Endo Year Reflections: #10 How Two Pioneering Surgeons Changed My View Of Pain, Surgery, And Possibility

Reflection Series Kickoff

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With
the
Indo
Year
coming
up,
it's
a
perfect
time
to
reflect
on
all
the
lessons,
growth,
and
amazing
guests
we've
had
on
Indobattery.
But
instead
of
one
big
recap,
I'm
breaking
it
into
quick,
bite-sized
reflections
multiple
times
a
week.
Let's
revisit
what
inspired
us,
learn
what
we
missed,
and
recharge
together
in
our
Endo
Year
Reflection
series.
Join
me
each
episode
as
we
look
back.
Welcome
to
Indobattery,
where
I
share
my
journey
with
endometriosis
and
chronic
illness
while
learning
and
growing
along
the
way.
This
podcast
is
not
a
substitute
for
medical
advice,
but
a
supportive
space
to
provide
community
and
valuable
information
so
you
never
have
to
face
this
journey
alone.
We
embrace
a
range
of
perspectives
that
may
not
always
align
with
our
own,
believing
that
open
dialogue
helps
us
grow
and
gain
new
tools.
Join
me
as
I
share
stories
of
strength,
resilience,
and
hope,
from
personal
experiences
to
expert
insights.
I'm
your
host,
Alana,
and
this
is
Indobattery,
charging
our
lives
when
Indometriosis
drains
us.
Welcome
back
to

What Neuropelveology Teaches Us

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Indobattery.
As
we
continue
in
our
Indo
Year
Reflection
series,
I
am
still
in
awe
of
the
year
that
we
have
had.
I'm
still
pinching
myself
in,
is
this
my
reality?
And
it
kind
of
is.
And
I
hope
that
you
feel
that
way
too.
When
I
look
back
at
episode
144,
sitting
down
with
Professor
Mark
Possover
was
one
of
those
conversations
that
fundamentally
shifted
how
I
understand
pain,
endometriosis,
and
the
body
as
a
whole.
We
talked
about
neuropalveology,
a
word
many
people
have
never
heard,
but
a
field
that
affects
so
many
lives.
At
its
core,
neuropalveology
is
about
the
nerves
of
the
pelvis,
but
we
didn't
stop
there.
We
talked
about
the
nerves
throughout
the
entire
body,
including
one
of
the
most
influential
nerves
we
have,
the
vagus
nerve.
Professor
Prosover
walked
us
through
the
role
of
the
vagus
nerve,
the
sympathetic
and
parasympathetic
nervous
system,
and
the
balance
between
the
fight
or
flight,
rest
and
digest.
And
suddenly,
so
many
things
clicked.
How
we
experience
pain,
how
inflammation
shows
up,
how
our
nervous
system

Autonomic Balance And Pain

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may
influence
the
way
endometriosis
manifests
and
persists.

SPEAKER_02
2:15

You
have
two
kinds
of
nerves.
You
have
what
we
call
somatatic
nerve
that
on
the
nerve
which
command
the
red
muscle.
So
if
you
want
to
move
a
leg,
it's
because
you
have
an
activation,
for
example,
of
the
somatic
nerve.
And
behind
this
somatitic
nerve,
you
have
an
auto
another
nervous
system,
what
we
call
autonomic
nervous
system
or
vegetative
nerve
system.
That
is
a
nerve
system
we
cannot
control.
For
example,
if
I'm
breathing,
and
it's
no
need
for
me
to
think
about
that,
or
if
my
cardiac
is
working,
it's
because
I
have
an
autonomic
nerve
system.
Or
for
example,
in
the
pelvic
cavity,
the
bladder.
If
I
want
to
go
on
the
toilet
and
to
empty
my
bladder,
my
brain
is
giving
the
information
to
it.
But
then
the
autonomous
nerve
system
is
doing
is
no
need
for
me
to
think
I
am
already
avoiding
my
bladder.
That's
the
reason
why.
Suppose
you
want
to
empty
your
bladder,
you
go
on
the
toilet,
and
suppose
you
have
a
book.
So
you
can
say,
okay,
I
want
to
pee,
the
brain
will
give
you
information,
but
the
vegetative
nerve
system
will
do
by
himself.
So
it's
no
need
for
you
to
think
while
you
are
empty
your
bladder.
You
can
read
a
book
because
the
autonomous
system
does
that
by
your
own.
And
the
vegetative
nerve
system
is
the
nerve
system
that
the
Chinese
medicine
well
knows.
And
you
have
two
systems.
You
have
a
bad
nerve
system
and
a
good
nerve
system.
And
the
bad
nerve
system
is
what
we
call
the
sympathetic.
It's
called
sympathetic
in
French.
Sympathetic
would
now
mean
nice.
But
it's
not
a
nice
nerve
system.
The
sympathetic
nerve
system
is
involved
is
in
its
increase
in
pain,
in
uh
dysmemory,
if
you
have
a
headache,
if
you
are
worried,
if
you
don't
feel
good.
That
is
the
uh
the
sympathetic
nerve
system.
And
on
the
other
side,
you
have
the
parasympathetic
nerve
system,
which
is
called
the
rest
and
digest
nerve
system.
And
this
parasympathetic
nerve
system
is
for
the
well-feeling.
So
if
you
have
no
pain,
if
you
feel
good
in
your
life,
you
are
you
enjoying
your
life,
you
can
properly
avoid
your
bladder,
you
are
properly
intercourse,
and
all
these
things
is
because
you
have
the
autonomous
nerve
system.
And
these
both
nerve
systems
are
in
balance.
So
the
parasympathetic,
the
good
autonomic
nerve
system
is
uh
if
it
increases,
it
will
decrease
the
sympathetic
nerve
system.
So
suppose
you
have
pain,
pain
means
you
have
an
activation
of
the
sympathetic
nerve
system.
You
can
say
I
will
reduce
this
sympathetic
nerve
system,
for
that
I
will
take
painkillers.
There
is
another
way
to
say
because
they
are
in
balance,
you
can
reduce
the
sympathetic
nerve
system,
and
that
way
the
well
nerve
system
will
increase,
or
you
will
say
will
increase
by
myself
without
painkiller,
the
parasympathetic
nerve
system.
And
the
parasympathetic
nerve
system,
you
have
two
systems,
one
in
the
pelvis,
which
you
cannot
control
with
the
brain,
and
you
have
the
second
system
is
the
vagus
nerve.
And
the
vagus
nerve
is
a
nerve
that
emerges
directly
for
the
brain,
is
running
in
the
neck
outside
the
spinal
cord
and
go
in
your
abdomen
and
will
go,
will
control
your

Vagus Nerve And Wellbeing

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cardiac
activity,
the
lung,
um,
all
the
different
functions.
So
if
you
are
able
to
activate
the
vagus
nerve
in
your
life,
you
will
be
more
happy.
It's
so
simple
as
that.

Nerve-Sparing Surgery Realities

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Professor
Possover
has
spent
studying
the
role
of
nerves
in
the
body,
working
with
patients
ranging
from
those
with
endometriosis
to
individuals
with
spinal
cord
injuries.
One
of
the
areas
he's
especially
known
for
is
sciatic
endometriosis,
a
rare
but
devastating
condition
that
requires
an
extraordinarily
skilled
surgeon.
He
spoke
candidly
about
how
delicate
nerve-sparing
surgery
truly
is,
and
how
choosing
the
wrong
surgeon
in
these
cases
can
lead
to
outcomes
worse
than
symptoms
someone
had
before
surgery.
The
margin
for
error
is
small
and
the
consequences
are
lifelong.
What
struck
me
most
though
wasn't
just
his
expertise,
it
was
his
kindness.
I
had
the
privilege
of
spending
over
an
hour
with
him
before
even
starting
to
record.
Our
conversation
was
filled
with
curiosity,
big
ideas,
and
thinking
outside
the
box.
And
not
once
did
he
make
me
feel
inadequate,
underqualified,
or
out
of
place.
In
fact,
when
I
shared
a
few
thoughts,
ideas
I
half
jokingly
assumed
were
probably
wild,
he
paused
and
said,
hmm,
that's
actually
a
very
good
thought.
And
I'll
be
honest,
I
had
to
mentally,
you
know,
pat
myself
on
the
back
for
that
one.
As
one
of
the
leading
surgeons
in
neuropalveology,
Professor
Possover
could
easily
stay
in
the
operating
room
and
never
look
back.
But
he
chooses
to
teach,
to
educate
patients,
to
mentor
doctors
because
he
doesn't
want
to
be
the
best.
He
wants
the
next
generation
to
be
better.
He
wants
this
knowledge
to
outlive
him,
and
that
speaks

Fertility Data After Excision

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volumes.
The
same
sense
of
reverence
and
awe
followed
me
in
episode
173,
where
I
had
the
immense
honor
of
sitting
down
with
Professor
Horace
Ramon.
I
truly
cannot
overstate
what
a
privilege
this
conversation
was.
Professor
Roman
is
widely
regarded
as
one
of
the
best
endometriosis
surgeons
in
the
world.
And
that's
not
my
opinion.
That's
coming
from
his
surgical
peers,
from
physicians
across
the
globe
who
speak
of
him
with
deep
respect
and
admiration.
He
teaches
complex
endometriosis
surgery
to
doctors
from
all
over
the
world,
but
his
work
doesn't
stop
in
the
operating
room.
For
more
than
15
years,
Professor
Ramon
has
studied
the
role
of
proper
surgical
excision
and
fertility
outcomes.
He
has
followed
patients
after
excision,
tracking
natural
conception
rates
and
quality
of
life
improvements,
and
the
data
is
remarkable.

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8:40

Now
I
think
we
have
uh
5,000,
6,000
women
who
had
surgery,
well
done
surgery,
excisional
surgery,
with
a
follow-up,
which
is
uh
now
is
uh
15
years.
The
oldest
the
oldest
patients
have
15
years
of
follow-up,
and
we
have
just
today
submitted
an
article
about
15
years
follow-up
after
colorectal
endometriosis
surgery.
So
this
database
allows
me
to
study
everything
postoperatively,
what's
happened
after
the
surgery.
And
it
also
also
allows
me
to
see
the
real
number,
the
real
percentage,
who
who
is
pregnant
and
who
is
not,
how
the
presence
how
the
pregnancy
is
achieved,
how
long
time
after
the
surgery.
And
I
could,
in
this
case,
I
could
publish
studies
which
show
that
after
the
surgery
of
most
advanced,
most
complex
endometriosis,
the
pregnancy
rate
is
very
high.
And
this
happened
at
a
moment
where
a
lot
of
colleagues,
a
lot
of
gynecologists
were
telling
to
patients,
don't
have
surgery
because
you
will
be
infertile.
And
my
answer
was
no.
Conversely,
if
you
want
to
be
so
if
you
want
to
be
to
be
pregnant,
please
consider
the
surgery
as
a
treatment
of
your
infertility.
And
of
course,
all
my
studies
try
to
put
in
the
mirror
pregnancy
rates
in
women
who
have
no
surgery
and
have
only
IVF
with
women
who
have
surgery.
And
I
could
demonstrate
that
women
with
surgical
management
of
endometriosis
have
at
least
the
same
pregnancy
rate
that
women
who
have
up
to
four
IVF,
successive
IVF.
And
right
now
in

Rethinking IVF Pathways

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the
world
there
are
two
randomized
trials
comparing
in
a
random
manner,
comparing
IVF
to
the
surgery.
One
of
them
is
in
France,
EndoFert,
and
the
other
one
is
Bordeaux
and
Denmark.
It
calls
FOR.
So
I
am
involved
in
both
studies,
I
recruit
for
both
studies,
because
both
studies,
the
hypothesis
is
based
on
my
data.
And
both
studies
try
to
show
that
the
pregnancy
rate
after
the
surgery,
with
natural
conception
or
postoperative
IVF,
this
pregnancy
rate
is
better
than
in
women
who
have
no
surgery
and
or
sent
directly
to
IVF.

SPEAKER_00
11:05

What
his
work
asks
us
to
consider
is
this.
What
if
IVF
isn't
always
the
first
or
only
answer?
What
if
addressing
the
root
cause,
endometriosis
itself,
could
improve
fertility
and
overall
quality
of
life?
In
a
space
where
fertility
conversations
are
often
rushed,
fragmented,
or
emotionally
overwhelming,
Professor
Ramon's
work
offers
something
grounding,
evidence,
patience,
and
a
long-term
view
of
healing.
After
sitting
down
with
both
Professor
Possover
and
Professor
Ramon,
I
truly
had
to
pinch
myself.
I'm
just
a
patient,
someone
who's
curious,
someone
who
wants
to
learn
and
understand
the
nuances
of
this
disease
better.
And
yet
I
found
myself
at
the
table
with
two
of
the
most
respected
minds
in
endometrios'
care.
And
not
once
did
I
feel
small.
I
never
felt
dumb.
I
never
felt
like
I
didn't
belong.
They
valued
my
questions.
They
welcomed
my
perspective.
And
that
kind
of
respect
leaves
a
lasting
impact.
These
are
the
doctors
who
remind
me
why
progress
happens.

Respect, Curiosity, And Progress

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12:07

They
think
outside
the
box,
they
refuse
complacency.
Because
of
their
and
the
work
of
others
like
them,
patients
aren't
just
surviving
inside
cycles
of
pain
and
trauma.
They're
being
offered
better
care,
better
outcomes,
and
real
hope.
I'm
endlessly
grateful
for
the
years
of
dedication,
research,
and
innovation
they've
given
to
this
community.
And
I
cannot
wait
to
see
what
breakthroughs
they
bring
next,
because
I
know
whatever
it
is,
it
will
change
the
status
quo
in
the
best
possible
way.
And
here
is
your
little
nugget
for
your
holiday
survival
guide.
Redefine
productive.
Resting
is
doing
something.
Just
food
for
thought.
As
we
continue
looking
back
through
this
year,
I
invite
you
to
listen
with
curiosity
and
openness.
You
may
hear
something
that
changes
how
you
understand
your
body.
You
may
find
language
for
an
experience
you've
never
been
able
to
explain.
And
you
may
discover
that
an
episode
you
didn't
expect
to
need
becomes
exactly
what
you
need

Holiday Nugget: Rest Is Productive

SPEAKER_00
13:06

all
along.
Thank
you
for
being
here.
Thank
you
for
learning
with
me,
and
thank
you
for
continuing
to
come
back
to
this
table
where
curiosity,
compassion,
and
courage
meet.
We'll
keep
moving
forward
together,
one
meaningful
conversation
at
a
time.
Until
next
time,
continue
advocating
for
you
and
for
others!