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Are you ready to conquer the mysteries of endometriosis, pelvic pain, and nerve impingement? Yes? Great! Buckle up and join us today as we delve into this complex world with the unparalleled insights of Dr. Sallie Sarrell and our special guest, Inge. In our fruitful discussion, we unmask the numerous culprits behind groin and pelvic pain, including the nuances of herniated discs, no-buldge hernia and the much-dreaded sciatica. As we dig deeper, we will inevitably equip you with the knowledge to engage confidently with your medical providers.
Unleashing the wonders of techniques like cupping therapy, we’ll journey through the intricate layers of scar tissue and enter the realm of fascia release. We’ll investigate how a castor oil pack softens tissue before a release session and how hands-on tools like dry needling or cupping can facilitate this process. Wading through the murky waters of ovarian cysts and their effect on the posterior cutaneous nerve, we make a mindful stop at the importance of consent before embarking on any treatment journey.
Navigating further, we’ll discover the complexities of the iliacus muscle group, alignment issues, pelvic disease, and the omnipresent influence of diaphragm excursion in all three planes. Learn about the role of Carnett’s tests and MRIs in hernia diagnosis and the invaluable protocol developed by Shirin Towfigh in identifying occult or no-bulge hernias. As we unearth the parallels between frozen pelvis and hernias, we also shed light on the empowering role of physical therapy and strength training in rehabilitation. Finally, we reveal the differences between diastasis recti and hernias and the unexpected role testosterone plays in endometriosis care. So, are you ready to take the plunge? Let’s dive together into this enthralling journey of exploration and discovery.
https://theendometriosissummit.com/
Website endobattery.com
Understanding Endometriosis-Related Groin and Pelvic Pain
Speaker 1
0:03
Welcome
to
Endo
Battery
,
where
we
are
sharing
our
endometriosis
journey
and
learning
along
the
way
.
This
podcast
is
in
no
way
meant
to
diagnose
or
give
medical
advice
,
but
a
place
where
you
can
gain
knowledge
and
information
that
can
help
you
to
not
feel
alone
,
as
well
as
become
your
best
advocate
.
We
want
to
learn
with
you
and
support
you
wherever
you
are
in
your
journey
.
Thanks
for
joining
us
as
we
navigate
the
ups
and
downs
and
share
stories
of
strength
,
resilience
and
hope
.
Come
with
us
as
we
dive
deep
into
the
world
of
endometriosis
,
from
personal
experiences
to
expert
insights
.
This
is
Endo
Battery
charging
our
life
when
Endo
drains
us
.
Welcome
back
to
Endo
Battery
.
Speaker 1
0:42
Today
we
are
joined
once
again
by
high
demand
by
Dr
Sally
Sorrell
,
who
has
enlightened
us
already
once
in
one
episode
,
and
if
you
haven't
heard
that
episode
,
then
you
need
to
go
back
and
listen
to
it
,
because
I'm
also
joined
by
Inga
,
who
is
she
was
highly
invested
in
that
episode
and
was
like
Alana
,
you
need
to
have
Sally
back
,
we
have
more
questions
.
We
got
to
talk
about
a
lot
more
.
So
Inga
approached
me
actually
and
was
like
can
you
please
have
Sally
back
on
here
?
I
have
more
questions
.
And
I
said
,
well
,
why
don't
you
just
join
me
.
Why
don't
you
just
come
,
inga
?
And
she
said
okay
.
So
she
took
the
day
off
work
.
Oh
,
she
did
.
She's
committed
,
good
to
know
,
committed
.
She
canceled
appointments
,
took
the
day
off
work
and
was
like
I'm
going
to
be
there
because
I
have
so
many
questions
on
this
,
because
you
listened
to
that
last
episode
.
Speaker 2
1:35
It
did
like
six
times
Sally
,
and
the
first
time
I
was
driving
down
the
road
and
it
hit
home
for
me
because
I've
been
dealing
with
sciatica
for
like
since
March
and
then
,
sort
of
exactly
like
you
were
talking
about
in
your
last
podcast
,
I
had
the
imaging
done
of
my
back
.
We
found
three
herniated
discs
L3
,
L4
,
L5
.
And
it
was
like
,
okay
,
this
is
the
source
of
your
problem
.
I've
had
some
injections
.
It's
helped
nothing
.
And
I
actually
went
back
to
the
pain
management
doc
who
was
doing
the
injections
and
I
said
what
are
your
thoughts
on
?
Could
this
be
from
my
pelvis
?
Because
I
was
literally
listening
to
your
podcast
right
before
I
walked
in
and
he
said
really
,
I
really
do
.
I
feel
like
at
this
point
,
with
no
relief
after
everything
that
we've
done
,
I
actually
do
.
Speaker 2
2:29
And
I
guess
his
daughter
or
daughter-in-law
has
a
pretty
long
history
of
dealing
with
endo
,
is
also
a
doctor
of
PT
,
and
he's
like
let's
start
looking
at
your
pelvis
.
And
I
just
thought
is
this
the
next
endo
?
And
you
were
talking
about
the
fat
hernia
specifically
.
Is
what
I
was
like
what
is
this
?
And
just
really
wanted
to
kind
of
dive
into
that
a
little
bit
more
and
for
you
to
share
your
insights
,
because
up
until
listening
to
that
podcast
,
I
had
never
heard
of
this
,
so
welcome
to
both
of
you
Yay
.
Speaker 3
3:06
I'm
so
excited
.
Welcome
.
Thank
you
for
having
me
,
yeah
.
Speaker 1
3:10
But
that
is
the
roadmap
for
today
because
that
was
a
lot
to
unpack
for
us
for
the
hernias
.
So
when
you
talk
about
no-bolt
hernia
,
can
you
expand
a
little
bit
more
about
the
no-bolt
hernia
and
maybe
where
it's
at
specifically
?
Is
it
in
the
pelvis
it
can
it
be
anywhere
anatomically
?
Where
do
we
typically
find
those
hernias
?
Speaker 3
3:35
Well
,
first
of
all
,
remember
that
our
title
of
last
podcast
was
growing
ecology
,
and
so
that
groin
pain
and
pelvic
pain
,
it
all
goes
together
.
It's
not
always
just
one
thing
.
And
I
would
say
,
when
it
comes
to
if
you
have
those
herniated
discs
and
just
a
backtrack
to
,
your
personal
question
.
Speaker 3
4:00
If
you
have
those
herniated
discs
,
they
should
be
able
to
do
a
dermatome
map
on
your
body
and
if
your
pain
is
consistent
with
those
discs
or
not
consistent
with
those
discs
,
because
they
very
much
could
be
a
driver
of
pain
.
But
they
could
not
be
a
driver
of
pain
and
so
you're
treating
those
and
it's
not
helping
and
that's
a
concern
.
If
somebody
has
bowel
and
bladder
incontinence
or
a
failure
to
be
able
to
go
and
they
also
have
those
herniated
discs
,
let's
also
remember
that
that's
a
medical
emergency
and
if
those
two
come
together
you
need
a
neurologist
to
take
your
spine
very
,
very
seriously
.
And
you
think
I'm
giving
the
warning
for
,
oh
,
she
has
to
cover
her
ass
.
But
the
actual
reality
is
I
had
it
happen
twice
with
patients
last
year
that
they
were
convinced
it
was
something
else
and
really
when
you
do
that
full
exam
on
them
and
check
the
dermatome
and
myotome
and
whether
or
not
they
have
bladder
,
they're
not
able
to
have
bladder
and
bowel
incontinence
or
they
have
a
failure
to
be
able
to
empty
.
They
had
impinged
nerves
that
needed
almost
immediate
spinal
surgery
.
So
I
always
mention
that
,
as
I
had
it
happen
twice
.
Speaker 3
5:22
But
I
want
to
mention
that
when
you
talk
about
noblege
hernia
you're
typically
talking
about
in
females
,
though
it
could
happen
in
anyone
.
You're
typically
talking
about
impinging
what's
known
as
the
allele
and
glenal
nerve
,
or
the
genital
branch
of
the
genital
femoral
nerve
,
or
the
femoral
nerve
,
which
,
and
those
pain
tend
to
be
down
the
groin
into
the
inner
thigh
,
across
the
pubic
bone
and
wrapping
around
from
L3
.
So
it
wraps
around
the
body
to
the
side
of
the
stomach
and
down
into
your
groin
,
tends
to
be
the
allele
and
glenal
and
the
genital
branch
of
the
genital
femoral
nerve
.
The
femoral
nerve
tends
to
be
.
If
it's
impinging
that
nerve
tends
to
be
this
deep
,
achy
,
gnawing
pain
right
down
the
front
of
the
leg
into
the
quadricep
pain
.
So
what's
interesting
to
me
is
that
people
call
any
of
those
sciatica
and
those
are
not
sciatica
.
Sciatica
,
very
exclusively
,
is
the
sciatic
nerve
and
it
runs
from
your
ischial
tuberosity
,
which
is
this
little
sitz
bone
in
the
back
of
your
tush
,
down
the
back
of
your
leg
.
That
is
a
true
sciatica
.
Speaker 3
6:48
And
when
you
talk
about
sciatica
,
what's
interesting
is
that
the
uteral
sacral
ligament
,
if
you
have
endometriosis
you
have
uteral
sacral
endometriosis
is
going
to
aggravate
and
irritate
the
sciatic
nerve
as
well
,
as
if
you
have
a
very
tight
either
piriformis
that's
aggravating
the
pudental
nerve
,
or
if
the
pudental
nerve
is
fired
up
,
you're
going
to
get
that
sciatic
like
pain
right
from
that
as
well
.
And
then
the
last
thing
is
if
you
have
a
little
femoral
acetabular
impingement
,
which
is
a
hip
disorder
,
you
can
get
some
sciatic
related
issues
.
Now
at
this
year's
endometriosis
summit
March
8
through
the
10th
2024
,
we
will
be
having
a
full
course
on
groin
ecology
,
and
so
I've
been
doing
a
lot
of
research
related
to
these
pain
syndromes
that
we
get
in
our
legs
as
people
with
endometriosis
.
And
there
is
a
little
bit
of
research
some
published
,
some
I've
called
the
authors
,
some
I've
called
the
researchers
that
if
you
have
an
upregulated
bladder
,
which
we
know
comes
very
often
in
endometriosis
,
that
you're
also
going
to
get
an
upregulated
ilioin-greenle
nerve
,
which
is
that
nerve
that's
sort
of
on
your
side
of
your
belly
,
into
the
groin
,
and
you
may
also
get
an
upregulated
pudental
nerve
.
Speaker 3
8:24
Now
that
research
begins
to
flow
into
this
other
research
that
says
you
may
need
,
if
you're
working
on
those
nerves
,
to
work
on
what's
called
the
posterior
cutaneous
nerve
and
that
particular
nerve
.
I
sort
of
knew
my
exploration
into
that
since
the
last
time
we
talked
,
if
you
were
to
sort
of
take
your
hand
and
grab
sort
of
the
fatty
part
of
the
tush
.
You
know
,
like
you
wanna
cop
a
feel
on
your
own
tush
.
I
mean
,
obviously
you
give
yourself
consent
,
but
if
you
wanted
to
cop
a
feel
on
your
own
tush
,
then
it's
sort
of
what
you
grab
is
that
posterior
cutaneous
?
And
they
make
this
soup
together
pudendal
,
posterior
cutaneous
and
ilium
glenol
,
and
I
thought
that
that's
sort
of
very
interesting
.
Speaker 1
9:22
Okay
,
we
were
talking
about
this
because
you
were
talking
about
the
.
It
like
skips
,
your
butt
goes
right
underneath
there
,
right
,
and
then
skips
.
Speaker 2
9:35
Skips
my
hamstring
and
then
goes
right
into
the
back
of
my
knee
.
But
I
also
have
right
in
the
front
,
where
my
torso
meets
my
thigh
,
this
pain
.
Speaker 3
9:49
And
honestly
for
me
,
the
way
that
I
learned
,
I
have
to
see
it
Right
,
so
that
a
little
wait
,
wait
.
But
I
have
something
else
to
say
now
that
you
stood
up
and
you're
showing
me
something
so
that
very
much
could
be
a
mixture
of
ilium
glenol
and
also
maybe
a
little
obturator
.
Is
there
a
scar
?
Almost
right
where
you're
putting
your
hand
,
you
have
a
horizontal
scar
.
Speaker 1
10:14
Yeah
,
C-section
scar
.
Speaker 2
10:17
That
particular
,
and
it's
C-section
,
c-section
or
a
surgery
,
two
C-sections
,
and
that
was
excised
when
I
had
my
excision
surgery
.
Speaker 3
10:26
That
particular
scar
tissue
.
It's
very
possible
that
scar
tissue
itself
because
fascia
is
a
layered
healing
response
,
that
that
is
so
tight
that
it's
not
compressing
those
nerves
but
that
it's
pulling
into
those
nerves
.
So
the
first
thing
I
would
do
,
find
your
way
to
either
New
Jersey
or
Miami
,
either
one
doesn't
matter
to
me
and
I
would
do
a
manual
,
integrative
release
of
that
particular
scar
tissue
because
,
listen
,
scar
tissue
has
to
proliferate
to
heal
.
That's
how
you
heal
.
But
when
you
heal
normal
fascia
is
linear
in
its
laying
down
,
you
see
like
this
.
And
when
you
heal
scar
tissue
it's
like
this
right
.
Of
course
these
are
all
easier
on
video
than
probably
on
audio
.
Speaker 3
11:21
And
that
particular
scar
tissue
when
it's
healing
all
in
multiple
directions
like
that
.
It's
almost
as
if
you're
pulling
your
shirt
here
.
I
can
have
the
tension
over
here
and
honestly
,
the
first
thing
I
would
do
in
your
particular
case
and
almost
anyone
who's
had
C-section
,
open
hysterectomy
,
abdominal
wall
endometriosis
is
do
a
scar
tissue
release
and
that's
its
own
podcast
.
But
there
are
multiple
forms
of
scar
tissue
release
.
I
do
a
very
integrative
method
that
has
four
parts
and
it's
as
if
you're
playing
a
piano
on
the
skin
and
you're
moving
it
in
multiple
directions
.
But
other
people
might
use
some
of
which
is
called
ISTEM
I-A-S-T-M
and
that's
a
derivative
of
Gua
Sha
,
which
is
a
way
of
using
tools
to
manipulate
the
scar
tissue
.
Speaker 3
12:20
I
think
when
somebody's
had
a
lot
of
trauma
,
I
like
to
use
my
hands
because
their
body
will
let
me
in
as
it
needs
to
and
,
I
think
,
a
tool
you're
just
going
in
,
no
matter
what
.
Don't
forget
we
all
have
a
trauma
background
and
so
I
wanna
be
let
in
rather
than
force
my
way
in
.
But
also
,
if
you
can't
access
a
physical
therapist
,
who
has
great
techniques
for
this
,
you
can
try
dry
needling
it
.
Sometimes
you
can
find
an
orthopedic
PT
who
can
dry
needle
a
scar
tissue
and
sometimes
you
can
find
an
acupuncturist
who
is
willing
to
go
with
you
and
use
the
acupuncture
needles
on
the
scar
tissue
.
That's
a
good
thing
to
try
and
I
can
say
you
could
find
very
temporary
relief
on
a
very
specific
placement
of
a
TENS
unit
.
But
it's
very
temporary
,
like
as
soon
as
you
touch
the
unit
off
it
would
stop
.
Speaker 1
13:21
Would
cupping
be
beneficial
in
this
situation
as
well
,
or
is
that
just
more
trauma
?
Oh
,
I
love
this
.
I
love
this
question
.
Scar Tissue and Cupping Therapy
Speaker 3
13:27
Okay
.
So
when
we
talk
about
,
remember
,
I
showed
you
how
scar
tissue
layers
very
differently
,
right
?
So
when
you
do
Think
of
like
lasagna
layering
.
Speaker 1
13:35
For
those
who
can't
see
,
it's
like
a
lasagna
layer
.
Like
you
have
multiple
layers
.
Speaker 3
13:40
Right
,
but
then
when
it's
healing
,
anytime
you've
been
cut
and
something's
trying
to
heal
,
think
of
you
tried
to
make
lasagna
with
spaghetti
,
right
,
you
know
.
Think
of
what
would
happen
.
Which
I'm
gluten-free
,
so
I
forget
lasagna
.
I
had
to
.
It's
the
holiday
time
and
I
had
to
make
coogle
oh
.
I
couldn't
find
a
.
I
couldn't
find
a
Cassava
noodle
,
because
I
can't
even
do
the
rice
noodle
.
That
was
lasagna
,
so
I
had
to
make
my
coogle
out
of
spaghetti
.
So
that's
how
I
know
it's
not
gonna
.
Speaker 3
14:09
And
no
dairy
,
and
it's
not
a
new
but
you
know
that's
how
I
know
it's
not
gonna
lay
down
right
,
so
I
Would
.
One
of
the
things
that's
very
interesting
is
when
we
used
to
do
trigger
points
,
which
we
now
call
tender
points
.
We
press
into
the
skin
,
so
you're
going
from
the
outside
layer
to
the
in
Inside
layer
sometimes
is
forced
,
depending
on
how
much
you
go
with
it
.
What
I
find
lovely
about
hopping
is
you're
going
from
the
outside
layer
,
from
the
inside
layer
to
the
outside
,
because
it's
a
suction
cup
that's
Suctioning
away
the
different
layers
of
the
fascia
.
So
would
it
be
helpful
there
?
It
certainly
can't
be
hurtful
.
How
many
weeks
are
you
past
?
That
looks
like
years
.
Speaker 3
15:02
Yeah
so
like
,
certainly
can't
be
I
.
I
would
definitely
have
the
scars
years
old
.
I
would
feel
very
comfortable
using
cupping
there
.
I
would
use
the
tiny
little
cupping
.
Cupping
became
my
favorite
thing
because
during
COVID
,
because
people
could
access
cups
on
Amazon
and
then
get
online
and
I
could
show
them
how
to
use
it
.
So
you
have
to
be
aware
that
you
can
Bruise
and
a
bruises
,
that
you've
popped
a
blood
vessel
.
You
know
you
don't
want
to
do
that
with
.
You
don't
want
it
to
Aggressively
cup
.
I
don't
like
moxie
combustion
,
which
is
like
a
burning
cup
for
somebody
to
do
at
home
.
It's
different
.
If
you're
practitioner
does
it
and
that
is
a
nice
thing
to
try
there
.
But
so
are
all
the
other
things
that
I
mentioned
as
well
.
Speaker 3
15:51
I
also
left
out
of
the
conversation
.
You
could
begin
your
Release
session
whether
you're
gonna
use
your
hands
.
You're
gonna
need
to
use
dry
needling
or
you're
gonna
use
a
cupping
With
a
castor
oil
pack
to
soften
the
tissue
first
.
Yeah
,
that's
yeah
,
instead
of
just
heat
.
But
honestly
,
like
I'm
telling
you
,
like
you
guys
can't
see
it
on
the
audio
the
way
the
lateral
most
corner
of
that
scar
is
pulling
,
I
can
almost
See
how
it's
tensioning
.
It's
tensioning
into
the
nerve
.
Is
that
your
only
problem
?
I
don't
know
,
but
you
really
need
to
start
with
that
.
Okay
,
so
good
thing
I
made
you
get
almost
naked
.
Speaker 2
16:33
I
know
I'll
get
more
naked
.
If
you
want
me
to
Dedicated
,
I
would
say
is
I'll
just
stand
up
?
Speaker 3
16:40
is
that
the
posterior
cutaneous
nerve
?
Is
you
know
?
Speaker 3
16:44
remember
I
said
,
like
after
you
consent
for
yourself
,
that
it's
that
where
you
grab
that
little
,
yeah
,
like
and
and
I
have
never
met
someone
who
has
an
ovarian
cyst
that
doesn't
grab
their
tush
like
that
,
never
,
ever
,
huh
,
and
I
find
that
really
interesting
.
It
and
especially
if
you
have
a
rupture
,
that
somehow
the
fluid
really
aggravates
that
nerve
I
that
posterior
cutaneous
and
it's
very
superficial
and
of
course
FAI
,
which
is
a
impingement
syndrome
of
the
hip
,
can
cause
a
little
bit
of
pain
back
there
as
well
Understanding and Diagnosing Pelvic Pain
Speaker 3
17:21
.
Speaker 1
17:21
Would
the
?
So
both
of
us
do
,
do
?
We've
done
dry
needling
for
the
iliacus
.
We
both
have
been
very
,
very
,
very
tight
right
there
,
and
it's
released
a
little
bit
.
You
said
this
last
time
,
right
.
Speaker 2
17:36
Or
not
so
much
,
I
don't
know
.
I
feel
like
I
go
one
week
I'm
good
,
and
then
it
were
.
I
feel
like
it's
good
,
and
then
the
now
I'm
back
to
almost
square
one
.
Speaker 3
17:45
I
.
So
this
is
my
thing
with
this
so
as
syndrome
,
right
,
mm-hmm
,
the
so
as
is
,
and
and
for
those
of
you
who
don't
know
this
,
the
so
as
muscle
group
is
combination
of
a
hip
flexor
Complex
.
I
guess
we
would
call
it
one
being
being
iliacus
and
one
being
so
is
,
and
certainly
you
can
go
to
and
see
what
both
of
these
muscles
look
like
.
I
think
two
things
.
Rarely
is
Like
you
know
,
before
your
diagnosis
.
Um
,
it
happened
to
me
.
Speaker 3
18:19
A
lot
People
go
oh
,
you
have
so
is
syndrome
,
you
know
.
And
the
issue
becomes
that
the
I
think
it's
illy
I'm
going
to
runs
Between
the
so
is
muscle
.
I
have
to
double
check
the
nerve
,
but
I
,
the
nerve
,
runs
between
the
so
is
muscle
.
So
anything
with
that
nerve
is
going
to
turn
up
,
your
so
is
muscle
.
But
anything
with
your
pelvis
,
any
alignment
issue
,
any
one
muscle
that's
too
tight
,
is
going
to
throw
off
iliacus
,
because
iliacus
runs
like
almost
against
the
bone
,
right
?
Speaker 3
18:50
The
other
thing
is
that
the
so
is
itself
has
a
component
that's
both
pre
peritoneal
and
retroperitoneal
,
and
so
any
component
of
a
pelvic
disease
is
going
to
throw
off
the
muscle
.
So
I've
seen
this
with
people
I
have
terrible
so
is
syndrome
,
but
like
,
really
they
have
nine
million
other
things
that
need
to
be
treated
,
and
then
the
so
is
probably
would
release
on
its
own
,
including
that
the
so
is
is
providing
support
for
a
diaphragm
that's
not
Working
with
full
excursion
in
all
three
planes
the
way
a
diaphragm
should
,
and
also
that
their
abdominal
muscles
maybe
aren't
contracting
and
expanding
the
way
that
they
should
because
there's
some
sort
of
ongoing
weakness
may
be
triggered
by
pelvic
disease
,
may
be
triggered
by
a
hernia
,
and
the
so
is
is
doing
double
time
there
,
and
I
mean
so
is
syndrome
in
the
foot
.
They're
like
very
good
friends
.
So
if
you're
an
internal
rotator
Of
,
or
if
you're
a
pronator
in
your
foot
,
like
your
hip
flexors
going
to
do
double
time
trying
to
To
fix
that
.
Speaker 2
20:02
I
know
complex
,
you
know
it's
like
super
complex
it
is
,
but
it's
all
we
like
Um
,
I'm
going
to
give
a
shout
out
.
Speaker 3
20:08
I
like
Amanda
Olson
is
a
good
interview
on
this
one
,
and
also
Jay
Michelle
Martin
.
Speaker 1
20:14
Well
,
jay
Michelle
Martin
and
Amanda
Olson
are
both
fabulous
people
,
but
Both
good
interviews
on
these
particular
talk
going
back
to
like
figuring
this
out
,
though
,
because
we're
Recognizing
that
that
it's
not
one
or
the
other
right
away
.
It's
hard
to
differentiate
.
How
do
we
get
this
diagnosis
when
we're
talking
hernia
,
is
it
just
so
,
as
is
it
hip
placement
,
is
it
?
Is
Carnets
test
helpful
in
finding
hernias
,
though
the
carnets
test
?
I
?
Speaker 3
20:42
think
in
a
day
and
age
when
we
have
decent
imaging
,
I
don't
need
from
a
Carnets
test
that
could
or
could
not
be
positive
of
her
.
You
know
,
right
,
so
many
other
things
are
gonna
.
It's
like
,
um
,
how
many
of
you
had
appendix
?
And
then
that
that's
.
I
don't
remember
what
side
you're
showing
me
.
But
if
you
have
appendix
endometriosis
Then
you're
like
how
much
appendix
endometriosis
did
I
have
?
And
everybody
was
like
no
,
mcburney's
wasn't
positive
.
Yeah
,
because
like
I
had
already
ruptured
off
piece
of
my
appendix
.
So
I
mean
that
that's
.
You
know
,
those
tests
are
not
fail
safe
.
And
that's
also
one
of
my
issues
with
when
people
with
endometriosis
Head
to
an
ER
and
ER
is
looking
for
what's
going
to
kill
you
.
Speaker 3
21:26
Yeah
,
they're
not
looking
for
what's
going
to
increase
the
quality
of
your
life
.
And
in
an
ER
those
things
need
to
be
positive
To
get
treatment
.
And
then
everybody
screams
at
the
ER
gas
,
let
them
.
Which
the
?
The
ER
doesn't
know
better
.
I
don't
think
they're
.
And
also
,
in
the
day
and
age
of
covid
,
I
think
most
ERs
have
had
it
and
we
need
to
revamp
the
way
our
medical
practitioners
work
to
get
them
some
Body
,
mind
and
soul
care
for
themselves
,
because
they
can't
give
anymore
.
Speaker 3
21:59
But
I
think
I
would
not
rely
on
carnets
.
I
do
believe
that
if
your
imaging
is
done
properly
and
read
properly
,
you
can
locate
the
hernias
.
What
happens
is
,
when
it's
read
,
though
,
the
doctor
will
say
to
you
I
don't
know
if
that's
the
cause
of
your
pain
,
and
most
people
want
to
Want
somebody
to
go
yep
,
this
is
this
,
is
that
cause
?
Like
.
So
when
the
doctor
says
to
you
I
don't
know
,
this
is
what
I
see
,
I'm
reading
this
,
I
see
the
hernia
there
and
it
might
be
your
cause
of
pain
,
but
it
might
not
be
your
cause
of
pain
,
that's
like
not
enough
for
a
lot
of
people
.
No
,
and
I
think
you
have
to
do
some
Soul
searching
to
decide
if
that's
enough
for
you
,
because
there
are
plenty
of
people
when
I'm
convinced
that's
,
that's
their
pain
and
they
should
roll
the
dice
and
try
fixing
the
hernia
.
Speaker 1
22:52
So
but
do
they
need
a
specific
MRI
done
for
the
hernia
to
be
found
or
a
certain
placement
?
Speaker 3
23:00
I
believe
there
is
a
protocol
,
okay
,
developed
by
Shireen
Tofai
,
twfi
,
gh
,
and
the
protocol
used
to
be
on
her
website
and
you
would
need
that
protocol
read
by
somebody
who
spends
a
lot
of
time
dealing
with
occult
or
noble
churnia
,
dr
Tofai
being
one
.
I
think
she
has
some
sort
of
system
where
you
can
upload
and
have
her
read
.
In
New
York
and
sort
of
on
the
East
Coast
we
tend
to
send
off
MRIs
to
be
read
by
Dr
Zolin
Z-O-L-A-N-D
,
who's
also
a
wonderful
podcast
guest
,
because
he
talks
about
my
other
,
not
really
such
a
big
concern
,
but
he
talks
about
pubalgia
,
which
is
pubic
bone
related
issues
,
or
sports
hernia
or
pubalgia
.
In
that
particular
case
you
can
get
a
disruption
at
the
plate
where
the
abdominals
and
the
adductors
they
both
connect
in
the
same
area
.
You
can
get
a
little
tear
in
there
.
That
generates
pain
itself
.
Not
as
common
in
the
pelvic
pain
community
,
but
for
those
of
us
that
are
very
active
not
uncommon
,
not
hugely
common
Now
that
one's
its
own
podcast
.
Speaker 3
24:29
But
when
it
comes
to
sport
hernia
and
pubalgia
,
you
have
to
decide
if
it's
worth
fixing
.
Not
that
are
you
worth
fixing
,
but
that
is
the
possibility
of
the
outcome
worth
fixing
.
Somebody
does
a
lot
of
figure
skating
.
You're
certainly
going
to
roll
the
dice
on
the
sport
hernia
.
Somebody
plays
a
lot
of
tennis
but
it's
been
five
years
since
they've
had
the
sport
hernia
.
You're
going
to
try
a
whole
lot
of
therapy
first
.
That
sport
hernia
I
would
defer
to
him
.
Speaker 2
25:00
Are
you
taking
notes
because
?
Speaker 3
25:02
first
I'm
going
to
.
Speaker 2
25:03
New
Jersey
.
Then
I'm
taking
the
notes
.
Speaker 3
25:08
Why
.
I
believe
that
Dr
Zollan
will
read
remotely
and
I
believe
Dr
Tofile
read
remotely
.
I
don't
know
if
both
of
them
do
,
but
a
lot
of
them
will
say
if
I
see
this
,
this
could
be
generating
your
pain
,
but
it's
not
necessary
,
they're
not
going
to
give
you
the
gotcha
.
And
I
think
,
like
,
unfortunately
,
having
pelvic
pain
,
people
want
the
gotcha
and
also
people
want
we've
talked
about
this
before
People
want
one
answer
yes
,
you
have
endometriosis
.
That's
driving
your
pain
.
Except
endometriosis
isn't
the
only
driver
of
pain
,
and
if
you
have
endometriosis
,
you
could
still
have
25
other
things
wrong
with
you
,
from
something
like
a
conductive
tissue
disorder
to
a
hernia
,
to
a
bladder
and
we
just
talked
about
how
the
bladder
is
a
component
of
up
regulating
the
nerves
.
And
so
there
is
no
gotcha
moment
.
There
is
a
now
we're
going
to
begin
down
this
different
journey
of
figuring
out
and
unlayering
the
things
that
could
be
wrong
.
So
when
a
patient
seeks
a
gotcha
they
may
not
always-
find
it
?
Speaker 2
26:19
Yeah
,
and
I
think
I
think
for
me
naively
I
thought
,
you
know
,
my
first
surgery
was
ablation
.
We
all
know
about
that
.
I
really
thought
naively
that
after
I
had
excision
I
was
going
to
be
good
,
this
crippling
pain
was
going
to
be
gone
,
and
that
crippling
pain
is
gone
.
But
now
it's
sort
of
,
like
you
said
,
all
these
other
pain
generators
and
all
of
these
like
25
years
worth
of
this
that
I'm
now
sort
of
working
through
and
I
wish
there
was
that
I
found
it
and
that's
it
,
and
but
you
just
,
I
think
,
stay
the
course
and
keep
trying
,
because
the
quality
of
life
is
super
important
.
Speaker 3
27:01
I
think
a
lot
of
the
issue
becomes
that
by
the
time
we're
diagnosed
and
then
we
access
excision
,
most
of
us
don't
have
the
mental
wherewithal
to
go
through
another
journey
,
because
we're
already
traumatized
,
gaslit
and
partially
mentally
broken
already
.
And
so
when
somebody
says
,
but
here's
the
78
other
things
that
can
be
wrong
with
you
,
it's
double
the
frustration
.
And
then
perhaps
you've
paid
for
your
excision
and
you
are
just
.
Then
the
anger
develops
and
then
that
only
up
regulates
the
nerves
and
then
you're
left
in
this
situation
.
That
is
just
like
a
bomb
went
off
in
my
life
and
it's
now
.
I'm
never
going
to
pick
up
every
piece
.
It's
very
hard
.
Speaker 3
27:53
And
I
will
also
say
as
somebody
who's
been
an
advocate
for
a
very
,
very
long
time
years
ago
we
were
so
eager
to
get
the
word
not
me
,
because
I
always
preached
it
this
way
I'm
going
to
stick
up
that
flag
but
many
people
were
so
eager
to
get
the
word
out
about
excision
that
it's
unfortunately
translated
into
this
excision
is
the
answer
in
the
endometriosis
community
and
excision
is
an
initial
step
to
answers
.
And
there
is
no
the
answer
and
I
think
it's
very
,
very
frustrating
and
it's
frustrating
.
You
know
the
endometriosis
summit
.
We
do
talk
about
excision
,
but
we
have
hours
and
hours
and
hours
of
content
on
what
else
?
You
know
,
we
had
four
hours
on
the
ladder
last
year
.
Speaker 1
28:53
And
that's
what
I
think
is
so
valuable
in
what
not
only
what
you're
doing
,
but
like
why
we're
taking
a
whole
body
approach
is
because
the
endometriosis
is
one
part
of
this
.
It
may
.
Is
it
the
thing
that
caused
all
of
this
?
Maybe
,
maybe
not
.
We
don't
know
right
and
there's
no
way
of
really
finding
out
what's
causing
what
right
.
But
at
the
end
of
the
day
,
if
we're
not
addressing
every
part
of
us
,
the
grief
,
so
we're
going
to
have
a
grief
counselor
on
here
soon
talking
about
this
,
because
we've
missed
that
sometimes
when
in
our
process
of
thinking
of
healing
right
,
you're
very
good
at
it
,
sally
.
You've
done
a
lot
with
talking
about
that
grieving
process
and
processing
that
,
but
we
have
to
.
You
do
this
so
well
.
This
is
why
I
love
the
summit
and
I'm
probably
a
free
advertisement
for
you
any
day
of
the
week
because
you
do
this
so
well
.
You
connect
so
many
different
dots
that
allow
us
to
just
not
fixate
on
one
thing
and
one
thing
that's
failed
us
.
It
allows
us
avenues
of
potential
life
changing
quality
of
life
.
Speaker 2
30:02
Yeah
,
I
think
there's
hope
,
there's
just
hope
.
Speaker 3
30:05
Empowerment
.
Speaker 2
30:05
Yeah
.
Speaker 3
30:06
But
I
think
also
like
the
financial
state
of
endometriosis
,
and
that's
its
own
conversation
.
But
we
,
even
as
an
entity
,
tried
to
get
involved
with
creating
something
that
would
increase
access
and
that
particular
entity
just
wanted
to
profit
off
of
patients
and
we
had
to
leave
.
And
yet
it
still
exists
and
everybody
thinks
it's
like
some
directory
to
care
and
it
isn't
.
And
I
think
ultimately
,
until
we
change
the
guidelines
from
ACOG
and
truly
change
them
not
change
them
as
like
a
response
to
they
have
to
do
something
to
seem
okay
,
but
until
those
guidelines
are
really
changed
,
we
can't
begin
to
embrace
those
out
there
that
are
so
frustrated
.
I
think
a
lot
of
that
starts
with
the
way
endometriosis
was
founded
and
it
does
unfortunately
tie
back
to
Samson
and
tie
back
to
Jovenson
Meigs
.
That's
why
we'll
spend
some
time
on
that
,
but
I
think
it's
really
,
really
difficult
,
it
is
really
hard
.
Speaker 1
31:24
Do
you
feel
like
,
when
we're
talking
diagnosis
and
getting
care
for
physical
therapists
,
when
we're
talking
hernia
and
all
these
other
elements
that
are
pain
factors
,
what
are
some
ways
that
they
can
check
off
certain
like
not
a
list
,
because
I
think
everyone's
so
different
,
but
how
are
ways
to
rule
out
?
Is
this
a
hernia
?
Is
this
maybe
just
this
muscle
?
What
are
some
ways
that
can
help
physical
therapists
and
people
going
to
physical
therapy
trying
to
navigate
that
Because
it
is
so
expensive
?
Speaker 3
31:55
Well
,
we're
going
to
defer
to
Dr
Shri
Kandy
and
Dr
Ahmed
,
who
have
developed
a
checklist
from
that
.
I
can
also
say
that
,
while
I'm
not
a
fan
of
everything
that
they
do
,
the
International
Public
Pain
Society
has
a
checklist
as
well
,
but
I
think
ultimately
it
can
become
very
overwhelming
.
If
you
see
me
,
I'll
give
you
the
whole
checklist
,
but
if
I
give
you
a
checklist
for
12
things
,
then
it
becomes
very
overwhelming
.
And
don't
forget
,
my
ultimate
goal
is
to
make
sure
that
you
don't
have
a
sick
person
persona
and
so
if
I
hand
you
a
list
of
,
if
I
go
down
,
16
things
I
don't
think
I'm
going
to
get
any
.
It
can
become
very
overwhelming
.
Yeah
,
so
top
things
I
would
rule
out
.
Exploring Endometriosis and Pelvic Health
Speaker 3
32:46
I
think
the
irony
is
super
easy
to
rule
out
or
rule
in
.
What's
hard
to
rule
out
or
rule
in
is
whether
it's
coming
from
the
endometriosis
or
not
.
It
is
not
a
fail
safe
,
but
you
can
try
lidocaine
into
the
ilioenguino
nerve
and
the
general
branch
of
the
general
femoral
nerve
.
You
can
do
the
femoral
nerve
but
it's
much
harder
.
You
can
also
do
the
pudental
nerve
.
Sometimes
if
you
do
the
pudental
nerve
,
then
all
the
pain
stops
in
the
front
,
for
whatever
reason
.
And
trying
the
lidocaine
in
those
nerves
which
most
pain
management
anesthesiologists
anywhere
in
the
US
should
be
able
to
do
.
Whether
or
not
they'll
do
it
if
you
ask
I
don't
know
If
you're
getting
relief
from
those
you
can
try
a
series
of
them
or
you
can
ask
for
an
MRI
to
really
rule
in
or
rule
out
whether
or
not
you
have
a
hernia
.
Speaker 3
33:37
I
think
to
rule
in
or
rule
out
pelvic
floor
dysfunction
it
takes
a
very
good
pelvic
PT
.
Whether
or
not
they
take
your
insurance
is
a
whole
other
conversation
.
And
I
think
ruling
in
or
ruling
out
bladder
dysfunction
or
bladder
up
regulation
,
if
you
have
endometriosis
in
your
pelvis
because
the
bladder
is
the
sensory
driver
of
the
pelvis
,
you
have
a
bladder
dysfunction
Right
and
that's
going
to
just
turn
to
rule
in
or
rule
out
.
Those
three
things
are
really
important
and
years
ago
we
used
to
have
all
patients
on
all
endometriosis
patients
on
a
bladder
diet
but
it
became
so
restrictive
that
people
were
like
getting
eating
disorders
.
So
I
don't
do
that
with
patients
anymore
because
that's
not
good
.
No
,
and
I
think
I
do
working
clinics
and
with
doctors
that
like
to
do
a
bladder
installation
and
if
it
stops
because
that's
,
they
call
that
noninvasive
.
I've
had
one
.
Speaker 2
34:34
I
don't
call
it
noninvasive
.
Speaker 3
34:36
You're
sticking
a
tube
in
my
urethra
.
That
to
me
is
the
definition
of
invasive
,
right
so
?
But
there
are
people
that
they
do
the
that
particular
test
and
if
your
pain
silence
is
after
that
,
then
we
know
something's
going
on
with
your
bladder
.
Some
doctors
will
prescribe
medicine
to
try
to
see
that
instead
of
the
installation
.
But
,
and
I
think
you
know
,
pelvic
floor
PT
should
be
more
accessible
than
the
person
who's
had
one
class
and
they
think
you
know
a
dilator
and
biofeedback
or
where
it's
at
,
even
though
those
may
be
a
component
of
care
,
but
they're
not
the
only
part
of
care
.
You
know
those
are
the
big
three
.
Speaker 1
35:14
Here's
something
that
I
don't
know
as
much
about
how
do
you
differentiate
between
,
maybe
,
a
frozen
pelvis
and
a
hernia
,
or
do
?
Can
they
go
hand
in
hand
?
Can
they
not
like
the
?
Speaker 3
35:25
pain
Go
hand
in
hand
?
I
think
they
would
likely
go
hand
in
hand
.
Okay
,
it
is
not
proven
in
the
research
,
but
I
believe
that
because
we
have
a
frozen
pelvis
for
like
10
years
before
anyone
pays
any
attention
to
us
,
that
that's
how
we
dislodge
the
piece
of
pre-peritoneal
fat
that
lays
against
the
nerve
.
I
think
that
that's
a
big
component
.
It
also
may
be
that
lays
down
a
utero
experience
,
but
I'm
not
sure
on
that
.
I
think
a
frozen
pelvis
can
be
you
don't
really
diagnose
it
but
can
be
suspected
through
a
bimanual
gynecological
exam
.
A
physical
therapist
wouldn't
be
doing
that
right
Right
Years
ago
.
They
would
do
a
finger
in
the
rectum
and
a
finger
in
the
vagina
to
see
how
much
everything
glides
.
That's
a
gynecological
thing
,
not
a
pelvic
PT
thing
.
And
then
the
other
thing
is
nowadays
and
we're
going
to
show
this
at
our
imaging
course
our
frozen
pelvis
can
very
much
show
on
MRI
.
Speaker 1
36:33
Because
that
has
been
a
question
is
is
this
frozen
pelvis
?
Is
this
a
hernia
?
Are
they
going
hand
in
hand
?
Does
frozen
pelvis
mean
every
part
of
the
pelvis
or
does
it
mean
a
section
of
the
pelvis
Usually
?
Speaker 3
36:45
it
only
has
to
be
a
section
.
But
patients
love
to
have
,
they
love
to
come
out
because
they
finally
feel
validated
.
But
they
love
to
.
My
pelvis
was
frozen
.
Speaker 1
36:57
It's
like
okay
,
Right
.
Speaker 3
37:00
And
that
gets
back
to
that
conversation
of
working
on
the
identity
and
persona
of
somebody
who
has
endometriosis
.
But
the
other
piece
of
it
is
that
,
yes
,
they
can
come
together
.
If
you've
had
one
really
decent
excision
,
it's
unlikely
that
you
have
a
frozen
pelvis
.
You
could
have
adhesions
.
I
tend
to
believe
.
If
one
of
these
hernias
is
present
,
it's
not
the
adhesions
,
but
you
don't
know
,
unless
you
are
really
working
with
someone
who's
willing
to
see
it
through
with
you
.
And
then
the
other
thing
,
because
I
had
this
one
called
a
couple
of
weeks
ago
you
can't
expect
to
feel
all
better
48
hours
after
surgery
or
even
that's
a
good
podcast
I
could
come
back
for
or
even
eight
weeks
out
of
surgery
because
you
have
to
recondition
your
body
.
Speaker 3
37:56
If
you
had
a
hernia
or
frozen
pelvis
or
both
,
you
don't
have
to
even
fire
your
glutes
.
You
have
to
work
with
somebody
that
does
that
.
Speaker 1
38:07
And
there's
so
atrophied
after
having
I
mean
even
before
surgery
,
because
we
were
master
compensators
.
We're
a
little
cheaters
when
it
comes
to
our
bodies
and
so
we
have
no
idea
even
how
to
fire
it
.
Like
I've
talked
about
this
before
,
we
have
no
idea
how
to
fire
our
glutes
.
I
think
I'm
firing
it
and
you
could
touch
me
and
it's
like
the
pillberry
dome
and
like
just
right
,
but
there's
nothing
firing
there
.
Speaker 3
38:30
Weakness
begets
weakness
,
so
you're
in
pain
,
so
you
sit
down
and
then
,
like
you
know
,
you're
in
pain
,
so
you're
not
standing
back
up
again
.
And
I
don't
mean
it
that
way
,
you
know
.
I
don't
only
mean
stand
up
and
sit
down
,
but
like
you
have
to
work
with
somebody
,
one
on
one
,
to
get
that
strength
back
.
Yep
,
cause
weakness
causes
a
lot
of
pain
too
,
and
I'm
not
saying
that
you
are
weak
and
I'm
not
saying
that
weightlifting
or
toning
is
going
to
outrun
your
pain
,
but
it
is
part
of
a
rehabilitation
process
,
and
we
would
not
do
a
total
knee
replacement
without
reconditioning
the
body
and
not
just
the
quadriceps
.
So
why
do
we
think
we
can
have
major
gynecological
surgery
without
reconditioning
the
body
?
Absolutely
.
Speaker 1
39:21
Yeah
,
absolutely
,
and
Libby
Hainsley
was
just
on
.
We
talked
about
this
,
so
go
and
listen
to
Libby
Hainsley's
episode
.
And
we
talk
about
this
,
about
the
reconditioning
and
strengthening
of
atrophied
muscles
and
joint
stability
and
the
importance
of
that
post-surgery
,
and
it's
a
slower
process
for
those
of
us
who
have
connective
tissue
disorders
as
well
.
Why
do
we
rush
ourselves
when
we
didn't
rush
ourselves
to
get
better
care
?
Sometimes
and
I'm
speaking
for
me
.
Speaker 3
39:48
We
wanted
to
rush
ourselves
to
get
better
care
,
but
we
couldn't
,
we
couldn't
.
Speaker 1
39:51
Yeah
,
I
had
two
kids
and
I
went
through
the
process
postpartum
.
She
said
it
took
you
nine
months
to
get
to
this
point
.
It's
going
to
take
you
nine
months
to
rehabilitate
your
core
and
everything
else
,
and
that
is
triggering
for
some
people
.
But
it
is
true
in
surgery
as
well
.
I
had
surgery
for
both
of
mine
,
and
so
that
gave
me
just
a
slight
bit
of
inkling
,
post
my
ablation
surgeries
,
of
how
much
our
body
will
compensate
and
break
down
if
we're
not
kind
to
it
and
healing
.
Speaker 3
40:25
Well
,
it's
very
interesting
to
me
is
the
ACOG
guideline
for
postpartum
care
includes
pelvic
physical
therapy
,
but
it
doesn't
include
that
in
endometriosis
and
it's
so
like
the
pelvic
PT's
want
to
cheer
on
ACOG
for
including
that
and
I'm
not
cheering
anything
,
because
everybody
deserves
access
.
Speaker 1
40:48
Everyone
and
it
is
harder
for
I
will
tell
you
,
knowing
people
who
have
had
kids
and
knowing
,
obviously
,
having
endometriosis
,
some
who
haven't
had
kids
,
endometriosis
pelvic
floor
PT
has
been
way
more
beneficial
with
endometriosis
patients
Long
term
.
It's
a
long
term
healing
process
and
I'm
not
a
let's
get
you
back
on
track
after
having
kids
,
which
is
valuable
and
needed
,
but
endometriosis
patients
,
we
are
untangling
this
for
years
for
years
.
So
it's
,
I
don't
understand
.
Don't
get
us
started
on
ACOG
over
here
,
okay
,
don't
get
us
started
on
ACOG
.
Speaker 3
41:29
So
,
yeah
,
I
mean
I
think
it's
also
an
awareness
related
issue
,
because
what
you
don't
realize
is
,
as
long
as
that
standard
stays
the
same
,
then
other
specialties
just
believe
we
can
take
a
pill
or
have
a
hysterectomy
,
and
so
then
it's
hard
for
that
GI
specialist
to
send
you
to
someone
,
the
urologist
to
send
you
to
someone
,
the
primary
care
to
send
you
to
someone
.
So
it
becomes
a
whole
issue
.
Yeah
,
I
mean
that's
,
that's
its
own
.
Speaker 1
41:59
That's
its
own
podcast
.
That's
his
own
week
long
podcast
.
I
feel
like
that's
a
whole
season
Diastasis Recti and Hernias
Speaker 1
42:05
.
Yeah
,
can
you
tell
us
is
there
a
difference
between
rectiostasis
and
a
hernia
,
or
a
way
to
tell
the
difference
?
Speaker 3
42:12
Well
with
diastasis
recti
.
Speaker 1
42:15
So
at
its
core
.
Speaker 3
42:17
A
diastasis
recti
is
when
the
linear
elbow
or
the
fascia
that
lays
between
the
rectus
abdominus
muscle
splits
.
Now
people
say
it
splits
during
pregnancy
.
I
have
never
been
pregnant
and
mine
split
from
adenomyosis
.
And
I
would
like
walk
around
New
York
City
in
the
summer
and
everybody
you
know
New
York
City
in
the
summer
,
people
wearing
very
tight
clothing
and
I
would
be
like
why
does
my
belly
look
like
?
I'm
nine
months
pregnant
and
I
never
had
a
baby
and
that's
because
the
diastasis
I
had
split
and
in
my
splitting
I
put
myself
at
risk
for
a
big
abdominal
wall
hernia
that
eventually
I
had
fixed
.
Speaker 3
43:01
But
at
its
core
the
diastasis
recti
could
be
called
,
I
think
,
by
some
,
a
hernia
,
technically
by
the
definition
of
hernia
,
but
I
don't
always
loop
them
together
because
of
ventral
hernia
.
That
would
be
not
an
inguinal
or
ephemeral
hernia
but
a
ventral
hernia
is
sort
of
on
a
flat
part
of
your
abdominal
wall
and
it
would
be
anywhere
on
the
abdominal
when
the
linea
alba
splits
.
There's
different
gradations
to
that
and
I
think
it's
graded
one
through
one
through
five
.
Now
,
tummy
tuck
is
not
for
everybody
.
It
is
a
brutal
recovery
and
very
,
very
hard
and
very
expensive
.
But
if
you
have
a
larger
diastasis
,
I
believe
,
having
lived
many
different
ways
of
trying
to
help
this
diastasis
,
you're
going
to
get
a
lot
more
stability
from
having
the
diastasis
sewn
clothes
.
Now
,
that's
only
if
you
have
a
progressed
grade
of
it
.
If
you
have
a
small
one
,
it's
not
a
big
deal
.
And
I
remind
people
that
one
day
you'll
be
old
.
God
willing
,
we
should
all
get
old
.
Speaker 2
44:16
Forever
,
forever
.
Speaker 3
44:17
And
you're
going
to
want
that
stability
in
your
abdominal
wall
because
,
as
your
lungs
change
,
your
abdominals
are
going
to
help
you
breathe
,
your
diaphragm
is
going
to
help
you
breathe
,
it's
going
to
give
you
support
to
your
bladder
.
There's
lots
of
different
reasons
.
Now
there's
this
big
personal
trainer
out
there
who
says
no
,
the
tuck
doesn't
provide
.
I've
lived
it
.
He
tells
me
,
when
they
sew
that
diastasis
back
together
,
it
is
like
night
and
day
,
and
so
never
rule
out
that
if
you're
really
struggling
with
it
,
If
it's
a
small
one
,
there
are
very
specific
exercises
you
can
do
to
draw
it
back
together
.
Never
perfectly
,
yeah
.
Speaker 1
45:00
Yeah
,
because
we
were
talking
about
that
is
just
,
both
of
us
have
had
that
experience
having
kids
and
then
having
all
the
surgeries
and
things
like
that
is
differentiating
between
what's
a
normal
hernia
when
we
go
to
talk
to
physicians
and
how
do
we
communicate
the
different
types
.
Not
that
we
need
to
communicate
the
different
types
,
but
when
we're
struggling
with
what
we're
talking
about
the
no
bulge
and
when
we're
,
it's
really
hard
to
communicate
these
pains
to
the
pain
doctors
or
to
you
know
?
Speaker 3
45:30
A
inguinal
or
femoral
hernia
is
going
to
cause
pain
down
into
the
groin
,
perhaps
down
the
front
of
the
leg
,
even
though
it's
really
located
in
what
is
the
site
of
that
abdomen
.
A
diastasis
recti
is
going
to
cause
like
an
aching
of
the
front
abdomen
and
a
heaviness
in
the
pelvis
,
as
well
as
,
for
many
,
some
back
pain
not
for
all
,
and
sometimes
the
back
pain
isn't
ever
resolved
,
even
with
diastasis
,
pt
or
tummy
tuck
,
things
like
that
.
And
so
I
wouldn't
.
If
you
have
a
large
diastasis
and
you're
having
bloating
and
you're
having
pain
in
your
like
a
heaviness
in
your
pelvis
and
you
don't
think
you
have
a
denomyosis
,
because
diastasis
is
more
like
ruling
in
or
ruling
out
,
the
denomyosis
versus
the
diastasis
If
you're
having
those
particular
issues
,
that's
usually
not
hernia
.
Speaker 3
46:32
I
mean
you
could
have
a
ventral
hernia
.
I
saw
one
yesterday
.
Actually
you
could
have
a
ventral
hernia
in
the
front
like
that
,
but
you're
not
confusing
that
with
a
diastasis
.
I
have
seen
I
did
have
a
patient
over
and
over
and
over
who
was
like
super
thin
so
that
when
she
got
pregnant
she
gained
a
lot
of
weight
and
split
right
and
it's
sort
of
a
normal
experience
of
splitting
,
even
though
it's
not
normal
,
and
she
was
convinced
she
had
a
denomyosis
,
had
a
hysterectomy
for
a
denomyosis
and
everything
was
really
coming
from
the
diastasis
.
Speaker 3
47:09
That's
so
interesting
,
which
is
not
to
say
like
I
think
it's
typically
the
other
way
doctors
blame
the
diastasis
,
but
they
have
a
denomyosis
.
I
think
that
that's
more
common
,
but
I
have
seen
it
.
I
have
seen
it
the
other
way
around
and
she
was
very
young
and
again
it
gets
back
to
.
You
know
,
that's
a
patient
autonomy
and
it's
her
choice
to
have
the
hysterectomy
and
doctors
should
honor
that
.
Yeah
,
you
know
she
shouldn't
have
had
to
go
to
three
doctors
because
one
was
like
you
might
want
more
children
.
No
,
she's
making
a
choice
,
she's
holding
up
to
make
a
choice
.
She
exists
.
Speaker 2
47:45
Right
.
So
on
your
last
podcast
I
told
you
I
listened
to
this
a
number
of
times
.
The
other
thing
that
sort
of
struck
me
.
So
you're
probably
fine
if
I
say
this
,
but
both
Alana
and
I
ufrectomy
,
hysterectomy
none
of
that
left
.
And
so
now
we're
on
this
hormone
journey
,
with
not
a
lot
of
literature
out
there
to
support
replacement
with
testosterone
and
I
know
you
specifically
talked
about
estrogen
replacement
and
the
importance
in
that
for
joints
and
ligaments
.
Do
you
have
any
words
of
wisdom
or
any
sort
of
thought
process
,
right
or
wrong
,
when
it
comes
to
testosterone
and
the
role
it
plays
with
that
,
or
is
it
just
specifically
estrogen
?
Speaker 1
48:30
Join
us
next
week
as
we
unpack
part
two
of
this
conversation
.
You
won't
want
to
miss
the
insight
that
Sally
has
when
it
comes
to
hormones
and
endometriosis
care
.
So
next
week
,
continue
advocating
for
yourself
and
for
those
that
you
love
.