Resonance is a student-run podcast aimed at showcasing the science at Baylor through the eyes of young professionals. Each episode is written and recorded by students who have a passion for research and the medical community. Guests on the show include both clinical and basic science research faculty who are experts in their fields.
Dr. Michelle Ludwig describes her journey through school and to her current career as an oncologist. She discusses her research interests and what it's been like to learn and practice as a person who is deaf.
Cancer Therapy and What’s Around the Corner | Transcript
Erik: And we’re here
Brandon: We are here.
Erik: This is the Baylor College of Medicine Resonance podcast. I am one of your hosts Erik Anderson.
Brandon: I'm another host Brandon Garcia.
Erin: And I'm the writer for this episode, Erin Yang.
Erik: Yeah so today we're gonna be talking with Dr. Michelle Ludwig about her work as a radiation oncologist, and all that goes into that, and some of the research that she's done. And, yeah, Erin if you want to take it away.
Erin: So, radiation oncology - pretty crazy and interesting and complex field. I think they have to work very closely with I guess the two other kind of branches of oncology which is medical oncology and surgical oncology, so I think they have to do a lot of interdisciplinary work but at the same time they have to be super specialized in their field
Erik: Yeah, and one thing that Dr. Ludwig talks about you know today you hear a lot about how medicine is becoming more and more team based. I mean it's always been team-based, but it's not so much now you have the doctor that sort of dictates everything. It's more spread out and yeah, a little bit more egalitarian. And I think this has been especially true for the oncology field for a long time, as she talks about. Because like you said, you have the medical oncologist, a surgical oncologist, a radiation oncologist; and then she specifically talks about with her work at the Smith clinic, which is a safety net hospital for you know lower-income patients. There's a lot of counselors that are needed and so you know there's a lot of other people of the medical team that don't normally get talked about but are an integral part. And she talks a little bit about that, and it really is a team-based thing so and I think she does a good job of explaining that.
Erin: Yeah there's psychologists, there's genetic counselors, there’s social workers so definitely a lot of people involved. I think she, you know, she also mentions that she did her a lot of her training at MD Anderson and I'm sure all of our listeners know that MD Anderson is like the number one place for cancer treatment in the U.S., probably in the world there's all sorts of crazy things going on at MD Anderson I think the fact that we are here and we get to I know do some rotations there and learn from the faculty there - I think it's just amazing. I'm very humbled by it every day.
Erik: Definitely, and she'll talk a little bit about her story of how she got into oncology; she also has an interesting story in that she did a Masters and a PhD sort of in an untraditional way, which is I think always good for people to hear especially because you know, we are all taught that we need to have everything figured out at you know whichever stage, but things have a way of working itself out. It was a really good interview.
Erin: Yeah Dr. Ludwig did her medical degree at Emory and I think she mentions that she took a year off or took a break in the middle to pursue her MPH just because she found such a calling to understand epidemiology and how to use statistics and big data especially in cancer. And after that she started her residency down in Texas at MD Anderson and then surprisingly started to pursue a Ph.D. in the middle of her residency which is just mind-boggling to me. I don't understand how anyone can do that, but she finished up her Ph.D. here and then stayed here at Baylor and is now an assistant professor and an adjunct assistant professor of epidemiology at UT School of Public Health. So, she's definitely got her hands full.
Brandon: She sounds like she's one of those people that shows how when you find a direction in life doing whatever you take to get the education you need to do what you want to do.
Erin: Oh yeah.
Brandon: So, I'm excited to hear what she has to say about that.
Erin: Yeah, I'm excited to hear too.
Erik: Alright, and here's our interview with Dr. Ludwig
Erin: So, we are here today with Dr. Ludwig, who's gonna tell us a little bit about her life and her research and what her daily duties as a physician scientist looks like. So, Dr. Ludwig do you mind sharing a little bit about your path through medicine and did you ever get tired of being in school?
Dr. Ludwig: I think I would say in school as long as I could. Now I've really enjoyed my studies. I think I decided I wanted to go into medicine when I was three. My grandfather was a physician - he was an immigrant from Italy and worked his way and went through medical school and so I kind of grew up thinking that that's what I would do. But because of my hearing impairment I was not sure that I would get accepted into medical school. So in undergrad I majored in pharmacy, which at that time you could do a BS, a bachelor's in pharmacy, and I figured well, if I didn't get into medical school then I could work as a pharmacist or maybe work while I was trying to get into medical school. But then I got in and then I took a year off after my third year of medical school to get an MPH, which was fascinating. It's a whole different way of thinking about a population instead of an individual and trying to solve problems that affect six million people instead of the six people you see in that day in that clinic. And then during residency, I started my PhD coursework in epidemiology kind of looking at the same thing, so it's kind of a nice balance between - I'm seeing the individual and then trying to solve problems on a wider scale.
Erin: I'm just curious - I think it's pretty rare to hear anybody starting a PhD during their residency. It seems like a pretty busy time - how did you manage to do that?
Dr. Ludwig: well my residency was fortunate to have a year of research, dedicated research time, so during that research time I did my Ph.D. coursework and then finished my defense after I became faculty which was, that was challenging, but it was, it was good. It kept me engaged and it's kind of nice to take a break, take a step back from clinic, and have successes in other fields.
Erik: Well, so can you share a little bit about your experience of becoming deaf at a young age?
Dr. Ludwig: So, I lost my hearing when I was two. I had pneumococcal meningitis and it was a fortunate time for me to lose my hearing because I was already speaking. I'm profoundly deaf now and when people talk the only thing I hear are the deeper tones, which are the vowel sounds, so I have to kind of interpolate in between the vowel sounds. So, it's kind of like doing a crossword puzzle and thus I can lip read. But having lost my hearing at that young of an age, your brain is plastic enough that you can learn how to do those things like lip-reading and figuring out words that people are saying without really having to be formally taught just like learning a second language. And in addition to losing my hearing I also lost my vestibular system, so I had to learn how to walk again and how to learn how to walk without a vestibular system. You can do it - you just have to use your eyes a lot more than the average person would. So, I’m very fortunate that it wasn't you know six months or a year earlier, or much later in life because I think it's harder to adapt.
Erik: Well and you began to talk a little bit about this, but can you share how this impacted your life as a student and then also as a physician?
Dr. Ludwig: I was very fortunate. In college I went to the office of disability services and said, you know, what can you do? I figured maybe I could have a note taker or something because if you think about it, looking down on your paper to write - if you have to lip read then you miss the next thing that somebody says. So, they have a program called court reporting - computer activated real-time - and it's kind of like a court stenographer where they take notes real-time to what the professor is saying, and it pops up on your laptop. So, I could literally read word for word what they were saying. And in the beginning the stenographer had to come to class with me but then as technology became more advanced - remember the internet was basically just invented when I was in high school. But now when they do that, they just log in remotely as long as the room is wired for sound, and then I click a button and a screen pops up on my computer and it's a real time transcription of what's being said. And it's pretty accurate. It's the same people that do medical dictation. And so I use that now when I have a conference call, and it's not perfect and I don't know who said what, which can sometimes be difficult for a conference call, but it really, I don't think I would have made it through med school without having that available. The most tricky part during medical school in addition to that was my surgery rotation, because with the mask it's hard to lip read. They've actually just invented a clear plastic mask for use in the OR, and I just placed my order today. So, after all these years I’m really looking forward to when I go to the OR to giving out everybody the plastic masks and for the first time actually being able to understand what's being said.
Erik: That’s amazing. It's also amazing it took this long to make one.
Dr. Ludwig: Well, there’s not that much of a demand. I mean, if you think about it, you know, the people that would want it. Although I think it would be helpful for kids like in a pediatric hospital, because I would imagine it would be scary for a child to see the anesthesiologist all covered up. So, I think there might be a little demand there, but for the most part the demand would be hearing impaired physicians that lip read, and I don't think there's a huge number
Erin: So, you mentioned you're still going to the OR, you’re still doing research, you're doing all this stuff. How did you get involved in like medical school curriculum, and how did you manage to find time? Because we had the privilege of working with you through our PRN, which is the Peer Resource Network, through our first year curriculum and we really enjoyed that. So, I was wondering how you managed to find time to work with us MS1s.
Dr. Ludwig: I think you kind of make time for the things that are important to you. In my field I'm able to limit my clinic to two days a week and then maybe one or two mornings a week in the OR. It's just because the way my field is structured. And I really like having that balance between clinic and research and teaching. I think as an oncologist it can be kind of a depressing job sometimes. We have some days where it seems like every patient that come to see me has a terrible story. And doing research and teaching, if you work on that, you know, can kind of I think keep you from getting burnt out.
Erik: Well, as a student advisor how has your own journey as an oncologist and just your own experiences impacted your advising?
Dr. Ludwig: I think as an oncologist I have a chance to talk to my patients a lot about quality of life. Things like work/life balance. There's a kind of a standard phrase that I tell my all of my patients that are metastatic, that at this point in your life the way that you beat cancer is by not letting the cancer keep you from being who you are. And I think I kind of take those things to heart and encourage my students to think about their life outside of medicine. Think about their relationships outside of medicine and make sure they cultivate those and make sure they take time, maybe not every day, but every week to make sure that they're well rounded person so that they have something to give back to their patients.
Erik: Yeah, it's hard. Yeah, only just finished the first year but it's like just making time for all that stuff and spending ten plus hours a day sometimes studying.
Erin: Yeah it seems to only get worse from here. Seems like you just have less time the older you get, I guess. So, I was curious - we had heard that you have a hearing dog who helps you out I guess sometimes in the clinic. Can you tell us a little bit more about that?
Dr. Ludwig: I do. Her name is Marguerite and she turns 14 next week. So sadly, she has actually starting to lose some of her hearing. She is from an organization called Canine Companions for Independence. And what she does - she's a Lab/Golden cross so half Lab half Golden. When my doorbell rings, when my pager goes off, when my phone rings, she comes and taps me on the leg, and I say “what” and she takes me to it to the sound. That could be an oven timer or doorbell, and now a baby cry. And she's actually very helpful because before that I would have to, if I was on call I didn't sleep very well, cause I was afraid I'd missed my page, or if somebody knocked on my door when I was at home before I got married, that I would miss them coming over. And if you’re waiting for a package that you have to sign for, just all these other things. When we're driving if there's a siren that comes, she’ll pop her head up and look at the siren so I can tell where it's coming from. Sometimes I can hear it, but I don't know where coming from and where I need to go so, she’s actually very helpful. And she’s semi-retired now. Just because she’s 14 it’s hard for her to come to work with me but she used to come to clinic with me. And if I had to have a family conference, basically where I sat down and have a goals of care discussion with a patient, I would ask them ahead of time if they wanted to bring their kids and if they would like my dog to be there for that. So, she's come and kind of helped out with a lot of difficult discussions, and she's been good for the kids if they have kids to give them something to focus on.
Erik: How long have you had her - how long has she worked with you?
Dr. Ludwig: So, she's been with me since she was 2 – a long time – they’re raised until they're 18 months by a volunteer puppy raiser. And then at 18 months they're sent to have a basically a personality test to see, should they be a guide dog - which is the former term for a seeing-eye dog - or a wheelchair dog for kids or adults in wheelchairs, or what’s called a facility dog. Sometimes they work in a court room for like if a kid has to testify about a violent crime, or a bomb dog. So, they give them a personality test and then depending on what they're, what they show, then they go into that training for six months and at the end of the training period they have a what they call a team training, which is a match process. So, I went to Santa Rosa, California, which is where they do the hearing service dogs for the program. And the first day I worked with eight dogs. It's kind of like The Bachelor/Bachelorette. And the second day their trainer cut the list down to four and then the third day two, and the last day was like the rose ceremony where they match you with a dog. And the dogs usually end up picking the people. The trainer watched and most of the dogs turned around in the kennel and took a nap when I was working with the other dogs, but Marguerite was watching me work with all the other dogs. And the trainer said, she's trying to learn what the sequence of the commands is gonna be so when it’s her turn she can impress you. One of the neat things that she does since I don't have a vestibular system is, we can go stand-up paddle boarding and she balances the paddleboard for me. She lays on the front and she wasn't even trying to do that, but she just figured out that I needed help with it.
Erik: That's amazing.
Erin: Yeah, wow and speaking of I guess like bringing her into clinic, like what is a day in the life look like for you? Are you in clinic most of the time, are you doing research? What does maybe a week in the life look like for you?
Dr. Ludwig: Well one of the neat things about my job is every day is different. Two mornings a week I have tumor boards so different specialties - my specialties are gynecologic and breast cancer. So, Monday mornings from 7:00 to 8:00 I have breast tumor board, which is where the medical oncologists, surgical oncologists, radiation oncologists, pathologists, radiologists, get together and they go over difficult cases. And we all discuss, or maybe argue, what the best course of action should be about different patients. And then on Monday the rest of the day, I'm in clinic. I see all the patients that are on treatment once a week just to see how they're doing. Tuesday mornings some mornings I’m in the OR or doing procedures and in the afternoon, I catch up. And Wednesdays I work with the Learning Communities advising and wellness and do tumor board. And Thursdays I see new patients and follow-up patients, and then Friday mornings I'm in the OR. So, my academic time is Wednesday morning, Tuesday afternoons and then Friday afternoons. So I have that time to work on my clinical trials, or meet with people, make phone calls, prepare for clinic.
Erik: Well I have a two-part question actually. I guess the first is what made you, well, can you define radiation oncology and then what made you want to go into that?
Dr. Ludwig: So, radiation oncology is the concept of using therapeutic radiation for mostly for cancer. We can use it to definitively treat cancer so to shrink cancer without having to take out the organ. For example, laryngeal cancer, if you take out the larynx people have less quality of life. So laryngeal cancer, we can actually cure the cancer with radiation. Anal cancer, once again, you know, the surgery can be life-altering. We can actually do radiation to kill the cancer while preserving the organ. In cases like lymphoma we do what’s called consolidated variation where we do radiation after chemo to where the cancer used to be to basically sterilize the area. We often do that for breast cancer, for example after surgery, to sterilize microscopic disease to reduce the risk of local recurrence. This is done with again therapeutic radiation - either external beam radiation with a linear accelerator that makes mega voltage X-rays or what’s called brachytherapy. Brachy from the Greek word meaning short. Brachytherapy is with a radioactive isotope – iridium, cesium – that we place inside the tumor, and it releases, it disintegrates inside the tumor.
Erik: And then what made you get into this field?
Dr. Ludwig: I initially thought I would go into pediatric oncology. I worked for St. Jude Hospital in Memphis for two summers. And I really like the multidisciplinary nature of oncology. We work very closely with surgery, pathology, radiology, child life psychology, and pretty much every case presented was discussed before anybody did anything and I kind of like that approach to patient care. That was when I was in pharmacy school, so I did some time at the onco-pharmacy, and then in medical school I got exposed to radiation oncology, and we’re one of the few oncological specialties that deals with every single cancer. So almost every single cancer in some stage or another, there could be a role for radiation. I liked how comprehensive that was and I liked the procedural aspect of it, to do the brachytherapy, to go to the OR to do short procedures, to think about the anatomy, everything from high-level anatomy to social determinants of health.
Erin: Can you tell us a little bit about I guess your clinical research interest or maybe basic science research interests -- whatever you're working on at the moment?
Dr. Ludwig: I have basically three clinical trials that are going on right now in kind of different areas. One of them is a quality of life study. We are trying to prospectively evaluate what quality of life metrics impact patient compliance, whether it's physical, emotional. So, we're giving our cervical cancer patients a quality of life survey that they fill out at baseline every week during their treatment, and then at follow-up, and then we're going to go back and correlate that with compliance to radiation treatment and chemotherapy. This started because we went back and looked to see if patients that had higher side effects were more likely to miss treatment, which sounds intuitive. But in our population, they actually weren’t. So, we looked at again what patients were missing treatment and our patients that had a history of mental health disorders were, that was the most significant finding that was associated with patients missing treatment. The reason it’s such a big deal is because for definitive radiation, so if I'm trying to cure cancer with radiation, they have to go about 25 to 30 times, and it has to be in a row. And every day that they miss decreases their chance of local control by 1.2 to 2%. So, it’s to our advantage to figure out what we can do to intervene early if we think a patient might be at risk of non-compliance. So that's one kind of a behavioral health project. The other project that I have going on is an investigator-initiated trial using what’s called a PARP-inhibitor with poly ADP-ribose. It works on homologous recombination. It's an oral chemotherapy that was initially developed for BRCA sensitive ovarian cancer. They found out that it didn't just have to be in the BRCA cell line, that our patients had gotten a chemotherapy called Cisplatin, and if they were responsive to that then that oral chemo would work on these patients. So, I'm combining it with radiation for metastatic cervical cancer patients to see if they can take this oral chemo instead of IV chemo with radiation. The IV chemo they have to go, it’s a four-hour infusion. So, thinking that this might improve their quality of life and also because it's targeted therapy, maybe be a little bit less toxic than some of the traditional chemotherapy. We just enrolled our first patient on that trial. It’s taken me about four years to work and develop and write it. My first experience writing a clinical trial. There’s a big learning curve with doing that so I'm very excited to have our first patient. And the third thing I'm working on is developing a topical agent to prevent radiation dermatitis. Radiation dermatitis is basically a sunburn that’s caused by radiation for – this one is for breast cancer or head and neck cancer – because the skin is part of the target, and the skin does get an acute reaction meaning during the radiation they get a pretty intense sunburn. There's no real standard of care for managing that sunburn. Some people use a corticosteroid ointment but the problem with that is that leads to thinning of the tissue with long-term use, and then especially in patients that have diabetes you can get bacterial or fungal overgrowth with long term use. So, we’ve been developing a topical agent for radiation dermatitis and we are working with the FDA on getting what’s called an IND, which means investigational new drug. This drug is currently available in an oral form but we're repurposing it in a topical form. We had to develop a method that a patient could put it on their skin and the agent would take it down to the dermal layer which is where the fibroblasts are. So, we had to work with the formulation of the cream to get it to do that. Once we hear back from the FDA, we’ll be ready for patient studies.
Erik: So is this is the kind of work that you're doing now pretty similar to what you were doing in your PhD or has it changed a lot? And I say this because I'm curious, I'm actually in the MD/PhD program here, so I have a first-hand interest in how much do you have to actually stick to your PhD.
Dr. Ludwig: My Ph.D. was in cancer epidemiology, looking at big data…
Erik: Okay, and was it building off of your masters then?
Dr. Ludwig: Well my master's was in cancer epidemiology, too. So, I think basically a PhD teaches you how to think and how to solve problems and how to write, how to write grants, how to write a good research question, how to write your aims so that you can do any of these things. I don't think my PhD work is directly correlated with what I'm doing now, but I think that the case with a lot of researchers.
Erin: So, what you say is maybe the most frustrating part of your work as well as the most rewarding?
Dr. Ludwig: I think the most frustrating part of my job, as is the case with working with a safety net system, with the Harris Health system, is trying to care of patients that have very limited resources. When they have issues with transportation or lack of funding to buy over-the-counter drugs for their side effects, or food insecurity. Even though I know that these conditions exist, it's very hard to get them connected with the proper channels to address those in a timely enough setting to not impact their cancer care. I think I'm a decent oncologist; I'm a terrible social worker. And unfortunately, the social workers and support staff that is available through the county are stretched very thin. And I often have to rely on kind of a cobbled approach of my medical student trying to look up things and my residents trying to help the patients as best as we can, and it’s a different, it's a different approach for every patient.
Erik: So, you said safety net hospital. In case some of our listeners don't understand what that is, would you mind explaining a little bit about that?
Dr. Ludwig: I may not get all the details right, but a majority of the patients that I see in my clinic are below 200 percent below the federal poverty line, and Harris County is one of the few county health systems in the country that is able to provide excellent level oncologic care to medically underserved patients. There's not very many other programs like that in the US, so I'm very proud to be working for a hospital that does offer those services. We have the top-of-the-line radiation equipment, we have pretty much every chemotherapy option that they could need, we have clinical trials available for our patients. But they do often struggle with, as I said, transportation, childcare, food insecurity, and things that are beyond my level of expertise to be able to address.
Erik: And so, I guess jumping maybe into the future, what do you see cancer treatment looking like in 10 or even 20 or 50 years? Do you think it's gonna change a lot? I mean we've been – radiation is about a hundred years old right so we're still using it. It seems to be pretty good, but do you see any major changes ahead?
Dr. Ludwig: So, we've been using radiation since 1895. In fact, we were using radiation before anybody ever heard of chemotherapy. I think we cured our first lymphoma patient in 1896. And in terms of cervical cancer, I'm hoping in 50 years there won't be any. We now have the HPV vaccine. A lot of my patients are from countries that I don't know will have access to the HPV vaccine, so if that continues, I think we may still have a few patients, but I'm hoping that right now there's about 14,000 new cases in the US of cervical cancer. I'm hoping that maybe in 50 years that number will go down to two or three thousand. The Australians have already seen a decrease in cervical cancer and they're attributing it to the HPV vaccine, so I’m hoping that that would be something that goes well. I think we'll have an increased risk of obesity related cancers namely the one that I treat being breast cancer. I do think in terms of treatment we keep talking about personalized medicine. I think we're gonna see a lot more of that exploding as we see all of the -omics, radiomics, genomics, and we're seeing that again a lot in breast cancer -- Herceptin being one of the first widely available targeted therapies. And I think we’ll do a lot more, kind of like we do for antibiotic resistance, where you culture bacteria. I think it'll be more that kind of paradigm for cancer treatment whether that’s finding a chemotherapy, whether it's determining if it’s a radiation sensitive tumor. If we think about it, radiation is actually the ultimate immune modulatory technique because what we do only radiate somebody? We basically blast the cells open so that they're exposing their antigen to the body. If the body's not already terribly immune-suppressed then we're seeing a lot of the new MHC antigen being presented and activating the immune system. I think we need to figure out, and a lot of people are doing this, and combining radiation with immunotherapy for things like melanoma, CNS melanoma. So, I think we'll see a lot more combinations of radiation with immune modulation.
Erik: Well and that's interesting because you started mentioning something that for some reason, I didn't consider but I probably should have is, the idea of lifestyle treatments for cancer. I mean a lot of these can be prevented, like you mentioned HPV with the new vaccine and just obesity. Is that something that a lot of I guess oncologists are thinking about? Because I always hear about people funneling a lot of money into the newest treatment option, like the newest medicine, which was what my question was getting at. But do you see a lot of people focusing on that end of things, or maybe it's more of the family care physicians that might be thinking about that kind of stuff?
Dr. Ludwig: I think a lot of oncologists think about tertiary prevention. For example, a recommendation, if a patient has an obesity related cancer and they lose weight, do they lower their chance of it coming back? So, I think in the oncology world we’re concerned about that, but certainly primary care concerned about reducing obesity, reducing carcinogen exposure, lack of exposure, would go a long way. I think a lot of us are pretty active and talking about the HPV vaccine, anti-smoking to schools and things like that, but it’s an uphill battle.
Erin: I just wanted to –I was personally curious about—you have so much like going on at work and with like educating students and like doing all these trials and being in the OR. How do you unwind outside of work and what do you like to do for fun I guess in Houston?
Dr. Ludwig: I have a six month old daughter, so coming home and seeing her, and seeing her learn every day and learn new things, and spending time with her, and watching her smile at you is just a great way to make you forget about all the stressful parts of your day.
Erin: Any like hobbies or anything that you like? I remember during a class you were telling us that we had to try all these like new restaurants in Houston and that you were a big foodie. Do you like to do that still or is your daughter keeping you pretty busy?
Dr. Ludwig: I do! My husband, when we got married, he moved from just outside of New York City, and he was a little concerned about the food scene here. I said, I’ll put up a restaurant in Houston against New York City any day of the week. He didn't believe me, but I think he's been converted now. There's some great diverse and affordable food culture in Houston and we probably haven't been doing that as much lately with a six-month old. Look forward to getting back into that.
Erik: That's actually a really good point because I'm from outside of Chicago and so I always thought, not exactly the same, but I had I think some food snobbery in me too, but it's exactly what you're saying. It's amazing and you can find like any type of food that you would ever want. Maybe not deep-dish Pizza. Chicago’s still got that.
Dr. Ludwig: But that also contributes to the obesity epidemic.
Erik: You got me.
Dr. Ludwig: I’m looking forward to restaurant week benefitting the Houston Food Bank. A lot of my patients are recipients of meals from the Houston Food Bank. It’s from Aug. 1 through Labor Day. There's probably about 150 restaurants participating and I think they raised almost 12 million dollars for the Houston Food Bank.
Erik: Well, I think that's all the questions we had, if you have any additional comments, but if not, we will let you go. And thank you so much for taking the time to be interviewed by us.
Erin: Yeah thank you Dr. Ludwig. We really enjoyed talking to you today.
Dr. Ludwig: Thank you both and good luck with the rest of your medical school careers.
Jennifer: Well that's it for now. We’d like to thank everyone out there who took the time to listen to this episode of the podcast. Special thanks to Erin for writing the episode. Thank you to our faculty advisor Dr. Poythress for helping us put everything together and thank you to the Baylor Communications department for helping us with the production and website. And thank you again to Dr. Ludwig for taking the time to be interviewed by us. We hope everyone enjoyed it and we hope you tune in again soon. Goodbye for now!