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Discover the harrowing yet hopeful journey through the maze of endometriosis and adenomyosis care with our guest expert Dr. Abhishek Mangeshikar. Experience the solidarity of shared struggles as we dissect the arduous path to an accurate diagnosis and the potential pitfalls of repeated surgical endeavors. Dr. Mangeshikars insights highlight the indispensability of multidisciplinary teams and the promise of alternative therapies in the chronic pain battleground. We also confront the daunting specter of disease recurrence and weigh the long-term consequences of hormonal suppression therapies, while pondering their apparent overuse in certain healthcare systems. It’s a dialogue that not only empathizes with the fears and frustrations but also emboldens listeners with expert knowledge and strategies for navigating the complex healthcare landscape of these pervasive conditions.
Embark on a global odyssey of endometriosis management with us as we compare how cultural and demographic factors shape the diagnosis and treatment across the world. Dr. Mangeshikar and I investigate the significance of early detection and the role it plays in constructing effective treatment plans, including the potential enlightenment an international study might offer. Delving into the heart of healthcare disparities, this episode offers a critical look at the research hurdles faced by private practitioners and the imperative for adaptable treatment blueprints. Listen as we shed light on the French approach to centralized data collection and what it could mean for the progression of endometriosis care. It’s an episode brimming with revelations that empower patients and practitioners alike to forge a path toward more comprehensive and personalized healthcare.
Website endobattery.com
Understanding Endometriosis and Adenomyosis Care
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
as
we
continue
with
our
guest
,
dr
Abhishek
Mingashakar
.
The
first
part
of
this
episode
left
us
with
a
lot
of
thought-provoking
conversation
.
If
you
haven't
already
,
I'd
go
back
and
listen
to
part
one
,
but
this
is
where
we
left
off
and
where
we're
going
.
Speaker 2
1:01
One
of
the
things
you
brought
up
was
my
biggest
personal
grouse
with
the
diseases
is
that
the
onus
to
get
the
diagnosis
has
fallen
onto
the
patient
,
which
shouldn't
be
the
case
.
They
should
be
getting
the
diagnosis
a
lot
sooner
and
a
lot
more
clearly
and
accurately
than
they
do
currently
.
There's
too
many
patients
that
fall
through
the
gaps
in
the
systems
due
to
lack
of
access
of
care
or
even
just
lack
of
awareness
among
the
medical
community
.
That
is
causing
a
lot
of
problems
.
My
biggest
problem
is
patients
who
have
not
the
ones
who
have
severe
disease
,
but
who've
had
multiple
failed
surgeries
and
then
we
have
to
do
a
surgery
.
It
makes
life
a
lot
more
difficult
and
a
lot
more
complex
,
but
what
was
already
complex
surgery
in
the
first
place
is
just
adding
to
the
levels
of
complexity
on
this
.
Exudate
on
this
.
Now
,
the
second
part
was
when
you
have
access
to
care
among
the
patient
population
.
You're
right
.
Speaker 2
2:18
As
an
endometriosis
specialist
,
I
can't
diagnose
EDS
,
I
can't
treat
it
.
So
I
think
another
point
we
need
to
is
we
need
teams
,
so
multidisciplinary
teams
,
not
just
for
surgery
but
also
to
treat
other
conditions
that
coexist
with
endometriosis
patients
,
to
treat
those
symptoms
and
conditions
as
well
.
So
rheumatology
is
a
good
start
.
Chronic
pain
specialists
are
very
useful
and
if
you
want
to
go
down
the
road
of
alternative
therapies
,
I
think
those
can
be
tried
.
I
don't
know
how
much
evidence
we
have
for
them
,
but
there
is
some
coming
about
.
There
are
some
publications
that
speak
to
it
.
I
personally
don't
have
any
experience
with
it
,
but
I
don't
dissuade
anyone
from
trying
it
if
they
want
to
and
it
gives
them
relief
.
Speaker 1
3:07
Right
Bottom
line
is
that
we
all
want
symptomatic
relief
.
It's
just
managing
how
to
get
there
and
I
have
to
say
I
told
you
this
is
going
to
be
everywhere
.
This
podcast
is
not
my
typical
podcast
,
but
it's
because
I
could
pick
your
brain
for
days
and
still
learn
a
ton
.
Speaker 2
3:24
I
wouldn't
have
that
much
to
.
Speaker 1
3:25
So
it's
probably
fair
.
But
you
know
,
part
of
this
too
is
like
understanding
the
steps
of
the
disease
.
So
many
of
us
live
with
this
disease
for
years
and
years
and
years
.
We
get
surgery
,
we
get
proper
treatment
and
we
still
struggle
with
muscular
skeletal
issues
and
this
all
can
correlate
right
.
But
then
we
feel
like
,
oh
,
maybe
my
endometriosis
is
back
.
We
hear
this
a
lot
.
Right
,
we
hear
,
well
,
I
had
to
have
another
surgery
because
of
the
endometriosis
but
they
didn't
find
anything
.
And
this
is
where
it
gets
tricky
,
because
then
that
leaves
the
patient
in
limbo
to
figure
out
what
comes
next
.
Is
it
pelvic
floor
PT
,
or
is
it
that
you
have
to
work
with
a
trainer
,
or
is
it
so
there's
other
modalities
?
Are
we
seeing
I
don't
know
if
this
is
relevant
or
not
,
but
are
you
seeing
a
prevalence
in
people
who
feel
like
they
have
reoccurrence
of
endometriosis
in
certain
parts
of
the
world
over
others
?
I
don't
know
if
that
makes
any
sense
,
but
does
that
make
sense
?
Speaker 2
4:39
No
,
it
makes
perfect
sense
.
So
I
think
the
biggest
fear
that
I've
seen
in
my
patients
is
that
they're
worried
about
their
disease
coming
back
.
So
,
years
after
surgery
,
if
there's
any
pain
that
comes
in
,
the
first
thought
the
brain
jumps
to
is
that
oh
,
my
endo
is
back
,
because
that's
the
thing
they
don't
want
to
go
through
again
.
Furthermore
,
speaking
of
musculoskeletal
issues
,
I
see
a
lot
of
iatrogenic
musculoskeletal
disease
which
is
secondary
to
years
and
years
of
hormonal
suppression
,
which
has
kind
of
led
to
osteoporosis
,
lupron
and
GnRH
agonists
,
and
at
the
age
of
26
,
they
have
osteopenia
and
early
onset
arthritis
.
This
is
not
a
disease
they
were
born
with
.
Speaker 2
5:31
This
is
a
disease
that
has
been
given
to
them
by
years
of
these
drugs
,
so
that
is
something
that
really
does
need
to
be
addressed
.
We
do
need
to
understand
the
consequences
of
long-term
administration
of
these
drugs
in
the
medical
community
.
The
pharmacologic
companies
take
no
responsibility
in
educating
it
.
They
say
just
give
this
to
the
patient
,
she'll
be
asymptomatic
and
she'll
be
fine
.
And
then
you
see
down
the
line
,
you
see
these
conditions
cropping
up
very
frequently
nowadays
.
So
I
think
that
is
one
of
the
biggest
problems
.
Speaker 1
6:06
And
I
think
this
is
a
good
point
to
bring
up
,
because
with
these
GnRH
drugs
are
they
more
accessible
in
other
parts
of
the
country
.
So
we're
seeing
more
of
the
muscular
skeletal
problems
in
certain
parts
of
the
world
as
opposed
to
others
.
Because
this
is
a
question
I've
had
for
a
while
now
is
you
know
,
in
America
we
have
access
to
a
lot
and
in
fact
that
is
their
primary
go-to
for
any
care
treatment
in
the
general
OBGYN
arena
.
So
for
us
,
like
I
feel
like
we're
seeing
more
and
more
people
continue
to
have
pain
post-excision
and
jump
to
reoccurrence
,
when
actually
it's
not
reoccurrence
,
it's
because
of
these
drugs
.
Is
it
more
prevalent
in
countries
like
America
,
or
are
we
seeing
this
worldwide
?
Speaker 2
6:53
So
when
we
speak
to
recurrence
we
have
to
talk
about
whether
it's
true
recurrence
,
whether
there's
disease
that
was
maybe
not
completely
removed
,
that's
continued
to
grow
,
that
was
maybe
not
completely
removed
,
that's
continued
to
grow
,
that's
growing
now
,
or
microscopic
disease
that's
you
know
,
progressed
or
you
know
.
Or
whether
it's
persistence
of
disease
,
where
somebody
had
a
big
nodule
in
the
bowel
and
they
had
two
or
three
cysts
removed
and
they
still
have
disease
in
the
bowel
obviously
.
So
that's
not
a
recurrence
,
that's
persistence
of
disease
.
It's
like
I
tell
someone
you
know
,
if
you
have
appendicitis
and
somebody
removes
your
uterus
,
you
still
have
appendicitis
at
the
end
of
the
day
.
So
if
you
have
disease
in
the
rectum
and
you
remove
your
uterus
or
your
ovaries
,
you're
still
going
to
have
disease
in
the
rectum
.
So
it's
more
about
making
the
diagnosis
completely
and
removing
the
disease
.
Endometriosis Treatment and Recurrence Rates
Speaker 2
7:42
So
when
you
look
at
general
recurrence
rates
reported
by
ACOG
back
in
the
day
,
they
were
50
to
80%
.
Okay
,
when
ablation
was
standard
of
care
.
But
when
you
zoomed
in
the
microscope
onto
endometriosis
centers
the
recurrence
rates
dropped
.
So
the
recurrence
rates
for
endometriomas
were
10
to
15%
.
The
recurrence
rates
for
bowel
endometriosis
if
you
had
a
resection
,
the
recurrence
rate
was
0.5%
.
If
you
had
a
disc
excision
it
was
1%
.
If
you
were
shaving
it
was
about
6%
because
you
leave
some
degree
of
fibrosis
behind
,
and
for
deep
endometriosis
it's
between
3%
to
5%
,
so
in
the
pelvic
side
wall
and
the
uterine
sacral
.
Speaker 2
8:26
So
very
low
recurrence
rates
compared
to
50
to
80%
.
So
that
is
where
we
need
to
define
standard
of
care
to
differentiate
between
true
recurrence
and
persistence
of
disease
.
And
when
I
look
at
my
patient
population
that
I
follow
up
with
,
I
see
most
re-operations
would
primarily
happen
due
to
adenomyosis
,
at
the
most
.
Of
course
there
are
some
who
have
.
I
can
remember
very
specific
cases
at
the
top
of
my
head
that
had
a
recurrence
in
the
bowel
,
but
very
low
recurrence
rate
compared
to
if
adenomyosis
progresses
and
becomes
symptomatic
and
then
they
need
treatment
for
that
,
which
is
a
much
more
difficult
disease
to
treat
than
endometriosis
,
because
your
options
are
kind
of
limited
and
also
when
you
have
cysts
,
cysts
tend
to
have
a
slightly
higher
recurrence
rate
and
not
all
recurrence
cysts
need
reoperation
unless
they
become
very
large
or
very
symptomatic
.
Speaker 1
9:33
Is
this
prevalent
worldwide
in
your
experience
?
Because
,
culturally
,
I
mean
,
I
feel
like
we
are
a
culture
here
in
America
that
we
want
everything
accessible
.
I
don't
know
if
that's
true
everywhere
,
but
here
it
is
,
and
so
we'll
take
anything
we
can
to
alleviate
symptoms
,
and
that's
what's
accessible
.
Are
these
drugs
?
So
when
you're
looking
in
Asia
and
other
parts
of
the
world
,
are
you
seeing
the
same
trend
with
muscular
skeletal
issues
postoperatively
?
Speaker 2
10:02
Yes
,
speaking
about
the
drugs
,
when
you
look
at
OBGYN
in
general
,
there's
a
tremendous
reluctance
to
do
surgery
for
the
disease
.
Fair
enough
,
it's
a
very
difficult
surgery
to
do
surgery
for
the
disease
.
Fair
enough
,
it's
a
very
difficult
surgery
to
do
.
Very
few
people
can
do
it
and
even
fewer
can
do
it
successfully
.
So
why
upskill
when
you
can
?
You
know
medicate
Because
the
belief
is
that
if
they
keep
the
patient
on
suppression
,
the
patient's
not
going
to
bother
them
with
symptoms
,
right
.
So
they
say
I'm
in
pain
,
do
something
.
Speaker 2
10:39
And
now
,
suppression
doesn't
work
for
everyone
and
but
if
somebody
is
put
on
suppression
,
say
60
of
the
time
they
will
have
some
resolution
of
symptoms
and
I
mean
only
symptoms
,
not
resolution
of
disease
.
So
but
they
don't
understand
the
downfall
because
this
delays
your
diagnosis
,
this
delays
treatment
.
Just
because
there's
a
down
regulation
of
symptoms
doesn't
mean
that
there
is
a
cessation
in
the
progression
of
the
disease
.
The
disease
can
still
grow
in
the
absence
of
symptoms
.
It
can
still
go
and
cause
a
block
in
the
ure
.
The
disease
can
still
grow
in
the
absence
of
symptoms
.
It
can
still
go
and
cause
a
block
in
the
ureter
which
can
cause
the
kidney
to
fail
.
It
can
go
and
cause
an
obstruction
in
the
bowel
that
can
lead
to
an
intestinal
obstruction
which
can
be
life-threatening
.
So
in
those
cases
it's
very
important
to
have
that
diagnosis
before
prescribing
medical
therapy
,
because
you're
kind
of
endangering
somebody's
life
when
you're
doing
that
.
Speaker 2
11:35
If
you're
allowing
an
obstruction
of
the
ureter
to
turn
into
kidney
failure
,
if
you're
allowing
a
bowel
nodule
to
turn
into
an
obstructive
lesion
,
you're
you
know
,
if
you
go
into
intestinal
obstruction
it's
life-threatening
.
Then
you
need
big
emergency
surgery
and
usually
in
the
casualty
of
the
A&E
they're
not
going
to
do
a
laparoscopy
,
they're
going
to
do
a
big
open
surgery
and
do
a
resection
of
the
bowel
and
say
,
okay
,
at
least
it's
not
cancer
.
So
those
are
true
stories
that
have
happened
to
patients
and
then
,
like
I
said
,
there
needs
to
be
more
awareness
,
more
awareness
.
But
there
is
a
big
uh
that
between
,
especially
,
fertility
specialists
and
uh
endometriosis
surgeons
,
where
they're
more
.
They're
like
,
okay
,
we'll
get
the
patient
pregnant
,
but
we
won't
treat
the
disease
.
So
that's
how
it
works
.
Speaker 1
12:25
Which
is
interesting
to
think
about
,
because
and
correct
me
if
I'm
wrong
if
you
were
to
take
a
drug
,
say
Lupron
,
it
does
affect
your
fertility
,
but
it
doesn't
treat
the
disease
,
Am
I
?
Right
in
that
assumption
,
like
the
ovarian
reserve
can
be
diminished
because
of
this
,
or
is
that
completely
anecdotal
?
Speaker 2
12:44
So
estrogen
levels
.
So
the
Lupron
is
a
GnRH
drug
anode
that
acts
on
the
levels
of
the
brain
,
so
it
goes
and
competes
with
estrogen
receptors
,
so
it
drops
estrogen
levels
.
And
there
are
a
lot
of
studies
and
I
think
Dr
David
Rudwine
showed
that
there's
no
great
recovery
of
estrogen
levels
even
after
cessation
of
Lupron
therapy
and
they
suppressed
that
data
as
well
.
There
are
protocols
in
fertility
treatments
where
they
give
short
doses
of
GnRH
agonists
to
downregulate
the
ovaries
and
once
that
effect
goes
off
the
ovaries
overproduce
so
you
get
more
of
a
response
to
produce
AIDS
.
So
that's
why
they
use
those
drugs
and
it
also
for
them
.
It's
symptomatic
relief
for
the
patient
and
it
downregulates
,
so
it
fulfills
their
purpose
for
the
upcoming
IVF
cycle
.
Speaker 1
13:43
I
told
you
this
episode
is
going
to
be
random
.
We're
everywhere
today
,
but
it's
all
good
.
I
feel
like
I'm
sitting
down
and
just
getting
the
answers
that
I
have
had
brewing
in
my
brain
for
a
really
long
time
.
So
thanks
for
joining
this
train
with
me
of
crazy
and
answering
a
lot
of
those
questions
,
because
I
think
it's
relevant
and
I
think
these
are
questions
that
I
hear
all
the
time
from
patients
who
are
walking
through
this
journey
,
not
so
much
on
like
the
anecdotal
part
of
like
worldwide
endometriosis
and
persistence
of
disease
and
things
like
that
,
but
that's
curiosity
on
my
part
.
Speaker 1
14:23
It
is
important
to
just
kind
of
note
that
it
doesn't
really
matter
where
you
are
in
the
world
,
what
diet
or
environment
you're
Global Perspectives on Endometriosis Care
Speaker 1
14:31
in
.
Endometriosis
is
endometriosis
.
It's
invasive
at
its
core
and
you're
going
to
have
to
figure
out
care
and
treatment
,
which
is
what
really
is
the
hard
part
,
or
a
diagnosis
actually
,
for
that
matter
.
Diagnosis
is
probably
the
hardest
part
to
get
for
a
lot
of
people
,
but
I've
always
just
questioned
that
the
relationship
between
cultures
and
demographics
and
endometriosis
.
So
that
answered
that
.
Thank
you
for
that
.
That's
good
,
anecdotally
,
of
course
,
but
also
just
to
talk
about
the
different
care
and
treatment
that
people
get
around
the
world
.
I
think
that
we
talked
about
this
a
lot
at
the
summit
.
Actually
,
it's
a
topic
of
conversation
that
I
think
we
need
to
continue
having
about
endometriosis
and
getting
people
worldwide
better
care
and
diagnosis
.
Speaker 2
15:16
Dr
Mosbrocker
was
saying
it's
very
interesting
because
she's
had
a
couple
of
patients
of
Indian
origin
that
she
treated
and
she's
noticed
certain
phenotypes
.
She
was
asking
me
what
my
experience
was
and
I
said
you
know
,
it
would
be
a
very
interesting
study
to
have
specialists
from
different
parts
of
the
world
compare
their
patient
population
and
see
where
they
primarily
have
disease
and
if
there
are
any
,
you
know
geographic
trends
of
whether
,
say
,
bowel
endometriosis
or
ovarian
endometriosis
or
,
you
know
,
diaphragm
or
thoracic
endometriosis
.
So
I
think
that
would
be
a
very
interesting
study
to
put
together
from
different
centers
and
it
would
take
a
lot
of
work
and
coordination
among
different
centers
.
Speaker 1
16:04
It
would
.
But
I
mean
,
I
think
to
that
point
too
it
would
be
interesting
and
I
think
it
would
probably
be
beneficial
long
term
.
But
it's
also
that's
kind
of
putting
the
cart
before
the
horse
.
We
,
we
first
have
to
get
people
diagnosed
at
an
earlier
stage
.
Speaker 2
16:20
I
think
that's
going
to
be
key
in
understanding
that
portion
of
the
disease
diagnosis
is
a
very
interesting
topic
because
there
is
a
movement
in
some
of
the
countries
where
they're
banding
a
hashtag
that
diagnosis
is
therapy
but
diagnosis
is
diagnosis
.
Yes
,
that's
step
one
.
I
mean
you
should
be
completely
prepared
with
your
diagnosis
before
you
attempt
surgery
.
Speaker 2
16:48
There
was
a
big
debate
in
the
early
2000s
where
they
would
see
a
big
endometriosis
surgeon
would
say
I
don't
need
that
diagnosis
,
I'll
put
the
scope
in
and
figure
it
out
.
But
now
we
know
that
there
is
such
severe
endometriosis
that
can
be
affecting
the
nerves
which
even
when
you
put
a
scope
in
your
pelvis
would
look
normal
and
you'd
have
to
really
dig
down
deep
along
that
nerve
to
pick
out
the
disease
.
So
unless
you
were
able
to
make
that
diagnosis
clinically
or
via
imaging
,
you
would
never
know
how
to
treat
this
patient
.
So
I
think
diagnosis
is
important
,
but
only
to
help
you
plan
your
treatment
.
Speaker 2
17:25
Diagnosis
is
not
a
substitute
for
treatment
.
You're
not
going
to
replace
good
surgery
at
the
end
of
the
day
,
and
good
surgery
will
never
happen
without
good
diagnosis
.
So
they
kind
of
go
hand
in
hand
and
we
need
to
understand
that
distinction
and
I
think
you
either
if
you're
an
endometriosis
surgeon
,
I
believe
you
have
to
make
the
diagnosis
yourself
.
So
do
your
own
ultrasound
or
read
your
own
MRI
,
or
work
with
someone
who
you
trust
and
who
you
can
pull
up
to
the
OR
and
yell
at
them
if
they
miss
something
,
so
that
they
learn
.
That's
very
important
to
have
that
kind
of
relationship
in
your
team
.
So
I
think
that's
how
teams
have
to
work
.
You
can't
have
a
radiologist
sitting
100
miles
away
and
you
call
them
up
and
say
okay
,
what
do
you
have
?
And
then
you
go
into
surgery
and
it's
not
matching
with
what
they
found
.
And
then
there's
no
accountability
and
there's
no
learning
process
there
right
,
okay
,
let's
make
a
roadmap
.
Speaker 1
18:24
So
first
we
need
diagnosis
,
and
then
we
need
a
roadmap
for
surgery
and
treatment
.
And
then
what
comes
next
after
that
?
Post-operative
care
with
physical
therapy
,
physiotherapy
what
else
am
I
missing
?
Speaker 2
18:43
Occupation
therapy
,
mental
health
,
sexual
therapists
,
whatever
the
problems
are
.
So
each
patient
is
different
.
Speaker 2
18:54
You
have
to
tailor
their
therapy
to
what
the
problems
are
.
So
each
patient
is
different
,
so
you
have
to
tailor
their
therapy
to
what
the
problems
are
and
you
have
to
fix
or
attempt
to
diagnose
and
then
treat
everything
.
So
it's
very
important
to
have
a
good
team
and
a
good
network
of
different
specialties
at
your
disposal
,
and
I
think
it's
easier
in
some
countries
,
like
in
India
at
least
the
way
I
work
,
it's
private
care
,
so
we
have
everyone
accessible
and
pretty
close
by
,
so
it's
easy
enough
to
do
.
But
I
understand
limitations
in
countries
,
especially
in
university
hospitals
or
in
academia
,
where
everybody's
kind
of
doing
their
own
thing
and
they
don't
have
that
much
time
to
dedicate
to
a
specialty
that
may
not
be
considered
their
own
.
So
there
are
challenges
in
different
countries
.
So
if
we're
going
to
create
a
roadmap
or
a
template
,
it
has
to
be
adaptable
to
different
working
environments
.
Speaker 1
19:51
And
then
,
once
we
get
to
that
point
,
can
get
more
research
.
This
is
a
big
picture
.
Speaker 2
19:57
Research
is
very
difficult
because
you
get
research
from
,
mostly
from
academia
so
university
hospitals
which
do
the
least
amount
of
work
or
the
least
challenging
work
and
I'm
speaking
broadly
.
I'm
sure
there
are
some
university
hospitals
that
do
fantastic
work
,
but
usually
most
cutting-edge
centers
are
private
care
that
are
doing
that
and
then
to
publish
and
do
your
own
research
becomes
your
own
responsibility
.
The
expenses
come
out
of
your
own
pocket
.
So
if
you're
paying
research
analysts
or
statisticians
to
track
your
data
,
you're
paying
it
out
of
your
own
pocket
,
which
may
not
be
incentive
enough
for
most
people
yeah
you
know
the
guy
I
trained
with
,
Forrest
Roman
in
France
.
Speaker 2
20:44
The
French
have
a
fantastic
database
for
endometriosis
care
so
everything
goes
into
national
database
and
everything
is
entered
.
He
personally
goes
and
enters
it
after
each
surgery
so
everything
is
logged
and
they
can
extrapolate
data
and
come
up
.
They
come
up
with
the
best
papers
on
endometriosis
because
they
have
such
fantastic
data
entry
and
records
and
he
pays
his
research
team
out
of
his
own
profits
.
He's
a
very
dedicated
guy
.
It
doesn't
really
work
in
other
countries
where
you're
resource
limited
and
or
some
people
just
may
not
be
interested
in
putting
their
research
out
.
They
just
want
to
do
their
work
.
Speaker 1
21:24
Yeah
,
so
maybe
we
need
a
research
database
where
all
the
physicians
can
put
in
their
data
.
So
anyone
out
there
who's
a
tech
guru
we've
already
clarified
that
neither
one
of
us
or
that
should
make
a
database
for
all
the
doctors
to
put
all
their
information
in
,
and
then
we
could
have
better
data
worldwide
.
I
just
solved
the
world's
problem
,
done
.
Speaker 2
21:46
But
see
again
,
I
can
come
up
with
more
problems
for
that
,
because
does
everybody
speak
the
same
language
in
endometriosis
?
Some
people
use
stage
1
,
2
,
3
,
4
.
Some
people
use
the
AGL
classification
.
Some
people
use
the
NGIN
score
.
How
many
people
are
making
complete
diagnosis
and
how
are
you
going
to
extrapolate
all
that
data
?
Yes
,
you
can
.
The
French
do
it
very
well
,
but
they
have
standardized
data
entry
.
Now
to
get
consensus
about
data
entry
is
you're
going
to
have
to
take
the
world's
top
endometriosis
surgeons
and
convince
them
that
this
is
the
way
,
and
from
my
experience
,
any
surgeon
tends
to
be
the
most
egoistic
person
in
the
room
.
So
to
convince
them
that
they
have
to
change
the
way
they're
thinking
and
doing
things
is
a
Herculean
effort
at
best
yeah
,
that's
true
,
but
I
like
your
optimism
and
I
think
we
should
work
towards
that
.
Speaker 1
22:43
I
was
just
trying
to
solve
all
the
world's
problems
here
.
That's
all
all
the
world
of
endometriosis
.
If
we
could
just
solve
it
with
one
app
,
wouldn't
that
be
amazing
?
We're
not
there
yet
.
Speaker 2
22:54
Well
,
they
trying
,
not
for
lack
of
trying
.
I
mean
,
mauricio
Obrado
came
up
with
the
AGL
classification
.
It
was
an
app
that's
quite
fantastic
.
Even
the
enzyme
system
is
brilliant
.
So
I've
seen
MRI
reports
from
countries
where
I
don't
speak
the
language
and
I
didn't
have
to
use
Translate
because
they
wrote
the
enzyme
score
at
the
end
and
I
knew
exactly
where
the
language
.
And
I
didn't
have
to
use
Translate
because
they
wrote
the
angioenesis
score
at
the
end
and
I
knew
exactly
where
the
disease
was
.
Speaker 1
23:19
So
I
knew
how
to
treat
that
patient
Interesting
I
,
you
know
.
And
that's
why
I
think
it's
important
to
talk
about
worldwide
endometriosis
,
because
we
get
stuck
in
at
least
I
do
in
my
little
American
bubble
where
I
don't
understand
some
of
the
challenges
that
people
face
worldwide
or
that
doctors
face
worldwide
.
I
mean
,
I
think
that
that's
I
mean
a
whole
nother
topic
that
we
could
talk
about
another
time
.
But
I
do
think
that
just
the
barriers
that
we
face
in
endometriosis
isn't
just
the
disease
,
it's
cultural
language
,
diagnostic
,
it's
the
list
goes
on
.
So
it's
a
good
point
.
Oh
,
my
goodness
.
Speaker 1
23:55
Okay
,
this
is
a
lot
to
process
and
I
hope
that
we
can
continue
having
conversation
surrounding
this
and
be
as
sporadic
as
possible
in
the
future
,
because
this
is
how
we
,
this
is
how
we
talk
at
the
dinner
table
,
this
is
we
talk
about
all
the
different
things
,
and
this
is
why
when
I
tell
people
,
you
know
,
join
me
at
the
table
.
It
know
,
join
me
at
the
table
.
It
truly
is
joining
me
at
the
table
in
these
conversations
that
are
everywhere
but
also
very
informative
,
because
they're
part
of
this
conversation
,
what
we've
talked
about
today
.
Everyone
has
a
piece
of
that
.
We
all
have
a
place
at
the
table
of
endometriosis
,
where
we
can
talk
about
it
and
we
can
expand
our
horizons
and
knowledge
.
Speaker 1
24:36
And
it
doesn't
have
to
be
uniform
all
the
time
.
It
can
be
conversational
.
So
that's
why
this
is
so
good
.
And
,
of
course
,
you're
amazing
all
the
time
,
dr
Manks
,
thank
you
so
much
for
your
time
.
Thanks
for
joining
me
today
.
Thanks
for
everything
you're
doing
groundbreaking
research
on
your
own
thought
process
,
everything
.
Also
,
again
,
if
you
need
a
bowel
resection
,
he's
a
great
surgeon
for
that
.
Speaker 2
24:59
So
thank
you
for
having
me
and
for
making
it
such
an
easygoing
informal
conversation
.
I
think
you
have
a
natural
gift
that
gets
people
to
just
keep
talking
and
kind
of
self-incriminate
as
well
.
You
could
have
been
a
lawyer
.
Speaker 1
25:17
Gonna
need
a
lawyer
.
No
,
anytime
.
You
know
you're
welcome
here
anytime
,
anytime
at
the
table
.
So
until
next
time
,
everyone
continue
advocating
for
you
and
for
those
that
you
love
.
Thank
you
.