Send us a text with a question or thought on this episode ( We cannot replay from this link)
Can removing ovaries in young women with endometriosis do more harm than good? Join us asa we discuss the critical long-term implications of surgical decisions with Dr. Cindy Mosbrucker. We tackle the often-overlooked consequences of oophorectomy (removal of ovaries), such as accelerated aging, bone brittleness, and cognitive decline. Dr. Mosbrucker emphasizes the necessity of comprehensive patient discussions and appropriate hormone replacement therapy to mitigate these effects. We also examine the disparity in medical approaches between genders, questioning how differently men’s health issues would be handled.
Discover the truth about hormone replacement therapy (HRT) that many women have been missing. Dr. Mosbrucker guides us through the flawed conclusions of the early 2000s Women’s Health Initiative study, which led to a widespread cessation of HRT and subsequent health issues. We dissect how this study’s design flaws misled women and explore more recent research showing the benefits of estrogen-only HRT, including a lower risk of breast cancer. Tune in to gain a deeper understanding of how medical research and study designs impact health decisions, and empower yourself with knowledge that’s crucial for navigating this complex landscape.
Website endobattery.com
Navigating Endo Treatment and Hormones
Alanna
0:03
Welcome
to
Endo
Battery
,
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
,
Alanna
,
and
this
is
Endo
Battery
charging
our
lives
when
endometriosis
drains
us
.
Welcome
back
to
Endo
Battery
.
Grab
your
cup
of
coffee
or
your
cup
of
tea
and
join
me
at
the
table
as
we
continue
with
our
discussion
with
Dr
Cindy
Mosbrucker
in
this
part
two
of
a
two-part
series
.
Dr
Mosbrucker
shared
historical
knowledge
with
us
last
time
and
if
you
haven't
had
the
opportunity
to
do
so
,
I
encourage
you
to
go
back
and
listen
to
the
part
one
of
this
series
.
But
just
in
case
you
need
a
refresher
,
here's
where
we
left
off
and
where
we're
going
.
Dr. Cindy Mosbrucker
1:08
Right
now
,
standard
of
care
is
people
doing
ablations
.
It's
okay
for
doctors
to
remove
totally
normal
ovaries
in
a
25-year-old
,
you
know
.
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
and
it's
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
and
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
.
Dr. Cindy Mosbrucker
1:55
I
talk
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
.
All
these
things
are
going
to
happen
to
your
body
,
not
right
away
,
but
over
time
,
and
your
aging
process
is
going
to
be
accelerated
.
And
yes
,
we
can
reverse
some
of
that
and
abate
some
of
it
with
hormone
replacement
.
But
there
was
a
study
a
few
years
ago
that
showed
that
women
who
have
bilateral
oophorectomies
prior
to
menopause
have
an
increased
what's
called
all-cause
mortality
,
which
means
death
by
any
reason
,
and
giving
them
hormone
replacement
will
minimize
that
somewhat
and
make
that
increased
risk
come
back
towards
one
which
is
no
increased
risk
but
it
never
quite
gets
to
one
.
It
gets
close
to
it
but
it
never
quite
gets
there
.
Dr. Cindy Mosbrucker
3:06
And
then
the
other
thing
that
I
see
,
a
lot
is
women
who've
had
their
ovaries
out
and
they're
not
appropriately
replaced
hormonally
.
So
they've
got
hot
flashes
,
they
don't
sleep
well
,
they're
emotional
,
they
feel
like
crap
and
nobody
takes
the
time
to
say
well
,
you
need
estrogen
,
you
need
testosterone
,
you
might
need
a
little
progesterone
,
maybe
,
maybe
not
,
but
we
need
to
get
you
.
If
you're
30
years
old
and
you
have
no
ovaries
,
you
can't
just
give
them
a
0.05
patch
,
which
is
perfectly
fine
for
a
55
or
60
year
old
woman
,
because
they're
30
,
you
know
,
and
they're
used
to
estradiol
levels
fluctuating
between
103
or
400
,
you
know
,
whereas
when
you're
50
and
you're
about
to
be
menopausal
,
your
average
estradiol
level
is
probably
,
you
know
,
you'd
be
happy
at
50
.
You
,
you
know
these
younger
gals
.
They
need
a
higher
dose
and
they
need
higher
levels
,
and
that's
just
normal
and
physiologic
,
but
doctors
are
afraid
to
do
it
.
I
don't
know
why
.
Alanna
4:15
I
think
doctors
are
just
as
afraid
as
patients
,
especially
when
it
comes
to
endometriosis
.
Because
when
you're
talking
testosterone
,
the
number
one
thing
that
they're
thinking
is
it's
going
to
aromatize
into
estrogen
,
my
endometriosis
is
going
to
come
back
,
and
that
is
just
not
true
,
Like
there's
no
evidence
to
say
otherwise
when
it's
removed
correctly
.
Dr. Cindy Mosbrucker
4:34
When
it's
been
removed
correctly
,
absolutely
yes
.
So
they
don't
want
the
people
who
don't
do
excision
and
they
just
say
well
,
you
have
endo
,
we'll
do
a
hysterectomy
and
take
your
ovaries
out
.
But
then
they
don't
want
to
give
them
estrogen
because
they
don't
want
to
feed
the
endo
.
But
they
don't
realize
that
the
endo
has
aromatase
and
it
can
feed
itself
hormones
for
cognitive
abilities
.
Alanna
4:57
You
need
these
hormones
to
be
able
to
live
a
semi-functional
life
beyond
a
shriveled
up
raisin
.
You
know
you
need
these
and
we
shouldn't
be
afraid
of
these
things
because
there's
no
evidence
to
say
otherwise
.
There's
actually
quite
a
bit
of
evidence
to
point
adversely
that
you
need
these
things
.
You
know
so
,
but
that's
true
.
I
think
that
the
more
that
these
residents
,
or
the
more
that
fellowships
are
educating
,
the
more
the
patients
are
going
to
be
educated
in
their
care
and
sitting
down
and
having
these
discussions
,
and
we're
not
going
to
just
remove
any
organ
,
just
to
remove
potential
of
disease
.
We're
going
to
keep
organs
that
are
essential
and
remove
the
disease
if
it's
possible
.
I
think
that
has
to
be
the
conversation
.
Dr. Cindy Mosbrucker
5:53
Yeah
,
I
mean
I
hate
to
flip
this
around
into
a
misogynistic
comment
,
but
you
know
,
if
men
had
endometriosis
,
none
of
them
would
agree
to
being
castrated
to
fix
their
end
up
.
I
mean
,
it
would
be
world
ending
.
Alanna
6:12
Yeah
,
I
mean
,
and
there's
so
much
truth
to
that
,
because
castration
is
not
just
removing
body
parts
,
it's
removing
a
lot
more
,
even
from
a
psychological
and
physiological
standpoint
.
Dr. Cindy Mosbrucker
6:23
Right
and
so
not
just
for
men
,
but
for
women
too
,
absolutely
,
absolutely
.
And
that's
what
the
world
in
general
I
mean
.
Obviously
we're
generalizing
,
but
you
know
,
that's
what
people
don't
realize
Right
,
and
I
think
a
lot
of
women
don't
realize
it
either
how
important
their
ovaries
are
for
who
they
are
and
how
they
think
and
how
they
view
themselves
and
how
they
view
the
world
,
and
how
much
mojo
they
have
.
Alanna
6:50
Yeah
,
and
I
can
speak
to
that
on
a
personal
standpoint
because
,
you
know
,
when
I
first
had
my
surgery
and
I
was
put
on
Estradiol
which
was
you
know
I
didn't
even
really
know
why
to
the
full
extent
I
knew
that
there
was
reasons
for
it
,
but
no
one
had
mentioned
testosterone
to
me
and
I
started
viewing
myself
a
lot
differently
,
incapable
of
doing
things
.
I
felt
inadequate
in
so
many
different
areas
,
not
only
when
it
comes
to
intimacy
,
but
when
it
comes
to
being
able
to
function
and
drive
a
car
or
make
decisions
or
carry
on
a
conversation
,
all
of
those
things
.
It
wasn't
until
I
started
testosterone
.
Someone
had
mentioned
it
to
me
and
I
was
like
what
do
you
mean
I
can
have
testosterone
.
I
had
no
idea
.
No
one
told
me
about
this
.
Alanna
7:36
So
when
I
started
testosterone
,
my
trainer
was
one
of
the
first
people
to
notice
.
He
said
you
are
totally
different
.
He's
like
you're
able
to
lift
more
.
He's
like
you're
so
much
more
clear
in
mind
,
you're
not
nearly
as
sleepy
,
you're
able
to
process
what
I'm
telling
you
a
lot
faster
.
Your
proprioception
awareness
has
completely
changed
,
and
so
we
should
talk
about
this
prior
,
and
I'm
working
on
talking
to
another
OBGYN
who's
really
big
into
hormones
about
this
very
thing
,
the
importance
of
doctors
educating
their
patients
and
I
think
part
of
that
education
comes
in
their
education
as
well
of
how
to
talk
to
patients
.
Hormone Replacement Therapy Misconceptions
Dr. Cindy Mosbrucker
8:16
Well
,
a
lot
of
the
problems
with
hormone
replacement
,
even
in
menopause
.
You
know
problems
with
hormone
replacement
even
in
menopause
.
You
know
.
Naturally
,
menopausal
women
started
after
the
stupid
women's
health
initiative
study
that
was
published
in
2001
or
two
and
I
was
in
Hawaii
doing
general
OBGYN
back
then
and
the
study
comes
out
that
says
Frempro
.
The
study
comes
out
that
says
PremPro
,
prem
and
Provera
.
So
horse
piss
urine
and
the
worst
synthetic
progestin
in
the
world
increases
women's
risk
of
breast
cancer
and
strokes
and
doesn't
protect
their
brain
and
doesn't
do
all
these
things
that
we
always
thought
that
it
did
.
So
you
should
really
stop
it
.
So
all
these
women
,
just
whole
turkey
,
stopped
their
hormones
and
a
month
or
two
later
,
man
,
the
doors
were
being
broken
down
.
I
feel
horrible
and
all
this
stuff
.
And
it's
like
,
okay
,
well
,
let's
read
not
the
abstract
that
was
given
to
everybody
,
but
let's
read
the
details
.
Dr. Cindy Mosbrucker
9:23
Okay
,
this
was
a
study
done
in
65
year
old
women
who
did
not
need
hormones
.
They
were
asymptomatic
.
Because
they
wanted
them
to
be
asymptomatic
so
that
they
wouldn't
know
who
was
in
the
placebo
group
and
who
was
in
the
drug
group
,
and
so
they
were
giving
something
to
a
group
of
people
who
did
not
need
it
.
Secondly
,
these
were
not
newly
menopausal
women
.
The
average
age
was
64
.
And
so
of
course
there's
no
benefit
,
because
they
weren't
having
hot
flashes
,
they
weren't
having
night
sweats
,
they
weren't
having
mood
swings
,
they
weren't
feeling
the
effects
of
brain
fog
acutely
like
they
did
when
,
you
know
,
10
years
earlier
,
right
.
And
so
when
it
was
on
the
benefit
side
,
there
was
really
nothing
to
be
gained
.
You
could
have
predicted
that
from
the
get-go
.
The
breast
cancer
risk
was
eight
cases
per
10,000
per
year
,
which
is
like
0.08
.
To
me
that's
not
a
very
high
percentage
rate
,
like
0.08
.
To
me
that's
not
a
very
high
percentage
rate
.
And
then
the
memory
group
was
10
years
older
.
So
they
took
75-year-old
women
who
again
were
asymptomatic
,
and
they
gave
them
Prevara
and
Provera
,
the
same
dose
that
they
gave
the
younger
patients
,
which
now
we
know
that
hormone
replacement
should
be
tapered
gradually
as
women
age
,
so
that
when
you
get
to
be
75
or
80
,
you're
on
a
teeny
tiny
dose
because
that's
all
you
need
.
And
so
they
didn't
do
that
and
what
they
found
was
that
it
actually
hormone
replacement
worsened
their
memory
.
Why
was
that
happening
?
Because
they
were
having
these
little
mini
strokes
and
it's
completely
not
physiologic
.
So
that
study
was
so
far
out
there
in
the
.
This
is
just
bad
design
.
Dr. Cindy Mosbrucker
11:19
So
the
second
phase
of
the
Women's
Health
Initiative
came
out
a
couple
of
years
later
and
it
was
in
women
who
did
not
need
progesterone
because
they
did
not
have
a
uterus
,
so
it
was
estrogen
only
,
and
their
average
age
was
51
or
52
.
Dr. Cindy Mosbrucker
11:37
So
they
were
much
closer
to
menopause
I
mean
the
onset
of
menopause
and
what
they
found
was
there
was
less
risk
of
breast
cancer
,
no
risk
of
worsening
their
memory
and
all
the
things
that
we
always
thought
that
estrogen
did
for
women
,
which
is
protect
their
brain
,
protect
their
bladders
,
protect
their
vaginas
and
all
these
other
things
it
does
.
Dr. Cindy Mosbrucker
12:02
And
so
since
then
,
since
the
mid-2000s
,
there
have
been
a
number
of
studies
looking
at
estrogen
,
estradiol
specifically
with
and
without
various
different
progestins
,
and
some
of
them
,
a
lot
of
them
,
show
that
estrogen-only
hormone
replacement
actually
decreases
the
risk
of
breast
cancer
.
And
it
certainly
is
not
a
given
that
estrogen
increases
the
risk
,
and
probably
only
in
combination
with
progestins
does
it
increase
the
risk
.
And
the
other
progestins
so
,
like
natural
micronized
progesterone
,
which
is
the
same
chemical
that
our
bodies
make
,
probably
has
very
minimal
risk
at
all
of
increasing
breast
cancer
.
And
some
of
the
other
synthetic
the
newer
synthetic
like
Northendrone
and
things
like
that
have
less
risk
than
the
Provera
did
.
So
it's
really
fascinating
to
do
kind
of
a
deeper
dive
into
all
this
stuff
.
It's
really
fascinating
to
do
kind
of
a
deeper
dive
into
all
this
stuff
.
But
the
problem
is
the
cardiologists
and
the
internal
medicine
docs
.
They
only
saw
that
first
part
of
the
Women's
Health
Initiative
and
that's
what's
stuck
in
their
brain
.
They
haven't
gone
into
the
weeds
and
looked
for
all
the
rest
of
the
newer
studies
on
hormone
replacement
.
Alanna
13:22
And
a
lot
of
it
was
retracted
.
Alanna
13:25
So
I
mean
that's
pretty
key
if
you're
actually
looking
at
the
research
,
to
look
at
the
fact
that
it
was
retracted
,
and
that's
huge
Like
for
a
paper
to
be
published
and
then
retract
.
Alanna
13:38
That's
like
a
big
deal
in
the
medical
world
.
I
think
that
really
set
us
back
a
long
ways
and
that's
why
I
think
it's
important
that
I
mean
I
talk
about
this
often
understanding
where
research
is
coming
from
.
And
that's
why
I
started
the
whole
endobattery
fast
charge
is
because
you
know
a
lot
of
research
is
coming
out
but
we
don't
always
know
as
a
patient
how
to
understand
this
research
and
how
to
understand
if
it's
valuable
or
if
it's
impactful
in
any
way
,
shape
or
form
.
So
sometimes
we
go
off
of
what
sounds
good
but
we
are
not
uncovering
the
nuances
of
the
research
or
nuances
of
the
study
.
And
so
when
I
started
endobattery
refast
charge
,
that
very
reason
was
to
understand
it
as
it
pertains
to
us
in
the
community
.
You
know
you
have
to
understand
who
is
behind
the
research
,
who's
doing
the
research
,
how
they
did
the
research
,
how
the
statistics
are
done
,
and
all
that
.
Dr. Cindy Mosbrucker
14:31
Yeah
,
all
of
that
.
Alanna
14:32
So
that's
so
important
for
our
health
and
why
it's
important
to
understand
those
.
So
,
oh
,
this
is
.
We
could
probably
go
on
for
hours
.
I
think
we
could
.
Yeah
,
I
know
,
welcome
to
the
table
.
You
know
,
and
that's
when
I
say
to
join
us
at
the
table
because
,
again
,
the
best
conversations
happen
at
the
dinner
table
.
Whether
you're
eating
or
not
,
you
get
the
best
information
,
you
can
have
conversation
and
you
can
let
it
flow
and
you
learn
the
best
when
you're
sitting
and
having
a
meal
with
people
at
the
dinner
table
.
So
that's
why
I've
always
done
the
podcast
at
my
table
,
because
I
want
people
to
join
us
at
the
table
.
Dr. Cindy Mosbrucker
15:10
Well
,
I
should
have
cooked
for
you
.
Alanna
15:12
I
know
,
see
,
that
would
have
been
great
.
Next
time
we're
going
to
make
that
happen
.
I'm
going
to
come
out
there
one
of
these
days
,
but
I
can't
eat
seafood
,
so
I'm
out
of
the
mix
.
Oh
,
you
can't
.
Dr. Cindy Mosbrucker
15:21
So
Crystal
,
our
nurse
practitioner
,
she
is
such
a
special
girl
,
she
has
the
biggest
heart
and
she
does
such
a
good
job
of
nurturing
our
patients
and
I
just
love
her
to
death
.
Well
,
a
video
on
how
to
make
scallops
and
it's
a
recipe
from
Windows
on
the
World
,
which
was
the
restaurant
that
was
in
the
World
Trade
Center
,
and
it's
a
very
simple
scallop
recipe
with
.
You
know
,
you
just
brown
the
scallops
and
then
you
make
.
It's
almost
like
a
beurre
blanc
,
but
not
quite
as
much
butter
and
shallots
and
capers
and
a
little
bit
of
vermouth
to
deglaze
the
pan
,
and
then
a
little
bit
of
butter
,
but
about
a
third
of
what
you
would
put
in
a
beurre
blanc
,
and
it
was
delicious
.
So
,
anyways
,
I
can
figure
out
something
else
to
make
you
,
though
.
Okay
,
my
specialty
is
seafood
.
Alanna
16:24
I
know
,
See
thatific
northwest
vibe
is
the
seafood
that's
why
I
wouldn't
make
it
there
.
I'm
in
cattle
country
here
.
That's
why
I
make
it
in
cattle
country
,
but
I
can't
eat
beef
anymore
I
got
a
smoker
,
I
can
make
you
some
pretty
good
barbecue
brisket
I'm
here
for
it
.
I
will
eat
that
all
day
long
.
I
will
eat
.
I'm
a
Wyoming
girl
.
So
meat
and
potatoes
is
like
my
thing
,
that's
,
that's
what
.
I'm
.
You
know
I've
turned
a
little
bit
more
Colorado
into
the
veggies
,
a
lot
of
veggies
.
But
it's
.
Alanna
16:55
I
grew
up
on
the
meat
and
potatoes
,
so
that's
my
jam
.
But
it's
always
so
good
to
sit
down
at
the
table
with
people
.
It's
always
so
good
to
get
perspectives
that
widen
our
horizons
and
help
us
better
educate
ourselves
.
And
I
think
when
we
sit
down
and
when
we're
honest
in
conversation
and
we
have
a
history
to
go
off
of
,
like
your
history
is
by
far
some
of
the
most
interesting
.
Alanna
17:18
You
and
Nancy
,
that's
what
I'm
going
to
come
.
For
you
and
Nancy
to
give
a
history
lesson
,
that
would
be
amazing
,
but
it's
so
refreshing
.
And
yet
I
do
want
to
leave
with
just
a
little
bit
of
hope
,
because
I
think
that
we
do
need
to
have
that
hope
for
what
is
to
come
in
the
future
.
We
can't
live
in
a
place
of
where
we've
been
,
and
so
I
think
you
are
perfect
evidence
of
that
,
of
continuing
to
push
and
strive
forward
,
and
you've
learned
that
from
Dr
Redwine
and
Nancy
,
and
now
you
are
continuing
in
this
trajectory
as
well
of
making
it
better
for
future
generations
.
So
for
that
,
thank
you
,
thank
you
for
taking
the
time
to
do
that
.
Dr. Cindy Mosbrucker
17:57
Well
,
Alanna
,
thank
you
for
doing
what
you're
doing
,
because
those
of
us
who
are
endosurgeons
,
we
couldn't
do
what
we
do
without
the
advocates
directing
the
patients
to
the
right
places
,
and
we
don't
have
the
time
to
educate
patients
as
much
as
they
need
to
be
,
and
it's
,
I
would
say
,
probably
80%
of
our
patients
,
if
not
90%
,
have
come
because
they've
been
on
Nancy's
Nook
or
they've
listened
to
podcasts
or
they
have
done
their
research
and
found
the
endo
advocates
who
have
kind
of
guided
them
to
the
right
place
,
to
somebody
who
can
take
care
of
them
appropriately
,
to
somebody
who
can
take
care
of
them
appropriately
,
and
so
none
of
us
would
be
where
we
are
,
we
would
not
have
the
volume
that
we
have
,
we
wouldn't
have
the
capabilities
that
we
have
without
you
guys
,
and
so
I
appreciate
your
work
more
than
I
could
ever
tell
you
Thank
you
.
Alanna
19:00
That
really
means
a
lot
to
me
,
so
thank
you
.
Dr. Cindy Mosbrucker
19:16
Anything
you
want
to
impart
on
our
listeners
before
we
wrap
up
in
the
right
,
and
don't
let
somebody
take
your
ovaries
out
without
having
a
very
,
very
,
very
good
explanation
for
why
that
is
necessary
.
Don't
take
your
ovaries
out
until
all
of
your
endo
has
been
excised
.
Or
you
know
if
you've
had
three
cystectomies
?
You
know
two
or
three
cystectomies
for
recurrent
endometriomas
and
in
your
forties
,
okay
,
fine
.
But
even
in
that
situation
you
need
to
be
counseled
appropriately
as
to
what
the
risk
is
and
what
the
downside
is
and
what
you're
going
to
have
to
do
for
the
rest
of
your
life
,
you
know
.
And
then
the
other
thing
is
don't
let
a
generalist
operate
on
an
endometrioma
because
you
may
lose
your
fertility
,
you
may
lose
the
function
of
your
fallopian
tube
.
In
my
experience
,
either
they
take
out
half
of
a
normal
ovary
or
they
don't
get
all
of
the
cyst
wall
out
and
then
you
have
a
recurrent
endometrioma
and
you
have
to
have
another
surgery
which
is
,
you
know
,
is
more
damage
to
the
ovary
.
Dr. Cindy Mosbrucker
20:24
But
hang
in
there
,
there
is
hope
.
There
are
becoming
more
endosurgeons
who
can
do
good
surgery
.
And
beyond
surgery
,
there
are
a
lot
of
people
doing
a
lot
of
research
on
biomarkers
and
treatments
and
the
genetics
and
the
epigenetics
of
endo
.
Hopefully
one
day
there
will
be
some
sort
of
a
treatment
that
will
get
at
the
cellular
nature
of
endo
,
almost
like
a
chemotherapy
.
We're
not
there
yet
and
you
know
I
don't
know
when
that's
going
to
happen
.
I
don't
know
that
anybody
knows
when
that's
going
to
happen
.
But
you
know
we'll
keep
on
doing
what
we
know
works
now
,
which
is
excision
.
Alanna
21:07
Good
excision
,
good
excision
,
yep
.
And
it
is
not
endometrium
.
It's
endometrium
Like
let's
define
that
clearly
for
those
like
Sallie
.
She's
right
,
we
have
to
define
that
clearly
and
understanding
the
disease
and
everything
else
.
And
I
want
to
say
too
I
think
that
you
made
a
good
point
to
this
before
we
wrap
up
you
as
a
patient
out
there
,
listening
,
you
are
intelligent
,
you
are
wise
enough
to
advocate
for
yourself
,
even
if
you've
been
told
otherwise
.
You
are
smart
,
you're
capable
of
doing
that
and
you
are
empowered
to
do
that
.
And
if
anyone
on
a
care
team
says
otherwise
,
that's
probably
not
the
right
care
team
for
you
.
I
think
all
these
things
really
points
to
your
ability
to
do
so
,
but
with
support
of
others
,
and
we
need
to
be
this
team
to
be
able
to
do
that
.
We
need
the
advocates
,
the
patients
,
the
doctors
,
the
providers
to
all
make
this
happen
.
So
thank
you
for
your
time
and
for
your
wisdom
and
just
being
an
advocate
alongside
the
rest
of
us
.
So
thank
you
for
that
.
Dr. Cindy Mosbrucker
22:13
Well
,
you're
welcome
.
Thank
you
too
,
and
it's
been
a
pleasure
.
Alanna
22:16
Yes
,
and
until
next
time
,
everyone
continue
advocating
for
you
and
for
those
that
you
love
.