are already challenged. So I think that you're
406
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having a big conversation already, but it does warrant an
407
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even bigger conversation of managing expectations and trying to think
408
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about what exactly it's gonna look like if that's the
409
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choice that you make. And then further into the weeds
410
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and kind of getting into the really granular details and
411
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nitty gritty, since we are talking about Huntington's disease is
412
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talking about if you're doing IVF and genetic testing of
413
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those embryos, what is your number threshold? So when you're
414
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talking about, you know, doing these genetic tests of HD,
415
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what exactly warrants an embryo that is being implanted versus
416
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an embryo that is not, you know, if you had
417
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an embryo that was in the intermediate range, as we've
418
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talked about before, where that CAG is somewhere between 27
419
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to 35, is that some, is that, you know, someone who,
420
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an embryo that gets implanted and, you know, are you
421
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able to keep that number away from yourself? You know,
422
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and if that's the case, do you, warrant this discussion
423
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for that eventual child when they turn 18 about their
424
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own personal risk? Or do you try to, you know,
425
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quote unquote, keep it simple where it's anything under 27
426
00:25:02.880 --> 00:25:05.059
is good to go. We don't want to deal with,
427
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you know, anything 27 or above. These things are conversations
428
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that you're going to want to have if you're talking
429
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about genetic testing and what to move forward with and
430
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what not to move forward with. Yeah. Yeah.
431
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And so I think we could wrap up the show,
432
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but I'm going to do one more question. It's one
433
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I have not prepared Wes for, so he's going to get,
434
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I love doing this sometimes. How do you handle when
435
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you're giving results back and you've listened to this whole
436
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family history and then you see two positive numbers sitting
437
00:25:40.079 --> 00:25:43.000
on your screen, maybe one in positive and one in
438
00:25:43.039 --> 00:25:46.220
the gray zone. And now you know that there's possibly
439
00:25:46.279 --> 00:25:49.420
another side of the family that's also now being diagnosed?
440
00:25:50.339 --> 00:25:52.500
Yeah, that is a really tricky one, Katie. What a
441
00:25:52.559 --> 00:25:56.819
great question. I'm glad you asked that. That does happen.
442
00:25:57.099 --> 00:26:00.450
That does come up and it is tricky. It is
443
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most often, I think in my experience, most often the
444
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case that someone would have a positive result a positive allele,
445
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a positive copy of the gene where it's 40 or
446
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above and a intermediate copy where it's somewhere between 27
447
00:26:18.150 --> 00:26:22.799
to 35. And that's tricky because when someone is receiving
448
00:26:22.839 --> 00:26:26.339
that result, the way that I deliver those results is
449
00:26:26.619 --> 00:26:32.200
generally reading the two CAG repeat numbers and then describing
450
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what they mean. And so like, let's say that someone
451
00:26:36.049 --> 00:26:38.930
were to receive a result where their CAG was somewhere,
452
00:26:38.950 --> 00:26:42.990
let's say it was a 42 and a 17. I
453
00:26:43.029 --> 00:26:46.799
would say your CAG repeats are 42 and 17, meaning
454
00:26:46.839 --> 00:26:49.160
that you have inherited a copy of the gene that
455
00:26:49.200 --> 00:26:55.880
causes Huntington's disease. That already is a heavy result to receive.
456
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When you adjust that to be, your CAG repeat numbers
457
00:27:00.980 --> 00:27:04.759
are 42 and 31, meaning you've inherited a copy of
458
00:27:04.799 --> 00:27:10.019
the gene that causes Huntington's disease, that CAG of 42,
459
00:27:10.019 --> 00:27:12.400
but you've also inherited a copy of the gene that
460
00:27:12.480 --> 00:27:17.549
is in what we call the intermediate range at 31.
461
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This is the lower end of the gray area, meaning
462
00:27:20.730 --> 00:27:24.269
we're not really concerned that that would cause Huntington's disease,
463
00:27:24.710 --> 00:27:26.900
but it is possible for this copy of the gene
464
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to maybe change when passed to offspring, meaning it could
465
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get larger. That's a tough one because basically someone is
466
00:27:35.420 --> 00:27:39.140
dealing with receiving that positive result and then immediately put
467
00:27:39.160 --> 00:27:42.329
in a place where they're like, wait, what? So I have,
468
00:27:43.309 --> 00:27:45.849
I have a copy of the gene that causes Huntington's,
469
00:27:45.890 --> 00:27:48.750
but I also have another one and it ends up,
470
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you know, I think probably expectedly turning into a longer
471
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conversation where I then try to say, you know, upfront,
472
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those are the numbers. This is what it means. Let's
473
00:27:59.839 --> 00:28:03.359
back up. Let's talk about the 42. Let's talk about
474
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what that means. Let's talk about real quick what that
475
00:28:07.019 --> 00:28:10.660
31 means, but let's focus on the 42. Okay. Now
476
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we've kind of got to a place where the 42
477
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makes sense. Now let's really talk about the 31, you know,
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and try to get into that. And I, I think
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we do the best that we can when we're in
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that situation, but I think that it really, it maybe
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doesn't sink in until we have the follow-up after results appointment,
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maybe a week or two weeks later. And, Depending on
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if you're a genetic counselor at a clinic or you
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do this differently or whatever the case is, your after
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results follow up experience may be different. But I think
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it's worth like, let's say that you are someone in
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this situation personally. and you didn't get that from your provider,
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it's worth reaching out to them, you know, again, later
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to talk more about it and what it means, or
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even you can reach out to me at HD genetics.
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I'm happy to talk to you through it. Basically, it's just, it's,
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it can be a lot of a mental load for
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someone to, to really understand those two different things.
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Yeah.
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Great question, Katie. Yeah.
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And I have a couple of friends that this has
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happened to. That's why I brought this up. Interestingly enough,
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two of my friends, it was their child being diagnosed
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with JHD is when they learned, both of them. And
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now they're friends and they talk often. But if this
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does happen, definitely, like Wes said, reach out to him,
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reach out to a genetic counselor. But also you can
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reach out to the nonprofits because we do actually have
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people that they're going through this and they're walking this journey.
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So we can connect you guys to talk one on one.
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I know the two women, my dear friends that this
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happened to. They are such wonderful advocates and they would
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love to talk to you if you need anything at all,
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especially if your parent that is in the gray zone
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00:29:59.470 --> 00:30:01.109
that would have never guessed. That's kind of what they
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went through. Right. So definitely always reach out to your community.
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It's amazing what supports we have out there for sure.
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So I think we could wrap up the show for now.
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Thank you so much, Wes, for coming on. And again,
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thank you to all of our sponsors for making Health
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for HD Live possible. We will see you guys. It
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looks like we are going into the holidays. So this
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whole month was on genetic testing. And then next month,
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we will be jumping into the holidays and the grief
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and hard times of the holidays, but also the joys
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we can find in it and being with the ones
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we love. So that will be in November. So tune
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in for the monthly lineup. The monthly lineup should come
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out soon. Until next time, everyone take care.
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Thank you for tuning in to Help for HD Live.
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This podcast is made possible by Teva Pharmaceuticals, Neurocrime Biosciences, Sarepta, Unicure,
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and the Griffin Foundation. I am your host, Katie Jackson.
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And today we have Wes back with us. So in
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our last show, we talked about timing of testing and
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the testing process. But today we are going to get
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a little bit more into the weeds of it slightly.
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So thank you for coming back with us today, Wes.
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Absolutely. Happy to be here.
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Let's talk about personal and family impact. So first question,
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how can knowing your genetic status for Huntington's disease impact
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you personally?
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Yeah, gosh, that's a really great question. And often kind
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of a big driver in making this decision, right, is
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really thinking about how does this information affect you personally
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and your world? So individually, you know, personally, how does
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this affect you? And And I think that there are
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some things to consider as far as emotional effects. There's
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interpersonal effects, whether that's with your partner or your spouse,
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or if that's having to do with your family, but
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really kind of centering on the individual can be really
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heavy information to receive, right? And that's whether that test
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comes back positive or negative, you know, I think there's
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a lot of focus on if that test were to
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come back positive, how heavy that information can be and
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what kind of effects can be there. And kind of
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thinking about the future, what that would look like for
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you and kind of drawing conclusions from lived experiences with
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family members that, you know, maybe have you've watched deal
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with Huntington's disease. That can be especially difficult drawing that
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parallel to your own life and kind of wondering what
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that will look like for you in the future. Additionally,
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receiving a negative result, sometimes people don't expect that to
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be as heavy as it can be. And it really
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can be when, you know, especially heightened by having maybe
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another at risk sibling. And you're kind of thinking about
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receiving these results. And you're feeling this sense of relief
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and celebration. And you're like, man, I don't have to
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worry about this. But then you're reminded of your sibling
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that's still at risk. And that's a challenging position to
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be in. And Do I share this information? Do I
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feel sort of guilty about having this result when they're
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still at risk? Or whenever I have another family member
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that's living with Huntington's disease and experiencing it right now,
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there's just a whole mix of things that can go
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along with receiving your results that really, I think, it
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really highlights the importance of talking it through with someone,
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a genetic counselor or someone who's really specialized with Huntington's
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disease or someone really knowledgeable in the community. Yeah.
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In what ways might test results affect family relationships and dynamics?
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Great question. Yeah. So this can come up in different ways.
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And one of which is, you know, mentioning, thinking about
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the at-risk siblings and thinking about how that can, you know,
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come into play or thinking about sibling who has already
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tested and you're testing and getting your results and maybe
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your results are discordant with theirs, or maybe you know,
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you both tested positive and you're sharing this information with them.
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There's all kinds of things to consider there. There's also,
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you know, when we think about another dynamic, it's sharing
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that information with your parent. And, you know, that can
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be all sorts of different scenarios too, where are you
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sharing this information with the parent that is experiencing Huntington's disease?
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And does that maybe bring up some feelings of guilt
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for that parent or, you know, some resentment or, you know,
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all kinds of different things that can come to surface. Similarly,
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sharing that information with maybe your parent that's not experiencing
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Huntington's disease can be tricky too, because of what they've
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lived with the parent that has lived with Huntington's disease.
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You know, I think one of the important things about
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genetic counseling and why, you know, I recommend folks try
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to talk with a genetic counselor about this decision is
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is exactly this reason. So there's already a lot to
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consider as far as individual effects and how it may
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affect you personally. But beyond that, it's interpersonal. It's thinking
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about how does this affect people other than me, people
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close to me and people I love. Who do I
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wanna know and who do I not wanna know? And
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these kinds of questions I think are really important to ask.
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How do you counsel individuals about the possibility of passing
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Huntington's disease onto their children?
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That's a great question. The short answer is sharing with
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folks that if you've inherited this genetic cause of Huntington's disease,
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if you have this genetic cause of Huntington's disease, any
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biological children that you have will be at a 50-50
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risk of inheriting that genetic cause of ADHD. Unless you
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were to take some biological measures, whether that's IVF and
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genetic testing of embryos prior to implantation and other scientific
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marvels like that, there's a 50-50 risk of each child
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of an affected parent. Beyond that, with the answer being
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a little more complicated, I think is thinking about the
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psychosocial effects, thinking about the emotional side of talking with
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someone about the possibility of them having this genetic cause
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of HD and what that could mean for their children
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and the potential risk there is often a really hard
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conversation to have when we're talking about testing. So when
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we're talking about these family dynamics, like I was earlier
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with siblings or parents, When you think about it from
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the perspective of the individual already having children and they're
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thinking about this potential risk for them, that can be
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a really tough conversation.
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It came out of so left field for us. And
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I remember like learning that it was like more scary.
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I think for my husband that he was thinking he
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was testing to see if his kids were at risk. Right.
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And like, cause that's when we started doctor Googling and learning,
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we thought, oh my gosh, they're at risk too. When
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we started learning, if someone finds out their genetic status,
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How might their information directly reveal the status of untested
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family members, such as a parent who hasn't been tested?
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Yeah, this does come up. So sometimes, like, let's talk
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about this is something that comes up called 25% risk,
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where let's say there's an individual who is curious about
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genetic testing for Huntington's disease. They know that their grandparent
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is affected by HD or has passed from HD, but
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their parent, so the kind of middle generation there, their
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mother or their father has not tested, but they are
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at risk of Huntington's. They're at the 50-50 risk. But
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that parent's child is the one who's curious about testing.
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Maybe they're in a stage of family planning. Maybe they're
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wanting to think about having their own kids or maybe
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they just want to know for themselves. They're just sort
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of in a position where they're like, I want to
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know if I'm at risk for Huntington's. And maybe they
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talk to their parent and they say, hey, if you
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test and you test negative, I don't have to worry
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about it. But that parent just does not want to know,
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which is fine, right? That person seeking testing, if they
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were to test positive, that would of course mean that
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their parent is also positive. And that can be a
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really difficult situation, especially if that parent really doesn't want
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to know their own status. So this is definitely something
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to explore before you undergo testing is thinking about, you know,
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thinking ahead and thinking about, is this information that I
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share with them or do I have a way that
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I keep this to myself or me and my spouse
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or kind of keep it away from them and as
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healthy of a way as possible? what does that realistically
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look like? Cause sometimes people approach it and they say, well,
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I just want to know. And they haven't really thought
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about that. And they've sort of thought about it like, well,
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I want to know, and I'm going to find out.
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And when I find out, I guess they're going to
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find out, take, take a breath on that one, you know,
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like maybe think about it a little more and just
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kind of approach it with an intention and, Thoughtfulness, you know,
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that's not to say that's not your information to learn, right?
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Of course, you have your own life, you need to
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do your own things. But maybe just thinking about that
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parent that's at risk and how to approach that. Sometimes,
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this might be helpful to share. Sometimes what people will
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do is they will approach this conversation with their parent as, hey,
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I am really thinking about testing. Like, I'm really thinking,
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I think I'm going to do it. Is that information
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that you want to know or not? Like, should I
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not share it with you or should I? And just
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have that direct conversation. You could have already tested at
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that point, and maybe you know your answer, but you're
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gauging them to see if that's a comfortable conversation, that
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they are open to receiving your information. And if they are,
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then maybe that's a different conversation. You guys talk about it.
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if they're very much against it and they put up
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their guardrails and they're like, I don't want to talk
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about this, then you know that that's something that maybe
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you guys don't talk about. And maybe you're like, well,
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I'm glad I didn't bring up that. I've tested, you know,
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so just food for thought.
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Yeah, for sure. What about identical twins?
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Identical twins is really tough. Yeah. That, that's come up too.
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If they are truly identical twins, then that means you're
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testing and And if you get your results, you're finding
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out for your twin as well. And this is very
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similar to that situation with the parent that maybe wants
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to know, maybe doesn't want to know. It's very important
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to have a clear conversation with your twin and say,
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here's the situation. I want to know this information. If
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I find out, it's basically like testing you too. Is
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this information that you want to know or not? Or
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how do we navigate this? I think it's, you know,
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a matter of just being intentional and having these open conversations.
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Yeah, absolutely. It's so, to me, it's so crazy because
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like for an identical twin, you know, we hear in
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clinics that they won't test siblings together. So they'll make
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them test like X amount of time apart from each other.
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We won't give you your, you can test the same time,
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but we won't give you the results within a room together.
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We hear that often.
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Yeah.
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But like an identical twin, you almost feel like that
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has to be an exception to the rule. I mean,
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why would you not tell them together if they both
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want the knowledge? Because they're going to tell each other
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and find out anyways. It's like, it's such a different,
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I mean, I know it's rare, but it's there, right? Yeah. Yeah.
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That's a tricky one. I would say, you know, sometimes
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the way I always try to approach it the way
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that I described, which is, you know, essentially you're going
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to get that result. It's going to inform everything. the
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other person's result, but when the other twin does want
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to test for themselves, I always leave open the possibility
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that maybe they're not identical twins.
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Let's get into a little bit about supports and counseling.
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What emotional and psychological support resources are available and what
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should individuals consider when undergoing testing?
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Yeah, I think that that's something important to focus on
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if you're thinking about diving into the consideration of testing
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is think about your support network. And I think that
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that term sometimes can get thrown around, but it's true.
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Think about who do you want to go on this
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journey with you? Is that a spouse or partner or
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is it a close friend that you've confided in through
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this process? Is it someone just, you know, someone that
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comes to mind when you think about, I want to test,
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you know, what does this look like? I think it's beyond.
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So that's, that's sort of your personal world when you're
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thinking about your support network and, and how to go
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through this journey of testing beyond that. Think about like, okay,
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but what else? Like what, whenever I'm, having tested and
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I'm sort of ready to turn to other folks, maybe
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professional help. I think it's important. I'm always a big surprise,
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but I'm a big champion of therapy and talking to
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a therapist. And sometimes I think that gets tied up
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with folks feeling like they have to be depressed or
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anxious or something like that to have a therapist. And
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that's not necessarily true. So just in life in general,
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it can be helpful to have a therapist. So it's
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especially helpful if you're trying to make a big decision
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like this, such as undergoing testing for HD and what
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life looks like after that. So genetic counselors are there
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to help you through this process and help talk you
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through what it looks like and things to consider. But
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a therapist, like an actual psychotherapist or counselor, can be
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a really good resource to lean on about all of
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your inner world, your interpersonal world with your family dynamics
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and how you think this might affect your life and
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your work and all these sorts of different things. So
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it's a really good idea maybe to get connected with
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these things. Sometimes people get hung up on feeling like,
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I want a therapist, but I want a therapist that
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already knows about Huntington's disease. Because I don't want to
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have to explain it to them and, you know, they
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should just know about it. And I hear where you're
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coming from, if that's you. I do also wish that
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that was the case. But more important than anything is
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try to find a therapist that you truly connect with
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and you feel like is someone that you can confide
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in and you feel like has your back and is
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in your corner. Because, you know, more likely than not,
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that person is going to be the one that you
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want in your corner and that you want having your
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back and is willing to learn about Huntington's disease and
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really kind of trying to get in there. And if
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you're listening to this and you're thinking like, well, I
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do have a therapist, they don't know about Huntington's disease,
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send them my way. I'm happy to talk to your
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therapist and educate them about Huntington's disease. Send them to Katie, Katrina,
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send them to Help4HD.
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Com.
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They are going to find this information to help you. So, yeah,
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I think that that's really important. And social workers, too.
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Always keep a lookout for social workers. You can connect
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with Help for HD, of course, with Jamie. You can
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go to your HDSA center of excellence. They generally have
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a social worker tied to their clinic that is, you know,
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knowledgeable about that local or regional space.
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So my kids, I listen, even though I go to
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all these guys, we host these conferences. I actually sit
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and listen to almost every session and I take notes
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because I'm an HD family. So, you know, and one
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thing that we talked about early on was, was counseling
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for my children. So I had my children established at like,
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for instance, my, my oldest Madison, she was established with
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a counselor at 15 and she's kept that counselor her
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whole entire, now she's 23 and she still has that
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same counselor. So even though she doesn't know, yes, about
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Huntington's disease directly, she went through her dad's, you know, journey,
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her dad passing all of these milestones, Madison, you know,
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starting college, Madison finishing high school. me getting remarried, right?
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All these different things that went on in Madison's life, um,
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she's followed. And then, so Madison, as she goes, you know,
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as she's going through the testing process, she has that support, um,
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to be able to go and see this very, you know,
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so I'm so glad that I started that really young
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and I know it's expensive. I know like it, But,
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you know, it's and it's hard to get a counselor.
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Let's all be honest. You know, you call mental health
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services on your insurance and you sit for six months
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waiting for someone to have an opening on their schedule.
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But yeah, it's so important. I really do believe it's important.
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And sometimes an outsider that knows nothing about you, she
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isn't a bad thing either.
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Absolutely. That is a really great point, Katie. Sometimes just
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getting that outside perspective of someone that's not all wrapped
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up in it can be really, really helpful. So, yeah, yeah. Yeah.
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I think it's anyone that understands like grief and those things.
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And most counselors do, right? Yeah. So we'll wrap up
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with reproductive choices. So, yeah. What options exist for family planning,
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such as pre-implantation? You say it for me.
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It's a crazy one. Pre-implantation genetic testing. Yeah.
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Yeah. prenatal testing for people who are at risk for
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Huntington's disease.
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Absolutely.
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Yeah.
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It's funny that, you know, getting into this whole world,
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the world that we're in, I still have trouble saying
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neurodegenerative and it's, oh my gosh, it comes up. Oh
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my gosh. Anyway, options, family planning options. There are a
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number of options. The first option that I always want
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to make sure that people consider, and sometimes they feel
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a certain way about, but you know, that's up to
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you to each their own. Again, it's just the good
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old fashioned way. You can just have kids if you
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want to, you know, I think that there's a lot
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of judgment sometimes about, you know, knowing your HD risk
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and having kids, but this is truly your decision, you know,
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and I think it's something to think about, right? When
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we're weighing out all the options, let's consider all the options.
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And if that is your choice, and that's the way
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you're going, That's okay. That's your choice. But when we're
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talking about ways of mitigating risk or, you know, lowering
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or eliminating risk of Huntington's disease risk for family planning
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and pregnancies and these kinds of things, there are a
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number of options. So sometimes what folks will do is
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look into adoption. First of all, maybe adopting kids is
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the route to go. I have Personally, a lot of
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friends that were adopted, they're really lovely friends and come
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to mind whenever I think about adoption. So I think
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it's really excellent to be a parent adopting. There are
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also situations, so depending on which parent is at risk,
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you can have donor egg or donor sperm. If, you know,
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having biological children is important to you and you want to,
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you know, have half of the DNA be from one
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parent and that kind of thing, that's a possibility. There
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is also, as Katie mentioned earlier, this possibility for what
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we call, well, the name always changes, but generally it
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kind of revolves around IVF-PGT, which is essentially in vitro
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fertilization and pre-implantation genetic testing, meaning genetic testing of embryos.
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so the sperm and the egg combined, genetic testing of embryos,
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and then implanting those embryos that are free of risk
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of Huntington's disease. And this process, this can actually be
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done through something called non-disclosure testing, meaning if you personally
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don't want to know your own genetic status, you don't
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want to know if you've inherited that genetic cause of
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Huntington's disease, but you want to move forward with family
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planning and having pregnancies free of risk of HD, you
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can do that. You can have IVF, PGT through non-disclosure
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testing where they essentially, the fertility clinic identifies those embryos,
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only implants those embryos free of risk of HD, and
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they don't tell you if they found any embryos that
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are actually at risk of HD. That way, you don't
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have to learn your status before you're ready. And that's
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something that a lot of people don't know is possible.
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And further, if that is something that you're interested in,
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I would just caution you to reach out to that
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fertility clinic directly and just be very, very straightforward, direct
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and open about it and say, here's the situation. I
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do not want to know my own genetic status for
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Huntington's disease, but we want to make sure we have
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pregnancies that are free of risk of HD. That way
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they don't accidentally somehow put it in your record. I
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would just not be afraid of just overstepping and being
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as clear as day about it, if that's what you're
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concerned about, just to be really, really safe and sure.
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So there's a number of options, but yeah.
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Right. I, we, I just had a friend, well, this
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is a couple of years ago. I had a friend
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and she, I'm so glad this is why I just
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love Wes. He just said, Hey, look, there's just like
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the old fashioned way that don't, you know, there's judgment
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in this. And I think the people that judge the
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most are the people within the HC community. They're the
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worst at this. And I, I, I had a friend
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and her, her child had passed from JT and her, her, um,
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she was pregnant, um, by her and her and her
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husband were having another baby who was symptomatic. And she
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came to one of our events and she was like,
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I was kind of embarrassed to come here. Cause I
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know people are looking at me and I was like,
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you're having a baby.
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That's a beautiful thing.
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Like it's, you know, I remember Mike was fully symptomatic
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when I delivered Macy.
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I put him, put her in his arms and, Yeah.
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He gave her, I swear he lived a couple more
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years because of her and loved her. And he was
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a wonderful father, even symptomatic with Korea and everything. He
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was an amazing father. Macy is an amazing human. So
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I don't, the judgment is just, it's, but yes, I
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do believe this is, I love what you said. This
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is your journey. So yeah, completely. So let's finish with
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how do you help patients discuss genetic risks and reproductive
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choices with their partners?
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Yeah, that's a good question that comes up. So I
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would say, you know, it's, it's really important to have
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these conversations. And it's really important to, if you're having
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children together to really find common ground and really decide
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what it is that you want to do. You know,
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one thing is, Well, one thing that comes to mind
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is when we talk about IVF and pre-implantation genetic testing
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and this option that's available, I think sometimes it can
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get tossed around like it's just this easy option when
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it is extremely difficult on the prospective mother to undergo
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these rounds of IVF and egg retrieval and these things.
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And it's also not a guarantee. It's really... the chances
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of having successful egg retrievals and successful implantation and pregnancies
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from IVF are already challenged. So I think that you're
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having a big conversation already, but it does warrant an
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even bigger conversation of managing expectations and trying to think
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about what exactly it's gonna look like if that's the
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choice that you make. And then further into the weeds
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and kind of getting into the really granular details and
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nitty gritty, since we are talking about Huntington's disease is
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talking about if you're doing IVF and genetic testing of
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those embryos, what is your number threshold? So when you're
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talking about, you know, doing these genetic tests of HD,
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what exactly warrants an embryo that is being implanted versus
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an embryo that is not, you know, if you had
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an embryo that was in the intermediate range, as we've
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talked about before, where that CAG is somewhere between 27
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to 35, is that some, is that, you know, someone who,
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an embryo that gets implanted and, you know, are you
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able to keep that number away from yourself? You know,
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and if that's the case, do you, warrant this discussion
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for that eventual child when they turn 18 about their
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own personal risk? Or do you try to, you know,
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quote unquote, keep it simple where it's anything under 27
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is good to go. We don't want to deal with,
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you know, anything 27 or above. These things are conversations
428
00:25:09.519 --> 00:25:11.400
that you're going to want to have if you're talking
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00:25:11.460 --> 00:25:15.769
about genetic testing and what to move forward with and
430
00:25:15.809 --> 00:25:18.390
what not to move forward with. Yeah. Yeah.
431
00:25:19.109 --> 00:25:20.509
And so I think we could wrap up the show,
432
00:25:20.529 --> 00:25:22.650
but I'm going to do one more question. It's one
433
00:25:22.690 --> 00:25:24.910
I have not prepared Wes for, so he's going to get,
434
00:25:24.930 --> 00:25:31.630
I love doing this sometimes. How do you handle when
435
00:25:31.710 --> 00:25:34.930
you're giving results back and you've listened to this whole
436
00:25:34.970 --> 00:25:40.019
family history and then you see two positive numbers sitting
437
00:25:40.079 --> 00:25:43.000
on your screen, maybe one in positive and one in
438
00:25:43.039 --> 00:25:46.220
the gray zone. And now you know that there's possibly
439
00:25:46.279 --> 00:25:49.420
another side of the family that's also now being diagnosed?
440
00:25:50.339 --> 00:25:52.500
Yeah, that is a really tricky one, Katie. What a
441
00:25:52.559 --> 00:25:56.819
great question. I'm glad you asked that. That does happen.
442
00:25:57.099 --> 00:26:00.450
That does come up and it is tricky. It is
443
00:26:00.630 --> 00:26:04.609
most often, I think in my experience, most often the
444
00:26:04.630 --> 00:26:10.250
case that someone would have a positive result a positive allele,
445
00:26:10.289 --> 00:26:12.349
a positive copy of the gene where it's 40 or
446
00:26:12.390 --> 00:26:18.150
above and a intermediate copy where it's somewhere between 27
447
00:26:18.150 --> 00:26:22.799
to 35. And that's tricky because when someone is receiving
448
00:26:22.839 --> 00:26:26.339
that result, the way that I deliver those results is
449
00:26:26.619 --> 00:26:32.200
generally reading the two CAG repeat numbers and then describing
450
00:26:32.259 --> 00:26:35.539
what they mean. And so like, let's say that someone
451
00:26:36.049 --> 00:26:38.930
were to receive a result where their CAG was somewhere,
452
00:26:38.950 --> 00:26:42.990
let's say it was a 42 and a 17. I
453
00:26:43.029 --> 00:26:46.799
would say your CAG repeats are 42 and 17, meaning
454
00:26:46.839 --> 00:26:49.160
that you have inherited a copy of the gene that
455
00:26:49.200 --> 00:26:55.880
causes Huntington's disease. That already is a heavy result to receive.
456
00:26:56.240 --> 00:27:00.900
When you adjust that to be, your CAG repeat numbers
457
00:27:00.980 --> 00:27:04.759
are 42 and 31, meaning you've inherited a copy of
458
00:27:04.799 --> 00:27:10.019
the gene that causes Huntington's disease, that CAG of 42,
459
00:27:10.019 --> 00:27:12.400
but you've also inherited a copy of the gene that
460
00:27:12.480 --> 00:27:17.549
is in what we call the intermediate range at 31.
461
00:27:17.549 --> 00:27:20.670
This is the lower end of the gray area, meaning
462
00:27:20.730 --> 00:27:24.269
we're not really concerned that that would cause Huntington's disease,
463
00:27:24.710 --> 00:27:26.900
but it is possible for this copy of the gene
464
00:27:26.920 --> 00:27:29.740
to maybe change when passed to offspring, meaning it could
465
00:27:30.220 --> 00:27:33.839
get larger. That's a tough one because basically someone is
466
00:27:35.420 --> 00:27:39.140
dealing with receiving that positive result and then immediately put
467
00:27:39.160 --> 00:27:42.329
in a place where they're like, wait, what? So I have,
468
00:27:43.309 --> 00:27:45.849
I have a copy of the gene that causes Huntington's,
469
00:27:45.890 --> 00:27:48.750
but I also have another one and it ends up,
470
00:27:49.049 --> 00:27:52.869
you know, I think probably expectedly turning into a longer
471
00:27:52.930 --> 00:27:57.420
conversation where I then try to say, you know, upfront,
472
00:27:57.460 --> 00:27:59.779
those are the numbers. This is what it means. Let's
473
00:27:59.839 --> 00:28:03.359
back up. Let's talk about the 42. Let's talk about
474
00:28:03.380 --> 00:28:07.019
what that means. Let's talk about real quick what that
475
00:28:07.019 --> 00:28:10.660
31 means, but let's focus on the 42. Okay. Now
476
00:28:10.680 --> 00:28:12.559
we've kind of got to a place where the 42
477
00:28:12.559 --> 00:28:16.559
makes sense. Now let's really talk about the 31, you know,
478
00:28:16.660 --> 00:28:19.440
and try to get into that. And I, I think
479
00:28:19.480 --> 00:28:22.599
we do the best that we can when we're in
480
00:28:22.640 --> 00:28:26.220
that situation, but I think that it really, it maybe
481
00:28:26.299 --> 00:28:31.920
doesn't sink in until we have the follow-up after results appointment,
482
00:28:31.940 --> 00:28:34.789
maybe a week or two weeks later. And, Depending on
483
00:28:34.849 --> 00:28:37.970
if you're a genetic counselor at a clinic or you
484
00:28:38.019 --> 00:28:42.000
do this differently or whatever the case is, your after
485
00:28:42.079 --> 00:28:46.619
results follow up experience may be different. But I think
486
00:28:46.680 --> 00:28:49.240
it's worth like, let's say that you are someone in
487
00:28:49.289 --> 00:28:54.809
this situation personally. and you didn't get that from your provider,
488
00:28:55.029 --> 00:28:58.640
it's worth reaching out to them, you know, again, later
489
00:28:58.920 --> 00:29:00.920
to talk more about it and what it means, or
490
00:29:01.000 --> 00:29:03.880
even you can reach out to me at HD genetics.
491
00:29:03.960 --> 00:29:08.849
I'm happy to talk to you through it. Basically, it's just, it's,
492
00:29:09.450 --> 00:29:12.109
it can be a lot of a mental load for
493
00:29:12.150 --> 00:29:15.089
someone to, to really understand those two different things.
494
00:29:16.049 --> 00:29:16.269
Yeah.
495
00:29:16.309 --> 00:29:18.059
Great question, Katie. Yeah.
496
00:29:18.140 --> 00:29:20.980
And I have a couple of friends that this has
497
00:29:21.019 --> 00:29:23.400
happened to. That's why I brought this up. Interestingly enough,
498
00:29:23.440 --> 00:29:25.720
two of my friends, it was their child being diagnosed
499
00:29:25.740 --> 00:29:29.529
with JHD is when they learned, both of them. And
500
00:29:29.589 --> 00:29:33.750
now they're friends and they talk often. But if this
501
00:29:33.769 --> 00:29:36.700
does happen, definitely, like Wes said, reach out to him,
502
00:29:36.750 --> 00:29:39.670
reach out to a genetic counselor. But also you can
503
00:29:39.690 --> 00:29:42.180
reach out to the nonprofits because we do actually have
504
00:29:42.940 --> 00:29:45.779
people that they're going through this and they're walking this journey.
505
00:29:45.859 --> 00:29:48.400
So we can connect you guys to talk one on one.
506
00:29:48.420 --> 00:29:51.769
I know the two women, my dear friends that this
507
00:29:51.809 --> 00:29:54.430
happened to. They are such wonderful advocates and they would
508
00:29:54.470 --> 00:29:56.430
love to talk to you if you need anything at all,
509
00:29:57.089 --> 00:29:59.450
especially if your parent that is in the gray zone
510
00:29:59.470 --> 00:30:01.109
that would have never guessed. That's kind of what they
511
00:30:01.150 --> 00:30:04.900
went through. Right. So definitely always reach out to your community.
512
00:30:04.940 --> 00:30:09.039
It's amazing what supports we have out there for sure.
513
00:30:09.480 --> 00:30:12.400
So I think we could wrap up the show for now.
514
00:30:12.509 --> 00:30:15.809
Thank you so much, Wes, for coming on. And again,
515
00:30:15.890 --> 00:30:17.829
thank you to all of our sponsors for making Health
516
00:30:17.849 --> 00:30:20.470
for HD Live possible. We will see you guys. It
517
00:30:20.490 --> 00:30:22.769
looks like we are going into the holidays. So this
518
00:30:22.829 --> 00:30:26.450
whole month was on genetic testing. And then next month,
519
00:30:26.490 --> 00:30:29.329
we will be jumping into the holidays and the grief
520
00:30:29.410 --> 00:30:32.150
and hard times of the holidays, but also the joys
521
00:30:32.190 --> 00:30:33.890
we can find in it and being with the ones
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00:30:33.930 --> 00:30:37.089
we love. So that will be in November. So tune
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00:30:37.130 --> 00:30:40.089
in for the monthly lineup. The monthly lineup should come
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00:30:40.130 --> 00:30:42.930
out soon. Until next time, everyone take care.
