Send us a text with a question or thought on this episode ( We cannot replay from this link)
Ever wondered how a childhood dream of becoming a veterinarian could evolve into a distinguished career in urogynecology? This week, we welcome Dr. Cindy Mosbrucker, a leading expert in minimally invasive excision of endometriosis. Her journey is nothing short of extraordinary—from hands-on experiences to impactful mentorships, and even a pivotal training encounter with the renowned Dr. David Redwine. Dr. Mosbrucker’s story is a testament to the power of perseverance and passion in transforming the landscape of women’s health.
We also delve into the groundbreaking work of Dr. David Redwine, a pioneer in excision surgery for endometriosis. Despite facing fierce criticism, Dr. Redwine’s innovative approach and dedication to patient outcomes have revolutionized our understanding of the condition. His humor and humanity shine through, making his contributions not just scientifically significant but also deeply personal and humane. This episode highlights the emotional and professional challenges specialists face and underscores the importance of better patient education and collaboration within the medical community.
Our discussion extends to the complexities of training and identifying skilled endometriosis surgeons. We explore the limitations of MIGS fellowships and the critical need for specialized education and experience in endometriosis care. Additionally, we touch on the slow but promising advancements in endometriosis research, focusing on genetics and immunotherapy. The episode is a comprehensive look at the multifaceted journey of improving patient care, from surgical expertise to addressing the psychological aspects of chronic pain. Join us for an insightful conversation that promises to inform, challenge, and inspire.
Website endobattery.com
Urogynecology and Endometriosis Expert Interview
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
I'm
joined
by
my
guest
,
dr
Cindy
Mosbreker
,
who
is
a
nationally
recognized
expert
in
minimally
invasive
excision
of
endometriosis
and
the
diagnosis
and
treatment
of
pelvic
pain
in
women
.
She
completed
her
medical
degree
at
Northwestern
University
and
honed
her
skills
in
OBGYN
during
her
residency
at
the
National
Naval
Medical
Center
.
Following
her
Navy
service
,
she
specialized
in
GYN
and
urogynecology
surgery
in
Hawaii
,
before
training
under
the
renowned
Dr
David
Redwine
.
Now
based
in
Gig
Harbor
,
washington
,
Dr
Mossbrecher
runs
a
private
practice
focusing
on
pelvic
pain
,
endometriosis
and
incontinence
,
advocating
for
a
multidisciplinary
approach
to
patient
care
.
Certified
in
female
pelvic
medicine
and
reconstructive
surgery
.
She
is
dedicated
to
improving
her
patient's
quality
of
life
through
a
collaborative
and
comprehensive
treatment
plan
.
Please
help
me
in
welcoming
Dr
Cindy
Mosbricker
.
Thank
you
,
dr
Mosbricker
,
for
joining
me
today
and
taking
your
time
out
of
your
busy
schedule
and
allowing
us
to
be
part
of
your
information
resource
list
,
and
that
your
history
and
everything
else
.
Thank
you
for
joining
me
.
Speaker 2
1:50
You're
very
welcome
,
and
it's
my
pleasure
.
Speaker 1
1:52
Thank
you
.
Can
we
start
because
you
have
a
history
that
no
one
else
does
.
Your
history
career
as
far
as
surgery
and
medical
career
is
very
different
than
anyone
I
know
,
which
is
true
to
most
people
,
but
you
have
a
special
history
.
Can
you
explain
what
inspired
you
to
pursue
your
career
in
urogynecology
as
well
as
specialize
in
endometriosis
?
Well
,
it's
a
long
story
.
Speaker 2
2:18
When
I
was
15
,
I
decided
I
want
to
be
a
veterinarian
.
Because
I
worked
at
a
ranch
for
summers
and
the
vet
would
come
out
and
take
care
of
the
animals
that
got
hurt
.
And
the
vet
would
come
out
like
once
a
week
and
he'd
need
somebody
to
do
the
dressing
,
changes
and
whatever
.
And
so
I
would
volunteer
and
I'll
do
it
.
So
,
anyways
,
I
came
home
that
summer
and
I
told
my
dad
that
I
figured
out
what
I
wanted
to
do
when
I
grew
up
and
I
wanted
to
be
a
veterinarian
.
And
he's
like
why
don't
you
be
a
people
doctor
?
I'm
like
well
,
you
got
to
be
smart
for
that
.
And
he's
like
well
,
you
got
to
be
smart
to
be
a
veterinarian
too
.
Speaker 2
2:55
So
my
neighbor
was
an
internal
medicine
doc
and
his
best
friend
was
an
orthopod
.
And
so
I
started
spending
time
with
those
guys
and
decided
,
yeah
,
I
kind
of
like
orthopedics
.
I
was
into
sports
when
I
was
younger
and
sports
medicine
was
really
interesting
to
me
.
And
so
I
went
to
med
school
thinking
that
I
was
going
to
do
orthopedics
.
And
then
I
did
my
surgery
rotation
and
loved
the
finesse
of
belly
surgery
,
being
in
the
abdomen
and
doing
bowel
surgery
and
all
that
kind
of
stuff
.
And
then
I
went
to
do
my
ortho
rotation
and
it
was
like
this
is
sterile
carpentry
.
It
was
just
so
unfinessed
and
hammer
and
chisel
and
stuff
like
that
.
And
so
I
had
a
hard
time
in
med
school
deciding
between
general
surgery
,
urology
and
gynecology
and
the
general
surgeons
were
on
call
every
other
night
and
I
knew
my
body
couldn't
handle
that
and
so
it
came
down
to
urology
and
GYN
and
I
picked
GYN
because
I
would
rather
take
care
of
women
basically
.
Speaker 2
4:05
And
so
during
my
residency
this
new
field
of
urogyne
was
beginning
.
That
really
caught
my
interest
because
I
liked
both
and
I
really
wasn't
nuts
about
OB
.
But
it
kind
of
came
along
with
the
package
.
So
you
kind
of
had
to
do
a
little
bit
of
it
.
And
back
then
in
the
early
90s
there
were
only
a
few
fellowships
in
urogyne
and
the
thinking
was
that
if
you
wanted
to
do
research
and
be
an
academic
,
then
you
needed
to
do
a
fellowship
,
and
if
you
just
wanted
to
do
it
,
you
just
did
it
.
Speaker 2
4:38
I
was
in
the
Navy
.
I
got
the
Navy
to
pay
for
med
school
,
so
I
went
to
Guam
and
for
my
first
three
years
and
made
friends
with
urologists
and
so
I
do
bladder
cases
with
them
and
learn
how
to
do
systos
and
stents
and
all
that
kind
of
stuff
,
and
then
did
a
lot
of
slings
once
slings
were
introduced
in
the
early
2000s
and
prolapse
repairs
and
all
that
kind
of
stuff
.
I
wound
up
getting
out
of
the
Navy
and
moving
to
Hawaii
and
did
kind
of
half
general
OBGYN
and
urogyne
for
about
eight
years
over
there
and
eventually
I
felt
this
little
tap
on
my
shoulder
like
in
the
cartoons
where
the
angel
sitting
on
your
shoulder
tapping
you
and
it's
like
there's
something
more
you're
supposed
to
be
doing
.
And
I
knew
I
had
the
potential
to
be
a
better
surgeon
and
to
do
more
challenging
cases
.
And
I
also
knew
that
what
I'd
been
taught
about
endometriosis
made
no
sense
at
all
.
And
so
we
were
looking
to
move
back
from
Hawaii
back
to
the
mainland
and
our
parents
were
in
the
Northwest
and
we
didn't
want
to
be
too
close
to
our
parents
but
we
wanted
to
be
close
enough
that
we
could
get
there
if
we
had
to
.
And
so
Bend
,
oregon
,
seemed
like
a
great
place
to
go
.
Speaker 2
5:58
And
lo
and
behold
,
david
Redwine
had
put
an
ad
in
the
Green
Journal
,
which
is
the
journal
of
OBGYN
,
looking
for
somebody
to
come
join
him
.
So
I
wrote
to
him
and
he
wrote
back
with
this
like
three
page
long
saying
everything
that
he
did
and
all
the
crazy
surgical
stuff
that
he
did
and
how
he
took
care
of
these
women
with
endometriosis
,
and
at
first
I
thought
he
was
just
making
it
all
up
.
I'm
like
he's
doing
bowel
resections
and
ureteral
reimplantations
and
all
this
stuff
and
I'm
like
that's
crazy
.
And
then
,
the
more
I
wrote
back
and
forth
to
him
,
the
more
I
realized
no
,
this
is
really
what
he
does
.
It's
everything
that
I
had
always
ever
wanted
to
do
.
So
,
anyways
,
I
went
out
and
spent
a
week
with
him
in
December
of
I
think
it
was
2005
,
and
came
home
thinking
this
this
guy
is
an
incredible
surgeon
and
what
he
does
is
life
changing
for
these
women
and
I
need
to
do
this
.
Speaker 2
7:01
And
so
we
we
moved
in
the
summer
to
Bend
Oregon
and
I
was
there
for
two
years
and
operated
with
David
every
day
.
And
it
was
in
2008
when
the
two
years
was
up
.
It
kind
of
was
the
subprime
mortgage
financial
crisis
and
it
was
kind
of
clear
that
his
practice
was
a
one
person
practice
and
,
you
know
,
not
really
enough
volume
.
People
didn't
have
the
money
to
be
traveling
to
crazy
places
like
Bend
Oregon
for
surgery
,
so
I
moved
back
home
up
to
Gig
Harbor
,
which
is
where
I
grew
up
.
I
grew
up
in
Fort
Crest
,
which
is
right
across
the
Narrows
Bridge
,
but
spent
a
lot
of
time
in
Gig
Harbor
,
so
I
felt
like
home
.
Fircrest
,
which
is
right
across
the
narrows
bridge
,
but
spent
a
lot
of
time
in
gig
harbors
,
so
it
felt
like
home
.
Speaker 1
7:45
So
I've
been
here
since
2008
doing
initially
it
was
like
50
50
endo
and
urogyne
,
and
over
the
years
it's
become
now
now
I
do
probably
90
,
95
percent
endo
and
very
little
urogyne
that's
what
I
mean
,
like
that
history
,
because
correct
me
if
I'm
wrong
,
but
you
were
Dr
Redwine's
only
fellow
,
correct
,
which
is
something
no
one
else
obviously
can
say
and
you
have
a
perspective
that
I
think
is
so
unique
because
you've
seen
the
conception
of
excision
and
endometriosis
from
a
different
viewpoint
with
Dr
Redwine
,
and
from
the
very
beginning
of
what
many
called
crazy
,
so
to
speak
.
You
know
they
said
so
many
different
things
.
Speaker 2
8:31
The
medical
staff
board
brought
him
in
and
was
going
to
sanction
him
because
he
was
removing
endometriosis
and
some
I
think
it
was
the
chief
of
the
department
of
OBGYN
thought
that
he
was
being
a
cowboy
and
doing
all
this
stuff
that
he
shouldn't
do
.
And
they
brought
him
in
in
front
of
the
board
of
directors
and
said
what
are
you
doing
and
why
are
you
doing
this
?
And
he's
like
well
,
let
me
explain
it
to
you
this
way
If
a
patient
had
appendicitis
,
would
you
take
out
their
gallbladder
?
Pioneering Surgeon in Endometriosis Care
Speaker 2
9:10
You
know
,
if
somebody
had
a
kidney
mass
,
would
you
take
out
their
bladder
?
No
,
you
would
take
out
the
disease
.
He's
like
I
remove
the
disease
and
I
leave
normal
reproductive
organs
alone
.
And
they're
like
really
,
oh
,
why
isn't
everybody
doing
this
?
It
seems
to
make
so
much
sense
,
right
,
but
you
know
?
But
yet
that's
the
kind
of
ostracism
that
he
got
from
the
community
.
Speaker 1
9:40
Yeah
.
Speaker 2
9:41
And
he
was
called
crazy
.
Speaker 2
9:42
Didn't
help
that
he
lived
in
the
middle
of
Central
Oregon
,
which
was
when
he
moved
there
in
78
,
it
was
kind
of
the
middle
of
nowhere
,
Right
,
but
he
,
I
really
believe
,
is
the
father
of
excision
surgery
.
Speaker 2
9:57
And
when
you
go
through
and
read
all
of
his
papers
and
you
were
at
the
end
of
summit
and
Sally
asked
me
to
speak
about
David's
life
and
I
went
through
all
of
his
papers
and
kind
of
briefly
summarized
them
in
that
talk
and
it
really
made
me
think
again
about
how
the
genius
of
that
man
and
how
he
thought
to
create
this
database
and
how
he
knew
at
the
get-go
that
he
was
doing
something
that
was
going
to
change
medical
practice
and
that
he
needed
to
record
that
.
And
then
he
needed
to
keep
track
of
those
patients
and
their
outcomes
and
in
doing
so
he
kind
of
defined
how
well
does
excision
work
?
What
does
endo
look
like
?
What
does
it
look
like
in
a
teenager
versus
in
a
40-year-old
woman
?
Does
it
spread
?
No
,
40-year-olds
have
as
many
areas
of
endo
as
20-year-olds
do
.
And
so
some
of
the
kind
of
existential
questions
about
endometriosis
he
answered
.
Speaker 1
11:09
Right
.
And
he
you
know
it's
interesting
because
right
before
he
passed
away
he
was
on
the
podcast
and
I
,
you
know
same
way
I
always
start
when
I
have
guests
on
I
say
,
how
would
you
like
me
to
refer
to
you
,
because
I
think
that's
important
to
understand
.
And
he's
like
,
well
,
I'd
like
to
be
called
the
emperor
,
because
I
think
that's
important
to
understand
.
And
he's
like
,
well
,
I'd
like
to
be
called
the
emperor
.
And
I
said
,
okay
,
you're
the
emperor
.
Speaker 1
11:32
And
I
think
,
beyond
just
his
fight
for
endometriosis
and
patience
with
endometriosis
,
you
know
,
I
think
his
humor
really
allowed
people
to
see
the
human
side
of
him
and
how
much
he
genuinely
cared
for
those
in
the
endometriosis
community
.
And
I
think
that
it
was
shown
within
his
papers
.
It
was
shown
in
the
way
that
he
would
teach
about
endometriosis
and
the
way
that
he
continuously
,
until
his
passing
,
would
educate
and
fight
for
those
with
endometriosis
to
get
proper
care
.
And
that
didn't
happen
just
over
one
night
.
It
was
,
it
was
a
progression
.
And
he
fought
,
and
he
fought
hard
against
those
who
criticized
,
who
bashed
him
,
whom
you
know
wanted
to
defeat
the
emperor
,
so
to
speak
.
Speaker 2
12:19
And
he
didn't
let
them
and
he
kept
fighting
.
Speaker 1
12:21
I
think
that
should
be
a
role
model
,
beyond
just
the
endometriosis
piece
,
but
be
a
role
model
that
we
can't
give
up
at
just
the
criticism
of
what
you're
doing
when
you
know
it's
right
.
So
you're
saying
I
can't
retire
,
you
can't
retire
,
that's
it
right
there
.
You're
not
allowed
to
retire
.
Nancy
hasn't
retired
from
advocacy
.
You're
not
allowed
to
retire
.
Speaker 2
13:07
Nancy
hasn't
retired
from
advocacy
.
Speaker 2
13:09
You're
an
interest
in
me
.
Speaker 2
13:10
I
think
they
saw
a
potential
,
you
know
,
and
they
really
helped
me
learn
how
to
dissect
and
how
to
approach
surgery
,
which
I
think
gave
me
a
leg
up
in
my
residency
and
allowed
me
to
become
a
better
surgeon
than
most
of
my
peers
just
out
of
residency
.
Speaker 2
13:28
But
I
never
learned
how
to
dissect
out
a
ureter
.
I
never
learned
how
to
divide
the
uterine
artery
lateral
to
the
ureter
and
basically
do
a
radical
hysterectomy
,
which
is
what
we
have
to
do
sometimes
for
endo
,
when
there's
really
deeply
infiltrating
disease
on
the
uterus
sacral
.
We
have
to
treat
it
like
a
cancer
case
.
And
I
had
learned
how
to
do
ovarian
cystectomies
but
we
never
closed
the
ovary
and
it
makes
so
much
more
sense
to
put
a
suture
in
it
and
close
it
and
prevent
the
adhesions
that
happen
after
you
don't
close
it
and
so
many
things
that
you
don't
close
it
and
so
many
things
that
you
know
.
I
thought
I
was
a
good
surgeon
and
I
was
nothing
until
I
spent
two
years
with
David
and
he
taught
me
as
far
as
surgical
technique
goes
.
He
taught
me
90%
of
what
I
do
today
.
Speaker 1
14:18
Did
that
also
affect
the
way
that
you
interact
with
patients
,
seeing
it
different
from
the
fellowship
perspective
and
getting
into
endometriosis
,
versus
not
doing
a
fellowship
and
potentially
not
knowing
anything
about
endometriosis
?
How
do
you
think
that
shaped
?
Speaker 2
14:33
you
.
Before
I
spent
time
with
him
.
I
did
not
specialize
in
endometriosis
and
you
know
,
occasionally
we'd
have
somebody
that
had
endo
and
I'd
operate
on
them
and
do
the
ablation
techniques
.
And
I
had
one
girl
that
had
these
recurrent
cysts
in
her
pelvis
despite
having
done
oophorectomy
on
her
for
endometriomas
,
and
I
didn't
realize
what
was
happening
and
I
didn't
know
what
I
didn't
know
because
I'd
never
been
taught
.
And
now
I
know
exactly
what
was
happening
with
that
girl
and
I
wish
I
could
go
back
and
say
,
hey
,
let
me
do
your
surgery
the
correct
way
,
because
she
had
an
ovarian
remnant
and
we
never
got
the
disease
out
from
a
retroperitoneal
approach
.
And
so
I
know
now
what
I
should
have
done
in
some
of
those
cases
before
I
learned
what
I
learned
from
him
.
But
I
will
tell
you
the
first
I
don't
know
a
couple
of
months
that
I
was
there
in
Bend
I
would
cry
when
I
heard
these
women's
stories
about
surgery
after
surgery
after
surgery
and
people
not
treating
them
right
and
doctors
making
the
patients
feel
like
they're
crazy
because
the
doctors
didn't
know
what
was
wrong
with
them
.
Challenges in Endometriosis Care Progression
Speaker 2
15:55
And
initially
it
made
me
sad
and
made
me
upset
and
then
it
just
made
me
mad
.
And
it
still
angers
me
when
I
see
28
year
olds
who
had
normal
ovaries
removed
and
they
weren't
told
what
the
repercussions
were
of
that
,
they
weren't
told
what
their
life
was
going
to
be
like
,
you
know
,
for
the
next
25
years
,
until
they
should
have
normally
gone
through
menopause
,
and
the
patients
who
are
dismissed
because
they're
just
looking
for
secondary
gain
,
oh
,
you
know
,
nothing's
really
wrong
with
you
.
You
know
,
why
are
you
here
?
Why
are
you
on
my
doorstep
asking
for
meds
?
You
must
be
drug
seeking
.
You
know
.
You
must
be
crazy
,
you
must
have
been
raped
sometime
in
the
past
and
you
just
don't
remember
it
.
So
you
need
to
go
do
psychotherapy
.
So
you
,
you
know
,
so
that
you
can
deal
with
this
,
or
you're
just
stressed
.
That's
why
your
pelvic
floor
is
tight
.
There's
really
nothing
wrong
with
you
.
Speaker 1
16:58
Yeah
.
Speaker 2
16:59
So
I
mean
,
you
see
these
things
all
the
time
and
I
don't
know
how
to
deal
with
it
,
because
general
OBGYNs
it
seems
like
a
lot
of
them
aren't
really
interested
in
what
I
have
to
say
.
Some
of
them
are
,
some
of
them
are
wonderful
,
and
I've
developed
a
relationship
with
some
generalists
who
you
know
,
when
they're
,
when
they
have
patients
that
have
pain
and
you
know
endo
that
they
know
that
they
can't
deal
with
,
they're
like
you
need
to
go
see
Cindy
.
Yeah
,
I
really
appreciate
that
and
I
would
love
to
nurture
those
relationships
and
I
would
love
to
make
more
of
them
,
but
it
seems
hard
because
a
lot
of
them
are
like
yeah
,
yeah
,
yeah
,
fine
,
whatever
.
Speaker 1
17:40
It's
uncomfortable
for
them
to
be
faced
with
that
.
Speaker 1
17:42
Yeah
,
absolutely
.
It
sounds
like
I
mean
,
and
I
haven't
really
thought
of
it
this
way
,
but
I
see
it
time
and
time
again
with
doctors
who
specialize
with
endometriosis
.
They
almost
go
through
a
grieving
process
with
their
patients
,
like
it's
not
.
You
go
into
the
office
,
you
tell
your
story
,
they
find
a
solution
.
They
kind
of
just
grieve
with
you
because
it
impacts
them
and
impacts
the
way
that
they
treat
other
patients
down
the
road
when
they
are
faced
with
certain
situations
or
circumstances
.
And
I
think
that
we
forget
that
as
a
patient
,
that
when
we
go
to
see
an
endometriosis
specialist
,
yes
,
they
care
,
yes
,
they
validate
,
but
they
also
grieve
because
they're
hearing
this
time
and
time
again
.
And
it's
the
different
stages
of
grief
it's
the
sadness
,
it's
the
anger
,
it's
the
how
could
they
,
the
denial
.
You
know
,
I
think
they
all
go
through
that
.
I
mean
that
just
is
an
impactful
statement
for
those
that
have
dealt
with
it
to
understand
that
they
grieve
with
you
.
Speaker 2
18:37
Yes
,
I
think
,
I
mean
,
I
certainly
do
.
Speaker 1
18:40
What
has
changed
?
What
have
you
seen
in
the
progression
with
fellowships
in
the
years
that
you've
been
doing
this
?
Because
now
you
know
you've
gone
through
your
fellowship
,
you've
practiced
,
you
have
started
creating
a
space
for
other
fellows
to
come
in
.
What
is
the
biggest
difference
you're
seeing
in
endometriosis
and
fellowships
?
Speaker 2
19:00
Well
,
there
really
aren't
many
.
I
mean
,
I
had
a
fellow
from
2019
to
2021
,
and
then
she
went
away
for
two
years
and
then
she
came
back
last
fall
,
dr
Newville
,
and
she's
phenomenal
,
she's
just
an
awesome
human
being
and
she's
an
amazing
surgeon
and
she
right
now
is
probably
capable
of
doing
90%
of
what
I
can
do
.
The
you
know
,
the
last
10%
is
going
to
take
a
while
because
it's
the
hardest
and
you
know
the
frozen
pelvises
and
the
you
know
digging
out
ureters
and
all
that
kind
of
stuff
.
And
then
last
summer
I
had
a
new
fellow
come
,
dr
Yagy
,
who
was
on
your
podcast
,
and
so
she
started
last
August
and
I
think
her
mind
is
blown
on
a
daily
basis
with
what
she
hears
from
these
people
and
it's
a
honor
and
a
pleasure
and
I
think
my
mission
in
life
to
educate
the
next
generation
of
endosurgeons
,
and
David's
mission
in
life
was
to
define
the
disease
and
I
think
my
mission
is
to
try
to
train
the
next
generation
.
Identifying Endometriosis Surgery Expertise
Speaker 2
20:16
There
are
a
lot
of
minimally
invasive
GYN
fellowships
now
.
Speaker 2
20:19
They
started
probably
25
,
30
years
ago
with
basically
mentorships
where
surgeons
would
go
work
with
an
established
gynecologist
who
did
a
lot
of
minimally
invasive
stuff
,
like
Tom
Lyons
and
Dan
Martin
and
people
like
that
and
so
gradually
over
time
,
aagl
developed
minimally
invasive
gynecologic
surgery
or
MIGS
fellowships
,
and
now
there's
probably
I
don't
know
20
,
25
locations
,
maybe
more
than
that
,
maybe
30
across
the
country
.
Speaker 2
20:55
But
some
of
them
do
a
pretty
good
job
at
endo
and
others
don't
really
do
much
of
anything
with
respect
to
endo
,
and
so
there's
a
little
bit
of
a
problem
when
it
comes
to
who's
an
endo
specialist
.
You
know
,
because
a
lot
of
these
kids
that
have
finished
a
MIGS
fellowship
they're
like
oh
,
I'm
a
specialist
in
endo
,
you
know
I
can
do
endo
,
but
they
really
don't
understand
.
Yeah
,
maybe
they
can
do
a
cystectomy
decently
and
maybe
they
can
suture
laparoscopically
so
they
can
sew
the
ovary
closed
,
but
they
don't
understand
the
deep
disease
,
they
don't
understand
how
deep
they
have
to
go
to
get
around
the
base
of
it
.
There's
a
lot
of
stuff
they
don't
do
,
and
they
can't
do
because
they
were
not
taught
adequately
how
to
take
care
of
endopatients
.
It
would
be
wonderful
if
there
were
true
endometriosis
fellowships
,
if
there
were
more
of
them
,
but
the
problem
is
that
you
have
to
have
a
mentor
and
you
have
to
have
somebody
who's
an
expert
endosurgeon
in
order
to
be
the
trainer
.
Speaker 1
22:02
Right
,
it's
true
.
I
mean
,
I
think
that
that
also
brings
up
the
next
point
of
why
it's
important
to
know
where
your
surgeon
has
gotten
their
education
and
why
it's
important
to
know
if
they've
done
a
fellowship
and
where
that
fellowship
was
done
.
Because
you
can
go
to
a
MIGS
certified
doctor
but
doesn't
necessarily
mean
they
know
enough
about
endometriosis
to
do
a
good
surgery
for
endometriosis
Like
,
yes
,
they
can
maybe
do
a
good
surgery
for
other
gynecological
issues
because
that's
what
they're
trained
in
.
But
it
doesn't
mean
that
endometriosis
is
going
to
be
the
same
,
because
endometriosis
,
like
many
of
us
know
,
is
almost
like
a
cancer
,
so
it
responds
differently
for
everyone
,
it's
different
presentation
for
everyone
and
it
can
be
really
scary
to
go
in
there
.
Dr
Yagi
was
actually
talking
about
that
.
How
,
when
she
went
in
one
time
,
she
was
like
this
is
beyond
my
scope
.
The
same
can
be
true
with
a
MIGS
certified
surgeon
or
a
MIGS
fellow
surgeon
.
Speaker 1
23:04
And
so
it
is
important
,
I
think
,
to
have
an
understanding
of
,
before
you
decide
on
surgery
or
treatment
,
where
your
doctor
got
their
education
on
endometriosis
Not
just
their
education
as
a
whole
,
but
their
education
on
endometriosis
.
Maybe
a
few
extra
pieces
of
that
.
What
do
you
think
is
the
most
important
part
to
look
for
when
you're
looking
for
that
,
because
most
of
us
don't
know
where
these
fellowships
are
,
but
what
can
help
us
identify
a
good
education
on
endometriosis
?
Speaker 2
23:35
That
is
,
the
$100,000
question
.
You
know
because
you
know
.
Nancy
says
there's
a
hundred
or
200
people
in
the
country
who
do
excision
and
I
say
,
well
,
that
may
be
true
,
but
there's
probably
20
people
in
the
country
who
do
excision
.
Well
,
and
there
are
doctors
at
academic
institutions
who
write
lots
and
lots
of
papers
on
endometriosis
,
yet
they
are
not
very
good
surgeons
and
I
see
their
videos
at
meetings
and
online
and
places
like
that
.
And
I
look
at
these
people
who
claim
to
be
experts
in
endometriosis
and
I'm
watching
them
operate
and
I'm
watching
them
operate
and
I'm
like
you
should
have
done
this
.
You
should
have
done
that
.
Why
did
you
do
that
?
This
makes
no
sense
,
and
so
,
unless
you
know
how
to
evaluate
somebody's
videos
,
it
makes
it
hard
to
know
how
good
of
a
surgeon
they
are
,
right
,
how
good
of
a
surgeon
they
are
.
And
so
there
are
gynecologists
who
they
write
lots
and
lots
of
articles
and
I've
seen
patients
that
they
have
operated
on
and
it's
like
this
just
this
doesn't
look
like
a
true
excision
specialist
has
been
here
.
Speaker 2
24:58
I
mean
,
I
even
had
a
patient
who
had
surgery
by
one
of
the
top
dog
people
and
after
that
surgery
she
was
told
well
,
you
have
endo
on
your
rectum
and
there's
nothing
you
can
do
about
it
.
There's
nothing
anybody
can
do
about
it
.
You
just
have
to
go
meditate
and
do
Chinese
herbs
and
,
you
know
,
come
to
peace
with
it
.
And
she
came
out
to
see
us
and
she
had
a
five
centimeter
mass
in
her
rectum
and
we
did
a
bowel
resection
and
you
know
she
was
better
.
But
these
are
well-known
academic
centers
and
it's
so
frustrating
because
it's
like
,
well
,
how
should
a
patient
know
,
right
?
So
we
we
tried
to
start
this
thing
and
we're
trying
to
put
our
heads
together
to
figure
out
how
do
we
create
a
way
to
look
at
surgeons
videos
to
say
,
yes
,
they
know
what
they're
doing
,
or
no
,
they
don't
know
how
what
they're
doing
.
Speaker 1
25:56
Right
.
Speaker 2
25:57
And
we
met
this
guy
.
You
know
he's
like
well
,
I
have
the
platform
that
I
can
facilitate
this
.
So
we
started
working
together
and
initially
there
were
probably
20
,
25
people
who
were
vetted
,
and
everybody
,
including
me
,
had
to
submit
de-identified
videos
of
our
surgeries
and
each
other
reviewed
it
and
said
,
yes
,
this
is
good
,
we
know
what
we're
doing
.
And
then
we
vetted
other
people
and
then
the
vetted
people
would
be
able
to
vet
other
doctors
,
and
so
initially
it
was
a
really
good
program
.
Recently
,
I
have
heard
that
he
is
allowing
people
to
pay
him
to
put
them
on
this
list
,
and
so
I
haven't
actually
been
to
the
website
to
see
what
it
looks
like
.
But
it's
sad
because
it
dilutes
the
effectiveness
of
knowing
that
,
okay
,
this
doctor
has
been
reviewed
,
their
surgical
technique
has
been
reviewed
by
all
the
true
expert
excision
specialists
and
you
know
they've
been
deemed
adequate
to
do
X
,
y
and
Z
,
and
meaning
stage
one
,
stage
two
,
stage
three
,
stage
four
,
diaphragm
,
you
know
whatever
.
So
originally
it
was
.
Speaker 2
27:20
It
was
a
great
idea
.
It
was
something
that
was
drastically
needed
,
because
patients
need
to
know
how
good
is
this
person
sitting
in
front
of
me
?
Because
a
lot
of
doctors
are
very
nice
.
A
lot
of
doctors
are
very
persuasive
they're
,
they're
very
sweet
,
they
seem
to
care
about
their
patients
,
but
they
can't
operate
their
way
out
of
a
paper
bag
and
you're
not
going
to
know
that
.
Patients
aren't
going
to
know
that
,
unless
there's
some
way
to
identify
who
they
are
.
Speaker 2
27:48
Nancy
keeps
a
list
on
the
Nook
,
but
her
list
is
based
on
patient
feedback
,
right
,
which
is
important
,
which
is
definitely
important
,
but
it's
not
necessarily
based
on
outcomes
or
let's
watch
your
surgical
technique
and
see
how
things
looked
.
So
I
don't
know
that
there
is
a
way
to
know
other
than
word
of
mouth
knowing
who
was
originally
vetted
,
knowing
who
trained
with
the
people
who
have
been
vetted
,
knowing
who
trained
with
the
people
who
have
been
vetted
.
So
if
somebody
trained
with
Vidali
or
Cenervo
or
somebody
with
a
name
like
that
,
somebody
that's
known
to
be
in
a
known
quantity
of
expertise
,
somebody
who
came
from
Brazil
and
the
University
of
Sao
Paulo
,
where
they
do
amazing
work
,
and
some
of
the
Italian
hospitals
are
pretty
amazing
Horace
Roman
in
France
,
but
it's
you
know
,
how
do
you
find
these
people
?
Speaker 1
28:45
Yeah
,
that's
a
challenge
.
Speaker 2
28:47
It
is
.
Speaker 1
28:47
Absolutely
,
I
mean
,
I
think
,
as
a
patient
,
when
you
are
in
the
midst
of
trying
to
navigate
your
care
through
pain
,
through
medical
trauma
,
through
mental
trauma
,
and
years
and
years
of
being
dismissed
or
not
understanding
your
own
body
.
It
is
hard
,
though
,
to
find
someone
that
you
can
truly
trust
,
because
it
is
a
decision
that
will
affect
the
rest
of
your
life
one
way
or
the
other
,
and
it
doesn't
necessarily
mean
that
it's
a
drastic
change
all
the
time
,
but
it
certainly
can
be
,
and
so
it's
hard
for
patients
to
understand
who
is
good
,
who
isn't
good
,
and
it's
also
hard
for
patients
to
decide
who
is
good
for
their
care
,
because
I
think
there
is
a
difference
between
who's
just
good
and
who's
good
for
what
they
need
in
their
care
and
who's
going
to
be
a
good
fit
for
them
.
I
think
that
makes
a
huge
difference
in
their
care
,
and
who's
going
to
be
a
good
fit
for
them
.
Speaker 2
29:43
I
think
that
makes
a
huge
difference
,
Absolutely
.
I
think
that
there's
a
lot
of
docs
who
are
just
fine
for
stage
one
,
stage
two
and
probably
a
lot
of
endometriomas
,
but
they
can't
really
do
stage
four
.
They're
not
really
experts
at
getting
the
deep
disease
out
of
the
uterus
sacral
or
off
of
the
sciatic
nerve
and
things
like
that
,
where
you
really
do
need
a
true
expert
.
Speaker 1
30:07
Absolutely
.
That's
a
lasting
outcome
right
there
,
one
way
or
the
other
,
yeah
.
Speaker 2
30:12
I
kind
of
look
at
surgeons
like
baseball
players
.
I
love
baseball
,
I
do
too
.
My
dad
used
to
take
me
to
.
You
know
,
my
,
my
mom
loved
baseball
too
,
so
we'd
all
go
to
baseball
games
from
when
I
was
a
kid
and
you
know
,
it's
like
there's
there's
only
so
many
Justin
Verlanders
,
there's
only
so
many
doctors
who
are
like
a
household
name
and
,
yeah
,
they're
who
you'd
want
on
your
team
,
no
matter
what
.
But
there's
a
lot
of
major
leaguers
who
are
.
Nobody
knows
them
unless
you
know
.
You
go
to
the
games
all
the
time
and
you
follow
your
team
.
And
people
like
cal
raleigh
,
the
mariners
catcher
yeah
,
he's
,
he's
a
great
player
,
but
nobody
knows
him
outside
of
seattle
,
right
,
you
know
,
that's
like
char
.
Speaker 1
31:00
Blackman
here
.
My
husband
and
I
were
just
talking
about
this
.
Speaker 2
31:02
He
cut
his
hair
.
Speaker 1
31:03
I
bet
he
will
when
he
retires
.
I
bet
he'll
retire
,
but
it's
his
luck
.
You
know
how
superstitious
they
are
.
Speaker 2
31:09
He's
not
going
to
cut
his
hair
.
Speaker 1
31:10
He
doesn't
care
.
He
doesn't
care
,
but
he's
got
some
of
the
best
stats
in
the
league
,
but
he's
widely
under-recognized
across
the
board
.
I
feel
like
that's
it's
true
.
Now
that
you're
saying
this
,
this
is
really
good
,
it
is
similar
.
Speaker 2
31:26
Yeah
,
because
I
mean
,
there
are
some
.
There
are
some
people
who
are
like
you
know
,
derek
Jeter
A-Rod
,
you
know
everybody
,
even
people
who
don't
follow
sports
.
They're
like
oh
yeah
,
I
know
who
Derek
Jeter
is
,
but
you
don't
need
Derek
Jeter
if
you
have
stage
one
endometriosis
,
you
need
Ty
France
,
my
favorite
first
baseman
from
the
Mariners
.
He's
a
great
player
,
he's
a
great
guy
.
And
so
one
of
my
good
friends
has
three
boys
and
their
dad
is
MIA
,
and
so
I've
tried
to
kind
of
step
in
,
not
to
replace
their
father
,
but
to
do
things
with
them
,
like
take
them
to
sporting
events
and
teach
them
how
to
ski
.
And
her
oldest
son
he's
my
15-year-old
best
friend
.
We
ski
together
and
we
used
to
golf
together
and
stuff
like
that
,
but
so
,
anyways
,
they
took
the
boys
to
the
baseball
game
and
it
was
during
COVID
,
so
we
were
sitting
in
the
front
row
and
Ty
France
came
over
and
handed
after
the
warmups
,
handed
each
one
of
those
boys
a
baseball
,
and
I'm
like
this
guy
is
my
new
favorite
player
anywhere
.
Yeah
,
is
my
new
favorite
player
anywhere
.
Speaker 1
32:39
Yeah
,
and
that
could
be
said
for
turning
it
back
,
but
,
like
those
doctors
who
listen
and
validate
and
can
assess
what
is
right
for
you
,
you
just
changed
my
outlook
on
how
we
approach
this
.
But
it
is
true
,
I
mean
this
could
be
a
whole
other
discussion
about
staging
and
understanding
and
mapping
out
the
endometriosis
and
what
the
patient
needs
,
but
I
think
there's
something
to
be
said
about
finding
a
provider
that
meets
your
needs
where
you're
at
in
your
journey
.
And
if
it's
a
doctor
,
firstly
that
validates
you
and
can
treat
where
you're
at
.
Speaker 2
33:18
Yeah
,
it
starts
with
listening
Absolutely
and
believing
and
saying
,
yes
,
there's
something
going
on
with
you
.
I
don't
know
what
it
is
,
but
I'm
not
going
to
rest
until
I
figure
it
out
.
Speaker 1
33:28
Stage
one
is
not
the
minor
leagues
Stage
one
,
in
the
sense
that
an
excision
specialist
still
needs
to
address
that
stage
one
Stage
.
Speaker 2
33:36
one
is
like
your
routine
everyday
guy
on
the
Colorado
Rockies
or
the
Seattle
Mariners
that
you
and
I
know
who
they
are
because
we
follow
the
teams
but
nobody
else
knows
.
Speaker 1
33:48
Yeah
,
but
the
minor
leagues
are
the
ablation
surgeons
,
yeah
.
Speaker 2
33:53
Triple
A
,
double
A
is
general
OBGYNs
who
make
a
mess
out
of
things
,
and
you
know
.
You
said
your
mission
in
life
was
to
educate
people
on
hormones
and
castrations
and
why
to
not
get
their
ovaries
out
.
My
mission
in
life
is
to
stop
average
gynecologists
from
taking
care
of
endometriomas
and
operating
on
them
because
they
just
make
a
mess
out
of
it
.
Speaker 1
34:19
There's
so
much
value
in
that
and
you
have
to
start
out
growing
and
learning
along
the
way
,
because
you're
not
going
to
be
the
A-Rods
first
.
You
can
be
a
fantastic
surgeon
,
but
lived
experience
and
working
with
patients
day
in
and
day
out
is
what
really
makes
you
one
of
the
biggest
in
the
league
.
Right
,
like
?
It
is
not
something
you
learn
overnight
and
you
have
to
grow
into
that
.
What
do
you
look
forward
to
and
what
is
your
hope
for
the
future
?
In
fellowships
and
in
endometriosis
care
and
endometriosis
treatment
?
Do
you
see
promise
and
hope
in
the
future
,
and
what
is
that
for
you
?
Speaker 2
35:01
Well
,
I
mean
there
are
a
lot
more
people
doing
excision
now
than
there
were
what
is
it
18
years
ago
when
I
started
?
And
so
that's
a
good
thing
.
There
are
a
lot
of
video
resources
now
that
there
didn't
used
to
be
,
and
so
a
doctor
who's
really
interested
in
learning
how
to
do
surgery
can
go
to
SurgeryU
can
go
to
.
There's
a
kind
of
a
European
surgery
video
repository
that
has
a
ton
of
really
good
videos
on
how
to
do
excision
and
how
to
do
it
right
.
You
know
you
can
watch
Arnold
Wattier
,
you
can
watch
,
you
can
watch
all
these
Mauricio
Abreu
,
all
these
kind
of
godfathers
of
endosurgery
,
and
you
can
watch
their
techniques
.
And
you
know
you
don't
have
to
be
in
a
fellowship
to
learn
anymore
.
You
can
learn
on
your
own
by
watching
and
doing
and
gradually
Advancing Endometriosis Care Through Research
Speaker 2
36:00
get
better
.
Hopefully
some
of
the
MIGS
fellowships
will
do
more
endo
and
will
graduate
more
people
who
understand
at
least
the
basics
of
excision
.
But
it's
a
long
road
and
it's
a
very
slow
process
and
I
don't
think
anything
is
going
to
happen
overnight
.
Working
on
the
genetic
basis
of
endo
and
immunotherapy
and
things
like
that
I
mean
maybe
there's
some
promise
there
.
Speaker 2
36:29
My
friend
Vicky
Vargas
,
who's
I
kind
of
mentored
her
from
afar
,
she's
a
MIG
surgeon
in
DC
.
She
had
finished
her
MIGS
fellowship
and
recognized
that
she
really
didn't
know
as
much
as
she
should
have
known
about
endo
,
and
so
we
got
together
and
shared
videos
and
,
you
know
,
spent
probably
a
year
doing
video
reviews
and
coaching
and
,
you
know
,
teaching
from
afar
.
And
she's
an
amazing
young
surgeon
I
mean
,
she's
the
hope
for
the
future
because
she's
brilliant
.
She
and
Dr
Yege
actually
did
their
residencies
together
,
and
so
they
went
to
Switzerland
for
some
endoconference
I
think
it
was
the
WERF
conference
or
something
and
they
were
plotting
about
all
the
things
that
they
needed
to
do
for
research
and
creating
a
database
so
that
we
can
document
how
well
excision
works
.
And
I
think
that's
kind
of
going
a
little
bit
off
track
,
but
that's
what
we
need
to
do
in
order
to
convince
everybody
,
including
insurance
companies
,
that
excision
is
worthwhile
.
Speaker 2
37:37
And
I've
said
for
a
long
time
that
we
need
to
collect
a
bunch
of
data
beforehand
not
only
like
standardized
pain
scores
,
but
standardized
anxiety
,
depression
,
central
sensitization
and
catastrophizing
pain
catastrophizing
prior
to
surgery
and
then
follow
people
,
stratify
them
out
based
on
stage
and
then
see
what
their
outcomes
are
and
then
correlate
their
outcomes
with
their
surgical
stage
and
also
their
degree
of
central
sensitization
and
then
I
think
if
we
follow
these
people
out
long
enough
,
we
will
get
better
data
on
how
successful
excision
is
and
then
I
think
we'll
be
able
to
show
that
the
people
who
are
more
likely
to
fail
excision
surgery
have
more
central
sensitization
and
that
their
nerves
are
just
so
sensitive
and
whether
it's
a
process
in
their
brain
or
whether
it's
the
peripheral
nervous
system
and
they
have
almost
like
a
CRPS
of
the
pelvis
.
Speaker 2
38:43
Crps
is
complex
regional
pain
syndrome
and
it's
kind
of
like
phantom
limb
syndrome
where
patients
have
people
have
traumatic
amputations
and
their
arm
is
gone
or
their
leg
is
gone
.
Speaker 2
38:58
It's
no
longer
there
,
but
they
still
feel
pain
in
their
legs
or
their
arm
and
it's
because
of
partly
because
of
the
trauma
,
I
think
,
that
that
their
brain
got
so
sensitized
that
they
you
know
these
nerves
are
still
sending
input
to
the
brain
,
whether
it's
the
fault
of
the
peripheral
nerve
that's
still
sending
the
impulse
or
the
brain
.
That's
so
sure
less
than
5%
that
have
something
like
that
going
on
in
the
pelvis
and
that
that's
why
they
have
persistent
pain
.
But
if
we
can
correlate
surgical
outcomes
,
stratify
them
,
like
I
said
,
by
stage
,
and
then
look
at
their
degree
of
central
sensitization
and
then
see
if
the
central
sensitization
reverses
itself
.
Because
there
was
a
study
out
of
China
,
I
think
probably
10
years
ago
,
where
they
did
look
at
markers
of
central
sensitization
before
they
did
excision
and
then
what
they
found
was
that
six
to
12
months
after
surgery
people's
nervous
systems
the
tendency
was
that
they
normalized
and
that
that
central
sensitization
went
away
.
Speaker 1
40:16
Interesting
and
I
resonate
with
that
because
you
know
,
after
I
had
my
ovaries
out
,
I
would
still
feel
like
I
had
ovary
pain
occasionally
and
it
was
a
very
and
there
are
still
times
I
will
say
like
there's
times
I'm
like
is
that
that
feels
like
an
ovary
pain
?
But
I
know
I
don't
have
my
ovaries
,
so
is
it
something
else
?
And
this
is
what
the
common
thought
process
is
is
my
endo
is
back
.
That's
what
the
patient's
thought
process
is
right
.
Speaker 2
40:43
Yeah
,
yeah
,
exactly
.
Speaker 1
40:44
But
the
endo
can't
be
back
on
my
ovary
.
I
don't
have
an
ovary
,
so
that
doesn't
make
sense
,
right
?
So
it's
understanding
how
our
brain
works
in
conjunction
with
the
trauma
that
it's
had
with
our
bodies
,
and
who
is
heightened
in
that
area
as
opposed
to
others
,
and
understanding
that
component
of
it
.
I
think
that's
magnificent
,
because
this
is
a
huge
part
of
realistic
expectations
of
surgery
,
as
well
as
healing
expectations
of
surgery
and
understanding
the
disease
from
the
psychological
standpoint
too
.
Right
,
like
it's
not
just
a
physical
standpoint
.
It
does
alter
the
way
our
body
perceives
pain
.
Speaker 2
41:23
So
Well
,
and
it's
hard
for
some
people
because
they've
been
so
dismissed
for
so
long
and
they've
been
told
well
,
it's
all
in
your
head
.
But
pain
really
is
all
in
your
head
because
because
the
pain
signals
are
not
really
painful
until
they
get
to
the
brain
and
they're
processed
,
and
so
that's
why
we
talk
about
nociceptive
signals
,
which
means
that
it's
the
nerve
transmission
of
potentially
painful
experiences
,
but
it's
not
really
turned
into
pain
until
it's
processed
in
your
brain
.
And
so
I've
had
discussions
with
patients
and
trying
to
explain
the
role
of
the
brain
and
their
history
of
trauma
and
their
anxiety
and
how
that
plays
a
role
in
how
they
perceive
pain
.
And
most
of
I
will
say
most
of
my
patients
are
like
oh
well
,
that
makes
a
lot
of
sense
.
But
a
few
of
them
are
like
they
get
really
mad
and
really
upset
and
they
think
that
I'm
trying
to
dismiss
them
and
tell
them
that
you
know
their
pain's
all
in
their
head
and
there's
nothing
wrong
with
them
.
But
that's
not
the
point
.
The
point
is
to
say
,
you
know
,
we
need
to
think
.
When
we're
taking
care
of
women
with
endo
and
pelvic
pain
,
we
need
to
think
not
only
of
what's
going
on
in
the
pelvis
,
but
how
is
this
affecting
their
brain
?
How
is
it
affecting
their
emotions
?
How
are
their
emotions
affecting
their
pain
?
What
can
they
do
about
it
?
How
can
cognitive
behavioral
therapy
and
other
things
like
this
try
to
ramp
down
the
emotion
of
the
pain
?
You
know
,
I
kind
of
understand
why
it's
a
bit
of
a
slippery
slope
,
but
it's
also
necessary
because
it's
basic
biology
and
it's
you
know
how
our
bodies
work
.
Speaker 2
43:19
I
realized
that
firsthand
because
I
had
a
labral
tear
in
my
hip
and
I
had
surgery
.
Speaker 2
43:24
Probably
10
years
ago
,
12
years
ago
now
I'd
been
home
for
I
don't
know
a
week
and
hadn't
gone
anywhere
and
I
was
going
stir
crazy
.
Speaker 2
43:32
I
got
in
my
car
and
went
to
Costco
and
went
a
couple
other
places
.
By
the
time
I
got
into
the
back
of
Costco
I
was
dying
and
it's
like
where's
the
furniture
section
?
I
need
to
sit
down
for
a
while
,
and
and
so
,
anyways
,
I
got
home
and
when
I
got
home
things
were
not
calm
and
I
got
all
upset
and
my
hip
was
just
killing
me
and
my
pain
just
went
through
the
roof
and
I
laid
down
on
the
bed
and
I
thought
,
oh
my
gosh
,
this
is
what
my
patients
are
feeling
when
their
anxiety
gets
out
of
control
and
then
their
pain
gets
worse
,
because
it
wasn't
like
this
ephemeral
thing
,
it
was
like
boom
,
you
know
.
And
as
soon
as
I
,
as
soon
as
I
recognize
that
,
I'm
like
,
okay
,
I
need
to
calm
down
,
I
need
to
not
be
so
upset
.
And
you
know
,
it
helped
because
I
connection
and
the
role
that
anxiety
and
trauma
play
into
people's
pain
perception
and
how
that
affects
them
.
Speaker 1
44:47
Absolutely
Well
,
and
I
think
too
,
once
you
down-regulate
that
system
,
you're
able
to
better
pinpoint
where
the
not
the
emotional
pain
of
what
you've
carried
for
so
long
is
,
but
where
actual
pain
and
where
your
body
is
really
telling
you
what's
going
on
.
I
think
it's
easier
to
pinpoint
where
things
are
coming
from
better
,
and
that's
a
physiological
fact
,
right
?
Speaker 2
45:12
So
when
,
when
pain
becomes
more
emotional
and
it
gets
upregulated
in
the
brain
,
it
becomes
less
localized
and
more
diffuse
and
it's
like
everything
hurts
.
Speaker 1
45:25
Exactly
,
absolutely
.
Oh
,
that's
going
to
be
fascinating
.
So
what
I'm
hearing
that
you
say
is
that
you're
hopeful
that
,
with
new
fellows
coming
on
and
people
getting
excited
about
endometriosis
,
we're
going
to
see
more
research
,
we're
going
to
see
more
change
and
progression
within
the
knowledge
and
the
base
of
the
disease
,
as
well
as
the
treatment
of
the
patients
who
have
the
disease
.
I
think
that's
huge
because
you're
getting
,
like
this
new
blood
,
so
to
speak
.
You're
getting
rejuvenated
through
these
people
coming
on
that
are
excited
to
talk
about
it
.
Speaker 2
45:55
And
that
data
will
allow
us
to
change
standard
of
care
.
And
that's
what
needs
to
happen
,
because
right
now
,
standard
of
care
is
people
doing
ablations
.
It's
okay
for
doctors
to
remove
totally
normal
ovaries
in
a
25-year-old
.
If
the
patient
decided
to
take
them
to
court
to
say
you
took
my
ovaries
out
,
all
they
have
to
do
is
say
you
signed
the
consent
form
Because
it's
within
standard
of
care
.
If
somebody
has
persistent
pain
and
thought
to
be
from
endometriosis
,
it's
okay
to
castrate
a
25-year-old
.
Speaker 2
46:37
To
me
,
that's
not
okay
in
any
world
and
it
certainly
isn't
okay
without
a
very
long
discussion
,
even
in
my
40
year
old
patients
who
come
in
and
say
you
know
,
I
really
want
you
to
take
my
ovaries
out
.
Discussion on Menopause and Aging
Speaker 2
46:52
I
talked
to
them
for
a
long
,
long
,
long
time
about
what
are
you
going
to
feel
?
You're
going
to
be
menopausal
.
Your
bones
are
going
to
get
brittle
,
your
brain
is
going
to
get
old
,
your
vagina
is
going
to
dry
up
,
your
bladder
is
going
to
be
irritable
,
you're
going
to
have
to
pee
all
the
time
.
You're
going
to
be
incontinent
.
You're
going
to
you
know
all
these
things
are
going
to
happen
to
your
body
,
not
right
away
,
but
over
time
.
And
going
to
happen
to
your
body
not
right
away
,
but
over
time
,
and
your
aging
process
is
going
to
be
accelerated
.
Speaker 1
47:21
Thank
you
for
joining
us
for
part
one
of
this
fascinating
discussion
.
If
you
found
this
thought
provoking
and
intriguing
,
make
sure
that
you
tune
in
for
part
two
of
this
discussion
with
Dr
Mossbrucker
,
and
until
next
time
,
everybody
continue
advocating
for
you
and
for
those
that
you
love
.