Episode 3-Dr Jeanette Kowalik

Transcript

0:35

Hello, good morning, good evening, good afternoon, whatever it may be for you. This is Chris Ford again. I am an emergency medicine doctor here in Milwaukee, Wisconsin. And again, as always, thanks so much for joining us for episode three of Pulse Check Wisconsin. We got a good episode here for you today. We will start off as always with one of our cases, just to roll us into the topic that we'll discuss. In addition, we're going to have today a very special guest, a, healthcare pioneer in the history of the city of Milwaukee, Jeanette Kowalik, who will be coming in and talking to us and providing some context, not only into her own healthcare journey, but also to, what was going on at around the time of the pandemic, as well as her approach to healthcare from a public health perspective. So very excited to have her here, very excited to get started. So with that being said. Let's go ahead and start with our case. Patient is a 32 year old female who is presenting with complaints of left eye pain and blurriness with numbness in her left hand and her left arm. This has been ongoing for about an hour prior to her arrival, but she noticed over the last month she has had similar episodes and had not been to the doctor or to the emergency department because of this. Patient has no significant past medical history. She's not on any medications currently. Unfortunately, she doesn't have a primary care doctor that she receives any primary care from. She's got a family history of stroke in her father's mother or her paternal grandmother. She had a brother with a heart condition, but she's not certain as to what that heart condition was. She has no history of any migraines, no drug or alcohol use history either. She doesn't wear glasses. She doesn't have any history of any ocular conditions. On her exam, she's well appearing, but she looks anxious as is appropriate. She has no difficulty breathing. She denies any chest pain. She has no apparent pain at all at this point in time. She is Otherwise, without any significant neurological dysfunction, we do what's called a fast examination in EMS as well as an emergency medicine in order to determine if we need to automatically activate a stroke alert for a patient. So in going through the fast algorithm, F usually is for facial drooping. We don't see any signs of any facial drooping. A is for arm weakness. So she does not have any significant arm weakness in comparison to her right and left. S is for speech difficulty. She doesn't have any speech difficulty at this time. The symptoms are mostly isolated to the left eye and some numbness in the left arm again. And T is more so for, if you're outside of the hospital system. So time to call 9 1 1 is what the T usually stands for. Again, she's complaining of slight numbness in the left arm and blurred vision in the left eye. With regards to the left eye, her vision on the right is perfect. It's 20 20 vision on the right. On the left, however, her vision is about 20 60. And again, she does not have any history of any ocular conditions, nor does she wear any glasses or anything of that nature. With the rest of her examination being unremarkable, we had concerns that with her left visual field changes, as well as with the numbness in her left arm, that this unfortunately could be related to something like a stroke. So she was made what's called a stroke alert. When you are made a stroke alert in the emergency department, typically what happens is you will activate a litany of labs that will perform in addition to a CT of your head and a CT of your neck as well. So all those things were ordered for her. She had an EKG, which is a tracing of the heart's rhythm. That looks okay. So there's nothing that looked to be out of the ordinary. And of course, one of the things that we always want to check is your glucose. Because if your glucose is low, sometimes that can cause some neurological dysfunction. We don't see anything that looks off with that or glucose is completely normal. So after a while, after talking to our neurologist who agreed to proceed with the CT scans and the labs that we perform, all have come back in about 15 to 20 minutes as being all negative. And when we say negative, that means there's no bleeding, there's no large vessel occlusion, meaning there's no major blockages of the vessels in the brain. After further discussion with the neurologist following the negative testing, the decision was made to proceed with an MRI, which gives us a better view of some of the smaller territories in the brain outside of those large blood vessels that we were able to see on the CT scan. Fortunately, this occurred during the daytime hours and we had in the community, an MRI that was available at that time. One of the things that we discussed with the neurologist was that she was not a candidate with just the eye findings, as well as with the numbness in the arm for what we call thrombolytics, which we'll get into in future episodes. After an hour. Her MRI results had resulted. There was no evidence of acute stroke or acute occlusion on the MRI. However, she had multiple findings that were noticed, in the MRI read what they noted were multiple focal lesions, that were in the white matter of the brain. and in the spinal cord. All in all, with her multiple focal lesions that were noted on the MRI, all these things were concerning for what was the eventual diagnosis, which was multiple sclerosis. So there's a lot to unpack in that case. this patient was able to get patched in with a neurologist within the healthcare system. I was working at at the time and is. As of the last time that I was able to check in with her was doing incredibly well on some medications for multiple sclerosis. What she was experiencing is what we consider in the neurological world as a Clinically Isolated Syndrome. What a clinically isolated syndrome is, is the first episode. of neurological symptoms that's caused by the inflammation that's associated with multiple sclerosis. So I guess we should take a step back and talk about what multiple sclerosis is. Multiple sclerosis is an unpredictable disease that affects the central nervous system, and affects the way that information is transmitted. Is communicated within the brain as well as the brain communication with the body And so there's four types that we usually will recognize as is defined by the International Advisory Committee on Clinical Trials of MS. In 1996, they released a policy statement that stated that clinically isolated syndrome is one type Relapsing remitting multiple sclerosis is another secondary progressive MS as well as primary progressive multiple sclerosis. Just as a whole what MS is, is again, an autoimmune condition in which there's inflammation and what we call demyelination or some breakdown of the insulation of the nerves for lack of a better word. Because of that, what you get on the. MRI that we saw in this case were these lesions or these Areas in which there is decreased signal as noted on the MRI in the brain and also the spinal cord as well. Because of this, because of this breakdown in the sheath or that covering of the nerves in the central nervous system you get visual problems. And so in this case, the patient was experiencing visual problems and some pain initially which we call optic Neuritis, which is a complication of multiple sclerosis, patients can get vertiginous or get vertigo. You can have loss of sensation, weakness in the arms or in the legs. In this case, she had some numbness and tingling, so paresthesia of the arms. Folks can have difficulty with coordination and with walking and balance as well. It's something that You know, I wanted to touch on during this episode in order to kind of plant that in the mind of folks who may be having similar symptoms. Again, what we'll do in future episodes, we'll be having some of my colleagues on who are neurologists. And we'll be talking about stroke because stroke is paramount, especially in, A lot of the minority communities, African American communities as well we're hit a lot harder when it comes to acute strokes and the recovery can be so much different than it can in other communities and other cohorts of patients. And so it's something that I definitely want to touch on. I'll post a link to the multiple sclerosis society because there is a national branch that has a lot of information for folks who may be suffering from MS or folks that have family members that are I personally have a very good friend of mine who, Was diagnosed with multiple sclerosis very early on in his life and seeing what he has gone through and some of the strength that he has embodied and has demonstrated throughout the course of his illness, which hit him relatively hard has been something that, you know, is, is eyeopening and it's something that hits home for me. So I want to make sure that Anyone out there who may be experiencing those symptoms, I want you to know that there are treatments that are available. There are treatments for both the acute setting as well as the the chronic course of this disease process. So make sure that As always, as we talk about, make sure that you have a primary doctor that is paramount in getting you to the next steps if you are experiencing some of these symptoms and getting you patched in with a specialist that can walk you through some of these treatment options. As far as this case goes this patient was given some treatment in the acute setting. We usually will do high dose steroids at the time to reduce some of the symptoms of that initial clinically isolated syndrome. And again, as I said before, she was able to have the ability to get patched in with a primary care doctor as well as to have follow up with a very excellent neurologist who is treating her long term at this time. With that being said, I want to take time to introduce our next guest who will share some of her experience with autoimmune disorders as well as multiple sclerosis. Her name is Jeanette Kowalik. She was our prior, or former I should say, health Commissioner of the city of Milwaukee. Not only was she the health commissioner at the time of the pandemic, she was paramount in keeping us safe during that time frame in implementing some of the Some of the protocols that we still have in place to this day, as well as, providing resources to the hospitals, to the communities as well. So, with that being said, and we'll talk about some of the things, some of the amazing initiatives that she also was able to implement during her time. Without further ado here is the interview with Dr. Jeanette Kowalik.

Jeanette: 12:45

Jeanette Kowalik president and owner of JL Solutions Consulting Services. Also adjunct instructor at Baylor University and Morehouse School of Medicine.

Chris : 12:57

That's what's up. That's what's up. And for those who are not aware by the intro that we gave before, Dr. Kowalik also was our health commissioner here in the city of Milwaukee. In one of the most trying times in healthcare of this generation, period. So it's during the pandemic and had an impossible task of keeping the city, you know, on the rails at that time, which we'll get into a bit later. But before we get into that what I want to get into a little bit more is kind of your background, talk about all the amazing things that you're doing. So are you from Milwaukee originally, or where are you from originally?

Jeanette: 13:26

I am from Milwaukee. I was born and raised in the Sherman Park community or neighborhood. So, yeah, it used to be a boys and girls club member at Sherman Park when it was the old clubhouse before it became Mary Ryan. So that's how far back I go.

Chris : 13:46

Awesome. Awesome. And then you went to To school here too, right? You went to UWM?

Jeanette: 13:52

Yes. So MPS all day. So I went to Sherman Elementary, Lincoln Middle School of the Arts and Marshall High School, John Marshall High School, University of Wisconsin, Milwaukee for my bachelor's in healthcare administration and my PhD in health sciences and then Northern Illinois University for my master of public health. So yeah, that's my journey, educational journey in a nutshell.

Chris : 14:21

That's what's up. And so, like you said, you kind of came at it from a lot of different perspectives in terms of building on, your educational background from public health. And you brought it back to Milwaukee how did you feel being from the community and, you know, having that, that those educational pulls to the community as well with UWM? How did that help you in your, in your endeavors with the commissioner position as well as what you're doing now.

Jeanette: 14:47

Well, honestly, being from the community is a gift. You know, I remember mayor Barrett had acknowledged me being a home girl, which is what I had always saw myself as, as well and being able to relate to people. Being able to relate to the communities that we serve, I think is really important. You can always get somebody in one of these appointed leadership roles from another part of the country or even another part of the state, but there's nothing that can substitute for relatability. And growing up in one's community and actually having relationships with various people as we all have moved up in various ways, shapes and forms. So, it's really cool to have that experience like, oh yeah, remember when we were struggling, we used to live in Section 8 housing, be on WIC, on welfare, all of these things. And now we're like, In charge of organizations that are helping people get on their feet and get out, get, you know, from being in poverty to being empowered. So I'm just really grateful for all of those experiences that I've had along the way that made me. I believe very effective leader. I know some people have their thoughts or criticisms or whatever. And you're always going to get that when you're in a leadership role, especially a public facing role. But I know I did what I needed to do based off of what was tasked on my soul and my mission and my purpose for even being in this world. So I have a strong sense of. Of self and purpose and, you know, I just have always tried to maintain that no matter what. So I think that's very important to be grounded in whatever your purpose is in

16:29

life.

Chris : 16:31

Yeah, absolutely. And like you say, you know, no matter what you do in leadership positions, you're always going to have someone say, you know, That they agree with you, they disagree with you for the majority of us. I can speak for us in Milwaukee. We wholeheartedly were behind you, especially, like you said, you, you, you come from the environment, you know some of the issues inherent and some of the things that folks have to fight against every day. 1 of the things that that you made it is 1 of the tenants of your 10 years health commissioner was the idea of focusing on, you know, the social determinants of health. So things like, you know, racism, not only as an issue, but as a public health emergency. And this is something that I talk about in lectures to this day. I always give you a shout out because, you know, it's right on. But you didn't work, but can you speak on that? And kind of the importance of, Making that you know, public health emergency and what that really meant at that time.

Jeanette: 17:22

Yeah, for sure so honestly, I started my career in health care Let's see late 2000s or not late 2000s early 2000s and I learned about public health because a part of the health care administration program at uw Milwaukee is to do rotations in different areas of health care administration So once I got to the public health rotation And we had to learn about the HIV pandemic epidemic and everything that kind of went down at that point in our history, which we're seeing now with COVID in many ways that just really spoke to me. I was really intrigued by it. I was compelled to get involved. So my first I wouldn't say first internship, cause actually my first internship in healthcare administration was at Frederick. So I got to do the hospital administration round and I was like, you know what? I don't care if they make big money. I don't want to work 24, seven. I don't want to have to wear closed toe shoes. I like to wear cute shoes. You know, they have the OSHA requirements. Are you serious? Like if you really know me, you know, I love fashion. So it is true, but I just didn't want to do hospital administration. I was not. Feeling it. So I ended up doing my like required internship in public health. So I was an intern at the Milwaukee health department. And at the time, Bevan Baker was the second in command. Seth Foley was the commissioner. I just fell in love with it. I was like, I want to be a commissioner. This is dope. These are my people. Like, I just really fell in love with it. And I was like, whatever it is, like, I need to learn. You know, talk to people, how do you become a health commissioner? That's how I, how I was like strategic and like moving into different roles in public health. So I could have like a well rounded like rotational experience in the field, acknowledging that public health isn't just food inspection or lab, it also is maternal child health and environmental health and Everything that comes with it. So that was important. Now addressing the social determinants of health that wasn't talked about then, you know, in the early 2000s, even addressing the role of racism and health outcomes was not even touched. Now I started like my research arm because I was a Ronald McNair scholar. in maternal and child health. And I was looking at birth outcomes for Black and Latinx or Latina adolescents in Milwaukee. And it was very apparent to me that racism was a role in those birth outcomes, but yet we were forbidden to talk about it. But we didn't even have the tools to measure it other than just qualitatively, like, what was your experience at your prenatal visit? Or how come you're not going to your prenatal visits? And like hearing from young people about the racism that they experienced in the course of their care, even from being disrespected by the receptionist to the actual clinician. There was just so many accounts. And then I was also a late teen mom. So I knew about my experiences and I feel like that made me more relatable to knowing what folks were going through and. Just, you know, not getting the full quality of care as if I was someone that was on commercial health insurance, or a white person, you know, even though I have a Polish last name, you know, it's just like seeing the variance and quality of treatment just was really apparent to me what was going on. But like I said, at that time, no one was talking about it. My understanding is that this shift happened under Dr. Michael Wu, who ended up becoming the head of the federal HRSA's Maternal Child Health Bureau. And he was the one that really was, like, pushing for social determinants of health. in the course of maternal and child health. And then you had Dr. Kamara Jones, who was very vocal about the role of racism in health outcomes. And then once she moved into her president role at American Public Health Association, she was the one that was the first to declare racism as a public health crisis or issue. And then from there, others had adopted that terminology, the frameworks, so on and so forth. And we were able to get that into actual workable policy now. I started at the Milwaukee Health Department again because I was there from when I was an intern. I was a seasonal employee. Then I became a a union employee. Then I moved into management from 2002 to 2008. I left in 2008. Worked for Wauwatosa Health Department, then the Boys and Girls Clubs. I was a health director there. Then Chicago Department of Public Health. I was the surveillance director. Then back to Wisconsin where I was the health officer for the University of Wisconsin. Then I moved to D. C. where I was the Associate Director for Women's and Infant Health for the Association of Maternal Child Health Programs. And then back to Milwaukee in 2018 to be the Health Commissioner for those two years, again, starting out the pandemic. So thank you for acknowledging that. But just giving you a sense of The movement in my career, as well as the movement and acknowledging the role of racism and health outcomes, specifically birth outcomes, had evolved so much. So, like, even understanding, like, what was happening nationally, that helped me when I moved back to Milwaukee in 2018 to really be vocal and push for racism declarations at the local level. Now, the county was already working on it. And then the city. So we, it was a big crew of us. I know some folks like to take credit and say that they were the one that came up with this, but it was a collective effort. There were many people working behind the scenes, different city and county departments that came together to make this happen, and once it became. Policy. So the county did that, I believe in May of 2019, the city in July of 2019. Then we were able to start the process of moving a policy into action. And so there were like five action items for the city one that were in place. As you know, whenever you start out this work, the first thing you do is a needs assessment. You do like an environmental scan. You want to see what's going on in the field, what are other organizations doing, and then you move into actually changing your organization and then moving other organizations to also follow the same process or procedure. Unfortunately, COVID started during that first year of moving that policy into action. However, because we did it right before the pandemic started. We were teed up to start the process of paying attention to the role of race and ethnicity and health outcomes. So we had already did our like staff assessment. Folks are kind of new, you know, there's like, we were in the process of doing training, just all of this great stuff. Pandemic started March of 2020, so four years ago, and that teed us up to like really elevate what was happening. We had in our ArcGIS, our like maps to show where the disease burden was in the city and the county, and it was very clear as day to see that our first hot spot or outbreak was in the neighborhood that I grew up in, in Sherman Park. And the data that we had, because we were doing daily media, was like, look. The majority of these cases are middle aged black men. What is really going on, because if you could recall at the beginning of the pandemic, all of the energy was surrounding international travelers, people that are from China Iran Italy, the

Chris : 25:35

Wuhan province, if you, if you hadn't been there, they were not, we were, we were forebode to do any tests on people if they hadn't been there, so,

Jeanette: 25:44

yes, exactly, so it was that, and then, you All of a sudden, it shows up in Waukesha, right? Well, actually, it's Madison first, right? Madison, yeah, as a family. Yep. Yep. It made sense because you have academics. That's how it was when Ebola started when I was a health officer there. We had somebody that was exposed and I first week on a job in 2014. But Yeah, this time around, it was like, you know, Waukesha, I think, or Madison was like January, the state health department was like, we're going to handle it. We'll let you know what to do. On the backside, we saw the Illinois had their Chicago was preparing was like, it's a matter of time. It's going to come here. So we were starting to prepare what are we going to do when it hits Milwaukee, Waukesha hit that we hit. And then it was. Our lives were forever changed. Right. But the fact that we knew who was being most impacted from the beginning, we didn't have to wait six months or a year to clean our data sets to say that most of the cases were happening here. We were able to do it in almost as real time as possible. It was pretty phenomenal.

26:51

Yeah.

Chris : 26:53

Yeah. And, you know, to kind of speak to that too, coming from the, you know, the, the front facing clinical aspect, we saw January, February, March, the majority of patients that were coming in that were extremely ill, critically ill, you know, the very first patient that I intubated had to place a breathing tube for COVID 19 was African American male in his forties. Right. And it was over and over and over again, we were seeing kind of that distribution, right. That, that, that, yeah. Disproportionate effect on folks in the neighborhoods that were, that were having COVID and kind of some of the misinformation that was propagated you know, beyond that to kind of got into kind of that social media aspect as well. But I remember being on meetings for folks in the state, you know, right around March, April of 2020, and folks were like, oh, you know, we don't have any COVID cases here. And okay, how things going up north? Oh, we have no COVID cases here. And I get on, like, I just saw 25 people like. Like, what are we talking about? Must be nice. Right? You got no patience, brother. But, you know, it kind of harkens back to the fact of, you know, that those social determinants, right? Like, COVID didn't create a lot of these issues in communities that were already disproportionately affected by, you know, poor maternal health outcomes or, you know, a lot of other, you know, outcomes that are affected by lack of housing, lack of resources, lack of, you know, kind of day to day health care. But, you know, it, it exacerbated it. It made it more apparent and it made those wounds bear.

Jeanette: 28:23

It absolutely did. And honestly, there was a lot of tension and anger coming from our community that, well, if this was, you know, an international problem, how did it get to Milwaukee? And, you know, concerns about sex work and sex trafficking and things like that, like people were, you know, exposed or infected coming into the inner city. Get in what they want. And that's how they brought it here. And what are you guys going to do about it? You know, that was, I kept hearing that. That's a whole nother issue that we're dealing with. You know, there's a lot of great work that's happening related to trying to address those issues. But you already know, they're so systemic. And we were like, just trying to keep our head above water. The fact that we were Had just like restructured the health department. We just did a new organization. So we had all of these positions that we were trying to fill. We didn't even have a public information officer when the pandemic started. Wow. I mean, that's a huge, a huge vacancy. Honestly, like the police department threw us a lob and we were able to get someone in, which was great. But we didn't, we didn't have a medical officer right away because the whole contracting issue there. I mean, there were so many, like, Policy procedure issues that were blocking our ability to like rapidly hired staff. So once the emergency was declared, we were able to bypass some of those processes, get through some of that red tape, which was a huge help. But, you know, the fact that we were starting without a full bench was really problematic. And I believe it's so like we were struggling, even like trying to get like People in various leadership roles that had the experience that had the emotional intelligence, like all of those things that was hard to find that you have a city like Chicago, a city like New York, you know, like where you have a lot of great candidates already there. We were, we were Scarce, you know, and then trying to get people to move to Milwaukee, you know, like, that's a whole nother issue, but it was, it was tough. It was tough. So we had to make do with what we had and, you know, try to, to, to do the best. And I was just on the Maggie Don show yesterday. And she, you know, the timing of this is awesome. This is like four years later reflecting on everything that's happened, you know, recommendations for the future. Just, you know, again, talking about social determinants of health. Like She brought up a good point about, like, in the county, there was so much disconnect, right? Like, the fact that there's not just a county health department, there's, like, 12 health departments in the county. Everybody could decide what they wanted to do once that stay at home order from the state was lifted in May of 2020.

31:15

The

Jeanette: 31:15

city of Milwaukee was the only one that kept protective orders. Everybody else abolished theirs, and that made it very difficult for us to maintain protection for our community because, you know, disease doesn't just stay at the city line.

Chris : 31:30

Isolated. Exactly.

Jeanette: 31:32

Right. And so then when we start getting pressure from the business community, from elected officials, like we're losing business, businesses are closing. Granted, PPP and the other one, EIDL and all those other. You know small business association funds started coming on the scene to help businesses stay open. But the fact that at that time we had no idea that this was going to go on as long as it was going to go on. And then just like. Pull the rug and be like, well, you're on your own. We have the tools. Even what was the last week CDC basically saying, Oh yeah, you don't need to isolate unless you got a fever, but it's pretty much on you. And now you're seeing businesses roll back all of their protections for their employees. It's just mind boggling to me that when you're in a federal role, like the lack of understanding of whatever you recommend or say that's what people use to craft their policy. So if you make yours weak or ineffective, then that means at the local level, they have nothing to go by. If there's a lawsuit, they can't say, well, why are you still doing this and the CDC. I got rid of this a year ago, you know, it's going to make it easier for them to get sued. So it's just sad that there's this lack of understanding that, you know, you have the power to do things to help the greater good, but you just refuse to do it. And I see a lot of my colleagues that are not speaking out for various reasons. Some, cause you are friends with some of these people that work in some of these agencies, but friendship aside, right is right and wrong is wrong. And you know how I am, like, I'm going to be vocal. So, And

Chris : 33:17

we thank you. We thank you for that.

Jeanette: 33:19

Thank you. It's like, I'm not in this to be anybody's little friend. You know, like, for me, this is about a God given role of action or duty for me. And if I'm not honoring while I'm here on this earth in the first place, what am I even doing? Like, what's the point? Like, go into another field if it's all about celebrity or likeability. Because public health is not it.

Chris : 33:44

Absolutely.

Jeanette: 33:45

Yeah. Well,

Chris : 33:46

you know, like I said, we all commend you for all that you did and for standing up for the community, especially at that time. That's an impossible thing, a possible task for anybody. But you were placed in that position for a reason. I believe how was it for you? Just kind of like walking us through, like, how was it for you and like your own health and your own like mental well being? How did you, how did you deal with it? You know, I couldn't even imagine being in that situation.

Jeanette: 34:10

It was terrible. It was terrible. Like my health definitely was on the back burner. You know, I have MS, I have ankylosing spondylitis, celiac, fibromyalgia, Raynaud's, you know, I have a few autoimmune conditions. They definitely had worsened while I was health commissioner because of the high levels of stress, toxic stress, and just the demanding nature of that job. Now, I know that There's, was it in Cleveland? Or, there's another health commissioner that has MS and has maintained her role throughout the pandemic. But that, I think the circumstances are different. Like, one, if you're coming into a role that you, You're just like sustaining the work. You're not coming in to clean up a mess. Also, the relationships between various community entities, mayor's office, other government offices and whatnot is more of a workable type of relationship versus like One that's very, like, grisly, if you will, would definitely make it easier for you to maintain in that role. And then the last, I think, is related to one's personal relationship, if they have just a really wonderful, loving partner. And to be quite honest, I didn't have that. The partner I had was all about themselves. So, I was all in my own, to be quite honest. End. Having someone to just decompress with just, you know, hold you and look like it's going to be okay, like help support you, I think is really golden to be able to work through tough circumstances like that. And I think that this pandemic. Experience has definitely shown that to a lot of people. You see a lot of people that have gotten back with their old booze,

36:04

like

Jeanette: 36:10

being able to get into a relationship with someone that maybe they never paid attention to before. That's like, wow, this is my person. This is my soulmate. So you've seen a lot of alignment with people and a lot of people that have ending relationships because they see that. This person's dead weight. They're not what I need. I'm not what they need. Let's just stop the charade and keep it moving, which is what I eventually had to do. But I think those circumstances definitely played into my ability to be to be able to stay in the role longer. But it was. At a point where it did become very dangerous and then after I left, you saw some of that pop up too, of staff being physically assaulted while they were trying to serve an order, them receiving death threats on the back end of that. A lot of that just was brewing. And I received my first threat. Before the pandemic got started I was speaking at a health equity summit and I talked about how the, I forget what the law was called, but when Trump was in office and they basically tried to make it difficult for people that were trying to obtain citizenship to get social services, like if you, like, applied for WIC or food stamps or whatever, then that wouldn't mean you're ineligible for citizenship and we started to see a big Very significant decline in like our Latinx patients, like 25% honestly. And I spoke about that. I was just sharing facts. And literally like a week or two after that, I got my first Mailing, if you will. I'm like, really? These people are just like, waiting to start drama, and sure enough, once the pandemic started, you know, I wasn't working in an office. We were pretty much remote starting like, March 15th of 2020. So I didn't know when The threats came in. I just know like I stopped in office maybe twice just to get mail and it was in the mail on a run. So I don't know when it came, but it was postcards basically. And I assume it was from the same person because it was like this type of handwriting and talking to other black elected officials. That shared, they received similar ones too. So I think it was just the same person or group that was just trying to like scare us pretty much. But for me, it was like, I was so traumatized by everything. I mean, working like 20 hour days, you know, lack of sleep. Just really pushing through each and every day, like by June of 2020, I realized that this pandemic wasn't ending anytime. So this was going to go on for quite some time. And I knew I wasn't going to survive it. And I was like, okay. You know, my executive coach, I shout out to everybody that has executive coaches, don't have one, you should have one, but that just really, yeah, get one, get one, you know, like the fact that had this like moment of clarity, like. Okay, you need to go like you can stay in this, but you're not going to survive it. You need to prepare to move into a different role where you can continue to provide support, but in a way that's going to allow you to heal and also provide some protection for you. So I eventually made that transition back to D. C. and was providing support through policy development at the Trust for America's Health in the fall of 2020. But prior to that, you know, I was just like each and every day like on fumes, even within my own family, like just the stress and worry about their well being and their care. Like, I just, I mean, I'm thankful I didn't have like a little kid or little children to tend to. My son was an adult, but he was still not doing well either. I mean, everybody was struggling, whether it was being physically ill, mentally, spiritually, just so much was going on that so many people didn't make it out of it. Right. We, people are still dying from COVID like this week. I just had COVID second time a couple of weeks ago. Thankfully, I got on Paxlovid right away. And I was only positive for six days. But that first day that I've tested positive. My symptoms had advanced so quickly, literally every hour I was declining. I should have went to the E. D. like my oxygen. I was like, come

Chris : 40:56

and see me, man. What you doing? I

Jeanette: 40:58

was in Chicago at the time. Oh,

Chris : 41:01

okay, okay. But I, just

Jeanette: 41:04

seeing like, that's what happens, right? People decline so fast. By the time they try to do something, it's too late. And a lot of people are not educated on this. They don't know what's going on. I hear so many people that are like, Oh, there's some virus going around. I'm sick, but yeah. Have you tested for COVID?

Chris : 41:19

Right. Exactly. You know, COVID is

Jeanette: 41:21

still around. Maybe you should test. And

Chris : 41:27

Especially now, like you said, we're four years out, right? And like, I feel like a lot of people have forgotten what we went through. And like, you know, some of it is a coping mechanism too, right? So like, a lot of people don't want to think back to those times because they were really dark times for a lot of people, like you were saying. But just in terms of the levity of what we went through and how much it did affect people, especially people with autoimmune diseases, people with pre existing conditions you know, COVID was devastating and still is devastating for a lot of folks, which is why it's important, you know, if you have any of those conditions to take those precautions and especially, like you said, tests still to this day, it's good to know if that's what you're dealing with.

Jeanette: 42:05

Yeah. And that's the other thing too, like, you know, there was like all of this energy behind. Masking. Then it was like demonized to wear a mask. And then it's like, if you see people masking now people, you know, some people are like, whatever you do you and then other people want to like harass or bully you for wearing a mask. So it's like we're in this like we're bio terrorist state. And I say that Because I've been, I've said it back in April of 2020 I was on radio and I was just like, you know, this is what we're saying. This was in relation to all of those protests about the public health orders where you had people that were out in Waukesha that were protesting what was happening in the city of Milwaukee. Like you don't even live here. Like don't you focus on what is going on over there. We're going to focus on what's going on over here. But having like Nazi flags and confederate flags and stuff, it's like. Clearly you're on some other stuff here. That's why I started saying the bio terrorist thing because it's like, Oh, you see that it's impacting us more. So now you're cool with it. The disease spreading like smallpox blanket type of energy versus it being like being like, Oh, you know, you see that mainly like white professors that are international travelers are getting it. Now you want to like. Let's do this in healthcare heroes, like, you know, all of that, like rhetoric we were seeing early on is gone. So yeah, that's why I started saying that and I still say it now and it's, you know, I still get like some like weird reactions and energy from it, but it's like, again, I'm not here to be people's little friend. I'm here to be a voice of reason. As a consultant, I have to stay up on my research and know what's going on and stay current, and I have since 2020.

Chris : 44:00

One of the things that you mentioned in there was kind of, you know, the complications and how it affected you with your autoimmune condition. And one of the cases that we talked about today, preceding our interview is an autoimmune presentation. One of the things that we talked about was that initial presentation, that first episode of a person with multiple sclerosis, that clinically isolated syndrome. What, what has been your own personal journey you know, with an autoimmune condition, and could you share any experiences just for our listeners about that?

Jeanette: 44:29

Yeah, thanks for asking. So I always say like, when people are like, oh, you know, if you have an autoimmune condition, your life is over. No, not necessarily. It made to me, it made me value life even. It made me not wanna waste time. It made me wanna like, make sure that I was. investing in my health and taking care of myself as much as possible versus before where I just took it for granted. So my first experience with autoimmune symptoms really started when I was in middle school. I used to run track. I started having issues with my hips. I couldn't run long distance or fast speed without my hips locking up. And I was told, Oh, that's just hip dysplasia, you know, or bursitis, you know, you're just like ibuprofen or whatever. And I'm like, of course, over time, it jacks up your stomach. And then when I got older, a little bit like so I couldn't run track anymore, but I was still able to stay active. So I played other sports, basketball, tennis, volleyball. But I would have issues with lung capacity. So I would have like a lot of like asthma like symptoms. Didn't realize that was from the ankylosing spondylitis from like costochondritis and like issues with like my lungs. Not being that expand like mechanically, like the space in my rib cage being able to allow my lungs to expand as much as possible. So fast forward to early two thousands. I was in two car accidents, and that's what prompted me to get the right diagnosis. So I didn't recover well from those accidents. I still have a lot of pain. I always tell people I'm a PT lifer. I've never rang that bell because of my conditions. I will always be in physical therapy. So shout out to my physical therapist. They're wonderful people. But the fact of the matter was my first orthopedic doc, and this was when I was on title 19 for Medicaid. They wanted to do spinal fusion. They were like, Oh, you know, your spine's going back, whatever. You have degenerative discs. So we want to just fuse it all together. So you get on with your life. And God, I'm so thankful. My dad was still around at that time. And he had a lot of issues too. He also had MS. He was in the military and the Marine Corps. But he was like, no, you're too young for spinal fusion. You need to get a second opinion. So I was able to find another orthopedic doc. Thankfully that took title 19. They were way out on the North shore. Same day Ozaki, honestly. And they were like yeah, you're too young for spinal fusion. I honestly think something else is going on here. So I'm going to send you to a rheumatologist. So I was a rheumatologist. That's her old people

47:15

like, what

Jeanette: 47:16

is, what is this? So sure enough I go to the rheumatologist and it like blew my mind. They ran all of the tests that the rheumatologist was so phenomenal. Miriam Cohen she's retired now. But she was just so thorough and so good and finally got to a diagnosis. So that's how I found out I had ankylosing spondylitis. So that was in 2008. And so then I was on Enbrel for a number of years, and I was able to really regain my, my fitness level and I was good. I was doing good for a while. It wasn't until 2015, so 2014 is when I moved to Madison, 2015 I was not doing well health wise, and I ended up feeling like I was dying. I was having A lot of burning, internal burning pain. It was very difficult to walk. Like, my gait had changed. I had problems with my bladder. I mean, I literally felt like I was dying. If you know what that feels like, you know, it's your body shutting down. And and I lived by a hospital at the time, Mertier, and was told to go to the ED and just, you know, what's going on. And my doctor at the time was like, You know, if you start having problems holding your bladder, bowel, you know, you're this doom dread. You need to go to the ED. That's a sign that you're dying.

48:39

Like,

Jeanette: 48:40

it's rapid, right? And I was like, Oh my God, like my son was still young too. So I was like, like I got to still stick around until he graduates from high school. But it was like that year I was in and out of care, trying to figure out what's wrong. And then that's when I was told that one, I could never take the Enbrel again, because there was some studies that linked Enbrel to MS development in younger women. And then the fact that my father had it from the military is also another concern. So there was eventually I had to get the lumbar puncture and all of that. And sure enough, MS. Diagnosis. So yeah, so managing MS and ankylosing spondylitis. And then of course I got the other diagnoses along the way. But I was finally able to get to a good point of managing all of the diseases. So having really good health insurance, coordinated care, I always do PPO. I have to with everything going on with me and then all the like holistic health stuff. So Reiki. Massage, acupuncture PT, you know, just everything. And of course, diet, exercise. Now I'm a yoga instructor. So like maintaining my mobility, flexibility, strength training. So it's like you got to do everything. You can't just like, you know, feel like, oh, I'm just going to like get at this PT for six weeks. Then I should be good. No, it's like a chronic thing. So you have to just maintain. Yeah, that's a long answer to your question. No, that's perfect.

Chris : 50:15

That's perfect. You know, I think it's going to help a lot of people because like, you know, the case that we discussed earlier was kind of that 1st manifestation and a young woman who was diagnosed with them as down the road, but a lot of people will have some of these symptoms and not know for quite some time what's going on. And like you said, yeah. You know, especially in our communities, right? Like a lot of people don't know about, let alone have primary care, but kind of taking that next step to for specialists to further work up that diagnosis. And so, you know, for anyone who is listening, who has similar symptoms, 1st off, primary care is paramount, but also carrying through to make sure that, you know, you, you, if you're having some of these symptoms, there are treatments for you and there are medications and long term therapy, but to hark. Back to one thing that you said to a lot of what we're seeing now in medicine is a lot of folks are promoting kind of building your immunity and rebuilding your immunity. And there's, you know, unfortunately, a lot of capitalistic ventures aimed at that. You can get this I. V. You can get this pill, things like that, but I like what you said in terms of. You know putting it all together having it be a long term effect diet exercise mobility, like you said to Having a adequate diet rich in vegetables things like that fruits and vegetables and taking your medications as prescribed All those things are going to be things that are going to rebuild that immunity. It's not just a silver bullet from what we know from the literature and what we know from the up to date literature as well

Jeanette: 51:41

Yeah. And the other thing, too, is like, I know a lot of people are like, that scoff at the whole gluten free thing. Like, they think it's just a fad or a weight loss thing. But for me, like, I didn't know gluten was poisoning me. You know, and I didn't, you know, until you get the right blood test, you actually remove it from your diet for long enough, you know, most people only do it for a couple of weeks and then they go back to going to town on the biscuits and the pizza and it's like, it has to be 90 days at least, right. Like doing it long enough. So I was able to get connected with a dietitian when I was in Madison. So shout out to UW health because they helped me really get to that point of the. MS diagnosis and everything and those other autoimmune diagnoses, but just sticking to it long enough and not just giving up because of lack of willpower or, you know having cravings for sweets and junk because you're stressed out, like really knowing that, like I think is important. But one of the other things I want to touch on about one of the early MS symptoms that I had as well was. I would wake up in the middle of the night and I had burning pain in between my shoulder blades. And I had shoulder problems prior from, you know, overuse or like chronic dislocation of my right shoulder. I eventually had that repaired, but in the process of getting that repaired and getting all of the imaging to prepare for the surgery, that's how they found a lesion in my spinal cord. So it was like by finding another problem, the other issue was exposed. And as you know, you're not supposed to have lesions in your spinal cord. It's not a good look. It's not what you want. It's not normal. And then of course, you know, when I look at your brain, you know, of course you're going to have some lesions from concussions and things, but Many more than what I was supposed to have for my age. So those things were important. So getting the right diagnostics, the MRIs to show what was going on. It's really important. And then one last thing I want to say is I have an iodine allergy. So there was a point where I wasn't able to get contrast dye for MRIs, but little did I know you just do a pre medication protocol and you can still get the. The imaging with a contrast dye. So until that breakthrough again that happened at UW Health, I was finally able to see some things that were not being revealed over the years to these M. R. I. S. Without the contrast. So, of course, it's a clinical decision, but I just wanted to say that was never Made clear to me that that was an option until I lived in Madison and was a patient in a UW health system.

Chris : 54:19

Yeah, but definitely shout out UW health. You know, that's my Alma mater. I love them. But no, absolutely. Right. Like, you know, like if you, if you don't know, you don't know what you don't know. Right. That's kind of the, the whole of medicine in general and the whole of life. And so, you know, like you said, having that knowledge base that you've had, you know, a contrast allergy, either to gadolinium or to, iodine as well. Those are things that can be invaluable, especially when you're trying to make that diagnosis of an autoimmune condition, such as multiple sclerosis. And so, you know, if you have that, like, like Dr Kowalik said, Make sure that, you know, you know that there are options available for you so they can do that complete workup on your physicians that you're going to hopefully your neurologist know that everyone else that knows that that's a part of your care as well.

Jeanette: 55:09

Yeah, thank you so much.

Chris : 55:10

So I just want to finish off with just, you know, just to update us on what you're doing right now. I want to shout out your company and what you do in case anyone listening is wanting any of your services.

Jeanette: 55:23

Oh, thank you so much. So, like I said, I'm a consultant. Normally, when you see consultant, people are like, what does that mean? Yeah. So, consultancy means different things for different industries. So, I'm in the health industry, public health industry. A lot of the work that I do is centered around startups. So, fund management, evaluation, policy development, strategic planning, and implementation. So, a lot of that stuff. When you're in the field, you know what that means when you're not in the field. You're like, that still sounds big to me. So like we mentioned the stay at home orders in Wisconsin, like how did somebody write that up? That's something I would advise on. I will look at what other cities and states are doing and provide some recommendations on what the actual. Policy needs to include and provide the references or rationale for whatever it is. I'm recommending for a strategic planning and implementation. We center equity and all of our work. So we look at like, okay, the composition of the organization or the community that's being served. Is it equitable? Do you have good representation across different variables, different groups? So if you like, Okay. And using the city of Milwaukee, for example, the city is majority minority. So the leadership of the city should also be majority minority. So if it's not, what are some recommendations on how to do that? So looking at, like, how do you prepare people to move into office? Like, what do you need? What types of candidates would be good? You know, doing all of the research on those things. I think. It has been really helpful. But just giving some examples for lay folks that don't necessarily know what that means. And of course, evaluation and measurement is like, how do you show something is working? So you have the number side, the quantitative side, you have the qualitative side, which is like people's. Lived experiences, storytelling, like, how do you make changes based off of gathering all of the information and packaging it in different ways? And of course, a lot of us like our, our Tik Toks, our videos, our memes, like translating things into social media formats that are digestible and not just full of a lot of science talk and jargon and acronyms and things like that. So there has been a lot of work in these spaces, which has been great. I definitely see a shift in funding for diversity, equity, and inclusion initiatives. A lot of companies are steering away from that. So I know some people that have recently moved into these spaces and I'm like, you're a little late in the game. You should have that four years ago, to be quite honest, because now, yeah, now it's like being packaged under strategic planning. With my experience, a lot of companies don't want to touch it. And for those that do touch it, they don't want to pay like they were paying. So just putting that out there, shout out to those companies that still invest in equity and inclusion initiatives, there's still a need for it. But I do know that there were some organizations and individuals that were in our space doing this work that were causing a lot of, I'm not going to call out any names, I'm just saying from what I've seen, people that are just taking advantage of this. situation and not really helping to improve things. That's not how I roll. I aim to improve things like I don't like, you know, take the money and run. So, you know, but yeah, the other thing too, is like being more into the wellness space, which has been a shift for jail solutions is. You know, testing different products, different trainings, different services, and sharing subject matter expertise on what do I think about it? Do I think this is a worthwhile investment or not? But as a yoga instructor, I do plan on teaching this year. So I have some things lined up, so stay tuned. My website needs to be updated, so stay tuned for that. But, like, where can you take advantage of these training opportunities? And, of course, you know. I'm an artist. I love music. So the playlists are going to be fired.

Chris : 59:21

A hundred percent. A hundred percent. And she already told you she has taste. And she's right.

Jeanette: 59:25

Thank you. Oh, we got to have that house music going on too.

Chris : 59:29

Man, man, you get back to get a little bit of footwork. We good. Well, I will definitely I'll definitely post JL Solutions website to our website. And so anyone who's listening can definitely click on that. And get in contact with Dr. Kowalik. But I want to thank you so much. Always a pleasure every time we get to link up Dr. Kowalik. And I wish you the best. And hopefully we can get you back on and talk about us. We can talk all day about what's going on in Milwaukee and Chicago.

Jeanette: 59:58

Thank you so much, Dr. Ford. And have a good rest of the week and stay COVID and sucker free. Absolutely. 100%.

Chris : 1:00:04

100%. All right. Bye.

1:00:10

So that's it. Again, thanks so much for joining us here today. You know, we packed a lot in there for you, but it has some good information about multiple sclerosis, about the pandemic, about the public health approach that we are going to continue to focus on throughout the duration of this podcast. Again, I want to thank you for joining us here today. Feel free to join us on our next episode. We're going to have more guests. We're going to continue to touch on the things that affect your health here in the city of Milwaukee, as well as in the state of Wisconsin until next time, take care of yourselves, take care of each other. If you need me, come and see me.