University of Southern California Dissertations and Theses

My gold lining: a lifestyle and medical documentary on patients with hidradenitis suppurativa

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My gold lining: a lifestyle and medical documentary on patients with hidradenitis suppurativa

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Content MY GOLD LINING: A LIFESTYLE AND MEDICAL DOCUMENTARY ON PATIENTS WITH
HIDRADENITIS SUPPURATIVA
Producer, Director, Writer, Editor: Jasmine “IVANNA” Espy
Master’s Thesis

My Gold Lining: A lifestyle and medical documentary on patients with Hidradenitis Suppurativa

By

Jasmine Espy

A Thesis Presented to the Faculty of the Annenberg School for Communications and Journalism

University of Southern California

In partial fulfillment of the Requirements for the Degree

Master of Arts (SPECIALIZED JOURNALISM: THE ARTS)

December 2019

1
Table of Contents

Table of Contents……………………………………………………………………………………...ii

Introduction…………………………………………………………………………………………….1

Documentary Script………………………………………………………………...…………………15

Bibliography……………………………………………………………………………………………45

1

Introduction. I have a rare chronic skin disease called Hidradenitis Suppurativa. It’s
plagued my life for over 15 years, presenting as recurrent and relapsing abscesses in the
inframammary, inner thigh, back, stomach, right and left axillary regions. When the abscesses
first formed, they ranged in sizes as small as a pea or as large as a tennis ball. After they form,
the abscesses, pimples or boils can take weeks to rupture on their own. In these cases it is
recommended by medical professionals to visit an emergency room or a primary care physician
to have the growth lanced. Once cut into, the abscess would drain a malodorous fluid of
concentrated skin cells, leukocytes (white blood cells), and living or dead microorganisms
(Encyclopedia Britannica 2019).
Once the procedure is over it typically continues to drains for some days.
Healing thereafter differs with every patient. Some completely heal with no recurrences
in the area, but others may experience an open wound with the chance of another boil growing
on top of the same area. This is what classifies HS as a chronically recurring condition. These
factors are also what makes HS harrowing having effects physically, mentally, socially, and
emotionally.
During the summer of 2018 following the rupture of one of the biggest abscesses I’ve had
in the last 4 years, I was motivated to produce a documentary centering on the intricacies of
living with HS through two first-person accounts.

My Gold Lining is the resulting documentary. The film centers on two African American
women battling HS with additional perspectives from patients, dermatologists, psychologists,
parents, and partners. One perspective focuses on a beauty influencer navigating her diagnosis in
2
adulthood, a relationship, and building a beauty brand in a society obsessed with “perfection”.
Perspective two follows the life of a journalist who sets out to create a visual series showcasing
the physical effects of HS on the body, while maneuvering through graduate school and
developing a career in entertainment.
Through the stories of Janee Allure and myself, audiences gain access to the raw realities
of managing HS, and navigating the complex social, mental, and emotional layers that present.
My Gold Lining unveils the history of HS, its impact on patients’ quality of life, and the healing
techniques used to relieve and, in some cases, induce the remission of HS (Danby 2015, S52-
S54).

Approach. To fully understand the manifestation, severity, progression, and treatment of
HS, inserted throughout the documentary are interviews from Dr. Itlefat Hamzavi, my personal
physician and the President of the Hidradenitis Suppurativa Foundation; Dr. Erin Martinez, my
personal social worker, and a sex therapist who works with Dr. Hamzavi to assess and treat the
mental health of HS patients.; naturopathic physicians Dr. Ashley Biscoe and Dr. Allision
Egeland who treat HS using natural medicine. Some of their focal points in practice with HS
patients center on balancing gut health, understanding genetics, detoxing from the pollution in
the environment, and diet.
In addition to being the President of the HS Foundation, Dr. Hamzavi is the head of the
HS clinic at Henry Ford Hospital. He also has additional private practices in Canton, Brighton,
and Shelby Township, Mi. Dr. Hamzavi and I met at the HS clinic in 2010-11. My mother, who
worked in health care at the time, received an email about a clinical trial for HS. This moment
was life changing because I hadn’t been diagnosed for three years. The physicians who
3
attempted to put a name to the mysterious condition, misdiagnosed me for years with life
threatening conditions like MRSA. Shortly after this time my mother and I visited a surgeon at
Children’s Hospital who diagnosed me properly with Hidradenitis Suppurativa. We wanted a
second opinion. So, when my mother found out about the clinical trial it was something like
perfect timing. But by the time I saw Dr. Hamzavi and his team, the HS spread rapidly on my
body going from Hurley Stage I to Hurley Stage III in a matter of years.
The Hurley staging system is commonly used to identify the extent of HS. However,
there is still no agreement for a grading system due to the diseases wide spectrum of severity
(James and Wilson 2019). There are three stages within this breakdown used to classify the
austerity of the axillary regions. Additional classification systems exist for inframammary and
mammary regions, the groin, and buttocks (James and Wilson 2019). The system measures
severity using Hurley Stage I-III; stage I is the least severe while stage III is debilitating (James
and Wilson 2019).
Stage I, the most common of the three (James and Wilson 2019), presents as single or
multiple nodule forming abscesses absent of sinus tract formations or interconnected scar tissue
(James and Wilson 2019). Stage II presents as multiple manifestations of recurring abscesses,
which often rupture to form separate sinus tracts (Oakley 2019) with normal skin in between
(HS Foundation 2019). Stage III, the most severe, presents as multiple manifestations of
recurring abscesses rupturing to form interconnected sinus tracts and atrophic scarring with no
normal skin in between (HS Foundation 2019).
During the trial I was divided into one of the three groups of patients. One was the
control group, the second group would undergo a deroofing procedure, and the third group was
put on several cycles of systemic antibiotics.
4
Deroofing is essentially the process of filling a lesion with anesthesia with a probe to
measure the length of the sinus tract. The roof of the lesion is then removed with a scalpel and
left open to heal forming a cosmetically acceptable scar (Van Der Zee 2010, 475-480).
To determine the group, I would be a part of Dr. Hamzavi flipped a silver quarter; heads
for group two and tails for group three. The quarter landed on tails. I was then placed on a cycle
of clindamycin and rifampin for a six-month period. During this time, Dr. Hamzavi and his the
bacteria wouldn’t develop an immunity to the medications.
After about a month or so of taking the antibiotic cocktail I did notice improvements in
inflammation and recurrence, but it was short-lived. However, the HS clinic is where I was
finally properly diagnosed after almost 7 years of misdiagnosis, which is common for patients
according to previous epidemiologic studies (Alharbi, Kauczok and Paulla 2012, 2). Dr.
Hamzavi and I built an ongoing relationship during the clinical trial which is what ultimately
inspired his involvement in the documentary.
Throughout the clinical trial, Dr. Hamzavi presented me with a Dermatology Life Quality
Index (DLQI) survey, a list of questions measuring the quality of life of patients with the HS.
This is commonly used to assess the mental and emotional states of patients (Kouris, Plasidaki
and Christodoulou 2016, 687-691).
Later down the line he inquired about how my mental health was being affected by HS.
This provided me space to talk about the social and personal difficulties of HS like, developing
and maintaining personal and professional relationships when a patient is chronically ill and
irritable. My poor mental state is not uncommon amongst HS patients (Kouris, Plasidaki and
Christodoulou 2016, 687-691).
5
After the assessment Dr. Hamzavi referred me to see Dr. Erin Martinez, who is the
director and founder of Dream Catchers Therapy Practice located in Dearborn, Michigan. Dr.
Martinez is a Licensed Masters Clinical Social Worker and Certified Sex Therapist. She works
closely with the patients in the HS clinic to unpack the trauma, grief, and emotional weight of
living with a chronic illness (Matusiak, Bieniek and Szepietowski 2010, 706-708).
During the first session Dr. Martinez took me through a general assessment through a
series of questions pertaining to my quality of life. It was different from the DLQI questions Dr.
Hamzavi presented to me.
After the assessment we began regularly scheduled sessions. My successful experience
with Dr. Martinez influenced her involvement in My Gold Lining.
Some of the negative experiences I’ve been through with the treatment and removal of
HS has motivated me to find natural remedies to slow the progression of HS. I experimented
with a variety of diets on my own and found success in adopting a vegan/ vegetarian lifestyle.
From this new adaptation I became curious about the link between gut health and HS. This
curiosity generated many results, but one source that stood out to me specifically was a YouTube
video produced by Dr. Ashley Biscoe entitled Foods to Avoid if You Have Hidradenitis
Suppurativa.
After watching this video, I looked into her naturopathic and functional medicine private
practice facility, Attune Functional Medicine. Her certified naturopathic knowledge for inducing
HS remission is what ultimately encouraged me to reach out to her and her colleague, Dr.
Allision Egeland, to participate in the making of My Gold Lining.
6
Without each professional’s contribution, the documentary would lack a full
understanding of the medical research and treatment it takes to manage a rare/ orphan (Khan,
Behairi and Katib 2015, 230-232) disease like HS.
From the documentary’s inception, my intent was to focus on HS through the lens of diet
which was inspired by my own success in adopting a vegan lifestyle. This caused the HS to
regress. But as I began conversing with Dr. Hamzavi, Dr. Biscoe, Dr. Egeland, other physicians
who did not participate in the documentary this idea expanded to focus on patient’s quality of
life, the history of the condition, and the treatments currently available to those who are
suffering. These conversations demystified the link between diet and HS to reveal that diet alone
is not a cure to HS but can revert in some patients. This proves diet is an answer, but not the
answer. Due to HS manifesting differently in a wide variety of patient’s doctors are having
trouble finding a suitable cure or treatment. Some experience lesions due to genetics (Ingram
2016), others due to diet (Danby 2015, S52-S54), but overall physicians are not sure how or why
HS manifests in the first place (HS Foundation 2019). This essentially means there’s not enough
research behind diet and its effects on HS. So, to frame an entire feature-length documentary
around this would be a bit irresponsible.
However, I am a member of a HS diet support group on Facebook that consists of over
ten thousand patients sharing their natural treatments for HS. Patients in this group have found
some relief and even have experiences of remission. Most of the time members have more
questions than other members have answers, but when someone can’t help, the group dishes out
messages of support and encouragement as a supplement. This proves that while support groups
can be beneficial, they too are experiencing a gap in creating beneficial long-term treatments.
7
This is essentially how I came to understand on a deeper level what works for me is not
necessarily what works for everyone else.
Adopting a vegan lifestyle proved to regress the HS in my body, but this is my
experience and my experience alone. All of this newfound information steered the documentary
in a new direction. Instead of diet being the sole focus I inserted diet as a topic in understanding
this complex condition. The documentary now focuses on the history of HS, treatment options,
and the patients affected by it.
Adding the first-person perspective was inspired by the documentary Unrest by Jennifer
Brea, who also used her personal experience with Myalgic Encephalomyelitis (ME/ chronic
fatigue syndrome) to bring awareness to this rare and controversial disease. As someone who has
undergone multiple clinical trials and surgeries, has experienced both misdiagnosis and diagnosis
my intent is to add a valuable expression of experience and healing physically and mentally.
Diverting from a documentary solely focused on diet and HS also the search to find
another patient who was using a public platform to speak about their experience. From the
beginning my intention was to find a social influencer on Instagram or YouTube that had HS.
My research revealed a variety of videos of mostly women sharing their experiences. They
varied in ethnicity from African American to European to Latin American women with differing
HS severity.
I contacted the sources to ask for their participation in the making of My Gold Lining. To
my surprise about 10% of them responded. One of the women who sent me a response is Janee
Allure, a beauty and lifestyle influencer on Instagram and YouTube. Her video entitled All About
HS; My Skin Disease (Graphic) currently has 7k+ viewers and over 100 comments and is what
influenced me to ask if she would participate. Once I attached her to the project, we arranged a
8
phone conversation to discuss her history with HS and the severity. Janee Allure, whose legal
name is Antonia, has Hurley Stage II. Much like myself and other HS patients, she developed the
disease after puberty (Kagan, Yakuboff and Warner 2005, 734-741) and experienced frequent
misdiagnosis, limited treatment options, and experimented with diet. The differences between
Janee and I are that she did not follow through with altering her diet due to financial limitations.
She also navigates the intersectionalities of having a relationship and a chronic illness and the
complexities that arise as a beauty influencer battling HS, which primarily affects the skin.
Developing a supportive community online or in person is also a key component to the
management and treatment of HS (Golbari, Parter and Kimball 2019, 1760-1762). Community is
important due to the embarrassment and avoidance in the discussion of symptoms with
physicians, friends, and even family (Golbari, Parter and Kimball 2019, 1760-1762). Therefore,
speaking to individuals who know exactly what you’re going through can prove to be
therapeutic. The culmination of these varied perspectives and experiences makes up the 40-
minute documentary that is My Gold Lining.
Interlaced between patient and physician perspectives and histories is an artistic metaphor
explaining the impact of HS on patients' lives through the art of Kintsugi. After regressing my
HS and experiencing a culmination of positive and negative surgery interventions, I searched for
a system to express the weight of my lived experience. I researched a variety of cultural
perspectives on beauty and scarring. Amongst the hundreds of concepts lie Kintsugi, a Japanese
pottery repair technique some Western healers have adopted to encourage the appreciation of
scars and imperfections. I used this to emancipate myself from a lack of self-esteem and
confidence in my own body.

9
It was difficult to express my feelings through my go-to modality. This encouraged me to
evolve beyond what I knew as a writer and storyteller to communicate my experience using my
body through photography and video.
During my search I came across and ancient Japanese art form that one therapist uses as a
metaphor for what I was going through. Kintsugi is essentially a pottery repair technique
developed by Japanese artisans in the 15th-century (My Modern Met 2019). Kintsugi is
traditionally used when a piece of pottery breaks, and instead of throwing the pieces away, they
are packaged up and sent off to be mended and painted with gold lacquer. Kintsugi as a
methodology aids in explaining the process of being broken open by chronic illness and the
process it takes to piece yourself back together mentally and physically. My gold lining in my
life, aside from it being the title of the documentary, has been creating art and conversation
around HS and my body. I adopted the framework first through a photography project and then
throughout My Gold Lining in four acts.
The photography component is a compilation of photos set against a burnt orange
background showcasing the scars in my inframammary, back, stomach, left and right axillary
regions in contorted positions. This intimate photography puts the scars produced by HS in the
foreground with deep orange hues to represent strength, creativity and healing.
From the documentary’s inception I wanted to incorporate the art of Kintsugi to
artistically explain how HS interferes with the lives of patients, how they work to gain control
back over their lives after diagnosis, and ultimately share their own experiences to serve as
guideposts for other patients. I broke down the process into four parts; the impact, the cracks, the
glue, and the gold.
10
I called on Kintsugi artist and psychologist Dr. Alexa Altman who was traditionally
trained by a Kintsugi master. With her teachers blessing she began hosting a workshop called
Kintsugi: Finding Peace in Broken Pieces. The hands-on workshop teaches the ancient Japanese
art of Kintsugi as a tangible metaphor that explores imperfections and brokenness. The workshop
encourages deep reflection on the repair and resilience developed through life’s greatest
challenges according to her personal website.
In addition to these practices, Dr. Altman has her Ph.D. in Health Psychology and has
extensively trained in areas related to mind and body interventions such as eye movement
desensitization and reprocessing [EMDR], Somatic Experiencing, Biofeedback and Mindfulness
Meditation. Her experience from Kintsugi to psychology and mindfulness practices are what
encouraged me to ask for her participation.
The four acts using Kintsugi in the foreground are sectioned off as the impact, the glue,
the cracks, and the gold. My Gold Lining begins by emphasizing this metaphor of Kintsugi. The
first frame out of the prologue is the impact of a hammer hitting what was previously a whole
bowl. The hammer symbolizes HS and the bowl represents Janee, me, or any other person
diagnosed with HS.
The second act represents the glue which binds the previously broken pieces back
together again. The glue represents the resources that have aided in the healing process. This can
come in the form of finally being properly diagnosed after years of misdiagnosis, fault, and
shame, which is a commonality between HS patients (Alharbi, Kauczok and Pallua 2012, 2). The
glue for some patients can also represent assembling a team of medical professionals to aid in the
treatment process, finding a therapist to address mental health challenges, or embracing art to
express experience.
11
The third act addresses the cracks or scars the impact has left. Similar to the processes in
Kintsugi, scars left on the body caused by HS, just like the cracks in a pottery bowl, are
extremely visible. The cracks in traditional Kintsugi inspired the adaptation of Kintsugi as a
means of illuminating the damage caused by HS. It represents the permanence of the condition of
mind and body.
The fourth act is the gold which is, metaphorically speaking, an acceptance of the way
things are. Through acceptance, our scars are illuminated and cared for. This space is where I’d
ideally reveal the cure to HS, but medicine isn’t there just yet. There is no cure to HS (Lee 2012),
so what is left are ways to embrace and adapt to this reality. Treatment options are evolving, and
through clinical trials and research, the medical community is finding the root cause (Lee 2012).
The fifth act focuses on hope for HS from the perspectives of patients, physicians and
caregivers. It serves as an encouragement piece for patients who may feel hopeless in their
battles with HS. Each act ties together to express the impact of HS artistically.
Media. Because HS is such a complex disease, when approaching the various media
available to produce this thesis, I decided video would aid in bridging a gap of understanding
between what’s presented online through text and the realities of an HS patient’s everyday life.
Merging the two demystifies what the condition looks like beyond descriptors on a page and
numbers in a case study. All of it is needed, but I believe text is not enough to execute the
invention and impact of my idea.
Difficulties. The making of this documentary did not come without its challenges and
roadblocks both personally and professionally. One of the many challenges was in gaining
approval from the head of Public Relations at Henry Ford to film the HS clinic. The
apprehension arose due to Henry Ford’s desire to avoid violating any HIPAA laws. While this
12
was challenging, I found alternative ways to navigate this limitation. One solution was filming
Dr. Hamzavi at Hamzavi Dermatology because this is his private practice. This allowed me to
see the work he does beyond HS and outside of Wayne County (Detroit, Mi) where the HS clinic
is located.
Another difficulty that arose was aligning my schedule with the busy schedules of
professionals and patients from all over the country. Janee was one source in particular where it
was complicated to align our schedules because she lives on the east coast. Luckily, I was able to
film Janee’s story.
I also faced challenges with filming my own story because filming a first-person
documentary, strategically, is complicated. The difficulty lies in filming me to capture desired
shot angles, reactions, and intense or heartfelt moments. With this limitation, I recruited my
brother, classmates, and some friends I knew were skilled at operating cameras. They removed
much of this limitation and their talents proved to be instrumental in the development of this
documentary.
Personally, My Gold Lining grew more challenging as the months went by. I found
myself ebbing and flowing through the weight of reliving the trauma buried deep in my mind. In
addition to this, I dealt with four major boils during the stent of the graduate program which had
a major effect on my mental health and ability to complete the documentary. I honestly thought
about giving up and questioned why I chose to do this, but I remembered what I am experiencing
is the primary reason I want to spread awareness. Many of my peers and teachers had no idea I
was experiencing this amount of pain. It’s not their job to know, but what I want to focus on here
is that I was largely ashamed to communicate these struggles to them because I didn’t want to
make excuses.
13
Successes. The conceptualization and filming of My Gold Lining challenged me to think
creatively about and strategically problem solve issues with scheduling, story development,
reaching out to sources, filming, and editing. I am proud that I can now call myself a producer
and director of a documentary film project. This experience also encouraged me to be extremely
clear about my intentions and goals within the creation process to my professors, thesis
committee, and sources. I’ve also gained a level of professionalism I didn’t have before due to
my lack of experience.
On a more personal note, the documentary allowed me to see myself and the coping
mechanism I've employed to avoid the difficulties I face in unfamiliar and challenging
environments. Despite this, I would produce My Gold Lining all over again and employ the many
lessons I’ve learned along the way. I appreciate the patience of my teachers as they’ve
encouraged me along the way and have helped to bring clarity and creativity to my overall
vision, without this support the documentary and thesis wouldn’t be what it is, complete,
thoughtful, and well researched.
Conclusion. My Gold Lining is the first feature-length documentary on Hidradenitis
Suppurativa. It’s an amalgamation of the history of HS, the quality of life of patients, the healing
modalities instrumental in the treatment and diagnosis of HS, and a lens the unfamiliar can look
through to gain knowledge of a rare and debilitating disease. Knowing about HS can help the
average person not affected by the disease, to recognize the signs in family members, friends,
partners, or classmates. This awareness can provide support for patients if the average person
knows how to show up for them. Despite the challenges in creating a documentary, I enjoyed
each step from concept to delivery. My Gold Lining will now serve as a proof of concept to a
larger documentary that will explore HS treatment and diagnosis around the world. This
14
documentary will serve as both an awareness piece and a film for patients and physicians to learn
about developing treatments for HS from Europe to Australia to India to the Caribbean.

15
Documentary Script:

My Gold Lining: A lifestyle and medical documentary on patients living with Hidradenitis Suppurativa

Producer, Director, Writer, Editor: Jasmine “IVANNA” Espy

September 10, 2019

TRT: 41:01

https://youtu.be/btQkZeCZBCM

FADE IN
Title card: A GOLD LINE PRODUCTION

CUT TO
Dr. Maya Angelou quote:
“There is no greater agony than bearing an
untold story inside you.”

MUSIC FADES IN

FADE IN
Title card: Janee Allure, Beauty Influencer,
Temple Hills, Md

CUT TO
Wide shot of Janee Allure sitting at her desk
putting on makeup.

CUT TO
Medium shot of Janee rubbing moisturizer on
her face.

CUT TO
Close up left to right pan from Janee’s desk to
her face applying concealer.

JANEE VO STARTS

CUT TO
Close up of Janee pulling cap off of liquid
foundation.

CUT TO
Over the shoulder close up of Janee applying
foundation to her face.
My brand is Janee Allure, but my real name is
Antonia. I do try to teach that beauty is more
than just the makeup you put on your face,
it’s what’s on the inside.
16

CUT TO
Janee putting glue on eyelash strip.

JANEE VO CONTINUES

CUT TO
Over the shoulder close up of Janee applying
eyelash strip.
I feel like this little piece that I do, do in the
beauty community is helping to show women
or people in general that if you do have HS
that doesn’t mean you’re less beautiful.
JANEE VO CONTINUES

CUT TO
Medium shot of Janee interview.
You don’t have to fit into a box.
CUT TO BLACK

FADE IN
Title card: Detroit, Mi, Jasmine “IVANNA”
Espy, Documentary filmmaker

CAMERA FLASH TO
Medium shot of Jasmine posing with her back
turned for a photographer.

CAMERA FLASH TO
Medium still shot of photograph of Jasmine
showcasing the scars on her back.

CUT TO
Medium shot pan from bottom to top of
Jasmine’s body as she covers her chest.

JASMINE VO STARTS
CAMERA FLASH TO
Medium shot of still photograph of Jasmine
covering scarred chest

CUT TO
Medium shot pan from Desmond, the
photographer, sitting on the floor. To Jasmine
in a seated position posing.

CAMERA FLASH TO
Medium shot of still photograph of Jasmine
exposing armpit scars.

Having Hidradenitis Suppurativa can come
with a lot of shame. Because you have boils
the size of tennis balls that can randomly pop
up underneath your armpits, your groin, your
breasts, your back. And when they burst, you
feel disgusting. Not only physically, but
mentally. So since I can never escape having
the disease, I’ve decided to live in it
unapologetically through art and
conversation. This is a form of me finally
taking back my life from HS, finally.
17
CAMERA FLASH TO
Medium shot of Jasmine in seated position
still posing, now looking up.

CAMERA FLASH TO
Medium shot of still photograph of Jasmine
showcasing the scars under her armpits while
looking up.

CUT TO
Title card: My Gold Lining

JASMINE VO ENDS

FADE OUT TITLE CARD

FADE OUT MUSIC
CUT TO
“Hidradenitis Suppurativa (HS) is a chronic
condition occurring in the armpit, groin, anal,
and breast regions. HS can be extremely
painful and debilitating but is rarely life
threatening, Cases vary in severity, but all
require some treatment and management. HS
was once thought to be a rare disorder
because only the most severe cases were
reported.”

-NORD (National Organization for Rare
Disorders)

CUT TO
“1-4% of the population is affected by HS
worldwide.”

-NORD (National Organization for Rare
Disorders)

FADE IN
Title card: the impact

CUT TO
Medium shot of Dr. Alexa Altman, kintsugi
artist, hammering a kintsugi bowl covered in a
white cloth upside down.

CUT TO
Close up of Dr. Alexa Altman’s hands feeling
for the broken pieces inside of the white cloth.

Just like that HS can hit you with no signs,
symptoms, or warnings. And because HS is
so rare, patients can go as long as seven
years or more without proper diagnosis. At
least I know that my story.
18

CUT TO
Close up bowl right side up, Dr. Alexa
unwraps the broken pieces.
MUSIC STARTS

CUT TO BLACK

FADE IN
Title card: Cornerstone Nevada Middle
School, Detroit, Mi.

JASMINE VO STARTS

CUT TO
Extreme wide establishing shot of
Cornerstone.

CUT TO
Wide shot of Cornerstone front of building.

CUT TO
Medium shot of Cornerstone flag flying.

CUT TO
Inside of school hallway, medium shot of two
posters hanging on the wall.

CUT TO
Wide shot slow zoom in down hallway.

CUT TO
Medium shot of classroom desks through
glass window.

CUT TO
Close/ medium POV shot of whiteboard.

CUT TO
Close up shot of row of desks, now facing
blackboard.

JASMINE VO FADES OUT

MUSIC CONTINUES

I got HS when I was in middle school. I woke
up one day with a boil the size of a golf ball
under my right armpit. I wasn’t scared. I was
more confused than anything else. At the time
I had been dealing with other health issues
like being prediabetic. So, when I got the boil
I thought this was just another thing. Little did
I know that this moment would change the
course of my life forever.
CUT TO Jasmine was a born leader. When she was
19
Still photograph of young Jasmine.
MURIEL ESPY VO STARTS

FADE IN
Title card: Muriel Espy, voice of Jasmine’s
mother.

CUT TO
Still photograph of young Jasmine, older
brother, mom.

CUT TO
Still photograph of Jasmine, Jasmine’s
mother, aunt, and grandmother.

CUT TO
Still photography of young Jasmine and older
brother.

CUT TO
Still photography of young Jasmine.

CUT TO
Still photography of young Jasmine and best
friend.

CUT TO
Still photograph of Jasmine in middle school
with friend sitting in lobby of middle school.

CUT TO
Still photograph of Jasmine in middle school.

CUT TO
CU of Jasmine’s hands typing on laptop

CUT TO
CU of pan up from behind laptop to reveal
Jasmine working

CUT TO
MS of Jasmine behind plants working on
laptop

CUT TO
MS of laptop from over Jasmine’s shoulder

MUSIC FADES OUT
young she was free. She discovered, she
wanted to go places, she wanted to do things,
she wanted to move around, she didn’t want
to be stuck in one place. She changed from
being that confident individual to someone
who didn’t have a lot of confidence. It was
traumatic for her, the HS was traumatic. I
hated watching her go from this confident
young lady to a child who felt insecure.
CUT TO My name is Jasmine Espy and I am 18-years-
20
Jasmine’s Biggest Loser audition tape

CUT TO
Jasmine in restaurant (Biggest Loser audition
tape)

CUT TO
Jasmine standing in the dining room of her
old home (Biggest Loser audition tape)

MUSIC FADES IN

DR. HAMZAVI VO STARTS

CUT TO
Medium shot of Dr. Hamzavi in interview.

CUT IN
Title card: Dr. Iltefat Hamzavi, President of
the HS Foundation, Dermatologist
specializing in the treatment of HS.

CUT TO
Still photograph of Jasmine with family.

CUT TO
Still photograph of Jasmine with immediate
and extended family.

CUT TO
Still photograph of Jasmine with mother and
father.

CUT TO
Medium shot of Dr. Hamzavi in interview.

CUT TO
The is no cure for hidradenitis suppurativa.
old and I am 5’9. I weigh 330lbs and I am
applying to Biggest Loser with my brother.

We are at Red, Hot, and Blue; me and my
brother and my dad. They always give these
huge meals. So, I have ribs, tilapia, hush
puppies, a biscuit, mashed potatoes, and
macaroni and cheese.

One of the reasons I want to lose weight on
the Biggest Loser is because for six years
now, I've had a condition called Hidradenitis
Suppurativa it’s like an extreme acne. It’s
actually stopped me from doing things that I
love like swimming, wearing short sleeved
shirts, or wearing shirts with no sleeves on
them at all. It even made me self conscious at
my prom because I had a tube top dress and
some of my scars were showing. This is
actually the Hidradenitis at its best. It was
actually worse six years ago.

HS has a common predilection. So, if you
have boils in the folds of your body you’re
much more likely to have HS if it’s symmetric.
So, you can get boils in one area and that can
be an acne variant of folliculitis, but if you get
boils in symmetric areas like both sides of the
underarms, both sides of the groin, both
areas below the breast, both sides of the
buttocks then you probably have HS. So, the
manifestation of how that presents differs
depending on geography, ethnicity and
gender. So, women tend to have a variant
where they have metabolic syndrome
associated with it. So, we know that diet and
food has some impact on HS because it leads
to metabolic syndrome meaning high blood
sugar, high blood pressure, high body mass
index are associated. Those patients have a
higher body mass index which means they
have more fat on their body and that is more
associated with women. It’s also more
associated with hormonal issues like
polycystic ovary syndrome.

21

-SHAH, NIPA 2005. “Hidradenitis
Suppurativa: A Treatment Challenge”.

CUT TO
Studies have shown weight loss may be a
method of prevention. It improves symptoms
associated with HS, and can induce
remission. HOwever, weight loss and diet
alone is not a cure, and being overweight is
not the sole cause of HS.

-SHAH, NIPA. 2005. “Hidradenitis
Suppurativa: A Treatment Challenge”.

CUT TO
Jasmine in kitchen at apartment in South Los
Angeles

CUT IN
Title card: Broomfield, Co

CUT TO
Medium/ close up of Attune Functional
Medicine sign

CUT IN
Nat sound of Dr. Biscoe typing on laptop.

One day my father told me about this
documentary called Fat, Sick, and Nearly
Dead. He was trying to live a better lifestyle
and encouraged me to do the same. After
watching it my whole life changed. I no longer
looked at food the same. Here was a man
who reversed his sickness through food and
exercise alone. I had never seen anything like
this before. Then, the thought crossed my
mind. What if I could cure my HS by changing
my diet? I began removing foods like pork,
beef, chicken, processed foods and sugar.
And over the course of two years, I became a
vegan. By then, I began to see a drastic
change I could’ve never imagined. I lost
150lbs and the HS went into remission. The
open wounds on my chest and my back
closed without any medical intervention
whatsoever. And the remaining scar tissue
was no longer inflamed which meant I was
now a great candidate for plastic surgery
because the chance of HS recurring in the
area was low now. I knew there was an
answer, I just needed to find it.

When it comes to diet, not everything works
for everyone. People have written to me
saying that going vegetarian or vegan was
22
CUT TO
Close up shot of Dr. Biscoe’s hands typing on
laptop to reveal shot from hands to close up
of Dr. Biscoe’s face

CUT IN
Dr. Biscoe VO

CUT TO
Medium shot of Dr. Biscoe still working on
laptop

CUT TO
Over the shoulder shot of Dr. Allison Egeland
from Dr. Biscoe’s shoulder

CUT TO
Close up shot of Dr. Biscoe’s screen

CUT TO
Close up shot of Dr. Biscoe’s hands scrolling
on laptop pad

CUT TO
Close up of Dr. Biscoe’s bookshelf

CUT TO
Close up of Dr. Egeland reading and then
highlight case study to reveal close up shot of
Dr. Egeland’s face

CUT TO
Over the shoulder shot of Dr. Biscoe from Dr.
Egeland’s shoulder

CUT TO
Medium shot of Dr. Egeland reading another
case study

CUT TO
Close up shot of Dr. Egeland’s hands holding
the case study

CUT TO
Close up shot of Dr. Biscoe sitting in interview

CUT IN
Title card: Dr. Biscoe, Attune Functional
Medicine

their cure and if that works for them, fine. I
haven’t seen that work for everybody. A paleo
diet can be very supportive because by
default you’re avoiding foods that can be very
disruptive to the gut barrier, like grains and
dairy. More recently there’s been attention to
the ketogenic diet. So essentially, a very very
low carbohydrate diet. I think that can be
incredibly therapeutic because again you’re
avoiding the grains and the high glycemic
starches and refined sugars. And things that
really have an influence on blood sugar,
insulin, and ultimately inflammation. We know
that nightshade foods can be a really potent
trigger for a lot of people. I’ve had patients
that have reacted very poorly to tomatoes and
not so much peppers. Right? And then some
people are very sensitive to any food in the
nightshade family or spices that come from
seeds. Things like, cumin or annisse or things
like that. So, it is so individual and depending
on what’s going on with the individual's
metabolism. Depending on what’s going on
with their genetics, with their gut and
intestinal health. There are a lot of variables.
If someone happens to have a lot of yeast
overgrowth or small intestinal bacterial
overgrowth, too many starches or sugars can
really feed those pathogens and produced
biotoxins that can really fuel inflammation.

A couple of tests I end up using a lot with my
23
CUT TO
Dr. Egeland in lab

CUT IN
Title card: Dr. Egeland, Attune Functional
Medicine

CUT TO
Close up shot of Dr. Egeland unpacking GI
map test kit

CUT TO
Back to Medium shot of Dr. Egeland in lab

CUT TO
Close up shot of Dr. Egeland’s GI map test
result binder

CUT TO
Wide shot of Jasmine’s toilet with a small pool
of blood on the floor

CUT IN
Title card: Jasmine’s Apartment, Los Angeles,
CA

CUT TO
Close up shot of blood at the bottom of the
toilet

CUT TO
Extreme close up of small pool of blood on
the floor

CUT TO
CU of Jasmine crying

CUT TO
MS of Dr. Hamzavi in Canton office

HS patients, is a GI map test. So, that’s a
DNA based stool test and that’s looking at the
microbes in the gut. And really it’s estimated
that about 80% of our immune system is in
the gut. You can see with an immune
condition like HS were there’s a lot of
inflammation, starting with the gut is a really
important place. And I know Dr. Biscoe had
mentioned the organic acids test, which I also
use to really get a lot of information about
mole toxins and yeast. But the GI map also
gives us really good information about the gut
microbiome, the good healthy microflora, and
other infections like parasites. In addition to
bad bacteria and viruses.

After being in remission for about three to four
years in 2018 the HS came back with a
vengeance. I think it was largely due to
introducing dairy back into my diet. I could
barely walk, eat, or sleep because my body
was experiencing these flu like symptoms.

So, it’s April 7. It’s a few weeks before
graduation and I have another boil. This is the
fourth one this year and I’m tired.

Rigorous studies haven’t been done in diet
because the system isn’t incentivized to do it
and that’s changing. A lot of the major articles
and big journals are suggesting that we need
more studies in diet and that’s not the fault of
the HS population, or the HS community or
the HS patients or physicians. It’s a problem
with the whole system, but that systems
addressing the need to get more dietary
studies because we do feel that diet has a
major role to play.

My skin condition is Hidradenitis Suppuratona
24
CUT TO
Title card: Janee Allure

JANEE YOUTUBE VO STARTS

JANEE YT VO FADES OUT

JANEE INTERVIEW VO CUTS IN

CUT TO
CU of Janee driving in car

CUT TO
WS of Janee standing in front of her car while
establishing a shot of her parents house

CUT TO
Close up of Janee holding up a black and
white photo of herself in highschool

CUT TO
Close up of Janee holding up a photo of her
and her sisters at a young age

CUT TO
MS of Janee interview shot

CUT TO
CU of Janee, her, mom, sister, and little
cousin in a photo

CUT TO
Dr. Hamzavi VO

CUT TO BODY DIAGRAM OF LOCATIONS
HS APPEARS ON THE BODY FOR BOTH
SEXES

CUT TO DR. HAMZAVI IN OFFICE
INTERVIEW

(she pronounces it wrong). I don’t really know
how to actually pronounce it, pronounce it,
but I will put it on the screen below so you all
can Google it and things like that if you’d like,
but that’s my skin condition. I also have
pilonidal cysts…

After I graduated, that’s when HS started. I
found out that I had HS around 19. It didn’t
develop really fast. I would say right when I
got the last pilonidal cyst, it started to
develop. And I went to my mom and she was
like oh they’re just pilonidal cysts. You know
don’t worry about them, we’re just going to
get them lanced open. So that’s what we did.
The doctor would just poke holes, drain it and
we would just go on because we’ve dealt with
this before. It wasn’t until it started to leave
what the doctors called tracts. The tunnels
that I guess go underneath my skin, that’s
when the doctors were like, “Oh, this is
something different.”

Anybody can get HS, it tends to hit younger
people, it tends to hit women more. What you
end up having in women is that you have
more under arm involvement that can be
pretty severe. You have more breast
involvement. You can have more buttock and
vaginal involvement, but it’s not as common
as men. So men, get much more severe
faster in our experience than women do. But
one of the things we are very careful about in
our HS population is, across the board,
across the board, HS patients suffer to a
great degree. They have a higher rate of
suicide, they have a lower quality of life, they
have higher pain scores than almost any
disease in all of dermatology, and it matches
25

CUT TO ESTABLISHING SHOT OF JANEE’S
PARENTS HOME

MUSIC CUTS IN

FADE IN
Title card: Janee’s Parent’s home, Temple
HIlls, Md

CUT TO
The inside of the home wide shot of Janee in
hallway

CUT TO
Close up shot of photo of young Janee picture
hanging on hallway wall

CUT TO
Close up shot of Janee’s face as she looks
through a box of photos

CUT TO
Close up shot of Janee’s hands sifting
through a box of photos

JANEE SITTING ON COUCH VO
INTERVIEW STARTS

CUT TO
Medium shot of Janee holding up baby

CUT TO
Close up shot of Janee’s hand as she holds
up baby photo

CUT TO
Close up shot of photo of Janee holding up
bathtub baby photo

CUT TO
An extreme close up of Janee holding up
another baby photo

CUT TO
up with some of the worse disease in
medicine. So, I don’t want to dismiss any
subgroup, but there are differences.

Who, who did this?

So, this is baby me. I was more of a boy
when I was younger. I was very boyish. I was
very like, hard. I was a crybaby too. Like my
parents would tell you I got whatever I wanted
because I would cry.

26
Close up of Janee’s hands sifting through
photo box

JANEE VO STARTS

CUT TO
Close up of Janee’s face as she brings photo
into frame

CUT TO
Close up shot of Janee holding photo of
herself and her sisters

JANEE VO STARTS

CUT TO
Medium shot pan out of Janee holding up the
same photo

CUT TO
Close up of Janee holding prom photo with
herself and her parents

CUT TO
Extreme close up of prom photo

Aw, this was 8th grade. This was My
Chemical Romance, Paramore stage. This is
basically what rock music did to me.

Middle school wasn’t a bad time for me, it
wasn’t until highschool where...middle school
was only bad 7th grade, but even then I still
had a lot of friends and a lot of support and
stuff. So I didn't really feel the brunt of it. It
wasn’t until highschool where I was like, it
was hard in highschool.

This was prom. I was actually cute at prom,
but I think at this stage that’s when like cysts
started to form underneath my under arms.
The HS started to form. So this was...having
my shoulder out was a lot.

VO STARTS
Dr. Hamzavi in office interview

CUT TO
Medium shot of Dr. Hamzavi office interview

CUT TO
Close up establishing shot of Janee’s
apartment

CUT IN
Title card: Janee’s Apartment

CUT TO
MS of Janee putting on shirt

CUT TO
CU shot of Janee’s cat Prince

When we first started, the Europeans did a lot
of work on HS. They were further ahead than
we were. And it suggested that Caucasians
were the ones who had HS at a more
frequent level. If you look at most of the
studies done in the United States, the group
that’s hit hardest is African American women.
They end up being the biggest subgroup.
Now they’re not the majority anymore in all of
the studies. But they are the biggest
subgroup.

27
CUT TO
Medium shot of Janee putting on t-shirt

CUT TO TITLE CARD
A higher prevalence in African-Americans has
been anecdotally suggested but has not been
investigated. The reasons for this racial
predilection are unclear and need further
study.

-”Hidradenitis Suppurativa Disproportionately
Affects African Americans: A Single-Center
Retrospective Analysis”.

CUT TO TITLE CARD
One clinical study sampled 55 million
patients. 1,240 of the patients had HS. The
highest prevalence of HS was observed
among AFrican American or biracial female
adolescents aged 15-37-years-od.

- “Prevalence Estimates For Hidradenitis
Suppurativa Among Children And
Adolescents In The United States: A Gender -
And Age Adjusted Populations Analysis”

CUT TO
Youtube video of Janee talking about HS on
her channel

CUT TO TITLE CARD WARNING
This is an incurable disease unfortunately, but
it is live withable. That’s not a word, but it is
live withable. So you can live with it. It doesn’t
really bother me. I’ll have flare ups here and
there. Well if you have it under your under
arms, you do notice because my under
arms...to me they look deformed. Because
sometimes my skin is buckled up and things
like that. I..I’m just going to show you all
okay? This is the moment of confidence that I
have right now.

28
Warning: The images you’re about to see can
be disturbing to some. View at your own risk.

CUT TO
Youtube video of Janee talking about HS on
her channel

I’ve had this condition for about two to three
years so my underarms are pretty deformed
at this point. Get your stomachs ready okay
because this is a graphic scene. That is what
my underarm looks like now.

CUT IN
Nat sound

CUT TO
Split screen establishing wides shots of
Jasmine’s apartment and Janee’s apartment

CUT TO
Cont. split screen wide shots of Jasmine and
Janee entering their seperate bathrooms

CUT IN
Title cards: Jasmine, Los Angeles, Ca
Janee, Temple Hills, Md

CUT TO
Cont. split screen wide shots of Jasmine and
Janee looking at their scars in bathroom
mirrors

MUSIC FADES IN

CUT TO
Right side of split screen close up pan shot of
Janee’s HS scars under her armpit to her face

CUT TO
Left side of split screen close up pan shot of
Jasmine’s plastic surgery scars under her
armpit to her face

JASMINE VO STARTS

CUT TO
Right side of split screen close up shot of
Janee cleaning seeping HS wound

CUT TO

Janee and I have two very different forms of
HS. When you look at my body for example, I
had stage 3, and that’s why you see scars on
my chest, scars on my stomach, and on my
back. The scars under my armpits are from a
CO2 laser surgery Dr. Hamzavi’s team
performed on me to cut out scar tissue
29
Left side of split screen wide shot of Jasmine
examining her right armpit now

CUT TO
Left side of split screen medium shot of
Jasmine preparing to clean the HS scar tissue
on her hip

CUT TO
Right side of split screen close up of Janee
setting down puss filled q-tip in pile
Left side of split screen close up of Jasmine’s
scar tissue on her hip

CUT TO
Left side of split screen close up of
Hibcleanse bottle on the counter

CUT TO
Left side of split screen medium/ close up of
Jasmine pouring Hibcleanse onto a wet rag
Right side of split screen close up of Janee
pouring Hibcleanse onto a wet rag

CUT TO
Left side of split screen medium/ close up of
Jasmine cleaning hip HS scar tissue
Right side of split screen close up of Janee
cleaning armpit HS open wound

CUT TO
Left side of the split screen medium shot of
Jasmine using towel to dry off HS scar tissue
on hip
Right side of split screen medium shot of
Janee using towel to dry off HS scar tissue
under armpit

FADE TO BLACK

caused by HS. But that’s not every patients
story. Some patients like Janee are stage I
and have maybe one or two boils under each
arm. Fortunately, some patients have it better
than Janee and unfortunately some patients
have it worse than I did. But regardless of
where you fall on the spectrum, the condition
affects your life greatly.
CUT TO TITLE CARD
Kintsugi is the Japanese art of repairing
broken pottery by mending the breakage with
lacquer dusted or mixed with powdered gold,
silver, or platinum.

CUT TO TITLE CARD

30
Some Western healers have adopted this
technique as a metaphor to embrace the
beauty in imperfection.

CUT TO TITLE CARD
For Jasmine, Kintsugi serves a metaphor for
how she’s healing from the effects of
Hidradenitis Suppurativa.

CUT TO TITLE CARD
The glue

CUT TO
Dr. Alexa putting gloves on her hands

CUT TO
Dr. Alexa pulling out glue brush from
container

DR. ALEXA VO CUTS IN

CUT IN
Title card: Voice of Dr. Alexa Altman, Trauma
therapist / Kintsugi artist

CUT TO
Medium/ close up of Dr. Alexa applying glue
to broken bowl piece

CUT TO
Close up of Dr. Alexa applying glue to broken
bowl piece

CUT TO
Medium/ close up of Dr. Alexa forming two
broken pieces together

CUT TO
Extreme close up of Dr. Alexa holding pieces
together

CUT TO
Medium/ close up shot of Dr. Alexa applying
glue to the other half of the broken bowl

CUT TO
Close up shot of Dr. Alexa forming the two
broken bowl halves together

The next teacher is the glue. The glue, I think
of the glue of where the healing happens. It’s
in connection. Because often times when
we’re building this back or we’re building
some part of our life back together, we are
also looking for what was. You know, the old
bowl or the old part. And or we are trying to
figure out what’s it going to be because
sometimes it’s hard to see something that
hasn’t taken shape or form right? So I look at
the glue and my saying is...like my mantra is
“Healing is about connection, it’s not about
perfection. It’s not about looking about what
was or trying to figure out or project what it’s
going to be. It’s just, let’s find the next piece.

31

DR. HAMZAVI VO STARTS

CUT TO
Medium shot of Dr. Hamzavi in interview.

CUT IN
Title card: Dr. Iltefat Hamzavi, President of
the HS Foundation, Dermatologist
specializing in the treatment of HS.

CUT TO
Still photograph of Jasmine with family.

CUT TO
Still photograph of Jasmine with immediate
and extended family.

CUT TO
Still photograph of Jasmine with mother and
father.

CUT TO
Medium shot of Dr. Hamzavi in interview.

CUT TO
CU shot panning out of bed in South Los
Angeles apartment

CUT TO
MS of Dr. Hamzavi in interview

CUT TO
Establishing shot of Dermatology Specialists
of Canton office door

CUT TO
CU shots of Jasmine’s underarm after CO2
laser surgery

CUT TO
CU shots of Jasmine’s under arm once the
wound healed
When Jasmine came to us, she came with
her mom and her father. I think one of the
things about HS patients is the emotional toll
this disease takes on both the patients and
the family is something you cannot
underestimate. And as a provider who is
probably very emotionally driven, it really
affected me to see her go through so much.
At the same time, we knew that what we had
at the time that she came in was inadequate,
so we had to assess the severity of her
disease, we also had to give her a sense of
hope. But we also had to be realistic and say
we are going to try different things and if the
things we traditionally try don’t work, we will
try experimental things.

Jasmine was involved with a trial where you
looked at different types of lasers. So, we
looked at laser hair removal devices. It
provided some relief, but not that much. We
also put Jasmine on a trial where we used a
combination of antibiotics; Clindamycin and
Rifampin specifically. And she had some mild
to moderate response, but Jasmine’s disease
continued to progress and at some point we
couldn’t control it with traditional therapy so
we had to perform surgical therapy. But you
have to understand your patient population
and I just felt like if we used some of our
cutting edge technologies that we handled
ourselves, since we knew her so well we
could possibly get a better outcome. Because
as a provider, as a physician you have to use
your own relationship with the patient to try to
heal and healing in a surgery situation is a
difficult process. So, we put Jasmine in the
CO2 trials and the CO2 laser which is a
cutting laser; similar to any scalpel. The
advantages of that laser is that it burns off
32
any surrounding tissue so we believe that it
prevents any of the sinus tracts from
reforming. And so we did the surgery and she
did very well, but unfortunately the wound
wasn’t healing properly and she kept opening
the wound even after months of healing.
Because with HS patients you do the surgery
and then you have months of constantly
working with them until the wound heals up.
So, luckily I work with a wound healing expert
David Olazog and he was willing to do
another type of laser called a fractional laser
to try to help the wound heal up. So, after that
journey Jasmine’s disease was much better
controlled.
CUT TO
MS of Jasmine talking to Dr. Erin Martinez via
Google Hangout

CUT TO
WS of airplane flying in the sky
Dr. Martinez: How’s the documentary
coming?

Jasmine: I’m actually going to visit my cousin
who actually has the condition. She lives here
in California, but she lives up north. So, I’m
going to be renting a car…

Dr. Martinez: Did you say that’s your cousin?

Jasmine: Yes, my cousin on my mom’s side.
CUT IN
Title card: Santa Clarita, Ca

CUT TO
MS of Nezi holding onto stair banister

CUT TO
Medium shot of Nezi standing in the hallway

CUT TO
Close up of sticky note on the door to the
library

CUT TO
Close up shot of books on shelf

NEZI VO STARTS

I think everything that everything that
happens to you in life is all about who you are
33
CUT TO
Close up of Nezi interview

CUT IN
Title card: Jasmine’s cousin

CUT TO
Close up of old pictures of Nezi on table

CUT TO
Close up of old picture of Nezi and her
brother when they were young

CUT TO
Close up of an old picture of Nezi

CUT TO
Close up of old picture of Nezi and her
brother

CUT TO
Wide shot of Nezi inteview

CUT TO
Close up shot of Nezi interview

CUT TO
Medium shot of Nezi interview

CUT TO
Close up shot of Nezi interview

CUT TO
Medium shot of Dr. Biscoe interview

CUT IN
Title card: Dr. Biscoe, Attune Functional
Medicine

and what you do with what happens. I think I
learned how to be a magnificent survivor who
thrived, not only survived, but who thrived. It’s
like I lived a full life finally. And I never
expected my life to expand the way that it did
with all of the illnesses with all of the baggage
that illnesses bring. On pretending not to be
sick on a day that you’re in terrible pain.

When I was around probably 25 and 27 is
when it started, and to this day I make sure
that I cleanse those areas because I have
scar tissue from when they would always cut
it open.

I think I was like my early 50’s when I had the
last really bad outbreak. It was a secret
illness. You feel dirty because that waste is
putrid, putrid.

There have been quite of research done on
the genetics of HS. I’ve found a couple of
studies that imply that HS could have an
autosomal dominant influence meaning that it
only takes one copy of that gene for it to
express in the individual, but there are also
other variants in certain genes that relate to
the immune system and also relate to the
skin. So, for example when I talked about
how the skin tissue tends to be very fragile in
people that have HS that could be related to a
mutation in the gamma secretase gene.
That’s an enzyme that helps to control the
integrity of the basement membrane of the
skin. So, in a person who is genetically
34
predisposed, there are environmental,
nutritional, type of influences that can change
how those genes express themselves.
CUT TO TITLE CARD
Detroit, MI

CUT TO
Medium shot of Jasmine’s mom

CUT IN
Title card: Muriel Espy, Jasmine’s Mother,
Detroit, Mi

CUT TO
Medium shot of Jasmine’s father

CUT IN
Title card: Jerome Espy Sr., Jasmine’s
Father, Detroit, Mi

MUSIC CUTS IN

CUT TO
Wide shot of Jasmine walking from apartment
walkway to sidewalk

JASMINE VO STARTS

CUT TO
Medium shot of Jasmine walking more with a
body reveal from behind a light pole

CUT TO
Medium shot side profile of Jasmine walking

CUT TO
Close up shot profile of Jasmine’s face as she
continues walking

CUT TO
We do know that I have a cousin that does
have HS, but just really recently found that
out because she’s older than I am and
nobody knew that. And that was only because
my daughter was talking to her. So, I found
out they had the same condition. So I
would’ve never known if she had not told me.
Because again it’s a secretive type of
condition because people feel very, very
uncomfortable discussing it with anybody else
because of the symptoms.

I used to get cysts on this side of my face
over here. That was like ingrown hairs, having
issues with those ingrown hairs kind of getting
infected and that kind of thing. So, I had some
minor skin issues. So, you ask a lot of
questions as a parent of someone who has
HS or a parent with a child that is going
through something. You ask yourself, is this
something that I passed on? Is this something
that I contributed to giving to my child?

After seeing my cousin Nezi, I do have some
hope. Knowing that I’m not the only one in my
bloodline to deal with this brings a sense of
comfort and worry all at the sametime. The
genetic connection helps me understand
why? But worry comes in when I think about
if I do decide one day to have children. Do
they have a risk in getting it too?

35
Wide shot of Jasmine continuing to walk into
frame, shot becomes medium shot

CUT TO
Medium shot of Jasmine standing at the
corner waiting to cross the street as camera
pans upward to stop sign

MUSIC CUTS OUT

CUT TO BLACK

CUT TO TITLE CARD
JANEE ALLURE

JANEE VO STARTS
CUT TO
MS of Janee and Grayson (boyfriend)

CUT TO
CU of Janee and Grayson in the kitchen

CUT TO
CU of Prince (cat)

It was one time I wore my boyfriends shirt and
he got an ingrown hair bump and he thought I
gave him HS.

He’s freaking out and I’m like no, it’s not that
big of a deal. He was just like ‘oh, you can
just keep this shirt.’ I mean he was nice about
it, but then I had to sit down and explain to
him that it’s not contagious. It’s not like a cold
where I can cough and you can get it. It’s a
genetic thing.

I wanted to hit him. That was my first reaction
because he’s been with me for so long. You
should...you should already know. You hadn’t
got it in these five years. Your not going to get
it all of spontaneously.

It made me realize that some people really
don’t understand if somebody has a disease
that it could just be a disease in them. It
doesn’t have to be contagious. It doesn’t have
to be like you can’t touch me, I’m in a bubble.
It hurt my feelings, it did. But I understand
that he's not coming from a bad place. I
understand, if it was me I would’ve said the
same thing. But I realize I have to sit down
and I have to educate him a lot more. I had to
explain to him like, you’re not just going to get
it by sharing a shirt with me. It’s more so in
my genes it’s in me. It just made me look and
see like what does everybody else think HS is
other than just something that is within
36
myself. Something that I can’t give you?

CUT IN
Title card: Erin Martinez, LMSW, CST
Social Worker

CUT TO
MS of Grayson

CUT TO
MS of Janee unfolding chair

CUT TO
Title card: the cracks

MUSIC CUTS IN

CUT TO
Medium establishing shot of Jasmine’s
apartment

CUT IN
Title card: Jasmine’s Apartment

CUT TO
Wide shot of Jasmine rolling out yoga mat

CUT TO
Close up shot of Jasmine’s hands

I think it’s interesting when we look at the
research and we see that it’s not necessarily
the level of severity of the disease, but we
also need to look at support system. And how
much support and time has been given for the
individual to, I don’t want to say accept, but
grasp the weight of what they’re dealing with.
I think those are the factors that I think are
just as important as the severity of their
symptoms.

Last summer we went down to Ft. Lauderdale
for vacation for a week and we was on the
beach, on the strip and listening to...I think a
band was playing. All of a sudden I seen
something leaking from her under arm and I
guess a big cyst had popped. You know, it
was everywhere but we wiped it up. That’s
the only time that I remember that it was
really out in public. Her cysts would pop at the
house and all that stuff but that’s the most
recent time that it affected us while we were
out.

My initial reaction when I seen it, it was nasty
but at the end of the day it didn’t change any
out look about her.

I’ve had depression and anxiety since the
37

CUT TO
Medium shot of Jasmine continuing to stretch

CUT TO
Close up shot of Jasmine’s hands on mat

CUT TO
Medium shot of more stretching

CUT TO
Close up of Jasmine’s face as she continues
to stretch

CUT TO
Medium shot of more stretching

CUT TO
Close up shot of Jasmine’s knee as it bends
into a child’s pose

CUT TO
Wide shot of Jasmine lying on the floor with
Reiki healer Numi Ori healing her chakras

CUT IN
Title card: House of Numi Ori, Reiki Healer,
Detroit, Mi

CUT TO
Close up of crystals aligned on the floor

CUT TO
Medium shot of Numi’s hands on Jasmine’s
stomach

CUT TO
Medium shot of Numi

MUSIC FADES OUT
inception of HS, but I didn’t realize the effects
it had on me until post plastic surgery and
remission.
I was numb to it essentially. Now that it’s 90%
gone and I’m fully present. I had to deal with
the wave of trauma I had avoided for 15
years. I didn’t want to spiral out of control so I
started seeing a therapist on the regular. And
I started using some Eastern practices like
yoga and Reiki to rebalance my energy.

VO OF DR. ERIN MARTINEZ CUTS IN

CUT IN
Title card: Dr. Erin Martinez, Clinical Social
Worker, HS Therapist

MUSIC CUTS IN

CUT TO
If there’s a medical trauma that’s happened
and the person’s body is in some way
changed by this then there’s likely to be a
disconnection not only between not just the
medical community and the person, but the
person and their body. And it’s the role of my
work with that client to begin to create a
bridge that heals that. And I think within that
you see experiences of depression, fear, high
38
Medium shot of Dr. Martinez interview

MUSIC FADES

CUT TO BLACK

FADE IN
Title card: Detroit, Mi

CUT IN MUSIC

CUT TO
Jasmine and her friends on the floor talking
about the photoshoot about to take place

VO OF JASMINE CUTS IN

CAMERA FLASH TO
Medium shot of Jasmine lying on the floor
posing

CAMERA FLASH TO
Medium shot of Jasmine lying on the floor
continuing to pose

CAMERA FLASH TO
Medium shot of Jasmine lying on the floor
continuing to pose

CAMERA FLASH TO
Medium shot of photographer

CUT TO
Medium shot of Dr. Martinez interview

CUT IN
Title card: Dr. Martinez, Dearborn, Mi

levels of anxiety, often isolation. And again
it’s because the larger world doesn’t
understand HS at all. Who do you talk to
about that? Who really gets it?

Jasmine: What do you think would look nice
with orange?
Desmond: Geen probably.
Jasmine: Let’s do green then.
Desmond: Or..or uh…
Jasmine: You just gone go through all the
colors?

As a way of reconnecting with myself, my
body, and my experience. I produced a visual
series putting my scars on display. Each
photo tells a story of the different stages I’ve
been through with HS. The battles were ugly
and long, but beauty arose from the pain. I
am perfectly imperfect.

Another way patients begin to take back their
life is speaking out. So the idea of a
documentary is speaking out about saying
other people should know about this. Since
I’ve become involved in this, I am shocked
about the fact that nobody knows about this
and it’s not talked about and people are
39

suffering very silently. People are walking
around in terrible pain and hurting so much
emotionally and many of their family
members don’t know. So I think that’s a
second way is to say I have this and I want
people to know about it and finding different
ways to get that information out there in the
world is really, really important. And I think
having some sort of way that you express
how it’s changed your life is also a way of
taking back your life.

CUT TO
Medium shot of Janee adjusting light stand

MUSIC FADES OUT

CUT TO
Medium/ close up shot of Janee attaching
camera to tripod

MUSIC FADES IN

CUT TO
Close up shot of Janee tightening stand

CUT TO
Close up of Janee flipping light stand on
switch

CUT TO
Wide shot of Janee adjusting the height of the
camera

CUT TO
Medium shot of Janee’s cat Prince

VO OF JANEE STARTS

Basically what I do on YouTube is make
40

CUT TO
Medium shot of Janee looking at laptop from
a distance

CUT TO
Close up of makeup on desk

CUT TO
Youtube video of Janee’s foundation friday
review

VO OF JANEE CUTS IN

CUT TO
Janee’s Instagram page, the video scrolls
through her photos

CUT TO
Close up of Janee applying foundation to her
eyebrows

CUT TO YOUTUBE VIDEO
MS of Janee in All About HS video

FADE TO BLACK

beauty videos and review videos. That’s what
my channel is considered now.

Hey guys! It’s your girls Janee Allure here
and I am back...with...another...video…

I am more so mainly on Instagram and I’m
known on Instagram mainly for special effects
and face painting. Different concepts other
than just glamorous looks.

My brand is Janee Allure, but my real name is
Antonia and I don’t think a lot of people know
that. But my real name is Antonia. I like to use
my middle name because my first name has
a lot of baggage with it.

I don’t like to just consider myself like makeup
because I feel like I have a lot of advice a lot
of experience to give. So I’m trying to talk
more.

The video I made was really the first time I
really spoke about HS. And I know people
have DM’d me and commented. And a lot of
people say they’re very insecure about having
HS and their self esteem is down. So, I just
try to be as honest as possible and say I still
struggle. I’m not completely perfect either.

A lot of people, they don’t have answers for
why this is happening to them or what is
happening to them, but this is a reference for
you to maybe Google it or ask your doctor
‘Hey is this what I have?’ Or if you do have it
then girl you’re not alone. You know what I’m
saying? I don’t have pretty underarms, but
you know? That’s just a piece of my condition
that I wish I could change, but I can’t change
it.

41
FADE TO
Title card: the gold

MUSIC FADES IN

CUT TO
Close up of Dr. Alexa holding newly formed
bowl

CUT TO
Close up of gold paint

CUT TO
Dr. Alexa painting bowl cracks

CUT TO
Title card: Voice of Dr. Alexa Altman, Los
Angeles, Ca

DR. ALEXA VO CUTS IN

CUT TO
Close up of Dr. Alexa applying more gold to
bowl cracks

CUT TO
Close up of gold paint

CUT TO
Close up of Dr. Alexa continuing to apply gold
to bowl cracks

CUT TO
Close up of Dr. Alexa holding bowl with all of
the cracks covered in gold

MUSIC FADES

The gold is the glory, it’s the highlighting of
the journey and you can’t do this prematurely.
Right? You can only do it once the bowl has
found its way back in piece or you’ve found
yourself back to wholeness. It’s the
integration of the ability to be able to tell the
story and literally draw the lines of the
pathway for you to get where you are. The
gold isn’t hiding the impact of the places you
were hammered, it’s actually highlighting it. It
is establishing the value of what happened,
what you learned from it, who you became as
a result of it. It’s the wisdom that only this
experience could’ve given you. And it’s not a
wisdom that comes from a book or something
your read or watched. But the wisdom that
came from the journey you took within
yourself to get where you’re.
JEROME ESPY SR. VO CUTS IN
CUT TO
CU shot of Jasmine’s father

As a father you want to protect your children,
you want to protect your wife, you want to
make sure that everything is okay. That is
what we feel like our job is. So, if something
enters into our family that you can’t do
anything about then you feel a little helpless.
And so, if I could, I would rather that happen
to me than to her. I would rather go through
the surgeries myself than to ever have an
issue like that.

42
MURIEL ESPY VO CUTS IN
CUT TO

CUT TO
Close up shot of Nezi’s interview

VO OF DR. HAMZAVI STARTS

CUT TO DR. HAMZAVI IN THE OFFICE
INTERVIEW

Even though you have HS, even though you
have a chronic condition you are still
priceless. There’s no amount of money to
purchase who you’re. You’re valuable. You’re
valuable. Don’t think that it takes away from
you. It doesn’t take away from you.

I was grateful I was who I was because, you
know I never said why me? Why not me?

There’s more and more people who are
interested in HS, who know about the
disease. So, that’s exciting. There’s better
laser technology that’s coming out than we
have today. There are better forms of topical
products coming out. There’s tremendous
advances going on in biologics. Those are the
medications that adopt the immune system
that are also showing a lot of promise. We’re
also learning to use the broad spectrum
antibiotics more effectively. The French
groups have been instrumental in developing
that. We are also slowly, we’re not there yet,
developing advocacy and studies to look at
diet and see what things help.
CUT TO
Close up of Dr. Egeland as she talks and
listens to Dr. Biscoe

CUT IN
Title card: Dr. Egeland

VO OF DR. BISCOE STARTS

CUT TO
Wide shot of Dr. Biscoe

CUT IN
Title card: Dr. Biscoe

CUT TO
Close up shot of Dr. Egeland looking at Dr.
Biscoe

CUT TO
Close up quick zoom in on Dr. Biscoe’s face
as she cries

It just makes me so sad to see people in pain.
Dr. Egeland: Absolutely
Dr. Biscoe: I just know that there’s so much
that can be done.

I’m really trying not to cry. But you know
people feel hopeless. When I struggled with
my own health I remember thinking I’ve been
to all of these doctors. I’ve seen all of these
nurse practitioners. I saw everyone and no
43

CUT TO
MS of Janee

one could find anything wrong or guide me in
anyway. I thought well if the experts of health
care don’t have any answers then what do I
do? That is the worst feeling when you’re
miserable and you’ve lost your quality of life
and the people that are supposed to have
answers and are supposed to care have
nothing to offer.

As long as you have a support system around
you, you can make it through everyday. HS,
it’s painful but you can still live and you can
still have a life and enjoy everything that
everybody else does.

CUT IN
Title card Jasmine’s Apartment, Los Angeles,
Ca

MUSIC CUTS IN

CUT TO
Wide shot of Jasmine grabbing water
container out of fridge

CUT TO
Close up shot of Jasmine turning on stove

CUT TO
Close up shot of flame coming on underneath
tea pot

VO OF JASMINE STARTS

CUT TO
Medium shot of Jasmine taking lid off of
teapot to pour water in

CUT TO
Close up shot of Jasmine grabbing tea bags
out of tea box

CUT TO
Close up of steam coming out of teapot head

CUT TO
Wide shot of plane in the sky

There are millions of people across the world
with HS; male, female, young, old, black,
white, Asian, Native American, hispanic. This
condition is no respecter of persons. And
while many of us feel hopeless and
exhausted and overwhelmed there is hope.
The hope lies in the support groups patients
are actively forming online and in person to
share remedies and experiences. Hope also
lies in the new research dermatologists
continue to produce from clinical trials. There
might not be a cure yet but there is relief.
Even if only for a short period of time.

44

CUT TO
Wide shot of Jasmine walking to balcony

CUT TO
Medium shot of Jasmine as she’s standing on
balcony with her back facing the camera

CUT TO
Medium shot pan up from cup to Jasmine
drinking tea to pan right to wide shot of LA

FADE TO BLACK

MUSIC CUTS OUT

MUSIC CUTS IN

ROLL CREDITS

45
BIBLIOGRAPHY:

1. Lee, Robert. 2012. Hidradenitis Suppurativa - NORD (National Organization for Rare
Disorders). Available at: https://rarediseases.org/rare-diseases/hidradenitis-suppurativa/.
2. Danby, Frederick. 2015. Diet in the prevention of Hidradenitis Suppurativa (acne
inversa). Journal of the American Academy of Dermatology, 73(5), pp.S52-S54.
Available at: https://www.sciencedirect.com/science/article/pii/S0190962215019908.
3. James, Sara and Wilson, Barbara. 2019. Update on Hidradenitis Suppurativa. The
Dermatologist. The-dermatologist.com. Available at: https://www.the-
dermatologist.com/content/update-hidradenitis-suppurativa.
4. James, Sara and Wilson, Barbara. 2019. The Hurley System: Grading Severity for
Hidradenitis Suppurativa. Consultant360.com. Available at:
https://www.consultant360.com/exclusives/grading-systems-hidradenitis-suppurativa.
5. Encyclopedia Britannica. 2019. Pus | pathology. Available at:
https://www.britannica.com/science/pus.
6. Alharbi, Ziyad, Kauczok, Jens and Pallua, Norbert. 2012. A review of wide surgical
excision of hidradenitis suppurativa. BMC Dermatology, 12(1), p.2. Available at:
https://bmcdermatol.biomedcentral.com/articles/10.1186/1471-5945-12-9.
7. Oakley, Amanda. 2019. Hidradenitis Suppurativa: severity assessment | DermNet NZ.
Dermnetnz.org. Available at: https://www.dermnetnz.org/topics/hidradenitis-suppurativa-
severity-assessment/.
8. HS Foundation. n.d.. Hidradenitis Suppurativa - HS Foundation. Available at:
https://www.hs-foundation.org/what-is-hs/.
46
9. Kouris, Anargyros, Platsidaki, E., Christodoulou, C., Efstathiou, V., Dessinioti, C.,
Tzanetakou, V., Korkoliakou, P., Zisimou, C., Antoniou, C. and Kontochristopoulos, G.
2016. Quality of Life and Psychosocial Implications in Patients with Hidradenitis
Suppurativa. Dermatology, 232(6), pp.687-691. Available at:
https://www.karger.com/Article/FullText/453355.
10. Matusiak, Ł., Bieniek, A. and Szepietowski, J. 2010. Hidradenitis Suppurativa markedly
decreases quality of life and professional activity. Journal of the American Academy of
Dermatology, [online] 62(4), pp.706-708.e1. Available at:
https://www.jaad.org/article/S0190-9622(09)01216-X/fulltext.
11. Kagan, R., Yakuboff, K., Warner, P. and Warden, G. 2005. Surgical treatment of
Hidradenitis Suppurativa: A 10-year experience. Surgery, [online] 138(4), pp.734-741.
Available at: https://www.sciencedirect.com/science/article/pii/S0039606005004344.
12. Golbari, N., Porter, M. and Kimball, A. 2019. Online communications among
Hidradenitis Suppurativa patients reflect community needs. Journal of the American
Academy of Dermatology 80(6), pp.1760-1762. Available at:
https://www.sciencedirect.com/science/article/pii/S019096221832485X?via%3Dihub.
13. My Modern Met. 2019. Kintsugi: The Centuries-Old Art of Repairing Broken Pottery
with Gold. Available at: https://mymodernmet.com/kintsugi-kintsukuroi/.
14. Buetow, S. and Wallis, K. 2017. The Beauty in Perfect Imperfection. Journal of Medical
Humanities, [online] pp.1-6. Available at:
https://link.springer.com/article/10.1007/s10912-017-9500-2#citeas.
15. Koren, L. 2008. Wabi-Sabi for Artists, Designers, Poets & Philosophers: For Artists,
Designers, Poets, and Designers. Point Reyes: Imperfect Publishing, pp.1-9.
16. John R. Ingram. 2016.The Genetics of Hidradenitis Suppurativa. Clinical Key.
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-
S0733863515000959?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2F
47
pii%2FS0733863515000959%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nl
m.nih.gov%2F.
17. van der Zee, H.H., Prens, E.P. and Boer, J. 2010. Deroofing: A tissue-saving surgical
technique for the treatment of mild to moderate Hidradenitis Suppurativa lesions. Journal
of the American Academy of Dermatology, 63(3), pp.475–480.

Abstract (if available)

Abstract The author documents the intricacies of living with the rare chronic skin disease called Hidradenitis Suppurativa.

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Asset Metadata

Creator Espy, Jasmine I. (author)

Core Title My gold lining: a lifestyle and medical documentary on patients with hidradenitis suppurativa

School Annenberg School for Communication

Degree Master of Arts

Degree Program Specialized Journalism (The Arts)

Publication Date 12/17/2019

Defense Date 12/17/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag abscesses,boils,Dr. Hamzavi,hidradenits suppurativa,HS,HS Foundation,Jasmine Espy,My gold lining,OAI-PMH Harvest,USC

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Birman, Dan (committee chair), Ploceck, Keith (committee member), Saltzman, Joe (committee member)

Creator Email JasmineEspyPh7@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-255905

Unique identifier UC11673880

Identifier etd-EspyJasmin-8091.pdf (filename),usctheses-c89-255905 (legacy record id)

Legacy Identifier etd-EspyJasmin-8091.pdf

Dmrecord 255905

Document Type Thesis

Rights Espy, Jasmine I.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA