AI, Surgery, And The Future Of Endometriosis Care With Dr. Gaby Moawad

Welcome And Guest Introduction

SPEAKER_00
0:02

Welcome
to
Indobattery,
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.
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.
Today's
guest
is
someone
who's
truly
changing
the
landscape
of
endometriosis
care.
Professor
Gabby
Mawad
is
a
globally
recognized
leader
in
robotic
surgery
and
endometriosis
management.
He's
a
board-certified
gynecologic
surgeon
and
the
founder
of
the
Center
for
Endometriosis
and
Advanced
Pelvic
Surgery
in
Washington,
D.C.
Dr.
Mawad
has
dedicated
his
career
to
advancing
minimally
invasive
and
robotic
techniques,
combining
surgical
innovation
with
deep,
compassionate,
patient-centered
care.
As
director
of
robotic
gynecologic
surgery
and
associate
professor
at
George
Washington
University,
he's
trained
surgeons
worldwide
and
helped
redefine
how
we
approach
complex
pelvic
disease.
He's
been
named
Top
Doctor
in
Washington,
D.C.
for
nearly
a
decade
and
has
authored
over
125
peer-reviewed
publications
leading
global
conversations
on
endometriosis
and
surgical
innovation.
It's
an
honor
to
sit
down
and
welcome
a
true
pioneer
and
advocate
for
better
outcomes
for
women
everywhere.
Please
help
me
in
welcoming
Dr.
Gabby
Moad.
Thank
you,
Gabby,
for
sitting
down
with
me
today
and
coming
all
the
way
to
spend
time
with
us.

SPEAKER_01
2:02

I
want
to
thank
you
and
thank
you
for
all
the
work
you
do.
It's
great
that
we
have
advocacy
groups
like
you
being
able
to
change
the
paradigm
in

AI’s Early Promise In Diagnosis

SPEAKER_01
2:11

patients
understanding
and
patient
education.

SPEAKER_00
2:13

We're
going
to
look
ahead
at
technology
because
this
is
something
that
you've
explored
significantly.
The
tools
and
how
they've
changed
and
plans
for
surgery
and
how
diagnosis
is
going
to
change.
So,
AI
and
diagnosing,
this
has
been
a
hot
topic.

SPEAKER_01
2:28

No,
no,
I
think
we're
at
the
infancy
of
AI
impact
on
our
daily
life,
even
though
it's
making
a
tremendous
progress.
In
endometriosis
specifically,
there
are
a
few
alleys
that
were
exploited
by
AI.
The
first
one
that
I
can
talk
about
is
the
imaging.
The
identification
of
the
endometriosis
lesions
through
machine
learning
can
help
diagnosing
endometriosis.
And
then
there
are
some
studies
that
showed
the
accuracy
is
as
much
as
expert.
The
other
area
where
it's
been
worked
upon
is
the
biomarkers.
The
biomarkers,
either
through
genetic
or
epigenetic
or
even
products
of
the
disease,
are
helping
us
to
try
to
understand
new
ways
of
diagnosing
non-invasive
endometriosis.
For
example,
there
is
a
couple
of
tests
that
have
been
developed.
They
work
on
microRNA,
which
is
a
portion
of
the
expression
of
the
gene.
And
then
they
use
artificial
intelligence
to
try
to
stratify
the
severity
of
endometriosis
and
the
phenotype.
And
this
has
been
done
through
blood,
through
menstrual
fluid,
through
saliva
recently.
So
again,
this
is
another
thing.
A
lot
of
algorithms
have
been
developed
by
combining
patient
symptoms,
patient
history,
some
of
the
imaging
and
lab
results
to
create
a
stratification
of
the
risk,
and
then
that
will
make
patients
be
referred
earlier
to
a
specialist
and
try
to
shorten
the
diagnosis
length.
Now
it's
all
great,
and
I
think
the
future
will
be
going
through
that
direction,
but
at
this
point,
most
of
the
studies
they've
been
done,
they've
been
done
on
you
know
homogeneous
populations.
So
it's
it's
extremely
hard
to
generalize
it.
And
they've
been
done
on
different
complexity
of
a
disease.
So
again,
we
still
need
longer,
more
longitudinal
studies
to
understand
the
impact
and
the
accuracy
of
those
studies.
In
addition
to
that,
like
machine
learning
behaves
through
neural
networks.
So
whatever
information
you
feed
them,
they
will
come
up
with
the
value
or
result.
If
you
feed
them
bad
information,
they're
gonna
come
up
with
a
bad
result.
So
bad
data
in,
bad
data
out,
there's
no
magic.
The
other
concerning
thing
in
most
of
the
um
the
machine
learning
experiences,
there
is
something
what
we
call
black
box
in
machine
learning.
So
you
give
them
the
information,
but
you
don't
understand
how
they
came
up
with
the
result.
And
the
result
through
those
neural
networks,
they
function,
or
mathematical
algorithm,
we
arrive
to
a
result
that
would
be
extremely
difficult
to
explain
it
clinically.
So
we
still
need
a
lot
to
further
our
understanding
in
machine
learning
and
artificial
intelligence.
But
I
think
the
this
field
is
moving
way
faster,
and
we
can
tell
in
our
real
life,
nobody
googles
anymore,
everybody
chat
GPT,

Black Boxes, Bias, And Caution

SPEAKER_01
5:40

anything
they
want.
So
we
should
look
at
it
considering
we
are
the
first
protector
of
patients,
right?
As
doctors
or
surgeons.
We
need
to
analyze
carefully
the
innovation
and
its
impact
on
our
patients,
uh,
and
it's
our
ethical
obligation
to
do
that.
So
we
don't
want
to
jump
into
technology
very
quickly,
yet
we
don't
want
to
miss
the
value
of
technologies
to
help
us
better
the
care
for
our
patients.

SPEAKER_00
6:09

How
do
you
think
this
is
gonna
change
the
learning
for
doctors?
How
do
you
think
this
is
gonna
change
how
they
identify,
treat,
acknowledge
endometriosis?
Because
I
think,
you
know,
the
old
method
of
you
go
to
medical
school,
you
learn
out
of
a
book.
I
do
think
that
new
doctors
coming
up
are
more
curious.
They're
hearing
more,
they're
more
is
accessible
to
them.
But
how
do
you
think
this
is
gonna
change
that
for
them
and
potentially
the
future
outcome
for
endometriosis
patients?

SPEAKER_01
6:40

I
think
now
we
struggle
with
the
uh
delayed
diagnosis
in
an
endometriosis
patient.
That's
gonna
help
shortening
the
time
from
diagnosis
to
intervention.
And
this
is
an
extremely
valuable
way
because
during
that
longer
period
of
time,
which
in
variable
study,
they
say
between
seven
and
eleven
years
you
get
diagnosed
with
endometriosis.
That
lengthier
period
is
the
period
where
the
patient's
body
harbors
the
disease
and
creates
damage
to
the
patient's
body
and
multiple
systems.
So
if
you
can
shorter
that,
that
we
can
intervene
earlier
and
help
managing
and
prevent
some
severe
diseases
that
even
in
the
best
hand
are
extremely
difficult
to
treat.
In
addition
to
that,
that
kind
of
help
us
analyze
big
data.
Big
data
is
that
they
need
longer
and
strenuous
efforts.
Now
it's
becoming
really
easier
to
analyze,
and
that
leads
to
deepening
our
understanding
of
the
disease
and
then
uh
helping
to
generate
a
generalizable
larger
scale
studies.
So
this
is
gonna
be
important
in
understanding
the
mechanisms
of
the
disease,
in
understanding
the
different
therapeutic
approaches
and
impacts
on
the
disease,
in
subtyping
endometriosis.
We
don't
talk
enough
about
it
because

Shortening Delays And Using Big Data

SPEAKER_01
7:58

not
every
endometriosis
is
the
same.
It
doesn't
behave
the
same
surgically,
it
doesn't
behave
the
same
medically,
it
doesn't
impact
the
same
the
patients.
And
embracing
technology
is
extremely
important
for
the
younger
generation
and
the
doctors.
Like
everything,
when
you
introduce
a
disruption
in
any
field,
right?
There
will
be
an
earlier
followers.
They
believe
in
it,
they
will
be
late
followers,
and
they
will
always
be
conservative,
then
the
train
will
pass
them.

SPEAKER_00
8:25

Right.

SPEAKER_01
8:25

So
the
pioneers,
early
followers
are
gonna
help,
you
know,
um
anchoring
our
understanding
of
the
disease.
The
late
followers
will
track
and
then
uh
this
is
how
everything
will
go.

SPEAKER_00
8:38

If
you
had
to
give
a
chat
GPT
prompt
to
get
the
best
information,
say
you're
a
patient
looking
for
some
sort
of
diagnosis,
what
would
you
do
for
that?

SPEAKER_01
8:48

Well,
I
I
I
try
to
avoid
using
chat
GPT
because
I
tested
it
for
multiple
things,
like
even
on
myself.

SPEAKER_00
8:55

Right.

SPEAKER_01
8:56

It's
like
he
cites
papers
that
I've
never
written.
I
go
look
at
the
paper
and
I
tell
him,
like,
this
is
not
the
paper
I've
written.
Oh,
I'm
sorry,
this
is
not
I'm
sorry,
but
like,
oh
no,
this
is
the
paper.
So
um
technology
is
important.
I
use
consensus,
which
for
me
it's
a
it's
a
great
tool
because
consensus,
you
can
go
and
type
anything,
and
it
will
summarize
the
whole
body
of
literature,
thousands
and
thousands
of
articles
about
something.
So
that
helps
me
even
more
understanding
things.
Right.
Like
uh
last
time
I
was
doing
uh
a
presentation
on
the
recurrence
of
endometriosis,
and
then
I
could
go
and
then
they
will
stratify
it
and
create
an
a
very
good
understanding,
but
this
is
summarizing
the
literature
right
now.
Again,
I
believe
that
those
tools
are
still
at
their
infancy
and
there
will
be
more
and
more
development
in
those
tools.
But
I
caution
a
lot
of
patients
as
much
as
it
is
easier
to
use,
fact-checking
is
always
important.
Because
even
when
you
say,
Oh,
give
me
uh
the
site,
some
papers,
literally
their
site
paper,
I
go
check
them.

SPEAKER_00
10:08

Right.
Yeah.
Well,
I
mean,
if
you
it's
interesting
because
we
we
did
this
experiment,
if
you
will,
of
explain
endometriosis,
define
it.
And
it
actually
gave
us
like
four
different
definitions.

SPEAKER_01
10:22

Yes,
yes.

SPEAKER_00
10:23

And
so
I
think
it
really
that's
where
I'm
like,
I
I'm
a
little
hesitant
to
implement
those
things.

SPEAKER_01
10:29

Especially
when
you
when
you
want
to
do
if
it
for
fun,
you're
you
know,
tell
me
how
do
you
make
uh
I
don't
know
uh
gin
vault
gin
tonic.
What
are
the
measurements?
Yes,
that's
fine,
because
at
the
end,
if
he
misses
the
ma
uh
the
recipe,
it's
okay.
But
when
you're
trying
to
establish
a
therapeutic
approach
for
a
patient,
we
can't,
you
know,
blindly
trust
them
and
then
start
getting
the
knowledge
and
the
care
for
our
patients
through
algorithm
that
we
don't
know
how
they're
built,
and
then
many
times
they
need
improvement.
Gives
you
an
idea.
I
think
it
gives
you
more
of
an
idea
rather
than
it
gives
you
100%
accurate
information.

SPEAKER_00
11:10

Yeah.
Mine
would
just
say
tequila
is
the
treatment.

SPEAKER_01
11:17

I
feel
like
that
would
be
my
but
I've
learned
like
I
I
have
a
couple
of
friends
who
are
very
savvy
in
the
artificial
intelligence,
and
they
told
me
even
the
chat
GPT
on
your
phone,
you
need
to
talk
to
them
more
frequently
so
they
understand
you.

SPEAKER_00
11:33

Yeah.

SPEAKER_01
11:34

So
that's
why
you
feed
them
information
and
they
can,
it's

Limits Of AI And The Human Touch

SPEAKER_01
11:40

like
a
baby.
Yeah.
You
teach
them
things
and
they
can
do
it
better.
And
it's
the
same
thing,
which
is
scary.

SPEAKER_00
11:47

It
is
scary
to
think
that
they
can
read
you
so
well
after
so
long.
It
is
a
little
scary
to
think
about
that.
There's
good
and
there's
bad,
right?
And
we
have
to
take
everything
with
with
a
side
of
caution.
Of
course,
you
know,
which
is
why
I
don't
think
that,
in
my
opinion,
you
can
replace
doctors
with
AI.
And
I
think
a
lot
of
people
are
afraid
of
that.
I
think
that
people
think
it's
coming
sooner
than
later.
But
I
don't
think
that
you
can
replace
humans
and
the
human
touch
because
that's
healing
in
and
of
itself.
But
then
just
knowing
the
skill
and
the
experience
and
everything
else,
I
just
don't
think
that
that's
gonna
happen
as
soon
as
some
may
think.

SPEAKER_01
12:25

Uh
I
don't
know.
This
is
for
me,
I've
never
felt
insecure
of
having
somebody
take
my
job.
No,
if
you're
confident
in
what
you
do,
what
care
you
provide,
uh,
there
will
always
be
the
new
doctor,
there
will
always
be
the
new
tool,
there
will
always
be
like
if
we
look
at
medicine,
90%
of
medicine
is
common.
10%
the
challenging,
this
is
when
it
requires
more,
you
know,
expertise.

SPEAKER_00
12:52

Right.

SPEAKER_01
12:53

But
part
of
the
medical
treatment
or
the
healthcare
journey,
there
is
a
major
part
that
is
emotional.

SPEAKER_00
13:02

Yeah.

SPEAKER_01
13:03

Because
we're
human,
we
have
emotions.
The
treatment
is
beyond
a
checklist.

SPEAKER_00
13:08

AI
can't
give
you
a
warm
touch.

SPEAKER_01
13:11

And
this
is
why,
like
if
it
is
for
the
patient
better
care,
I'm
happy
to
retire.

SPEAKER_00
13:19

That's
big
of
you.
We'll
still
need
you
around.

3D Modeling And Surgical Precision

SPEAKER_00
13:22

One
of
the
things
that
we've
I
don't
know
if
you've
touched
a
lot
on
this,
but
I
think
we've
you
did
present
a
little
bit
on
this
is
3D
modeling
for
surgery
specifically.
How
is
that
going
to
shift
and
change
for
patients
and
for
surgeons?

SPEAKER_01
13:39

No,
um,
we
started
with
3D
printing
10
years
ago
or
so,
where
we
3D
printed
the
model,
and
that
has
tremendous
value
for
uh
preparation
for
the
surgery.
Surgeons
can
see
the
uh
the
model,
can
see
the
uh
structures
around,
they
can
pre-plan
their
surgery
better.
Also,
that
leads
to
completeness
of
surgery
and
detection
of
lesions
in
some
areas
where
it's
difficult
to
rely
on
the
human
eye
and
then
the
imaging
alone,
and
also
for
uh
teaching,
teaching
the
newer
doctors
about
the
surgery,
but
also
educating
patients
as
well.
It's
important.
But
the
3D
printing
was
costly,
it
requires
a
longer
period
of
time
to
prepare,
and
it
relies
a
lot
on
the
technician
experience.
Nowadays,
that
there
is
mostly
the
work
is
on
um
trying
to
uh
virtually
3D
print
like
images
from
regular
MRI.
So
the
MRI
would
be
translated
to
image
color-coded
that
helps
understanding
also
the
same
value
as
3D,
but
it's
faster
now
with
the
presence
of
artificial
intelligence.
It
used
to
take
us
two
days
to
segment
an
MRI,
and
now
it
takes
one
minute
with
AI,
and
you'll
have
a
3D
image,
and
that
has
the
same
benefits,
but
the
future
and
the
work
that
a
couple
of
companies
are
doing
right
now
is
overlaying
those
3D
printed,
virtually
3D
printed
or
digitally
3D
printed
images
into
the
surgical
field.

SPEAKER_00
15:13

Right.

SPEAKER_01
15:14

And
that
helps
the
surgeon
more
visualize
things
and
that
helps
them
towards
a
better
precision
in
surgery,
completeness
of
surgery,
removal
of
the
disease,
respecting
the
surrounding
structures.
There
are
still
challenges
in
the
fact
that
again
we
need
millions
of
surgery
to
be
put
into
algorithm
where
the
machine
can
learn
how
to
do
the
stuff
and
then
can
do
it
accurately.
And
there
is
an
ethical
facet
of
this.
What
if
the
machine
tells
you
that
this
is
the
stuff
here
and
it
was
on
a
different
side?
So
uh
it
should
be
always
a
balance
of
technology
and
the
uh
the
contribution
of
the
surgeon.

SPEAKER_00
15:58

Right.

SPEAKER_01
15:59

Because
we
cannot
trust
blindly
technology,
especially
when
we
do
invasive
intervention.
Yeah.
It's
helpful,
it's
good,
but
we
have
to
create
a
lot
of
caution
into
blindly
trusting.
And
this
is
what
I
see,
and
this
is
what
I
see
more
people
now
not
utilizing
the
traditional
thinking
method
versus
everything,
go
chat
GPT.
Go
and
that
leads
to
you
know
losing
the
ability
to
assess,
analyze
on
the
longer
term,
and
maybe
not,
maybe
I'm
mistaken,
but
at
this
point
I
would
be
very
cautious
about
the
newer
technology.
Yet
I
would
embrace
them
and
try
them
and
see
the
value
because
everything
has
value
in
what
we
do,
but
we
need
to
extract
the
value
to
fit
our
patients'
care.

SPEAKER_00
16:47

Right.
It's
a
tool.

SPEAKER_01
16:48

Yes,
it's
a
tool.

SPEAKER_00
16:50

Like
and
I
think
of
that,
you
know,
it
can
be
a
really
good
tool,
but
you
still
have
to
put
the
work
in.
You
know,
I
I
always
think
about
Chat
GPT,
and
I'll
be
like,
I

Ethics Of Tech In The OR

SPEAKER_00
17:00

was
really
good
at
writing
papers,
and
then
Chat
GPT
came.
And
if
the
less
you
do
it,
the
less
you
recall
and
are
able
to
do
it
on
your
own.
So
there
is
risk
with
doing
that,
solely
counting
on
something
that
isn't
100%
accurate.
Leaves
room
for
error,
just
like
human
error.

SPEAKER_01
17:19

Yeah.

SPEAKER_00
17:19

It's
just
a
computer
human.

SPEAKER_01
17:21

So
no,
it's
like
stimulation
of
the
brain
is
always
an
important
thing.

SPEAKER_00
17:26

Yes,
it
is.
Because
we've
talked
about
better
tools,
removing
endriosis,
but
what
about
radical
new
ways
to
actually
reprogramming
or
curing
the
disease?
This
is
a
hot
topic
that
I
think
people
don't
really
want
to
touch.
But
also,
there's
a
lot
of
papers
out
there
that
could
be
either
misleading
or
give
false
hope.
And
so
I
want
to
touch
on
this
because
we
want
to
cure,
right?
Like
this
is
how
we
as
humans
work.
We
want
to
cure,
we
want
it
to
be
better.
Where
are
we
in
that
direction?
What's
the
science
behind
the
reprogramming?

SPEAKER_01
18:03

If
we
look
now
at
the
status
today,
what
is
the
treatment
of
randomitiosis?
Excision
surgery
that
helps
removing
the
disease,
yet
it
doesn't
cure,
disease
can
recur.
Hormones,
which
can
suppress
the
symptoms,
slow
down
the
disease
in
some
patients,
but
also
whenever
you
stop
them,
everything
gets
back
to
worse
than
before.
Now
the
concept
of
lesion
reprogramming
emanates
from
the
fact
that
what
if
we
can
change
the
behavior
of
endometriosis
rather
than
it's
a
tremendous
inflammation,
it
causes
infiltration
of
other
tissue,
make
it
a
benign
cell
that
will
not
do
any
of
that
stuff
or
will
not
grow
or
will
not
infiltrate
or
will
not
cause
pain.
That's
this
uh
the
uh
scientific

Reprogramming Lesions And Reality Check

SPEAKER_01
18:54

uh
stuff.
And
it's
extremely
appealing.
Now,
in
order
to
reprogram
the
behavior
of
any
cell,
including
endometriosis
cells,
you
need
either
to
modify
the
genetic
of
the
cell
or
the
epigenetic
of
the
cell,
or
the
environment
where
the
cell
thrives.
And
these
modification
um
we
can
see
that
some
attempts
have
been
done
on
immunomodulators
for
endometriosis
because
we
know
there
is
an
immunologic
uh
uh
immunologic
dysfunction
and
its
impact
on
endometriosis
uh
growth
and
cells.
So
immunomodulating
and
there
have
been
trials
on
those
immunomodulators
with
variable
uh
results
for
the
epigenetic
or
genetic
expressions,
this
will
become
a
little
bit
you
know,
cloudy.
Right
because
um
you
go
back
to
the
COVID
vaccine.
The
COVID
vaccine
was
a
need
in
an
urgent
situation.
Where
nobody
knew
what's
going
on.
And
now
we
know.
Now
if
you
ask
in
2020,
100
people,
95
will
take
the
COVID
vaccine.
In
2025,
if
you
ask
the
same
100
people,
5%
will
take
the
vaccine.
Because
of
we
realized
doing
those
genetic
or
epigenetic
interventions
created
far
more
sequally
than
what
we
believe
to.
Now
we
have
the
chronic
fatigue
symptoms,
we
have
the
vasculitis,
we
have
the
long
COVID,
we
have
a
lot
of
issues
that
we
didn't
gauge
and
we
didn't
expect
it
to
happen.

SPEAKER_00
20:39

Right.

SPEAKER_01
20:40

And
these
kinds
of
interventions
are
still
more
on
animal
models,
but
again,
translation
of
the
information
from
animal
models
might
not
feed
the
human
models.
Many
times
in
many
of
the
studies.
So
I
think
as
of
yet,
there
is
nothing
really
serious.
There
have
been
attempts
to
do
on
cells
in
mice
or
animal
models
to
try
to
create
that
reprogramming.
But
most
of
the
targets
are
working
on
genetic,
epigenetic,
and
immunologic,
and
we
don't
know
the
long-term
sequelae
of
these
studies.
So
it's
it's
it's
very
appealing,
a
very
sexy
concept
that
appeals
and
gives
hope
to
a
lot
of
patients.
I'm
sure
one
day
we'll
reach
out
to
some
form
of
a
therapeutic
approach
like
this.

SPEAKER_00
21:33

Right.

SPEAKER_01
21:35

But
uh
nothing
is
serious
right
now,
or
nothing
is
extremely
promising.

SPEAKER_00
21:42

So
we're
not
that
close
compared
to
what
some
people
might
say.

SPEAKER_01
21:46

The
speed
of
uh
things
evolving
in
this
world
are
uh
mind-boggling.
So
I
don't
know
how
close
it
is,
but
as
of
now,
the
evidence
does
not
support
any
real
progress
on
this.

SPEAKER_00
21:58

Interesting.
Do
you
talking
about
COVID?
Because
I
think
that
a
lot
of
people
with
long
COVID
are

COVID, Immunity, And Symptom Flares

SPEAKER_00
22:05

now
seeing
symptoms
worsen.
Have
you
experienced
that?
Or
is
there
anything
that
shows
that
COVID
had
an
effect
on
those
with
endometriosis?

SPEAKER_01
22:15

Because
I
know
this
is
gonna
be
a
hot
topic
and
I'm
going
off
script,
but
there
are
a
lot
of
studies
that
showed
that
the
COVID
or
even
the
COVID
vaccine
did
increase
the
uh
disease
burden
of
endometriosis
patients
and
the
pain
for
endometriosis
patients.
And
then
it's
it's
an
extremely
complex
situation
because
during
the
COVID,
there
is
a
high
level
of
stress
for
everybody.

SPEAKER_00
22:37

Right.

SPEAKER_01
22:37

And
we
don't
know
whether
it's
a
direct
causality
by
giving
the
vaccine
or
doing
the
COVID.
But
the
vaccine
also
induces
an
immune
response
to
create
the
immunity.
And
that
immune
response,
it
might
alter
further
the
immune
dysfunction
that
is
already
present
and
promote
further
inflammation
and
worsen
inflammatory
disease.
Because
we
see
a
lot
of
patients
that
have
joint
pain
increase,
they
have
more
vasculitis.
So
that
means
it's
a
progenitor
of
inflammation
in
the
body,
and
that
is
more
seen
in
patients
who
have
an
immune
dysfunction.

SPEAKER_00
23:18

Yeah.

SPEAKER_01
23:18

Because
it's
a
massive
reaction.
Whenever
you
take
a
vaccine,
you
have
fever,
you
have
chills.
Some
patients
experience
a
lot
of
inflammatory
symptoms.
And
then
in
patients
with
immune
dysfunction
who
have
endometriosis,
who
have
lesions
that
strive
or
thrive
on
um
inflammation,
that
helps
worsening
their
inflammation
and
then
their
symptoms
indirectly.

SPEAKER_00
23:43

It's
crazy
how
we
never
really
think
about
just
how
complex
endometriosis
can
be
with
every
environmental
factor
too.
Whether
it's
stress,
whether
it's
the
air
we
breathe
or
the
things
that
we
take,
or
you
know,
we've
talked
so
much
about
that,
but
I
think
that
we
can't
control
all
of
these
things.
What
we
can
control
are
the
ways
that
we
address
them.
And
that
I
think
is
going
to
maybe
hopefully
improve
as
time
goes
on.
But
I
do,
I
mean,
care
and
prevention
for
endometriosis
takes
greater
understanding.
And
I
think
that's
where
when
we
talk
about
this,
I
think
that
patient
movements
a
lot
of
times
are
what's
going
to
push
endometriosis
care
and
improvement
and
research
because
it's
already
did
and
it
will
continue
to
because
we
we're
not
silent
anymore.
We
have
platforms
and
we're
expecting
more,
demanding
more,
not
only
from
providers,
but
also
I
think
just
our
health
systems.
And
I
think
we're
seeing
this
wave
of
people
that
are
are
tired
of
feeling
the
way
they
feel.
And
as
a
patient,
I
can
tell
you
100%
I
am
tired
of
feeling
the
way
I
feel
half
the
time.
So
you
do
something
about
it.
We're
not
silent
anymore
about
that.
How
do
you
think
that's
going
to
change
the
research
to
potentially
find
maybe
not
a
curative
measure,
but
maybe
a
way
to
help
prevent
growth
of
endometriosis
and
its
severity?

SPEAKER_01
25:11

Definitely,
there
is
a
lot
of
uh
gaps
in
the
research

Research Gaps And Subtypes

SPEAKER_01
25:15

in
endometriosis.
So
we
can
start
from
the
mechanisms
of
how
endometriosis
we
only
know
bits
and
pieces
here
and
there.

SPEAKER_00
25:24

Right.

SPEAKER_01
25:25

So
further
research
about
the
mechanistics
helps
us
understand
the
therapeutic
of
endometriosis.

SPEAKER_00
25:32

Yeah.

SPEAKER_01
25:32

If
we
understand
more
how
the
disease
is
formed,
how
does
it
affect,
helps
us
understand
how
to
target
the
therapeutic
approaches?
Another
important
gap
is
always
we
look
at
endometriosis
as
a
whole
disease
and
we
fail
to
subtype
it.
So
that
would
become
a
hurdle
for
personalized
treatment.

SPEAKER_00
25:53

Right.

SPEAKER_01
25:54

You
do
have
endometriosis,
okay?
And
she
does
have
endometriosis,
but
what's
the
difference
between
you
and
her?

SPEAKER_00
26:02

Right.

SPEAKER_01
26:03

You
have
the
same
name,
right?
But
completely
different
approaches
of
treatment,
completely
different
impact
on
different
systems.
So
failing
to
subtype
endometriosis
or
to
understand
the
phenotypes
of
endometriosis
will
uh
continue
to
carry
a
lot
of
confusion
from
the
medical
community
and
from
the
patient's
understanding.
So
this
is
something
as
important
also
to
research.
The
other
thing
is
we
always
look
at
endometriosis
from
the
window
of
fertility
or
pain.
And
then
this
means
we're
narrowing
our
understanding
of
a
multisystemic
beyond
disease.
Right.
Everybody
talks
about
how
we
can
intervene
to
improve
infertility,
but
nobody
talks
about
what
are
the
impact
or
mechanism
of
impact
of
endometriosis
on
infertility.

SPEAKER_00
26:57

Yeah.

SPEAKER_01
26:58

Because
we're
treating
the
symptoms,
we're
not
treating
the
root
cause.
Again,
we're
looking
at
endometriosis
as
a
disease
that
requires
surgery,
but
we
fail
to
do
studies
for
patient-reported
long-term
outcome
and
impact
on
quality
of
life.
It's
beyond
pain
during
sex
pain,
pelvic
pain,
pain
during
during
pain.
What
about
the
bloating?
What
about
the
headaches?
What
about
the
uh
excessive
body
weight?
What
about
the
fatigue?

SPEAKER_00
27:24

Right.

SPEAKER_01
27:25

Nobody
in
the
studies
study
those
as
a
primary
outcome.
Always,
most
of
the
studies
study
pain
fertility.
So,
this
is
another
thing.
Uh
major
gap
also
in
the
research
is
how
can
we
train
people
to
be
able
to
take
care
of
the
disease?
How
can
we
find
solutions
for
early
diagnosis?
How
can
we
use
technology,
biomarkers
to
help
us
do
non-invasive?
Also,
about
the
therapeutic
approaches
of
endometriosis,
can
we
think
in
a
different
way?

SPEAKER_00
27:57

Yeah.

SPEAKER_01
27:58

Can
we
start
thinking
based
on
a
molecular
level,
targeted
therapy,
cellular
therapies?
So
all
these
kinds
of
things,
a
lot
of
gaps
in
holistic
approaches
to
endometriosis
in
research.

SPEAKER_00
28:09

Right.

SPEAKER_01
28:10

Patients
tell
you,
I've
done
an
anti-inflammatory
diet,
my
symptoms
improved.
The
gut
microbiome
had
its
impact,
the
total
body
microbiome.
For
me,
it
is
trying
to,
when
we
start
to
understand
the
microbiome,
we
understand
that
there
is
a
value
of
the
uterus.

SPEAKER_00
28:27

Right.

SPEAKER_01
28:28

And
the
uterus
have
a
microbiome.
And
there's
a
value
for
the
appendix
if
it's
not
affected.

SPEAKER_00
28:34

Yeah.

SPEAKER_01
28:34

The
appendix
controls
most
of
the
microbiome
in
the
abdomen.
It's
not
every
endometriose
patient,
I
go
remove
the
appendix.

SPEAKER_00
28:41

Right.

SPEAKER_01
28:42

So
these
approaches
that
were
practiced
more
could
lead
to
uh
with
poor
research,
could
lead
to
unnecessary
interventions
and
then
iatrogenic
disruptions
because
sometimes
we
do
cause
harm
if
we
don't
understand
what's
the
value
of
doing
things.

SPEAKER_00
28:59

Yeah.

SPEAKER_01
29:00

The
medications
that
we
prescribe
for
endometriosis
patients,
we
need
to
see
how
it
impacts
the
whole
ecosystem.

SPEAKER_00
29:06

Right.

SPEAKER_01
29:07

So
there
are
a
lot
of
research
gaps.
Pain.
Nobody
understands
the
pain.
No.
And
there
is
an
extremely
poor
understanding
of
the
pain
from
endometriosis,
from
different
lesions,
from
the
heterogeneity
of
the
locations.
How
does
the
pain
uh
is
impact
it?
So
this
is
why
it
saddens
you
where
you
see
a
disease
that
affects
10%
of
female
patients.
And
yet
the
huge
gap
in
research
and
funding

Microbiome, Diet, And Whole-Body Factors

SPEAKER_01
29:38

and
understanding
is
mind-boggling,
is
jaw-dropping.
It's
just
like
God.

SPEAKER_00
29:43

Well,
and
also
like
we
if
you
if
you
look
at
the
gap
in
research,
even
for
those
with
hormone
imbalance,
they
don't
do
it's
a
tricky
thing
to
do
research
on
people
who
have
fluctuating
hormones
all
the
time.

SPEAKER_01
30:00

Of
course.

SPEAKER_00
30:01

So
how
much
does
I
mean
I
would
be
curious
to
see
how
much
the
standard
of
care
when
it
gets
to
the
hysterectomy
and
how,
you
know,
for
those
who
are
not
maybe
as
experienced
with
endometriosis,
they'll
do
a
hysterectomy,
euphorectomy.
Then
you
have
this
hormonal
imbalance.
So
how
much
does
that
affect
the
whole
system
and
the
microbiome
and
everything
else?
And
there's
just
not
a
lot
out
there.

SPEAKER_01
30:26

Um
it
saddens
me
a
lot,
um,
especially
in
some
countries.
I'm
not
gonna
name
the
country
because
they
won't
know
themselves.
They
still
offer
ophorectomy
while
they
do
hysterectomy.

SPEAKER_00
30:39

Yeah.

SPEAKER_01
30:41

Despite
the
recent
solid
studies,
that
surgical
menopause
or
removal
of
the
ovary
during
surgery
does
not
only
impact.
I'm
not
gonna
talk
about
the
hot
flashes
and
the
bone
density,
but
I
will
talk,
it
impacts
the
lifespan
of
a
patient's
patients
with
surgical
ophorectomy
dies
earlier.
I'm
committing
a
patient
to
dying
early
by
just
doing
an
elective
ophorectomy.
Like
if
you
have
cancer,
we
understand.
If
you
have
irreparable
ovary,
completely
damaged
ovary,
we
understand.
But
we
should
all
strive
to
keep
even
a
piece
of
ovary
or
a
total
ovary.

SPEAKER_00
31:24

All
of
it
if
you
can.

SPEAKER_01
31:25

Yes,
yeah.
So
this
is
the
thing.
We
still
take
things
because
we
we
learned
how
to
do
that
from
outdated
guidelines
that
have
no
place
in
the
recent
medicine
or
the
recent
therapeutic
approaches
to
patients
with
endometriosis.

SPEAKER_00
31:42

It's
crazy.
What
is
the
in
your
mind?
What
are
the
risks
of
over-treating
and
over
too
many
surgeries?
Like
what
are
some
of
the
biggest
risks
associated
with
that?
Because
I
mean,
this
is
a
big
topic
that
we
don't
have
to
get
all
the
way
in,
but
I
really
feel
like
people
are
going
back
for
reoccurring
surgeries.
They
have,
you
know,
treatment
after
treatment
after
treatment
of
hormones
or
whatever
the
case
is.
I
mean,
there's
let
me
state
some
facts.

SPEAKER_01
32:09

30%,
and
that
might
be
shocking
for
a
lot
of
uh
patients.
Uh,
30%
of
patients
with
endometriosis
have
persistent
pain
after
their
surgery.

SPEAKER_00
32:19

Yeah,
I
believe.

SPEAKER_01
32:20

It's
like
one-third.
Why?
It's
not
always
how
we
say
it's
an
incomplete
surgery.

SPEAKER_00
32:26

Right.

SPEAKER_01
32:26

It
could
be
musculoskeletal,
it
could
be
pain
pathways,
it
could
be
hypermobility,
it
could
be
some
other
factors
that
are
help-producing
or
generating
the
pain.
I'll
give
you
a
scenario.
When
a
patient
has
persistent
pain,
the
surgeon
cannot
understand
that
pushes
the
patient
to
seek
care
from
another
surgeon.
The
lack
of
experience,
the
poor
understanding
of
the
disease
lead
to
premature
another
surgery.
Repetitive
surgery
in
many
instances
causes
more
damage,
more
scarring,
more
irreversible
damage.
For
me,
I'm
happy
every
day
to
do
a
stage
17
endometriosis
versus
to
do
a
stage
three
endometriosis
that
somebody

Surgical Menopause Risks And Outdated Care

SPEAKER_01
33:10

operated
on
incompletely.

SPEAKER_00
33:12

Yeah.
Yeah.

SPEAKER_01
33:14

It's
a
disaster
because
like
people
start
something,
don't
finish
it,
they
create
overscarring
in
the
presence
of
the
inflammatory
disease
that
is
persistent
in
addition
from
the
inflammation
of
surgery.
So
all
these
lead
to
multiple
unnecessary
surgery.
The
complexity
and
multi-systemic
facet
of
the
disease
creates
a
lot
of
symptoms
that
could
be
brushed
under
the
endometriosis
umbrella
that
are
not
belonging
to
endometriosis.
Maybe
you
have
a
herniated
disc.
It
doesn't
mean
that
the
low
back
pain
that
you
have
is
from
endometriosis
that
resists
after
surgery.

SPEAKER_00
33:56

Yeah.

SPEAKER_01
33:58

So
this
is
something.
There
is
an
immune
and
systemic
total
body
dysfunction,
and
it
produces
symptoms
like
we
discussed
the
bloating.
Patient
think
they
continue
to
have
bloating
after
surgery
because
first
in
the
uh
healing
period
the
doctor
tells
them
this
is
normal
after
surgery,
but
then
after
six
months,
they
think
endometriosis
recurs.

SPEAKER_00
34:19

Right.

SPEAKER_01
34:20

Setting
the
expectation
for
patients
in
the
presence
of
the
uterus,
even
if
the
uterus
is
not
affected,
a
lot
of
the
time
the
uterus
is
a
muscle
that
needs
rehabilitation.
That's
why
pain
during
the
first
three,
four
periods
is
still
persistent
because
the
uterus
is
a
muscle
is
cramping
and
it's
tender
and
it's
been
cramping
for
years.
It's
not
gonna
uh
resolve
after
surgery.
So
having
a
period
pain
three,
four
months
after
surgery,
is
not
a
signal
of
persistence
of
the
disease.

SPEAKER_00
34:51

Right.

SPEAKER_01
34:52

Now,
what
created
that
whole
thing
is
the
mistrust
that
happened
between
the
caring
and
the
patient,
the
caring
provider
and
the
patient.
Because
there
is
a
mistrust,
and
there
is
also
circulating
a
lot
of
misinformation
that
indirectly
or
directly
gaslight
the
patient
that
push
them
to
seek
hope
or
false
hope
somewhere
else.

SPEAKER_00
35:22

Yep.

SPEAKER_01
35:22

Saying,
oh,
I'm
a
better
surgeon,
I'm
great
at
what
I
do,
my
patients
are
cured
when
I
do
surgery,
I
have
zero
recurrence
rate.
And
that's
why
exploiting
the
vulnerability
of
endometriosis
patients
by
selling
them
false
hope
is
one
of
the
social
media
perpetuated
novel
ways
of
gaslighting
and
should
be
a
medical
crime
in
that
sense.
So
providing
education,
providing
empowerment,
providing
help
to
patient
support,
creating
strategy
is
what
prevents
this
kind
of
fragmented
care,
silo
care,

Over-Treatment, Pain Pathways, And Expectations

SPEAKER_01
36:02

no
multiple
provider,
isolated
care.
And
the
uh
caring
should
be
in
specialized
endometriosis
centers
because
it's
such
a
complex
disease
with
a
major
impact
on
the
quality
of
life.

SPEAKER_00
36:18

Yeah,
I
agree.
I
I
think
that
exploiting
patients
is
egregious.
It's
it's
not
okay.
But
I
do
see
everything,
you
know,
we've
talked
about
the
whole
system,
the
whole
body,
the
AI,
everything,
how
it
works
together.
And
I
think
what
I
want
people
to
understand
is
there
is
hope.
We
are
progressing,
and
it
is
good
to
be
knowledgeable
because
I
think
that
it
will
help
you
navigate
your
own
journey,
but
it'll
also
hold
those
doctors
more
accountable
the
more
knowledgeable
the
patients
are
as
well.

SPEAKER_01
36:49

It's
sad
that
we
have
to
be
more
knowledgeable
in
a
lot
of
ways,
but
understanding
knowledge
is
power,
understanding
your
body,
understanding
what
might
be
causing.
Uh
you
know,
when
you
do
any
intervention
on
a
patient,
there
is
something
called
informed
consent.
Yes.
And
I
know
my
friend
uh
Jeff
talks
about
it
a
lot,
and
I
I
uh
value
a
lot
the
messaging
that
he
sends.
Informed
consent
is
just
is
not
just
vomiting
complication
risks
or
the
intervention
side
effects.
Informed
means
giving
the
right
information,
the
total
information
for
the
patients
to
have
the
ability
to
decide
what's
best
for
her.
Not
what's
best
for
me
as
a
provider,
what's
best
for
her.
So
an
informed
is
not
hiding
or
sidelining
information
that
might
impact
the
approval
of
a
patient
for
this
procedure
or
another
procedure
or
this
therapeutic
tool
or
another
therapeutic
tool.
So
that's
why
giving
the
patient
the
knowledge,
patients
are
wise,
they
can
decide
what's
best
for
them
at
this
point
of
time.

SPEAKER_00
37:58

Yep.

SPEAKER_01
37:58

Some
patients
cannot
do
surgery
tomorrow
or
next
month.
Some
patients
have
social
commitment,
work
commitment.
They
want
to
manage
their
life
until
they
become
ready
for
surgery.
So
we
should
be
able
to
troubleshoot
their
life
during
that
period
of
time
with
them.

SPEAKER_00
38:17

Right.

SPEAKER_01
38:18

So
there
are
nothing
is
simplified
in
endometriosis
care,
considering
the
disease
is
very
complex.
But
I
don't
like
the
fact
that
patients
should
find
their
care,
their
cure.
I
think
it's
our
ethical
obligations
as
doctor
to
help
them
and
guide
them
through
that
route.
And
you
should
not
be
a
doctor.
Right.
You
came
to
a
doctor
because
he
spent
his
time
studying
and
doing
this
thing
so
you
can
get
the
best
care
that
you
believe
you
should
get.
It's
not
your
job
to
go
research
and
Google
and
Chat
GPT,
your
therapeutic
approaches,
and
then
figure
out
what's
going
on
with
you.
It's
my
obligation
to
understand
this.
And
this
is
the
the
pendulum
swung
the
other
way.

SPEAKER_00
39:09

Yeah.

SPEAKER_01
39:09

And
I
think
it's
about
time
to
balance
the
pendulum.
You're
a
patient,
we
empower
you,
we
inform
you,
we
take
care
of
you,
we
give
you
the
highest
quality
of
care.
And
then
you
have
some
homework
to
do
in
taking
care
of
yourself.
I
see
a
lot
of
time
trying
to
help
patients.
What
is
a
good
surgeon?
Who
is
an
endometriosis
exercise
specialist?
It's
extremely
important
to
educate
patients.
We're
trying
to
work
from
the
basis
because
this
should,
in
an
ideal
health
system,
this
should
not
happen.

SPEAKER_00
39:39

Right.

SPEAKER_01
39:40

Everybody
should
have
the
qualities
and
the
skills
and
everything
to
help
guide
the
patients
and
understanding.
And
that
only
comes
from
creating
that
paradigm
shift
that
has
started
with
advocacy
group
and
then
carried
by
knowledgeable
doctors
that
can
help
spreading
the
information.
Information
and
create
research
and
studies
to
further
our
understanding
of
the
disease
and
then
this
way
establish
a
newer
standard
of
care
for
endometriosis
patients
that
would
lead
to
a
better
outcome.

SPEAKER_00
40:12

Yeah.
It's
kind
of
like
having
it,
you
know,
I
always
say
we're
the
ones
paying
you,
right?
Like
we're
not
gonna
pay
a
contractor
on
our
house
and
then
go
build
the
house
ourselves.
Yes.

Center-Based Care And False Hope

SPEAKER_00
40:25

Like
that
doesn't
really
make
a
lot
of
sense,
right?
We
might
have
input
on
how
it's
built.
We
might
have
input
on
what
we
want
out
of
it,
and
that's
how
it
should
be.
But
if
you
let
me
build
a
house,
it's
not
gonna
look
pretty
because
I
don't
have
the
best
information.
I
don't,
I
don't
know
how
to
do
all
of
that
stuff,
like
what
the
specifications
should
be.
But
I
do
think
being
a
team
with
your
provider
is
key.
But
you
know,
one
of
the
things
I've
always
said
is
there's
a
lack
of
curiosity
with
a
lot
of
doctors.
And
time.

SPEAKER_01
40:59

It's
a
result,
it's
a
result
of
the
healthcare
system.
How
is
it
created?
It's
a
volume-based.
The
more
you
see,
the
more
you
make,
the
more
the
health
system
makes,
you
know,
so
it's
it's
uh
also
a
broken
circle
that
needs
a
major
reform,
the
healthcare,
because
it
pushes
patients
to
chase
the
numbers
rather
than
the
quality
of
care.
Yes.
And
then
uh
when
I
spent
an
hour
and
an
hour
and
a
half
with
the
patients
on
her
first
consult
with
endometriosis,
I
could
never
do
that
in
a
university
setting
or
where
you
know
you
have
to
spend
10,
15
minutes
because
you
have
to
see
100
patients.
And
that
that
does
not
work,
uh,
you
know.
So
I
don't
I
I
think
there
is
a
lot
of
blaming
to
doctors.

SPEAKER_00
41:46

Yeah.

SPEAKER_01
41:47

Uh,
but
I
think
we
have
also
to
reform
the
healthcare
system.

SPEAKER_00
41:51

Yeah.

SPEAKER_01
41:51

To
allow
doctors,
yesterday
we
were
talking
about
something
really
uh
uh
touch
me
deeper
when
now
uh
healthcare
practices
will
tell
the
doctor
you
cannot
do
surgeries
more
than
an
hour
or
a
certain
number
of
time.
And
I
and
I
was
telling
you,
this
is
some
of
the
most
dangerous
practices
because
that
lead
to
incompleteness
of
surgery,
that
lead
to
recklessness,
that
increases
the
stress,
increases
the
surgical
mistakes
of
a
surgeon
when
they
have
a
time
limit.
These
are
really
very
egregious
practices
that
some
of
the
healthcare
systems
are
pushing
among
doctors.

SPEAKER_00
42:27

Yep.
And
it's
more
expensive.
If
you
think
about
it,
it's
it's
more
expensive
for
the
patient,
it's
more
expensive
for
the
hospital
system.
I
mean,
it's
a
reactive,
not
a
proactive
approach.
And
we
all
know
that
if
you're
reactive,
outcomes
typically
aren't
as
great
as
if
you're
proactive,
right?
And
so
I
think
healthcare
has
become
so
reactive,
such
a
band-aid
in
so
many
circumstances
that
it's
really
hard
for
a
patient
to
feel
seen
in
that
15-minute
appointment,
that
45-minute
surgery,
and
to
really
have
a
better
quality
of
life.
Not
to
say
that
the
surgeons
aren't
good,
but
to
say
that
they
are
very
limited
by
what
they're
given.

SPEAKER_01
43:06

And
another
shocking
percentage,
do
you
know,
is
uh
looking
at
the
literature,
30
to
50
percent
of
endometriosis
surgeries
are
unnecessary.

SPEAKER_00
43:16

I
believe
it.

SPEAKER_01
43:17

So
whenever

Informed Consent And Shared Decisions

SPEAKER_01
43:18

I
see
patients
that
have
15
surgeries,
you
know,
uh
it's
it's
shocking
for
me.
Yeah.
Imagine
15
times
you
put
your
patient
at
risk
for
poor
understanding.
I
understand
the
recurrence
of
endometriosis,
and
recurrence
is
2.9%
in
experts
and
8.9%
for
endometriomas.
That
does
not
push
one
patient
to
have
15
surgery
if
you
do
the
math.
Having
15
surgery
mostly
is
because
of
the
misunderstanding
of
the
disease,
is
the
fragmented
care,
is
uh
because
of
the
incompleteness
of
the
surgery,
the
poor
uh
understanding
of
pain
pathways
and
understanding
how
the
disease
affects
or
creates
a
lot
of
symptoms.

SPEAKER_00
44:03

Yeah.
You
know,
and
that's
something
that
I
always
tell
people
when
they
come
to
me
and
they
ask
me
questions
about
endometriosis.
I'm
still
in
pain,
I'm
looking
at
having
another
surgery.
I
always
ask
them,
are
there
things
that
you
have
done
to
help
support
your
body
to
this
point?
Are
you
seeing
a
pelvic
floor
physical
therapist
or
a
physical
therapist
in
general?
Have
you
done
little
exercises
that
help
support
your
body?
Because
I
know
for
me
that
if
movement
is
power,
it's
exhausting,
and
if
you
overdo
it,
it's
not
good.
But
if
you
have
good
movement,
it
really
helps
a
lot
of
that
pain.
You
know,
it
gets
us
out
of
that
pain
cycle
a
lot
of
times.
And
so
I
always
caution
people
to
not
think
surgery
first
all
the
time,
because
it's
a
big
decision
with
big
outcomes
potentially.
You
know,
it
it's
certainly
a
helpful
tool
and
it's
definitely
a
way
that
we
can
address
the
disease,
but
again,
is
it
always
the
disease
or
is
it
something
else?
You
know?
I
mean,
that's
just
what
I've
learned
in
my
journey.
It's
not
always
the
disease.
There's
other
facets
of
this
disease
and
other
chronic
illnesses
that
play
with
it.
So
where
do
you
see
yourself
in
the
next
10
years
progressing
endometriosis?

SPEAKER_01
45:21

Hopefully,
I'm
retired.
No,
uh
I
will
continue.
I
still
enjoy
a
lot
challenging
the
challenges,
surgical
challenges,
the
difficult
cases.
Uh,
I
think
I
will
continue
to
do
my
research.
I
do
we
do
a
lot
of
research
about
endometriosis.
Uh,
the
other
thing
I
I
love
educating
surgeons,
standardizing
technique
for
endometriosis
surgery,
and
probably
when
I
retire
from
clinical
activity,
I
would
like
to
continue
this
the
education
side,
the
research
side,
the
understanding
side,
because
this
uh
is
is
good
for
me
and
for
my
uh
speedy
brain
all
the
time.
I
think
individual

System Pressures And Time Limits

SPEAKER_01
46:05

efforts
to
impact
communities,
whether
in
surgeons,
whether
in
patients,
something
that
I
uh
enjoyed
doing
for
the
past
years
and
I
will
continue
to
enjoy
doing
because
if
I
can
teach
more
people
to
fish,
I
don't
need
to
fish
for
them.

SPEAKER_00
46:21

Yeah.

SPEAKER_01
46:21

In
the
sense
when
we
help
or
we
train
or
we
teach
one
another,
uh
the
impact
will
grow
way
fast
way
faster
through
these,
hoping
we
can
come
to
a
better
standardization,
better
utilizing
the
resource
to
provide
better
care
beyond
the
negativity,
the
toxicity,
the
gaslighting,
the
things
that
are
currently
happening,
whether
on
a
healthcare
system,
whether
on
surgical
skills
system,
whether
on
research
and
understanding
basis.
So
all
these
will
come
together.
I
think
this
is
a
passion
and
you
cannot
retire
from
a
passion.
You
can
retire
from
certain
jobs
or
exercises,
but
uh
the
passion
will
remain
there.
It
was
grown,
it's
really
hard
when
you
set
the
fire.
Sometimes
it's
hard
to
uh
turn
it
down.

SPEAKER_00
47:12

I
mean,
you're
really
good
at
it.
You're
really
good
at
the
education,
so
you
can't
stop.
From
a
personal
perspective.

SPEAKER_01
47:20

Hopefully,
I
I
want
to
spend
time
with
my
kids,
my
family.
This
is
this
is
also
important
uh
because
uh
this
takes
uh
a
lot
of
toll
uh
on
you.
Caring
for
endometriosis
is
almost
very
similar
to
having
endometriosis
on
the
impact
on
societal
relationship.
You
lose
a
lot
of
friends
by
being
on
the
road
trying
to
educate,
you
uh
uh
miss
your
family
a
lot.
So
at
one
point
we
need
to
pass
the
torch
for
the
younger
that
will
help
pushing
things
way
beyond
what
we've
done,
and
that's
the
purpose
of
education
to
identify,
create
surgeons,
champions,
not
surgeons.
They
could
uh
understand
better
the
disease
and
create
that
impact
more
on
the
uh
value
of
care
they
provide
for
their
patients.

SPEAKER_00
48:12

Yeah.
Well,
I
hope
that
you
don't
stop
that
anytime
soon
because
I
hope
so.
Because
we
need
that.
And
thank
you
for
taking
the
time
to
do
exactly
what
you
said
you
would
do
in
coming
out
here
and
spending
this
quality
time
with
us
and
allowing
me
to
pick
your
brain
and
be
educated
about
this
and
sharing
that
with
so
many
other
people.
This
will
help
impact
those
living
with
endometriosis
to
better
understand.
I
am
excited
to
see
what's
next.
We'll
do
it
together.
If
this
episode
helped
recharge
your
indo
battery,
please
take
a
moment
to
like
and
subscribe
on
YouTube.
It
really
helps
others
in
our
community
find
these
resources
too.
And
if
you're
listening
on
a
podcast
app,
leave
a
quick
rating
or
a
comment
to
show
what
resonated
with
you.
Every
bit
of
engagement
helps
us
reach
more
people
living
with
endometriosis
and
chronic
illness

Unnecessary Surgeries And Alternatives

SPEAKER_00
49:10

and
reminds
them
they're
not
alone.
Until
next
time,
continue
advocating
for
you
and
for
others.