Endo Year Reflections: #2 Looking Back At Insurance, Hernia’s, & Mindset

Welcome And Series Setup

SPEAKER_00
0:00

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.

Why Expert Excision Rarely Fits Insurance

SPEAKER_00
1:06

This
year
truly
started
off
with
a
bang.
And
by
bang,
I
mean
one
of
those
moments
where
you
think,
okay,
this
conversation
has
been
a
long
time
coming.
It
actually
took
about
nine
months,
almost
a
full
year,
to
get
this
guest
on
the
podcast.
Not
because
he
didn't
want
to
be
here,
but
because
he's
incredibly
busy
doing
work
so
many
of
us
desperately
need.
Dr.
Jeff
Errington
joined
me
in
episode
108
to
talk
about
something
that
almost
every
single
one
of
us
feels
to
our
bones,
the
deep
frustration
around
insurance
and
excision
care.
Because
here's
the
reality
we
want
expert
care.
We
need
expert
care.
And
yet
so
often
we
simply
can't
afford
it.
And
what
I
appreciate
most
about
this
conversation
is
that
Dr.
Errington
didn't
sugarcoat
it.
He
broke
down
exactly
why
the
system
is
so
challenging,
not
just
for
patients,
but
for
providers
too.
How
the
insurance
models
make
it
incredibly
hard
to
do
things
the
right
way,
to
keep
the
lights
on,
and
to
practice
medicine
with
integrity
and
time
and
precision.
So
for
many
of
us,
insurance
feels
like
the
villain
in
the
story.
Why
so
many
expert
excision
surgeons
end
up
practicing
outside
of
traditional
insurance
models?

SPEAKER_02
2:36

There
is
there
is
far
more
complexity
to
really
doing
good
endometriosis
work,
doing
the
dissections,
separating
the
adhesion,
separating
the
bowel,
working
around
the
ureters,
than
somebody
that
goes
in
and
says,
Oh,
that
endometriosis
directly
over
the
ureter.
I
very
carefully
just
touched
cottery
to
it
so
I
didn't
damage
the
ureter
instead
of
doing
the
appropriate
dissection
and
separating
the
disease
out,
or
if
they
go
in
and
see
some
bowel
endometriosis
to
maybe
just
very
easily,
carefully
safely
burn
across
the
surface,
but
not
really
treat
it.
Or
the
the
risk
of
that
is
far
less
than
a
doctor
actually
going
in
and
cutting
the
disease
out
and
repairing
the
bowel
or
dissecting
the
ureter
out.
The
thing
where
that
comes
into
play
when
insurance
companies
look
at
that
RVU
for
laparoscopy,
they
don't
make
any
adjustments
on
the
complexity
risk
between
superficial
ablation
and
excision
of
disease.
To
the
insurance
companies
and
to
that
CAMS
RVU
system,
it's
all
the
same.
And,
you
know,
and
that's
that's
just
the
malpractice
side
of
things.
Certainly
the
work
involved,
you
know,
taking
10,
15
minutes
to
quickly
burn
a
few
places
rather
than
two
or
three
hours
to
cut
disease
out,
they
they
have
zero
accounting
for
the
extra
work
involved
and
the
tedious
work
involved
in
full
excision
rather
than
just
spot
burning
a
couple
places
and
saying
that's
the
best
I
can
do.
So
when
when
we
look
at
the
way
that
insurance
looks
at
things,
they
consider
a
superficial,
you
know,
let's
say
somebody
gets
in
and
there's
just
endometriosis
everywhere,
but
no
adhesions.
And
let's
just
say
that
it,
you
know,
there
is
some
depth
to
the
disease,
but
there's
no
bowel
involvement,
no
ureter
dissections,
but
really
widespread
endometriosis
with
some
depth
to
the
to
the
tissues,
to
the
side
of
the
rectum.
Going
in
and
cutting
that
out,
you
know,
can
take
an
hour
and
a
half,
a
couple
hours
sometimes
compared
to
a
dog
just
going
in
and
saying,
well,
here's
a
few
spots,
let's
burn
those,
and
then
leaving
everything
else
untreated
and
untouched.
We're
talking
a
10,
15
minute
surgery
versus
an
hour
and
a
half
surgery,
and
the
compensation,
the
RVU
value

Complexity, RVUs, And Surgical Tradeoffs

SPEAKER_02
4:36

for
those
procedures
is
exactly
the
same.

SPEAKER_00
4:38

One
of
the
biggest
takeaways
for
me
in
this
episode
was
the
conversation
around
informed
consent.
Because
informed
consent
isn't
just
about
signing
a
piece
of
paper,
it's
understanding
what's
happening
in
your
body,
what
your
options
are,
and
what
the
long-term
implications
might
be.

SPEAKER_02
4:55

The
most
important
thing,
I
mean,
both
both
words
in
that
informed
consent,
both
are
equally
important.
Patient
cannot
give
consent
if
they're
not
informed.
And
we
have
to
start
by
basically
providing
information.
And
that
starts
with
the
doctor
just
sitting
and
listening
to
a
patient,
understanding
and
considering
the
history
and
formulating
in
my
mind
as
a
physician
what
I
think
is
going
on.
This
is
what's
called
the
differential
diagnosis.
We
basically
try
to
piece
all
the
symptoms
together
together
and
try
to
think
of
all
the
different
things
that
could
explain
what
the
patient
is
experiencing.
Certainly
in
my
line
of
work,
the
most
common
are
endometriosis,
pelvic
floor
pain,
adenomyosis,
interstitial
cystitis,
nerve
impingements
or
nerve
irritations,
those
sorts
of
things.
And
then
we
try,
and
then
we
step
back
and
think,
okay,
what
can
I
do
to
explore
that
a
little
bit
more
and
see
if
we
can
wean
down
or
get
a
better
idea
between
all
those
possibilities,
what
the
most
likely
sources
are.
That's
where
the
exam
comes
into
play,
and
then
that's
when
any
imaging
comes
into
play.

SPEAKER_00
6:10

We
also
talked
about
dynamic
imaging,
specifically
dynamic
ultrasound
and
why
it
can
be
such
a
powerful
tool
in
endometriosis
diagnosis
when
it's
done
by
someone
who
truly
knows
what
they're
looking
at.
Expert
mapping
before
surgery
can
change
everything.
As
many
surgeons
will
tell
you,
and
Dr.
Errington
explains
this
beautifully,
they
would
often
rather
operate
on
a
stage
four
endometriosis
case
than
someone
who's
had
multiple
surgeries
labeled
stage
two
or
three.
Why?
Adhesions,
scarred
tissue,
the
damage
that
happens
when
disease
is
missed,
minimized,
or
incompletely
treated.
That
alone
is
something
I
wish
everyone
could
hear.
But
what
makes
this
relationship
with
Dr.
Errington
so
special
goes
far
beyond
the
podcast,
Mike.
He
didn't
just
show
up
to
educate,
he
showed
up
for
the
community.
As
many
of
you
know,
he
actually
traveled
all
the
way
out
here
to
Colorado
to
support
the
nonprofit
that
I'm
part
of,
an
event
that
we
had.
This
is
where
I
need
to
tell
you
a
little
behind
the
scenes
story.
Because
on
the
day
of
the
event,
my
car
battery
died.
Not
my
old
car,
my
nice
car.
Now,
I
also
own
what
we
lovingly
referred
to
as
the
barn
car.
And
if
you've
never
ridden
in
a
barn
car,
let
me
paint
you
a
picture.
It
smells
exactly
like
what
you'd
think
it'd
smell
like.
Horses,

Informed Consent Done Right

SPEAKER_00
7:38

hay,
manure,
the
full
experience.
I
was
running
late,
so
instead
of
picking
up
Dr.
Errington
myself,
I
had
one
of
my
teammates
grab
him
from
the
shuttle.
I
thought
I
was
being
kind.
I
thought
I
was
being
courteous.
I
thought,
surely,
no
one
wants
to
smell
like
a
barn
on
the
way
to
an
endometriosis
event.
Turns
out
I
was
wrong.
He
was
actually
disappointed
he
didn't
get
to
ride
in
the
barn
car.
Apparently,
it
brought
him
straight
back
to
his
childhood.
So,
yes,
we
now
know
this
about
Dr.
Errington,
world-class
excision
surgeon,
insurance
expert,
and
nostalgic
about
the
smell
of
a
barn.
Oh
no.
All
humor
aside,
I
continually
learned
so
much
from
Dr.
Errington.
He
has
this
rare
ability
to
break
down
incredibly
complex
topics,
insurance,
hormones,
informed
consent,
imaging
in
a
way
that's
factual,
clear,
and
actually
understandable.
And
the
best
part
of
education
doesn't
stop
here.
We'll
be
continuing
this
conversation
in
the
new
year,
including
discussions
around
hormones
and
you
know,
things
like
ACOG
updates.
So
definitely
be
on
the
lookout
for
that.
If
there's
one
thing
this
episode
reminded
me
of,
it's
this
knowledge
is
power,
but
shared
knowledge
is
how
we
change
outcomes.
And
while
the
system
is
frustrating,
conversations
like
this
help
us
advocate
more
clearly,
ask
better
questions,
and
understand
why
finding
true
experts
matters
so
much.
So
as
you
listen
to
these
clips,
I
invite
you
to
reflect
on
what
stood
out
to
you,
what
clicked,
and
what
you
wish
you
had
known
sooner.
And
if
nothing
else,
maybe
we
will
all
remember
that
sometimes
even
the
heaviest
topics
can
still
leave
room
for
learning,
connection,
and
apparently
the
occasional
barn-scented
memory.
Some
episodes
stay
with
you
because
they
teach
you
something
new.
Others
stay
with
you
because
they
change
the
way
you
think
about
pain
entirely.
And
this
episode
did
both.
In
episode
109,
Dr.
Sharin
Tofi
joined
me
to
talk
about
hernias.
And
I
know
if
you're
listening
to
this
right
now,
you
might
be
thinking,
what
do
hernias
have
to
do
with
endometriosis?
Turns
out
a
lot
more
than
we've
been
led
to
believe.
Because
endometriosis
isn't
always
the
pain
generator
in
the
body.
And
for
so
many
people,
especially
women,
hernia
pain
flies
completely
under
the
radar.

Dynamic Imaging And Surgical Mapping

SPEAKER_00
10:11

Dr.
Tofi
explained
something
that
really
stuck
with
me.
The
hernias
that
affect
women
often
don't
look
like
the
classic
bulge
we've
been
taught
to
watch
for.
They're
subtle,
they
press
gently
on
nerves,
they
whisper
instead
of
shout,
and
yet
they
can
cause
significant
life-altering
pain.
Pain
that
mimics
pelvic
pain,
hip
pain,
groin
pain,
pain
that
so
many
of
us
have
been
told
is
just
part
of
endometriosis.
One
of
the
most
striking
things
Dr.
Tofi
shared
is
that
men
often
don't
feel
pain
from
hernias,
but
women
do.
And
that
alone
should
make
us
pause.
Because
if
women
experience
hernias
differently,
but
we're
using
male-centric
diagnostic
expectations,
of
course,
things
are
going
to
get
missed.

SPEAKER_03
10:57

So,
you
know,
when
I
talk
to
my
medical
students,
when
I
teach
them,
I
ask
them,
when
do
you
guys
get
taught
about
hernias?
And
it's
during
the
male
genital
urinary
system.
So
it's
always
connected
to
a
male
disease.
There
are
gynecologists
that
don't
know
that
women
can
get
hernias.
So
it's
we
have
to
do
better
job
teaching
as
early
as
medical
school
that
women
can
get
hernias.
And
we
actually
publish
another
paper
that
specifically
outlines
how
women
present
differently
than
men
for
the
same
exact
disease.
Men
tend
to
present
with
a
bulge,
women
tend
to
present
with
pain.
Men
tend
not
to
present
with
pain,
actually.
And
so
there
are
surgeons
that
say
if
it's
if
it's
painful,
it's
not
a
hernia.
And
that
I'm
like,
that's
completely
wrong.
So
there's
a
lot
of
misinformation
out
there.
And
I
think
because
it's
always
been
a
male-dominated
view
of
hernia
disease
and
male-dominated
care,
all
of
our
surgical
techniques
are
for
man,
men.
All
of
our
randomized
controlled
trials
included
only
men,
our
mesh
is
designed
for
a
male
anatomy.
So
there's
a
lot
of
bias
against
women
for
this
disease
and
diagnosis
and
their
treatment.

SPEAKER_00
11:59

She
also
shared
something
incredibly
important
for
anyone
who's
had
a
hysterectomy.
In
her
experience,
women
who
have
had
hysterectomies
often
do
have
hernias,
and
many
of
them
have
had
no
idea,
not
because
the
pain
isn't
real,
but
because
no
one
thought
to
look.

SPEAKER_03
12:15

So
the
Ehlers
Download
syndrome
patients,
the
EDS
patients
that
have
the
hyperflexibility,
hypermobility
syndrome,
they
are
more
likely
to
just
have
like
loose
fascia
and
muscles.
And
if
they
have
surgery,
let's
say
they
have
a
hysterectomy,
they're
going
to
get
a
hernia
from
that
incision.

SPEAKER_00
12:31

Interesting.

SPEAKER_03
12:32

Because
they
don't
have
enough
collagen.
Their
collagen
is
like
not
normal.
So
you
need
normal
collagen
to
heal.
And
so
if
you're
not
healing
the
incision,
that's
why
we
would
prefer
we
prefer
laparoscopic
surgery
for
these
patients
because
the
incisions
are
much
smaller
to
heal.
There's
not
a
big
incision,
for
example.
That's
number
one.
Number
two,
they
get
pelvic
pain
because
everything
is
loose.
Their
pelvic
floor
is
loose
and
their
groin
is
loose.
And
I've
noticed

Community, Support, And The Barn Car

SPEAKER_03
12:59

that
when
I
go
in
there,
I
have
this
special
technique
technique
for
these
um
patients
with
EDS,
and
I
tighten
their
inguinal
floor,
a
lot
of
their
pelvic
floor
symptoms
go
away.
I
can't
explain
it,
but
it's
happened
on
every
single
patient
I've
done
it
on.
So
they
don't
need
the
organ
prolapse
surgeries
and
all
the
other
operations,
which
they
don't
do
well
with
anyway,
because
you're
operating
on
unhealthy
collagen,
low
collagen
kind
of
tissue.
So
you
have
to
be
very
careful
with
those
patients
that
you
don't
treat
them
like
a
typical
hernia
patient.

SPEAKER_00
13:30

That
moment
really
hit
me
because
awareness
alone
can
change
the
trajectory
of
someone's
healing,
knowing
that
there
may
be
another
pain
generator
and
that
it's
identifiable
on
imaging
when
done
with
the
right
specialist
can
be
the
difference
between
staying
stuck
and
finally
moving
toward
relief.
What
made
this
episode
especially
meaningful
for
me
was
that
I
was
genuinely
excited,
and
if
I'm
being
honest,
a
little
nervous
going
into
it.
I
know
how
respected
Dr.
Tofi
is.
I
know
how
deep
her
expertise
runs
when
it
comes
to
hernias.
And
sometimes
when
you
sit
across
from
someone
like
that,
you
just
hope
your
brain
keeps
up.
And
she
was
so
kind.
She
was
generous
with
her
time,
generous
with
her
knowledge,
and
incredibly
patient.
Even
on
a
day
when
I
was
completely
exhausted,
we
had
such
a
thoughtful
conversation
both
before
and
after
we
hit
record.
And
it
reminded
me
that
true
experts
don't
just
lead
with
credentials,
they
lead
with
compassion.
Then
came
episode
110.
And
this
one
surprised
me
in
the
best
possible
way.
I
sat
down
with
Dr.
Navita
or
Neve
and
Rick
Macy.
And
if
you
would
have
told
me
ahead
of
time
that
this
duo
would
end
up
being
one
of
the
most
inspiring
conversations
of
the
season,
I
might
not
have
fully
believed
you.
But
what
they
brought
to
the
table
was
something
I
hadn't
seen
done
quite
like
this
before.
They
connected
neuroscience,
the
literal
wiring
behind
pain,
with
mindset.
Not
in
a
dismissive,
just
think
positive
way,
but
in
a
grounded,
science-backed
understanding
of
how
thoughts,
beliefs,
and
nervous
systems
shape
how
we
experience
our
days
and
our
bodies.

SPEAKER_01
15:18

One
thing,
and
my
patients
are
all
struggling
with
chronic
pain
and
chronic

Hernias As Overlooked Pain Generators

SPEAKER_01
15:22

illness.
And
the
most
important
technique,
I
think
we're
talking
about
perspective
and
reframing,
but
one
of
the
main
things
is
gratitude.
And
as
soon
as
we
fill
up
our
parts
with
gratitude,
we
see
things
so
differently.
And
I
can
give
an
example.
And
I'll
never
forget
our
dean
told
us,
he
said,
go.
And
she
said,
Today's
exercise,
all
you
guys
are
complaining.
She
was
at
the
auditorium
in
the
pride,
she's
like,
all
of
you
are
complaining.
I'm
wanting
all
to
go
to
the
lobby
of
the
Mayo
Clinic
in
Rochester,
Minnesota,
and
just
sit
there
for
20
minutes
and
watch.
Okay,
now
we
all
sat
there.
I
remember
watching,
there's
like
beautiful
chandeliers,
beautiful
floors,
and
there
you
see
the
sickest
kids
that
have
maybe
three
or
four
months
left
to
live.
You
see
a
kid
having
a
seizure,
you're
seeing
another
person
with
a
leg
cut
off,
another
one
with
their
arm
cut
off,
and
then
you
see
someone
like
you
know,
with
dementia
and
their
family
members
pushing
them,
and
someone
with
a
brain
tumor,
and
all
of
a
sudden
there's
no
more
complaining.
Yeah,
because
you're
like
appreciative
of
what
you
have.
So
it
doesn't
mean
that
you
minimize
what
you're
having.
I
mean,
everybody
has
struggles
and
pains,
but
it's
it's
a
it's
a
combination
of
gratitude
and
perspective
and
recognizing
that
if
we're
grateful
for
what
we
have,
all
of
a
sudden
everything
else
is
not
as
it
it's
a
way,
it's
a
technique
to
get
out
of
the
pain,
maybe
and
to
improve
it
and
to
it
to
feel
the
situation
in
a
different
way.
And
that's
what
you're
talking
about,
perspective.
It
really
means
a
lot.

SPEAKER_00
16:57

What
struck
me
most
is
that
they
don't
just
teach
this,
they
live
it.
They
talked
about
how
mindset
sets
the
pace
for
our
day,
how
it
influences
how
we
move
through
pain,
through
challenges,
through
life
itself.
And
while
mindset
doesn't
replace
medical
care,
it
absolutely
plays
a
role
in
how
we
function
and
how
we
heal.
I
walked
away
from
that
conversation
feeling
inspired,
not
fixed,
not
magically
cured,
but
reminded
that
there
is
still
agency,
even
in
the
hard
bodies
and
hard
days.
And
then
because
life
is
funny
like
this,
there
is
a
little
moment
that
still
makes
me
smile.
Rick
Macy,
yes,
that
Rick
Macy,
legendary
tennis
coach,
the
man
who
coached
Venus
and
Serena
Williams
when
they
were
kids,
and
yes,
that
one
portrayed
in
King
Richard,
a
little
slice
of
Hollywood
tucked
into
neuroscience
and
mindset
conversation
on
Indobattery
Podcast.
Because
apparently
you
can
talk
about
pain,
the
brain,
elite
athletes,
and
resilience
all
in
one
episode.
If
this
conversation
taught
me
anything,
it's

Gender Bias In Hernia Diagnosis

SPEAKER_00
18:06

this
healing
is
rarely
one-dimensional.
Pain
has
layers,
causes
overlap,
and
sometimes
the
answers
we're
looking
for
live
just
outside
the
box
we've
been
told
to
stay
in.
So
as
you
listen
back,
I
invite
you
to
stay
curious,
to
consider
other
pain
generators,
to
notice
how
your
mindset
supports
or
challenges
you,
and
to
remember
that
learning
more
about
your
body
is
never
a
step
backwards.
It's
a
step
towards
life
with
more
understanding
and
hopefully
less
pain.
And
just
because
I'm
in
the
season
of
giving,
I
want
to
give
you
just
a
little
bit
of
advice
to
get
you
through
this
holiday
season.
And
here
it
is.
No
is
a
complete
sentence.
You
don't
owe
a
dissertation.
Just
say
no.
Our
plates
are
full
enough.
It
is
okay
to
say
no.
As
we
wrap
up
this
reflection,
I'm
always
struck
by
just
how
much
learning
lives
inside
these
conversations.
Looking
back,
it's
not
just
about
the
information.
It's
what
continued
to
inspire
me,
challenge
me,
and
sometimes
gently
nudge
me
to
see
things
a
little
differently.
My
hope
is
that
something
you
heard
today
sparked
a
moment
of
recognition,
curiosity,
or
even
a
quiet,
uh,
that
makes
sense
now.
So
here's
what
I'm
gonna
challenge
you
with.
Take
one
idea
from
this
episode,
just
one,
and
let
it
sit
with
you.
You
don't
have
to
fix
anything,
change
anything,
or
suddenly
become
a
brand
new
person
by
Monday.
Growth
counts
even
when
it
happens
in
sweatpants.
Be
gentle
with
yourself.
Honor
how
far
you've
come
this
year,
and
remember
you're
allowed
to
learn,
unlearn,
rest,
and
repeat.
Thank
you
for
reflecting
with
me.
Continue
being
curious
until
next
time.
Continue
advocating
for
you
and
for
others.