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What if the reason you’re still in pain after surgery isn’t failure—it’s complexity that wasn’t fully addressed? We sit down with a neurogastroenterologist and a colorectal surgeon to unpack why deep endometriosis often persists, how bowel involvement gets missed, and what a truly coordinated plan looks like when disease touches the colon, rectum, bladder, and beyond. Their candid insights replace false hope with a roadmap: document what’s found, refer when needed, and assemble the right team before anyone picks up a scalpel.
From the GI side, we spotlight the often-ignored drivers of rough recoveries: mast cell activation, POTS, and hypermobility. You’ll hear concrete perioperative steps that make a difference—stabilizing the neck for craniocervical instability, aggressive pre-op hydration for dysautonomia, avoiding mast cell-triggering anesthetics and opioids like morphine, and keeping steroids plus H1/H2 blockers ready for intra-op flares. These are practical, repeatable moves any care team can adopt to reduce anaphylaxis risk, dampen post-op nausea, and prevent the multi-day crashes that erode progress.
On the surgical front, we examine why repeat procedures happen and when restraint is the safest choice. Rather than forcing a high-risk resection, skilled gynecologists who encounter rectal nodules document and refer to colorectal partners, which protects patients from complications. That’s not a setback; it’s modern care. We walk through how multidisciplinary planning—similar to rectal cancer pathways—improves detection of deep infiltrating endometriosis, clarifies whether staged surgery is wiser, and sets honest expectations about recovery timelines.
If you’re navigating persistent symptoms after “successful” surgery, this conversation offers clarity and a plan. Learn the questions to ask, the protocols to request, and the markers of a team that’s ready for complex disease. If this helped you, follow the show, share it with someone who needs answers fast, and leave a review with your top question for our next Quick Connect.
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Quick Connect Setup And Disclaimer
SPEAKER_02
0:00
Life
moves
fast,
and
so
should
the
answers
to
your
biggest
questions.
Welcome
to
Indo
Batteries
Quick
Connect,
your
direct
line
to
expert
insights.
Short,
powerful,
and
right
to
the
point.
You
send
in
the
questions,
I
bring
in
the
experts,
and
in
just
five
minutes,
you
get
the
knowledge
you
need.
No
long
episodes,
no
extra
time
needed.
And
just
remember,
expert
opinions
shared
here
are
for
general
information
and
not
for
personalized
medical
advice.
Always
consult
your
provider
for
your
case-specific
guidance.
Got
a
question?
Send
it
in,
and
let's
quickly
get
you
the
answers.
I'm
your
host,
Alana,
and
it's
time
to
connect.
Meet The GI And Colorectal Experts
SPEAKER_02
0:39
Today
I'm
honored
to
welcome
two
incredible
physicians,
both
whom
bring
unique
expertise
and
deep
commitment
to
caring
for
patients
with
complex
conditions.
First,
we
have
Dr.
Zach
Spiritos,
a
neurogastroenterologist
and
internist.
Dr.
Spiritos
trained
at
UNC
School
of
Medicine,
completed
his
residency
at
internal
medicine
at
Emory
University,
and
went
on
to
a
fellowship
in
gastroenterology
at
Duke.
He
specializes
in
a
wide
range
of
gastrointestinal
and
liver
disorders
with
particular
interest
in
irritable
bowel
syndrome,
functional
abdominal
pain,
motility
disorders,
and
dysautonomia,
including
conditions
like
POTS
and
mast
cell
activation
syndrome.
He
also
has
expertise
in
GI
complications
connected
to
hypermobility
syndromes
like
E
Lers
downlos.
Also
joining
us
today
is
Dr.
Vincent
Obius,
a
professor
of
surgery
and
chief
of
the
Division
of
Colorectal
Surgery
for
the
National
Capital
Region.
Dr.
Obias
trained
at
the
Medical
College
of
Virginia,
Eastern
Virginia
Medical
School,
and
Cleveland
Clinic
with
additional
advanced
training
and
laparoscopic
colorectal
surgery
at
University
Hospital's
Case
Medical
Center.
He
is
double
board
certified
in
general
and
colorectal
surgery,
and
his
specialties
include
robotic
minimally
invasive
techniques
as
well
as
surgery
for
deep
infiltrating
endometriosis.
His
research
and
clinical
work
have
made
a
lasting
impact,
particularly
in
robotic
surgery
outcomes
and
complex
endometriosis
care.
Together,
these
two
doctors
bring
insights
from
both
the
gastrointestinal
and
surgical
perspectives,
making
today's
conversation
one
that
promises
to
be
both
informative
and
empowering
for
patients
and
providers
alike.
Please
help
me
in
welcoming
Dr.
Zach
Spiritos
and
Dr.
Vincent
Obius
to
the
Why Symptoms Persist After Multiple Surgeries
SPEAKER_02
2:30
table.
Vince,
have
you
experienced
that
you've
done
resections
and
you've
been
in
surgeries
where
they've
had
multiple
surgeries,
they
continue
having
these
symptoms.
Is
it
typically
disease
state
that
you're
seeing
again,
or
is
it
something
else
completely?
SPEAKER_00
2:46
Yeah,
I
I
will
say
that
um
every
time
I'm
in
a
case,
um,
especially
now
working
with
Dr.
Vargas
and
Dr.
Mikhail,
you
know,
their
success
rates
in
finding
nodules
and
of
involvement
of
the
bowel
is
like
100%.
So
whenever
and
and
like
we
had
mentioned
and
discussed
earlier,
sadly,
most
of
the
surgeries
I've
involved,
there's
been
previous
surgery,
which
is
it's
just
sad
to
see.
Honestly,
um,
the
gynecologist
did
the
right
thing.
Rather
than
tackle
this
complex
nodule
on
the
rectum
and
have
a
complication
that's
just
terrible,
don't
do
anything,
document
it,
get
it
to
an
expert.
But
yeah,
I
mean,
when
they're
having
post-surgical
and
there's
usually
because
of
endometriosis
that's
been
left
behind,
sometimes
inadvertently
and
regrown,
or
and
sometimes
they
knew
it
and
they're
like,
look,
I'm
not
gonna
not
gonna
risk
it.
And
it's
the
smart
thing
to
do,
understanding
that
you
know
they're
a
little
bit
out
of
their
element.
The
patient
is
not
aware
a
big
surgery
can
happen.
Um,
and
it's
better
to
just,
you
know,
get
out,
let
them
recover
quickly.
But
it's
very
frustrating,
honestly,
for
the
patients
who
are
like,
they
came
in,
they're
hoping
to
have
one
procedure,
they're
hoping
to
have
this
done,
taken
care
of,
and
they've
been
told
not
only
that
you
know
we're
we're
we're
doing
this,
but
there's
gonna
be,
you
know,
we
couldn't
do
it
all,
but
there's
also
a
worse
situation,
and
we
may
need
even
more
advanced
extensive
stuff.
So
um
so
yes,
I
absolutely
have
seen
it.
And
the
majority
of
the
time
it's
because
of
this
end
of
endometriosis
being
there.
SPEAKER_02
4:10
Okay.
Yeah.
I
would
I
think
that's
probably
pretty
common
with
people
that
I
hear,
including
my
own
story
of
that
of
disease
being
left
behind.
But
it,
you
know,
that
goes
to
say
that
that's
why
this
education
is
so
important,
right?
And
we
have
to
keep
educating
about
this.
Mast Cell And POTS Perioperative Protocols
SPEAKER_02
4:27
Zach,
is
there
a
ideal
pre
and
post-operative
routine
or
things
that
we
can
do
to
help
support
us
from
the
mast
cell
part
of
it?
Because
I
know
a
lot
of
people,
including
myself
coming
out
of
it,
things
flare
really
bad.
How
do
we
help
alleviate
a
little
bit
of
that
pre
and
post-operatively?
SPEAKER_01
4:47
Yes,
we
want
to
make
sure
their
mast
cell
is
under
as
best
control
as
possible
pre-operatively.
There's
always,
I
tend
to
reach
out
to
the
surgeon
to
discuss
the
case
and
just
say,
hey,
this
is
kind
of
this
is
how
I
would
think
about
this
specific
patient.
You
know,
whether
they're
hypermobile
and
they
need
a
neck
brace
during
a
surgery
because
they
have
a
lot
of
craniocervical
instability.
Do
they
have
HOTS
and
just
need
very
like,
do
they
really
need
to
be
fluid
resuscitated
before
the
case
and
really
just
make
sure
that
they're
adequately
hydrated?
If
they
have
mast
cell
activation
syndrome,
there's
certain
anesthetics
that
tend
to
flare
mast
cells
and
post-operative
narcotics
like
morphine
that
tend
to
be
more
aggravating
for
mast
cells.
And
there's
also
a
dialogue
like
what
happens
if
they
have
a
huge
flare
and
go
in
anaphylactic
shock.
Like,
we
should
probably
have
like
steroids
and
you
know,
H1
and
H2
blockers
ready
to
go
in
case
that
happens.
And
so
I
have
a
protocol
that,
you
know,
I've
I've
written
with
other,
I
haven't
written,
but
I've
adopted
from
other
um
mast
cell
clinicians.
And
I
often
will
reach
out
to
the
surgical
team
and
say,
this
is
kind
of
what
I
would
do
uh
and
how
I
would
approach
this
patient
kind
of
perioperatively
and
intraoperatively
just
to
get
the
best
outcomes.
Yeah.
Yeah.
SPEAKER_00
5:57
Honestly,
like
the
way
Zach
pointed
out,
it
it's
Multidisciplinary Care For Complex Endometriosis
SPEAKER_00
6:00
important
to
emphasize
that
when
you're
dealing
with
something
like
endometriosis
that
can
affect
so
many
different
areas:
colon,
rectum,
diaphragm,
bowel,
bladder,
it's
multidisciplinary.
Just
like
when
I
deal
with
rectal
cancer,
we
talk,
we
have
radiologists,
oncologists,
radiation
oncologists.
We
we
have
a
variety
of
people
on
the
team
to
discuss
it.
And
so
it
endometriosis,
especially
complex
stuff,
is
is
starting
to
lean
that
way
where
you
have
multidisciplinary
teams
talking
about
it
so
that
we
don't
miss
things.
And
Closing And How To Send Questions
SPEAKER_00
6:33
Zach
pointed
out.
SPEAKER_02
6:33
That's
a
wrap
for
this
quick
connect.
I
hope
today's
insights
helped
you
move
forward
with
more
clarity
and
confidence.
Do
you
have
more
questions?
Keep
them
coming.
Send
them
in,
and
I'll
bring
you
the
expert
answers.
You
can
send
them
in
by
using
the
link
in
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top
of
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description
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podcast
episode
or
by
emailing
contact
at
indobattery.com
or
visiting
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Indobattery.com
contact
page.
Until
next
time,
keep
feeling
empowered
through
knowledge.