Send us a text with a question or thought on this episode ( We cannot replay from this link)
- Is traditional endometriosis diagnosis failing patients?
– Dr. Ramiro Cabrera, a specialist from Mexico, shares how his sister’s battle with stage 4 endometriosis inspired his mission to revolutionize care using mapping and excision surgery.
- Why pre-surgical mapping matters:
– Learn how the outdated US staging system falls short and discover the NCM protocol, a groundbreaking technique offering precise pre-surgical visualization.
– Dr. Cabrera highlights **Dr. Luciana Chamie’s** work and the need for OBGYNs to better understand endometriosis.
- Global challenges in care:
– Explore how financial incentives drive ablation procedures, often harming patient outcomes.
– Countries like El Salvador lead with new standards in care, showcasing the importance of proper diagnostics and timely interventions.
- Key Topics:
– Excision surgery, mapping, global care disparities, and the push for improved treatment options.
Website endobattery.com
EndoBattery
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
.
Speaker 1
0:46
Today
I'm
joined
by
my
guest
,
dr
Romero
Cabrera
,
who
is
a
distinguished
endometriosis
excision
specialist
based
in
Mexico
,
with
extensive
expertise
in
diagnosis
and
surgical
treatment
of
endometriosis
.
Dr
Ram
has
earned
a
reputation
for
his
innovative
and
patient-centered
approach
.
His
commitment
to
advancing
the
field
of
gynecological
surgery
,
combined
with
his
compassionate
care
,
has
made
him
a
leading
figure
in
the
management
of
endometriosis
.
Dr
Ram's
work
not
only
improves
the
quality
of
life
for
his
patients
,
but
also
contributes
significantly
to
the
global
understanding
of
this
challenging
condition
.
Please
help
me
in
welcoming
Dr
Romero
Cabrera
.
Thank
you
,
dr
Ram
Cabrera
,
for
joining
me
today
.
I
appreciate
you
taking
the
time
and
the
work
that
you're
doing
and
the
impact
that
you're
making
for
the
endometriosis
community
is
it's
massive
.
So
thank
you
so
much
for
joining
me
and
taking
the
time
to
share
your
wisdom
and
knowledge
.
Speaker 2
1:38
Oh
my
God
.
Well
,
the
pleasure
is
mine
.
Speaker 1
1:40
Can
you
explain
to
us
just
a
glimpse
into
why
endometriosis
for
you
,
why
you're
passionate
about
it
?
Speaker 2
1:47
I
think
it's
really
important
for
the
community
of
patients
with
endometriosis
to
get
validated
,
because
that's
why
I
did
an
expertise
in
deep
endometriosis
and
this
is
a
really
personal
thing
for
me
because
I
don't
know
if
you
knew
but
my
sister
that
obviously
I
love
,
my
sister
had
a
deep
endometriosis
,
stage
four
.
So
,
by
shame
,
in
our
full
life
my
sister
went
under
through
five
surgeries
.
Each
one
of
them
,
as
you
probably
knew
,
were
without
the
high
quality
protocol
,
without
mapping
of
deep
endometriosis
.
They
only
performed
transvaginal
ultrasound
.
They
went
to
the
doctor
and
they
told
them
that
it
was
IBS
irritable
bowel
syndrome
.
She
underwent
surgery
for
the
endometrial
cyst
,
so
endometrioma
.
Then
she
lost
one
ovary
because
of
a
doctor
that
believed
that
it
was
cancer
and
she
continued
with
chronic
pain
and
,
as
you
can
imagine
,
even
underwent
through
IVF
to
get
my
nephews
.
So
I
saw
in
firsthand
how
harmful
the
disease
can
be
.
I
saw
in
firsthand
someone
that
I
love
the
amount
of
pain
that
it
can
go
through
.
I
even
sometimes
carry
my
sister
,
you
know
,
because
when
she
was
in
his
period
sometimes
she
got
vagal
symptoms
.
That
means
that
the
blood
pressure
went
down
and
she
turned
bad
and
fainted
,
even
in
the
showers
.
I
have
to
carry
my
sister
out
of
the
shower
.
And
it
was
really
important
for
me
because
I
don't
know
if
you
knew
,
but
my
dad
was
the
president
of
oncology
in
the
country
,
so
we
get
access
to
the
best
surgeons
in
the
country
.
And
even
my
sister
underwent
to
the
US
to
the
Houston
Texas
hospital
and
she
went
under
surgery
there
with
someone
that
was
,
or
supposed
to
be
,
a
specialist
in
endometriosis
.
And
by
all
these
reasons
they
even
they
perform
ablation
.
So
I
asked
you
can
imagine
to
see
someone
that
you
love
so
deeply
with
that
amount
of
pain
losing
partners
because
by
shame
she
lose
even
a
husband
.
So
imagine
that
going
through
many
years
.
Speaker 2
3:47
And
I
promised
myself
that
when
I
did
the
specialty
with
Professor
Kondo
and
I
tried
to
,
you
know
,
improve
when
I
went
one
year
to
Europe
to
see
the
best
in
the
world
to
do
this
type
of
surgery
,
to
never
let
anyone
like
my
sister
to
go
through
that
pain
you
get
me
,
or
to
go
through
the
losses
of
babies
,
to
go
through
the
losses
of
IVFs
,
the
amount
of
money
we
spend
as
a
family
,
the
amount
of
gaslighting
sometimes
that
doctors
used
to
say
to
my
sister
,
even
though
my
father
was
one
of
the
best
doctors
in
the
country
.
So
I
started
to
see
how
patients
were
mistreated
.
I
didn't
went
through
validation
about
the
symptoms
.
They
used
to
think
that
she
was
crazy
.
So
she
went
to
the
psychiatrist
and
it
wasn't
until
I
came
to
Mexico
and
the
only
thing
I
did
it's
not
because
I'm
a
genius
or
something
,
I
just
bring
the
high-quality
treatment
to
Mexico
.
Speaker 2
4:39
We
start
performing
mapping
,
like
they
do
in
Italy
and
Brazil
.
We
start
doing
excision
therapy
and
I
was
the
one
who
did
the
surgery
for
my
sister
after
she
got
finally
a
release
of
the
pain
.
Obviously
it's
a
process
,
because
not
the
surgery
will
never
cure
,
just
endometriosis
.
We
have
everything
for
it
.
We
have
physiotherapy
,
we
have
pain
medicine
doctors
,
we
have
neuropathologists
and
I
see
now
that
my
sister
,
thanks
to
God
,
now
she
is
with
my
nephews
and
she
is
without
pain
and
she
can
even
,
you
know
,
like
,
love
them
and
be
with
them
without
pain
.
So
that's
why
I
swear
to
my
life
and
to
my
soul
that
I
will
treat
patients
like
I
should
treat
my
sister
.
Speaker 1
5:18
Yeah
,
that's
.
I
feel
like
that's
so
refreshing
to
hear
,
but
I
feel
like
so
many
of
the
providers
who
are
pushing
the
boundaries
in
care
as
far
as
making
it
better
and
more
accessible
and
validating
the
patients
come
from
personal
experience
.
And
I
know
for
me
personally
,
doing
this
podcast
is
because
I've
got
kids
and
the
chances
of
them
having
endometriosis
is
much
higher
than
you
know
other
people
.
Speaker 1
5:43
Yeah
,
and
so
you're
advocating
for
not
only
the
people
you
love
,
but
for
future
generations
,
and
working
for
making
the
system
better
,
and
I
think
one
of
the
ways
that
you
have
done
that
,
which
you've
done
a
lot
of
different
things
that
have
been
amazing
to
see
,
and
I'm
really
excited
to
see
what
you're
doing
overall
but
one
of
the
things
that
I
think
is
fascinating
and
we
need
to
look
more
at
is
the
mapping
.
Can
you
explain
to
us
what
is
mapping
?
What
do
you
do
for
mapping
?
Speaker 2
6:13
Of
course
it's
not
something
that
I
create
.
It's
something
that
we
replicate
in
Mexico
and
now
it's
being
replicated
worldwide
.
Mapping
of
the
dipendometriosis
started
in
Europe
,
in
France
and
in
Italy
.
They
found
out
that
the
radiologists
who
are
used
to
see
deep
endometriosis
with
the
special
protocols
because
everyone
in
the
US
have
an
MRI
every
hospital
,
every
hospital
,
has
the
best
ultrasound
.
I
can't
even
assure
you
they
have
even
better
ultrasounds
than
the
rest
of
the
world
.
But
the
problem
is
that
the
radiologist
needs
to
go
to
a
learning
curve
to
see
deep
endometriosis
.
By
this
we
have
to
remember
that
endometriosis
has
to
be
subdivided
in
three
types
.
Something
is
peritoneal
,
this
is
superficial
.
That
is
the
one
that
is
so
little
that
even
sometimes
the
human
eye
cannot
see
.
Deep
endometriosis
is
the
one
that
infiltrates
itself
to
other
organs
,
and
that's
the
one
we
can
see
through
special
imaging
studies
.
And
ovarian
endometrioma
.
That
is
the
one
that's
super
easy
to
diagnose
.
With
a
normal
office
ultrasound
.
You
can
see
the
chocolate
cyst
and
then
we
can
suspect
endometriosis
.
Now
in
Europe
and
France
,
in
Italy
,
they
started
seeing
that
the
radiologists
to
see
this
every
day
have
better
sensibility
.
That
means
that
the
eyes
can
see
better
,
depending
on
the
diagnosis
,
than
the
normal
radiology
population
and
they
started
to
see
that
if
they
go
before
the
study
to
do
a
rectal
enema
and
when
they
perform
MRIs
they
put
a
rectal
gel
,
a
vaginal
gel
and
some
medication
for
the
bowel
to
not
move
,
then
they
can
see
better
the
disease
.
You
get
me
.
And
with
this
,
without
going
through
surgery
,
they
can
diagnose
if
you
have
endometriosis
,
deep
endometriosis
in
the
bowel
,
in
the
bladder
,
in
the
diaphragm
.
So
with
this
the
surgeon
can
individualize
the
treatment
and
then
get
a
special
team
of
surgeons
.
If
you
have
endometriosis
in
the
diaphragm
,
then
we
need
a
cardiothoracic
surgeon
and
so
on
.
If
you
have
endometriosis
in
the
bladder
,
a
urinary
surgeon
.
If
you
have
endometriosis
in
the
colorectal
area
,
we
need
a
colorectal
surgeon
.
Speaker 2
8:15
So
in
Italy
and
France
they
start
doing
something
that
is
a
high
quality
treatment
.
High
quality
treatment
defines
itself
by
doing
a
mapping
of
deep
endometriosis
.
The
mapping
of
deep
endometriosis
is
a
specialized
imaging
study
in
which
an
expert
in
radiology
that
has
a
super
long
learning
curve
at
least
five
to
10
years
with
a
specialized
protocol
.
That
means
with
bowel
gel
,
rectal
gel
,
bowel
inhibitory
movement
medication
,
with
an
MRI
,
or
if
they
are
going
to
do
an
ultrasound
.
It's
not
a
normal
ultrasound
,
I
will
say
to
you
,
it's
an
algorithm
in
which
we
have
to
see
the
african
,
we
have
to
see
the
appendix
,
the
sesum
,
we
have
to
see
the
full
bowel
.
That's
an
abdominal
ultrasound
with
a
bowel
preparation
.
And
then
we
go
through
the
transvaginal
ultrasound
and
see
not
only
the
uterus
and
ovaries
because
,
remember
,
by
definition
endometriosis
is
outside
the
uterus
.
So
we
have
the
bowel
,
the
bladder
,
the
ureters
and
with
this
a
true
expert
in
imaging
can
send
us
a
classification
,
a
presurgical
classification
that
is
mandatory
worldwide
.
It's
called
the
ANSI
classification
Surgery Mapping Importance in Endometriosis
Speaker 2
9:22
.
Speaker 2
9:22
In
the
US
they
are
still
doing
something
that
it's
called
the
ancient
classification
.
Speaker 2
9:24
In
the
us
they
are
still
doing
something
that
it's
a
association
for
reproductive
society
of
medicine
,
a
classification
that
divides
the
the
disease
in
stages
,
stage
one
to
stage
four
.
Speaker 2
9:34
Right
now
that
classification
is
really
old
,
is
the
one
that
my
father
used
to
use
,
because
if
they
go
under
surgery
and
they
classify
you
with
stage
four
,
like
they
did
with
my
sister
,
my
sister
sister
will
tell
you
oh
,
thank
you
very
much
,
but
that
doesn't
mean
anything
.
Speaker 2
9:50
That
means
that
I
have
in
every
place
.
With
the
NCM
protocol
we
can
do
the
classification
before
surgery
that's
mandatory
and
with
this
we
can
see
if
the
disease
is
affecting
the
intestine
,
the
bladder
or
other
organs
and
not
only
see
if
it's
affecting
,
we
can
also
see
the
size
of
the
nodule
,
the
length
,
the
percentage
of
bowel
affection
.
So
with
this
we
can
plan
the
surgery
before
going
in
,
because
we'll
never
do
again
a
laparoscopic
diagnosis
surgery
without
the
mapping
If
they
are
going
to
do
a
laparoscopic
surgery
.
The
human
eye
cannot
see
through
tissue
,
so
if
they
enter
and
see
everything
attached
to
itself
like
a
frozen
pelvis
,
no
surgeon
,
no
surgeon
worldwide
,
even
the
best
surgeon
in
the
world
,
even
myself
,
if
I
go
without
a
mapping
,
I
cannot
see
the
nodule
because
I
can
only
see
the
superficial
layers
of
the
organs
.
Speaker 1
10:43
Yes
,
I
think
that's
fascinating
and
also
I
agree
because
I
would
say
that
prior
to
my
surgery
there
was
not
any
of
that
mapping
and
I
question
whether
they
even
got
full
disease
because
they
didn't
properly
prepare
.
And
I
also
think
that
it's
almost
a
disservice
to
the
patients
to
not
do
some
mapping
.
It's
a
disservice
because
we
don't
know
what
we're
getting
ourselves
into
.
So
a
lot
of
patients
in
the
US
go
in
for
an
excision
surgery
but
come
out
with
a
colostomy
bag
or
more
of
a
major
surgery
than
what
they
had
anticipated
,
and
that
affects
their
recovery
Right
.
Speaker 2
11:21
Of
course
and
that's
really
important
,
because
it's
not
the
same
that
the
surgeons
or
the
group
of
surgeons
know
the
size
of
the
nodule
,
where
is
it
located
?
Because
the
most
important
part
is
now
worldwide
.
We
will
not
perform
colostomy
or
ileostomy
.
We
can
only
perform
it
if
the
bowel
nerve
is
something
that
is
in
a
low
resection
.
That
means
that
it's
really
close
to
the
anal
verge
,
because
the
nerves
are
really
really
affected
,
or
sometimes
the
irrigation
to
the
bowel
is
affected
.
So
in
that
type
of
cases
,
if
the
nodule
is
less
than
five
centimeters
from
the
anal
verge
,
sometimes
we
have
to
perform
a
colostomy
,
but
if
not
,
we
will
always
do
primary
reanastomosis
,
always
Because
endometriosis
is
not
cancer
.
Speaker 2
12:04
So
,
as
I
told
you
,
my
father
was
the
president
of
oncology
in
my
country
.
In
the
old
days
,
everything
when
we
cut
the
intestine
it
was
colostomy
or
ileostomy
just
because
it
was
safer
for
the
patient
.
But
because
endometriosis
is
not
cancer
and
the
patients
are
young
and
also
they
are
healthy
,
we
can
perform
a
primary
anastomosis
.
In
over
95%
of
cases
we
perform
the
primary
anastomosis
without
VAC
,
without
ileostomy
or
colostomy
,
and
that
should
be
.
It
should
be
speak
to
the
patient
with
a
mapping
.
So
if
you
have
an
anus
,
if
it's
really
far
away
from
the
anal
verge
.
If
it's
three
centimeters
long
,
okay
,
we
have
to
do
a
bowel
resection
,
but
we
are
not
doing
a
colostomy
,
we
are
doing
primary
anastomosis
.
And
then
the
patient
understand
,
they
understand
how
the
surgery
is
going
to
be
,
who's
going
to
enter
surgery
?
Speaker 2
12:54
Because
here
in
Mexico
they
used
to
go
on
their
surgery
for
deep
endometriosis
and
then
,
oh
,
we
have
to
call
the
colorectal
surgeon
because
everything
was
attached
.
And
what
did
they
do
?
Nothing
because
the
colorectal
surgeon
,
because
everything
was
attached
.
And
what
did
they
do
?
Nothing
.
Because
the
colorectal
surgeon
even
knew
the
patient
.
So
they
will
never
go
under
the
risk
of
cutting
that
part
of
the
nodule
.
So
all
the
time
,
the
disease
is
not
recurrency
,
it's
persistence
of
the
disease
.
They
didn't
take
the
nodule
away
,
you
get
me
.
So
that's
why
it's
mandatory
.
It's
not
only
my
center
in
Mexico
City
or
Tijuana
.
They
are
doing
it
in
Brazil
,
they
are
doing
it
in
Italy
,
they
are
doing
it
in
France
,
in
Dubai
,
all
the
world
centers
that
are
certified
are
doing
mapping
.
That's
the
end
point
of
it
.
So
if
you're
a
patient
with
deep
endometriosis
and
they're
trying
to
do
a
diagnosis
laparoscopy
,
please
tell
them
.
No
,
I
don't
think
it's
the
best
option
.
You
get
me
.
Speaker 1
13:54
And
we
hear
that
a
lot
and
I
think
a
lot
of
times
it
comes
from
most
of
the
general
OBGYNs
who
are
going
in
,
who
maybe
have
an
understanding
somewhat
of
endometriosis
but
not
the
surgical
technique
to
be
able
to
address
endometriosis
at
its
full
scope
.
And
that's
where
I
feel
like
we
need
to
be
better
at
communicating
why
this
is
so
important
.
It's
like
walking
into
a
horror
show
and
not
knowing
what
you're
getting
yourself
into
.
You
know
and
you're
thinking
it's
a
musical
,
it's
not
going
to
work
out
for
you
.
Well
,
you
know
,
and
I
think
that's
why
it's
so
important
to
have
pre-surgical
mapping
done
.
And
this
is
fairly
new
,
even
in
concept
,
to
me
,
in
the
last
year
and
a
half
probably
,
and
I
wish
I
would
have
known
earlier
.
But
here
we
are
and
now
I'm
learning
.
Speaker 2
14:34
So
and
it's
important
because
also
in
the
US
it
wasn't
already
protocolized
.
But
thanks
to
one
doctor
it's
a
friend
of
mine
though
.
It's
Luciana
Chamier
.
If
you
can
research
her
work
,
she's
doing
amazing
work
in
radiology
.
She's
a
radiologist
from
Brazil
.
She
has
a
postdoctorate
in
radiology
,
a
study
of
deep
endometriosis
.
So
now
she
went
to
Harvard
and
I
think
that
also
Stanford
and
they
are
doing
,
thanks
to
Luciana
Chamier
,
make
the
first
protocol
in
the
US
.
Speaker 2
15:04
The
Radiology
Magazine
that
is
the
best
magazine
for
radiologists
that
now
says
that
it's
mandatory
to
do
three
levels
of
ultrasound
for
deep
endometriosis
.
So
now
they're
putting
mapping
first
,
thanks
to
God
.
And
the
US
now
is
advancing
and
now
they
have
now
the
bibliography
you
get
me
.
So
now
it's
in
solid
stages
.
No
other
doctor
would
say
,
no
,
that
doesn't
exist
.
Now
it
exists
and
it's
in
the
best
magazine
in
the
world
,
thanks
to
Luciana
Chamier
.
Speaker 2
15:34
So
,
as
myself
,
there
are
many
doctors
who
are
trying
to
work
for
patients
to
get
validated
symptoms
,
to
get
you
know
,
to
see
the
disease
before
surgery
and
to
do
a
planned
surgery
.
So
that's
also
really
important
.
And
something
I
think
that
you
should
also
add
to
this
podcast
is
that
the
surgery
itself
should
always
be
done
by
true
experts
in
the
kitchen
.
Yes
,
and
I
will
always
make
it
clear
,
like
my
grandfather
used
to
tell
me
,
doing
surgery
is
like
playing
the
piano
.
You
can
take
a
10
year
lessons
to
play
the
piano
,
like
I
did
.
I
used
to
take
piano
lessons
,
but
I
cannot
create
Mozart
or
Vivaldi
.
I
cannot
create
.
I
can
only
play
Coldplay
.
You
get
me
,
even
if
I
10
years
,
so
that's
an
innate
ability
.
Sometimes
doing
surgery
you
have
to
have
obviously
classes
and
life
,
fellowships
and
everything
.
But
not
every
surgeon
would
get
into
the
point
to
get
to
full
disease
,
because
sometimes
the
disease
affects
the
pelvic
nerves
,
sometimes
the
disease
affects
the
intestine
,
the
bladder
,
the
diaphragm
,
and
if
you
don't
have
the
skills
to
do
it
,
even
though
you
can
stay
20
years
in
medical
school
and
residency
,
some
doctors
,
by
shame
,
will
not
get
into
the
point
.
So
that's
why
you
have
to
get
certified
in
surgery
,
you
have
to
get
validated
that
your
surgery
is
a
full
,
complete
excision
.
You
have
to
know
how
to
not
damage
the
organ
that
you're
treating
and
leave
function
,
because
an
oncologist
,
all
oncologists
,
can
take
any
organ
away
,
like
my
father
,
but
they
always
take
it
away
but
the
function
of
the
organ
will
be
affected
because
it's
cancer
and
if
I
leave
you
with
an
ileostomy
or
colostomy
or
something
that
you
cannot
pee
for
your
full
life
or
cannot
have
orgasms
,
you
will
still
say
thank
you
doctor
,
because
I'm
still
alive
.
It
was
cancer
In
endometriosis
.
Speaker 2
17:28
It's
totally
different
.
Yes
,
endometriosis
is
not
cancer
.
So
if
I
do
surgery
like
an
oncologist
and
I
cut
the
nerves
,
then
you
will
not
say
thank
you
doctor
.
You
will
say
,
hey
,
I
entered
with
pain
and
now
I
cannot
poo
,
I
cannot
pee
and
I
cannot
have
orgasms
.
So
it
was
oh
,
thank
you
doctor
,
you
get
me
.
Yeah
,
because
it's
not
cancer
.
That's
the
difference
between
an
oncologist
,
who
is
one
of
the
best
surgeons
worldwide
and
can
take
any
organ
away
,
and
the
endometriosis
surgeon
.
We
took
parts
of
that
organ
,
but
will
it
function
?
That's
something
really
important
.
Speaker 1
18:03
I
think
that's
key
.
I
would
say
that
it's
how
,
first
of
all
,
how
we
approach
our
surgeries
.
Do
we
want
complete
surgery
or
do
you
just
want
to
survive
?
And
that
is
a
big
difference
,
I
think
,
for
a
lot
of
patients
is
we
do
get
stuck
in
this
survival
mode
.
I
just
want
the
pain
to
go
away
.
Speaker 1
18:24
But
there
is
the
other
side
of
that
coin
.
If
you
don't
have
someone
on
the
team
that
maybe
is
a
neuropelviologist
to
look
at
,
you
know
those
nerves
and
nerve
preservation
,
because
those
nerves
serve
a
purpose
,
every
organ
serves
a
purpose
in
your
body
,
and
if
we
don't
take
care
of
those
organs
,
there's
going
to
be
a
repercussion
.
And
I
think
I
didn't
really
fully
understand
that
and
I
am
still
dealing
with
the
repercussions
of
that
.
Is
my
pain
better
?
Absolutely
,
my
pain's
better
.
Is
my
quality
of
life
better
?
Absolutely
,
my
quality
of
life
is
better
.
But
is
it
complete
?
Not
necessarily
.
I'm
still
fighting
,
you
know
,
and
I
think
that
that
is
the
big
picture
and
something
that
I
admire
so
much
about
what
you
are
doing
in
your
clinics
is
your
team
is
like
a
stellar
team
of
just
ram-packed
that's
what
I'm
going
to
call
it
ram-packed
the
specialists
,
because
they're
looking
at
every
component
,
they're
not
looking
at
just
the
front
end
of
the
surgery
.
They're
looking
at
lifelong
effects
of
endometriosis
.
Speaker 2
19:32
And
now
you
understand
something
that
we
were
talking
about
before
.
I'm
treating
my
patients
like
they
are
my
sister
.
She's
not
just
take
away
the
organ
and
see
you
in
20
years
and
let's
see
how
your
life
goes
.
No
,
the
surgery
is
also
a
really
key
point
of
treatment
.
But
we
also
have
a
post-op
treatment
like
physiotherapy
,
pelvic
nerve
function
.
Speaker 2
19:49
Some
patients
undergo
,
by
obvious
reasons
because
of
surgery
,
just
something
we
call
neuropractic
.
That
means
that
the
nerves
is
inflamed
.
If
we
do
not
treat
that
inflamed
nerve
they
will
always
stay
with
pain
during
sex
.
They
can
have
like
a
chronic
constipation
.
They
can
have
strange
a
chronic
constipation
.
They
can
have
strange
feelings
during
urination
,
even
though
the
quality
of
life
get
better
.
If
they
do
not
treat
this
,
then
we're
not
doing
full
treatment
.
You
get
me
so
,
where
my
sister
is
not
just
going
to
do
surgery
.
It's
more
.
It's
most
important
how
you're
going
to
be
well
with
your
kids
,
with
your
family
,
how
you're
going
to
be
with
a
normal
life
.
You
get
me
after
surgery
.
Obviously
it's
not
Harry
Potter
,
as
I
told
my
patients
,
I'm
not
Harry
Potter
,
it's
not
Abracadabra
and
you're
everything
fine
.
Speaker 2
20:34
It's
a
process
,
sometimes
even
with
you
will
probably
talk
with
Dr
Sierra
or
Passover
.
That
are
the
ones
who
are
moving
their
physiology
and
chronic
pain
sometimes
gets
into
the
brain
.
That
means
as
centrant
,
sensibilization
,
and
also
peripheral
.
So
that
means
that
the
brain
,
it
normalized
the
pain
.
It
already
have
normalized
pain
.
So
sometimes
even
the
nerves
,
the
only
thing
that
remember
that
,
the
feelings
,
or
even
the
nerves
,
the
pain
,
is
information
.
So
sometimes
the
nerve
is
so
affected
that
the
only
thing
that
it
knows
is
pain
.
So
even
if
you
just
do
something
that
is
a
touch
,
the
nerve
is
so
used
to
pain
that
they
change
the
information
to
oh
,
that's
also
pain
.
So
you
have
to
change
the
ways
of
the
brain
,
to
change
the
neurotransmitter
,
to
change
everything
.
It's
not
just
surgery
.
Right
,
even
you
can
have
surgery
in
the
world
,
and
if
they
do
not
have
this
postoperative
care
,
you
will
still
have
pain
.
Speaker 1
21:29
Yeah
,
what
do
you
find
the
most
challenging
about
doing
deep
infiltrating
mapping
?
Because
I
would
assume
that
it's
not
all
roses
all
the
time
and
it's
not
an
easy
process
all
the
time
.
What
do
you
feel
like
is
the
biggest
challenge
in
doing
this
mapping
?
Speaker 2
21:45
Well
,
in
the
mapping
the
challenge
are
obvious
by
all
reasons
that
the
radiologist
is
an
expert
.
Right
now
in
Mexico
we
have
only
for
over
20
million
women
affected
.
In
Mexico
we
have
only
three
radiologists
that
are
the
ones
who
can
perform
mapping
.
So
our
center
we
have
a
waiting
list
just
for
mapping
.
So
imagine
that
Patients
,
we
have
20
million
women
affected
and
thanks
to
the
social
networks
and
thanks
to
you
that
are
letting
me
you
know
,
process
the
information
and
pass
by
adequate
information
,
many
patients
it's
like
,
oh
,
I
want
to
do
the
mapping
,
but
worldwide
there
are
really
a
small
amount
of
radiologists
that
can
perform
mapping
.
So
that's
the
most
important
part
.
Improving Endometriosis Treatment Worldwide
Speaker 2
22:27
Also
,
many
radiologists
do
not
validate
the
symptoms
.
So
they
have
the
same
amount
of
money
if
they
learn
mapping
of
endometriosis
like
they
perform
a
normal
transvaginal
ultrasound
.
That's
why
the
US
will
take
too
long
to
change
,
because
if
they
I
don't
know
if
you
knew
,
but
in
the
US
if
they
perform
ablation
or
excision
,
the
doctor
wins
the
same
amount
of
money
.
So
excision
is
a
super
hard
skill
surgery
with
higher
risk
.
Ablation
is
just
to
enter
and
burn
the
tissue
.
So
all
the
doctors
are
like
,
if
I'm
going
to
earn
the
same
amount
of
money
,
I
will
do
ablation
Right
and
many
radiologists
are
doing
the
same
amount
of
money
.
I
will
do
ablation
Right
and
many
radiologists
are
doing
the
same
.
If
they
just
do
transvaginal
ultrasound
,
that
will
take
10
minutes
and
the
mapping
takes
40
,
50
minutes
one
hour
.
They're
like
no
,
I
prefer
to
do
five
in
one
hour
than
doing
one
in
one
hour
.
So
that's
a
really
big
problem
worldwide
.
Speaker 2
23:23
Many
doctors
,
because
of
the
hard
skill
and
they
have
to
,
you
know
overcompensate
the
skills
.
They
have
to
work
harder
.
They
sometimes
do
not
believe
that
it's
worth
the
work
.
I
do
it
because
my
sister
underwent
through
this
Some
surgeries
.
I
don't
even
earn
more
money
.
Speaker 2
23:40
Many
patients
in
Mexico
,
as
you
can
imagine
,
it's
a
third
world
country
,
so
they
don't
have
money
.
I
have
patients
that
I
even
have
to
pay
for
my
wallet
so
they
can
get
the
surgery
,
because
they
have
even
suicidal
attempts
and
I'm
a
human
being
.
It's
like
,
hey
,
you
will
not
kill
yourself
because
of
pain
.
If
I
have
to
pay
$1,000
,
I
will
pay
too
because
you're
a
human
being
.
Human
beings
,
there's
no
money
for
a
human
life
.
So
sometimes
I
even
have
to
pay
for
my
own
wallet
to
get
patients
better
and
they
pay
me
back
.
Sometimes
.
If
they
don't
pay
me
back
,
I
don't
care
for
them
.
And
that's
something
that
many
doctors
in
US
and
Canada
,
because
they
earn
really
good
amount
of
money
.
They
are
like
no
,
if
I
have
to
do
a
course
and
then
I
have
to
go
to
Italy
,
to
Mexico
,
instead
of
getting
vacations
,
no
,
I
will
stay
here
,
right
.
And
then
I
have
to
go
to
Italy
,
to
Mexico
,
instead
of
getting
vacations
,
no
,
I
will
stay
here
.
Speaker 1
24:25
Right
,
and
I
do
think
that
that
I
mean
that's
a
huge
issue
in
the
US
.
I
can
attest
to
this
because
my
second
surgery
was
supposed
to
be
a
laparoscopic
ablation
surgery
.
I
didn't
know
the
difference
at
that
point
.
That
was
in
2013
,
2012
.
And
so
I
didn't
know
the
difference
and
what
ended
up
happening
was
I
had
a
laparotomy
because
I
had
so
much
endometriosis
on
my
bowels
and
let
me
just
tell
you
,
the
recovery
on
that
was
intense
.
It
was
three
months
of
not
being
able
to
lay
flat
.
It
was
three
and
it
didn't
solve
anything
.
Speaker 1
25:03
Course
.
They
put
you
on
the
Lupron
and
they
put
you
on
the
,
the
birth
control
,
and
you
know
all
of
those
things
.
And
what
that
did
is
when
I
went
to
go
have
my
excision
surgery
,
knowing
that
I
had
all
of
this
involvement
bowel
involvement
,
amongst
others
it
really
created
a
harder
time
for
my
surgeon
to
be
able
to
even
do
some
of
the
surgery
because
he
had
to
go
through
adhesions
like
crazy
,
right
.
And
that's
why
I
think
that
what
you're
talking
about
is
so
important
,
because
getting
that
mapping
,
doing
it
right
the
first
time
,
will
prevent
a
lot
of
that
long-term
effect
.
Speaker 2
25:38
Yes
,
I
think
that
that's
the
most
important
part
of
it
and
,
as
you
,
I'm
so
sorry
because
you
underwent
through
the
full
list
of
low
quality
treatment
.
Sorry
about
mapping
laparotomy
that
we
should
never
do
for
deep
endometriosis
,
something
that
is
called
the
pseudomenopause
,
or
the
chemical
frustration
that
we
do
not
use
anymore
.
Oh
,
I'm
so
sorry
and
by
shame
,
I
wish
that
you
were
aware
.
You
know
,
like
a
sporadic
case
,
but
I
see
this
every
day
.
I
see
one
of
the
most
harmful
cases
for
me
it
was
a
patient
that
was
11
years
old
already
two
surgeries
,
two
laparotomies
and
they
took
away
the
ovary
.
Speaker 2
26:19
So
imagine
an
11-year-old
and
the
antimalarian
hormone
that
is
,
the
Ovarian
Reserve
,
was
in
0.7
.
That's
the
same
amount
like
a
45-year-old
.
So
,
and
she
still
having
the
metastasis
and
like
a
malformation
,
and
I
cannot
believe
that
.
That
was
the
first
time
that
I
even
want
to
.
You
know
,
punch
someone
like
oh
my
God
,
that's
being
harmful
.
You
know
that's
ignorance
.
Ignorance
,
that's
being
like
really
bad
it's
.
It
was
something
that
hurt
me
.
You
know
it's
like
,
oh
my
god
,
how
can
we
change
this
and
what
can
you
do
?
You
know
,
see
a
patient
at
11
year
old
already
with
a
reproductive
life
totally
lost
.
It
was
like
oh
my
god
.
So
imagine
that
in
all
over
the
world
and
the
amount
of
cases
we
have
we
have
200
million
it's
something
that
it's
really
,
really
,
really
,
really
bad
,
so
we
have
to
be
really
careful
about
that
.
Speaker 1
27:10
Yeah
,
and
that's
why
I'm
pushing
this
so
much
.
And
we
talked
about
I
have
two
girls
and
with
that
,
higher
probability
of
endometriosis
,
we
have
to
talk
about
this
for
future
generations
to
prevent
that
.
We
have
to
talk
about
this
for
future
generations
to
prevent
that
.
And
I
think
something
that
I've
been
focused
on
and
something
I've
been
talking
about
with
Nancy
Peterson
lately
actually
was
the
fact
that
young
children
are
being
stripped
of
the
option
of
future
fertility
.
Speaker 1
27:36
And
it's
starting
younger
and
younger
and
as
parents
we
want
to
do
everything
we
can
for
our
kids
,
to
make
sure
that
they
have
a
full
life
and
it's
not
full
of
pain
.
But
it
takes
more
than
just
a
surgery
to
do
that
.
It
takes
getting
the
right
surgeons
at
the
right
time
.
Speaker 2
27:54
I
know
and
that's
really
,
really
important
because
right
now
,
now
you
understand
a
little
bit
better
that
even
the
cause
of
the
disease
is
not
just
for
drug
administration
,
it's
mostigenetic
disease
and
that's
why
even
yes
,
even
my
sister
and
my
nephews
,
they
can
have
a
little
bit
more
chances
of
having
the
disease
.
And
now
we
just
change
the
future
generation
with
education
and
maybe
change
the
inflammatory
diet
to
an
anti-inflammatory
diet
,
to
get
less
alcohol
consumption
,
to
get
less
tobacco
usage
,
then
sometimes
the
disease
can
control
itself
in
early
stages
.
It's
not
the
same
the
patient
that
have
a
four-centimeter
nodule
that
the
one
that
has
a
millimetric
nodule
.
So
we
have
to
change
this
because
there
are
200
million
women
affected
and
probably
more
.
Now
talking
about
this
,
it's
a
little
bit
really
sad
that
the
disease
is
in
patients
that
are
with
a
uterus
,
and
sometimes
even
senators
or
presidents
,
and
all
this
undervalidate
the
disease
.
It's
like
is
it
cancer
?
No
.
Does
it
kill
the
patient
?
No
.
What
does
it
do
?
Chronic
pain
and
infertility
.
So
they
don't
even
believe
that
the
this
should
be
,
you
know
,
like
taken
care
of
.
Speaker 2
29:07
I
think
that
this
is
really
bad
because
now
in
mexico
we're
trying
,
we're
working
with
the
senate
so
we
can
create
even
laws
.
I
know
by
heart
,
shannon
,
con
and
also
patricio
that
are
the
ones
who
created
below
the
belt
and
Endowat
.
I
bring
them
to
the
Senate
,
to
you
know
,
it
was
really
beautiful
to
see
the
senators
to
see
the
documentary
,
but
by
shame
when
they
understand
that
they
need
to
put
money
and
it's
a
disease
of
women
and
it's
not
cancer
.
Imagine
that
in
Mexico
there
are
children
with
cancer
and
they
don't
even
have
medication
.
So
imagine
endometriosis
they
don't
even
take
care
of
it
.
So
I
think
that
in
developing
countries
like
ours
,
we
have
to
change
it
and
that's
why
,
as
soon
as
we
are
working
with
Shannon
,
with
Patricia
and
worldwide
with
many
other
advocates
,
we
found
that
the
problem
in
the
US
and
Canada
was
that
you
have
around
20
million
women
affected
,
25
million
in
the
US
and
around
10
million
in
Canada
and
right
now
certified
centers
are
less
than
20
.
So
we're
trying
to
change
this
,
like
the
Atlanta
Center
,
with
doctors
in
Erbo
and
JD
.
There
are
many
others
,
like
Abimawath
in
Miami
and
Washington
.
You
have
really
good
surgeons
,
but
the
problem
is
that
they
are
too
and
they
have
even
a
waiting
list
of
two
years
.
Nocelio
has
a
waiting
list
of
two
years
.
That's
why
many
of
them
we
came
together
to
Tijuana
.
Speaker 2
30:30
The
Tijuana
Center
was
created
by
Dr
Jorge
Zavala
because
he
saw
how
many
patients
are
affected
.
Even
her
is
affected
.
So
he's
a
really
well-renowned
doctor
over
there
and
he
has
a
center
.
So
he
offered
the
center
for
the
world
top
surgeons
to
go
and
do
surgery
there
.
So
the
patients
from
Canada
and
the
US
doesn't
have
to
go
through
the
waiting
list
.
And
the
most
important
part
is
that
every
time
we
go
we
go
like
five
or
six
top
of
the
world
doctors
and
we
enter
to
the
surgery
.
So
it's
really
beautiful
because
some
cases
are
like
really
big
cases
yeah
,
so
it's
not
the
same
like
one
really
good
surgeon
enter
that
you
have
a
three
,
three
of
top
of
the
world
.
So
that
type
of
surgery
is
less
risk
.
You
cannot
imagine
when
you
see
someone
that
is
top
of
the
world
,
imagine
three
at
the
same
time
.
It's
like
simbolic
,
it's
amazing
.
Speaker 1
31:21
Yeah
,
well
,
it's
interesting
because
I
actually
love
that
perspective
too
,
because
going
to
the
endometriosis
summit
and
they
do
this
panel
and
they
talk
about
the
different
approaches
that
they
take
surgically
and
they
they
kind
of
test
each
other
back
and
forth
and
I
think
there
is
so
much
power
in
that
and
there's
so
much
power
in
surgeons
.
It's
the
iron
sharpening
iron
,
and
I
think
that
can
only
benefit
the
patient
and
the
surgeon
.
Speaker 2
31:44
Yeah
,
and
that's
amazing
because
we
have
had
in
the
Tijuana
Center
like
cases
with
super
multi-organic
involvement
the
apharic
intestine
,
bladder
and
sometimes
that
type
of
cases
for
one
surgeon
take
like
six
hours
.
If
we
enter
three
,
we
reduce
the
risk
and
we
reduce
the
hours
.
So
,
yeah
,
and
the
most
important
beautiful
thing
is
that
you
see
the
patient
post-op
and
it's
amazing
,
they
go
home
two
,
three
days
after
,
even
with
the
afragmatic
resection
,
and
you're
like
,
oh
,
this
is
good
work
.
So
that's
why
we
created
that
center
Global Impact of Endometriosis Care
Speaker 2
32:16
.
So
right
now
,
even
Marcelo
Chacaroni
from
Italy
,
william
Kondo
from
Brazil
,
many
,
many
,
many
surgeons
are
going
to
the
Tijuana
Center
to
solve
the
problem
of
North
America
,
because
right
now
we
have
patients
that
have
even
tried
to
commit
suicide
.
We
have
a
law
in
Canada
that
now
with
endometriosis
you
can
go
with
assisted
suicide
.
That's
really
bad
.
So
imagine
that
they're
changing
laws
to
commit
suicide
.
They're
not
changing
laws
to
create
a
good
health
care
system
to
treat
endometriosis
.
So
it's
something
that
is
shameful
and
we
have
to
change
it
.
Speaker 1
32:51
Yeah
,
it's
amazing
.
I
am
really
excited
to
see
how
this
progresses
and
how
this
changes
the
dynamic
of
endometriosis
care
going
forward
.
What
are
you
hopeful
for
moving
forward
in
endometriosis
care
going
forward
?
What
are
you
hopeful
for
moving
forward
in
endometriosis
care
?
Speaker 2
33:06
Oh
my
God
.
Well
,
one
of
my
best
wishes
worldwide
.
Before
,
when
I
was
younger
,
I
tried
to
become
one
of
the
best
centers
worldwide
.
That
was
my
wish
.
Now
I
change
it
.
It
changes
a
lot
because
I
underwent
just
right
now
through
some
personal
duel
and
I
went
to
to
Colombia
and
my
patient
treat
me
.
I
was
a
little
bit
sad
over
there
and
then
she
was
telling
me
like
,
like
you
,
like
,
oh
my
god
,
thank
you
so
much
,
doctor
,
for
everything
you
have
done
.
And
I
told
him
like
,
yeah
,
but
the
problem
is
that
right
now
I'm
going
through
a
dual
and
she
told
me
you
don't
understand
the
amount
of
changes
that
you
have
done
just
by
education
.
And
the
second
thing
that
she
told
me
you
don't
understand
the
amount
of
changes
that
you
have
done
just
by
education
.
And
the
second
thing
that
she
made
me
understand
really
beautifully
is
that
now
I
don't
want
to
be
like
the
best
surgeon
worldwide
or
the
best
center
.
She
told
me
something
really
important
is
that
how
do
surgeons
transcend
or
how
do
we
change
the
quality
of
life
of
women
?
Now
it's
really
beautiful
for
me
to
change
the
perspective
,
change
the
quality
of
life
of
women
.
Now
,
it's
really
beautiful
for
me
to
change
the
perspective
.
And
really
,
because
sometimes
we
have
10
,
12
surgeries
weekly
and
sometimes
we
have
20
patients
to
see
in
the
same
day
.
We're
tired
,
you
know
.
But
now
she
changed
my
perspective
to
see
that
every
time
I
do
a
good
surgery
and
good
post-op
and
everything
,
like
my
sister
,
my
sister
go
every
night
and
hug
her
children
and
she's
without
pain
.
And
that's
how
we
transcend
,
because
every
time
I'm
tired
or
I'm
sad
,
because
we're
human
beings
,
you
know
,
it's
worthy
the
amount
of
effort
that
we
do
.
So
now
I
don't
want
to
be
the
best
surgeon
or
the
best
center
.
The
only
thing
that
I
want
is
,
you
know
,
obviously
,
to
be
happy
.
But
the
second
thing
is
that
my
patients
can
get
home
and
they
have
a
good
quality
of
life
and
be
with
their
loved
ones
.
And
that's
the
way
a
surgeon
should
transcend
,
because
through
all
that
lives
that
we
change
and
through
all
that
lives
that
she
can
get
,
like
my
sister
,
to
her
family
and
hug
them
and
be
,
you
know
,
love
them
,
and
without
pain
.
That's
how
we
will
transcend
forever
.
Yeah
,
so
that's
a
good
wish
that
I
could
change
worldwide
.
If
we
can
only
change
worldwide
how
they
should
treat
it
,
then
super
easy
.
Speaker 2
35:15
I
think
that
the
only
way
to
change
this
because
I
don't
know
if
you
knew
,
but
El
Salvador
,
the
country
,
the
one
who
approached
to
us
was
the
first
lady
.
So
the
first
lady
was
saying
about
endometriosis
it
was
amazing
,
el
Salvador
is
something
out
of
this
world
.
Even
the
president
is
really
good
and
intelligent
.
So
the
first
lady
sent
us
a
letter
to
the
Minister
of
Health
and
they
invited
us
to
change
in
one
year
endometriosis
care
.
So
they
understand
mapping
,
they
understand
everything
,
and
it's
like
I
will
put
all
of
the
doctors
of
El
Salvador
to
see
this
and
we're
going
to
create
one
center
for
full
Salvador
with
mapping
,
excision
,
everything
.
So
you
can
understand
how
a
full
country
just
by
one
mandate
.
That
was
the
first
lady
.
They
changed
one
year
everything
and
it
was
like
,
oh
my
God
,
that's
how
it's
supposed
to
be
done
,
but
that's
a
presidency
.
So
imagine
if
the
first
lady
of
the
US
approached
us
and
they
can
enter
with
mapping
and
everything
else
,
the
problem
is
solved
.
But
that's
something
hard
.
Speaker 1
36:22
It
is
.
It's
something
hard
.
It
is
.
It's
extremely
hard
,
and
we
have
to
break
generational
ties
to
what
used
to
be
,
and
I
think
that
is
probably
some
of
the
hardest
to
do
is
to
break
all
of
this
bad
knowledge
and
bring
in
the
new
.
And
that's
a
really
big
challenge
that
we
face
here
in
the
us
specifically
,
and
so
I'm
hopeful
,
though
I'm
really
hopeful
that
we
can
,
here
in
the
US
specifically
,
and
so
I'm
hopeful
,
though
I'm
really
hopeful
,
that
we
can
,
as
a
community
,
come
together
.
Speaker 1
36:47
And
something
that
you
said
that
is
impactful
is
that
you
put
yourself
outside
of
just
your
happiness
and
what
you
want
to
do
and
your
goals
for
the
overall
goals
in
life
of
your
patients
,
and
I
think
that
,
for
me
,
same
thing
it
drives
me
to
continue
going
.
There's
moments
I
do
want
to
give
up
,
and
there's
moments
that
podcasting
is
not
easy
,
because
you
know
this
is
a
voluntary
thing
for
me
,
and
so
to
do
this
,
sometimes
I
want
to
give
up
,
and
it's
those
patients
and
those
people
that
reach
out
to
me
and
say
this
really
impacted
me
,
this
really
helped
me
,
and
that's
what
keeps
me
going
,
that's
what
keeps
that
drive
alive
,
and
I
think
that
when
we
continue
doing
that
,
we
will
make
a
difference
as
a
community
and
I'm
really
excited
for
that
.
Speaker 2
37:28
Yeah
,
I
think
that
the
most
important
part
is
to
change
this
and
,
yes
,
thank
you
very
much
for
having
me
.
Obviously
,
whatever
we
can
do
to
change
the
quality
of
life
for
women
,
we
will
do
it
.
I
will
send
you
the
presentation
as
well
as
a
mapping
study
so
you
can
see
how
we
are
doing
it
,
and
also
,
you
can
send
this
to
other
patients
.
They
can
,
you
know
,
ask
for
this
for
their
doctors
.
Just
by
asking
.
With
this
,
they
will
change
the
quality
of
surgery
,
they
will
change
the
quality
of
treatment
,
and
that's
something
that
we
should
change
.
Speaker 1
37:57
Yeah
,
absolutely
.
Thank
you
,
dr
Carpenter
,
for
all
your
time
and
for
your
energy
and
effort
.
I
appreciate
you
so
much
more
than
you
probably
realize
,
so
thank
you
so
much
.
Speaker 2
38:06
Oh
no
,
it
was
my
pleasure
and
please
,
whatever
you
need
Also
,
I'm
there
already
for
you
guys
.
Speaker 1
38:11
Thank
you
so
much
.
It
was
such
a
pleasure
to
have
you
on
today
.
Do
you
have
any
questions
or
comments
about
this
episode
or
any
others
?
We'd
love
to
hear
from
you
.
While
I'm
not
an
expert
,
I
can
definitely
ask
one
on
your
behalf
.
You
can
reach
out
in
a
couple
of
ways
.
Just
click
on
the
,
send
us
a
text
link
in
the
episode
description
,
or
us
directly
at
contact
at
indobatterycom
.
I
look
forward
to
hearing
from
you
and
,
until
next
time
,
continue
advocating
for
you
and
for
those
that
you
love
.