Send us a text with a question or thought on this episode ( We cannot replay from this link)
Embark on an eye-opening journey with me, Alanna, as we pull back the curtain on the world of endometriosis and adenomyosis, guided by the wisdom of Dr. Mona Orady, MD, founder of the Orady Women’s Clinic. Discover the transformative impact of meticulous surgical techniques, like laser excision and ovary suspension, that promise to revolutionize patient outcomes. This episode illuminates the often-overlooked art of adhesion prevention and the profound difference it can make in preserving fertility and enhancing quality of life for those battling these conditions.
As we navigate the often turbulent waters of women’s health, Dr. Orady’s expertise shines a light on the pivotal role of early detection and specialized care for teens grappling with endometriosis. Learn why the expertise of a dedicated specialist can be a game-changer in managing this disease from its onset. The discussion also ventures into the broader healthcare landscape, advocating for reforms that ensure comprehensive post-surgery care and underscore a future where holistic treatment is the gold standard.
Closing this powerful episode, we celebrate the stories of resilience that define the path to recovery for many facing chronic conditions. From the potential of physical therapy to the joys of successful fertility treatments, we spotlight the diverse treatment avenues that offer hope and healing. Join us in our passionate plea for endometriosis education in schools, aiming to empower a new generation with knowledge and foster a world where awareness and timely intervention are the norm.
Website endobattery.com
Preventing Adhesions in Endometriosis Surgery
Speaker 1
0:03
Welcome
to
Indobattery
,
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
,
elana
,
and
this
is
Indobattery
charging
our
lives
when
endometriosis
drains
us
.
Welcome
back
to
Indobattery
.
Grab
your
cup
of
coffee
,
your
cup
of
tea
or
your
beverage
of
choice
and
join
me
at
the
table
as
I
continue
my
conversation
with
Dr
Mona
Arati
of
the
Arati
Women's
Clinic
.
This
episode
is
packed
full
of
information
,
so
come
join
the
conversation
.
This
is
where
we
left
off
.
Speaker 2
0:57
Thank
you
for
joining
us
.
In
terms
of
the
adhesion
piece
of
it
,
that's
a
whole
another
piece
I
want
to
talk
about
.
I
actually
just
created
an
entire
session
at
the
Society
of
Laptoprescopic
Surgeons
conference
that
I
just
organized
,
just
on
adhesion
prevention
.
I'm
giving
a
session
in
Europe
next
week
.
Actually
,
I'm
flying
to
Vienna
.
Speaker 2
1:14
I'm
giving
an
entire
session
on
adhesion
prevention
,
especially
in
fertile
women
,
because
a
lot
of
people
don't
talk
about
this
,
but
adhesions
can
have
a
huge
effect
on
women
who
are
still
wanting
childbearing
.
It
can
affect
their
fallopian
tubes
and
block
their
tubes
.
It
can
cause
pain
.
It
can
cause
shifting
of
the
uterus
.
A
lot
of
them
already
have
some
adhesions
from
the
endometriosis
.
The
question
is
how
do
we
minimize
reformation
?
As
I
said
,
it
would
be
a
whole
lecture
.
I
gave
a
whole
hour
lecture
at
SLS
about
all
the
techniques
that
I
use
to
minimize
adhesions
.
But
,
to
be
very
brief
,
number
one
minimizing
the
surgery
that
I
do
to
make
sure
I
only
touch
what
needs
to
be
touched
,
meaning
I
don't
sit
there
digging
around
.
I
pick
up
the
endometriosis
lesions
,
I
excise
it
using
the
least
amount
of
energy
and
the
least
trauma
as
possible
,
even
if
that
means
using
a
laser
to
actually
cut
out
the
lesion
.
It's
less
traumatic
than
using
monopolar
energy
or
monopolar
scissors
.
I
use
a
laser
a
lot
in
endometriosis
surgery
,
using
microlaparoscopy
when
I
can
,
using
sharp
dissection
when
I
can
,
minimizing
tissue
trauma
,
minimizing
bleeding
because
blood
can
cause
adhesions
and
inflammation
.
Speaker 2
2:24
My
surgeries
and
everybody
knows
this
,
I
don't
like
to
see
blood
ever
.
They
have
to
be
completely
dry
,
perfectly
hemostatic
at
the
end
.
It
has
to
do
everything
.
You
rinse
everything
really
clean
,
then
using
agents
like
ADAPT
,
which
is
an
adhesion
prevention
solution
that
coats
everything
and
prevents
things
from
sticking
together
.
It's
like
a
syrup
that
covers
everything
and
coats
it
so
that
things
don't
stick
together
.
It
makes
everything
slippery
so
that
you
don't
develop
adhesions
.
Speaker 2
2:53
When
I
do
procedures
where
I
elevate
the
ovaries
,
I'll
basically
suspend
the
ovaries
away
from
the
area
that
I
dissected
or
cut
out
endometriosis
for
three
or
four
days
until
that
area
heals
over
and
then
I'll
cut
the
string
and
release
the
ovaries
so
that
when
they
come
back
down
,
the
fallopian
tubes
and
ovaries
were
not
in
the
area
that's
healing
so
they
don't
develop
adhesions
around
them
.
There's
a
lot
of
techniques
that
I
specifically
do
and
I
teach
to
prevent
adhesions
,
because
the
majority
of
my
patients
and
I
think
the
majority
of
endometriosis
patients
have
not
yet
had
children
and
you
don't
want
to
affect
their
ability
.
You
want
to
preserve
their
fertility
Adhesion
.
Prevention
is
a
big
part
of
that
.
It's
also
a
big
part
of
preventing
pain
and
things
like
that
.
I've
seen
patients
where
I've
re-operated
on
who
had
surgery
somewhere
else
or
had
someone
else
do
surgery
,
and
you
go
in
and
it's
a
complete
plastered
mess
of
everything
stuck
to
everything
.
How
is
that
not
burning
?
That's
painful
just
to
look
at
,
let
alone
to
actually
experience
.
Speaker 1
3:48
I
think
that's
the
problem
with
endopatients
,
though
,
specifically
is
sometimes
we
think
,
oh
,
the
endometriosis
is
back
,
but
that's
not
always
the
case
.
It
can
also
be
adhesions
from
the
surgery
and
that
doesn't
necessarily
mean
just
ablation
surgery
with
a
general
GYN
.
That
also
means
that
can
happen
with
even
other
surgeons
.
I
think
it's
more
different
.
Speaker 2
4:08
Sometimes
I
wonder
because
a
lot
of
people
ask
me
what
my
recurrence
rates
are
.
And
I've
been
looking
because
I've
been
in
San
Francisco
now
for
over
five
years
and
I've
done
over
a
thousand
surgeries
In
the
literature
.
If
you
look
at
the
literature
,
the
recurrence
rate
is
supposed
to
be
like
40%
in
five
years
or
something
like
that
.
For
endometriosis
.
I've
done
over
a
thousand
surgeries
and
I've
only
had
to
go
back
in
on
maybe
five
or
10
for
recurrence
.
Speaker 2
4:33
My
recurrence
rate
is
I
don't
want
to
say
what
it
is
,
but
it's
much
less
than
40%
,
probably
less
than
five
or
10%
.
I'm
wondering
is
it
because
I'm
so
diligent
about
adhesion
prevention
and
when
I
do
go
back
in
on
those
patients
,
they
don't
have
adhesions
?
They
literally
have
recurrent
endo
that
I
can
see
and
remove
.
It's
not
adhesions
that
caused
it
in
those
patients
.
Even
the
general
surgeon
that
I
work
with
sometimes
will
leave
rectal
endo
and
do
it
later
after
they've
had
their
baby
.
They'll
go
in
and
they'll
be
like
where
are
all
the
adhesions
that
are
supposedly
have
formed
from
the
lab
?
Speaker 2
5:05
I've
had
general
surgeons
that
are
like
what
do
you
do
?
What's
wrong
with
your
patients
?
Why
do
they
not
have
adhesions
?
I
think
that's
a
big
part
of
something
that
I'm
hoping
will
talk
about
more
in
the
endometriosis
community
,
because
I
think
surgeons
some
of
them
are
kind
of
blasé
about
it
and
they
think
,
oh
,
adhesions
are
inevitable
.
I
don't
think
they
are
inevitable
.
I
think
that
we
can
do
what
we
can
.
I'm
not
saying
no
way
you're
going
to
develop
adhesions
,
but
I
think
we
have
to
work
really
hard
to
minimize
it
.
Speaker 1
5:32
It's
more
about
making
sure
that
you
complete
everything
within
the
surgery
,
the
full
care
,
not
just
exercising
Well
that
you're
thinking
about
it
.
Speaker 2
5:41
You're
thinking
about
the
future
.
It's
not
about
this
surgery
now
.
It's
about
what
happens
five
years
from
now
.
What
happens
10
years
from
now
?
How
is
this
going
to
look
in
a
year
?
How
is
this
going
to
look
after
healing
?
What's
going
to
happen
when
this
patient
wants
to
get
pregnant
?
You
have
to
think
about
the
future
,
not
just
the
here
and
now
.
I
think
,
as
a
surgeon
,
that's
really
important
.
Speaker 1
6:01
I
feel
like
that's
a
big
part
of
why
we
get
confused
about
reoccurrence
rates
is
because
we
think
,
at
least
from
a
general
population
standpoint
and
I'm
speaking
only
from
what
I've
experienced
with
people
talking
to
me
about
it
is
just
that
the
confusion
between
what
is
actual
reoccurrence
and
what
is
actual
adhesion
from
a
surgery
,
it's
a
very
confusing
thing
because
they
can
both
be
pain
generators
Absolutely
and
that's
where
I
think
can
we
be
better
surgically
to
prevent
some
of
these
pain
generators
by
preventing
some
of
the
adhesions
.
Speaker 2
6:41
I
absolutely
think
there
is
,
and
I
think
we
have
to
at
least
try
,
right
Like
I
do
think
that
patients
should
ask
their
doctors
,
like
what
do
you
do
to
prevent
adhesions
?
Speaker 2
6:52
Or
just
do
the
surgery
and
and
,
and
I
don't
know
,
I
don't
want
to
,
I
don't
want
to
.
You
know
,
I'm
sure
most
doctors
do
something
,
but
they
have
to
at
least
have
it
in
their
mind
,
right
,
right
,
you
know
you
have
to
think
about
energy
,
you
have
to
think
about
tissue
trauma
,
you
have
to
think
about
bleeding
,
you
have
to
think
about
adhesion
barriers
,
you
have
to
think
about
things
like
suspension
and
right
,
and
you
know
,
I
was
talking
to
one
of
my
good
endometriosis
colleagues
,
who's
from
Greece
,
who
actually
taught
me
about
Varian's
suspension
technique
way
back
when
,
many
,
many
,
many
years
ago
,
and
I
was
talking
to
her
about
it
at
SLS
,
because
she
saw
that
Diagnosing and Treating Endometriosis in Teens
Speaker 2
7:27
I
do
that
.
She's
like
,
wow
,
I
do
that
.
You
know
,
this
is
you
,
you
operate
the
same
way
like
me
.
Because
I
was
showing
some
videos
and
I'm
like
,
yeah
,
well
,
you
know
,
you
know
,
vicki
,
I
learned
a
lot
of
this
from
you
.
It's
,
you
know
,
it's
a
lot
older
than
me
and
she's
been
doing
endometriosis
surgery
for
,
you
know
,
30
years
or
something
like
that
.
And
she's
like
,
yeah
,
but
you're
there
,
a
few
people
still
do
what
I
do
.
And
I'm
like
,
I
know
,
but
why
?
Why
is
that
?
And
I
think
it's
just
something
,
hopefully
,
as
we're
talking
more
and
things
like
the
endometriosis
summit
.
Sls
is
a
great
conference
in
the
IPPS
,
which
I
also
really
admire
,
the
International
Public
Pain
Society
.
Doctors
are
talking
more
about
it
and
we
talked
about
this
.
Speaker 2
8:02
I
think
endometriosis
doctors
should
be
like
the
GYN
oncologist
,
like
why
is
there
a
GYN
that
specializes
in
cancer
and
there
isn't
a
GYN
that
specializes
in
endometriosis
,
when
endometriosis
in
some
ways
can
be
worse
than
cancer
to
treat
?
Yeah
,
oh
it
.
You
know
.
A
general
OBGYN
Honestly
should
not
be
operating
on
endometriosis
,
in
my
opinion
,
or
they
should
.
They
should
know
what
their
limitation
is
.
Go
in
,
put
the
camera
and
diagnose
it
.
Don't
touch
anything
.
Take
the
fixtures
and
then
send
them
to
the
specialist
,
because
as
soon
as
they
start
touching
things
or
burning
things
or
cutting
things
,
you
can
cause
those
adhesions
that
then
later
on
I'm
having
to
deal
with
and
try
to
prevent
from
reoccurring
,
and
that
becomes
more
difficult
.
It's
more
difficult
to
prevent
adhesions
once
adhesions
were
already
there
.
Speaker 1
8:50
Right
,
prevent
adhesions
when
you're
you're
just
doing
surgery
on
someone
who
didn't
have
adhesions
before
,
right
and
then
the
other
part
of
that
too
is
that
it's
much
harder
for
the
patient
long
term
to
get
a
good
quality
Excision
and
get
all
disease
out
,
because
it's
all
mingled
within
that
and
then
your
organs
and
other
pelvic
components
are
compromised
even
more
Long
term
because
it
affects
the
nerves
,
it
affects
the
muscles
,
the
bowel
is
kinked
,
everything
is
shifted
and
trying
to
unravel
,
then
put
everything
back
to
where
it
belongs
.
Speaker 2
9:25
Number
one
takes
a
long
time
,
but
number
two
,
you
know
,
you
end
up
with
a
lot
of
raw
surfaces
which
can
then
form
adhesions
Right
,
and
so
the
more
we
think
about
prevention
.
And
that
takes
us
to
the
next
step
.
You
know
why
aren't
we
diagnosing
endometriosis
when
patients
are
young
,
so
we
can
treat
it
early
,
before
it
becomes
the
stage
four
?
Frozen
Pelvis
infertility
patient
.
Speaker 2
9:45
Yes
why
can't
?
I
know
that
when
patients
are
in
their
teens
.
Most
patients
have
symptoms
in
their
teens
.
Right
,
my
mini
micro
laparoscopy
is
a
wonderful
thing
for
that
,
if
I
can
do
a
laparoscopy
and
tell
Someone
you
have
endometriosis
and
you're
12
years
old
,
or
13
,
or
14
or
15
.
And
these
are
the
things
we
can
do
to
minimize
inflammation
and
to
minimize
Spread
of
endometriosis
and
to
minimize
progression
and
let
them
be
aware
.
Speaker 2
10:08
Like
a
lot
of
patients
are
like
I
wish
I
knew
I
had
this
.
I
would
have
frozen
my
eggs
when
I
was
25
.
Hmm
,
waited
till
I'm
now
38
and
trying
to
get
pregnant
and
I
have
minimal
eggs
left
.
And
now
,
what
do
I
do
?
Right
,
they
have
an
awareness
that
they
have
this
disease
and
they
can
make
those
life
decisions
with
information
.
Right
,
with
knowledge
.
And
if
we
don't
diagnose
them
early
,
they
then
they're
coming
to
you
shopped
at
40
that
they
now
have
this
and
they
have
one
embryo
and
it's
like
,
oh
my
god
,
how
are
we
gonna
get
her
pregnant
?
Speaker 2
10:36
Yeah
,
and
it's
very
,
it's
emotionally
draining
when
you
see
those
patients
day
in
or
they
out
.
Honestly
,
because
it's
just
tragic
.
Because
you
go
back
and
you
ask
them
and
you're
like
did
you
have
painful
periods
?
Yeah
,
I
was
passing
out
in
college
or
I
was
,
you
know
,
throwing
up
in
high
school
.
How
come
nobody
knew
that
these
symptoms
are
endometriosis
?
Right
,
right
,
no
,
I'm
starting
at
it
.
How
do
people
not
know
that
dysmenorrhea
is
painful
periods
?
But
that
happens
before
the
period
.
Which
hunter
?
That
is
my
diagnostic
key
for
endometriosis
.
Endometriosis
pain
starts
one
or
two
days
before
the
period
.
Hmm
,
this
menorrhea
or
painful
period
starts
when
you're
bleeding
.
That's
dysmenorrhea
.
You
can't
call
pain
one
or
two
days
before
the
period
dysmenorrhea
.
They're
not
having
a
period
.
That
is
endometriosis
.
That's
almost
100%
diagnostic
for
endometriosis
.
If
you
have
pain
the
day
or
two
before
the
period
and
then
as
it
progresses
it
gets
worse
,
three
days
before
,
four
days
before
,
five
days
before
,
seven
days
before
from
all
the
way
into
the
period
from
the
whole
month
now
.
Speaker 2
11:36
Yeah
,
I
mean
that
if
you
go
back
their
history
,
you
can
actually
see
that
it's
literally
the
same
story
every
single
time
.
Speaker 1
11:43
Then
how
do
we
diagnose
earlier
?
Speaker 2
11:45
Through
,
through
discussion
,
through
history
,
through
exam
,
through
ultrasound
,
through
the
.
The
other
one
,
the
tilted
cervix
right
.
Oh
,
I
have
a
tilted
uterus
in
our
tilted
left
is
turned
tilted
right
,
it's
shifted
.
This
and
that
I
mean
.
Do
you
know
that
we're
all
born
with
our
uterus
in
the
middle
,
just
like
our
heart
?
Speaker 2
12:03
is
on
our
left
side
and
our
liver
is
on
our
right
side
and
our
gallbladder
is
over
here
and
our
appendix
is
over
here
.
The
uterus
is
in
the
middle
.
That's
how
we're
born
.
That's
how
it
was
created
.
If
it's
not
in
the
middle
,
when
we're
a
teenager
or
when
we're
in
our
20s
,
something
moved
it
.
Guess
what
moved
it
?
The
endometriosis
moved
it
,
the
fibrosis
moved
it
.
Speaker 2
12:25
If
your
uterus
is
tilted
,
I
almost
guarantee
you
have
endometriosis
.
It
boggles
my
mind
.
I
talked
to
the
patient
and
I
said
oh
,
your
uterus
has
shifted
this
or
that
.
Oh
yeah
,
they
told
me
when
I
was
a
teenager
that
it
was
hard
to
get
a
pap
smear
because
they
couldn't
find
my
cervix
because
it
was
shifted
.
There
was
no
clue
in
that
.
Oh
my
God
,
the
cervix
has
shifted
.
There's
something
going
on
.
Maybe
it's
endometriosis
.
This
is
one
thing
that
I
like
when
I
talk
to
internal
medicine
and
family
doctors
which
I'm
now
trying
to
educate
all
the
family
doctors
and
internal
medicine
and
pediatricians
in
this
area
when
I
tell
them
that
it's
almost
like
their
mind
is
blown
.
Oh
my
God
,
I
see
this
so
often
.
How
did
I
not
know
that
this
is
a
thing
?
Speaker 1
13:04
Well
,
it's
because
no
one
talks
about
it
.
In
medical
school
I've
talked
to
so
many
doctors
that
are
like
we
spend
maybe
30
minutes
to
maybe
a
day
and
a
half
on
endometriosis
.
Maybe
the
literature
just
isn't
there
,
it's
not
at
the
forefront
of
their
mind
.
They're
thinking
what
they
learned
in
school
is
IBS
and
they're
learning
this
.
Just
happens
to
be
this
way
.
Speaker 2
13:29
This
is
how
it
grows
.
These
are
the
things
like
if
people
are
more
aware
of
these
symptoms
.
The
signs
and
symptoms
,
endometriosis
.
We
can
get
a
diagnosis
sooner
.
People
are
aware
that
mini-microlaparoscopy
exists
.
That
are
ways
that
we
can
prevent
endometriosis
progression
.
Why
are
we
not
treating
them
?
Why
do
I
keep
seeing
these
debilitated
16
,
17
,
18
year
olds
that
started
having
symptoms
when
they
were
11
?
Right
,
that
now
can't
function
,
can't
go
to
school
.
This
is
going
to
affect
the
rest
of
their
life
.
Speaker 1
13:59
How
do
we
decipher
,
like
,
when
is
it
time
for
us
,
as
parents
,
to
look
at
the
situation
and
say
,
okay
,
it
might
be
time
for
surgery
?
Is
there
a
process
to
take
in
order
to
see
,
okay
,
they're
starting
to
feel
this
pain
now
?
Do
we
do
hormonal
suppression
or
do
we
do
surgery
?
Or
do
we
like
what
is
a
good
step
for
those
of
us
who
have
girls
that
will
potentially
and
likely
deal
with
endometriosis
?
I
mean
,
I'm
starting
to
see
certain
things
in
even
my
nine
year
old
right
now
,
that
I'm
like
girlfriend
.
We
got
to
watch
this
.
Speaker 2
14:36
I
mean
honestly
,
it's
the
same
as
an
adult
.
So
you
know
,
when
I
when
I
see
patients
with
endometriosis
,
I
tell
them
there's
like
basically
four
reasons
to
have
surgery
.
The
first
one
is
debilitating
pain
.
You
can't
function
and
it's
just
nothing's
working
.
You
can't
leave
them
like
that
Right
.
They're
debilitated
,
they
can't
function
.
No
medication
is
going
to
get
them
out
of
that
without
surgery
.
You
can
try
,
but
most
of
the
time
it'll
fail
and
end
up
with
surgery
.
The
second
is
severe
anatomic
distortion
.
Speaker 2
15:03
So
I've
operated
on
18
year
olds
,
19
year
olds
,
16
year
olds
who
already
have
a
10
centimeter
endometrioma
on
their
ovary
.
I'm
like
I
can't
leave
that
there
.
It's
already
destroying
most
of
their
ovary
.
I
have
to
save
their
ovary
and
so
for
those
people
and
then
surgery
is
an
answer
and
you
can
talk
about
how
you
approach
it
.
You
know
,
do
you
do
medications
first
,
try
to
shrink
it
.
There's
all
sorts
of
things
that
we
can
discuss
.
Speaker 2
15:28
The
third
one
is
they've
tried
hormonal
management
.
It's
not
working
.
They
don't
really
want
to
go
to
the
next
step
of
hormones
or
they
don't
want
to
stay
on
hormones
unless
they
know
for
sure
100%
they
have
endometriosis
.
So
more
for
like
their
diagnostic
capabilities
that
we
want
to
do
surgery
.
The
fourth
reason
is
fertility
,
which
,
if
someone
is
already
having
impacted
and
usually
it's
not
a
teen
,
it's
early
twenties
their
AMH
is
already
being
impacted
,
their
FSH
is
already
being
impacted
,
they
have
fertility
concerns
,
their
tube
is
already
dilated
.
Those
ones
I
would
rather
do
surgery
on
now
.
At
least
get
the
process
stopped
so
that
they
don't
keep
progressing
.
Okay
,
everyone
else
,
honestly
,
you
could
try
to
manage
their
symptoms
,
either
medically
or
with
physical
therapy
or
bladder
treatment
or
bowel
treatment
and
anti
inflammatory
Recognizing and Treating Teenage Endometriosis
Speaker 2
16:15
dice
.
There's
all
sorts
of
things
we
can
do
for
teenagers
.
Not
everyone
will
need
surgery
to
at
least
delay
the
need
for
surgery
.
But
we
still
need
to
diagnose
them
with
endometriosis
.
We
can't
just
say
oh
yeah
,
it's
all
in
your
head
.
Speaker 1
16:28
Go
to
therapy
.
Speaker 2
16:29
Go
to
therapy
right
,
yeah
.
Which
I
mean
.
There's
a
place
for
it
,
for
me
as
a
teenager
it
was
oh
,
you
need
to
eat
more
fiber
.
You're
constipated
,
you
know
.
I'm
like
really
,
Because
I
don't
feel
constipated
.
I
just
feel
like
I'm
going
to
die
.
Speaker 1
16:42
every
time
I
have
a
period
I'm
like
you
know
,
it's
kind
of
what
we
all
feel
,
and
to
be
dismissed
as
a
teen
,
I
think
does
perpetuate
the
mental
health
issues
that
we
already
faced
with
endometriosis
and
so
when
we're
not
believed
at
an
early
age
or
we
think
pain
is
just
normal
all
the
time
,
it's
perpetuating
something
further
on
down
the
line
.
If
we
can
address
it
earlier
,
even
if
it's
in
the
mini
micro
laparoscopy
,
like
it's
important
to
understand
our
body
,
but
do
it
the
least
invasive
that
we
can
and
just
yeah
,
and
it's
interesting
.
Speaker 2
17:20
It
is
interesting
because
I
have
a
lot
of
patients
that
tell
me
like
chronic
pain
patients
who
are
now
are
like
,
literally
in
chronic
pain
all
the
time
,
even
when
I've
now
dealt
with
their
pain
.
They
have
self
doubt
,
like
they
doubt
that
they
don't
have
pain
anymore
and
they
feel
they
tell
me
I
wish
I
had
been
validated
,
like
I
wish
someone
had
said
yes
,
you
have
pain
,
because
it's
now
.
They
don't
even
doubt
that
they
have
pain
,
like
it's
like
they
don't
believe
their
own
self
,
they
don't
believe
their
own
sensations
.
And
it's
tragic
because
it's
hard
to
take
care
of
them
,
because
you
ask
them
do
you
have
pain
?
And
they're
like
I
don't
know
.
Yeah
,
maybe
that's
me
half
the
time
.
Yeah
,
it's
like
I
don't
know
.
I've
been
living
with
pain
for
so
long
.
I
don't
know
what
not
having
pain
feels
like
you
know
,
and
that's
tragic
because
it
affects
you
.
Speaker 2
18:04
It
affects
you
in
every
single
way
and
it's
not
.
It
ends
up
with
those
patients
not
even
not
just
taking
care
of
their
pain
symptoms
.
They
ignore
every
aspect
of
their
life
,
yeah
,
ignore
their
emotions
,
they
ignore
their
needs
,
they
ignore
their
desires
,
they
ignore
their
dreams
.
And
it's
tragic
because
it's
so
hard
to
reverse
it
when
it
gets
to
that
point
.
It
is
so
hard
,
it
takes
years
of
therapy
and
years
of
treatments
and
years
of
self
love
and
self
care
and
affirmations
,
yeah
,
and
it
takes
so
much
to
do
that
and
it
makes
me
sad
when
I
see
that
.
And
you
try
your
best
.
But
it's
so
hard
because
and
that's
what
I
mean
when
I
tell
you
that
you
know
,
surgery
doesn't
fix
everything
Right
.
As
a
surgeon
,
it
hurts
me
to
say
that
because
I
mean
I
went
into
surgery
because
I
love
that
you
could
fix
it
Right
,
throw
medications
at
it
,
and
I
learned
how
to
do
endometriosis
surgery
because
I
love
that
I
could
go
in
and
remove
the
disease
and
like
feel
that
,
oh
my
gosh
,
I
fixed
it
.
Speaker 2
19:01
But
when
I
see
those
patients
that
you
do
the
surgery
and
they're
still
struggling
mentally
,
emotionally
and
in
other
ways
,
you
know
,
sexually
and
in
their
relationships
and
in
their
love
of
life
.
It's
heartbreaking
,
but
just
as
good
as
when
you
do
sit
,
when
you
do
catch
it
early
and
you
can
treat
people
and
people
telling
me
every
day
I
hear
that
you've
changed
my
life
.
I'm
a
new
person
,
you
know
,
I'm
a
new
woman
.
I
now
can
travel
.
I
now
can
do
this
.
I
now
can
pursue
my
career
dreams
.
I
now
I'm
pregnant
with
the
baby
that
I've
always
wanted
.
I
mean
these
,
these
messages
that
I
get
every
single
day
.
They're
what
keep
me
going
,
honestly
,
through
this
.
The
turmoil
of
the
medical
health
care
system
that
we're
in
,
that
we
talked
about
earlier
and
,
you
know
,
keeping
it
pushed
through
and
try
to
make
this
dream
happen
.
Speaker 1
19:44
I
feel
like
that's
one
thing
that
we
have
to
acknowledge
is
that
the
health
care
system
is
not
set
up
for
excision
surgeons
to
really
help
heal
and
bring
quality
of
life
back
for
endometriosis
patients
.
I
feel
like
it
is
set
up
almost
to
have
them
fail
.
The
something
that
I
want
to
highlight
to
everyone
is
the
fact
that
if
you're
seeing
a
true
excision
specialist
and
endometriosis
specialist
,
they
work
so
hard
and
put
so
much
out
there
with
very
little
return
for
them
personally
other
than
your
stories
and
your
ability
to
heal
in
life
.
They're
not
out
there
being
the
next
Jeff
Bezos
of
the
medical
system
.
It
is
hard
work
and
you're
seeing
trauma
.
You're
not
just
seeing
physical
trauma
.
You're
seeing
the
mental
trauma
,
the
emotional
trauma
,
the
financial
trauma
,
because
that's
real
in
this
system
,
right
,
and
so
managing
that
from
a
doctor's
perspective
.
Speaker 1
20:47
I
can't
imagine
how
challenging
that
would
be
to
see
that
day
in
and
day
out
.
If
we
can
prevent
that
just
a
little
bit
by
seeking
care
as
teens
when
the
symptoms
start
,
so
that
the
doctor
can
track
it
.
Okay
,
we're
seeing
a
little
bit
more
change
in
you
.
Maybe
we
need
to
look
at
potentially
having
surgery
in
the
next
year
or
so
.
What
ways
can
we
keep
you
comfortable
at
this
point
.
I
don't
know
,
I
just
feel
like
we
would
see
less
trauma
.
Speaker 2
21:14
We
would
,
and
even
to
be
honest
,
like
with
some
of
my
teenagers
,
just
knowing
that
they
have
this
and
that
there's
an
explanation
and
an
acknowledgement
of
what
they're
going
through
is
almost
enough
for
them
.
Speaker 1
21:28
I
can
see
that
.
Speaker 2
21:29
And
then
you
try
to
treat
them
medically
and
surgically
and
all
of
that
.
But
just
having
an
acknowledgement
because
as
a
teenager
you're
going
through
so
many
termoils
and
changes
and
hormones
and
all
sorts
of
stuff
and
you're
just
discovering
yourself
as
a
person
,
as
a
human
being
,
separate
from
your
parents
,
and
to
know
that
someone
believes
you
or
they
have
that
acknowledgement
of
that
you
are
suffering
or
that
you
are
in
pain
,
I
think
is
a
huge
thing
that
we
should
not
minimize
.
I'd
rather
over
diagnose
teen
ando
than
misaffuse
you
and
make
them
feel
traumatized
.
Speaker 1
22:03
Yeah
,
that's
huge
though
I
mean
.
I
look
,
I
think
back
to
when
I
was
a
teenager
and
all
the
things
that
I
went
through
and
I
didn't
I
mean
no
one
.
I
didn't
even
hear
the
word
of
endometriosis
until
I
was
married
for
about
a
year
and
had
a
kidney
stone
removed
and
it
was
then
that
they
found
an
endometrioma
.
And
that
was
the
first
time
that
I
had
ever
heard
when
I
went
to
my
OBGYN
,
who
said
immediately
she's
like
I'm
95%
sure
that's
an
endometriosis
,
I'm
pretty
sure
you
have
it
,
because
she
heard
all
my
other
symptoms
that
went
along
with
it
.
And
I
think
it
was
that
at
that
point
that
I
realized
that
I
wasn't
normal
in
my
cycle
,
I
wasn't
normal
in
my
pain
,
but
then
I
felt
really
abnormal
because
I
was
given
this
diagnosis
that
I
felt
like
was
super
rare
because
no
one
had
talked
about
it
to
that
point
.
Speaker 1
22:52
And
that's
also
,
I
think
,
what
you're
trying
to
do
is
you're
talking
about
the
whole
person
,
not
just
surgical
,
you're
not
just
talking
disease
,
you're
talking
the
years
of
trauma
.
How
can
we
get
you
help
Walking
through
that
?
I
think
something
that
we've
underestimated
is
the
ability
for
our
specialists
to
walk
with
us
in
complete
healing
,
and
that's
something
that
you
and
I
have
talked
about
a
little
bit
.
It's
just
,
this
is
step
one
surgery
.
Step
one
diagnosis
.
Step
one
like
half
step
,
yeah
,
half
step
,
but
that
complete
picture
.
Challenges and Improvements in Healthcare System
Speaker 1
23:29
Because
now
I'm
like
putting
my
pieces
together
and
I'm
like
,
mona
,
where
were
you
?
Huh
,
like
30
years
ago
,
yeah
,
30
years
ago
I
was
like
I
was
in
med
school
.
Speaker 2
23:38
I
think
I
was
in
college
.
Speaker 1
23:44
Yeah
,
but
I
just
feel
like
if
we
can
help
teens
navigate
this
disease
better
,
talk
about
it
and
it
not
be
so
unattainable
for
treatment
and
care
,
could
we
potentially
see
a
better
healthcare
system
.
Speaker 2
23:59
That's
the
thing
right
,
can
we
help
them
for
the
future
?
The
healthcare
system
is
a
whole
other
bottle
of
wax
.
Honestly
,
the
healthcare
system
.
I'm
Canadian
,
so
I
came
from
the
Canadian
healthcare
system
and
I
came
from
the
Canadian
healthcare
system
until
2001
when
I
graduated
medical
school
and
I
came
here
to
do
my
residency
because
my
family
had
moved
to
the
US
and
I
was
appalled
,
like
and
I've
been
appalled
and
the
feeling
of
oh
my
God
,
this
is
a
disaster
has
only
gotten
worse
.
It
is
the
healthcare
system
in
the
United
States
is
failing
us
.
Speaker 2
24:31
It's
failing
doctors
,
it's
failing
patients
,
it's
failing
everybody
and
it
needs
to
be
fixed
.
But
honestly
,
like
I've
had
this
discussion
with
other
doctors
,
it
almost
needs
to
completely
fail
and
just
fall
apart
so
that
we
can
rebuild
it
from
scratch
.
And
it
has
to
stop
being
a
business
.
It
can't
be
a
money
maker
for
insurance
companies
and
executives
that
make
millions
of
dollars
off
of
healthcare
.
The
money
has
to
go
into
one
pot
and
we
actually
spend
it
on
patients
and
doctors
and
caretakers
and
nurses
and
all
the
people
that
are
actually
doing
healthcare
.
Why
all
the
money
going
to
the
executives
,
the
business
people
?
They
can't
do
that
.
Speaker 2
25:16
You
can't
it's
just
it
can't
continue
that
way
.
This
is
not
a
business
.
We
should
not
be
profiting
hearing
off
of
people
being
ill
.
Speaker 1
25:25
No
.
Speaker 2
25:25
That's
a
whole
,
nother
philosophical
discussion
.
But
it
is
tragic
and
I
see
it
every
day
and
when
I
have
to
fight
10
times
a
day
and
I
have
to
do
peer-to-peer
calls
to
insurance
companies
to
get
an
MRI
on
a
patient
.
Speaker 2
25:39
Because
I
work
a
lot
of
MRIs
and
every
time
it's
like
an
argument
why
does
she
need
an
MRI
?
Well
,
she
has
endometriosis
.
Well
,
if
so
,
it's
like
well
,
I
need
to
see
where
the
endometriosis
is
so
I
can
do
her
surgery
.
Well
,
and
then
I
get
the
.
Oh
,
endometriosis
isn't
treated
by
surgery
.
It's
like
where
were
you
for
the
last
20
years
?
Like
,
are
you
talking
to
a
person
who's
like
pediatrician
or
like
some
weird
doctor
on
the
other
end
,
who
isn't
even
a
gynecologist
,
who's
telling
me
that
I
don't
need
an
MRI
?
It's
like
I'm
the
doctor
I
need
an
MRI
.
Approve
the
darn
thing
.
And
sometimes
it
takes
like
an
hour
of
conversation
for
me
to
convince
someone
to
let
me
order
an
MRI
on
a
patient
.
Can
you
believe
that
I
spend
an
hour
of
my
time
on
the
phone
trying
to
approve
an
MRI
?
That's
nice
,
or
peer-to-peer
discussion
or
whatever
it
is
that
I'm
ordering
which
you
could
have
done
A
whole
surgery
.
Speaker 1
26:30
A
whole
surgery
.
You
could
have
given
care
to
someone
that
desperately
needed
it
in
that
timeframe
.
That's
insane
to
me
.
Speaker 1
26:40
That's
insane
to
me
.
Well
,
and
I
think
too
that
something
that
we
had
talked
about
prior
to
coming
on
is
that
doing
surgeries
can
be
preventative
care
from
years
and
years
of
trauma
From
seeing
this
doctor
,
that
doctor
and
another
doctor
oh
wait
,
they
all
didn't
believe
you
,
so
let's
send
you
to
the
psychologist
.
And
now
the
trauma
is
even
tenfold
on
that
.
So
when
we're
talking
teen
endometriosis
,
early
diagnosis
,
early
treatment
,
it's
really
early
preventative
care
for
what
could
potentially
happen
and
the
trauma
that
could
potentially
happen
further
on
down
the
line
.
Speaker 2
27:16
Yeah
,
these
patients
can
develop
depression
,
they
can
develop
lifelong
disability
,
they
can
be
completely
absent
from
the
workforce
.
I
mean
,
their
entire
life
is
affected
.
Patients
who
spend
hundreds
of
thousands
of
dollars
on
fertility
treatment
that
could
have
been
prevented
,
where
we
could
have
done
surgery
and
they
could
have
gotten
pregnant
.
Like
why
?
Why
are
we
spending
all
this
money
?
And
we
could
actually
prevent
all
of
this
excess
expenditure
on
antidepressants
,
you
know
,
disability
,
fertility
treatment
,
all
of
this
if
we
treat
endometriosis
properly
from
the
beginning
.
Speaker 1
27:48
Yeah
,
and
that
takes
understanding
the
disease
properly
from
the
beginning
,
yeah
,
which
is
also
that's
another
conversation
,
but
that
is
another
.
That's
a
whole
nother
ball
of
wax
that
we
could
really
melt
on
that
one
.
Huh
,
I
mean
I
don't
.
I
don't
know
if
there's
any
easy
solution
at
this
point
,
but
I
do
think
that
what
you're
doing
is
so
important
because
the
surgery
that
,
like
we've
said
,
that's
one
piece
of
it
.
How
do
you
follow
up
with
patients
and
walk
through
them
past
that
surgery
and
what
should
be
?
I
don't
know
about
an
expectation
,
but
what
should
be
something
that
doctors
should
be
doing
with
their
patients
post
surgery
that
you
find
beneficial
?
Yeah
?
Speaker 2
28:28
I
mean
,
we
don't
.
We
talked
about
this
.
I'm
not
just
a
surgeon
who
does
surgery
and
then
send
you
back
on
your
merry
way
and
that's
it
.
We're
done
.
Like
for
me
,
my
patients
are
mine
for
life
.
I
will
follow
them
forever
,
make
sure
their
pain
stays
away
.
If
they
want
to
get
pregnant
,
they
get
pregnant
.
If
they
have
bladder
issues
,
we've
treated
,
address
those
issues
.
If
they
have
GI
issues
,
that
we've
addressed
those
issues
.
If
they
have
mental
issues
,
that
we've
addressed
those
issues
.
That
they
get
the
physical
therapy
they
need
,
they
get
the
bladder
treatment
they
need
,
they
get
the
fertility
treatment
they
need
.
And
following
them
to
make
sure
that
the
endometriosis
doesn't
come
back
.
And
if
it
does
come
back
,
how
do
we
treat
it
?
Like
to
me
,
it's
not
just
,
I'm
not
just
a
surgeon
who
does
surgery
and
that's
it
.
Speaker 2
29:05
For
me
once
an
endometriosis
patient
or
a
patient
with
other
diseases
fibroids
,
pcos
,
whatever
I
do
all
menstrual
disorders
right
.
Postmenopause
too
,
I
treat
menopause
patients
.
I
treat
teens
.
I
do
pediatric
gynecology
.
I'm
also
trained
in
pediatric
gynecology
.
So
for
patients
who
are
going
through
pubertal
problems
or
have
malaria
and
anomalies
,
the
double
uterus
,
absent
vagina
,
all
of
that
,
I
treat
all
of
that
.
So
for
me
,
a
patient
is
not
just
a
patient
.
Speaker 2
29:30
I'm
treating
one
disease
,
they're
an
entire
person
that
I
will
be
their
doctor
for
life
if
they
want
me
to
be
,
and
so
it's
so
much
the
diagnosis
beforehand
coming
up
with
a
management
plan
that
fits
that
patient
at
that
time
.
What
is
it
that
their
goals
are
?
And
I
work
with
that
.
They
tell
me
what
they
need
and
then
I
work
with
how
to
get
them
to
their
goals
.
Speaker 1
29:50
And
then
after
surgery
.
Speaker 2
29:51
It's
the
same
Patients
who
have
painful
intercourse
dysparunia
.
Sometimes
doing
the
surgery
is
not
enough
.
You
have
to
treat
the
vestibulitis
,
you
need
to
treat
the
vaginismus
.
Speaker 2
30:00
You
need
to
treat
the
psychological
trauma
of
being
afraid
of
having
sex
,
right
,
right
,
you
need
to
do
therapy
,
like
there's
the
.
I
always
tell
patients
with
who
especially
the
ones
that
are
really
bad
,
where
,
like
,
they
haven't
been
able
to
have
sex
I
tell
them
it's
going
to
probably
take
me
a
year
to
get
you
to
have
sex
,
even
if
I
have
the
surgery
.
So
we're
still
going
to
need
treatment
post-op
to
get
you
to
that
point
where
you
have
pleasurable
sex
,
and
it
may
take
six
months
,
it
may
take
a
year
.
Right
,
it's
going
to
be
an
instant
fix
.
It's
not
because
there's
a
lot
behind
that
.
Speaker 2
30:27
Same
with
bladder
issues
.
You
know
the
patients
that
come
to
me
and
they're
like
,
oh
my
God
,
I
wake
up
12
times
a
night
to
pee
and
I'm
like
,
oh
my
gosh
,
how
do
you
sleep
?
Right
,
you
get
to
sleep
.
And
again
,
I
tell
them
the
surgery
will
help
,
but
we're
still
going
to
need
to
do
some
treatment
post-op
and
it's
going
to
take
maybe
six
months
or
a
year
to
get
you
to
the
point
where
you
can
sleep
through
the
night
.
Speaker 1
30:45
Right
.
Speaker 2
30:46
And
because
it's
not
just
one
.
It
is
one
disease
but
there's
so
many
manifestations
and
so
many
side
effects
of
that
disease
right
.
Speaker 2
30:54
You
have
to
treat
Right
and
every
patient
is
different
.
So
my
point
is
a
surgeon
shouldn't
just
drop
a
patient
afterwards
.
You
do
their
surgery
and
they
go
away
.
And
that's
why
I
do
a
lot
of
telehealth
right
,
because
I
have
patients
from
all
over
the
country
and
I
try
to
manage
them
from
remotely
.
Between
me
and
my
physician
assistant
,
we
come
up
with
a
management
plan
when
they
leave
and
then
we
keep
checking
in
.
So
I
usually
check
in
with
patients
that
have
active
problems
.
I
usually
check
in
every
six
weeks
,
wow
,
post-op
,
until
they're
better
,
and
then
,
when
they're
better
,
we
go
to
six
months
and
then
,
with
they're
really
good
and
they're
doing
great
and
awesome
,
then
I
check
in
once
a
year
with
them
.
That's
amazing
.
So
it's
you
know
.
I
do
check
in
with
patients
,
you
know
,
pretty
frequently
.
Speaker 1
31:38
Yeah
.
Speaker 2
31:38
Up
until
they
get
to
their
goal
,
yeah
.
And
once
they
reach
their
goal
and
they're
like
,
yeah
,
I'm
good
,
dr
Roddy
,
let's
just
they're
not
like
,
okay
,
I'll
see
you
in
a
year
.
And
then
usually
they're
really
sad
by
that
point
,
because
they've
seen
me
.
What
do
you
mean
?
I'm
not
going
to
see
you
for
a
year
,
I'm
like
well
you're
good
,
right
,
you
need
anything
from
me
.
They're
like
,
yeah
,
we're
great
,
but
we're
going
to
miss
you
.
Speaker 1
31:55
But
can
we
go
have
dinner
now
?
Speaker 2
31:59
I'll
bring
cookies
to
the
office
or
something
like
that
yeah
,
just
to
stop
,
but
yeah
.
Speaker 1
32:05
That's
amazing
.
I
feel
like
that
kind
of
genuine
care
.
It
helps
with
healing
.
The
more
informed
a
patient
is
,
with
realistic
expectations
,
the
better
their
outcome
long
term
is
.
And
that's
something
that
I
feel
like
we
really
underestimate
is
the
realistic
expectations
of
what
surgery
is
,
of
what
endometriosis
is
the
care
,
everything
else
and
I
think
you
know
you've
talked
about
this
before
but
even
in
your
protocol
,
whether
it's
hormone
based
,
hormone
suppression
you
really
set
the
expectation
Okay
,
here
are
all
your
options
.
If
this
is
your
end
goal
,
here's
all
your
options
,
here's
what
each
of
these
options
do
.
That's
called
informed
consent
.
And
then
you
allow
them
to
pick
what's
going
to
be
best
for
them
,
and
I
think
that
that
also
lends
to
a
better
outcome
because
they're
not
as
traumatized
.
Speaker 1
32:56
Well
,
my
doctor
didn't
tell
me
that
,
or
my
doctor
didn't
tell
me
this
.
And
then
going
into
surgery
,
post
surgery
,
I
think
it's
just
as
informative
to
say
you're
not
going
to
be
100%
post
op
,
you're
not
going
to
be
100%
even
in
a
couple
weeks
.
It's
going
to
take
time
.
Let's
figure
out
,
let's
unravel
some
of
what's
going
on
,
and
I
just
feel
like
that's
a
really
hard
thing
and
something
that
all
of
us
not
all
,
I
would
say
,
a
majority
of
us
endometriosis
patients
who
have
had
multiple
surgeries
,
specifically
really
struggle
with
that
expectation
of
like
okay
,
we've
had
this
amazing
excision
surgery
,
but
I'm
still
feeling
this
pain
,
I'm
still
feeling
this
fatigue
,
I'm
still
having
issues
with
my
hormones
and
we
don't
feel
the
support
that
we
need
walking
through
that
.
Understanding and Treating Endometriosis
Speaker 2
33:45
Yeah
,
and
I
tell
my
patients
especially
the
fatigue
aspect
.
I
mean
,
a
lot
of
them
,
people
are
patients
with
chronic
fatigue
.
They
have
the
surgery
,
they
will
lose
that
chronic
fatigue
will
go
away
,
but
it
can
take
maybe
six
months
,
yeah
,
and
then
feel
so
much
energy
and
like
I
feel
amazing
.
But
I
always
have
to
tell
them
your
body
has
to
heal
from
that
surgery
.
And
then
the
other
patients
you
come
in
and
they're
like
oh
,
I
have
anemia
,
I
have
to
have
surgery
.
Some
of
them
are
actually
surprised
when
I'm
like
,
well
,
you
don't
have
to
have
surgery
right
now
,
we
can
try
physical
therapy
,
bladder
treatments
,
the
yada
,
yada
,
yada
.
If
that's
your
goal
is
not
to
have
surgery
right
now
,
we
can
do
other
things
and
then
if
we
ultimately
end
up
having
surgery
,
yeah
,
then
we
have
surgery
.
But
I
don't
,
like
I
don't
want
patients
to
come
in
thinking
,
oh
,
this
is
my
only
option
.
I'd
love
to
give
them
other
options
and
ultimately
we
may
need
to
have
surgery
,
but
I
don't
like
push
the
surgery
on
them
right
away
,
Like
oh
yeah
,
you
have
a
note
.
Speaker 2
34:39
you
have
to
have
surgery
,
not
necessarily
,
not
right
now
.
You
may
have
to
in
the
future
,
but
not
necessarily
right
now
.
Speaker 1
34:45
Yeah
,
I
mean
gosh
.
That
is
so
good
to
hear
,
I
think
,
for
people
and
it
does
give
hope
to
those
that
feel
that
way
of
like
I
just
need
to
have
surgery
and
I'll
be
all
better
,
maybe
,
maybe
some
of
this
can
be
preventative
too
of
like
the
pelvic
floor
dysfunction
and
making
sure
that
we
care
for
that
even
prior
to
surgery
,
to
see
if
surgery
is
needed
at
that
point
I
mean
,
don't
get
me
wrong
.
Speaker 2
35:12
So
a
lot
of
the
patients
are
old
right
after
surgery
.
I
mean
,
they
have
surgery
and
it's
amazing
,
all
of
a
sudden
they
have
no
pain
and
they're
pregnant
and
they're
every
other
goals
come
A
lot
.
A
lot
of
patients
are
like
that
.
But
for
patients
with
chronic
pain
specifically
,
who've
had
the
disease
for
a
long
time
and
they
have
a
lot
of
the
other
effects
the
bowel
problems
,
the
bladder
problems
,
the
fatigue
,
the
pelvic
floor
tension
,
the
neurologas
and
all
of
this
that
takes
a
long
time
to
reverse
.
It
took
a
long
time
to
happen
.
It's
going
to
take
a
long
time
to
reverse
and
I
like
it
very
,
you
know
,
it's
great
when
it
does
reverse
really
fast
and
at
three
months
are
like
I
feel
amazing
,
I'm
like
great
,
wonderful
.
But
I
don't
like
to
give
that
expectation
Right
.
Speaker 1
35:51
Oh
and
that's
and
I
think
that
that's
staying
within
the
bandwidth
of
like
knowing
that
you
can't
solve
everything
in
24
hours
.
That
would
be
amazing
,
though
,
if
you
could
figure
out
a
way
to
do
that
,
some
Star
Trek
way
of
doing
that
,
to
make
us
just
wipe
it
off
clean
.
That'd
be
amazing
when
?
Speaker 2
36:09
I
tell
patients
,
I
mean
,
when
we
get
pregnant
,
it's
like
,
oh
well
,
we're
going
to
have
a
baby
.
Guess
what
?
Nine
months
later
,
you
forget
the
baby
.
It's
not
like
the
next
day
you
have
the
baby
.
It
takes
time
.
It
takes
time
Right
,
it
takes
time
to
bounce
back
from
that
.
Speaker 2
36:21
It's
like
you
know
,
it
takes
you
like
frickin
,
like
I
mean
.
They
call
it
the
fourth
trimester
for
a
reason
.
There's
like
at
least
12
weeks
.
You
still
don't
feel
like
a
normal
person
.
Actually
I
would
argue
it's
like
12
years
.
But
anyway
,
12
years
it
takes
time
,
you
don't
?
You
know
,
everything
takes
time
it
doesn't
.
Speaker 2
36:39
It's
not
something
that's
instantaneous
.
What
is
amazing
to
me
,
though
,
in
terms
of
fertility
treatment
though
,
is
it
does
quite
amazing
how
fast
people
do
get
pregnant
after
surgery
.
Usually
,
it's
within
three
months
,
which
is
,
like
to
me
,
mind
blowing
,
yeah
yeah
.
Like
especially
fertility
patients
who
,
like
,
haven't
been
able
to
get
pregnant
for
six
years
and
then
a
month
later
they're
pregnant
.
That
amazes
me
.
I
see
that
all
the
time
,
and
every
time
I'm
like
wow
,
that's
amazing
,
that's
awesome
,
awesome
,
and
that
has
to
keep
you
going
.
Speaker 2
37:11
That
has
to
keep
me
going
,
and
it's
something
that's
really
sad
,
because
fertility
patients
should
know
that
that's
an
option
,
like
they
don't
.
I
don't
know
why
it's
still
touted
that
oh
,
if
you
have
infertility
,
you
have
to
do
IVF
First
.
And
that's
yeah
,
and
it's
like
,
why
do
we
spend
all
this
money
on
IVF
?
And
yes
,
ivf
can
get
some
of
them
pregnant
,
but
a
lot
of
them
fail
.
Speaker 2
37:31
And
going
through
failed
IVF
after
failed
IVF
after
failure
is
heartbreaking
.
Yeah
,
it
sucks
as
an
emotional
tool
and
you're
pumping
yourself
full
of
hormones
and
you
know
injections
and
it
is
so
difficult
.
Yeah
,
I
went
through
one
IVF
cycle
personally
and
I
couldn't
do
it
anymore
.
I
was
like
no
,
I
can't
.
I
,
you
know
,
I
and
it
and
it
,
and
it
and
it
and
it
.
And
some
people
who
do
it
over
and
over
,
I
mean
kudos
to
them
,
I
mean
you
are
a
trooper
,
but
why
?
Why
are
we
putting
them
through
that
before
we
diagnose
them
?
Why
don't
we
diagnose
them
?
Try
the
conservative
surgery
method
first
,
right
.
If
they
need
IVF
,
and
they
need
IVF
,
fine
Right
.
But
it
just
it's
heartbreaking
to
me
when
I
see
patients
who've
gone
through
six
,
eight
years
of
infertility
and
then
that
you
do
the
surgery
and
they
get
pregnant
.
And
it's
like
they
come
back
to
me
and
like
why
didn't
anyone
tell
me
this
?
And
I'm
like
I
don't
know
,
just
be
happy
or
pregnant
,
like
I
can't
answer
that
question
for
you
,
because
they
didn't
know
.
Speaker 2
38:26
Cause
they
didn't
know
yeah
.
Speaker 1
38:27
Right
,
yeah
,
and
and
that
I
see
that
so
many
times
and
talking
to
people
,
I
mean
even
in
my
own
story
I
wish
there
were
things
that
I
would
have
known
earlier
.
Speaker 2
38:37
Right
,
oh
,
all
of
us
.
Speaker 1
38:38
All
of
us
are
that
way
.
Speaker 2
38:39
Don't
you
wish
we
could
talk
to
our
20
year
old
self
and
say
hey
,
by
the
way
,
in
the
future
XYZ
.
You
should
do
this
.
I
wish
.
Right
,
I
would
have
changed
my
life
.
Speaker 1
38:48
I'd
be
so
much
more
wise
,
I
know
right
,
I
would
have
avoided
a
lot
of
things
along
the
way
.
Speaker 2
38:54
I've
had
a
lot
of
love
to
go
back
and
talk
to
my
20
year
old
self
.
Speaker 1
38:57
Right
that
would
be
amazing
.
I
would
love
that
,
it'd
be
great
,
but
we
can't
.
And
so
now
we
have
to
.
Now
we
take
what
we've
been
given
and
what
we've
walked
through
and
help
other
people
and
we
continue
this
journey
of
making
sure
that
endometriosis
is
,
first
of
all
,
understood
correctly
and
defined
correctly
and
taught
correctly
to
those
around
us
Right
,
and
then
understanding
that
it
is
.
It
is
a
major
disease
.
It's
not
a
period
pain
.
It's
not
missing
school
for
two
or
three
days
when
you're
a
teenager
.
It's
not
infertility
,
it
is
its
own
thing
that
causes
these
other
.
Speaker 2
39:37
Yeah
,
and
it
has
long-term
consequences
.
Yeah
,
you
know
,
it's
not
like
it's
just
a
one
time
thing
.
Like
you
know
,
sometimes
I
like
I
had
my
gallbladder
out
,
I
got
gallstones
.
I
had
my
gallbladder
out
as
a
teenager
.
Once
it
was
out
,
that
was
it
,
it
was
done
,
right
.
Right
,
you
don't
have
a
gallbladder
anymore
,
easy
Right
.
This
is
not
that
.
Speaker 1
39:54
No
.
Speaker 2
39:55
Not
the
same
.
Speaker 1
39:56
No
,
no
,
and
understanding
that
,
I
think
,
is
going
to
help
future
generations
with
seeking
better
care
and
treatment
for
this
disease
.
Speaker 2
40:06
I
mean
,
and
hopefully
,
hopefully
,
even
the
medical
community
starts
to
realize
that
this
is
like
cancer
.
It
should
have
its
own
specialty
.
Yep
,
it
just
should
.
Menstrual
disorders
is
not
even
just
endometriosis
.
Endometriosis
,
fibroids
,
pcos
,
hormonal
problems
,
like
menstrual
disorders
is
a
specialty
in
itself
.
Speaker 1
40:26
Yeah
.
Speaker 2
40:26
And
sometimes
I
joke
like
you
know
,
it's
always
obstetrics
and
gynecology
and
it's
like
obstetrics
is
first
,
gynecology
is
like
the
problem
child
,
right
?
Yeah
,
I
can't
explain
that
I've
forgotten
about
and
I'm
like
why
does
obstetrics
get
so
much
attention
when
you
only
spend
nine
months
of
your
month
life
pregnant
and
you
spend
like
40
years
menstruating
,
right
?
Speaker 1
40:47
Right
,
why
?
Why
is
?
Speaker 2
40:48
that
Right
,
you
spend
four
years
of
our
life
menstruating
.
Every
woman
will
have
some
menstrual
problem
at
some
point
,
right
.
A
fibroid
,
a
polyp
,
abnormal
bleeding
,
an
infection
,
whatever
.
But
that's
a
hormonal
issue
.
Right
,
every
woman
will
have
a
menstrual
issue
at
some
point
in
their
life
.
And
we
focus
so
much
on
the
nine
months
of
pregnancy
,
right
,
I'm
not
saying
it's
not
important
,
I'm
just
saying
why
is
gynecology
the
forgotten
child
?
Speaker 1
41:13
Yes
,
and
not
to
say
that
endometriosis
is
a
menstruation
problem
in
and
of
itself
.
It's
a
whole
body
issue
.
Right
,
like
we
see
the
diaphragmatic
,
we
see
the
thoracic
endometriosis
.
I
mean
it's
everywhere
,
so
it
just
typically
will
manifest
during
the
menstruation
cycle
and
that
is
a
huge
indicator
for
a
lot
of
people
not
everyone
,
but
a
lot
of
people
.
That
is
a
massive
indicator
as
to
something
else
is
going
on
.
It's
not
just
a
bad
period
,
it's
not
just
I
can't
walk
during
my
cycle
.
It's
not
just
I
can't
breathe
during
my
cycle
.
There
is
something
else
going
on
in
your
body
and
typically
people
will
notice
it
in
their
menstrual
Advocating for Endometriosis Education in Schools
Speaker 1
41:57
cycle
.
And
I
think
that
if
we
can
acknowledge
the
fact
that
it
is
not
just
those
things
,
it
is
something
else
causing
these
symptoms
during
that
time
,
oh
my
gosh
,
let's
talk
to
their
schools
about
this
,
right
,
let's
talk
to
nursing
programs
,
pediatrics
.
Speaker 2
42:12
Why
isn't
it
a
sexual
education
class
?
Like
everybody
has
sex
ed
class
.
Like
,
why
don't
we
teach
it
endometriosis
symptoms
and
sex
ed
class
?
Like
,
why
not
?
Yeah
,
we
don't
know
that
passing
out
and
throwing
up
during
our
period
isn't
normal
.
Speaker 1
42:24
No
,
yeah
,
through
our
nonprofit
that
we
started
here
.
That
is
a
goal
.
Of
ours
is
to
get
into
the
schools
and
talk
about
this
more
,
educate
young
people
about
this
disease
.
So
we
can
talk
for
days
.
I
know
we
could
go
for
on
for
hours
,
but
I
just
want
to
,
if
you
want
.
Speaker 1
42:40
Yeah
,
we
will
.
We'll
have
to
do
part
two
,
but
thank
you
so
much
for
bringing
light
to
something
that
we
really
haven't
talked
about
much
,
and
I
think
that
we
need
to
talk
more
about
teen
endometriosis
,
adhesion
and
the
healthcare
system
and
how
that's
designed
.
But
thank
you
so
much
for
taking
the
time
oh
,
thank
you
and
just
being
a
wave
maker
through
this
whole
thing
.
So
I
appreciate
it
,
and
until
next
time
,
endometriosis
warriors
continue
advocating
for
you
and
for
those
that
you
love
.