Send us a text with a question or thought on this episode ( We cannot replay from this link)
Dr. Zac Spiritos, a neurogastroenterologist, shares his expertise on the complex connections between endometriosis and gastrointestinal symptoms. We explore the critical role of the nervous system in gut function and discuss practical approaches to managing painful bowel movements, bloating, and food sensitivities.
• Common GI issues with endometriosis include chronic constipation, diarrhea, bloating (endo-belly), and food sensitivities
• The nervous system plays a crucial role in gut function and pain perception
• Regular bowel movements are foundational for addressing other GI symptoms
• Slower gut motility is common in patients with Ehlers-Danlos Syndrome and endometriosis
• Antidepressants can be effective for gut pain by modulating pain signals, not treating depression
• The microbiome is promising but testing lacks standardization and actionable insights
• Painful periods are not normal and should be investigated, particularly if they disrupt quality of life
• Endometriosis is often misdiagnosed, with patients seeing an average of 12 providers before diagnosis
• GI symptoms can sometimes appear before traditional gynecological symptoms of endometriosis
• Finding providers who are open to dialogue and willing to investigate complex symptoms is crucial
If you’re struggling with endometriosis and GI symptoms, start tracking your symptoms carefully, particularly around your cycle, and don’t give up if your first provider doesn’t have answers.
Website endobattery.com
Common GI Issues with Endometriosis
Speaker 1
0:00
Why
are
my
bowels
so
cranky
when
I
have
to
go
to
the
bathroom
?
And
what
does
the
microbiome
have
to
do
with
anything
?
Or
what
is
the
microbiome
?
And
what
would
a
doctor
ask
a
patient
if
they
had
endometriosis
?
To
learn
more
?
Don't
we
wish
we
all
had
those
doctors
?
Well
,
stick
around
,
because
that's
exactly
what
we're
going
to
be
covering
in
this
episode
with
Dr
Zach
Spiritos
.
You
won't
want
to
miss
it
,
spiritos
.
You
won't
want
to
miss
it
.
Speaker 1
0:30
Welcome
to
EndoBattery
,
where
I
share
my
journey
with
endometriosis
and
chronic
illness
,
while
learning
and
growing
along
the
way
.
This
podcast
is
not
a
substitute
for
medical
advice
,
but
a
supportive
space
to
provide
community
and
valuable
information
,
so
you
never
have
to
face
this
journey
alone
.
We
embrace
a
range
of
perspectives
that
may
not
always
align
with
our
own
,
believing
that
open
dialogue
helps
us
grow
and
gain
new
tools
.
Join
me
as
I
share
stories
of
strength
,
resilience
and
hope
,
from
personal
experiences
to
expert
insights
.
I'm
your
host
,
alana
,
and
this
is
IndoBattery
charging
our
lives
when
endometriosis
drains
us
.
Speaker 1
1:05
Welcome
back
to
IndoBattery
,
grab
your
cup
of
coffee
or
your
cup
of
tea
and
join
us
at
the
table
,
as
today
,
we
continue
with
part
two
of
our
two-part
series
,
featuring
our
guest
,
dr
Zach
Spiritos
,
a
neurogastroenterologist
who
practices
curious
,
patient-centered
care
.
He
looks
at
the
body
as
a
whole
,
not
just
as
a
collection
of
symptoms
.
His
approach
is
especially
impactful
when
it
comes
to
addressing
GI-related
issues
with
those
with
complex
illnesses
.
If
you
haven't
had
a
chance
to
listen
to
part
one
yet
,
I
highly
recommend
pausing
here
and
going
back
.
It's
full
of
context
,
insight
and
moments
that
really
set
the
stage
for
what
you'll
hear
today
.
But
,
just
as
a
reminder
,
this
is
where
we
left
off
and
where
we're
going
.
Speaker 2
1:53
Can
I
ask
you
,
as
someone
with
endometriosis
,
what
are
some
of
the
common
bowel
issues
that
people
like
I
see
people
in
clinic
,
but
what
is
like
the
?
What
are
some
of
the
day-to-day
concerns
that
have
come
up
in
your
life
that
you
think
people
would
really
want
to
hear
about
in
terms
of
just
making
sense
,
heads
and
tails
of
why
things
are
the
way
they
are
?
Speaker 1
2:19
Right
.
I
mean
what
I
hear
a
lot
and
what
I've
experienced
is
that
it's
automatically
assumed
that
we
have
IBS
because
we
have
chronic
constipation
,
chronic
diarrhea
and
then
bloating
,
bloating
,
bloating
,
bloating
.
You
know
we
talk
about
endo-belly
.
Endo-belly
is
a
very
real
thing
and
it
can
happen
.
You
know
,
you
can
wake
up
one
morning
and
feel
great
and
then
midday
you
literally
can't
put
your
pants
on
and
you
know
,
and
a
lot
of
it
is
cyclical
,
although
not
always
,
it
can
vary
all
month
long
and
then
another
part
of
that
is
just
that
nausea
,
nausea
,
vomiting
,
having
a
hard
time
with
food
,
keeping
it
down
,
but
also
just
not
wanting
to
eat
in
general
because
it
doesn't
feel
good
.
You
get
a
lot
of
joint
pain
with
certain
foods
.
You
get
a
lot
of
I
mean
just
that
inflammatory
response
.
Speaker 1
3:13
I
think
we
see
a
lot
of
that
with
endometriosis
and
a
lot
of
people
struggle
with
just
more
food
intolerance
.
A
lot
of
people
it's
gluten
,
a
lot
of
dairy
or
soy
.
For
me
specifically
and
I've
said
this
time
and
time
again
,
people
are
probably
sick
of
it
,
but
I
don't
have
the
same
response
to
that
as
other
people
.
I
have
a
hard
time
with
beef
and
eggs
.
It's
so
random
.
We
struggle
with
food
and
then
going
to
the
bathroom
and
then
we
tie
to
that
.
We
talk
bowels
,
we
talk
that
aspect
of
it
,
but
also
a
lot
of
us
really
struggle
with
UTIs
that
aren't
UTIs
,
so
that
is
a
huge
correlation
as
well
.
Or
overactive
bladder
,
where
you
feel
like
that
sense
of
urgency
I
got
to
go
,
I
got
to
go
right
now
.
That
commercial
,
the
got
to
go
,
got
to
go
right
now
.
There's
a
lot
of
that
.
That
kind
of
all
kind
of
we
deal
with
.
I'm
not
sure
if
I'm
answering
that
to
you
very
well
.
Speaker 2
4:12
You
answered
that
perfectly
.
And
there's
one
thing
that
underscores
almost
all
of
this
,
and
that's
the
nervous
system
.
Right
?
If
you
have
that
person
with
diarrhea
The Nervous System Connection
Speaker 2
4:20
and
constipation
,
I
guarantee
if
I
I
can't
guarantee
it
nine
times
out
of
10
,
if
I
scope
that
person
and
do
dual
studies
,
it's
going
to
be
completely
normal
,
right
?
So
why
is
that
?
It's
the
nervous
system
,
and
so
that's
what
IBS
is
.
But
also
,
if
someone
has
comorbid
POTS
,
they
may
have
a
slow
moving
colon
,
which
again
goes
back
to
the
nervous
system
.
So
how
do
we
mitigate
that
?
And
it
can
be
again
,
everybody's
different
and
a
lot
of
issues
.
Speaker 2
4:46
Whether
it's
bloating
pain
,
one
of
the
first
questions
I
ask
is
how
often
do
you
poop
?
Because
if
you're
not
pooping
very
often
,
nothing
is
going
to
solve
itself
.
Like
bloating
,
like
amazing
5
out
of
5
Yelp
review
supplement
is
going
to
help
this
.
Nothing's
going
to
work
unless
you
poop
regularly
.
And
it's
easier
said
than
done
,
right
,
but
I
refuse
to
go
into
anything
else
unless
you're
pooping
regularly
,
because
we
have
to
get
the
pipes
clean
.
There's
a
backup
on
95
.
Everything
before
that
it
doesn't
work
.
You
just
got
to
clear
that
out
first
.
Speaker 1
5:20
Right
,
so
yeah
,
and
that
can
be
.
Speaker 2
5:21
We
always
start
with
.
I
always
talk
about
lifestyle
there
first
,
Right
,
so
yeah
,
and
that
can
be
.
You
know
,
we
always
start
with
.
I
always
talk
about
lifestyle
there
first
.
You
know
,
drinking
enough
water
,
eating
sufficient
fiber
and
fiber
can
be
tricky
because
it
can
lead
to
bloating
,
and
so
there's
an
art
to
that
and
it's
starting
low
and
going
slow
and
trying
to
find
less
fermented
forms
of
fiber
.
You
know
,
psyllium
husk
is
a
good
one
If
you
really
can't
tolerate
any
fermentation
at
all
,
citric
cells
and
artificial
fibers
.
That
doesn't
cause
any
bloating
.
I
tend
to
like
that
less
because
it
doesn't
really
benefit
our
microbiome
.
But
there
are
forms
of
higher
fermented
carbs
or
fibers
that
are
called
FODMAPs
that
we
generally
like
to
avoid
in
that
patient
population
.
Yeah
,
like
low
fermentation
fiber
sources
is
a
good
place
to
start
.
Movement's
a
good
one
,
but
I
recognize
if
you
deal
with
post-exertional
malaise
,
brain
fog
,
like
moving
can
be
tough
.
So
I
say
that
with
a
grain
of
salt
.
Speaker 1
6:16
Right
.
Speaker 2
6:17
And
then
,
you
know
,
sometimes
we
do
use
laxatives
as
well
,
depending
on
what's
going
on
.
And
there
are
certain
ones
that
are
most
,
are
really
,
really
safe
and
don't
cause
no
laxatives
,
cause
a
dependence
on
the
colon
,
like
no
one
will
make
the
colon
leave
.
That's
a
myth
that
has
been
debunked
,
fortunately
,
and
we
try
to
do
things
without
medication
.
But
sometimes
you
need
something
to
help
that
colon
squeeze
or
to
get
more
water
into
that
colon
.
And
then
there's
issues
like
if
someone
has
EDS
,
a
pelvic
floor
dysfunction
is
a
really
big
Managing Painful Bowel Movements
Speaker 2
6:45
deal
.
Speaker 1
6:45
Same
with
endo
.
Speaker 2
6:47
Yeah
Huge
deal
,
and
that
is
I
had
three
patients
today
.
Like
I've
been
on
laxatives
for
years
,
I
can't
find
the
right
one
.
It's
because
it's
not
a
laxative
issue
,
it's
a
coordination
issue
.
It's
because
we're
not
evacuating
well
enough
,
and
so
we
can
talk
about
that
too
.
But
yeah
,
it's
the
first
conversation
when
people
have
nausea
bloating
.
Speaker 1
7:05
It's
just
making
sure
that
we're-
.
What
do
you
do
for
patients
who
have
pain
with
bowel
movements
?
Because
that
is
a
very
big
thing
for
the
endometriosis
patients
?
Obviously
,
if
you
have
lesions
obstructing
your
bowel
you're
going
to
have
pain
and
that
you
know
.
Maybe
it's
getting
the
proper
excision
specialist
that
can
do
those
bowel
resections
or
who
can
you
know
take
care
of
that
.
But
there
are
those
patients
that
they're
not
there
yet
.
Are
there
ways
to
help
with
painful
bowel
movements
.
Speaker 2
7:31
It's
a
really
good
question
and
so
it
all
depends
on
what's
causing
the
pain
.
So
if
it's
endometriosis
and
some
you
know
,
I
don't
know
the
data
between
painful
bowel
movements
and
endometriosis
If
you
treat
the
endometriosis
that
better
.
But
my
sense
is
that
.
So
the
first
issue
is
like
what
does
the
poop
look
like
?
Is
it
hard
and
pebbly
?
Is
it
just
if
you
just
if
it
,
is
it
painful
,
just
coming
out
because
it's
goodness
,
it's
desiccated
,
it's
hard
,
it's
dehydrated
and
just
have
a
tough
time
coming
out
?
So
that's
low-hanging
fruit
.
Just
getting
the
like
kind
of
moistening
the
stool
is
is
a
good
place
to
start
with
water
fiber
.
Soluble
fiber
works
as
a
sponge
to
absorb
a
lot
of
water
and
to
make
that
stool
softer
.
And
sometimes
you
may
need
laxatives
as
well
.
Speaker 2
8:12
But
painful
bowel
movements
is
somewhat
not
pathognomonic
.
But
a
lot
of
patients
with
IBS
have
this
and
it's
this
very
highly
sensitized
nerves
in
the
gut
.
So
how
do
you
make
it
less
sensitive
?
And
that's
an
individualized
conversation
.
So
first
and
foremost
is
,
how
do
we
get
from
those
nerves
?
Our
brain
is
quite
good
at
tuning
out
pain
signals
that
it
doesn't
need
to
hear
.
If
you
break
your
foot
,
your
brain
kind
of
needs
to
hear
about
that
.
But
when
you
poop
like
your
brain
doesn't
really
need
to
hear
about
what's
going
on
in
your
colon
.
It
doesn't
need
to
hear
those
pain
signals
and
your
brain
has
a
really
tough
time
tuning
those
signals
out
if
it's
stuck
in
fight
or
flight
mode
.
So
I'm
always
talking
about
how
well
do
you
sleep
,
because
you
can
really
never
get
a
fight
or
flight
if
you're
not
sleeping
well
.
How
often
do
you
get
outside
?
Do
you
exercise
?
Speaker 2
9:01
And
then
we
talk
about
methods
to
get
us
in
back
into
parasympathetic
mode
,
which
is
it's
meditation
,
something
that
worked
for
you
.
Hypnosis
worked
for
some
people
.
Cognitive
behavioral
therapy
really
works
well
.
If
someone
has
a
lot
of
really
um
,
it's
called
catastrophizing
,
like
,
oh
goodness
,
I'm
bloated
today
,
now
,
today's
ruin
,
right
,
and
that
thought
process
just
makes
things
so
much
worse
.
So
it
changes
your
thought
patterns
behind
the
symptoms
,
which
it
takes
some
time
.
Some
people
don't
buy
this
when
I
first
say
it
,
but
those
thought
patterns
can
make
symptoms
and
pain
way
,
way
worse
.
Speaker 2
9:37
And
then
sometimes
I
bring
up
medications
.
There
are
laxatives
like
linacletide
or
linzess
that
actually
have
analgesic
properties
in
the
colon
as
well
.
So
they
make
you
poop
but
also
help
with
pain
receptors
too
.
Okay
.
And
then
we
use
antidepressants
Interesting
and
this
is
a
controversial
topic
,
and
I
have
this
account
where
I
put
a
lot
of
information
out
there
and
every
time
I
talk
about
antidepressants
,
people
are
like
why
are
you
giving
us
this
poison
?
I'm
like
,
hold
on
,
it's
not
for
everybody
and
I
want
to
preface
this
.
It
is
a
valuable
tool
that
we
use
in
IBS
and
I'm
going
to
break
down
why
,
because
I
always
wanted
to
say
this
on
a
platform
.
Okay
,
so
we
don't
use
antidepressants
for
your
depression
or
anxiety
.
Okay
,
we
use
them
for
their
neuromodulator
problems
.
Speaker 1
10:18
What
does
that
?
Speaker 2
10:18
mean
,
okay
,
so
let's
take
.
There's
a
medication
called
Cymbalta
which
is
a
selective
serotonin
and
norepinephrine
reuptake
inhibitor
.
So
norepinephrine
,
otherwise
known
as
adrenaline
,
really
helps
with
pain
.
So
say
,
for
example
,
we're
playing
a
basketball
game
,
right
,
you're
going
two
on
two
,
one
on
one
.
You're
playing
against
your
sworn
enemy
.
You
turn
your
ankle
,
but
you're
kind
of
able
to
gut
out
the
game
because
of
adrenaline
.
You
don't
feel
that
ankle
a
whole
.
The
next
day
it
hurts
.
I
mean
,
it's
bananas
,
you
got
to
ice
,
you
got
to
rest
,
all
the
stuff
that
us
old
people
do
.
But
so
adrenaline
is
a
really
nice
chemical
that
we
can
use
in
our
own
body
to
tune
out
pain
signals
.
So
Cymbalta
really
helps
with
neuromodulation
Antidepressants for Gut Pain
Speaker 2
10:55
and
turning
down
the
pain
signals
at
the
level
of
spinal
cord
up
to
the
brain
.
So
the
brain
is
unable
to
tune
out
those
pain
signals
anymore
.
Cymbalta
really
helps
us
with
that
.
The
beautiful
thing
about
it
.
So
one
also
someone's
dealing
with
kind
of
comorbid
,
really
intrusive
anxiety
,
it
does
help
with
that
.
Speaker 2
11:11
But
if
not
,
this
medication
does
work
as
well
.
People
are
open
to
it
.
And
the
beautiful
thing
is
we
can
get
people
off
this
medication
.
So
we
benefit
from
neuroplasticity
,
so
those
nerves
can
learn
,
adapt
and
grow
over
time
.
So
we're
,
after
being
on
Cymbalta
and
being
pain-free
for
effectively
12
to
18
months
.
We
can
wean
people
off
the
medication
.
The
pain
doesn't
come
back
.
So
that's
how
we
use
antidepressants
.
Okay
,
it
is
not
forever
,
I
get
.
Being
on
a
medication
is
not
ideal
,
but
it
is
a
tool
in
our
toolbox
if
we
choose
to
use
it
.
And
the
beautiful
thing
about
irritable
bowel
syndrome
visceral
pain
like
this
is
there's
so
many
ways
to
go
about
it
.
You
want
to
get
hypnotized
?
Let's
press
that
button
.
You
want
to
use
a
medication
?
Cool
,
we
can
do
that
too
.
And
so
everybody's
plan
is
different
and
unique
to
who
they
are
,
what
their
goals
are
and
what
appeals
to
them
.
Speaker 1
12:00
Interesting
.
I'm
so
glad
you
broke
that
down
for
us
,
because
that's
I
mean
,
we
are
always
looking
for
tools
to
put
in
our
tool
belt
because
there's
different
ways
to
handle
it
for
everyone
,
and
we
see
this
with
hormones
,
we
see
this
with
you
know
,
care
and
treatment
is
that
everyone
is
going
to
be
different
in
what
they
need
,
desire
and
want
,
and
so
to
look
at
it
and
have
different
tools
to
kind
of
play
off
of
and
be
able
to
really
navigate
your
care
,
that
way
is
powerful
.
I
mean
knowledge
is
power
,
right
,
so
put
more
power
tools
in
your
belt
because
we
can
really
ramp
that
up
a
little
bit
more
.
Speaker 1
12:38
I
have
a
question
that
I
think
we'll
see
if
we
can
do
this
With
EDS
and
endometriosis
do
you
see
more
sensitivity
with
like
do
you
see
more
lazy
,
gut
with
this
,
or
lazy
,
or
like
the
microbiome
being
off
more
?
Speaker 2
13:00
Hmm
,
there's
a
lot
to
unpack
there
.
I
think
the
first
question
I
can
certainly
answer
and
that
EDS
patients
are
prone
to
slower
motility
.
Speaker 1
13:10
Right
.
Speaker 2
13:10
Okay
.
So
not
only
in
the
stomach
,
but
also
the
esophagus
,
the
small
intestines
and
the
colon
.
So
the
first
thing
I'm
thinking
about
is
is
this
person
Microbiome & Stool Testing Reality Check
Speaker 2
13:20
able
to
get
by
with
lifestyle
measures
alone
,
because
perhaps
their
colon
just
needs
a
kick
in
the
butt
to
squeeze
more
,
and
that's
where
we
have
some
laxatives
that
really
work
in
that
way
.
So
,
yeah
,
the
answer
is
yes
.
Patients
with
EDS
tend
to
have
more
sluggish
motility
.
The
gut
microbiome
question
is
very
fascinating
fascinating
,
and
we're
not
ready
to
answer
that
,
and
this
is
a
hotly
debated
online
as
well
,
and
so
,
you
know
,
I
really
hope
that
in
five
to
10
years
,
we
can
leverage
the
microbiome
to
get
people
feeling
better
.
We're
just
not
quite
there
yet
,
and
so
people
are
working
really
hard
to
understand
.
What
is
Alana's
microbiome
?
What
should
that
look
like
?
Okay
,
so
when
you
test
your
microbiome
and
they
say
,
okay
,
they
showed
this
bacteria
,
this
bacteria
.
Is
that
right
or
wrong
for
you
?
Right
,
testing
someone's
microbiome
is
saying
you
know
,
it's
like
your
hair
length
,
like
should
my
cause
?
My
hair
isn't
like
your
hair
.
Should
I
grow
my
hair
longer
?
Should
my
microbiome
be
like
your
microbiome
?
We
don't
know
.
And
so
when
you
do
these
tests
,
we
just
don't
know
what
to
compare
it
to
.
And
I'm
going
to
kind
of
go
on
a
little
tangent
here
.
But
you
know
,
in
any
test
that
we
order
in
medicine
,
you
have
to
understand
the
test
properties
.
Okay
,
there's
a
test
called
the
lipase
that
we
use
for
pancreatitis
and
it's
used
inappropriately
all
the
time
and
it'll
be
high
but
the
person
isn't
having
symptoms
consistent
with
pancreatitis
.
Well
,
the
test
isn't
good
.
In
this
clinical
context
you
have
to
understand
the
context
of
the
test
,
the
sensitivity
,
the
specificity
,
the
accuracy
.
There's
all
these
test
characteristics
that
we
know
about
all
these
tests
.
There's
a
lot
of
microbiome
tests
.
We
have
no
idea
about
the
accuracy
of
any
of
them
Interesting
.
So
when
patients
come
to
me
with
this
I'm
like
great
,
I
don't
know
.
I
don't
know
,
we're
not
there
yet
.
We
just
don't
understand
how
good
this
test
is
.
And
then
,
secondarily
,
we
don't
know
how
to
manipulate
it
,
right
.
So
you
say
,
okay
,
so
we
want
to
turn
these
knobs
and
get
more
of
this
bacteria
and
less
of
this
bacteria
.
Okay
,
say
that
that's
still
a
little
bit
misinformed
because
we
don't
know
manipulating
that
data
will
get
you
feeling
any
better
.
Let's
say
we
say
start
this
probiotic
.
Are
we
sure
that
works
?
The
answer
is
no
,
right
,
because
that
test
hasn't
been
done
.
Speaker 2
15:22
I
tend
to
believe
,
based
on
the
data
that
I've
read
,
that
probiotics
are
fly
buyers
.
Right
,
they'll
inhabit
your
colon
as
long
as
you
take
them
,
they're
not
sticky
and
they
don't
linger
.
So
are
you
then
forced
to
take
a
probiotic
for
50
bucks
a
pop
indefinitely
?
Are
we
sure
that's
a
good
idea
?
And
so
I
think
there's
a
lot
of
questions
that
we
need
to
answer
,
and
I've
met
people
that
said
probiotics
changed
my
life
.
I
can
now
use
the
bathroom
again
,
but
the
majority
of
people
that
I
see
in
clinics
said
they
didn't
do
a
darn
thing
.
And
so
I
say
use
probiotics
at
your
own
discretion
.
I
will
never
recommend
it
because
I
don't
think
.
I
don't
know
yet
.
I
just
don't
know
.
And
so
,
going
back
to
the
original
question
I'm
sorry
,
I
kind
of
soapboxed
.
Speaker 1
16:05
No
,
I
like
it
.
This
is
good
,
because
I'll
follow
up
first
.
Speaker 2
16:09
I
don't
know
how
the
microbiome
affects
endometriosis
,
eds
,
you
know
and
some
people
say
like
,
oh
,
look
at
obesity
.
There
are
these
patients
that
have
this
microbiome
changes
in
obesity
.
I
was
like
,
well
,
are
you
sure
that
didn't
happen
as
a
consequence
of
obesity
,
or
did
that
lead
to
obesity
?
And
are
you
telling
me
that
if
we
switch
the
microbiome
,
that
people
will
lose
weight
?
Are
we
sure
?
And
the
same
thing
for
all
these
conditions
,
right
?
So
if
we
test
someone's
microbiome
in
IBS
,
I'm
like
,
is
this
because
of
IBS
or
did
this
cause
IBS
?
And
what
does
it
mean
?
Do
I
make
these
changes
as
the
IBS
go
away
?
And
we're
just
goodness
we
are
.
They're
really
smart
people
working
really
hard
.
And
I
really
encourage
people
to
look
at
Will
Bolshevitz's
Instagram
.
He's
a
friend
,
he's
a
GI
doctor
,
he's
a
really
smart
guy
talking
about
the
microbiome
.
He's
a
really
good
resource
out
there
for
people
who
want
to
learn
more
.
Speaker 1
16:59
Well
,
and
that
leads
me
to
like
the
stool
testing
,
because
a
lot
of
people
will
do
the
stool
testing
to
see
what
they're
lacking
or
what
they
need
or
what's
going
.
You
know
they
use
that
as
a
metrics
for
wellness
,
if
you
will
.
What
are
your
thoughts
on
the
stool
testing
?
Because
a
lot
of
people
will
try
them
in
effort
to
figure
out
what's
going
on
with
their
body
.
Speaker 2
17:18
I
don't
think
we
know
what
to
do
with
those
tests
yet
I
never
recommend
them
.
I've
yet
to
see
it
benefit
anybody
.
I
also
don't
work
in
the
functional
medicine
space
right
,
where
they
use
these
tests
a
lot
.
We
haven't
brought
them
into
traditional
medicine
because
there's
not
enough
data
behind
it
.
So
we
like
to
say
when
I
get
this
test
,
what
is
the
likelihood
that
it's
informing
me
of
someone's
health
and
their
health
challenges
and
what's
the
likelihood
that
this
is
a
false
positive
?
Is
it
a
false
negative
?
How
accurate
is
it
and
is
it
actionable
?
If
I
get
this
data
,
what
can
I
do
to
improve
it
?
And
if
I'm
confident
that
I
can
improve
it
,
we'll
make
this
person
feel
better
.
There
are
so
many
steps
in
there
that
we
haven't
figured
out
with
microbiome
testing
.
Forget
the
fact
that
if
you
get
your
microbiome
test
from
five
different
places
,
you're
going
to
get
five
different
answers
,
right
.
So
the
test
itself
is
just
unreliable
.
So
I
get
what
people
want
to
know
and
this
is
one
of
those
things
that
I
categorize
in
you
know
,
just
to
know
.
But
is
it
really
going
to
help
you
?
And
my
answer
is
I'm
not
sure
yet
and
I
haven't
seen
any
data
to
suggest
that
it
really
helps
people
.
But
I
have
,
you
know
,
I
started
this
and
I'm
interacting
with
a
lot
of
people
that
I
otherwise
wouldn't
have
met
,
and
people
say
it
changed
my
life
and
I
said
how
?
And
no
one
has
given
me
an
answer
yet
.
Speaker 2
18:38
I
am
so
open
to
learning
more
.
I
am
not
in
this
traditional
medicine
camp
where
I
say
it's
pseudoscience
,
it's
made
up
.
I
don't
believe
that
.
I
just
don't
know
how
to
use
it
.
If
someone
can
teach
me
how
to
reliably
use
it
,
because
there's
no
clinical
data
to
say
that
it
works
yet
,
I
promise
you
,
I'm
all
ears
.
I
say
this
with
just
open
curiosity
and
wanting
to
learn
more
and
I'll
say
I
use
.
You
know
,
I
interact
with
a
few
natural
doctors
or
naturopaths
.
I
said
we
use
this
all
the
time
.
I
said
but
how
,
how
do
we
use
it
?
And
you
test
it
afterwards
what
?
How
do
you
leverage
it
?
Do
you
use
dietary
measures
?
Do
you
use
probiotics
?
Do
you
use
exercise
?
Do
you
sleep
?
And
I
have
.
I
haven't
really
got
an
answer
yet
.
So
I'd
love
to
have
that
dialogue
with
somebody
one
day
,
if
they're
open
to
have
it
,
yeah
.
Speaker 1
19:18
So
,
speaking
of
your
Instagram
,
tell
us
what
your
handle
is
,
so
that
people
can
follow
you
,
because
I
think
they
should
.
Speaker 2
19:24
It's
DrZachSpiritos
.
Speaker 1
19:27
There
you
go
.
Okay
,
what
is
your
biggest
piece
of
advice
?
Before
we
move
on
to
the
question
portion
for
you
,
what
is
your
biggest
piece
of
advice
for
patients
who
are
struggling
to
find
their
diagnosis
,
or
one
of
the
biggest
challenges
you
,
as
a
provider
,
have
in
helping
patients
with
these
challenges
?
It's
twofold
.
Speaker 2
19:49
So
yeah
,
so
I
think
that
I
would
.
I
would
catalog
all
of
your
symptoms
,
okay
,
and
when
you
bring
it
to
it
,
if
you
choose
to
go
to
a
doctor
for
this
,
I
would
write
it
down
in
a
very
succinct
.
This
is
what
really
bothers
me
.
I've
done
some
research
and
this
is
what
I
think
it
may
be
.
What
do
you
think
?
Okay
,
because
it
really
and
obviously
go
through
the
whole
,
like
you
have
to
tell
your
whole
history
and
go
through
everything
and
let
them
come
to
their
own
conclusions
.
And
if
you
guys
are
on
the
same
page
,
beautiful
,
okay
.
Speaker 2
20:24
But
if
perhaps
they're
like
,
maybe
this
is
IBS
,
I'm
like
I
disagree
.
You
have
to
say
,
well
,
I
think
it's
this
,
and
if
it's
not
this
,
or
you
don't
think
it's
this
,
can
you
tell
me
why
?
And
if
that
provider
isn't
open
to
that
dialogue
,
then
you
have
to
change
teams
.
And
it's
just
as
simple
as
that
.
If
you
don't
have
a
provider
that
is
open
to
a
dialogue
and
curious
about
what
may
be
going
on
,
then
they're
just
they're
not
the
right
person
for
you
,
because
,
by
nature
,
if
you're
listening
to
this
,
you
have
a
complex
,
chronic
illness
,
right
,
and
it's
it's
going
to
be
challenging
,
it's
going
to
be
an
ongoing
effort
between
you
and
your
medical
team
.
So
I
really
like
when
someone
says
like
this
is
what
I
have
,
this
is
what's
really
really
bothering
me
,
because
I
also
know
that
people's
brains
are
completely
washed
when
they
go
to
a
doctor's
office
.
Speaker 2
21:10
I
went
to
a
doctor
a
few
times
this
year
because
I
had
some
heart
stuff
going
on
and
I
completely
just
forgot
everything
when
I
went
to
go
talk
to
them
.
And
I'm
in
medical
,
it
just
happens
right
and
you're
so
excited
to
get
there
.
They
rush
in
right
.
They're
sweating
because
they've
been
seeing
20
patients
that
morning
and
they're
like
they
haven't
shaved
or
I
don't
know
if
that's
a
guy
,
I
guess
you
know
they're
unkempt
.
You're
like
,
oh
,
this
guy
looks
like
he's
disheveled
and
I'm
trying
to
condense
everything
.
But
a
piece
of
paper
,
really
,
you
know
it
anchors
you
to
what
your
reality
is
and
what's
been
going
on
.
Speaker 1
21:39
Yeah
,
okay
.
What
are
the
challenges
you
face
that
patients
should
be
more
aware
of
?
Speaker 2
21:44
Goodness
,
I
mean
,
there's
a
lot
really
tough
.
I'm
trying
really
hard
.
I
think
people
get
frustrated
by
the
lack
of
progress
sometimes
and
the
beauty
of
so
.
I'm
a
neurogastroenterologist
,
which
means
that
I
deal
with
a
lot
of
invisible
chronic
conditions
,
and
so
there's
not
a
lot
of
data
in
this
space
,
and
a
lot
of
my
Doctor-Patient Communication & Questions
Speaker 2
22:03
decisions
and
therapeutic
plans
are
based
on
what
I
think
is
an
intimate
knowledge
of
pathophysiology
and
medications
and
a
good
grasp
on
the
testing
out
there
and
so
.
But
it's
not
like
hey
,
I
broke
my
ankle
.
There's
an
x-ray
of
my
broken
ankle
,
you're
going
to
fix
it
.
That's
going
to
get
me
better
A
hundred
percent
.
Speaker 2
22:21
This
is
different
.
It's
a
lot
of
.
It's
certainly
not
guessing
,
but
it's
.
It's
a
we're
,
it's
expert
opinion
and
we'll
.
I'm
trying
so
fr
freaking
hard
,
I
promise
you
,
and
we're
going
to
try
.
And
if
this
hits
,
awesome
,
right
,
we're
not
going
to
get
100%
better
in
three
months
,
but
30%
is
what
I'm
looking
for
.
If
it
doesn't
work
,
let
me
know
immediately
and
we
will
pivot
and
try
something
else
,
because
this
is
an
ongoing
evolution
,
right
,
and
so
this
is
invisible
,
right
?
I
don't
have
a
test
result
to
say
that's
it
,
and
unfortunately
,
those
tests
don't
exist
,
because
a
lot
of
this
is
based
in
the
nerves
and
dysautonomia
which
we
,
quite
frankly
,
can't
test
for
the
most
part
,
and
so
,
yeah
,
I
just
it's
be
patient
with
the
process
,
and
we're
looking
for
getting
1%
better
each
day
,
as
opposed
to
a
complete
overhaul
.
Speaker 1
23:06
Yeah
,
that's
really
good
advice
and
that's
something
that
I
think
we
all
need
to
hear
.
This
is
the
portion
of
the
podcast
that
has
been
a
favorite
,
which
is
you
get
to
ask
me
any
questions
you
want
,
whether
it's
patient-based
or
provider
.
Oh
,
I
know
,
just
get
excited
for
that
because
it
may
not
be
good
,
but
we'll
see
how
it
goes
.
But
you
can
ask
any
of
these
questions
because
you
aren't
endometriosis
specific
,
and
so
I
think
it's
important
for
people
to
hear
things
that
other
providers
have
as
far
as
questions
go
to
the
patient
,
and
this
is
kind
of
a
reverse
role
to
play
.
So
let's
go
for
it
.
Any
questions
you
have
,
I'm
here
to
see
if
I
can
answer
them
you
have
.
Speaker 2
23:53
I'm
here
to
see
if
I
can
answer
them
.
Bring
it
on
,
All
right
.
So
what
is
the
biggest
misconception
about
endometriosis
that
doctors
have
?
And
I
think
I've
said
probably
three
or
four
things
that
I'm
sure
in
your
head
you're
like
.
That's
just
blatant
false
.
Yeah
,
yes
and
yes
,
you've
got
a
lot
of
incorrect
.
Speaker 1
24:07
So
one
of
the
biggest
things
is
the
definition
which
they
are
taught
endometrium
and
it's
not
endometrium
,
it's
endometrium-like
cells
.
They
are
actually
two
different
cells
.
They
actually
have
research
backing
this
up
,
that
it
is
not
retrograde
in
the
sense
that
it's
not
the
endometrium
coming
out
,
flowing
out
,
going
into
the
abdominal
cavity
or
the
pelvis
.
It
is
actually
endometrium-like
.
They're
two
different
things
.
Endometriosis
produces
its
own
estrogen
.
It's
a
crazy
disease
that
it
has
its
own
brain
,
it
has
its
own
food
source
and
it
can
provide
its
own
food
source
,
and
so
that's
probably
one
of
the
biggest
misconceptions
is
that
it
comes
flowing
out
and
it's
endometrium
.
It's
not
.
They're
different
cells
and
that's
why
it's
been
found
all
over
the
body
.
It's
been
found
in
the
brain
,
it's
been
found
in
the
nose
.
It's
been
found
there's
more
cases
showing
up
cardiothoracic
diaphragmatic
.
It's
been
found
everywhere
,
and
I
think
there's
that's
the
reason
that
it
can
be
so
complex
to
diagnose
as
well
is
because
depending
on
where
it's
located
and
how
it's
responding
with
your
nerves
means
that
your
symptoms
are
going
to
show
differently
and
you're
going
to
respond
to
that
differently
.
Right
,
we've
talked
about
the
brain
and
how
that
has
such
a
huge
role
in
how
we
perceive
pain
and
how
we
adjust
to
pain
right
and
in
our
environments
it's
highly
inflammatory
in
nature
.
Speaker 1
25:30
It's
genetic
in
nature
as
well
,
which
some
people
have
a
hard
time
understanding
.
That
Dr
David
Redwine
he
was
a
genius
at
this
,
he
really
dug
deep
into
the
genomic
aspect
of
it
.
It
tends
to
be
very
generationally
induced
.
So
if
someone
in
your
family
has
endometriosis
,
you
are
seven
times
more
likely
to
have
it
.
So
when
I'm
sitting
here
as
a
patient
who's
had
deep
infiltrating
endometriosis
,
I
have
two
daughters
.
They're
likely
to
have
it
.
In
fact
,
I
would
say
this
my
daughter
,
who
is
not
yet
on
her
cycle
,
is
showing
signs
in
her
GI
in
the
way
that
I
did
,
is
showing
signs
in
her
GI
in
the
way
that
I
did
.
So
we're
seeing
a
lot
of
generational
endometriosis
and
I
don't
know
and
this
is
something
that
you
know
,
I'm
going
to
talk
to
another
doctor
about
but
I
don't
know
why
it
seems
to
be
getting
worse
and
I
think
maybe
it
could
be
environmental
.
Speaker 1
26:28
It
could
be
that
we
are
in
a
heightened
state
in
the
sympathetic
system
,
more
we
aren't
good
at
balancing
our
sympathetic
,
parasympathetic
system
.
I
think
there's
that
role
to
play
in
there
,
and
Dr
Mark
Possover
,
who
is
a
neuropelviologist
,
talks
a
lot
about
this
and
how
we
don't
need
to
downregulate
our
sympathetic
,
we
need
to
up-regulate
our
parasympathetic
,
because
if
you're
trying
to
raise
that
sympathetic
,
it's
so
hard
,
it's
daunting
,
it's
so
hard
to
do
.
But
if
you
can
increase
your
parasympathetic
,
then
that's
where
it'll
kind
of
be
that
teeter-totter
of
leveling
out
,
if
that
makes
sense
.
So
those
are
just
some
of
the
biggest
misconceptions
that
we
kind
of
face
.
Speaker 1
27:12
Also
,
hysterectomy
will
cure
it
.
It
does
not
cure
it
.
Ablation
gets
rid
of
it
.
It
does
not
get
rid
of
it
.
Ablation
really
just
cuts
it
at
the
surface
instead
of
taking
all
the
disease
out
.
It's
like
a
cancer
.
It
grows
like
a
cancer
.
Take
it
from
the
root
,
and
so
that's
probably
some
of
the
biggest
misconceptions
that
we
hear
amongst
others
.
But
those
are
some
of
the
bigger
ones
that
you
will
hear
time
and
time
again
if
you
look
online
or
go
to
a
doctor's
office
fundamentally
changes
from
what
its
origin
was
to
something
different
,
and
that's
complete
news
to
me
.
Speaker 2
27:55
Yes
,
and
then
you
said
that
your
daughter
is
having
GI
symptoms
.
Do
you
find
that
GI
symptoms
are
sometimes
the
canary
in
the
coal
mine
for
endometriosis
?
Can
they
occur
before
kind
of
classic
gynecologic
symptoms
,
or
how
do
you
see
that
play
out
,
I
guess
the
chronology
of
those
things
?
Speaker 1
28:15
I
do
.
I
absolutely
do
so
when
we're
looking
at
food
sensitivity
and
getting
nauseous
diarrhea
to
certain
food
and
you
can
track
that
cyclically
prior
to
their
cycle
,
because
we
start
cycling
before
we
have
menstrual
flow
.
Right
,
that's
our
bodies
,
the
hormones
shifting
and
changing
.
So
as
I'm
seeing
these
shifts
and
changes
,
I'm
seeing
her
become
more
sensitive
to
certain
foods
.
I'm
seeing
that
she's
having
a
harder
time
going
to
the
bathroom
.
She
has
more
constipation
and
then
she
also
is
.
She's
always
had
a
sensitive
stomach
,
but
I
do
think
that
it
has
gotten
progressively
worse
as
she's
starting
to
get
into
that
hormonal
shift
.
Speaker 1
28:53
So
I
look
back
at
my
history
and
I
don't
remember
a
lot
,
but
I
do
remember
having
a
hard
time
as
a
kid
with
the
GI
symptoms
.
Most
people
I
talk
to
who
have
had
GI
symptoms
in
their
diagnostic
process
figure
it
out
.
A
lot
of
it
starts
prior
to
their
menses
.
So
it's
just
something
to
be
highly
aware
of
and
it's
something
that
a
colonoscopy
or
endoscopy
is
not
going
to
catch
because
it's
from
the
outside
going
in
.
So
most
of
the
time
a
lot
of
patients
will
have
a
colonoscopy
to
try
to
figure
out
what's
going
on
and
they're
going
to
say
well
,
it's
clean
.
It's
clean
as
a
whistle
Like
there's
nothing
there
and
and
then
an
endometriosis
surgeon
will
go
in
and
they'll
find
,
you
know
,
pretty
deep
disease
in
the
bowel
wall
and
which
you
know
,
or
their
rectum
or
their
,
you
know
.
So
it
kind
of
is
pretty
invasive
,
but
sneakily
so
sometimes
.
Speaker 2
29:51
Okay
,
tricky
.
And
so
when
someone
has
symptoms
,
okay
,
and
they
are
concerned
that
this
may
be
endometriosis
,
like
the
parallel
in
my
world
is
like
and
IBS
is
really
tough
to
diagnose
,
so
where
do
you
start
Right
?
And
then
,
if
imaging
which
I
imagine
imaging
is
rather
imperfect
for
picking
up
endometriosis
,
where
does
that
dialogue
continue
?
Is
it
just
a
clinical
diagnosis
,
like
I
have
these
symptoms
,
we've
rolled
out
everything
else
,
like
it's
got
to
be
this
,
or
how
do
you
,
how
will
you
inform
someone
to
start
that
conversation
with
the
doctor
and
start
that
diagnostic
journey
?
Speaker 1
30:23
Yeah
,
well
,
I
think
what
you
said
before
is
listening
right
.
So
as
a
patient
,
we
as
patients
have
a
responsibility
to
track
our
symptoms
and
if
we
have
a
hard
time
,
have
a
support
person
that
will
help
you
.
Because
I
will
tell
you
,
my
husband
picked
up
on
way
more
of
my
symptoms
than
I
ever
did
.
He
was
able
to
pinpoint
the
time
of
month
that
I
was
having
a
hard
time
,
like
he
would
be
able
to
see
things
that
I
wouldn't
,
because
I
was
in
so
much
pain
,
I
was
in
debilitating
pain
,
and
so
he
was
picking
up
that
I
was
moody
prior
,
like
PMS
.
They
say
PMS
if
you're
moody
,
that's
a
good
indicator
that
you
know
moody
,
plus
maybe
painful
periods
.
Speaker 1
31:05
Periods
should
not
be
painful
.
We've
said
that
they're
okay
to
be
painful
,
they
should
not
be
painful
.
Uncomfortable
is
one
thing
,
painful
is
a
whole
nother
thing
.
If
you
are
missing
out
on
your
quality
of
life
,
if
you're
having
to
cancel
events
or
not
being
able
to
go
to
school
,
if
you're
young
,
if
you
are
having
reoccurring
UTIs
,
things
like
that
,
during
your
period
,
that's
a
good
indicator
that
that
could
be
endometriosis
.
And
so
I
think
for
a
lot
of
people
,
painful
periods
have
been
normalized
.
It's
not
normal
and
we
should
be
looking
at
endometriosis
as
a
culprit
.
But
if
you're
having
constipation
,
diarrhea
,
more
food
sensitivities
during
your
cycle
or
maybe
during
ovulation
,
that's
a
good
indicator
putting
all
of
those
together
.
And
then
interstitial
stessitis
gets
.
I
can
never
say
it
right
,
but
that
gets
categorized
often
as
as
something
when
it
actually
is
endometriosis
on
the
bladder
.
So
there's
a
lot
that
you
can
look
at
.
Another
thing
that
I
think
providers
could
look
at
more
is
the
muscle
.
Speaker 1
32:05
I'm
your
most
alana
and
this
is
endobattery
charging
your
life
.
When
endometriosis
drains
,
that's
a
good
indicator
that
it's
on
the
utero-cycral
ligaments
and
that
is
not
a
non-common
place
for
it
to
be
.
It
actually
is
one
of
the
number
one
places
to
be
,
so
just
kind
of
seeing
.
Okay
,
here's
a
checkbox
of
things
that
they're
going
through
.
This
isn't
just
one
or
the
other
.
This
is
like
this
is
a
lot
going
on
during
specifically
the
cycle
,
but
if
it's
been
going
on
long
enough
,
sometimes
it's
all
a
month
long
.
So
that's
where
it
gets
tricky
.
The
question
on
the
imaging
a
lot
of
OBGYNs
will
do
imaging
,
but
it's
usually
they'll
say
,
oh
,
there's
nothing
in
there
,
we
don't
see
anything
,
there's
nothing
in
there
,
we
don't
see
anything
.
Speaker 1
32:53
This
is
where
an
endometriosis
specialist
is
going
to
be
the
best
option
for
you
if
you
want
to
do
imaging
,
because
they
can
do
things
like
a
sliding
or
a
dynamic
ultrasound
where
they
can
see
.
Speaker 1
33:02
So
if
you're
looking
at
your
uterus
,
your
ovaries
,
and
they
go
to
put
the
vaginal
ultrasound
in
and
they're
moving
it
,
if
it's
all
moving
together
,
that's
a
good
indicator
that
it's
all
tethered
together
right
,
like
there's
lesions
holding
that
together
.
Now
if
it's
moving
separately
,
usually
that's
not
an
indicator
of
deep
infiltrating
endometriosis
,
it's
just
,
but
that
doesn't
mean
that
you
don't
have
it
,
because
it
could
just
be
minimal
on
the
surface
but
still
painful
.
It
doesn't
dictate
the
pain
and
they
can't
do
that
in
like
the
utero
sacral
ligaments
and
stuff
like
that
.
So
there
is
imaging
that
you
can
do
,
especially
bowels
.
They
can
tell
on
MRI
and
on
ultrasound
If
,
if
they're
experienced
in
what
they're
looking
for
,
general
GYNs
are
not
experienced
enough
to
do
that
.
They're
not
trained
how
to
do
that
,
and
so
these
doctors
all
they
do
is
endometriosis
and
so
they're
able
to
identify
the
anatomy
that's
distorted
,
so
that
they
can
say
I'm
95%
sure
you
have
endometriosis
.
And
again
,
it's
hard
to
say
definitively
until
you
have
a
pathological
confirmation
of
it
.
So
long
version
,
but
that's
generally
how
.
Speaker 2
34:20
No
,
that's
very
helpful
and
it
sounds
like
you
just
need
to
find
yourself
someone
who's
well-versed
in
this
and
if
you
get
negative
testing
but
you're
like
,
goodness
,
this
is
something
is
not
right
,
is
to
continue
looking
.
It
sounds
like
there
are
specific
GYN
physicians
that
are
more
savvy
with
endometrial
disease
,
so
it's
good
to
hear
.
Speaker 1
34:38
It's
very
informative
.
Yeah
,
yeah
,
and
as
a
patient
,
you
know
we
can't
stop
at
one
no
from
a
doctor
and
sometimes
we
can't
stop
at
seven
.
I
think
the
average
providers
we
see
to
diagnosis
is
roughly
12
.
So
that
puts
things
in
perspective
a
little
bit
and
it
goes
anywhere
from
GYNs
,
primary
care
,
to
GI
doctors
to
anything
kind
of
depending
on
your
symptoms
.
Now
,
those
are
only
symptoms
that
I
talked
about
that
are
more
pelvic-related
symptoms
.
There's
diaphragmatic
and
cardiothoracic
and
other
things
.
But
yeah
,
that's
generally
what
people
are
going
to
deal
with
.
Speaker 2
35:14
Wow
,
Well
thank
you
for
being
such
an
amazing
patient
advocate
and
making
people
feel
heard
when
otherwise
their
teams
that
should
be
listening
to
them
or
hearing
them
may
not
kind
of
offer
that
solace
.
So
what
you're
doing
is
really
amazing
yeah
.
Speaker 1
35:30
Well
,
I
thank
you
for
what
you're
doing
and
being
open
to
conversation
and
learning
about
all
the
aspects
of
medicine
,
not
just
what
you've
learned
in
school
,
but
opening
up
and
expanding
your
horizons
,
if
you
will
,
to
learn
more
to
help
your
patients
,
because
it's
obvious
that
you
got
into
this
for
the
patient
care
,
not
the
paycheck
,
so
appreciate
that
.
Speaker 2
35:56
Oh
yeah
,
oh
yeah
.
It's
my
pleasure
.
I
I've
a
lot
of
fun
doing
it
,
a
lot
of
challenges
,
but
I
learn
from
patients
every
single
day
,
and
not
only
they're
.
You
know
the
pathophysiology
of
what
may
be
going
on
,
but
they're
just
like
how
they've
battled
through
all
of
this
and
the
resilience
that
comes
with
.
You
know
dealing
with
chronic
,
invisible
conditions
.
It
just
makes
them
so
fricking
tough
and
yeah
,
and
,
but
they
,
they
deal
with
a
lot
.
People
deal
with
a
lot
.
That's
unfortunate
,
and
I
always
make
the
analogy
.
You
know
it's
like
.
Having
one
of
these
conditions
is
like
,
you
know
,
driving
your
car
on
the
highway
and
your
car
rattles
and
it
shakes
and
you
take
it
to
a
car
dealer
Like
everything's
fine
.
I
don't
know
what
you're
talking
about
.
Maybe
you're
driving
it
wrong
.
Oh
my
God
really
.
And
that's
what
I
think
you
know
it's
,
and
so
I
always
you
know
I
give
a
lot
of
respect
and
admiration
to
people
dealing
with
these
conditions
.
Speaker 2
36:44
Hopefully
you
find
the
right
team
to
support
you
.
Speaker 1
36:46
Yeah
,
and
that
is
my
hope
for
everyone
the
more
informed
and
more
knowledge
they
have
that
they
can
find
a
good
team
that
helps
support
them
.
We're
going
to
have
to
do
this
again
.
I'm
sure
I'm
going
to
have
more
questions
at
some
point
.
We'll
have
to
answer
some
of
these
questions
,
but
we'll
have
to
continue
the
conversation
.
I
love
it
.
Speaker 2
37:02
Anytime
,
anytime
.
I
had
a
great
time
.
Speaker 1
37:04
Until
next
time
,
everyone
continue
advocating
for
you
and
for
others
.