Send us a text with a question or thought on this episode ( We cannot replay from this link)
Join us in this enlightening episode as we dive into the remarkable journey of Dr. Jenn Jaggi, from leading an OB/GYN department for a decade in an underserved Indian Health Service hospital to embarking on a transformative path as a surgeon specializing in endometriosis. Dr. Jaggi’s narrative is a testament to the power of passion and the pursuit of knowledge in the medical field.
Dr. Jaggi shares the pivotal moment when she stumbled upon an Endometriosis fellowship with Dr. Cindy Mosbrucker at Pacific Endometriosis and Pelvic Surgery. Through her experiences, she sheds light on the common challenge faced by many GYN practitioners: the lack of comprehensive information and education on endometriosis, despite their genuine desire to provide the best care for their patients.
Listen in as Dr. Jaggi candidly walks us through her personal discoveries about endometriosis and reflects on how her understanding of the condition has evolved over time. She delves into the complexities of diagnosis, treatment, and the impact of education on patient care. Dr. Jaggi’s insights offer a refreshing perspective, emphasizing the importance of continuous learning and growth in the medical profession.
This episode serves as a beacon of hope and empowerment for patients and practitioners alike, as we navigate the journey of understanding and managing endometriosis together. Dr. Yaggi’s story is a reminder that we are all constantly evolving, and her unwavering commitment to excellence makes her a guiding light in the field of women’s health.
Tune in to gain invaluable insights and be inspired by Dr. Jenn’s passion, perseverance, and dedication to making a difference in the lives of those affected by endometriosis.
https://pacificendometriosis.com
Website endobattery.com
Navigating Endo
Speaker 1
0:03
Welcome
to
Indobattery
,
where
I
share
about
my
endometriosis
and
adenomyosis
story
and
continue
learning
along
the
way
.
This
podcast
is
not
a
substitute
for
professional
medical
advice
or
diagnosis
,
but
a
place
to
equip
you
with
information
and
a
sense
of
community
,
ensuring
you
never
have
to
face
this
journey
alone
.
Join
me
as
I
navigate
the
ups
and
downs
and
share
stories
of
strength
,
resilience
and
hope
.
While
navigating
the
world
of
endometriosis
and
adenomyosis
,
from
personal
experience
to
expert
insights
,
I'm
your
host
,
elana
,
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
my
guest
tonight
,
dr
Jen
Yaggy
,
at
the
table
.
Speaker 1
0:49
Dr
Jen
is
a
board-certified
OBGYN
that
practiced
as
a
general
OBGYN
for
nearly
10
years
,
but
recently
started
her
fellowship
for
advanced
endometriosis
and
pelvic
surgery
with
Dr
Cindy
Mossberger
at
Pacific
Endometriosis
and
Pelvic
Surgery
in
Gig
Harbor
,
washington
.
Thank
you
,
jen
,
so
much
for
joining
me
today
.
I'm
excited
to
have
you
on
.
Thanks
for
taking
the
time
to
do
that
.
Oh
,
good
morning
.
Thanks
for
having
me
here
.
Speaker 1
1:14
Yes
,
I'm
excited
to
have
you
join
me
today
for
a
couple
different
reasons
.
One
of
the
reasons
is
that
you
have
a
unique
perspective
to
give
to
those
of
us
within
the
endometriosis
community
,
but
also
,
I
just
think
that
you
have
a
great
way
of
giving
us
insight
to
something
that
maybe
we
have
become
blind
to
as
far
as
when
it
comes
to
doctors
wanting
to
have
the
best
for
their
patients
but
not
equipped
properly
to
do
so
and
doing
something
about
that
,
and
I
think
I'm
excited
to
hear
more
about
your
story
.
And
so
,
without
further
ado
,
if
you
wouldn't
mind
sharing
just
a
little
bit
of
who
you
are
and
what
your
background
is
,
Of
course
,
and
yeah
,
thank
you
again
for
having
me
.
Speaker 2
1:58
I
was
surprised
to
hear
that
you
would
want
to
have
a
fellow
who's
early
in
training
in
endometriosis
on
your
podcast
.
But
I
guess
there's
one
thing
that
I
can
offer
.
I
guess
my
story
to
getting
where
I
am
is
probably
unique
,
though
I
realize
everyone's
story
in
one
way
or
another
is
unique
in
terms
of
how
they
get
to
where
they
are
.
Say
,
for
a
long
time
I
knew
I
wanted
to
be
a
physician
.
I
think
during
med
school
itself
.
I
for
a
while
was
kind
of
struggling
with
what
my
niche
or
my
specialty
would
be
.
I
think
I've
always
been
drawn
to
anatomy
and
sort
of
the
more
concrete
where
you
have
a
visual
problem
in
front
of
you
and
a
concrete
solution
.
So
I
think
I
was
always
more
drawn
to
the
surgical
specialties
.
And
yet
on
some
of
my
surgery
rotations
I
did
a
rotation
in
ENT
and
plastic
surgery
.
Speaker 2
2:49
While
I
loved
the
hands-on
time
in
the
OR
,
I
felt
like
maybe
in
terms
of
the
personalities
,
I
hadn't
quite
found
my
people
,
in
the
sense
that
I
also
really
liked
the
continuity
with
patients
and
I
really
enjoyed
talking
to
patients
about
their
stories
and
I
know
that's
a
generalization
,
I'm
not
saying
that
general
surgeons
or
orthopedas
don't
enjoy
that
too
,
but
I
think
there
are
different
personalities
and
the
stereotypes
of
the
medical
world
and
so
when
I
did
my
OBGYN
rotation
I
really
did
enjoy
just
the
connection
that
the
physicians
had
and
really
getting
to
take
care
of
patients
through
all
ages
and
seeing
teenagers
for
their
meaningful
periods
and
then
seeing
women
during
their
pregnancies
and
really
all
the
way
through
menopause
and
prolapse
.
I
really
did
like
the
breadth
of
it
and
just
really
the
continuity
that
a
lot
of
the
OBGYNs
had
with
their
patients
.
So
I
think
that's
ultimately
what
brought
me
to
OBGYN
.
But
I
was
always
from
the
beginning
thinking
that
I
wanted
to
focus
more
on
the
GYN
side
.
I
loved
my
GYN
oncology
rotations
as
a
medical
student
and
really
initially
actually
thought
I
would
do
OBGYN
residency
to
then
go
on
to
oncology
.
I
just
felt
like
they
were
amazing
surgeons
.
And
again
,
the
hands-on
part
,
I
really
loved
the
OR
.
And
then
I
think
at
the
time
when
I
was
in
residency
too
,
my
dad
was
sick
with
cancer
and
I
think
there
was
this
part
of
the
breadth
of
general
OBGYN
that
I
liked
and
I
suddenly
found
myself
not
wanting
perhaps
every
patient
to
be
a
cancer
patient
.
So
,
yeah
,
found
myself
deciding
that
I
was
going
to
be
doing
general
OBGYN
,
at
least
for
a
bit
,
with
the
idea
in
the
back
of
my
head
that
I
would
still
go
on
to
do
a
fellowship
.
I
then
thought
,
maybe
MIGS
or
Urogyne
.
Speaker 2
4:45
I
was
always
drawn
to
working
in
a
more
underserved
,
low
resource
area
.
During
med
school
and
residency
did
rotations
abroad
in
Guatemala
,
uganda
,
south
Africa
and
I
think
if
it
hadn't
been
for
the
fact
that
my
dad
was
sick
at
the
time
,
I
probably
would
have
ventured
off
to
another
country
after
residency
.
But
someone
told
me
no
,
if
you
want
to
do
work
in
a
low
resource
setting
,
kind
of
without
leaving
the
country
,
you
should
really
look
at
IHS
,
the
Indian
Health
Service
.
And
just
by
chance
there
were
two
MIGS
,
which
is
minimally
invasive
GYN
surgeons
who
were
going
out
to
one
of
the
hospitals
in
New
Mexico
on
the
Navajo
Reservation
called
SHIPRAQ
.
So
I
joined
them
for
a
week
of
surgeries
.
They
were
doing
the
more
complex
surgeries
that
the
GYNs
there
and
kind
of
saved
for
that
week
that
they
were
visiting
.
The
goal
of
the
week
,
I
think
,
was
really
to
both
do
the
surgeries
that
maybe
otherwise
would
have
had
to
be
referred
out
and
also
to
bring
more
knowledge
to
the
GYNs
that
were
practicing
there
and
just
through
a
kind
of
series
of
small
world
connections
,
met
another
physician
who
was
at
another
neighboring
Navajo
area
hospital
in
Gallup
and
a
few
months
later
found
myself
taking
a
job
at
that
hospital
called
Gallup
Indian
Medical
Center
,
where
I
then
practice
for
the
next
.
Speaker 2
6:07
You
know
,
I
thought
it
would
be
a
couple
years
until
I
went
back
to
fellowship
,
but
two
became
six
,
became
gosh
,
almost
10
,
shortly
after
getting
there
no-transcript
,
two
and
a
half
years
after
getting
there
we
went
from
being
a
group
of
six
GYNs
to
three
.
Speaker 2
6:23
There
were
several
GYNs
who
just
moved
on
for
other
reasons
,
you
know
,
one
retired
,
one
went
on
to
an
administrative
role
,
someone
had
a
baby
and
moved
closer
to
family
,
but
we
were
suddenly
in
a
lurch
,
having
three
docs
instead
of
six
,
and
so
it
just
did
not
feel
like
the
time
to
move
on
and
I
got
thrown
into
a
leadership
role
as
well
.
I
ended
up
taking
on
the
OB
chief
role
just
a
couple
of
years
after
residency
,
which
in
hindsight
you
know
was
one
of
those
things
you
look
back
on
.
And
you
know
I
certainly
learned
a
lot
,
but
I'm
not
sure
I
would
have
chosen
that
same
route
.
And
then
,
a
couple
of
years
later
,
I
had
my
first
baby
,
and
that
seemed
also
not
the
time
to
venture
back
to
fellowship
.
And
then
,
you
know
,
that
thing
called
COVID
turned
the
world
upside
down
.
Speaker 2
7:14
So
,
having
to
kind
of
lead
the
department
through
that
,
the
Navajo
Nation
got
really
hardly
hit
by
COVID
,
which
you
know
would
be
a
whole
other
podcast
on
its
own
.
But
it
took
a
couple
of
years
to
really
feel
like
we
were
on
our
feet
.
And
you
know
it
was
at
that
point
that
I
was
like
,
okay
,
if
I
really
want
to
go
back
to
further
my
surgical
training
,
like
this
would
be
,
I
think
,
the
time
to
do
it
,
or
otherwise
,
you
know
,
I
think
maybe
I
will
continue
down
this
route
of
general
OB
GYN
.
And
it
was
through
another
sort
of
series
of
small
world
connections
.
I
was
at
an
AAGL
conference
in
December
of
2022
when
one
of
my
former
residency
friends
introduced
me
to
Dr
Mossbroker
,
who
runs
Pacific
Endometriosis
and
Pelvic
Surgery
,
and
said
that
she
had
prior
fellows
.
You
know
that
she
trained
in
endometriosis
surgery
and
we
started
talking
with
her
and
ended
up
coming
out
for
a
week
to
see
her
in
practice
,
both
in
clinic
with
patients
and
in
the
OR
and
,
yeah
,
just
really
got
drawn
into
this
world
of
endometriosis
.
Speaker 2
8:19
I
was
just
so
surprised
by
the
stories
that
I
heard
when
she
was
in
clinic
.
You
know
she
really
took
the
time
with
the
patients
that
often
,
you
know
,
in
other
settings
,
you
don't
see
possible
,
you
know
,
in
a
15
minute
appointment
Just
hearing
about
patients
who
had
seen
doctor
after
doctor
and
either
not
been
diagnosed
or
had
had
surgeries
,
but
they
were
incomplete
surgeries
and
so
we're
having
,
you
know
,
continued
pain
.
So
,
yeah
,
I
was
really
drawn
in
on
the
clinic
days
and
then
,
of
course
,
the
OR
days
was
almost
feeling
like
,
wow
,
I'm
like
back
on
my
GYN
oncology
rotations
,
you
know
,
in
terms
of
the
complexity
of
these
surgeries
and
just
how
elegantly
she
does
them
.
Except
that's
not
.
These
aren't
cancer
surgeries
,
these
are
benign
surgeries
and
you
know
,
in
many
ways
it
is
similar
,
right
,
with
cancer
you're
trying
to
get
it
all
out
and
with
endo
as
well
,
it
just
somehow
,
you
know
,
I
feel
like
there's
a
whole
other
discussion
too
.
Speaker 2
9:11
But
cancer
,
you
know
,
in
terms
of
the
training
programs
,
is
just
a
much
more
established
world
than
endometriosis
training
.
So
,
to
make
a
long
story
short
,
I
went
home
and
told
my
partner
and
now
my
husband
,
but
I
felt
like
this
is
what
I
needed
to
do
next
.
And
then
,
within
a
few
months
,
we
moved
up
to
the
,
from
sunny
New
Mexico
to
rainy
Washington
and
I
know
,
six
months
into
my
fellowship
at
Pacific
Endometriosis
and
public
surgery
with
Dr
Mossbroker
and
yeah
,
learning
a
lot
and
do
you
ever
sit
back
and
look
back
at
where
you
started
out
as
an
OBGYN
and
the
stories
that
you
would
hear
from
patients
and
knowing
now
what
you
know
?
Speaker 1
9:57
looking
back
and
saying
I
wonder
if
that
patient
had
endo
,
I
wish
I
would
have
been
able
to
refer
this
patient
out
or
help
this
patient
more
.
What
has
that
looked
like
from
that
transition
?
Speaker 2
10:11
I
think
you
know
,
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
them
,
you
know
,
the
ones
who
maybe
don't
follow
the
classic
story
that
I
,
you
know
.
I
look
back
and
wonder
about
,
you
know
,
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
Mossbroker
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
,
huh
,
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
.
You
know
she
should
be
seen
for
a
workup
,
for
IVS
or
brain
or
social
cystitis
and
not
kind
of
have
put
the
you
know
the
more
subtle
things
together
.
Speaker 2
11:19
Yeah
,
I
do
,
and
I
think
about
,
you
know
,
the
patients
that
I
had
where
I
did
ablation
of
endometriosis
or
,
honestly
,
even
the
ones
you
know
.
I
can
think
of
one
case
where
I
was
planning
to
do
a
laparoscopicis
directory
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 2
12:03
I
think
had
her
ovary
taken
out
as
well
.
I
think
oncology
ended
up
doing
the
case
and
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 2
12:26
Yeah
,
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
as
a
physician
you
learn
first
do
no
harm
.
You
know
I
didn't
go
into
a
surgery
that
I
thought
was
above
my
skill
set
.
It's
sad
to
think
that
even
with
referring
her
on
,
you
know
she
may
not
have
had
the
most
optimal
surgery
.
Speaker 1
12:48
Yeah
,
and
that
brings
us
to
the
other
point
,
too
,
of
what
you're
learning
in
med
school
and
even
in
your
continuing
education
as
far
as
endometriosis
is
concerned
,
because
you
probably
hadn't
heard
much
about
endometriosis
beyond
just
what
text
was
given
to
you
or
what
little
pieces
you've
been
given
in
medical
school
.
Was
that
the
case
for
you
?
Speaker 2
13:10
I
mean
I
spent
a
lot
of
time
thinking
about
what
exactly
did
I
learn
during
the
med
school
and
residence
.
Yeah
,
I
mean
certainly
medical
school
.
I
mean
there
are
so
many
areas
that
are
covered
that
nothing
really
gets
more
than
like
half
day
or
a
day
,
other
than
probably
the
heart
and
the
lungs
.
I
remember
there
being
a
lot
of
emphasis
on
hormonal
treatment
of
endometriosis
,
so
it's
maybe
not
surprising
that
the
med
school
teaching
on
endometriosis
wasn't
that
thorough
.
But
I
remember
in
residency
,
I
honestly
think
I
mean
I
started
residency
in
2009,
.
Finished
in
2013
.
Advancements in Endometriosis Treatment
Speaker 2
13:45
I
think
even
then
,
like
excision
was
really
just
starting
to
be
kind
of
more
commonly
done
.
You
know
I
would
recall
of
endometriosis
cases
was
ablation
of
,
like
you
know
,
the
stage
one
in
two
cases
,
and
then
I
remember
being
involved
with
the
more
complex
like
stage
three
or
four
cases
,
but
usually
it
was
that
the
oncologists
were
getting
called
in
because
it
was
a
frozen
pelvis
or
it
was
.
You
know
some
of
the
MIG
surgeons
were
doing
you
know
the
more
complex
dissections
where
bowel
was
scarred
to
the
bladder
and
you
know
I
remember
long
,
long
surgeries
.
But
I
don't
really
remember
being
taught
about
excision
as
like
a
con
concept
.
I
think
you
know
we
were
taught
you
should
take
a
biopsy
for
conformation
,
but
the
idea
of
really
trying
to
remove
all
visible
endometriosis
like
is
not
something
that
I
recall
being
taught
as
a
resident
.
Speaker 1
14:41
Yeah
.
Speaker 2
14:41
And
so
we're
on
.
Yeah
,
the
hormonal
treatment
,
the
teaching
that
it
should
get
resolved
once
you
go
through
menopause
and
you
know
again
the
idea
that
the
ovaries
are
removed
.
You
know
that
there's
no
longer
the
driver
of
endometriosis
.
Speaker 1
14:56
Yeah
,
which
I
think
too
.
Speaker 1
14:57
I
mean
,
I
think
,
to
put
this
in
perspective
for
everyone
that's
listening
who
has
gone
through
the
doctors
,
like
myself
,
you
know
I
had
a
great
doctor
but
again
,
she
had
that
same
training
to
do
the
ablation
,
she
had
the
same
education
as
taking
the
ovaries
out
and
doing
hormonal
suppressions
and
things
like
that
,
and
I
don't
think
she
came
at
it
from
a
malicious
standpoint
or
she
had
to
be
right
standpoint
.
Speaker 1
15:27
It
was
she
really
truly
thought
she
was
doing
the
best
she
absolutely
could
for
me
and
she
felt
like
she
was
adequate
in
her
knowledge
of
endometriosis
and
her
skill
set
in
endometriosis
surgeries
.
Speaker 1
15:39
So
,
even
though
and
I
think
that
we
talk
a
lot
about
the
medical
trauma
that
we've
faced
and
certainly
this
is
not
to
bunch
every
doctor
into
that
category
,
but
by
and
large
I
would
say
most
OBGYNs
are
doing
their
absolute
best
with
what
they've
been
given
,
and
I
think
it's
just
as
a
testament
to
you
going
in
an
area
that
really
healthcare
is
hard
to
come
by
and
maybe
isn't
always
the
best
in
general
,
because
they're
.
Speaker 1
16:11
It's
not
,
it's
not
going
to
be
your
high
paying
market
,
you
know
.
It's
a
different
,
it's
a
different
area
,
it's
a
different
way
of
living
,
and
so
I
think
you
did
something
that
was
so
impactful
and
you
stuck
in
there
.
So
I
know
just
from
talking
to
you
that
you
truly
care
about
your
patients
,
so
you
would
never
want
to
lead
a
mustray
or
hurt
them
.
Or
you
know
,
and
I
and
I
want
to
emphasize
that
for
those
who
have
been
through
that
medical
trauma
too
yes
,
not
every
doctor's
the
same
,
but
most
of
them-
want
to
do
the
best
for
you
,
and
the
limitations
,
too
,
are
the
system
,
when
I
think
that
you
know
the
average
appointment
length
is
15
minutes
.
Speaker 2
16:49
That
doesn't
really
give
the
time
to
sometimes
dig
into
,
you
know
,
all
of
the
symptoms
or
even
,
you
know
,
do
very
thorough
assessment
,
like
that's
one
of
the
luxuries
that
I
,
you
know
I
do
have
.
Now
we
have
45
minutes
to
an
hour
with
every
new
patient
and
you
can
dig
into
things
a
little
more
deeply
.
And
yeah
,
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
or
four
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
17:49
What
are
some
of
the
things
that
you
have
really
learned
doing
this
fellowship
that
maybe
we're
shocking
,
but
more
like
wow
,
this
is
blowing
my
mind
on
this
information
,
you
know
,
because
I
certainly
have
learned
a
lot
and
I'm
obviously
not
in
a
fellowship
,
I'm
just
,
you
know
,
a
host
for
a
podcast
,
but
I've
learned
so
much
.
I
can
only
assume
that
you
have
had
that
same
experience
of
like
wow
,
this
,
I
had
no
idea
.
What
are
some
of
those
things
that
have
been
just
shocking
to
you
or
enlightening
?
Speaker 2
18:21
One
thing
that
I
feel
like
again
wasn't
on
my
radar
as
much
and
I
you
spent
a
lot
of
time
thinking
back
to
it
,
was
like
,
did
I
just
not
know
that
or
was
that
a
just
general
gap
in
knowledge
?
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
.
Advances in Adenomyosis Diagnosis
Speaker 2
19:13
Ultrasound
is
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
an
ametriosis
.
You
know
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
to
look
at
those
static
images
and
then
a
couple
of
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
was
maybe
a
physiologic
system
on
the
ovary
,
or
you
know
essentially
that
it
was
unremarkable
.
Speaker 1
20:07
Right
.
Speaker 2
20:08
And
now
you
know
,
with
every
consult
that
I'm
doing
with
Dr
Mossbrokker
,
we
do
have
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 2
20:20
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
is
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
you
know
.
I've
been
doing
ultrasound
for
years
but
never
really
thought
of
it
as
a
way
to
look
for
some
of
the
markers
of
adenomyosis
.
You
know
if
everything
is
stuck
together
or
if
patients
have
pain
when
you're
pushing
on
the
uterus
?
Speaker 2
20:49
sacral
ligaments
you
know
,
it
really
is
almost
an
extension
of
the
exam
.
That
is
really
pretty
,
you
know
,
simple
and
can
just
really
help
or
make
you
more
suspicious
that
the
underlying
issue
could
be
adenomyosis
,
as
opposed
to
just
saying
,
oh
,
that
one
,
you
know
,
came
back
unremarkable
,
you
know
we
don't
know
why
you're
having
this
pain
.
Speaker 1
21:08
Yeah
,
and
I
think
that's
true
.
I
mean
,
that's
more
and
more
a
conversation
that
we've
been
having
within
the
adenomyosis
community
.
Is
imaging
right
?
Because
you
know
,
we've
been
taught
for
many
years
the
only
way
that
you
can
truly
identify
adenomyosis
is
through
a
laparoscopic
surgery
and
to
100%
diagnosed
,
yes
,
that's
still
the
case
.
However
,
imaging
is
doing
a
great
job
now
with
giving
doctors
a
roadmap
,
but
a
lot
of
times
,
if
you
just
order
the
images
and
let
someone
else
read
them
,
you're
not
seeing
the
roadmap
,
you're
letting
someone
else
draw
it
out
for
you
,
and
I
think
that
that
has
been
a
conversation
that's
really
starting
to
take
hold
within
the
last
couple
years
probably
.
But
I
think
maybe
that
is
a
good
differentiating
factor
between
a
specialist
and
kind
of
for
lack
of
a
better
word
but
a
generalist
,
because
even
though
OBGYNs
are
still
specialties
within
what
they're
doing
,
they're
still
not
a
specialist
in
GYN
,
and
so
I
think
that
is
another
thing
to
consider
when
people
are
looking
to
find
treatment
for
this
.
Speaker 2
22:16
So
I
think
having
that
ultrasound
in
connection
with
you
know
,
a
thorough
history
and
exam
,
yeah
,
I've
.
Also
.
In
terms
of
the
things
you're
asking
about
,
things
I've
learned
or
been
surprised
about
,
you
know
,
I
don't
feel
like
I
learned
very
much
about
,
like
pelvic
floor
dysfunction
and
you
know
,
incorporating
that
into
every
exam
I
do
and
just
the
number
of
patients
that
are
not
only
dealing
with
endometriosis
but
the
pelvic
floor
spasm
or
who
have
symptoms
of
interstitial
cystitis
,
like
they're
so
often
all
tied
together
.
Speaker 1
22:46
Which
is
what
yeah
?
Speaker 2
22:47
Which
is
not
new
news
to
you
,
but
yeah
.
Speaker 1
22:50
But
it
would
be
.
I
mean
,
I
wouldn't
have
known
that
in
my
journey
,
you
know
,
and
I
kind
of
correlate
your
journey
to
a
lot
of
us
who
have
gone
through
this
,
because
we've
all
started
really
in
the
same
place
,
right
you
on
the
doctor's
side
,
us
on
the
patient
side
but
we're
walking
through
it
and
learning
more
and
becoming
better
advocates
for
those
with
endometriosis
because
of
our
lived
experiences
,
because
of
what
drives
us
right
.
So
I
think
the
value
in
us
doing
this
together
and
what
you're
learning
I'm
right
there
with
you
for
a
lot
of
it
.
So
it's
kind
of
fun
I'm
really
.
That's
why
I
wanted
to
talk
to
you
,
because
I
was
like
,
wow
,
this
really
feels
like
you're
walking
with
me
on
this
stuff
too
and
learning
with
me
.
Speaker 2
23:33
Yeah
,
I'd
say
like
the
part
yeah
,
that
the
end
of
the
day
leaves
me
so
sad
.
On
many
days
it's
just
how
many
doctors
patients
have
already
seen
and
you
know
how
long
it's
been
until
they
get
that
you
know
appointment
where
they
feel
like
someone
is
kind
of
putting
it
all
together
.
Speaker 2
23:49
Or
you
know
then
they
have
the
surgery
,
which
then
the
large
majority
of
the
time
kind
of
shows
what
we
were
suspecting
,
and
I
can't
tell
you
how
many
times
there's
patients
in
tears
at
their
consults
,
just
feeling
like
they're
finally
validated
,
and
as
a
patient
who
has
felt
that
way
.
Speaker 1
24:05
again
,
I
don't
blame
my
doctor
for
not
knowing
what
she
didn't
know
.
It's
just
not
well
known
outside
of
the
specialty
,
really
.
But
I'm
excited
to
see
where
you're
going
with
this
.
So
you
are
doing
a
fellowship
now
.
Can
you
explain
what
a
fellowship
is
?
Because
I
think
that
a
lot
of
us
hear
about
excision
specialists
and
they
hear
about
these
specialists
,
but
there's
a
step
to
getting
to
that
point
of
being
a
specialist
and
that's
the
fellowship
.
Can
you
explain
what
the
fellowship
is
and
what
the
different
kind
of
fellowships
there
are
?
Speaker 2
24:37
I
guess
to
start
very
basically
,
you
know
there's
four
years
of
OBGYN
residency
that
all
OBGYNs
do
,
and
then
afterwards
there's
the
option
to
do
a
fellowship
.
There
are
certain
fellowships
that
are
like
ACGME
,
approved
fellowships
.
Specialized Fellowships in Gynecology
Speaker 2
24:52
So
for
instance
,
high
risk
obstetrics
,
that's
called
an
MFM
fellowship
,
infertility
,
called
REI
,
reproductive
anachronology
and
infertility
,
and
then
neurogyne
and
MIGs
minimally
invasive
GYN
surgery
is
the
other
one
that
some
of
your
listeners
may
have
heard
of
and
that
there
are
MIGs
fellowships
through
AGL
and
through
SLS
and
essentially
it's
typically
two
years
of
additional
training
and
with
MIGs
it's
usually
pretty
broad
.
It's
all
of
the
more
complex
parts
of
GYN
surgery
,
fibroids
and
ametriosis
,
and
it's
interesting
because
MIGs
it's
really
,
you
know
,
minimally
invasive
GYN
surgery
is
talking
more
about
,
in
a
way
,
the
approach
,
laparoscopic
and
robotic
,
versus
,
you
know
,
with
high
risk
OB
or
with
infertility
.
It's
more
the
subject
matter
,
but
I
would
say
overall
with
MIGs
it
tends
to
be
again
an
ametriosis
,
fibroids
,
all
of
the
things
that
make
GYN
surgeries
more
complex
.
And
so
you
know
,
migs
is
not
a
fellowship
through
gosh
I'm
going
to
mix
up
my
acronyms
through
KBug
that
,
like
MFM
and
REI
are
,
though
I'm
guessing
in
the
next
few
years
it
may
be
going
that
route
as
well
and
a
lot
of
the
people
who
are
,
you
know
,
experts
in
their
fields
now
did
more
informal
fellowships
in
the
past
,
like
,
for
instance
,
dr
Mossbrook
,
who
I'm
working
with
now
,
did
a
fellowship
with
Dr
Redwine
.
Speaker 2
26:13
You
know
,
in
the
past
people
really
did
fellowships
more
informally
and
now
they're
getting
more
formalized
.
Speaker 2
26:19
So
what
I'm
doing
is
two
years
working
with
Dr
Mossbrook
,
both
in
the
clinic
and
the
OR
and
essentially
,
you
know
,
learning
from
her
expertise
and
her
skill
set
.
It's
a
little
different
than
people
who
are
doing
a
fellowship
like
MIGs
,
where
it
may
be
kind
of
a
broader
scope
in
terms
of
laparoscopy
and
robotic
surgery
,
fibroids
,
ametriosis
.
This
with
Dr
Mossbrook
is
really
focused
specifically
on
endometriosis
.
So
I
think
the
word
fellow
,
depending
on
you
know
a
person's
specific
background
they
may
have
done
a
fellowship
with
a
specific
physician
or
,
you
know
,
nowadays
fellowship
could
mean
again
doing
a
AGL
MIGs
fellowship
where
you're
at
typically
at
an
academic
center
.
And
again
,
I
think
it
really
varies
,
some
MIGs
fellowships
having
more
emphasis
on
endometriosis
and
others
having
less
emphasis
on
endometriosis
,
just
depending
on
who
the
faculty
are
.
And
I
think
in
general
,
you
know
,
for
patients
,
someone
who
is
MIG-strained
means
they're
generally
focusing
on
the
GYN
portion
only
and
not
the
obstetric
side
.
So
someone
who's
MIG-strained
is
going
to
be
better
at
approaching
endometriosis
surgeries
,
but
it
doesn't
necessarily
mean
that
they
,
for
instance
,
are
an
excision
expert
.
Speaker 1
27:41
I
think
it's
important
to
note
,
too
,
that
just
because
they've
done
a
MIGs
program
doesn't
make
them
a
specialist
in
endometriosis
.
Speaker 2
27:50
Yeah
,
I
mean
,
I
guess
the
word
specialist
it's
so
hard
Like
what
defines
a
specialist
?
Yeah
,
it's
hard
.
Certainly
Dr
Mossbrook
is
an
endometriosis
specialist
.
I
think
again
,
people
who
have
done
a
MIGs
fellowship
certainly
have
a
lot
more
endometriosis
training
than
someone
who
did
general
OB-GYN
residency
.
But
I
think
there's
just
a
lot
of
variation
,
you
know
,
from
program
to
program
and
in
a
way
,
you
know
,
I
think
about
my
fellowship
with
Dr
Mossbrook
or
it's
almost
like
an
apprenticeship
you're
learning
,
in
this
case
from
a
specific
physician
and
in
this
case
it
is
very
,
I
would
say
,
disease-focused
with
endometriosis
.
And
in
other
programs
,
again
with
MIGs
,
if
you
think
about
even
the
title
Minimally
Invasive
GYN
Surgery
the
focus
is
on
laparoscopic
and
robotic
approaches
,
again
generally
to
complex
GYN
problems
Exploring Endometriosis
Speaker 2
28:43
.
Speaker 1
28:43
Yeah
,
what
was
I
mean
?
I
know
that
you
wanted
to
do
the
surgical
side
of
things
more
,
but
what
was
it
that
pulled
you
more
into
the
endometriosis
side
of
doing
a
fellowship
?
Speaker 2
28:56
Yeah
,
it's
interesting
,
I
was
thinking
about
this
this
morning
like
,
in
a
way
,
it
was
really
the
surgery
part
,
you
know
,
that
I
was
looking
for
and
that
I
knew
was
,
you
know
,
an
area
that
I
felt
like
I
wanted
more
,
you
know
,
to
advance
or
to
refine
.
But
it
was
really
kind
of
everything
else
that
drew
me
in
in
the
sense
of
,
you
know
,
even
going
back
to
what
I
said
early
on
,
you
know
,
being
on
my
surgery
,
rotations
and
like
plastic
surgery
and
ENT
,
and
feeling
like
I
love
the
,
you
know
,
the
anatomy
part
of
it
,
but
felt
like
it
wasn't
my
people
.
I
feel
like
in
this
endometriosis
world
,
like
they're
really
you
have
to
kind
of
consider
the
whole
,
the
whole
body
,
and
be
a
little
more
holistic
about
the
approach
,
and
I
think
that's
always
,
you
know
,
been
an
interest
of
mine
.
And
there
is
also
this
continuity
with
patients
too
,
like
through
their
journey
,
and
so
for
me
,
yeah
,
it
really
is
this
just
unique
meld
of
kind
of
everything
that
I
feel
like
I've
been
interested
in
and
been
good
at
kind
of
coming
together
in
one
disease
.
Speaker 2
29:59
And
it's
funny
because
I
always
,
you
know
,
thought
of
myself
initially
just
,
you
know
,
having
this
kind
of
broad
approach
.
I
would
have
never
thought
that
I
would
,
at
the
end
of
the
day
,
want
to
have
,
you
know
,
focus
on
just
one
disease
.
But
I
feel
like
,
with
endometriosis
,
you're
bringing
so
many
different
things
together
and
also
,
again
,
it's
like
,
if
you
think
of
one
in
10
women
having
endometriosis
,
that
is
a
large
subset
of
women
,
and
so
we
do
need
more
people
who
are
focusing
on
this
.
But
yeah
,
I
think
it's
just
been
really
interesting
how
I
wasn't
it's
almost
like
I
wasn't
seeking
endometriosis
out
,
but
it
kind
of
sound
me
,
you
know
.
Speaker 1
30:40
Yeah
,
I
feel
like
that's
true
with
a
lot
of
doctors
who
have
done
that
and
they've
,
you
know
,
talked
about
it
.
Speaker 1
30:45
It's
just
the
intrigue
of
it
and
the
whole
body
approach
to
it
and
really
seeing
how
unjustly
it
was
treated
within
the
healthcare
system
and
I
think
that's
been
probably
one
of
the
most
shocking
things
for
a
lot
of
doctors
who
get
into
it
is
just
,
you
know
,
not
only
from
the
excision
standpoint
but
as
being
recognized
as
something
that
is
more
harmful
than
just
a
painful
period
and
seeing
the
effects
that
it
has
on
the
patients
and
how
it's
treated
when
it
comes
to
medical
billing
and
how
it's
treated
when
it
comes
to
people
calling
you
crazy
because
of
the
pain
you
know
and
not
recognizing
that
it's
such
a
big
pain
,
contributor
to
different
parts
of
your
body
beyond
just
your
uterus
or
ovaries
.
And
I
think
the
fact
that
you've
done
this
and
you've
seen
two
different
sides
of
the
coin
,
so
to
speak
you've
seen
it
with
the
more
marginalized
community
,
as
an
OB-GYN
,
and
now
you're
seeing
it
as
a
fellow
in
endometriosis
Just
the
healthcare
discrepancies
in
women's
health
is
large
discrepancy
.
Speaker 2
31:59
I
don't
know
how
else
to
say
that
.
Yeah
,
I
mean
,
I
think
that's
the
other
part
.
You
know
,
in
a
way
that
has
been
hard
,
like
I
you
know
,
as
I
was
saying
,
as
far
back
as
residency
was
really
interested
in
working
in
an
underserved
area
.
The
first
what
?
Almost
10
years
of
my
life
I
worked
at
a
Navajo
Reservation
Hospital
and
so
really
was
taking
care
of
patients
I
mean
again
,
not
all
,
but
for
the
most
part
with
much
fewer
resources
.
And
now
I'm
sort
of
at
the
other
end
of
the
spectrum
,
working
in
a
practice
that
is
out
of
network
,
with
insurance
and
just
very
different
patient
population
,
and
in
some
ways
that
has
been
hard
.
Speaker 2
32:35
I
come
back
to
the
fact
that
for
these
two
years
I
really
am
learning
how
to
do
these
surgeries
well
and
how
to
take
care
of
patients
with
endometriosis
well
.
Speaker 2
32:45
And
then
I
think
you
know
,
the
next
battle
that
I
feel
like
I
want
to
put
my
energy
into
is
,
yeah
,
how
do
we
make
this
more
accessible
for
the
average
patient
and
make
it
so
that
you
know
,
right
now
I
feel
like
a
lot
of
the
patients
that
I'm
seeing
have
in
a
way
,
found
us
,
like
they
have
come
from
sites
like
Nancy's
Nook
,
or
their
physical
therapist
suggested
that
they
may
have
that
dough
and
come
to
us
.
Speaker 2
33:10
But
I
think
back
to
,
you
know
,
the
patients
that
I
was
taking
care
of
and
my
prior
practice
setting
and
you
know
they
were
really
relying
on
what
the
what
the
GYN
was
telling
them
in
the
in
the
office
and
I
think
,
like
,
how
do
we
get
to
that
point
that
patients
are
getting
the
info
and
the
diagnosis
from
the
person
they're
seeing
,
you
know
,
for
their
appointment
and
don't
need
to
come
to
it
from
this
you
know
roundabout
way
?
Speaker 2
33:36
I
mean
,
I
think
it's
amazing
all
the
advocacy
that
patients
are
doing
for
other
patients
and
trying
to
get
the
word
out
,
but
in
the
long
run
,
yeah
,
I
just
feel
like
there
are
so
many
,
so
many
battles
still
to
be
fought
,
you
know
,
or
how
can
we
get
to
the
place
where
insurance
reimburses
these
procedures
appropriately
and
sees
,
you
know
,
not
only
that
they're
effective
for
the
patient
,
but
I
can't
imagine
that
it's
not
cost
effective
to
do
the
you
know
surgery
the
right
way
the
first
time
,
as
opposed
to
having
,
what
do
they
say
,
the
average
patient
it's
seven
years
or
eight
years
until
they
get
the
diagnosis
and
if
you
think
that
during
that
time
,
you
know
,
the
average
patient
has
seen
so
many
different
providers
,
perhaps
like
had
one
or
two
surgeries
.
You
know
,
it
just
seems
to
me
like
it
has
to
be
cost
effective
to
do
the
right
thing
first
.
And
you
know
how
do
we
get
to
that
place
with
the
insurance
companies
and
yeah
,
I
mean
I'm
going
to
focus
on
surgeries
,
but
yeah
,
all
of
those
other
battles
I
feel
like
are
the
other
driver
.
Speaker 1
34:41
Were
you
aware
of
that
?
Going
into
the
fellowship
of
just
?
Speaker 2
34:44
how
I
was
like
when
I
was
at
the
AA
GL
conference
.
I
remember
my
residency
colleague
tell
me
that
,
yeah
,
the
Jardee
of
Excision
Surgeons
being
out
of
network
,
and
I
think
you
know
,
coming
from
a
very
low
resource
place
,
I
would
admit
my
first
like
reaction
to
that
was
like
well
,
that's
not
,
that's
not
right
,
or
you
know
how
can
that
be
?
I
think
I
had
a
very
limited
understanding
of
you
know
why
it
is
that
they're
out
of
network
and
now
I
understand
that
much
better
and
realize
how
complicated
the
issue
is
.
You
know
,
in
terms
of
you
know
if
an
insurance
company
reimburses
the
same
way
for
a
ablation
as
for
a
long
,
complex
surgery
.
You
know
,
obviously
that
is
part
of
the
issue
and
I
was
,
I
would
say
,
more
peripherally
aware
of
the
issue
and
I
think
I
had
my
biases
about
sort
of
being
out
of
network
Improving Endometriosis Care and Education
Speaker 2
35:36
.
Now
understand
that
better
and
,
of
course
,
hope
that
we
get
to
a
place
where
this
is
something
that
every
patient
has
access
to
.
Speaker 1
35:44
Yeah
,
absolutely
,
and
I
think
when
you
have
a
heart
for
the
communities
that
are
underserved
and
you
want
to
be
able
to
help
those
patients
who
can't
pay
out
a
pocket
,
you
know
,
I
think
that's
always
got
to
be
kind
of
on
your
mind
.
I
know
,
for
me
as
a
patient
,
it's
always
on
my
mind
Well
,
is
insurance
going
to
cover
this
?
Is
am
I
going
to
be
able
to
see
the
person
that
I
want
it
or
that
I
need
to
see
?
It's
not
even
I
want
to
see
,
it's
that
I
kind
of
need
to
see
to
get
the
proper
care
right
.
That's
a
challenge
and
that's
what
I
think
sometimes
can
add
to
the
trauma
of
the
medical
trauma
.
Right
,
so
it's
not
always
necessarily
that
it's
the
doctors
that
are
doing
these
things
and
the
patients
have
bad
outcomes
.
It's
really
that
the
medical
system
isn't
set
up
for
the
patient
to
have
long
term
quality
of
life
and
that's
a
little
frustrating
from
the
patient
standpoint
and
the
doctor
standpoint
and
it's
a
complex
thing
that
we
don't
have
enough
time
to
talk
about
,
right
?
I
?
Speaker 2
36:40
think
it
has
to
come
from
both
ends
,
in
terms
of
patient
advocacy
and
then
positions
,
to
change
the
current
system
.
Yeah
absolutely
,
there's
more
education
during
residency
,
making
sure
that
even
some
of
the
ongoing
maintenance
of
certification
involves
more
education
about
endometriosis
.
And
then
,
yeah
,
unfortunately
I
don't
think
without
addressing
the
reimbursement
side
of
it
,
the
issue
will
get
solved
.
Speaker 1
37:10
Yeah
,
was
it
?
I
think
this
is
an
interesting
thing
to
think
about
.
Were
you
aware
of
the
one
in
10
number
prior
to
doing
your
fellowship
?
Speaker 2
37:20
No
,
no
Interesting
.
I
knew
it
was
relatively
common
,
but
I
feel
like
that's
a
statistic
that
I
more
recently
learned
.
Speaker 1
37:29
Was
that
a
shock
to
you
,
or
was
it
?
Oh
,
that
aligns
,
that
checks
out
.
Speaker 2
37:36
Of
course
,
now
,
since
I'm
primarily
seeing
patients
with
endometriosis
,
it
seems
like
it
should
be
even
higher
,
but
I
think
it
does
make
sense
.
Speaker 1
37:46
Yeah
,
I
think
that's
something
that
we
,
as
people
who
have
been
in
the
endometriosis
community
,
oftentimes
forget
is
just
how
many
doctors
don't
have
the
knowledge
of
endometriosis
,
because
it's
not
the
first
thing
that
would
pop
into
someone's
head
if
they're
not
infiltrated
with
it
,
right
,
like
you
said
,
irritable
bowel
syndrome
and
other
things
that
could
contribute
to
pain
factors
,
urination
issues
,
whatever
To
think
one
in
10
,
you're
not
thinking
oh
,
that's
this
patient
.
They
just
don't
know
.
That's
unfortunate
and
something
that
I
hope
that
we
can
get
better
at
.
Speaker 2
38:22
We've
decided
that
a
system
or
an
issue
with
our
medical
system
as
a
whole
,
right
,
you
kind
of
get
referred
from
one
specialist
to
see
another
specialist
and
they
refer
on
and
it's
like
who
is
the
person
putting
it
all
together
?
So
I
think
,
yeah
,
even
separate
from
GYNs
needing
more
knowledge
about
endometriosis
,
it's
probably
also
family
practice
doctors
and
therapists
and
it's
so
nuanced
,
isn't
it
?
Speaker 1
38:50
This
disease
is
just
a
very
tricky
disease
and
I
think
something
I
admire
about
what
you're
doing
is
that
you
took
yourself
out
of
a
I
don't
know
if
it
was
comfort
zone
of
knowing
what
you
knew
to
get
better
.
I
think
that's
promising
,
for
a
lot
of
us
who
have
dealt
with
this
disease
for
a
long
time
is
to
be
able
to
see
someone
say
I
want
to
get
better
at
my
skill
and
my
craft
and
I'm
going
to
step
out
of
that
comfort
zone
.
Do
you
think
more
and
more
doctors
are
going
to
start
doing
that
to
understand
their
patients
better
,
or
is
that
something
that's
not
really
that
common
?
Speaker 2
39:25
That's
a
good
question
.
I
mean
,
I
think
in
some
ways
it's
both
,
yeah
,
certainly
stepping
out
of
comfort
zone
in
the
sense
that
I
was
the
department
supervisor
and
now
I'm
going
back
to
a
learning
role
and
being
at
the
bottom
of
the
totem
pole
,
to
speak
.
But
I
think
in
other
ways
it
was
also
that
I
recognize
there
were
certainly
for
a
large
majority
of
GYN
surgeries
felt
very
comfortable
but
also
just
like
feeling
that
there
were
these
more
complex
cases
that
I
wanted
to
be
able
to
do
and
not
need
to
rely
on
referring
to
someone
else
.
So
in
a
way
it
was
almost
like
my
discomfort
with
that
that
drew
me
to
wanting
to
learn
more
.
Yeah
,
I
think
it's
complicated
.
Speaker 2
40:07
I
think
it's
also
complicated
by
the
fact
that
OB
and
GYN
are
tied
together
as
one
specialty
and
I
think
for
a
lot
of
general
OB
GYNs
the
bulk
of
their
practice
is
the
OB
side
.
Speaker 2
40:19
I
think
,
again
,
obstetrics
is
such
a
bulk
of
our
residency
training
and
then
just
the
logistics
of
the
average
OB
GYNs
practice
I
think
is
heavily
OB
and
so
I
think
everyone
ideally
would
like
to
further
their
surgical
skillset
.
But
it
is
hard
to
do
it
unless
you
and
I
mean
I
consider
myself
myself
lucky
that
I
was
able
to
say
okay
,
I'm
going
to
take
a
two-year
pause
or
I'm
going
to
go
back
to
learning
.
I
think
in
many
cases
it
may
not
be
an
option
for
people
.
There's
loans
to
pay
back
,
there's
family
responsibilities
or
you're
in
a
practice
where
that's
not
an
option
.
So
I
consider
myself
lucky
to
have
this
opportunity
and
a
supportive
partner
who
was
like
encouraging
me
to
go
back
and
learn
more
.
So
I
think
it's
one
of
those
things
where
probably
a
lot
of
physicians
would
like
to
do
something
similar
,
but
there's
also
the
reality
of
how
do
you
make
that
happen
when
you're
already
10
years
into
practice
.
Speaker 1
41:25
What's
something
that
you
wish
that
they
would
put
into
medical
school
and
residency
programs
that
you
think
would
help
just
the
general
GYN
be
able
to
identify
endometriosis
better
and
even
refer
out
appropriately
?
Speaker 2
41:40
Yeah
,
I
mean
,
I
think
in
a
way
medical
school
is
where
it
all
starts
,
and
I
think
if
more
people
can
become
aware
or
can
be
taught
that
endometriosis
isn't
just
pain
during
your
periods
and
people
see
it
as
more
of
a
multi-system
there
may
be
bladder
involvement
,
bowel
involvement
,
almost
IBS
.
Speaker 2
42:03
If
you're
considering
a
diagnosis
of
IBS
,
you
should
also
be
thinking
about
possible
endometriosis
.
I
think
if
that
can
be
incorporated
into
medical
training
,
that
would
probably
be
the
most
helpful
.
The
reality
is
,
I
don't
think
we
will
be
able
to
train
every
general
OBGYN
to
do
these
complex
cases
,
and
I
think
it
is
a
matter
of
recognizing
which
cases
need
to
be
referred
out
.
But
having
it
on
your
differential
when
it
should
be
is
probably
a
better
goal
.
And
then
the
other
,
I
guess
big
question
is
how
do
we
increase
the
number
of
people
who
are
doing
this
type
of
surgery
?
Because
I
think
if
once
there
is
more
awareness
,
there's
going
to
be
more
of
a
demand
for
excision
surgery
,
and
then
it's
not
like
you'll
be
able
to
create
the
excision
surgeons
overnight
preparing
for
that
as
well
.
I
think
it's
a
two-pronged
approach
,
like
creating
awareness
but
then
also
having
if
that's
going
to
create
more
demand
for
these
types
of
surgeries
and
then
also
having
more
GYN
physicians
who
are
able
to
do
them
.
Speaker 1
43:09
Yeah
,
you
give
us
hope
,
though
that's
what
I'm
saying
,
right
,
you
give
us
hope
.
Looking
at
your
future
.
What
are
you
excited
for
in
where
you're
going
with
your
fellowship
and
potential
practice
later
down
the
line
?
What
is
exciting
for
you
moving
forward
?
Speaker 2
43:28
Yeah
,
I
mean
,
I
think
again
,
right
now
,
one
of
the
things
that
is
really
the
most
exciting
is
sort
of
seeing
the
whole
process
through
getting
to
see
a
patient
in
clinic
and
doing
an
initial
consult
,
being
there
for
the
surgery
,
seeing
them
through
the
recovery
period
as
well
.
Speaker 2
43:46
Yeah
,
I
think
now
that's
one
of
the
things
that
is
really
them
and
it's
really
part
of
how
I'm
learning
to
right
.
Speaker 2
43:51
Thinking
back
to
what
were
the
symptoms
they
talked
about
during
the
consult
and
then
seeing
the
anatomy
at
the
time
of
surgery
I
think
is
one
of
the
best
ways
to
learn
is
to
have
that
continuity
.
Speaker 2
44:03
Yeah
,
and
then
,
yeah
,
I
mean
I
really
I
don't
know
exactly
where
I
will
be
when
this
fellowship
concludes
and
still
thinking
about
bigger
picture
questions
of
whether
I'll
be
able
to
make
this
entirely
my
focus
,
or
whether
I
will
be
a
GYN
physician
that
is
much
better
burst
in
endometriosis
and
doing
some
of
the
perhaps
simpler
endometriosis
cases
and
still
seeing
some
other
GYN
types
of
problems
,
or
being
able
to
be
like
Dr
Mass
Brooker
,
who
is
really
an
excision
expert
.
You
know
,
all
of
that
,
I
think
,
still
remains
to
be
seen
,
but
I'm
just
excited
to
learn
more
and
then
,
yeah
,
hopefully
at
some
point
in
the
future
,
be
able
to
collaborate
with
other
people
who
are
focusing
on
this
as
well
,
to
address
some
of
these
bigger
picture
issues
,
like
I'm
looking
forward
to
the
conference
in
April
that
I'll
be
going
to
in
Geneva
focusing
on
endometriosis
,
and
just
getting
to
talk
with
other
people
who
have
made
this
their
life's
focus
.
Speaker 1
45:07
Yeah
,
it's
always
exciting
and
inspiring
and
yeah
,
oh
,
it's
a
breath
of
fresh
air
to
hear
you
talk
about
it
and
just
your
journey
and
I
and
I
and
,
like
I
said
,
I
just
really
feel
like
you
are
on
this
journey
with
a
lot
of
us
.
It
feels
like
you're
right
there
with
us
from
the
other
perspective
,
and
I
think
that's
impactful
for
a
lot
of
people
to
understand
,
because
we
can
often
feel
like
the
doctors
don't
get
it
,
they
don't
understand
,
but
they
do
.
It's
just
from
a
different
standpoint
,
right
,
it's
from
a
different
perspective
.
And
so
to
see
it
from
this
perspective
and
to
see
someone
that
has
practiced
for
quite
some
time
to
be
able
to
step
back
and
and
learn
some
more
and
grow
some
more
in
their
skills
,
that
is
just
refreshing
for
a
lot
of
people
.
It
is
for
me
at
least
,
and
I
knew
that
when
Nancy
Peterson
said
you've
got
to
meet
this
gal
,
I
said
okay
,
nancy
,
I'll
meet
her
.
And
she
said
,
no
,
I
want
you
to
talk
to
her
.
I
said
,
okay
,
nancy
,
what
you
want
you
get
.
So
you
made
an
impact
.
Speaker 2
46:08
I
appreciate
it
.
I
had
a
chance
to
when
I
first
heard
about
the
podcast
.
I
got
to
listen
to
to
your
story
as
one
of
the
early
episodes
and
I
felt
like
you
were
so
thoughtful
when
you
were
talking
about
,
you
know
,
the
physician
you
had
initially
seen
.
When
you
talk
,
I
felt
like
you
even
sort
of
beat
yourselves
up
about
not
having
done
you
know
the
research
yourselves
about
endometriosis
.
You
know
,
in
the
sense
of
kind
of
those
early
decisions
and
,
yeah
,
I
just
appreciated
your
thoughtful
approach
to
that
Cause
in
many
ways
.
You
know
I
was
identifying
with
that
GYN
that
you
initially
saw
.
You
know
,
in
terms
of
the
,
the
steps
,
yeah
.
Speaker 2
46:46
And
the
through
.
So
,
yeah
,
I
appreciate
all
that
you're
doing
to
bring
more
information
to
other
patients
on
their
journey
and
I
appreciate
you
tying
me
in
Cause
.
Yes
,
I'm
on
a
similar
journey
myself
.
Speaker 1
46:58
Yeah
,
yeah
and
it's
.
It's
kind
of
just
kind
of
fun
to
see
that
journey
happen
.
I'm
excited
to
see
what
the
future
brings
for
you
.
I'm
excited
to
see
the
change
that
you
will
elicit
,
because
I
really
truly
feel
like
having
a
broad
picture
of
this
is
going
to
be
impactful
longterm
for
many
,
many
people
.
So
I'm
excited
.
Plus
,
you
really
have
a
just
a
sweetheart
for
those
patients
and
the
underserved
communities
and
the
ones
that
are
often
overlooked
.
So
thank
you
,
thank
you
for
doing
the
work
that
you're
doing
.
Speaker 2
47:32
Shout
again
when
I'm
closer
to
the
end
of
my
fellowship
,
but
I've
learned
a
few
more
things
along
the
way
.
Speaker 1
47:37
Oh
,
I'd
love
that
.
That
would
be
so
good
,
and
then
hopefully
,
we'll
get
to
meet
in
person
one
of
these
days
and
have
those
conversations
.
Well
,
thank
you
so
much
for
joining
me
today
and
sharing
your
story
and
your
heart
,
and
I'm
sure
that
people
will
be
able
to
resonate
with
us
.
So
thank
you
so
much
for
taking
the
time
.
Speaker 2
47:54
Thank
you
,
lana
,
oh
my
gosh
.
Speaker 1
47:56
You're
so
welcome
and
until
next
time
,
everyone
continue
advocating
for
you
and
for
those
that
you
love
.