Endo Year Reflections: #8

Welcome to EndoBattery, where I share my journey with endometriosis and chronic illness, while learning and growing along the way. This podcast is not a substitute for medical advice, but a supportive space to provide community and valuable information so you never have to face this journey alone. We embrace a range of perspectives that may not always align with our own. Believing that open dialogue helps us grow and gain new tools always align with our own. Believing that open dialogue helps us grow and gain new tools. Join me as I share stories of strength, resilience and hope, from personal experiences to expert insights. I'm your host, alana, and this is Indobattery charging our lives when endometriosis drains us. Welcome back to Indobattery. Grab your cup of coffee or your cup of tea and join me at the table. As the year comes to a close, I find myself looking back on all the EndoBattery episodes. We've shared Conversations that have inspired me, challenged me and helped me piece together the intricate puzzle that is my health journey. This reflection isn't just about my story, though. It's about ours. Together, we've tackled tough topics, asked hard questions and found moments of validation and clarity. The end-of-year reflection series is my way of revisiting those episodes that left a mark, moments that I believe are worth pausing to appreciate again. With the holiday season upon us, I know how precious time is. It's easy to feel overwhelmed and even harder to find space to recharge. But recharging shouldn't feel like another item on the to-do list it's essential. That's why this series is designed to be taken in small doses, bite-sized reflections that I hope will leave you feeling recharged rather than drained. Together, let's look back, celebrate the insights we've gained and carry them forward into the new year with renewed energy and hope. So cozy up and let's start reflecting on the moments that have shaped us this year, because you're not alone and together we're finding the power to move forward. Let's dive in. These episodes wouldn't be possible without the diligence, passions and persistence of one man who changed the narrative of endometriosis surgery forever. Episode 51 with Dr David Redwine wasn't new this year, but it's one I couldn't leave out of this reflection series.

Speaker 1:
2:14

With the passing of Dr Redwine, I was reminded just how fleeting life really is. Before his passing, chelsea and I had the honor of sitting down with him as he walked us through what would become his final presentation on the origins of endometriosis. He was kind, funny and absolutely brilliant. A true pioneer, or, in his words, emperor, whose insights could blow your mind and shift how you understood the disease. If it weren't for Dr Redwine's relentless drive to question surgical care and push for something better, I wouldn't be sitting here today. I'd still be trapped in relentless pain, weighed down by overwhelming fatigue and fighting for even a moment of relief. His work transformed what care could look like and gave so many of us a chance to reclaim our lives.

Speaker 1:
3:03

What always amazed me about Dr Redwine was how deeply he sought to understand the origins of endometriosis, not just to treat it better, but to rewrite how it's perceived, diagnosed and ultimately lived with. His legacy lives on in every patient who finds relief because of the standards he fought for. So, as we reflect, let's honor the foundation he laid for us. So, as we reflect, let's honor the foundation he laid for us all. Take a moment to listen to this unforgettable conversation, one that captures his brilliance, his humor, his profound impact. Dr Redwine's work changed lives and I hope revisiting this episode will inspire you as much as it did me. Let's take a listen.

Speaker 2:
3:44

Episode will inspire you as much as it did me. Let's take a listen. I first heard about Samson's theory of reflux menstruation as the origin of endometriosis when I was in medical school and I recall distinctly now that when I heard it I laughed almost out loud. It sounded preposterous. Okay, fine, went through medical school, internship, I decided I wanted to go into OBGYN because you could do surgery, you could do medicine, you can do a little bit of pediatrics you can do. You know, you're treating kind of several different cross specialties, and so that appealed to me. I kind of envisioned myself being a surgeon as I was growing up and that's what eventually happened.

Speaker 2:
4:32

So anyway, I met and married my first wife while in medical school at Baylor College of Medicine in Houston, texas that was in 1970. And she, unbeknownst to her, she had endometriosis and she was always talking about pelvic pain and pelvic pain throughout the month and intercourse was painful and this was kind of all new to me in a sense. When I got out of medical school and going to internship and residency, she continued to have these problems and so she was seen by a gynecologist a general gynecologist in Portland, where we were, where I was undergoing training, and Vincent, she had laparoscopy and endometriosis was found and we were told well, there wasn't very much and we burned it, so she should be fine. Well, she wasn't fine, and so when I got through my training and was going to.

Speaker 2:
5:25

Bend, oregon, to open up my practice, my wife still had the same degree of problem. She had been put on birth control pills, which really didn't help. She had also, along the way, been put on Danazol, which really didn't help. And so we went to Bend and I talked with one of my partners about you know, my wife, that she might have endometriosis still and everything that a patient with endometriosis encounters. We encountered along the way. My wife was dismissed, endometriosis itself was dismissed. It's just endometriosis, you know, blah, blah, blah. And we realized, as many patients with endometriosis realize, eventually, that you have to fight to make any forward progress. And so my wife was no better. And so we went to one of my former partners and said look, we think she needs surgery. She's had birth control pills, she's had Danazol, she's had the endometriosis burned at laparoscopy. Can we just cut the disease out? And he kind of went like that and said what you want me to let me get this straight you want me to remove the disease from the body. And we said yeah, that's right.

Speaker 3:
6:37

Shocking, that's right.

Speaker 2:
6:39

We want the disease out of the body.

Speaker 3:
6:41

Yeah.

Speaker 2:
6:41

And he said that's just not done. And I said well, you know what? Nothing else has worked, just do it. No-transcript. And he had to do a laparotomy, but he cut the disease out. She woke up in the recovery room pain-free. I had already been seeing in my own patients a little bit of endometriosis, and so when I saw that my goal to have the disease removed from the body would result in relief of symptoms, which at one level is a very simple connection I mean, that's what we do in medicine, but at another level it's the profession is so in control of people who don't know much about endometriosis I mean then and now that there was all this confusion and contradiction and such. So I was able to kind of cut through it with my wife. I saw the results in her. I was seeing the same results in my patients.

Speaker 1:
7:39

What started with Dr Redwine's groundbreaking work didn't stop with him. He passed the torch to his fellow Dr Cindy Mosbreker, who we'll reflect on in another episode, and now her fellow Dr Jen Yagy, in episode 72,. I had the opportunity to sit down with Dr Jen Yagi, an OBGYN who spent years passionately practicing medicine and performing surgeries. Yet, like so many in her field, she was limited by the scope of her training. What struck me during our conversation was her honesty, her acknowledgement that for a long time she believed she was providing the best care for her endometriosis patients. She truly thought she knew almost all there was to know about this disease.

Speaker 1:
8:20

I often say we do the best with what we know. That's not just true for patients navigating their health journeys, it's true for our providers as well. Dr Yagi's experience is a testament to the importance of continuing education, of seeking out new knowledge, even when we think we've mastered something. In this episode, dr Yagi shares her journey of unlearning, relearning and committing to better care for her patients. Her story is both humbling and inspiring, a reminder that it's never too late to grow and do better. Take a listen as Dr Yagi opens up about her experience and how stepping into advanced training transformed her approach to endometriosis care.

Speaker 3:
9:04

I do think when you go through OBGYN residency, I think we are well trained to diagnose those classic cases of endometriosis. But it's the ones who maybe don't follow the classic story that I look back and wonder about patients where I missed that diagnosis. I was thinking about it as an example, like I think it was just a couple of weeks ago I was seeing a patient for a new consultation and I remember when I was presenting it to Dr Mosbroker I said you know, on first glance like this didn't seem like a classic story to me, but you know she's been on OCPs this whole time, so you know, I think it was probably suppressed. She was a patient who was having more bowel symptoms and more bladder symptoms and the pain really hadn't become an issue until she stopped birth control. And you know, as I was presenting, I was like this is the kind of patient that, yeah, I think a couple of years ago I would have more quickly jumped to like, oh, this is probably GI or you know she should be seen for a workup, for IBS or brain recidivitis, and not kind of have put the you know the more subtle things together.

Speaker 3:
10:04

Yeah, I do and I think about, you know, the patients that I had where I did ablation of endometriosis or or, honestly, even the ones you know. I can think of one case where I was planning to do a laparoscopic hysterectomy for fibroids and adenomyosis and got in and it was, you know, a much more complex case of stage four endometriosis. And in that case, you know, I recognized that that was above my surgical skill set and we called it a diagnostic laparoscopy. You know she just ended up with one or two small incisions and then referred her on to the closest tertiary care center for what I thought would be, you know, a minimally invasive procedure. She ended up having an open hysterectomy.

Speaker 3:
10:49

I think had her ovary taken out as well. I think oncology ended up doing the case. When I think back, I was like, I mean, even in all of New Mexico I don't think there are many true excision specialists Now I would know, like you know, there may have been somewhere in Arizona or you know somewhere where she could have had a truly minimally invasive procedure.

Speaker 3:
11:12

But you know, you, I guess, do the best that you can with the knowledge that you have at the time and you know, I think, at least with that case you know, I guess, do the best that you can with the knowledge that you have at the time and you know, I think at least with that case, you know I as a physician, you learn first, do no harm.

Speaker 3:
11:23

You know I didn't go into a surgery that I thought was above my gill set. It's sad to think that even with referring her on, you know she may not have had the most optimal surgery. It's interesting because I feel like I really was seeking out more surgical training, because I think that's a more obvious you know, you more clearly see, tools in your toolbox are lacking, like I knew, stage three endometriosis cases are not something that I can do after finishing a general OBGYN residency. But I think you know we leave residency feeling like we have the medical, you know knowledge and I think that's the part that, in a way, has almost been more surprising with doing this fellowship. Just that I may not been asking the right questions or just yeah, again, like you mentioned, thinking about those patients where I may have missed the diagnosis, even though I thought I was being thorough.

Speaker 1:
12:15

Dr Yagi has been incredibly vulnerable in sharing how this fellowship has transformed her perspective, not just as a surgeon, but as a provider deeply committed to improving care. What I especially loved about our conversation is how she broke down practices she once thought were standard for diagnosing and treating conditions like endometriosis and adenomyosis. Now she's utilizing new techniques and seeing things differently. For instance, she discussed how adenomyosis isn't limited to those who've had C-sections a misconception she once held but has since unraveled through advanced training. She also emphasized the importance of ultrasounds, but not in the traditional sense of simply looking at a fetus through the lens of a technician, but not in the traditional sense of simply looking at a fetus through the lens of a technician. Instead, she's taken on a hands-on approach, using imaging as a critical tool to truly understand what's happening in the body. Take a moment to listen to Dr Yaghi's reflections. It's a conversation that challenges old assumptions and shines a light on the progress being made.

Speaker 3:
13:17

But like, for instance, adenomyosis, where we were kind of taught as something that is more an issue of women who have had multiple pregnancies and can only be diagnosed at time of hysterectomy. But you know, I'm seeing a fair number of patients that have not had any children and are, you know, in their early 20s, even where their symptoms are classic for adenomyosis and then the ultrasound suggests adenomyosis and when you look in at time of surgery, see again, you know the gold standard really still is to only make that diagnosis at time of hysterectomy. But yeah, I've been learning there's a lot of other ways that you can almost make that diagnosis. Ultrasound is another thing where you know I was doing quite a bit of ultrasound as a general OBGYN, but usually in another thing where you know I was doing quite a bit of ultrasound as a general OBGYN, but usually in the context of, you know, an early pregnancy, ruling out abnormalities there and not really thinking about ultrasound as something that can give you hints that there may be endometriosis, you know.

Speaker 3:
14:11

So usually for ultrasounds that I wasn't doing for you know, like someone walking in with abnormal bleeding and a positive pregnancy test, more often if we were wanting to look at the uterus or the ovaries, we would order the ultrasound. It would get done in radiology. So you know, we order it, then the tech takes the images and then it gets sent to the radiologist who looks at those static images and then a couple days later you get the report back and you know, often it would say you know just that the uterus was a normal size, there were, there was maybe a physiologic cyst on the ovary, or you know essentially that it was unremarkable.

Speaker 1:
14:46

Right.

Speaker 3:
14:48

Now you know, with every consult that I'm doing with Dr Mossberger, we do an ultrasound while the patient's there and there's really just so much more that you can see with the ultrasound if you kind of use it as a tool in real time.

Speaker 3:
14:59

You know you can see if the ovaries are tethered or stuck to the sidewall, if the ovaries are stuck to the uterus, if there's movement between the cervix and the rectum and you know and more subtle signs of adenomyosis, you can see as well. And again, that's something that I've been doing ultrasound for years but never really thought of it as a way to look for some of the markers of endometriosis.

Speaker 1:
15:24

In this episode, dr Yaghi shares her journey of unlearning, relearning and committing to providing better care for her patients. Her story is both humbling and inspiring, a powerful reminder that it's never too late to grow, evolve and strive for better. I hope this episode inspires you as much as it inspired me. If you're looking to dive deeper, I highly recommend revisiting episode 51 with Dr David Redwine and episode 72 with Dr Jen Yagi. Reflecting on these conversations left me feeling empowered to continue my advocacy efforts and I have no doubt they'll do the same for you. Thank you for taking the time to reflect and recharge with me. Don't forget to subscribe so you'll be notified when we gather again for our next Endo your Reflection episode. Until next time, continue advocating for you and for those that you love.