Endo Year Reflection: #16

Surgical Mapping in Endometriosis Care

Speaker 1
0:02

Welcome

to

EndoBattery
,

where

I

share

my

journey

with

endometriosis

and

chronic

illness
,

while

learning

and

growing

along

the

way
.

This

podcast

is

not

a

substitute

for

medical

advice
,

but

a

supportive

space

to

provide

community

and

valuable

information

so

you

never

have

to

face

this

journey

alone
.

We

embrace

a

range

of

perspectives

that

may

not

always

align

with

our

own
.

Believing

that

open

dialogue

helps

us

grow

and

gain

new

tools

always

align

with

our

own
.

Believing

that

open

dialogue

helps

us

grow

and

gain

new

tools
.

Join

me

as

I

share

stories

of

strength
,

resilience

and

hope
,

from

personal

experiences

to

expert

insights
.

I'm

your

host
,

alana
,

and

this

is

IndoBattery

charging

our

lives

when

endometriosis

drains

us
.

Welcome

back

to

IndoBattery
.

Grab

your

cup

of

coffee

or

your

cup

of

tea

and

join

me

at

the

table

for

the

last

time

this

year
.

Happy

New

Year
.

As

we

close

out

this

year

and

the

Indo

Year

Reflection

Series
,

I

hope

you're

leaving

this

year

feeling

hopeful
,

inspired

and

full

of

anticipation

for

what's

to

come
.

This

year

has

been

a

journey
,

hasn't

it
?

Together
,

we've

walked

through

challenges
,

breakthroughs

and

so

many

lessons
.

I've

grown

tremendously

and

found

new

confidence

and

guidance

in

my

own

journey
,

and

I

hope

this

podcast

has

done

the

same

for

you

as

we

wrap

up

2024,
.

Speaker 1
1:17

I

feel

it

was

only

fitting

to

conclude

this

series

with

a

discussion

about

a

topic

which

should

set

the

standard

of

care

for

the

future
,

which

is

surgical

mapping
.

In

episode

88
,

I

sat

down

with

Dr

Romero

Cabrera

to

explore

what

should

be

the

gold

standard

in

presurgical

intervention

in

endometriosis

care
.

For

the

longest

time
,

I

believed

what

so

many

of

us

have

been

told

Imaging

is

useless

when

it

comes

to

endometriosis
.

And

yes
,

there's

a

margin

for

error

in

diagnosing

with

imaging
,

especially

when

the

person

interpreting

lacks

the

right

training
.

But

shifting

my

mindset

to

understand

the

value

of

imaging

for

surgical

mapping
,

that

was

mind-blowing
.

What

shocked

me

even

more

was

learning

just

how

outdated

the

US

and

other

countries

are

in

its

protocol

for

staging

and

imaging

for

endometriosis
.

Take

a

listen

to

this

insightful

clip

from

Dr

Ram

as

he

breaks

this

down

for

us
.

Speaker 2
2:14

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

endometriosis

started

in

Europe
,

in

France

and

in

Italy
.

They

found

out

that

the

radiologists

who

are

used

to

see

the

endometriosis

with

the

special

protocols

because

everyone

in

the

US

has

an

MRI

every

hospital

has

the

best

ultrasound
.

I

can't

even

assure

you

they

have

the

best

ultrasound

in

the

rest

of

the

world
.

But

the

problem

is

that

the

radiologist

needs

to

go

through

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

disease

or

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

who

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

the

pedometriosis

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

a

MRIs

they

put

a

rectal

gel

and

vaginal

gel

and

some

medication

for

them

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
,

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
4:15

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
.

Speaker 2
5:22

In

the

US

they

are

still

doing

something

that

is

Association

for

Reproductive
,

society

of

Medicine

classification

that

divides

the

disease

in

stages
,

stage

1

to

stage

4
.

Speaker 2
5:33

Right

now

that

classification

is

really

old
.

Speaker 2
5:36

It's

the

one

that

my

father

used

to

use
,

because

if

they

go

under

surgery

and

they

classify

you

with

a

stage

four
,

like

they

did

with

my

sister
,

my

sister

will

tell

you

oh
,

thank

you

very

much
,

but

that

doesn't

mean

anything
.

That

means

that

I

have

in

every

place
.

With

the

NCM

protocol

we

can

do

the

classification

before

surgery
.

That's

mandatory
,

and

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

we
,

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
6:43

Hearing

this

and

understanding

why

mapping

matters

is

so

important
.

As

someone

who's

undergone

multiple

surgeries
,

including

one

where

I

expected

a

straightforward

laparoscopy

but

woke

up

with

a

C-section

length

incision

and

a

far

more

extensive

procedure
,

I

wish

this

approach

had

been

available
,

or

better

known
,

back

then
.

Dr

Ram

explains

why

this

is

so

important
.

Take

a

listen
.

Speaker 2
7:06

So
,

as

myself
,

there

are

many

doctors

who

is

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

excision
.

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'm

10

years
,

so

that's

an

innate

ability
.

Sometimes

it's

doing

surgery
.

Speaker 2
7:56

You

have

to

have
,

obviously
,

classes

and

like

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
.

Speaker 2
8:59

Endometriosis

is

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
.

Speaker 2
9:16

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
9:35

As

we

step

into

a

new

year
,

I

hope

we

all

set

the

bar

higher

for

presurgical

planning
.

For

many

of

you
,

2025

may

bring

surgery
.

Some

of

you

may

already

have

it

on

the

schedule
.

My

advice

ensure

your

doctor

has

a

clear
,

well-thought-out

plan

with

solid

reasoning

behind

it

before

agreeing

to

surgery
.

Trust

me
,

this

can

make

all

the

difference

in

your

outcome

and

recovery
.

Having

realistic

expectations

is

equally

important
.

Those

with

severe

disease

often

need

longer

recovery

times

and

additional

strategies

to

achieve

better

quality

of

life
,

but

knowing

this

beforehand

can

go

a

long

way

toward

preparing

you

mentally
,

emotionally

and

physically
.

Endometriosis Podcast Community Appreciation

Speaker 1
10:18

Thank

you

for

being

part

of

this

journey

with

me
.

It

means

the

world

that

I

get

to

do

this

and

share

it

with

you
.

I'm

constantly

looking

for

ways

to

improve

this

podcast

and

meet

you

where

you

are
.

If

you

have

recommendations

or

questions
,

please

email

me

at

contactendobatterycom

or

message

me

on

Instagram
.

I'd

love

to

hear

them
.

If

this

podcast

has

helped

you

this

year
,

consider

sharing

it

with

others

who

might

need

a

little

endo

recharge
.

Being

part

of

this

community

is

truly

a

gift
.

While

this

disease

can

take

so

much

from

us
,

it

also

gives

us

the

strength

and

solidarity

of

walking

along

others

who

understand
.

Thank

you

for

walking

with

me

this

year
.

I

am

abundantly

grateful

and

until

next

year
,

continue

advocating

for

you

and

for

those

that

you

love
.