Episode 11: School Accommodations with Dr. Cathy Pederson and Dr. Brian Yontz Link: https://tinyurl.com/2t4yn9bz

00:00:01 Announcer: Welcome to the Standing Up to POTS podcast, otherwise known as the POTScast. This podcast is dedicated to educating and empowering the community about postural orthostatic tachycardia syndrome, commonly referred to as POTS. This invisible illness impacts millions and we are committed to explaining the basics, raising awareness, exploring the research, and empowering patients to not only survive but thrive. This is the Standing Up to POTS podcast.

00:00:28 Jill (Standing Up to POTS): Hello fellow POTS patients and nice people who care about POTS patients. I'm Jill Brook and today I'm excited to interview the two experts who recently published an important article called what chronically ill students need from their schools. Because we all know that chronic and visible illness can throw a huge variety of symptoms and life challenges at patients. And sometimes our loved ones or doctors have a tough time even understanding it, so how the heck do we get our schools to understand and accommodate our population's unique needs? Not a simple topic. But luckily our two fabulous guests have given this a lot of thought and they are working to help educate the educators about what the needs of students with POTS and related conditions are. I think you'll get a lot out of hearing their wisdom and advice. Our first guest is someone you already know, if you've heard our earlier episodes. Dr. Cathy Pederson is a professor of biology at Wittenberg University. She's a POTS researcher, a POTS parent, and the founder of Standing Up to POTS. Our 2nd guest is Dr. Brian Yontz. He is chair and associate professor of education at Wittenberg University. He holds a doctorate in educational policy and leadership. He has authored many articles and book chapters, presented at numerous national and international conferences, and has won major awards, including his university's top award for teaching excellence and other national awards. Dr. Yontz, Dr. Pederson, thank you for being here today.

00:02:15 Dr. Yontz: Thank you, Jill. It's great to be here.

00:02:18 Dr. Pederson: It's our pleasure, Jill.

00:02:20 Jill (Standing Up to POTS): So if I could start, Dr. Pederson, with you, you personally lived through the challenges of getting your daughter through the school system with very severe POTS and related illnesses starting from the 4th grade. What was that like?

00:02:33 Dr. Pederson: It was really difficult. In our case, it took us a while to get a diagnosis. My kid was highly symptomatic, but we didn't have a name to put with anything which made it a real problem for the schools. Now, we were really lucky. The school district where my daughter happened to be has been extremely accommodating over the years, but there are so many families that don't have that experience and that's why we felt like it was so important to write on this topic to try to give parents something to hand to their school administrators to say, "hey, it's normal for a chronically ill kid to need these kinds of accommodations."

00:03:13 Jill (Standing Up to POTS): Dr. Yontz, can I ask how did you hear about POTS? Because I would like to dare to hope that maybe because it affects 1% of teenagers, maybe it's well known among educators, but how did you learn about it?

00:03:29 Dr. Yontz: Well, Jill, to be completely honest with you, it's from Cathy's advocacy work, her presence on our campus, Standing Up to POTS organization is a group that I've been following on social media, I think probably since it was launched onto social media, but you know this is not a particular illness that, you know, shows up in our textbooks in our field. As far as I can best tell, it's really the great work of you all that has, you know, enlightened me to this particular chronic illness.

00:04:02 Jill (Standing Up to POTS): So Dr. Pederson, is chronic illness in general a significant problem for our schools?

00:04:09 Dr. Pederson: I think it really is. I actually did a little research before we taped this episode and of course you mentioned earlier that 1% of teenagers are thought to have POTS - postural orthostatic tachycardia syndrome. And I knew that, and I think you knew that. And lots of people listening know that. But some of the other numbers I was not aware of, and so when you look at chronic fatigue syndrome and its big brother or sister, which is called myalgic encephalomyelitis, they estimate that half a percent to 2% of teenagers have that disorder. Go even further into fibromyalgia, and I know lots of our listeners have heard of fibromyalgia. And there was a study that estimated 2 to 6% of school children. So not just teenagers - going down into the elementary years are thought to have fibromyalgia. And then the last one that we know is an underlying cause of POTS and maybe chronic fatigue syndrome and some other things, is Lyme disease. And in the case of Lyme disease, 25% of all cases are in children 5 to 19. So, this is a much more significant problem than I think most people realize, and it's something that the schools need to be working on and accommodating when they find a student who has this issue. Now, the problem is that these are chronic illnesses, but they're also invisible and so my daughter, as an example, didn't look particularly ill. You know, she was good weight, and she smiled at you. There were some signs if you really knew her and knew what she was like before, but this is very difficult. The other thing that's difficult, I think, is that often these kids who become chronically ill with POTS and these other disorders are very intelligent and more than that, they're highly athletic. And so, you take these people that have tremendous potential - and in the case of my daughter, we think it was viral - get a virus and their life has changed forever. And so again that makes it very difficult - the schools, a lot of times this is happening around puberty, they're thinking, "Oh, the kid is acting out, you know something else is going on here," and it makes it very difficult for the administration.

00:06:46 Jill (Standing Up to POTS): Right, and I know that in your paper you start out by giving an example of a patient who is like this and suddenly her grades are dropping and she's calling in sick and your paragraph ends with are her complaints valid or is she working the system? Maybe later on we can address how you tell the difference. But Dr. Yontz, what kind of options are out there to help chronically ill students graduate from high school if they have some of these conditions that present them with so many different symptoms and challenges?

00:07:27 Dr. Yontz: It's a great question and I think it's important to kind of understand the contemporary system we’re in in our public schools in our country. You know I would think ever since probably - you know, some scholars would say the launch of Sputnik in 1957 - the American school system has been in this kind of highly competitive international literal race to producing students and that has led to this obsession, whether it be from policymakers, voters, taxpayers, you know, folks that keep track of schools, this obsession with the outputs of schools. And what I mean by an output of school is the: what does that adolescent look like when they graduate from 12th grade? Or what does that school report card say at the end of an academic year? And you know, we become as a society very focused on the outputs. And I challenge my students all the time. We need to think about inputs, we need to think about inputs in this system, and particularly what's going on in schools because the output of any type of system is always going to be influenced by what is input into the system. You know, if you drive a Buick into a car wash, and here, you know, it's going to get cleaner. It's going to get more shiny, but it's not going to come out as a Mercedes. And I think that your question about what is going on in schools is absolutely critical, and one that is often forgotten because of the highly competitive system we're in. And so I think that obviously there are opportunities for children with chronic illnesses to have accommodations or a 504 plan in their brick-and-mortar schools. My daughter suffers from a chronic illness and she's able to take some of her classes at the local community college which has a much more relaxed schedule. And so you know, supplementing high school classes with college classes is tending to become a more popular option for all children and adolescents you know, not just those with chronic illnesses. Most states have an alternative to the high school diploma, you know, something like a GED or another certificated program that would allow students to complete that credential in an extended period of time or a nontradition type of way. Obviously with the pandemic that we are emerging from, the online options of schooling has become more fine-tuned or better fine-tuned perhaps, and those are certainly options that can help chronically ill students graduate from high school. And then there's home schooling options too, which again, many of us work you know during this pandemic as well too. But you know research is, you know, emerging that there are lots of barriers there and hurdles there so, you know, there are a menu of options, but I think until we, as a society, and those of us that think about educational policy, begin to focus on the inputs of schools and things that are going on in schools and not be only focused with the outputs.

00:10:32 Jill (Standing Up to POTS): So Dr. Pederson, can you talk a little bit about how hard it is for some chronically ill students to even attend school?

00:10:42 Dr. Pederson: Absolutely. So there have been a couple of studies in the literature in the past few years that have looked at this exact issue, and the first one was a study back in 2002 by Lawson and her colleagues, and they showed that 25% of POTS patients were too sick to attend school regularly or adults were too ill to go to work regularly, and so that's the number that lots of folks have heard about POTS. But there have been some more recent studies. There was one in 2010 by Evans and their colleagues that was really looking at chronically ill students only, not just POTS patients, and found that less than half of those chronically ill students were able to attend school full time. And so this is something that, again, chronic illness is more common in the schools than a lot of people realize, and these kids can be really debilitated in a way that makes it difficult for them to go to school. And then the last study that I found was in 2018. It was a study of students with chronic pain syndromes. And what was striking about this is how many were not in school full time. So 22% were fully homebound. They were not leaving to go to the grocery store or to the library, or certainly to school. Five percent of those kids were partially homebound where they might be able to make a short trip to school or somewhere but not get out easily. And then 37% were in school full time, but they had accommodations - might be reduced course load, it might be a buddy in the hall to be sure if fainting is an issue, it might be that they have classes that are strategically put closer together so that they don't have to walk as far. And then the last 36% we're attending full time with no accommodations at all. So in these students with chronic pain, only 36 percent were in school full time with no accommodations from 504, which is medical disability or an IEP, the Individualized Educational Plan. Really scary numbers I think, as the mother of a of a teenager with chronic illness myself.

00:13:08 Jill (Standing Up to POTS): Dr. Yontz, from your perspective as an educator or an expert on education. How big of a deal is it if students are not able to attend school in person?

00:13:21 Dr. Yontz: I've been thinking a lot about that after the past 18 months and the impact that the missing of school had on the general population, so I think that's another really good question. Schooling in our country is compulsory, meaning that students really don't have a choice. They're there. Public schools in our country are free at the point of service too, so it's you know it's something that as they walk in the door each day, they're not paying a tuition charge or admissions charge. The other thing that I you know, often think about as I work with my students and think about what makes an educator is this idea of the social aspect of learning. There's, you know, lot of research that would suggest that the action of learning is a social activity, and so being removed from those type of social settings, there are implications there and major impacts and that extends through co-curricular activities too. Again another byproduct of the pandemic may be thinking about how to engage students co-curricularly in a remote fashion or in some type of way that is not done where one has to be present. For instance, my daughter, she's very involved in the mock trial team at her high school and this past year all of her practices, all of her competitions, all of her scrimmages happened remotely through a Zoom platform or those types of things. And while it did not provide the same experience that she was used to co-curricularly, there was a way that she was able to participate with her teammates in a competitive nature. And so, perhaps, again, that might be one of the positive byproducts in a post COVID area for the opportunity for chronically ill students to participate in co-curricular activities.

00:15:16 Jill (Standing Up to POTS): Yeah, and that reminds me that one thing that I think is so wonderful about your article is that you do divide it up by the physical needs, the cognitive needs, the social needs, and the emotional needs of students and how schools and parents and students can all work together to address all of those things. So that's a good reminder that it's not just learning facts. But also in your article you discussed a study that you conducted with some parents. Dr. Pederson, can you tell us about that?

00:15:50 Dr. Pederson: Yes, absolutely. And some of our listeners may have participated in that, and so we thank you for that. We had an online survey that went through the Standing Up to POTS social media platforms, as well as some other POTS groups, and because of legal issues we were not going to try to survey the children and the teenagers themselves. We actually asked the parents, so legally there's a difference there. And we had parents of 179 chronically ill children fill out the survey for us. So, we really appreciate your support in that. Here's what they told us. The parents reported that these teenagers, these adolescents, had an average of seven discrete symptoms, and if you think about a child who is 10 or 12 or 16, that is too much. But as we crunched the numbers, most of the students again had POTS as their primary illness and 88% reported having a crushing fatigue. Real problems with stamina. We've talked about that in past episodes. This is common in folks with POTS. Seventy-one percent reported issues with light or noise sensitivity, and I know my daughter had that. She's still noise sensitive. Light doesn't bother her as much, but when she was in fifth grade we were literally writing to the principal saying, put my child in a dark corner because she would have tremendous headaches from the fluorescent lights. Seventy percent of these kids were having frequent or severe headaches and then particularly impactful I think, in the educational setting, is that 67% - about 2/3 of these kids had brain fog. And so when we're asking them to be in school from 7:30 to 2:30 or whatever those hours are, they may not always be thinking as clearly as the teacher or the administrator assumes that they are. There were others. So dizziness and lightheadedness, abdominal pain, and neuropathic pain were also reported, but the numbers were a little bit lower there. In addition to the seven symptoms that were typical per student, each of these students, by the time the survey was complete, had been diagnosed with three different disorders as well. And I know my daughter fit into that category and many of us in this community understand that, right? We're looking for answers and you get another diagnosis and a third diagnosis. But again, the problem is that the severity of these symptoms in these illnesses was enough that it was causing the adolescents to miss school. And so more than half of the parents reported that their children missed at least one week worth of school in a single nine week period. And so that's a lot, and it's stressful, I think, for those kids to try to get caught back up academically, but also, socially and emotionally.

00:19:01 Jill (Standing Up to POTS): Yeah, that is a lot for young people to be dealing with while they try to concentrate, because I remember my stereotype of my POTS symptoms, and so many of them was that my body was always bothering me about something. "Hey, I gotta lay down. Hey, my head hurts. Hey, I'm too hot," you know, and I was lucky enough that I was mostly finished with school by the time that happened. But I cannot imagine being young and having a lot of years of school left, but on the other hand, I can also see where, from a school's point of view, this sounds really tough. Dr. Yontz, what are the challenges from the schools’ point of view?

00:19:42 Dr. Yontz: I certainly want to preface that the response to your question is that I am not a special educator. Be very clear on that, but I am someone that studies educational policy and law and you know one of the things that has always plagued the special education community was the wording of the 1975 IDEA law and this law speaks particularly both about public and private institutions, but the term "least restrictive environment" comes from that law which states, to the maximum extent appropriate, children with disabilities are educated with children who are non-disabled and goes on to say that special classes, separate schooling, or other removal of children with disabilities from their regular educational environment occurs only if the nature or severity of the disability is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactory. And so, you know, we've always struggled with the subjectivity of some of those words: 'to the maximum extent appropriate', 'the severity of the disability'. And so I think that it is challenging for schools and families to really kind of decipher what the least restrictive environment is. I would be one that would suggest that nobody knows better than the child and her or his family, but it is a challenge for schools to adhere to the law and also assure that the services are being provided.

00:21:21 Jill (Standing Up to POTS): My question is, for your purposes, does a child need to have a diagnosis officially in order to have a disability that should be addressed? Because we know that in POTS, there is a very long average diagnostic delay, and so if a child, for example, has debilitating migraines or brain fog for three years, but no actual diagnosis to explain, why does that make a difference for the purposes of this law? Or is it good enough if the parents say my child has brain fog, does that qualify as a disability?

00:22:03 Dr. Yontz: That's a great question and point, and from you know my best understanding that is worked on in a kind of district by district, almost school by school basis. And it really depends a lot upon, you know, how much the administration is going to push back or want to meet those needs. But the length by which a diagnosis comes and the understanding by school personnel of the medical condition is also a challenge for the school. A child will come with a diagnosis that the full understanding may not be, you know, understood by the school personnel, or they may have not met a child or worked with a child with brain fog, and how do they provide the accommodations for that? So, part of it is just a process of becoming better educated on the challenges that these students may have.

00:23:07 Jill (Standing Up to POTS): So that sounds like that's a job for parents to help really communicate well with the school. Is that what I'm hearing?

00:23:15 Dr. Yontz: Yes, but I also think it's a call to action for school personnel to understand the students. And when we see chronic absenteeism or reduced attendance from students or, you know, students having problems sitting upright, visibly uncomfortable while walking between classes, or sitting in a lunchroom without backs to the cafeteria tables. Students fainting at school, highly sensitive to light and sound - schools are noisy places, schools tend to be very bright places. And so, they call to action for educators to pay attention to a student that may not want to take sunglasses off as they walk into the school building or tend to walk around with some type of noise cancellation device. You know, the opportunity of paying attention and staying on task and how that overlaps with many other medical situations and how to seek resources to help with these observations that they're making. Then finally, as I mentioned before, too, Cathy mentioned that these are these are many times our brightest students or most athletic students, and paying attention to changes in social interactions and how they're interacting with teammates, how they're interacting with folks that they might be in the choir with. You're right, it is important for the parents to help educate, but I also think that there's a call to action for educators to become more sensitive to these, perhaps, hidden illnesses which sometimes take a very, very long time to diagnose.

00:24:57 Jill (Standing Up to POTS): Yeah, so this feels like where it starts to get pretty complex. Dr. Pederson, where can a student start? What do chronically ill students need from the school at this point?

00:25:12 Dr. Pederson: I think talking to anyone who will listen is a good place to start. That might be the child's teacher, especially if they're little younger and they have a primary teacher in the day. But really, anyone who has been sympathetic to the plight of your child is a good place to start. We were really lucky. For us, most of the advocacy came from the guidance counselor, and so that was a great resource for us, especially as my daughter got a little bit older and moved into middle school and then high school. But there are committees that are called 504 committees, and so again, I think Brian could tell you better than I could, but it's the number of a law, I think, that really gives medical disability to children and allows them to have accommodations in the school. And I think what the kids and the families really need are positive interventions. Let's not doubt this child who is in pain, who is clearly suffering, where maybe you're seeing academic changes. Maybe you're seeing personality changes. My daughter was missing - she was in 4th grade at the time - was missing field trips because she didn't feel well enough to go, so anything that was fun she skipped. But on the regular days she made an extra effort really to be there. So positive interventions where we just come in with the mindset: "Why would this kid, why would this parent come in and try to pull the wool over our eyes?" I think is really important. The second part of that is individualized support. And for our avid listeners, you know already that my daughter's symptoms and Jill's symptoms are very different. We've talked about that several times as we've gone through the POTScast. And so, what Jill would need as a 16 year old in the high school and what my daughter needed as a 16 year old in the high school were really different. And so we need to match the accommodations to the symptom load of that child or that teenager right now. And I know in my own daughter it was really scary and I again I think I talked about this before, she was adding symptoms for about a year. A new symptom would pop up every two to three weeks. Now, eventually we figured out that she had POTS and understood what that was and there was no threat to life, but it was a really scary time, and certainly I was communicating regularly with the school as these new symptoms were presenting themselves. And in our case, we were met with kindness. We were met with that support. But I know of so many families in the POTS groups and other groups that are really having to fight on behalf of their children. So that individualized support, matching the accommodation to the symptom load of that child at that moment is huge. And then the last one that I think I've probably woven in here already is just believing them. Believe that child. Whether it's the teacher, it's the nurse, it's the guidance counselor, it's the principal - believe them when they talk about their symptoms and how it's impacting their life at school. So the good news is in the study that Brian and I conducted, we found that most parents felt like the school had been responsive or very responsive to their needs. In fact, it was 82% of parents felt like their child's school had been responsive or very responsive. Seventy-four percent of those parents reported that the school arranged for either a 504 meeting - again that's medical disability - or an IEP - individualized educational plan - meetings. Where again, they're creating accommodation to help that child in that situation. And only 18% felt like the school was unresponsive. Now, clearly that's where the work needs to be done, right? If the schools are already responding, we can always get better, but we really need to work on those schools that, for whatever reason, are strict in policy and can't give a little compassion to individuals who are struggling. And I'd like to just point out here that there are some studies and one from our beloved Dr. Boris, who is a really famous pediatric POTS cardiologist in Pennsylvania. And he published an article in 2018 with one of his research partners, that actually said that these kids who are severely debilitated could have as a reasonable accommodation, partial school days, and that's what my daughter did. Depending on the year, she went two or three periods per day. And then, as Brian was suggesting earlier, she supplemented with summer school. But also she took online college courses. So she went to school in the morning, and then she sat and worked on the college courses and then also did some summer work as well. So that reduction in course load, and that's certainly what my daughter's school did for her, I think students are required to have five courses per year, five year-long courses. But the college courses would count as one year's worth of a high school course. And so that's how my daughter kept up - she would take a different course fall semester and then another one spring semester which would count as two full high school courses. So there are lots of ways to get around that and I will say when she was younger, we talked about not finishing. It was really, really difficult for her to do the summer work and remember she was ill. And the college work on addition to physically showing up in school and we talked seriously more than once about doing a GED, sitting down and taking the test to finish high school, instead of going through all of the requirements that the school had. So there are lots of different ways around it, and each student and family really needs to figure out what's best for them.

00:31:25 Jill (Standing Up to POTS): And I'm guessing listeners are curious now and they're wondering, did your daughter finish high school on time?

00:31:33 Dr. Pederson: She did. She did.

00:31:35 Jill (Standing Up to POTS): How did things go?

00:31:36 Dr. Pederson: We worked so hard she took her first summer college class actually at Wittenberg after her 8th grade year, so she had not been to high school yet. And it was an in person six-week class and if any of you have taken a summer college course, it is crazy fast and she got an A plus. I told her not, you know, in college those things don't happen. She ended up graduating on time and she was class rank number one, so she really had a lot of struggles. Intelligence was not one of them, but it was difficult. It was really difficult.

00:32:16 Jill (Standing Up to POTS): So Dr. Yontz, from your perspective, how can schools help chronically ill students like this?

00:32:23 Dr. Yontz: I think Cathy has firsthand experience of some very specific things that schools can help with: the reduced course load, the access to, you know, alternative learning environments, access to food and water, gum in class for students, providing the modifications for light sensitivity, sound sensitivity, physical opportunities for students to be mobile when they need to be, or you know, have the support to sit or stand for a long period of time. But I think there are some larger, overarching ways that schools can help chronically ill students, too. First, I would say that the predictable and consistent communication with parents and trust in parents is absolutely foundationally important here, and this goes beyond the, you know, the once-a-year parent teacher conference that parents have the opportunity to meet with their teacher. I'm talking about consistent, predictable, reliable communication. Weekly gathering of work and sending home academic progress communications, informing parents of changing needs, that ebb and flow of the academic year that I talked about earlier would be a really important thing. Now this comes with a challenge. The research is very clear. Doris Santoro you know, produced some research about two years ago on the work life of a teacher in our country. And the top two things that were reported by teachers that they want more of is time and autonomy. Not a higher salary, not more support from their administration, not better technology, not up to date resources. They want time and they want autonomy. So you know, as I challenge schools for this, consistent, predictable, reliable communication with parents, the cost factor there is time. And so, figuring out how to free teachers up to provide that communication to families is a challenge, but I think that you know foundationally, that's the number one thing that schools can do is increase in predictable, consistent communication with families. I also think that we need to understand chronic absenteeism and, you know, in most states truancy and tardiness is decriminalized. It's not something, you know, you're going to go to jail for, and those types of types of things, but understanding that when students are out for long period of times, are they really maintaining as much progress as their health allows? Or are they just slipping through the cracks? When students are gone for behavior reasons - expulsion, suspensions, those types of things - we often forget about the lack of academic progress that occurs when they're off campus or off site. And so, this the same can happen for chronically ill children and adolescents that are absent for long periods of time. Schools can prepare and support home instruction in a new way. And again, I think that could be a positive byproduct of COVID, this opportunity when learning has to happen at home, you know, making sure that that's done in a delivery method that is well paced, that whoever the caregiver is at home has the understandings and the abilities to do so. And I think something else that is really important for schools to think about, is when these students do return from long periods of absenteeism, school re-entry is very complex, particularly at different socially developmental stages of our students. The re-entry to schools can impact students in very, very negative ways, particularly as we think about our adolescents as they're going through this very significant identity development. If they're gone for a month, high schoolers change in a month’s time and they the reentry that they're coming into may look very different. That lunch table may be very, very different. And so an understanding of this reentry is really important socially, but also physically. We certainly want to guard against want to protect from another flare up of symptoms and the difficulties of coming back on one’s body to a new schedule to something that is certainly less comfortable, perhaps, than the situation that they're in. I think schools can really model for chronically ill children and their families what postsecondary life might look like. As students move from childhood into adulthood, this transition of spending their first 18 years, 20 years, you know having an advocate and becoming their own advocate, I think schools can work with families to understand how that transition will happen once they leave high school.

00:37:51 Jill (Standing Up to POTS): So that is a lot of wonderful, wonderful advice. If somebody wants to print out your article and take it to their school district, where can they find that?

00:38:04 Dr. Pederson: I've published a lot of papers and we got 50 free preprints that we could distribute and it was gone within hours. If our listeners email me at info@standinguptopots.org, so again that's info@standinguptopots.org, I would be happy to send a .PDF of this article.

00:38:30 Jill (Standing Up to POTS): And if there are parents out there who feel they need to help educate their teachers or their school about POTS, the standinguptopots.org website is a great place to get all kinds of information and articles for that. Do either of you have any parting words or parting advice for parents or teachers or students or anyone involved in all this?

00:38:57 Dr. Pederson: From the parent side, I would always say keep fighting for your kid. You know them better than anybody else does, you know what they need. You know if they're trying to pull something over on you and my kid never was. Every time she said, "Mom, I've got..." whatever the problem was, I knew 100% that that was true and so don't stop fighting. And it takes some time. Sometimes on the school side, they do have limited resources. They do have limited time. They do have constraints, but be polite about it, but don't ever give up in advocating for your child.

00:39:33 Dr. Yontz: And I would say from the educator side that Cathy is exactly right. As educators, we like parents who fight for their children. We like parents that are all in for their own child and all parents are, but making themselves visible, making themselves vocal, sharing their concerns with us makes our job easier. Nobody knows that child better than that parent, and so, you know, as we work with them in a classroom, we're also working with dozens of other students, and so providing that insider information, those needs those desires to help the child reach their full social, emotional, and cognitive capacity is highly desirable by educators. So keep fighting for your children. Communicate with your teachers. We like that. We like that additional information and most of us have entered the profession because we want to see children and adolescents reach their full potential.

00:40:47 Jill (Standing Up to POTS): That is so wonderful to hear. Wow, I'm so happy to have that well known! Dr. Yontz and Dr. Pederson, I can't thank you enough for taking this time with us today and for working so hard to help POTS patients and other chronic illness patients get the appropriate accommodations in school. Your work is so valuable. Thanks a million. And hey listeners, as always, these podcasts are never meant as medical or personal advice. Consult your medical team about what's right for you, but thank you for listening. Remember, you're not alone. Remember to email Dr. Pederson for a copy of that article info@standinguptopots.org and please join us again soon.

00:41:35 Announcer: You can find us wherever you get your podcasts or on our website, www.standinguptopots.org/podcast and I would add if you have any ideas or topics you'd like to suggest, send them in. You can also engage with us on social media at the handle @StandingUptoPOTS. Thanks for listening and we hope you join us. This show is a production of Standing Up to POTS. © 2021 Standing Up to POTS. All rights reserved.