Unmasking the Complex World of Hormones with Dr. Sallie Sarrel DPT.

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. Join us as we continue with our part two with Sally Surrell and Inga. This is where we left off.

Speaker 2:
0:48

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 3:
1:32

So it's not. I'm not a hormone replacement doctor, so anything that I'm saying is just discussion. But we are not meant to be creatures without estrogen, progesterone and testosterone like I believe really ever, but certainly at the young age that many are forced to go through that with endometriosis and in terms of you know, we don't want to be again, we're going to get old one day and we don't want to be osteopenic, so we don't want to lack bone and to not lack bone. You need muscle development and you do need many need some testosterone supplementation for that. If it's done, if your endometriosis was fully excised, then you should be able to find the combination of testosterone that won't aromatize, which means transfer into estrogen. It may take a couple of different brands, it may. You know most people. If they go into early menopause, the minute you get them the right combo, they like it's like drinking a Celsius.

Speaker 1:
2:51

They think they're like amazing Right.

Speaker 3:
2:55

I would not. So I told my story on the last podcast. But having had that overtaken without consent and then, given my history with PCOS as well, I went into menopause very, very young. I would not have won a national tennis championship had I not been given testosterone. But let's not negate the effects of progesterone as well, and not to mention bladder health and estrogen, as well as cardiovascular health and estrogen, because I point out that the Harvard nurses study was completely retracted, right. So that study, everybody stopped giving it, but they should be giving it.

Speaker 3:
3:39

And there are studies about breast cancer, actually estrogen being protective, except for one particular type which you can be tested for, and as well as neurodegenerative health. And you're not going to update estrogen the way your system should without testosterone and progesterone. You know we started and I put Dolly in the other room and but Dolly was just hysterectomized because she's a dog, right, right, you know it's not a human. I have spoken to hormone specialists who say if she gets incontinent when she's older, you might have to smear a little estrogen on her belly, and that we see in humans also. So I had this with a patient.

Speaker 3:
4:26

She's has very light bleeding after sex. Light bleeding after sex. You definitely have to go to the doctor, right? Right. She goes to the doctor, tested and she has the hysterectomies. So no pap smear. But they do everything they can do. They determine it's not cancer, right, because you want to rule that out. And then they send her home and she's like wait, sally says I might need estrogen. Can we talk about that? And first of all, it was who is Sally?

Speaker 3:
4:52

And second of all, it was no, your tests are normal, but you have to be like you can have. That range is not necessarily what's right for your body and the tissue definitely fins without the presence of testosterone or estrogen or progesterone. So you feel like you've had your oophorectomy and hysterectomy, but your boobs are still sore. That's usually absence of progesterone, not to mention and this is taking a little bit of a whole other thing. Your insulin metabolism is going to suck without these hormones and either you're going to drink water and eat a vegetable that isn't a carrot, because that's due high in carbs, or you're going to have to supplement with something, and if your progesterone, esterine testosterone, are off, that's also going to contribute to cravings. So now you have all these cravings and your insulin metabolism sucks, you're just talking about this, literally right before this man.

Speaker 1:
5:55

We crave the sweets and I was telling Inga, the minute I got out of surgery from having my excision hysterectomy, opherectomy, I wanted that chocolate chip cookie. And if anyone took that chocolate chip cookie away from me I was like what are you thinking Like? I went on a whole tirade because I craved the sweet and I had never done that before.

Speaker 3:
6:17

Yeah, I would never. I don't want to say never, but unless I 100% knew that the ovary was diseased through and through, I would be really hesitant to take it over.

Speaker 2:
6:34

And most.

Speaker 3:
6:34

MDs are that I work with? Certainly not most MDs. They just do. They think they're starving the endo and what they are is starving your elderly future. Yes, and I think there's an organization advancing health after hysterectomy Aha, and they really tried it. The plaques and Alzheimer's they're showing our estrogen depleted brains in many people, and so we have to be proactive, we have to take the reins of this, and you have to be careful who you go to.

Speaker 3:
7:13

First of all, a lot of people are trying to take advantage of you. Yes, I called the state medical board on someone, and when I called the state medical board, it turned out their medical license was in Pennsylvania. It wasn't even in New Jersey. I mean that. But the other thing is like I had this. Now I have someone I really work with. You think I'm annoying, but we really work together and he you know, and it helps. But last year, if your testosterone is too high and you have Hashimoto's, you're going to change the way your thyroid works and that in itself will raise your insulin, and then you're not losing First of all, you're not losing anyway.

Speaker 3:
7:54

Right but it's not what's right. It's you have to work with someone who's constantly taking levels and who's constantly working on you, and it's it's expensive. Well, and I think the new frontier is going to be ozembic, because, instead of normalizing their hormones, a lot of people are going to turn to ozembic because they're getting this insulin response and they're not going to, you know, and ozembic can do wonders. But should we really be normalizing the hormones and then using the ozembic if you need it or the manjarro if we need it? Because I'm not against ozembic or manjarro, but it's like what, what? What is the order that people are doing? Because just because you're thin doesn't mean you're not going to break every bone in your body when you're older.

Speaker 2:
8:42

Right, well, and I think you know, I was listening to a pretty interesting podcast about the different hormones, but that's also along with this, like peeling back the onions and doing all of this with the pelvis and trying to figure out, like, what generator is this? Or you know, what pain generator is this? I've gone to six different doctors, probably for hormone stuff, and each one tells me something different. One is like testosterone for a woman, like we wouldn't do that unless you were trying to. You know, transition, transition, transition, but that's very not true.

Speaker 3:
9:17

I know and then. But then At Yale they do a lot of work with they actually do a lot of work with testosterone. I think you can get both hair loss and hair growth in places you don't want from testosterone, right, but I think, like another industry, that isn't regulated.

Speaker 2:
9:36

And well, no studies for women. And it's just so frustrating and it's, you know, I always tell. I mean I said to Alana I mean we have how many drugs for erectile dysfunction for a man, but like a woman's sexual desire, we don't have anything for that. There's no studies for women for that. And there's one drug, but it's for women who are.

Speaker 3:
9:57

Yeah, I was going to say there is one drug.

Speaker 2:
9:58

Who are pre menopausal and it's really expensive and if you look at the data on it, it was almost no different from the placebo, so it's just frustrating. It's it's frustrating to find somebody.

Speaker 3:
10:12

And also like is sexual dysfunction? That's its own podcast, but is sexual dysfunction happening? Also, I don't like the word dysfunction, but are there issues? Because there are issues within the vaginal wall tissue itself. Are there issues because of the lack of the hormone circulating in the system? Is sex painful? Is there a history of sex being only for procreation because it's painful and then that's impacting desire Is? Are all of these things going on at once? And also, are we talking about all and any of them?

Speaker 3:
10:51

You know I, like Dr Rachel Rubin, who's a urologist, is trying to, you know, really further that conversation, Dr. There's another doctor in Florida who's furthering that conversation as well, Because we shouldn't be like whispering in the shadows about what's going on here. And then the real crazy part of the conversation is and I've sat with leading experts in the world about hormone replacement and why we don't typically present a section on it is what is the efficacy of hormone replacement in endometriosis patients If the research is so grounded in this estrogenic backflow of menstrual blood? You know, does it? You know, whatever. So I think, by the way, you can make your own decision, which is what I did, and if you have a full excision, then you should be able to take hormones, but there's no data on it, I know.

Speaker 1:
11:55

It's infuriating to me Don't put your doctor on, say Sally says you say Sally says I'm going to have walked through this for like the last six months and you know. That's why having and we're going to talk about this in another podcast but why having community is so important, because we feed off of each other and being able to bounce ideas off of hey, are you feeling this or are you feeling that? But we've been talking about this for the last six months and trying to navigate all this.

Speaker 3:
12:22

All you have to do is see ah-ha, is research on how bad it is not to have estrogen, to have like a moment in your life where you're like, do I want to? I mean, somebody with endometriosis like you could literally be going 60 years. Do you want that on your brain? Do you want that on your vaginal tissue? I just had lunch for the holiday with somebody who has chronic bladder infections. Do you want that? Do you want to do that too, to yourself? So are you willing to? And it's not a risk of cancer anymore? Are you willing to risk that your endometriosis wasn't fully excised? And the other issues we have Dr Gargiulo talking about this the, if you still have a uterus, progesterones actually a little protective against adenomyosis. So for those, I went in very early but I had natural menopause and I'm not willing to not have any bone either, you know.

Speaker 2:
13:28

Right, I think a lot of women are scared to take estrogen and I think a lot of that stemmed from that. Like women's health initiative study that was done, that was like just so flawed with the group of women that they chose. They were much older, I think it was like 67-year-olds.

Speaker 3:
13:47

And they admitted the study was flawed and they retracted everything and it never took.

Speaker 2:
13:52

But that's still there. No, it's. That stigma is still there, unfortunately, right.

Speaker 3:
13:58

And what's worse is it's still there in the medical population. So most people who are seeking hormones are going to be. I have to go out of pocket.

Speaker 2:
14:08

Mm-hmm.

Speaker 3:
14:09

Same. I have to go out of pocket. Now I have one. They were living abroad, but in France it's very common hormone replacement and there, you know, it was a whole different ballgame than we're getting there and all I have to say is it's a very different society sexually and look at what they're accepting. But I think it's so damaging that Harvard's Women's initiative and the type of breast cancer can be typed out. It's like one you can test for to see if you're at more risk and obviously then you can't have a certain kind of estrogen. But yeah, you should meet the other serral. Does this, the other serral? Does this the other serral, does this my uncle? Like invented hormone replacement.

Speaker 1:
14:54

Get out? Wow, no way. That's why you're so smart, sally it's genetic.

Speaker 3:
15:00

No, but like my uncle's, totally badass like, trained by Masters and Johnson and not great with endometriosis. But hormone replacement, that's your guy. Well, I probably won't do a podcast.

Speaker 1:
15:16

But let's just, inga and I are trying really hard over here to figure out this hormone thing, because it is and that's the other frustrating thing about this is like we're talking about all these anatomical things or and we're talking about frozen pelvis, hernias and all of the other avenues, but how much of that and how much of the hormone and how much of the endometriosis are all tied together? That's what's really hard to navigate, because we don't know and we don't know.

Speaker 3:
15:45

But like, don't forget, like carpal tunnel is tied to menopause and so, like I think at some point my friend, when she first said it to me, she was, like you got to look at menopause like now it's its own animal and you have to check out of the, not that endometriosis is ended at menopause, but that to get menopause care you're going to have to stop telling people you had endometriosis and just count on how good that excision was, because otherwise you're not getting anything right. And I've been looking at this summer because I'm the only one who plays tennis three hours a day and gains weight right, how we work out changes based on our hormones too, and you do need more weightlifting after menopause. But you're not going to get any results or even feel very good doing it without testosterone. Right, and I'm not talking about steroids and jacking yourself up.

Speaker 3:
16:44

I'm talking about being able to turn on a toning video and do 30 minutes with a five pound weight. I mean like, just like basic weightlifting and that's.

Speaker 1:
16:52

it's interesting. You say that because when I finally in and I were talking about this, I was like she's like, did you get your testosterone tested? I was like no, she goes, you need to go get it tested. I said okay. So I went and got it tested and it was low, not as low as yours, yours was, mine was two.

Speaker 1:
17:09

Yeah, it's stupid low, but then. So I was like oh so I started to form, I started testosterone and I put this out there before and I strongly believe that we need to talk about it more. But I started the testosterone within two weeks. The trainer my trainer looked at me and he goes you are worlds different than what you were two weeks ago.

Speaker 3:
17:31

Yeah, but it's not just muscle, it's insulin metabolism, it's thyroid health, like it's very sensitive with that thyroid Fatigue. It's too high, then it'll. It's fatigue and it's sense of self. It's very interesting. You know. You should try their Lethos L-I-T-H-O-S and Snowden S-N-O-D-E-N. They're physical therapists that work only in this realm. But then again you have to conduct the interview as if that endometriosis doesn't exist anymore because, if?

Speaker 3:
18:08

because, based on our lousy history, if you mentioned the word endometriosis, everybody thinks like you can't give any estrogen, which is, but I feel like they should go try to live it, because I'm not on a fun trip.

Speaker 1:
18:21

Both of us, we've all been in that way. We and the thing is is like why do we feel like it's okay to deplete our body of something that is so necessary? Like okay, well, that's a whole other conversation We'll have.

Speaker 3:
18:35

Dr Maria Rivolo will be speaking at the summit about the history of patriarchy in endometriosis, and the reason, ultimately, why we think it's okay is because women's job in life is to have babies and we might as well throw you away once you're done. So why should we do any decent research?

Speaker 3:
19:00

And you think I'm just being bitter but this is actually a history that impacts us every single day, and I think it's so bad. You know, when you're looking at decent studies about plaque in the brain and Alzheimer's and estrogen, and yet somebody can't get any, yeah, yep, yeah. I heard, though, that there is an online, a concierge service, that does the vaginal estrogen for bladder infections, because I had a patient need it and the doctor wouldn't give, and she was just convinced that she needed it because the bladder pain started after the hysterectomy and her tissues, even though she had rolled out cancer, her tissues were thin and bloody, so not bloody like a period, but like a little bit of blood, and she used the vaginal, as she tried it within the first, like two days.

Speaker 2:
20:04

The problem the one which is shocking is for so many people, the vaginal estrogen is stupid, expensive and that's so sad. Welcome, that's so sad. Yeah, like why.

Speaker 3:
20:16

Well, I'm working with AUA and, like you know, when you talk about diversity, equity, inclusion, everybody should be able to get progesterone and estrogen.

Speaker 2:
20:24

Right.

Speaker 3:
20:25

You know, it shouldn't be that hard. But I'm telling you what's going to happen is it's going to be a lot easier Eventually. Right now it's expensive, but it's going to be a lot easier. To prescribe someone with manjarra, which all for the drug. I'm not saying that the drug is bad, but then to fix their hormonal dysfunction and let them metabolize through it on their own.

Speaker 1:
20:46

Yeah, and we have to be careful. As people that have gone through a lot of trauma and our body has had endometriosis and now we don't have our own supply of hormones, we have to be careful of what we're putting in our body and how we're navigating health of our body. It's not, we can't just throw everything to it or we're not solving the problem. It's like having an ablation surgery you just put a bandaid on it, right.

Speaker 3:
21:13

Well, I mean, I tried like three or four different types of progesterone before I found one and I don't always love the doctor that prescribes that, but I know I can't go anywhere else because that's the only one that I didn't get sick from, and a lot of times somebody who does have a history of endometriosis will get sick from progesterone because the receptor site sensitivity is different, so I needed just a very specific one. Interesting, yeah. So like you were fine on the testosterone they give you right off. I need to try three of them.

Speaker 1:
21:48

Well, and we, yeah, we have a. They compound it at one pharmacy. We can only get it at one pharmacy here and they compound it on site and that is, and it's a, the interleague cream. You've had a different experience with it than I have.

Speaker 2:
22:05

Mine is just like this I can't get like a nice. I did trokies, then they were having me inject and I was like man, I feel fantastic. And then I went and had my levels done and it was like 230, whatever.

Speaker 1:
22:21

And now I did the cream and I'm up again Like I can't.

Speaker 3:
22:25

I've been told the cream can only be used vaginally and so that you really have to take it, swipe the top and put it vaginally and not clitorally, by the way.

Speaker 2:
22:35

No, they. The way they have us do it now is on the inside of our leg. But then I was listening that there's this like 1% and the tube should last you 10 days, where, like a guy, it's like one tube for one day and I'm like, well, what is this?

Speaker 3:
22:50

No, so I've heard a lot, from more than one source, that if you're putting it on the inside of your leg, you're not going to be getting enough of it to make a difference, so you could even be using less of it, but that you have to put it badging the testosterone has to be done. Badging Interesting, or so. The other one is inside of the elbow, but it's funny. So like talk about patriarchy, the doctors like explaining this to me and he's like he goes like this can you put it vaginally? Like what are?

Speaker 2:
23:21

you whispering?

Speaker 3:
23:23

I'm basically like do you know what I do with my life? Like what are you whispering?

Speaker 1:
23:26

about.

Speaker 3:
23:30

Yeah, I've heard the story. We went out to dinner like we were traveling somewhere and some woman recognized me and she started to ask me questions. I can't take my dad's like. Really, you're more dad. So I think, like that's the thing. We're like guinea pigs. I think a lot of women, at least with hormone replacement, a lot of women are guinea pigs, which is disgusting as it, but it's still not a great situation.

Speaker 1:
23:59

No, but I do feel like we are smart enough to continue pushing and advocate for it to be better for future generations. It's going to have to happen at some point. We can't not try this out, otherwise we would be stagnant and any health benefits of it, and so I think that we need to be able to push harder for future generations so that this doesn't perpetuate, but that again.

Speaker 3:
24:25

Well, I think AHA is a great and well funded organization. Well funded because they train primary care physicians and physicians. They have massive training programs and that's where it's at. That's one of the reasons why we're doing the imaging course for physicians. You have to start training so that those people can go out in the field and train the next part. That's a huge part of change. I think, like if you talk about is this my hernia or is this hormone replacement? You're not going to testosterone away a hernia.

Speaker 1:
25:02

No, no. But does it hold structure? Because does a testosterone help with joint and ligament and muscle?

Speaker 3:
25:11

We're talking about all of that. Right, you know that whole thing that in pregnancy they're relaxing, and that was all proven to be not true, Really, Really, that's not what triggers ligament laxity and pregnancy. What is it? It's a structural trigger. It's not triggered by your hormones. That another way, some male, somewhere, decided to blame something on a hormone In terms of testosterone and stability, because you're able to maintain muscle mass probably not put on muscle mass, but at least maintain muscle mass and then that muscle mass will pull at the tendon better. That could be some of your joint stability with testosterone. That is a proven thing to provide joint stability. Right, I would have to look up. The progesterone is like. You know who gets anxiety now that they're in menopause? You know that's a little bit of a progesterone deficiency, bloating anxiety. It's sort of like your, your counteract or your progesterone.

Speaker 3:
26:22

Well and then when Progesterone's a hard one, and people with a history of endometriosis.

Speaker 2:
26:26

Well with progesterone. So I'm getting back to like getting different information from different doctors. The first person I saw was like, yes, you absolutely need to be on a progesterone even though you don't have a uterus. The next one was like why are you taking progesterone? You don't have a uterus? Like we're not trying to prevent, you know, uterine cancer.

Speaker 3:
26:45

But you're not taking it to prevent uterine cancer. You're taking it for brain and physical wellness and the you know. The issue with progesterone for people that don't know is that endometriosis is proven to, in many people, have an absence of the receptor sensitivity for progesterone. So this is Sader Ballon's work, which is sponsored by pharma, by the way, but I don't want to discount his work. He's a great guy.

Speaker 3:
27:16

So we can't uptake progesterone the way somebody else can, and so many times. That's why, like, they put you on a progesterone only pill and you feel like you want to kill yourself because you're so bloated, because just throwing more at you didn't actually make the receptor more sensitive so you could take it in. And even though endometriosis has been excised, that receptor sensitivity likely there's no research on that, but it likely hasn't changed, and so it becomes a game on how much progesterone you can really get in Some people. I can only do the trochies and I can only do a certain amount. It took me two years to build up to the right dosage and what typically happens is the person goes to a hormone specialist, they give them a pill, they feel sick and can't do math the next day because they're so foggy, and then they never try it again.

Speaker 2:
28:17

So you know it's back to that kidney pain syndrome. They're like here's 100 milligrams, take it to help you sleep, and I was like, well, I don't feel anything at all from this.

Speaker 3:
28:27

Is it raising your levels? I don't know, nobody ever checked it and I asked the doctor about that?

Speaker 2:
28:33

We don't have to check it. It's based on how you feel and I'm like, well, how?

Speaker 1:
28:36

am I supposed to know how to feel?

Speaker 3:
28:38

Yeah, it's just interesting. You know you could my guy's a little odd, but we certainly could have. You certainly could have him on.

Speaker 2:
28:45

I love odd people.

Speaker 3:
28:47

I can do odd, we can do odd We'll talk about it off air, but I really hesitated, especially during COVID, because I didn't want to have blood work done Right, but you need, like every three to six months you need to be checking if you're, and a lot of that is because it affects your thyroid and it affects your insulin metabolism.

Speaker 1:
29:06

It's so like we've been on this for a while because I think both Inga and I not that we're not looking at endometriosis being, oh, I think, anyone with endometriosis. We're always looking to see if, like, even if we've had a great excision doesn't mean that we can't have a presence of endometriosis still there. But we're still looking at other pain factors, hormone factors. We're on this whole new kick now.

Speaker 2:
29:31

It's like how can we optimize ourselves as best as possible after all of this?

Speaker 3:
29:36

I don't understand. You mean you can't optimize yourself as best as possible by purchasing a $2,500 coaching system from Instagram? Yeah, what that's the issue is that we need to be well as a person and because there's no true roadmap and there isn't even a rope. So we try to teach you with the endometriosis summit how to analyze the options, but you become fodder for somebody else's profits. You know, and yeah, it's really, really hard. Now people accuse the excisionist of that, but I don't agree that the Instagram coaching is like unreal. Yeah, not all. I'm not saying everyone, no, I'm just saying there are some out there and now they know exactly what they say to get their numbers high. And then there's, before you know it, they're selling you like I don't know what they're saying because I don't buy it.

Speaker 1:
30:31

Yeah, there's a lot out there and I think we have to be really careful about this pill and everything will be okay.

Speaker 3:
30:39

And you know you'd have to like go swimming in a vat of curcumin to get it strong enough, and it dies. Everything yellow. So I don't know. Is that you know, then, the world's?

Speaker 1:
30:49

yellow, I don't know yeah.

Speaker 3:
30:52

And when I remember somebody was trying to before I had surgery or diagnosis, they were trying to make me feel better and they gave me fish oil and it was like a bottle, like you know, a bottle of fish oil and I had to take it was like crazy expensive.

Speaker 1:
31:06

And they were like it's a delicious tasting lemon oil.

Speaker 3:
31:09

to this day I live on the beach. Sometimes I have trouble going to the beach because I remember that.

Speaker 2:
31:14

I was gagging.

Speaker 3:
31:16

And then you know the Chinese herbs that you grew yourself. My family was like we're gonna ask him move out and that's gonna solve it all. And I must.

Speaker 2:
31:26

those herbs were like $250 a week, but you're willing to try anything to feel better, and I think that's that's the hard part. And then they prey on you because they know sort of like you said, and you're just like, I just want to feel good and so I'll do anything. I will take the fish oil and burp it up all day, I will brew the herbs, I will do all the things like just I just want to feel good and I had somebody move.

Speaker 3:
31:53

They decided it was mold in their house, which I'm not saying mold in your house is good, right? Or that it's Candida, and they're doing months and months of Candida detoxes. It's like if we got diagnosis in the first place, if we were valued in society as being worthy of research, both for the disease of endometriosis and for the after effects of experiencing life with endometriosis, we would be totally dead. It would be totally different. But instead we're like preyed upon. Yeah for sure.

Speaker 3:
32:27

And then I get accused of preying upon people because I have to charge for the conference, and you know what. I can't put it on without charging no because then I have to ask pharma for money, and if I ask for money, then we're being preyed upon again. You see, it's not good.

Speaker 1:
32:41

No, I mean, we have to be mindful of that and we felt that at so many levels of trying to figure this out, and I think it's so easy for us to be like we will just do anything, you say, just to feel an ounce better, and that's not okay.

Speaker 1:
32:55

We we've talked a lot about that because it is expensive. This disease is expensive. The pot, the after effects of the disease are very expensive, and so you want to get it right. And that's why I think there's so many questions of how can we not shortcut treatment to getting better, but how can we analyze and effectively look at all the scenarios without having to spend years doing it? And I think the hernia has been a huge game changer for us to look at instead of jumping straight to oh, this is endometriosis, or this is herniated, this, or or not herniated that, or it's wrong pelvis position, frozen pelvis you can go in so many different directions, but having the knowledge to say, okay, we've taken this step, I'm not going to spend six more years looking at that step, I'm going to look at the next step. And how can I effectively find care that's going to give me a better quality of life? Bottom line right.

Speaker 3:
33:59

So I always say you rule out endometriosis, pelvic floor dysfunction, hernia, bladder up regulation. I probably would do bladder up regulation like endometriosis, bladder up regulation, pelvic floor herni, right? I also think so many doctors have patient blamed that when someone comes along and starts to talk about these things, it's not another way of patient blaming, it's a very, very important thing. It's not a way of blaming, it's a way of trying that help and that's also very hard and people's resources, mentally and financially are usually gone and and that's why something like this podcast is important. Something like the summit is important, right? Something like Dr Molling and Dr Fogelsen and Dr Vidalis work on Instagram is super important. The amount of information center for endometriosis care puts out there, somebody like Endo Girls blog that's why those free are YouTube we have a fabulous YouTube the endometriosis summit and that free stuff I feel like could cut down on somebody's journey for like a good you know, a good shave, like four to five years off of somebody's journey, yeah.

Speaker 1:
35:08

Yeah, it's so valuable and that's why we adore you for so many reasons, not only because you're wise, but because you care so much about it and or always like it is, I think.

Speaker 2:
35:20

I appreciate that and I was, I feel, super fortunate to have met you today. I am so excited to meet you next year and learn and become a better advocate, and I thank you for today.

Speaker 3:
35:33

Yeah, thank you, sally, wonderful, wonderful.

Speaker 1:
35:36

And I'm, and you know, you're always welcome here.

Speaker 3:
35:39

Well, we'll come back again. Can't wait what. I don't know what we're doing next.

Speaker 1:
35:44

You know what? I don't even think we always need direction, because we just, we can just talk for hours.

Speaker 3:
35:49

I know, I know, I know We'll see what happens, but yes, it's wonderful to come with you guys.

Speaker 1:
35:56

Yeah, well, and until next time, everyone, remember to advocate for you and for those that you love.