Send us a text with a question or thought on this episode ( We cannot replay from this link)
Unveil the mysteries of endometriosis as it intersects with the rich tapestry of cultural diversity in my latest sit-down with Dr. Abhishek Mangeshikar from the Indian Center for Endometriosis. Dr. Mangeshikar, a giant in the world of excision surgery, shares his expertise on how environmental factors like diet impact this pervasive condition. Our conversation sheds light on the startling under diagnosis of endometriosis across the world. We explore the significance of traditional diets alongside the global variations in disease severity. This is an episode replete with insights that promise to broaden your understanding of endometriosis and its multifaceted global impact.
Imagine living with a condition that intertwines with your daily diet, causing an uproar in your digestive system. This reality is faced by many with bowel endometriosis, a topic I examined in-depth with Dr. Mangeshikar. We uncover why this variant of endometriosis eludes diagnosis and discuss the precision required in surgical treatments. The silver lining we reveal is the transformative relief patients often feel following successful excision surgery, which may alleviate the dietary sensitivities that have long plagued them. This episode is a beacon of hope, illuminating the path to mitigating the gastrointestinal havoc wreaked by this disease.
Wrapping up, our discussion takes a crucial turn towards the holistic approach needed in managing a patient’s journey through multicondition care. Dr. Mangeshikar and I tackle the hard truths about the persistence of symptoms post-surgery, such as chronic fatigue and bloating, and emphasize the importance of managing expectations. We also underscore the importance of patient advocacy and the tireless journey towards accurate diagnosis and comprehensive treatment. Every individual’s battle with endometriosis is unique, and this powerful conversation underscores the necessity of personalized care and the strength found in advocacy. Join us for part one of a profound exploration into the world of endometriosis care, where every story matters and every voice can spark change.
Website endobattery.com
Endometriosis and Cultural Diversity
Speaker 1
0:03
Welcome
to
EndoBattery
,
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
,
alana
,
and
this
is
EndoBattery
charging
our
lives
when
endometriosis
drains
us
.
Welcome
back
to
EndoBattery
,
grab
your
cup
of
coffee
or
your
cup
of
tea
and
join
me
at
the
table
.
I'm
joined
today
by
my
guest
,
dr
Abhishek
Mangeshkar
.
Speaker 1
0:52
Dr
Mangeshkar
is
a
renowned
excision
surgeon
and
advocate
for
accurate
endometriosis
awareness
.
As
the
founder
and
director
of
Indian
Center
for
Endometriosis
,
or
ICE
,
he
leads
efforts
to
dispel
myths
,
provide
factual
information
and
facilitate
discussions
on
treatment
options
.
With
extensive
training
in
laparoscopy
and
over
2,000
surgeries
to
his
credit
,
dr
Ming
specializes
in
treating
various
aspects
of
endometriosis
,
particularly
focusing
on
bowel
endometriosis
and
imaging
advancements
.
Committed
to
education
,
he
teaches
laparoscopic
gynecology
and
holds
esteemed
positions
on
gynecological
boards
.
Dr
Ming's
mission
,
through
ICE
,
is
to
revolutionize
endometriosis
care
in
India
,
advocating
for
timely
diagnosis
and
expert
treatment
.
Help
me
in
welcoming
Dr
Abhishek
.
Mangeshkar
.
Thank
you
,
dr
Ming's
,
for
joining
me
today
.
Today
is
going
to
be
an
episode
that
I've
not
really
done
before
,
and
this
is
something
that
I
have
wanted
to
talk
about
for
quite
some
time
,
so
this
is
going
to
be
completely
anecdotal
for
a
lot
of
this
,
but
thank
you
,
dr
Mengs
,
for
joining
me
on
this
fun
and
unique
episode
.
Speaker 2
2:01
Thank
you
,
Alana
,
for
having
me
.
It's
a
pleasure
,
as
always
,
and
we
just
spent
a
great
time
together
at
the
EndoSummit
and
this
is
following
up
to
that
,
and
this
is
going
to
be
a
different
podcast
from
even
what
I'm
used
to
,
because
it's
very
experiential
and
less
evidence
based
.
Speaker 1
2:17
Yes
,
which
is
something
that
this
is
we're
going
to
be
talking
about
how
or
what
we
see
the
difference
in
endometriosis
and
cultural
diversity
,
whether
it's
food
,
whether
it's
environment
.
I
mean
,
there's
a
lot
to
this
that
we
can
talk
about
,
but
this
is
something
that
I
have
wanted
to
talk
about
for
so
long
,
really
since
my
diagnosis
,
because
I
remember
and
this
is
why
this
is
so
fascinating
to
me
and
I
wanted
to
talk
about
it
,
and
you're
just
crazy
enough
to
talk
about
it
with
me
.
So
,
welcome
to
this
train
.
But
I
remember
my
doctor
telling
me
in
her
office
.
She
said
,
you
know
,
I
think
I
just
see
a
lot
of
endometriosis
patients
here
,
and
my
husband
and
I
were
like
,
okay
,
is
it
because
of
something
in
the
water
?
Is
it
because
of
our
diet
?
Speaker 1
3:07
Like
we
tend
to
be
here
in
Colorado
,
a
little
bit
more
granola
is
what
they
call
us
and
it's
,
you
know
,
a
lot
of
like
the
plant-based
eating
,
and
then
you
have
a
lot
of
,
you
know
,
organic
,
but
then
you
also
have
,
like
a
lot
of
different
processed
foods
that
aren't
necessarily
,
I
don't
want
to
say
whole
foods
,
but
kind
of
whole
foods
.
You
know
they
,
they
replace
foods
.
So
it
started
us
on
this
mindset
of
like
,
okay
is
this
?
Is
it
because
of
this
,
or
is
it
just
that
we're
not
noticing
endometriosis
?
The
same
,
or
is
it
?
Colorado
that's
different
?
The
environment
we
really
weren't
sure
.
But
you're
,
first
of
all
,
an
expert
excision
specialist
for
endometriosis
.
But
you've
also
traveled
the
world
.
You're
like
a
world
traveler
You're
always
traveling
.
Speaker 2
3:56
Not
by
choice
.
I
did
my
residency
in
India
in
OBGYN
and
it
was
very
interesting
that
you
brought
that
up
because
when
I
was
a
resident
because
my
father
is
a
famous
gynecologist
and
I
used
to
attend
a
lot
of
conferences
internationally
with
him
and
a
lot
of
the
Europeans
and
Americans
were
doing
very
radical
endometriosis
surgery
then
and
I
always
came
back
to
India
and
I
asked
the
question
I
was
like
why
aren't
we
picking
up
this
kind
of
disease
and
why
aren't
these
surgeries
happening
here
?
And
then
a
lot
of
the
so-called
specialists
at
that
time
were
saying
we
don't
have
this
kind
of
disease
that
is
so
invasive
into
the
bowel
,
into
the
nerves
,
because
Indian
diets
are
primarily
vegetarian
and
they're
primarily
whole
foods
,
so
there's
not
so
much
invasive
disease
in
the
bowel
,
which
was
complete
rubbish
.
They
were
just
missing
the
diagnosis
.
And
once
I
started
identifying
the
lesions
myself
after
my
fellowship
,
which
I
did
in
Taiwan
a
long
time
ago
so
I
spent
two
years
there
specializing
in
GYN
oncology
and
then
I
specialized
in
endometriosis
and
then
I
came
back
and
I
realized
that
a
lot
of
patients
were
being
underdiagnosed
or
misdiagnosed
and
a
lot
of
disease
that
was
deep
endometriosis
,
so
in
the
bowel
,
in
the
bladder
,
in
the
ureters
,
in
the
nerves
on
the
bladder
,
in
the
ureters
in
the
nerves
on
the
diaphragm
,
was
getting
missed
and
people
were
getting
more
focused
on
the
cysts
,
the
ovarian
endometriomas
.
Speaker 2
5:33
So
it
is
quite
prevalent
in
India
,
it
is
quite
prevalent
in
the
US
,
it's
very
prevalent
in
Africa
,
the
Middle
East
and
in
Asia
.
But
you
do
see
slight
variations
in
the
phenotypes
of
the
disease
the
more
you
get
exposed
to
different
patients
from
different
parts
of
the
world
,
because
India
is
quite
centrally
located
,
so
Asia
and
the
Middle
East
and
Australia
and
some
of
Europe
as
well
,
so
we
do
get
patients
from
all
across
these
continents
and
countries
.
So
I
do
see
certain
variations
in
pathologies
.
So
in
India
and
the
African
subcontinent
you
would
get
very
large
endometrial
cysts
and
very
severe
parametrial
disease
as
well
as
very
severe
uterine
disease
,
so
adenomyosis
,
fibroids
and
all
of
that
,
whereas
from
Western
patients
or
European
patients
or
even
Australian
patients
you
won't
get
such
big
cysts
but
you
will
get
deep
disease
,
bowel
disease
,
whether
it's
in
the
rectum
,
whether
it's
in
the
sigmoid
colon
,
in
the
diaphragm
,
in
the
small
bowel
.
So
you
see
those
phenotypes
in
those
patient
populations
.
Speaker 1
6:47
Interesting
.
Why
do
you
think
this
is
?
Is
it
just
the
food
,
or
do
you
really
think
it
is
the
location
?
Or
what
is
your
take
on
that
?
Speaker 2
6:58
We
do
know
that
endometriosis
has
definitely
got
a
genetic
component
to
it
,
so
there
is
a
gene
passed
down
.
But
whether
that
gene
expresses
itself
has
a
lot
to
do
with
epigenetics
and
probably
environmental
,
dietary
,
hormonal
.
You
know
,
stress
and
I
don't
mean
just
mental
stress
,
it
could
be
physiological
,
inflammatory
stress
that
causes
whether
the
disease
grows
,
how
it
expresses
itself
and
how
aggressively
it
can
grow
and
spread
.
That
determines
these
certain
phenotypes
of
disease
.
The
short
answer
is
we
don't
know
yet
.
There
should
be
a
lot
more
studies
going
on
about
this
,
but
it's
very
difficult
to
get
a
widespread
diaspora
,
multicultural
,
multidiverse
population
to
study
.
Speaker 1
7:52
Yeah
,
and
I
would
imagine
that
part
of
that
comes
down
to
access
to
care
too
,
because
I
know
in
different
parts
of
the
world
care
is
not
really
accessible
for
a
lot
of
people
,
so
I
think
it's
probably
hard
to
really
get
a
good
study
based
off
of
what
we
currently
have
Unless
I'm
wrong
about
that
,
but
that
would
be
my
take
on
that
too
is
like
care
is
not
accessible
for
a
lot
of
people
in
a
first
world
country
,
let
alone
a
third
world
country
.
Speaker 2
8:22
Actually
I
think
you
kind
of
nailed
it
or
you
hit
the
nail
on
the
head
because
from
what
I
said
is
when
you
would
see
more
advanced
disease
from
the
lesser
populations
or
the
lower
economy
populations
compared
to
the
US
or
Europe
or
Australia
,
where
they
would
get
early
primary
care
so
they
would
have
the
cysts
dealt
with
earlier
,
and
the
deeper
disease
,
which
is
more
complex
and
very
few
people
can
treat
,
that
kind
of
gets
left
behind
and
filtered
through
,
whereas
in
the
other
populations
,
like
India
,
the
Middle
East
,
africa
,
asia
,
they
would
not
have
such
early
access
to
care
or
there
would
be
delays
in
diagnosis
and
treatments
.
So
you
would
see
more
advanced
disease
in
those
cases
,
especially
when
it
had
to
do
with
cysts
in
the
ovaries
affecting
the
tubes
or
even
uterine
disease
.
That's
being
allowed
to
progress
because
of
the
inertia
of
the
medical
systems
in
those
countries
.
Speaker 1
9:19
Interesting
.
See
,
this
is
something
that
I
am
intrigued
by
even
more
because
when
I
was
going
through
my
diagnosis
process
in
treatment
,
initially
it
was
the
thought
process
of
if
you
eat
more
soy
,
you're
going
to
have
worse
endometriosis
.
And
that's
probably
not
the
case
,
although
it
can
be
inflammatory
for
some
people
,
which
would
then
maybe
progress
that
a
little
bit
more
symptomatically
.
Speaker 2
9:47
Yeah
.
So
soy
,
we
know
,
is
fight
the
estrogens
and
a
lot
of
the
disease
.
We
know
that
endometriosis
is
very
sensitive
to
estrogen
as
well
as
progesterone
,
but
it
doesn't
have
to
do
with
the
amount
of
circulating
estrogen
in
the
body
.
Have
to
do
with
the
amount
of
circulating
estrogen
in
the
body
.
It
depends
on
the
sensitivity
of
the
receptors
on
the
disease
to
the
estrogen
that's
already
present
.
So
we
know
that
endometriosis
can
synthesize
its
own
estrogen
and
also
,
depending
on
how
aggressive
the
disease
is
,
how
it
reacts
to
the
estrogen
which
would
cause
a
flare
up
and
that
is
going
to
kind
of
trigger
that
.
So
we
don't
have
very
conclusive
evidence
in
terms
of
dietary
changes
and
how
it
does
help
.
There
are
certain
studies
that
say
low
inflammatory
diets
and
low
FODMAP
and
all
of
that
,
but
the
evidence
is
far
from
conclusive
.
That
means
it
will
work
for
some
people
and
it
doesn't
work
for
some
people
.
So
it's
quite
anecdotal
evidence
at
best
.
Speaker 1
10:48
I
mean
I
think
a
lot
of
us
have
become
prey
at
one
point
or
another
to
if
we
want
to
become
less
symptomatic
,
or
if
you're
some
dieticians
,
you
can
cure
your
endo
with
certain
diet
and
certain
measures
that
you
can
take
to
or
supplements
that
you
can
take
to
cure
your
endo
.
But
what
I
think
more
endo
with
certain
diet
and
certain
measures
that
you
can
take
to
or
supplements
that
you
can
take
to
cure
your
endo
,
but
what
I
think
more
endo
patients
will
think
is
maybe
I
can
suppress
my
symptoms
if
I
change
my
diet
in
X
,
y
and
Z
way
.
And
although
I
think
that
there's
value
to
that
,
I
think
that
you
know
ultimately
,
if
you
eat
what
your
body
needs
and
what
it
can
process
overall
,
we're
all
going
to
feel
better
.
Right
,
like
this
isn't
endometriosis
specific
,
but
I
think
it
does
lend
to
the
point
that
just
because
you
change
your
diet
doesn't
necessarily
mean
that
you're
going
to
become
less
symptomatic
all
the
time
.
Speaker 2
11:37
Correct
.
It's
quite
Bowel Endometriosis and Food Sensitivities
Speaker 2
11:39
logical
.
When
you
look
at
bowel
endometriosis
,
for
example
,
if
you
have
disease
in
the
rectum
or
in
the
small
bowel
or
even
in
the
sigmoid
colon
,
there's
going
to
be
hyperstimulation
of
the
enteric
plexus
,
which
is
the
nervous
system
of
the
entire
GI
tract
.
So
for
someone
without
endometriosis
,
you
know
,
six
cups
of
coffee
a
day
will
cause
you
mild
heartburn
and
maybe
some
small
amount
of
bloating
.
But
in
an
endometriosis
patient
,
because
that
nervous
system
is
firing
,
you're
going
to
have
a
hyper
response
.
So
there
will
be
excessive
bloating
to
the
amount
of
discomfort
or
even
pain
,
and
so
there
are
certain
sensitivities
.
You
have
lactose
intolerance
that
is
exacerbated
because
of
the
presence
of
disease
.
Speaker 2
12:27
It
doesn't
even
necessarily
have
to
be
in
the
bowel
.
It
can
be
along
the
nerves
that
supply
the
bowel
.
So
your
hypogastric
plexus
and
the
pelvic
splenic
nerves
,
which
supply
the
rectum
and
the
bladder
,
function
as
well
.
So
you
have
these
hyper
responses
in
the
bowel
and
the
bladder
because
of
dietary
changes
as
well
.
Speaker 1
12:47
So
that's
an
exaggerated
response
to
a
normal
stimulus
yeah
,
oh
,
I
already
told
you
that
if
I
have
to
have
a
bowel
resection
,
you're
going
to
be
doing
it
.
Just
because
you
understand
that
,
so
well
,
I
understand
that
it's
.
It's
not
,
you
know
,
like
something
that
everyone
wants
to
,
but
you're
still
going
to
do
my
bowel
resection
if
I
ever
need
it
.
Speaker 2
13:09
I
said
if
you
need
it
,
it's
not
like
a
nose
job
where
you
can
elect
and
have
one
.
So
bowel
endometriosis
is
my
favorite
subject
.
Speaker 2
13:19
I
missed
my
calling
as
a
GI
surgeon
and
I
you
know
,
I
became
a
gynecologist
,
but
now
I
spend
more
time
operating
on
the
rectum
than
I
do
on
the
uterine
organs
.
And
it's
fascinating
because
this
is
this
is
even
with
endometriosis
.
This
is
the
only
disease
of
the
bowel
that
grows
from
outside
in
,
and
everything
that
GI
surgeons
are
used
to
grew
from
inside
out
.
So
colonoscopy
is
the
mainstay
of
diagnosis
and
it's
antithetical
to
an
endometriosis
diagnosis
.
So
colonoscopies
are
useless
and
anybody
who's
doing
a
colonoscopy
to
diagnose
bowel
endometriosis
that's
a
big
red
flag
.
Secondly
,
it
is
very
different
from
what
colorectal
surgeons
or
GI
surgeons
are
used
to
,
unless
they're
specifically
trained
for
endometriosis
.
What
they're
used
to
is
you
do
a
big
resection
of
the
bowel
what
they're
trained
to
do
for
cancer
and
you
remove
lymph
nodes
,
you
remove
blood
vessels
that
supply
the
bowel
and
they're
taught
to
do
prophylactic
colostomies
or
ileostomies
.
So
that's
where
you
loop
the
intestines
out
into
a
bag
for
these
receptions
.
Speaker 2
14:31
But
what
they
don't
understand
is
that
this
is
benign
disease
.
We
don't
need
to
take
out
the
lymph
nodes
.
We
can
keep
the
vasculature
intact
and
we
just
need
to
do
a
wide
excision
of
the
disease
.
So
we
don't
need
to
remove
a
foot
of
the
bowel
,
we
just
need
to
remove
exactly
above
and
below
the
disease
and
then
join
it
back
together
,
which
you're
usually
able
to
accomplish
without
any
tension
.
Speaker 2
14:55
And
our
patients
are
younger
and
they
have
better
quality
of
life
and
healthier
.
So
you
don't
have
to
do
a
stoma
.
So
the
risk
of
a
stoma
is
less
than
2%
if
it's
done
correctly
and
depending
on
the
type
of
nodules
.
So
we
never
do
prophylactic
stomas
.
We
don't
do
it
as
a
preventive
measure
.
Of
course
we
do
monitor
the
patients
and
2%
of
patients
may
have
complications
that
may
require
a
temporary
diversion
of
the
stoma
,
which
is
reversed
after
four
to
six
weeks
.
So
it's
never
permanent
and
we
have
to
even
spread
awareness
about
this
to
the
colorectal
surgeons
that
we
work
with
that
this
is
a
very
different
disease
from
what
you're
used
to
,
so
you
need
to
tailor
your
approach
toward
that
.
Speaker 1
15:41
Going
back
to
that
portion
of
it
again
.
This
is
why
you're
going
to
do
any
bowel
resection
that
I
may
end
up
having
in
the
future
,
if
I
ever
have
one
.
But
I
do
think
something
to
highlight
,
or
maybe
even
just
to
talk
about
,
is
that
a
lot
of
people
are
really
sensitive
to
foods
and
the
way
it
manifests
is
within
the
bowel
and
the
rectum
,
whether
that's
rectal
bleeding
,
whether
that's
inflammation
of
the
bowel
,
whether
that's
constipation
or
whatnot
.
In
your
experience
,
is
this
something
that
,
if
given
proper
treatment
,
can
be
eliminated
in
the
way
of
like
the
food
sensitivities
and
the
way
that
people
respond
,
or
is
that
kind
of
a
lifelong
thing
that
you're
noticing
people
have
even
after
proper
treatment
?
Speaker 2
16:27
That's
a
very
interesting
question
.
So
if
there
is
disease
in
the
bowel
and
somebody
has
food
sensitivities
,
then
removing
said
disease
most
of
the
time
will
eliminate
those
food
sensitivities
.
So
a
lot
of
patients
have
messaged
me
later
on
after
they
served
the
reason
and
said
oh
,
I
had
dairy
,
I
had
gluten
,
it
was
fantastic
and
I
had
no
pain
while
passing
stools
and
I
didn't
have
constipation
,
I
didn't
have
diarrhea
or
any
of
those
things
.
So
it
does
work
.
Managing Expectations in Multicondition Care
Speaker 2
16:58
By
removing
the
surgical
well
,
the
pathological
insult
to
the
bowel
,
by
removing
the
disease
,
that
the
pathological
insult
to
the
bowel
,
by
removing
the
disease
,
that
sorts
out
most
of
the
problems
.
Speaker 2
17:08
But
we
also
have
to
remember
that
this
has
been
around
for
a
long
time
so
that
nervous
system
of
the
GI
tract
has
kind
of
been
hypersensitized
so
it
does
take
some
time
to
downregulate
in
some
cases
.
So
you
know
,
when
it
comes
to
bloating
,
those
symptoms
are
usually
the
ones
in
my
experience
that
take
the
longest
to
dissipate
over
time
.
So
you
know
,
somebody
may
still
have
bloating
even
after
their
bowel
resection
but
it
does
kind
of
wean
down
and
resolve
over
some
time
,
kind
of
weaned
down
and
resolved
over
some
time
.
The
most
difficult
symptom
I've
had
,
facing
with
resolution
,
is
fatigue
,
chronic
fatigue
,
because
this
is
an
immune
response
in
a
way
where
,
because
the
disease
is
so
inflammatory
,
so
there's
always
this
hyperimmune
response
going
on
,
that
kind
of
depletes
energy
stores
for
some
level
.
Get
that
back
on
track
even
after
surgical
removal
and
reducing
inflammation
is
a
bit
of
a
task
.
So
I
think
there's
a
big
role
for
like
a
holistic
approach
for
that
with
physiotherapy
and
maybe
even
the
role
of
an
anti-inflammatory
diet
post-surgery
to
kind
of
bring
that
down
.
Speaker 1
18:27
But
I
do
think
to
that
point
.
The
fatigue
point
,
which
I
still
have
a
lot
of
brain
fog
and
fatigue
,
but
it's
kind
of
hard
to
decide
whether
that's
,
or
even
figure
out
whether
that's
endo-related
or
autoimmune-related
or
hormone-related
,
which
in
my
case
,
because
I'm
surgical
menopause
,
is
likely
the
case
.
But
also
just
understanding
just
because
we
have
surgical
removal
of
this
disease
doesn't
mean
that
our
bodies
aren't
going
to
respond
long
term
because
of
all
the
other
comorbidities
,
because
we
get
so
entranced
in
the
disease
that
we
forget
that
our
bodies
still
have
other
things
going
on
.
And
that's
where
I
think
sometimes
an
anti-inflammatory
diet
can
be
helpful
.
But
also
understanding
that
you
have
to
work
in
other
areas
.
Whether
that's
EDS
I
don't
know
if
you've
experienced
this
with
EDS
patients
specifically
that's
EDS
.
I
don't
know
if
you've
experienced
this
with
EDS
patients
specifically
.
It's
really
hard
to
decipher
.
Okay
,
is
this
an
endofatigue
or
is
this
an
EDS
fatigue
?
Is
this
a
surgical
menopause
fatigue
?
Yeah
,
that's
very
interesting
.
Speaker 2
19:43
I
think
one
of
the
most
important
conversations
to
have
between
a
doctor
and
a
patient
is
managing
expectations
right
so
we
can
identify
.
I
mean
,
if
you're
an
endometriosis
surgeon
,
you're
basically
looking
at
that
.
Speaker 2
19:59
You're
saying
okay
,
I
can
identify
this
disease
and
these
patients
may
also
have
other
comorbidities
which
you
like
EDS
,
for
example
,
very
difficult
to
treat
.
There
is
no
surgical
treatment
for
it
.
Like
EDS
,
for
example
,
very
difficult
to
treat
,
there
is
no
surgical
treatment
for
it
.
Even
musculoskeletal
disorders
like
fibromyalgia
,
osteoarthritis
all
of
those
things
are
very
difficult
to
treat
.
So
,
yes
,
you
can
treat
the
endometriosis
,
but
your
surgery
is
not
going
to
treat
other
conditions
.
So
I
think
it's
very
important
to
be
humble
in
your
conversation
and
manage
somebody's
expectations
when
you're
planning
a
surgery
for
them
and
you
say
this
is
what
I've
diagnosed
.
Speaker 2
20:39
In
most
cases
this
is
what
is
going
to
happen
.
You
will
have
resolution
of
these
symptoms
.
But
there
is
a
small
chance
that
you
may
still
have
persistent
pain
if
you
have
certain
other
conditions
that
are
not
so
easily
diagnosed
.
And
if
you
do
,
you
kind
of
have
to
work
with
other
specialists
,
like
rheumatology
or
pain
management
or
whoever
,
to
help
them
get
to
that
diagnosis
and
get
the
appropriate
care
for
that
.
So
just
because
you
work
with
a
hammer
,
not
all
diseases
nails
.
You
have
to
identify
what
other
potential
causes
of
pain
might
be
for
that
patient
and
treat
patient
as
a
patient
and
not
just
as
a
disease
.
So
to
figure
all
of
that
out
is
very
important
.
Speaker 1
21:23
Yeah
,
do
you
notice
?
Other
inflammatory
diseases
are
more
prevalent
in
certain
parts
of
the
world
as
opposed
to
others
are
more
prevalent
in
certain
parts
of
the
world
as
opposed
to
others
.
Speaker 2
21:35
That
is
interesting
,
but
I
think
it's
more
about
how
much
access
patients
have
to
those
kind
of
specialties
to
make
those
diagnoses
.
So
I
work
very
closely
with
a
rheumatologist
and
we're
putting
together
data
where
we
have
overlap
between
endometriosis
patients
together
data
where
we
have
overlap
between
endometriosis
patients
,
and
she
primarily
treats
fibromyalgia
,
eds
and
other
conditions
,
musculoskeletal
connective
tissue
disorders
.
So
we're
putting
together
a
table
of
those
patients
to
see
what
the
overlying
similarities
are
.
How
did
surgery
affect
them
in
terms
of
quality
of
life
and
pain
scores
?
So
we
track
that
and
then
we
use
controls
from
patients
without
any
of
these
conditions
and
see
if
there's
a
big
difference
in
their
outcomes
from
surgery
when
it
comes
to
decrease
in
pain
scores
and
improvement
in
quality
of
life
.
Speaker 1
22:29
Interesting
.
You
know
,
I
think
that
a
lot
of
this
is
my
internal
brain
.
Thinking
through
my
scenario
personally
,
the
more
people
I'm
meeting
,
the
more
I'm
realizing
that
a
lot
of
us
have
other
conditions
.
But
I
can
tell
you
from
my
experience
that
the
care
and
the
treatment
has
ultimately
been
the
deciding
factor
for
a
lot
of
people
.
But
I
do
see
that
there
is
more
patients
coming
forward
knowing
that
they
have
like
EDS
or
fibromyalgia
and
things
like
that
.
Why
do
you
think
that
is
in
your
opinion
?
I
know
this
is
opening
probably
a
can
of
worms
,
but
Right
.
Speaker 2
23:04
So
one
is
,
we
have
to
look
at
the
different
systems
of
healthcare
in
different
countries
.
Speaker 2
23:12
Systems
of
health
care
in
different
countries
,
so
in
the
US
it's
either
insurance
or
you're
going
out
of
network
and
that's
a
whole
other
challenge
to
get
the
diagnosis
In
Canada
.
Canada
is
like
the
UK
and
similar
to
Australia
where
they
have
similar
to
the
NHS
,
so
it's
a
public
health
system
you
have
to
go
to
a
referral
through
a
general
practitioner
.
If
they
diagnose
endometriosis
,
you
go
to
a
specialist
center
and
so
on
and
so
forth
,
and
then
even
in
Germany
they
have
to
kind
of
make
their
way
to
get
referred
to
an
endometriosis
center
once
they
have
the
diagnosis
.
So
it
becomes
many
stumbling
blocks
to
get
through
,
whereas
in
India
patients
in
private
care
can
approach
whichever
doctor
they
want
,
they
want
.
They
can
,
you
know
,
kind
of
get
onto
the
internet
,
find
out
who
is
the
endometriosis
specialist
near
me
and
they
can
find
that
person
and
go
to
them
for
the
appropriate
treatment
and
diagnosis
.
Speaker 2
24:10
So
it
works
differently
in
different
countries
when
you
have
these
other
diagnoses
,
because
in
countries
in
the
West
primarily
they
do
the
family
practice
medicine
or
the
general
practitioner
is
very
good
at
understanding
symptoms
and
getting
diagnoses
and
referring
to
the
appropriate
specialists
,
which
the
patient
who's
kind
of
doing
their
own
research
may
not
be
able
to
do
that
.
So
if
they
go
online
and
join
their
support
groups
they
may
have
a
diagnosis
.
And
if
they
go
even
to
an
endometriosis
specialist
,
it
may
be
difficult
for
them
to
get
a
diagnosis
of
EDS
because
it's
a
very
difficult
diagnosis
to
make
unless
you're
treating
that
disease
.
So
when
it
comes
to
neuropelviology
and
you're
looking
at
vascular
entrapments
of
nerves
,
a
very
good
endometriosis
surgeon
may
still
not
be
able
to
make
that
diagnosis
unless
you
know
how
to
make
that
diagnosis
.
So
at
the
summit
we
saw
Anna
.
You
have
a
brilliant
presentation
on
neuropathy
.
She's
changing
the
game
.
Speaker 1
25:20
She
is
.
I
want
her
to
be
my
new
best
friend
.
Sorry
,
you've
been
removed
.
She's
my
new
best
friend
,
just
kidding
,
we're
very
good
friends
,
so
it's
all
right
.
Speaker 2
25:31
I
have
tremendous
respect
and
admiration
for
her
.
So
,
no
,
no
problems
there
.
Perfect
,
and
so
what
we
have
with
that
is
we're
able
to
make
better
diagnoses
now
.
We're
understanding
more
about
pain
and
not
just
looking
at
one
particular
disease
and
we're
looking
at
pelvic
pain
as
a
whole
extra
kind
of
syndrome
almost
,
but
looking
at
different
diagnoses
and
putting
it
all
together
.
Speaker 1
25:58
I'm
excited
for
the
future
to
see
what
comes
of
that
,
because
you
know
I
look
at
future
generations
and
I'm
so
hopeful
that
they
don't
have
to
walk
through
what
a
lot
of
us
had
to
because
of
the
new
advances
being
made
and
the
understanding
of
the
disease
and
other
diseases
that
kind
of
are
endometriosis
counterparts
,
if
you
will
.
Speaker 1
26:18
I'm
hopeful
that
maybe
we'll
find
a
way
to
differentiate
between
the
multiple
different
things
that
we
tend
to
carry
with
us
,
because
I
think
it
is
hard
for
the
patients
to
put
together
their
care
and
treatment
,
and
I
think
maybe
that's
the
bigger
question
and
maybe
the
bigger
picture
here
is
that
because
we
do
deal
with
so
much
,
it's
hard
for
us
to
understand
where
we
should
go
to
find
our
care
and
treatment
.
The
reality
to
this
too
and
maybe
you
can
speak
to
that
is
that
you're
an
endometriosis
surgeon
.
You're
not
an
EDS
specialist
,
so
you're
not
going
to
be
able
to
treat
EDS
,
but
you
could
the
endometriosis
.
But
adversely
,
eds
is
.
You
know
,
doctors
cannot
treat
endometriosis
,
and
so
trying
to
figure
out
where
we
need
to
go
,
what
we
need
to
do
in
our
next
steps
,
is
really
challenging
right
now
,
but
I'm
hopeful
in
the
future
that
maybe
we'll
be
able
to
have
a
better
path
,
a
clear
path
to
be
able
to
manage
that
.
Patient Advocacy in Endometriosis Care
Speaker 2
27:19
Yeah
,
that's
very
true
.
One
of
the
things
you
brought
up
was
my
biggest
personal
grouse
with
the
diseases
is
that
the
onus
to
get
the
diagnosis
is
falling
on
to
the
patient
.
The
onus
to
get
the
diagnosis
is
falling
on
to
the
patient
.
Speaker 1
27:35
Thanks
for
joining
us
today
,
and
if
you
thought
part
one
of
this
discussion
was
fun
and
intriguing
,
join
us
for
part
two
of
this
discussion
,
as
Dr
Mingz
continues
to
impart
his
knowledge
and
wisdom
when
it
comes
to
endometriosis
in
patient
care
.
You
won't
be
disappointed
.
Until
next
time
,
continue
advocating
for
you
and
for
those
that
you
love
.