December 10, 2025 • 49 mins
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AI might finally shrink the brutal seven-to-eleven-year journey to endometriosis diagnosis—but only if we pair smarter tools with real clinical judgment. We sit down with Professor Gaby Moawad, a global leader in robotic surgery and endometriosis management, to unpack where technology genuinely helps and where hype can harm. From machine learning that flags lesions on imaging to microRNA biomarkers that stratify risk, we chart what’s promising, what’s premature, and how to avoid black-box mistakes.
We take you inside the OR to explore 3D modeling that transforms standard MRIs into color-coded maps of the pelvis in minutes, then overlays them in surgery for more complete, nerve-sparing excision. Precision is powerful, but ethics matter: surgeons must remain the final guardrail when algorithms error. Beyond the tech, we face the tough questions—why one-third of patients still have pain after surgery, how musculoskeletal drivers and pelvic floor dysfunction are missed, and why 30–50% of endometriosis surgeries may be unnecessary without comprehensive evaluation and aftercare.
We also probe hot topics: the seductive idea of “reprogramming” lesions through immune or epigenetic pathways, the complex links between COVID, vaccination, and inflammatory flares, and the huge research gaps that keep care one-size-fits-all. Subtyping, patient-reported outcomes like fatigue and bloating, and microbiome-informed strategies could reshape treatment, but only with rigorous studies and honest communication. The path forward is center-based, team-driven care anchored by informed consent that puts full information—and real choices—in your hands.
If this conversation sparks questions or clarity, help us reach more people navigating endometriosis: subscribe, share this episode with someone who needs it, and leave a quick review telling us what resonated most. Your engagement helps build better care, faster.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:02):
Welcome to Indobattery, where I share my
journey with endometriosis andchronic illness while learning
and growing along the way.
This podcast is not a substitutefor medical advice, but a
supportive space to providecommunity and valuable
information so you never have toface this journey alone.
We embrace a range ofperspectives that may not always
align with our own, believingthat open dialogue helps us grow
(00:23):
and gain new tools.
Join me as I share stories ofstrength, resilience, and hope,
from personal experiences toexpert insights.
I'm your host, Alana, and thisis Indobattery, charging our
lives when endometriosis drainsus.
Welcome back to Indobattery.
Grab your cup of coffee or yourcup of tea and join me at the
(00:46):
table.
Today's guest is someone who'struly changing the landscape of
endometriosis care.
Professor Gabby Mawad is aglobally recognized leader in
robotic surgery andendometriosis management.
He's a board-certifiedgynecologic surgeon and the
founder of the Center forEndometriosis and Advanced
Pelvic Surgery in Washington,D.C.
(01:07):
Dr.
Mawad has dedicated his careerto advancing minimally invasive
and robotic techniques,combining surgical innovation
with deep, compassionate,patient-centered care.
As director of roboticgynecologic surgery and
associate professor at GeorgeWashington University, he's
trained surgeons worldwide andhelped redefine how we approach
(01:29):
complex pelvic disease.
He's been named Top Doctor inWashington, D.C.
for nearly a decade and hasauthored over 125 peer-reviewed
publications leading globalconversations on endometriosis
and surgical innovation.
It's an honor to sit down andwelcome a true pioneer and
(01:49):
advocate for better outcomes forwomen everywhere.
Please help me in welcoming Dr.
Gabby Moad.
Thank you, Gabby, for sittingdown with me today and coming
all the way to spend time withus.
SPEAKER_01 (02:02):
I want to thank you and thank you for all the work
you do.
It's great that we have advocacygroups like you being able to
change the paradigm in patientsunderstanding and patient
education.
SPEAKER_00 (02:13):
We're going to look ahead at technology because this
is something that you'veexplored significantly.
The tools and how they'vechanged and plans for surgery
and how diagnosis is going tochange.
So, AI and diagnosing, this hasbeen a hot topic.
SPEAKER_01 (02:28):
No, no, I think we're at the infancy of AI
impact on our daily life, eventhough it's making a tremendous
progress.
In endometriosis specifically,there are a few alleys that were
exploited by AI.
The first one that I can talkabout is the imaging.
The identification of theendometriosis lesions through
(02:50):
machine learning can helpdiagnosing endometriosis.
And then there are some studiesthat showed the accuracy is as
much as expert.
The other area where it's beenworked upon is the biomarkers.
The biomarkers, either throughgenetic or epigenetic or even
products of the disease, arehelping us to try to understand
(03:15):
new ways of diagnosingnon-invasive endometriosis.
For example, there is a coupleof tests that have been
developed.
They work on microRNA, which isa portion of the expression of
the gene.
And then they use artificialintelligence to try to stratify
the severity of endometriosisand the phenotype.
(03:36):
And this has been done throughblood, through menstrual fluid,
through saliva recently.
So again, this is another thing.
A lot of algorithms have beendeveloped by combining patient
symptoms, patient history, someof the imaging and lab results
to create a stratification ofthe risk, and then that will
(03:59):
make patients be referredearlier to a specialist and try
to shorten the diagnosis length.
Now it's all great, and I thinkthe future will be going through
that direction, but at thispoint, most of the studies
they've been done, they've beendone on you know homogeneous
populations.
So it's it's extremely hard togeneralize it.
(04:21):
And they've been done ondifferent complexity of a
disease.
So again, we still need longer,more longitudinal studies to
understand the impact and theaccuracy of those studies.
In addition to that, likemachine learning behaves through
neural networks.
So whatever information you feedthem, they will come up with the
(04:43):
value or result.
If you feed them badinformation, they're gonna come
up with a bad result.
So bad data in, bad data out,there's no magic.
The other concerning thing inmost of the um the machine
learning experiences, there issomething what we call black box
in machine learning.
(05:05):
So you give them theinformation, but you don't
understand how they came up withthe result.
And the result through thoseneural networks, they function,
or mathematical algorithm, wearrive to a result that would be
extremely difficult to explainit clinically.
So we still need a lot tofurther our understanding in
(05:28):
machine learning and artificialintelligence.
But I think the this field ismoving way faster, and we can
tell in our real life, nobodygoogles anymore, everybody chat
GPT, anything they want.
So we should look at itconsidering we are the first
protector of patients, right?
As doctors or surgeons.
(05:50):
We need to analyze carefully theinnovation and its impact on our
patients, uh, and it's ourethical obligation to do that.
So we don't want to jump intotechnology very quickly, yet we
don't want to miss the value oftechnologies to help us better
the care for our patients.
SPEAKER_00 (06:09):
How do you think this is gonna change the
learning for doctors?
How do you think this is gonnachange how they identify, treat,
acknowledge endometriosis?
Because I think, you know, theold method of you go to medical
school, you learn out of a book.
I do think that new doctorscoming up are more curious.
(06:30):
They're hearing more, they'remore is accessible to them.
But how do you think this isgonna change that for them and
potentially the future outcomefor endometriosis patients?
SPEAKER_01 (06:40):
I think now we struggle with the uh delayed
diagnosis in an endometriosispatient.
That's gonna help shortening thetime from diagnosis to
intervention.
And this is an extremelyvaluable way because during that
longer period of time, which invariable study, they say between
seven and eleven years you getdiagnosed with endometriosis.
(07:00):
That lengthier period is theperiod where the patient's body
harbors the disease and createsdamage to the patient's body and
multiple systems.
So if you can shorter that, thatwe can intervene earlier and
help managing and prevent somesevere diseases that even in the
best hand are extremelydifficult to treat.
(07:21):
In addition to that, that kindof help us analyze big data.
Big data is that they needlonger and strenuous efforts.
Now it's becoming really easierto analyze, and that leads to
deepening our understanding ofthe disease and then uh helping
to generate a generalizablelarger scale studies.
(07:44):
So this is gonna be important inunderstanding the mechanisms of
the disease, in understandingthe different therapeutic
approaches and impacts on thedisease, in subtyping
endometriosis.
We don't talk enough about itbecause not every endometriosis
is the same.
It doesn't behave the samesurgically, it doesn't behave
the same medically, it doesn'timpact the same the patients.
(08:06):
And embracing technology isextremely important for the
younger generation and thedoctors.
Like everything, when youintroduce a disruption in any
field, right?
There will be an earlierfollowers.
They believe in it, they will belate followers, and they will
always be conservative, then thetrain will pass them.
SPEAKER_00 (08:25):
Right.
SPEAKER_01 (08:25):
So the pioneers, early followers are gonna help,
you know, um anchoring ourunderstanding of the disease.
The late followers will trackand then uh this is how
everything will go.
SPEAKER_00 (08:38):
If you had to give a chat GPT prompt to get the best
information, say you're apatient looking for some sort of
diagnosis, what would you do forthat?
SPEAKER_01 (08:48):
Well, I I I try to avoid using chat GPT because I
tested it for multiple things,like even on myself.
SPEAKER_00 (08:55):
Right.
SPEAKER_01 (08:56):
It's like he cites papers that I've never written.
I go look at the paper and Itell him, like, this is not the
paper I've written.
Oh, I'm sorry, this is not I'msorry, but like, oh no, this is
the paper.
So um technology is important.
I use consensus, which for meit's a it's a great tool because
(09:16):
consensus, you can go and typeanything, and it will summarize
the whole body of literature,thousands and thousands of
articles about something.
So that helps me even moreunderstanding things.
Right.
Like uh last time I was doing uha presentation on the recurrence
of endometriosis, and then Icould go and then they will
(09:38):
stratify it and create an a verygood understanding, but this is
summarizing the literature rightnow.
Again, I believe that thosetools are still at their infancy
and there will be more and moredevelopment in those tools.
But I caution a lot of patientsas much as it is easier to use,
fact-checking is alwaysimportant.
(10:01):
Because even when you say, Oh,give me uh the site, some
papers, literally their sitepaper, I go check them.
SPEAKER_00 (10:08):
Right.
Yeah.
Well, I mean, if you it'sinteresting because we we did
this experiment, if you will, ofexplain endometriosis, define
it.
And it actually gave us likefour different definitions.
SPEAKER_01 (10:22):
Yes, yes.
SPEAKER_00 (10:23):
And so I think it really that's where I'm like, I
I'm a little hesitant toimplement those things.
SPEAKER_01 (10:29):
Especially when you when you want to do if it for
fun, you're you know, tell mehow do you make uh I don't know
uh gin vault gin tonic.
What are the measurements?
Yes, that's fine, because at theend, if he misses the ma uh the
recipe, it's okay.
But when you're trying toestablish a therapeutic approach
for a patient, we can't, youknow, blindly trust them and
(10:52):
then start getting the knowledgeand the care for our patients
through algorithm that we don'tknow how they're built, and then
many times they needimprovement.
Gives you an idea.
I think it gives you more of anidea rather than it gives you
100% accurate information.
SPEAKER_00 (11:10):
Yeah.
Mine would just say tequila isthe treatment.
SPEAKER_01 (11:17):
I feel like that would be my but I've learned
like I I have a couple offriends who are very savvy in
the artificial intelligence, andthey told me even the chat GPT
on your phone, you need to talkto them more frequently so they
understand you.
SPEAKER_00 (11:33):
Yeah.
SPEAKER_01 (11:34):
So that's why you feed them information and they
can, it's like a baby.
Yeah.
You teach them things and theycan do it better.
And it's the same thing, whichis scary.
SPEAKER_00 (11:47):
It is scary to think that they can read you so well
after so long.
It is a little scary to thinkabout that.
There's good and there's bad,right?
And we have to take everythingwith with a side of caution.
Of course, you know, which iswhy I don't think that, in my
opinion, you can replace doctorswith AI.
And I think a lot of people areafraid of that.
I think that people think it'scoming sooner than later.
(12:10):
But I don't think that you canreplace humans and the human
touch because that's healing inand of itself.
But then just knowing the skilland the experience and
everything else, I just don'tthink that that's gonna happen
as soon as some may think.
SPEAKER_01 (12:25):
Uh I don't know.
This is for me, I've never feltinsecure of having somebody take
my job.
No, if you're confident in whatyou do, what care you provide,
uh, there will always be the newdoctor, there will always be the
new tool, there will always belike if we look at medicine, 90%
(12:45):
of medicine is common.
10% the challenging, this iswhen it requires more, you know,
expertise.
SPEAKER_00 (12:52):
Right.
SPEAKER_01 (12:53):
But part of the medical treatment or the
healthcare journey, there is amajor part that is emotional.
SPEAKER_00 (13:02):
Yeah.
SPEAKER_01 (13:03):
Because we're human, we have emotions.
The treatment is beyond achecklist.
SPEAKER_00 (13:08):
AI can't give you a warm touch.
SPEAKER_01 (13:11):
And this is why, like if it is for the patient
better care, I'm happy toretire.
SPEAKER_00 (13:19):
That's big of you.
We'll still need you around.
One of the things that we've Idon't know if you've touched a
lot on this, but I think we'veyou did present a little bit on
this is 3D modeling for surgeryspecifically.
How is that going to shift andchange for patients and for
surgeons?
SPEAKER_01 (13:39):
No, um, we started with 3D printing 10 years ago or
so, where we 3D printed themodel, and that has tremendous
value for uh preparation for thesurgery.
Surgeons can see the uh themodel, can see the uh structures
around, they can pre-plan theirsurgery better.
Also, that leads to completenessof surgery and detection of
(14:02):
lesions in some areas where it'sdifficult to rely on the human
eye and then the imaging alone,and also for uh teaching,
teaching the newer doctors aboutthe surgery, but also educating
patients as well.
It's important.
But the 3D printing was costly,it requires a longer period of
time to prepare, and it relies alot on the technician
(14:25):
experience.
Nowadays, that there is mostlythe work is on um trying to uh
virtually 3D print like imagesfrom regular MRI.
So the MRI would be translatedto image color-coded that helps
understanding also the samevalue as 3D, but it's faster now
(14:48):
with the presence of artificialintelligence.
It used to take us two days tosegment an MRI, and now it takes
one minute with AI, and you'llhave a 3D image, and that has
the same benefits, but thefuture and the work that a
couple of companies are doingright now is overlaying those 3D
(15:08):
printed, virtually 3D printed ordigitally 3D printed images into
the surgical field.
SPEAKER_00 (15:13):
Right.
SPEAKER_01 (15:14):
And that helps the surgeon more visualize things
and that helps them towards abetter precision in surgery,
completeness of surgery, removalof the disease, respecting the
surrounding structures.
There are still challenges inthe fact that again we need
millions of surgery to be putinto algorithm where the machine
(15:37):
can learn how to do the stuffand then can do it accurately.
And there is an ethical facet ofthis.
What if the machine tells youthat this is the stuff here and
it was on a different side?
So uh it should be always abalance of technology and the uh
the contribution of the surgeon.
SPEAKER_00 (15:58):
Right.
SPEAKER_01 (15:59):
Because we cannot trust blindly technology,
especially when we do invasiveintervention.
Yeah.
It's helpful, it's good, but wehave to create a lot of caution
into blindly trusting.
And this is what I see, and thisis what I see more people now
not utilizing the traditionalthinking method versus
(16:20):
everything, go chat GPT.
Go and that leads to you knowlosing the ability to assess,
analyze on the longer term, andmaybe not, maybe I'm mistaken,
but at this point I would bevery cautious about the newer
technology.
Yet I would embrace them and trythem and see the value because
(16:41):
everything has value in what wedo, but we need to extract the
value to fit our patients' care.
SPEAKER_00 (16:47):
Right.
It's a tool.
SPEAKER_01 (16:48):
Yes, it's a tool.
SPEAKER_00 (16:50):
Like and I think of that, you know, it can be a
really good tool, but you stillhave to put the work in.
You know, I I always think aboutChat GPT, and I'll be like, I
was really good at writingpapers, and then Chat GPT came.
And if the less you do it, theless you recall and are able to
do it on your own.
So there is risk with doingthat, solely counting on
(17:14):
something that isn't 100%accurate.
Leaves room for error, just likehuman error.
SPEAKER_01 (17:19):
Yeah.
SPEAKER_00 (17:19):
It's just a computer human.
SPEAKER_01 (17:21):
So no, it's like stimulation of the brain is
always an important thing.
SPEAKER_00 (17:26):
Yes, it is.
Because we've talked aboutbetter tools, removing
endriosis, but what aboutradical new ways to actually
reprogramming or curing thedisease?
This is a hot topic that I thinkpeople don't really want to
touch.
But also, there's a lot ofpapers out there that could be
either misleading or give falsehope.
(17:49):
And so I want to touch on thisbecause we want to cure, right?
Like this is how we as humanswork.
We want to cure, we want it tobe better.
Where are we in that direction?
What's the science behind thereprogramming?
SPEAKER_01 (18:03):
If we look now at the status today, what is the
treatment of randomitiosis?
Excision surgery that helpsremoving the disease, yet it
doesn't cure, disease can recur.
Hormones, which can suppress thesymptoms, slow down the disease
in some patients, but alsowhenever you stop them,
(18:25):
everything gets back to worsethan before.
Now the concept of lesionreprogramming emanates from the
fact that what if we can changethe behavior of endometriosis
rather than it's a tremendousinflammation, it causes
infiltration of other tissue,make it a benign cell that will
(18:46):
not do any of that stuff or willnot grow or will not infiltrate
or will not cause pain.
That's this uh the uh scientificuh stuff.
And it's extremely appealing.
Now, in order to reprogram thebehavior of any cell, including
endometriosis cells, you needeither to modify the genetic of
(19:06):
the cell or the epigenetic ofthe cell, or the environment
where the cell thrives.
And these modification um we cansee that some attempts have been
done on immunomodulators forendometriosis because we know
there is an immunologic uh uhimmunologic dysfunction and its
(19:30):
impact on endometriosis uhgrowth and cells.
So immunomodulating and therehave been trials on those
immunomodulators with variableuh results for the epigenetic or
genetic expressions, this willbecome a little bit you know,
cloudy.
Right because um you go back tothe COVID vaccine.
(19:55):
The COVID vaccine was a need inan urgent situation.
Where nobody knew what's goingon.
And now we know.
Now if you ask in 2020, 100people, 95 will take the COVID
vaccine.
In 2025, if you ask the same 100people, 5% will take the
(20:16):
vaccine.
Because of we realized doingthose genetic or epigenetic
interventions created far moresequally than what we believe
to.
Now we have the chronic fatiguesymptoms, we have the
vasculitis, we have the longCOVID, we have a lot of issues
that we didn't gauge and wedidn't expect it to happen.
SPEAKER_00 (20:39):
Right.
SPEAKER_01 (20:40):
And these kinds of interventions are still more on
animal models, but again,translation of the information
from animal models might notfeed the human models.
Many times in many of thestudies.
So I think as of yet, there isnothing really serious.
(21:01):
There have been attempts to doon cells in mice or animal
models to try to create thatreprogramming.
But most of the targets areworking on genetic, epigenetic,
and immunologic, and we don'tknow the long-term sequelae of
these studies.
So it's it's it's veryappealing, a very sexy concept
(21:25):
that appeals and gives hope to alot of patients.
I'm sure one day we'll reach outto some form of a therapeutic
approach like this.
SPEAKER_00 (21:33):
Right.
SPEAKER_01 (21:35):
But uh nothing is serious right now, or nothing is
extremely promising.
SPEAKER_00 (21:42):
So we're not that close compared to what some
people might say.
SPEAKER_01 (21:46):
The speed of uh things evolving in this world
are uh mind-boggling.
So I don't know how close it is,but as of now, the evidence does
not support any real progress onthis.
SPEAKER_00 (21:58):
Interesting.
Do you talking about COVID?
Because I think that a lot ofpeople with long COVID are now
seeing symptoms worsen.
Have you experienced that?
Or is there anything that showsthat COVID had an effect on
those with endometriosis?
SPEAKER_01 (22:15):
Because I know this is gonna be a hot topic and I'm
going off script, but there area lot of studies that showed
that the COVID or even the COVIDvaccine did increase the uh
disease burden of endometriosispatients and the pain for
endometriosis patients.
And then it's it's an extremelycomplex situation because during
the COVID, there is a high levelof stress for everybody.
SPEAKER_00 (22:37):
Right.
SPEAKER_01 (22:37):
And we don't know whether it's a direct causality
by giving the vaccine or doingthe COVID.
But the vaccine also induces animmune response to create the
immunity.
And that immune response, itmight alter further the immune
dysfunction that is alreadypresent and promote further
(22:59):
inflammation and worseninflammatory disease.
Because we see a lot of patientsthat have joint pain increase,
they have more vasculitis.
So that means it's a progenitorof inflammation in the body, and
that is more seen in patientswho have an immune dysfunction.
SPEAKER_00 (23:18):
Yeah.
SPEAKER_01 (23:18):
Because it's a massive reaction.
Whenever you take a vaccine, youhave fever, you have chills.
Some patients experience a lotof inflammatory symptoms.
And then in patients with immunedysfunction who have
endometriosis, who have lesionsthat strive or thrive on um
inflammation, that helpsworsening their inflammation and
(23:41):
then their symptoms indirectly.
SPEAKER_00 (23:43):
It's crazy how we never really think about just
how complex endometriosis can bewith every environmental factor
too.
Whether it's stress, whetherit's the air we breathe or the
things that we take, or youknow, we've talked so much about
that, but I think that we can'tcontrol all of these things.
What we can control are the waysthat we address them.
(24:05):
And that I think is going tomaybe hopefully improve as time
goes on.
But I do, I mean, care andprevention for endometriosis
takes greater understanding.
And I think that's where when wetalk about this, I think that
patient movements a lot of timesare what's going to push
endometriosis care andimprovement and research because
(24:29):
it's already did and it willcontinue to because we we're not
silent anymore.
We have platforms and we'reexpecting more, demanding more,
not only from providers, butalso I think just our health
systems.
And I think we're seeing thiswave of people that are are
tired of feeling the way theyfeel.
And as a patient, I can tell you100% I am tired of feeling the
(24:52):
way I feel half the time.
So you do something about it.
We're not silent anymore aboutthat.
How do you think that's going tochange the research to
potentially find maybe not acurative measure, but maybe a
way to help prevent growth ofendometriosis and its severity?
SPEAKER_01 (25:11):
Definitely, there is a lot of uh gaps in the research
in endometriosis.
So we can start from themechanisms of how endometriosis
we only know bits and pieceshere and there.
SPEAKER_00 (25:24):
Right.
SPEAKER_01 (25:25):
So further research about the mechanistics helps us
understand the therapeutic ofendometriosis.
SPEAKER_00 (25:32):
Yeah.
SPEAKER_01 (25:32):
If we understand more how the disease is formed,
how does it affect, helps usunderstand how to target the
therapeutic approaches?
Another important gap is alwayswe look at endometriosis as a
whole disease and we fail tosubtype it.
So that would become a hurdlefor personalized treatment.
SPEAKER_00 (25:53):
Right.
SPEAKER_01 (25:54):
You do have endometriosis, okay?
And she does have endometriosis,but what's the difference
between you and her?
SPEAKER_00 (26:02):
Right.
SPEAKER_01 (26:03):
You have the same name, right?
But completely differentapproaches of treatment,
completely different impact ondifferent systems.
So failing to subtypeendometriosis or to understand
the phenotypes of endometriosiswill uh continue to carry a lot
of confusion from the medicalcommunity and from the patient's
(26:25):
understanding.
So this is something asimportant also to research.
The other thing is we alwayslook at endometriosis from the
window of fertility or pain.
And then this means we'renarrowing our understanding of a
multisystemic beyond disease.
Right.
(26:45):
Everybody talks about how we canintervene to improve
infertility, but nobody talksabout what are the impact or
mechanism of impact ofendometriosis on infertility.
SPEAKER_00 (26:57):
Yeah.
SPEAKER_01 (26:58):
Because we're treating the symptoms, we're not
treating the root cause.
Again, we're looking atendometriosis as a disease that
requires surgery, but we fail todo studies for patient-reported
long-term outcome and impact onquality of life.
It's beyond pain during sexpain, pelvic pain, pain during
during pain.
What about the bloating?
(27:19):
What about the headaches?
What about the uh excessive bodyweight?
What about the fatigue?
SPEAKER_00 (27:24):
Right.
SPEAKER_01 (27:25):
Nobody in the studies study those as a primary
outcome.
Always, most of the studiesstudy pain fertility.
So, this is another thing.
Uh major gap also in theresearch is how can we train
people to be able to take careof the disease?
How can we find solutions forearly diagnosis?
(27:46):
How can we use technology,biomarkers to help us do
non-invasive?
Also, about the therapeuticapproaches of endometriosis, can
we think in a different way?
SPEAKER_00 (27:57):
Yeah.
SPEAKER_01 (27:58):
Can we start thinking based on a molecular
level, targeted therapy,cellular therapies?
So all these kinds of things, alot of gaps in holistic
approaches to endometriosis inresearch.
SPEAKER_00 (28:09):
Right.
SPEAKER_01 (28:10):
Patients tell you, I've done an anti-inflammatory
diet, my symptoms improved.
The gut microbiome had itsimpact, the total body
microbiome.
For me, it is trying to, when westart to understand the
microbiome, we understand thatthere is a value of the uterus.
SPEAKER_00 (28:27):
Right.
SPEAKER_01 (28:28):
And the uterus have a microbiome.
And there's a value for theappendix if it's not affected.
SPEAKER_00 (28:34):
Yeah.
SPEAKER_01 (28:34):
The appendix controls most of the microbiome
in the abdomen.
It's not every endometriosepatient, I go remove the
appendix.
SPEAKER_00 (28:41):
Right.
SPEAKER_01 (28:42):
So these approaches that were practiced more could
lead to uh with poor research,could lead to unnecessary
interventions and theniatrogenic disruptions because
sometimes we do cause harm if wedon't understand what's the
value of doing things.
SPEAKER_00 (28:59):
Yeah.
SPEAKER_01 (29:00):
The medications that we prescribe for endometriosis
patients, we need to see how itimpacts the whole ecosystem.
SPEAKER_00 (29:06):
Right.
SPEAKER_01 (29:07):
So there are a lot of research gaps.
Pain.
Nobody understands the pain.
No.
And there is an extremely poorunderstanding of the pain from
endometriosis, from differentlesions, from the heterogeneity
of the locations.
How does the pain uh is impactit?
So this is why it saddens youwhere you see a disease that
(29:30):
affects 10% of female patients.
And yet the huge gap in researchand funding and understanding is
mind-boggling, is jaw-dropping.
It's just like God.
SPEAKER_00 (29:43):
Well, and also like we if you if you look at the gap
in research, even for those withhormone imbalance, they don't do
it's a tricky thing to doresearch on people who have
fluctuating hormones all thetime.
SPEAKER_01 (30:00):
Of course.
SPEAKER_00 (30:01):
So how much does I mean I would be curious to see
how much the standard of carewhen it gets to the hysterectomy
and how, you know, for those whoare not maybe as experienced
with endometriosis, they'll do ahysterectomy, euphorectomy.
Then you have this hormonalimbalance.
So how much does that affect thewhole system and the microbiome
(30:22):
and everything else?
And there's just not a lot outthere.
SPEAKER_01 (30:26):
Um it saddens me a lot, um, especially in some
countries.
I'm not gonna name the countrybecause they won't know
themselves.
They still offer ophorectomywhile they do hysterectomy.
SPEAKER_00 (30:39):
Yeah.
SPEAKER_01 (30:41):
Despite the recent solid studies, that surgical
menopause or removal of theovary during surgery does not
only impact.
I'm not gonna talk about the hotflashes and the bone density,
but I will talk, it impacts thelifespan of a patient's patients
(31:01):
with surgical ophorectomy diesearlier.
I'm committing a patient todying early by just doing an
elective ophorectomy.
Like if you have cancer, weunderstand.
If you have irreparable ovary,completely damaged ovary, we
understand.
But we should all strive to keepeven a piece of ovary or a total
(31:23):
ovary.
SPEAKER_00 (31:24):
All of it if you can.
SPEAKER_01 (31:25):
Yes, yeah.
So this is the thing.
We still take things because wewe learned how to do that from
outdated guidelines that have noplace in the recent medicine or
the recent therapeuticapproaches to patients with
endometriosis.
SPEAKER_00 (31:42):
It's crazy.
What is the in your mind?
What are the risks ofover-treating and over too many
surgeries?
Like what are some of thebiggest risks associated with
that?
Because I mean, this is a bigtopic that we don't have to get
all the way in, but I reallyfeel like people are going back
for reoccurring surgeries.
They have, you know, treatmentafter treatment after treatment
(32:04):
of hormones or whatever the caseis.
I mean, there's let me statesome facts.
SPEAKER_01 (32:09):
30%, and that might be shocking for a lot of uh
patients.
Uh, 30% of patients withendometriosis have persistent
pain after their surgery.
SPEAKER_00 (32:19):
Yeah, I believe.
SPEAKER_01 (32:20):
It's like one-third.
Why?
It's not always how we say it'san incomplete surgery.
SPEAKER_00 (32:26):
Right.
SPEAKER_01 (32:26):
It could be musculoskeletal, it could be
pain pathways, it could behypermobility, it could be some
other factors that arehelp-producing or generating the
pain.
I'll give you a scenario.
When a patient has persistentpain, the surgeon cannot
understand that pushes thepatient to seek care from
another surgeon.
(32:47):
The lack of experience, the poorunderstanding of the disease
lead to premature anothersurgery.
Repetitive surgery in manyinstances causes more damage,
more scarring, more irreversibledamage.
For me, I'm happy every day todo a stage 17 endometriosis
versus to do a stage threeendometriosis that somebody
(33:10):
operated on incompletely.
SPEAKER_00 (33:12):
Yeah.
Yeah.
SPEAKER_01 (33:14):
It's a disaster because like people start
something, don't finish it, theycreate overscarring in the
presence of the inflammatorydisease that is persistent in
addition from the inflammationof surgery.
So all these lead to multipleunnecessary surgery.
The complexity andmulti-systemic facet of the
(33:36):
disease creates a lot ofsymptoms that could be brushed
under the endometriosis umbrellathat are not belonging to
endometriosis.
Maybe you have a herniated disc.
It doesn't mean that the lowback pain that you have is from
endometriosis that resists aftersurgery.
SPEAKER_00 (33:56):
Yeah.
SPEAKER_01 (33:58):
So this is something.
There is an immune and systemictotal body dysfunction, and it
produces symptoms like wediscussed the bloating.
Patient think they continue tohave bloating after surgery
because first in the uh healingperiod the doctor tells them
this is normal after surgery,but then after six months, they
think endometriosis recurs.
SPEAKER_00 (34:19):
Right.
SPEAKER_01 (34:20):
Setting the expectation for patients in the
presence of the uterus, even ifthe uterus is not affected, a
lot of the time the uterus is amuscle that needs
rehabilitation.
That's why pain during the firstthree, four periods is still
persistent because the uterus isa muscle is cramping and it's
tender and it's been crampingfor years.
(34:42):
It's not gonna uh resolve aftersurgery.
So having a period pain three,four months after surgery, is
not a signal of persistence ofthe disease.
SPEAKER_00 (34:51):
Right.
SPEAKER_01 (34:52):
Now, what created that whole thing is the mistrust
that happened between the caringand the patient, the caring
provider and the patient.
Because there is a mistrust, andthere is also circulating a lot
of misinformation thatindirectly or directly gaslight
(35:14):
the patient that push them toseek hope or false hope
somewhere else.
SPEAKER_00 (35:22):
Yep.
SPEAKER_01 (35:22):
Saying, oh, I'm a better surgeon, I'm great at
what I do, my patients are curedwhen I do surgery, I have zero
recurrence rate.
And that's why exploiting thevulnerability of endometriosis
patients by selling them falsehope is one of the social media
perpetuated novel ways ofgaslighting and should be a
(35:46):
medical crime in that sense.
So providing education,providing empowerment, providing
help to patient support,creating strategy is what
prevents this kind of fragmentedcare, silo care, no multiple
provider, isolated care.
And the uh caring should be inspecialized endometriosis
(36:11):
centers because it's such acomplex disease with a major
impact on the quality of life.
SPEAKER_00 (36:18):
Yeah, I agree.
I I think that exploitingpatients is egregious.
It's it's not okay.
But I do see everything, youknow, we've talked about the
whole system, the whole body,the AI, everything, how it works
together.
And I think what I want peopleto understand is there is hope.
We are progressing, and it isgood to be knowledgeable because
(36:41):
I think that it will help younavigate your own journey, but
it'll also hold those doctorsmore accountable the more
knowledgeable the patients areas well.
SPEAKER_01 (36:49):
It's sad that we have to be more knowledgeable in
a lot of ways, but understandingknowledge is power,
understanding your body,understanding what might be
causing.
Uh you know, when you do anyintervention on a patient, there
is something called informedconsent.
Yes.
And I know my friend uh Jefftalks about it a lot, and I I uh
(37:10):
value a lot the messaging thathe sends.
Informed consent is just is notjust vomiting complication risks
or the intervention sideeffects.
Informed means giving the rightinformation, the total
information for the patients tohave the ability to decide
what's best for her.
(37:32):
Not what's best for me as aprovider, what's best for her.
So an informed is not hiding orsidelining information that
might impact the approval of apatient for this procedure or
another procedure or thistherapeutic tool or another
therapeutic tool.
So that's why giving the patientthe knowledge, patients are
(37:53):
wise, they can decide what'sbest for them at this point of
time.
SPEAKER_00 (37:58):
Yep.
SPEAKER_01 (37:58):
Some patients cannot do surgery tomorrow or next
month.
Some patients have socialcommitment, work commitment.
They want to manage their lifeuntil they become ready for
surgery.
So we should be able totroubleshoot their life during
that period of time with them.
SPEAKER_00 (38:17):
Right.
SPEAKER_01 (38:18):
So there are nothing is simplified in endometriosis
care, considering the disease isvery complex.
But I don't like the fact thatpatients should find their care,
their cure.
I think it's our ethicalobligations as doctor to help
(38:39):
them and guide them through thatroute.
And you should not be a doctor.
Right.
You came to a doctor because hespent his time studying and
doing this thing so you can getthe best care that you believe
you should get.
It's not your job to go researchand Google and Chat GPT, your
therapeutic approaches, and thenfigure out what's going on with
(39:02):
you.
It's my obligation to understandthis.
And this is the the pendulumswung the other way.
SPEAKER_00 (39:09):
Yeah.
SPEAKER_01 (39:09):
And I think it's about time to balance the
pendulum.
You're a patient, we empoweryou, we inform you, we take care
of you, we give you the highestquality of care.
And then you have some homeworkto do in taking care of
yourself.
I see a lot of time trying tohelp patients.
What is a good surgeon?
Who is an endometriosis exercisespecialist?
(39:30):
It's extremely important toeducate patients.
We're trying to work from thebasis because this should, in an
ideal health system, this shouldnot happen.
SPEAKER_00 (39:39):
Right.
SPEAKER_01 (39:40):
Everybody should have the qualities and the
skills and everything to helpguide the patients and
understanding.
And that only comes fromcreating that paradigm shift
that has started with advocacygroup and then carried by
knowledgeable doctors that canhelp spreading the information.
Information and create researchand studies to further our
(40:04):
understanding of the disease andthen this way establish a newer
standard of care forendometriosis patients that
would lead to a better outcome.
SPEAKER_00 (40:12):
Yeah.
It's kind of like having it, youknow, I always say we're the
ones paying you, right?
Like we're not gonna pay acontractor on our house and then
go build the house ourselves.
Yes.
Like that doesn't really make alot of sense, right?
We might have input on how it'sbuilt.
We might have input on what wewant out of it, and that's how
(40:33):
it should be.
But if you let me build a house,it's not gonna look pretty
because I don't have the bestinformation.
I don't, I don't know how to doall of that stuff, like what the
specifications should be.
But I do think being a team withyour provider is key.
But you know, one of the thingsI've always said is there's a
(40:53):
lack of curiosity with a lot ofdoctors.
And time.
SPEAKER_01 (40:59):
It's a result, it's a result of the healthcare
system.
How is it created?
It's a volume-based.
The more you see, the more youmake, the more the health system
makes, you know, so it's it's uhalso a broken circle that needs
a major reform, the healthcare,because it pushes patients to
(41:19):
chase the numbers rather thanthe quality of care.
Yes.
And then uh when I spent an hourand an hour and a half with the
patients on her first consultwith endometriosis, I could
never do that in a universitysetting or where you know you
have to spend 10, 15 minutesbecause you have to see 100
patients.
And that that does not work, uh,you know.
(41:42):
So I don't I I think there is alot of blaming to doctors.
SPEAKER_00 (41:46):
Yeah.
SPEAKER_01 (41:47):
Uh, but I think we have also to reform the
healthcare system.
SPEAKER_00 (41:51):
Yeah.
SPEAKER_01 (41:51):
To allow doctors, yesterday we were talking about
something really uh uh touch medeeper when now uh healthcare
practices will tell the doctoryou cannot do surgeries more
than an hour or a certain numberof time.
And I and I was telling you,this is some of the most
dangerous practices because thatlead to incompleteness of
(42:12):
surgery, that lead torecklessness, that increases the
stress, increases the surgicalmistakes of a surgeon when they
have a time limit.
These are really very egregiouspractices that some of the
healthcare systems are pushingamong doctors.
SPEAKER_00 (42:27):
Yep.
And it's more expensive.
If you think about it, it's it'smore expensive for the patient,
it's more expensive for thehospital system.
I mean, it's a reactive, not aproactive approach.
And we all know that if you'rereactive, outcomes typically
aren't as great as if you'reproactive, right?
And so I think healthcare hasbecome so reactive, such a
(42:48):
band-aid in so manycircumstances that it's really
hard for a patient to feel seenin that 15-minute appointment,
that 45-minute surgery, and toreally have a better quality of
life.
Not to say that the surgeonsaren't good, but to say that
they are very limited by whatthey're given.
SPEAKER_01 (43:06):
And another shocking percentage, do you know, is uh
looking at the literature, 30 to50 percent of endometriosis
surgeries are unnecessary.
SPEAKER_00 (43:16):
I believe it.
SPEAKER_01 (43:17):
So whenever I see patients that have 15 surgeries,
you know, uh it's it's shockingfor me.
Yeah.
Imagine 15 times you put yourpatient at risk for poor
understanding.
I understand the recurrence ofendometriosis, and recurrence is
2.9% in experts and 8.9% forendometriomas.
(43:39):
That does not push one patientto have 15 surgery if you do the
math.
Having 15 surgery mostly isbecause of the misunderstanding
of the disease, is thefragmented care, is uh because
of the incompleteness of thesurgery, the poor uh
understanding of pain pathwaysand understanding how the
(44:00):
disease affects or creates a lotof symptoms.
SPEAKER_00 (44:03):
Yeah.
You know, and that's somethingthat I always tell people when
they come to me and they ask mequestions about endometriosis.
I'm still in pain, I'm lookingat having another surgery.
I always ask them, are therethings that you have done to
help support your body to thispoint?
Are you seeing a pelvic floorphysical therapist or a physical
therapist in general?
(44:24):
Have you done little exercisesthat help support your body?
Because I know for me that ifmovement is power, it's
exhausting, and if you overdoit, it's not good.
But if you have good movement,it really helps a lot of that
pain.
You know, it gets us out of thatpain cycle a lot of times.
And so I always caution peopleto not think surgery first all
(44:48):
the time, because it's a bigdecision with big outcomes
potentially.
You know, it it's certainly ahelpful tool and it's definitely
a way that we can address thedisease, but again, is it always
the disease or is it somethingelse?
You know?
I mean, that's just what I'velearned in my journey.
It's not always the disease.
(45:09):
There's other facets of thisdisease and other chronic
illnesses that play with it.
So where do you see yourself inthe next 10 years progressing
endometriosis?
SPEAKER_01 (45:21):
Hopefully, I'm retired.
No, uh I will continue.
I still enjoy a lot challengingthe challenges, surgical
challenges, the difficult cases.
Uh, I think I will continue todo my research.
I do we do a lot of researchabout endometriosis.
Uh, the other thing I I loveeducating surgeons,
(45:43):
standardizing technique forendometriosis surgery, and
probably when I retire fromclinical activity, I would like
to continue this the educationside, the research side, the
understanding side, because thisuh is is good for me and for my
uh speedy brain all the time.
(46:03):
I think individual efforts toimpact communities, whether in
surgeons, whether in patients,something that I uh enjoyed
doing for the past years and Iwill continue to enjoy doing
because if I can teach morepeople to fish, I don't need to
fish for them.
SPEAKER_00 (46:21):
Yeah.
SPEAKER_01 (46:21):
In the sense when we help or we train or we teach one
another, uh the impact will growway fast way faster through
these, hoping we can come to abetter standardization, better
utilizing the resource toprovide better care beyond the
negativity, the toxicity, thegaslighting, the things that are
(46:45):
currently happening, whether ona healthcare system, whether on
surgical skills system, whetheron research and understanding
basis.
So all these will come together.
I think this is a passion andyou cannot retire from a
passion.
You can retire from certain jobsor exercises, but uh the passion
will remain there.
(47:06):
It was grown, it's really hardwhen you set the fire.
Sometimes it's hard to uh turnit down.
SPEAKER_00 (47:12):
I mean, you're really good at it.
You're really good at theeducation, so you can't stop.
From a personal perspective.
SPEAKER_01 (47:20):
Hopefully, I I want to spend time with my kids, my
family.
This is this is also importantuh because uh this takes uh a
lot of toll uh on you.
Caring for endometriosis isalmost very similar to having
endometriosis on the impact onsocietal relationship.
(47:40):
You lose a lot of friends bybeing on the road trying to
educate, you uh uh miss yourfamily a lot.
So at one point we need to passthe torch for the younger that
will help pushing things waybeyond what we've done, and
that's the purpose of educationto identify, create surgeons,
(48:02):
champions, not surgeons.
They could uh understand betterthe disease and create that
impact more on the uh value ofcare they provide for their
patients.
SPEAKER_00 (48:12):
Yeah.
Well, I hope that you don't stopthat anytime soon because I hope
so.
Because we need that.
And thank you for taking thetime to do exactly what you said
you would do in coming out hereand spending this quality time
with us and allowing me to pickyour brain and be educated about
this and sharing that with somany other people.
(48:34):
This will help impact thoseliving with endometriosis to
better understand.
I am excited to see what's next.
We'll do it together.
If this episode helped rechargeyour indo battery, please take a
moment to like and subscribe onYouTube.
It really helps others in ourcommunity find these resources
(48:57):
too.
And if you're listening on apodcast app, leave a quick
rating or a comment to show whatresonated with you.
Every bit of engagement helps usreach more people living with
endometriosis and chronicillness and reminds them they're
not alone.
Until next time, continueadvocating for you and for
others.
Welcome to Indobattery, where I share my
journey with endometriosis andchronic illness while learning
and growing along the way.
This podcast is not a substitutefor medical advice, but a
supportive space to providecommunity and valuable
information so you never have toface this journey alone.
We embrace a range ofperspectives that may not always
align with our own, believingthat open dialogue helps us grow
(00:23):
and gain new tools.
Join me as I share stories ofstrength, resilience, and hope,
from personal experiences toexpert insights.
I'm your host, Alana, and thisis Indobattery, charging our
lives when endometriosis drainsus.
Welcome back to Indobattery.
Grab your cup of coffee or yourcup of tea and join me at the
(00:46):
table.
Today's guest is someone who'struly changing the landscape of
endometriosis care.
Professor Gabby Mawad is aglobally recognized leader in
robotic surgery andendometriosis management.
He's a board-certifiedgynecologic surgeon and the
founder of the Center forEndometriosis and Advanced
Pelvic Surgery in Washington,D.C.
(01:07):
Dr.
Mawad has dedicated his careerto advancing minimally invasive
and robotic techniques,combining surgical innovation
with deep, compassionate,patient-centered care.
As director of roboticgynecologic surgery and
associate professor at GeorgeWashington University, he's
trained surgeons worldwide andhelped redefine how we approach
(01:29):
complex pelvic disease.
He's been named Top Doctor inWashington, D.C.
for nearly a decade and hasauthored over 125 peer-reviewed
publications leading globalconversations on endometriosis
and surgical innovation.
It's an honor to sit down andwelcome a true pioneer and
(01:49):
advocate for better outcomes forwomen everywhere.
Please help me in welcoming Dr.
Gabby Moad.
Thank you, Gabby, for sittingdown with me today and coming
all the way to spend time withus.
SPEAKER_01 (02:02):
I want to thank you and thank you for all the work
you do.
It's great that we have advocacygroups like you being able to
change the paradigm in patientsunderstanding and patient
education.
SPEAKER_00 (02:13):
We're going to look ahead at technology because this
is something that you'veexplored significantly.
The tools and how they'vechanged and plans for surgery
and how diagnosis is going tochange.
So, AI and diagnosing, this hasbeen a hot topic.
SPEAKER_01 (02:28):
No, no, I think we're at the infancy of AI
impact on our daily life, eventhough it's making a tremendous
progress.
In endometriosis specifically,there are a few alleys that were
exploited by AI.
The first one that I can talkabout is the imaging.
The identification of theendometriosis lesions through
(02:50):
machine learning can helpdiagnosing endometriosis.
And then there are some studiesthat showed the accuracy is as
much as expert.
The other area where it's beenworked upon is the biomarkers.
The biomarkers, either throughgenetic or epigenetic or even
products of the disease, arehelping us to try to understand
(03:15):
new ways of diagnosingnon-invasive endometriosis.
For example, there is a coupleof tests that have been
developed.
They work on microRNA, which isa portion of the expression of
the gene.
And then they use artificialintelligence to try to stratify
the severity of endometriosisand the phenotype.
(03:36):
And this has been done throughblood, through menstrual fluid,
through saliva recently.
So again, this is another thing.
A lot of algorithms have beendeveloped by combining patient
symptoms, patient history, someof the imaging and lab results
to create a stratification ofthe risk, and then that will
(03:59):
make patients be referredearlier to a specialist and try
to shorten the diagnosis length.
Now it's all great, and I thinkthe future will be going through
that direction, but at thispoint, most of the studies
they've been done, they've beendone on you know homogeneous
populations.
So it's it's extremely hard togeneralize it.
(04:21):
And they've been done ondifferent complexity of a
disease.
So again, we still need longer,more longitudinal studies to
understand the impact and theaccuracy of those studies.
In addition to that, likemachine learning behaves through
neural networks.
So whatever information you feedthem, they will come up with the
(04:43):
value or result.
If you feed them badinformation, they're gonna come
up with a bad result.
So bad data in, bad data out,there's no magic.
The other concerning thing inmost of the um the machine
learning experiences, there issomething what we call black box
in machine learning.
(05:05):
So you give them theinformation, but you don't
understand how they came up withthe result.
And the result through thoseneural networks, they function,
or mathematical algorithm, wearrive to a result that would be
extremely difficult to explainit clinically.
So we still need a lot tofurther our understanding in
(05:28):
machine learning and artificialintelligence.
But I think the this field ismoving way faster, and we can
tell in our real life, nobodygoogles anymore, everybody chat
GPT, anything they want.
So we should look at itconsidering we are the first
protector of patients, right?
As doctors or surgeons.
(05:50):
We need to analyze carefully theinnovation and its impact on our
patients, uh, and it's ourethical obligation to do that.
So we don't want to jump intotechnology very quickly, yet we
don't want to miss the value oftechnologies to help us better
the care for our patients.
SPEAKER_00 (06:09):
How do you think this is gonna change the
learning for doctors?
How do you think this is gonnachange how they identify, treat,
acknowledge endometriosis?
Because I think, you know, theold method of you go to medical
school, you learn out of a book.
I do think that new doctorscoming up are more curious.
(06:30):
They're hearing more, they'remore is accessible to them.
But how do you think this isgonna change that for them and
potentially the future outcomefor endometriosis patients?
SPEAKER_01 (06:40):
I think now we struggle with the uh delayed
diagnosis in an endometriosispatient.
That's gonna help shortening thetime from diagnosis to
intervention.
And this is an extremelyvaluable way because during that
longer period of time, which invariable study, they say between
seven and eleven years you getdiagnosed with endometriosis.
(07:00):
That lengthier period is theperiod where the patient's body
harbors the disease and createsdamage to the patient's body and
multiple systems.
So if you can shorter that, thatwe can intervene earlier and
help managing and prevent somesevere diseases that even in the
best hand are extremelydifficult to treat.
(07:21):
In addition to that, that kindof help us analyze big data.
Big data is that they needlonger and strenuous efforts.
Now it's becoming really easierto analyze, and that leads to
deepening our understanding ofthe disease and then uh helping
to generate a generalizablelarger scale studies.
(07:44):
So this is gonna be important inunderstanding the mechanisms of
the disease, in understandingthe different therapeutic
approaches and impacts on thedisease, in subtyping
endometriosis.
We don't talk enough about itbecause not every endometriosis
is the same.
It doesn't behave the samesurgically, it doesn't behave
the same medically, it doesn'timpact the same the patients.
(08:06):
And embracing technology isextremely important for the
younger generation and thedoctors.
Like everything, when youintroduce a disruption in any
field, right?
There will be an earlierfollowers.
They believe in it, they will belate followers, and they will
always be conservative, then thetrain will pass them.
SPEAKER_00 (08:25):
Right.
SPEAKER_01 (08:25):
So the pioneers, early followers are gonna help,
you know, um anchoring ourunderstanding of the disease.
The late followers will trackand then uh this is how
everything will go.
SPEAKER_00 (08:38):
If you had to give a chat GPT prompt to get the best
information, say you're apatient looking for some sort of
diagnosis, what would you do forthat?
SPEAKER_01 (08:48):
Well, I I I try to avoid using chat GPT because I
tested it for multiple things,like even on myself.
SPEAKER_00 (08:55):
Right.
SPEAKER_01 (08:56):
It's like he cites papers that I've never written.
I go look at the paper and Itell him, like, this is not the
paper I've written.
Oh, I'm sorry, this is not I'msorry, but like, oh no, this is
the paper.
So um technology is important.
I use consensus, which for meit's a it's a great tool because
(09:16):
consensus, you can go and typeanything, and it will summarize
the whole body of literature,thousands and thousands of
articles about something.
So that helps me even moreunderstanding things.
Right.
Like uh last time I was doing uha presentation on the recurrence
of endometriosis, and then Icould go and then they will
(09:38):
stratify it and create an a verygood understanding, but this is
summarizing the literature rightnow.
Again, I believe that thosetools are still at their infancy
and there will be more and moredevelopment in those tools.
But I caution a lot of patientsas much as it is easier to use,
fact-checking is alwaysimportant.
(10:01):
Because even when you say, Oh,give me uh the site, some
papers, literally their sitepaper, I go check them.
SPEAKER_00 (10:08):
Right.
Yeah.
Well, I mean, if you it'sinteresting because we we did
this experiment, if you will, ofexplain endometriosis, define
it.
And it actually gave us likefour different definitions.
SPEAKER_01 (10:22):
Yes, yes.
SPEAKER_00 (10:23):
And so I think it really that's where I'm like, I
I'm a little hesitant toimplement those things.
SPEAKER_01 (10:29):
Especially when you when you want to do if it for
fun, you're you know, tell mehow do you make uh I don't know
uh gin vault gin tonic.
What are the measurements?
Yes, that's fine, because at theend, if he misses the ma uh the
recipe, it's okay.
But when you're trying toestablish a therapeutic approach
for a patient, we can't, youknow, blindly trust them and
(10:52):
then start getting the knowledgeand the care for our patients
through algorithm that we don'tknow how they're built, and then
many times they needimprovement.
Gives you an idea.
I think it gives you more of anidea rather than it gives you
100% accurate information.
SPEAKER_00 (11:10):
Yeah.
Mine would just say tequila isthe treatment.
SPEAKER_01 (11:17):
I feel like that would be my but I've learned
like I I have a couple offriends who are very savvy in
the artificial intelligence, andthey told me even the chat GPT
on your phone, you need to talkto them more frequently so they
understand you.
SPEAKER_00 (11:33):
Yeah.
SPEAKER_01 (11:34):
So that's why you feed them information and they
can, it's like a baby.
Yeah.
You teach them things and theycan do it better.
And it's the same thing, whichis scary.
SPEAKER_00 (11:47):
It is scary to think that they can read you so well
after so long.
It is a little scary to thinkabout that.
There's good and there's bad,right?
And we have to take everythingwith with a side of caution.
Of course, you know, which iswhy I don't think that, in my
opinion, you can replace doctorswith AI.
And I think a lot of people areafraid of that.
I think that people think it'scoming sooner than later.
(12:10):
But I don't think that you canreplace humans and the human
touch because that's healing inand of itself.
But then just knowing the skilland the experience and
everything else, I just don'tthink that that's gonna happen
as soon as some may think.
SPEAKER_01 (12:25):
Uh I don't know.
This is for me, I've never feltinsecure of having somebody take
my job.
No, if you're confident in whatyou do, what care you provide,
uh, there will always be the newdoctor, there will always be the
new tool, there will always belike if we look at medicine, 90%
(12:45):
of medicine is common.
10% the challenging, this iswhen it requires more, you know,
expertise.
SPEAKER_00 (12:52):
Right.
SPEAKER_01 (12:53):
But part of the medical treatment or the
healthcare journey, there is amajor part that is emotional.
SPEAKER_00 (13:02):
Yeah.
SPEAKER_01 (13:03):
Because we're human, we have emotions.
The treatment is beyond achecklist.
SPEAKER_00 (13:08):
AI can't give you a warm touch.
SPEAKER_01 (13:11):
And this is why, like if it is for the patient
better care, I'm happy toretire.
SPEAKER_00 (13:19):
That's big of you.
We'll still need you around.
One of the things that we've Idon't know if you've touched a
lot on this, but I think we'veyou did present a little bit on
this is 3D modeling for surgeryspecifically.
How is that going to shift andchange for patients and for
surgeons?
SPEAKER_01 (13:39):
No, um, we started with 3D printing 10 years ago or
so, where we 3D printed themodel, and that has tremendous
value for uh preparation for thesurgery.
Surgeons can see the uh themodel, can see the uh structures
around, they can pre-plan theirsurgery better.
Also, that leads to completenessof surgery and detection of
(14:02):
lesions in some areas where it'sdifficult to rely on the human
eye and then the imaging alone,and also for uh teaching,
teaching the newer doctors aboutthe surgery, but also educating
patients as well.
It's important.
But the 3D printing was costly,it requires a longer period of
time to prepare, and it relies alot on the technician
(14:25):
experience.
Nowadays, that there is mostlythe work is on um trying to uh
virtually 3D print like imagesfrom regular MRI.
So the MRI would be translatedto image color-coded that helps
understanding also the samevalue as 3D, but it's faster now
(14:48):
with the presence of artificialintelligence.
It used to take us two days tosegment an MRI, and now it takes
one minute with AI, and you'llhave a 3D image, and that has
the same benefits, but thefuture and the work that a
couple of companies are doingright now is overlaying those 3D
(15:08):
printed, virtually 3D printed ordigitally 3D printed images into
the surgical field.
SPEAKER_00 (15:13):
Right.
SPEAKER_01 (15:14):
And that helps the surgeon more visualize things
and that helps them towards abetter precision in surgery,
completeness of surgery, removalof the disease, respecting the
surrounding structures.
There are still challenges inthe fact that again we need
millions of surgery to be putinto algorithm where the machine
(15:37):
can learn how to do the stuffand then can do it accurately.
And there is an ethical facet ofthis.
What if the machine tells youthat this is the stuff here and
it was on a different side?
So uh it should be always abalance of technology and the uh
the contribution of the surgeon.
SPEAKER_00 (15:58):
Right.
SPEAKER_01 (15:59):
Because we cannot trust blindly technology,
especially when we do invasiveintervention.
Yeah.
It's helpful, it's good, but wehave to create a lot of caution
into blindly trusting.
And this is what I see, and thisis what I see more people now
not utilizing the traditionalthinking method versus
(16:20):
everything, go chat GPT.
Go and that leads to you knowlosing the ability to assess,
analyze on the longer term, andmaybe not, maybe I'm mistaken,
but at this point I would bevery cautious about the newer
technology.
Yet I would embrace them and trythem and see the value because
(16:41):
everything has value in what wedo, but we need to extract the
value to fit our patients' care.
SPEAKER_00 (16:47):
Right.
It's a tool.
SPEAKER_01 (16:48):
Yes, it's a tool.
SPEAKER_00 (16:50):
Like and I think of that, you know, it can be a
really good tool, but you stillhave to put the work in.
You know, I I always think aboutChat GPT, and I'll be like, I
was really good at writingpapers, and then Chat GPT came.
And if the less you do it, theless you recall and are able to
do it on your own.
So there is risk with doingthat, solely counting on
(17:14):
something that isn't 100%accurate.
Leaves room for error, just likehuman error.
SPEAKER_01 (17:19):
Yeah.
SPEAKER_00 (17:19):
It's just a computer human.
SPEAKER_01 (17:21):
So no, it's like stimulation of the brain is
always an important thing.
SPEAKER_00 (17:26):
Yes, it is.
Because we've talked aboutbetter tools, removing
endriosis, but what aboutradical new ways to actually
reprogramming or curing thedisease?
This is a hot topic that I thinkpeople don't really want to
touch.
But also, there's a lot ofpapers out there that could be
either misleading or give falsehope.
(17:49):
And so I want to touch on thisbecause we want to cure, right?
Like this is how we as humanswork.
We want to cure, we want it tobe better.
Where are we in that direction?
What's the science behind thereprogramming?
SPEAKER_01 (18:03):
If we look now at the status today, what is the
treatment of randomitiosis?
Excision surgery that helpsremoving the disease, yet it
doesn't cure, disease can recur.
Hormones, which can suppress thesymptoms, slow down the disease
in some patients, but alsowhenever you stop them,
(18:25):
everything gets back to worsethan before.
Now the concept of lesionreprogramming emanates from the
fact that what if we can changethe behavior of endometriosis
rather than it's a tremendousinflammation, it causes
infiltration of other tissue,make it a benign cell that will
(18:46):
not do any of that stuff or willnot grow or will not infiltrate
or will not cause pain.
That's this uh the uh scientificuh stuff.
And it's extremely appealing.
Now, in order to reprogram thebehavior of any cell, including
endometriosis cells, you needeither to modify the genetic of
(19:06):
the cell or the epigenetic ofthe cell, or the environment
where the cell thrives.
And these modification um we cansee that some attempts have been
done on immunomodulators forendometriosis because we know
there is an immunologic uh uhimmunologic dysfunction and its
(19:30):
impact on endometriosis uhgrowth and cells.
So immunomodulating and therehave been trials on those
immunomodulators with variableuh results for the epigenetic or
genetic expressions, this willbecome a little bit you know,
cloudy.
Right because um you go back tothe COVID vaccine.
(19:55):
The COVID vaccine was a need inan urgent situation.
Where nobody knew what's goingon.
And now we know.
Now if you ask in 2020, 100people, 95 will take the COVID
vaccine.
In 2025, if you ask the same 100people, 5% will take the
(20:16):
vaccine.
Because of we realized doingthose genetic or epigenetic
interventions created far moresequally than what we believe
to.
Now we have the chronic fatiguesymptoms, we have the
vasculitis, we have the longCOVID, we have a lot of issues
that we didn't gauge and wedidn't expect it to happen.
SPEAKER_00 (20:39):
Right.
SPEAKER_01 (20:40):
And these kinds of interventions are still more on
animal models, but again,translation of the information
from animal models might notfeed the human models.
Many times in many of thestudies.
So I think as of yet, there isnothing really serious.
(21:01):
There have been attempts to doon cells in mice or animal
models to try to create thatreprogramming.
But most of the targets areworking on genetic, epigenetic,
and immunologic, and we don'tknow the long-term sequelae of
these studies.
So it's it's it's veryappealing, a very sexy concept
(21:25):
that appeals and gives hope to alot of patients.
I'm sure one day we'll reach outto some form of a therapeutic
approach like this.
SPEAKER_00 (21:33):
Right.
SPEAKER_01 (21:35):
But uh nothing is serious right now, or nothing is
extremely promising.
SPEAKER_00 (21:42):
So we're not that close compared to what some
people might say.
SPEAKER_01 (21:46):
The speed of uh things evolving in this world
are uh mind-boggling.
So I don't know how close it is,but as of now, the evidence does
not support any real progress onthis.
SPEAKER_00 (21:58):
Interesting.
Do you talking about COVID?
Because I think that a lot ofpeople with long COVID are now
seeing symptoms worsen.
Have you experienced that?
Or is there anything that showsthat COVID had an effect on
those with endometriosis?
SPEAKER_01 (22:15):
Because I know this is gonna be a hot topic and I'm
going off script, but there area lot of studies that showed
that the COVID or even the COVIDvaccine did increase the uh
disease burden of endometriosispatients and the pain for
endometriosis patients.
And then it's it's an extremelycomplex situation because during
the COVID, there is a high levelof stress for everybody.
SPEAKER_00 (22:37):
Right.
SPEAKER_01 (22:37):
And we don't know whether it's a direct causality
by giving the vaccine or doingthe COVID.
But the vaccine also induces animmune response to create the
immunity.
And that immune response, itmight alter further the immune
dysfunction that is alreadypresent and promote further
(22:59):
inflammation and worseninflammatory disease.
Because we see a lot of patientsthat have joint pain increase,
they have more vasculitis.
So that means it's a progenitorof inflammation in the body, and
that is more seen in patientswho have an immune dysfunction.
SPEAKER_00 (23:18):
Yeah.
SPEAKER_01 (23:18):
Because it's a massive reaction.
Whenever you take a vaccine, youhave fever, you have chills.
Some patients experience a lotof inflammatory symptoms.
And then in patients with immunedysfunction who have
endometriosis, who have lesionsthat strive or thrive on um
inflammation, that helpsworsening their inflammation and
(23:41):
then their symptoms indirectly.
SPEAKER_00 (23:43):
It's crazy how we never really think about just
how complex endometriosis can bewith every environmental factor
too.
Whether it's stress, whetherit's the air we breathe or the
things that we take, or youknow, we've talked so much about
that, but I think that we can'tcontrol all of these things.
What we can control are the waysthat we address them.
(24:05):
And that I think is going tomaybe hopefully improve as time
goes on.
But I do, I mean, care andprevention for endometriosis
takes greater understanding.
And I think that's where when wetalk about this, I think that
patient movements a lot of timesare what's going to push
endometriosis care andimprovement and research because
(24:29):
it's already did and it willcontinue to because we we're not
silent anymore.
We have platforms and we'reexpecting more, demanding more,
not only from providers, butalso I think just our health
systems.
And I think we're seeing thiswave of people that are are
tired of feeling the way theyfeel.
And as a patient, I can tell you100% I am tired of feeling the
(24:52):
way I feel half the time.
So you do something about it.
We're not silent anymore aboutthat.
How do you think that's going tochange the research to
potentially find maybe not acurative measure, but maybe a
way to help prevent growth ofendometriosis and its severity?
SPEAKER_01 (25:11):
Definitely, there is a lot of uh gaps in the research
in endometriosis.
So we can start from themechanisms of how endometriosis
we only know bits and pieceshere and there.
SPEAKER_00 (25:24):
Right.
SPEAKER_01 (25:25):
So further research about the mechanistics helps us
understand the therapeutic ofendometriosis.
SPEAKER_00 (25:32):
Yeah.
SPEAKER_01 (25:32):
If we understand more how the disease is formed,
how does it affect, helps usunderstand how to target the
therapeutic approaches?
Another important gap is alwayswe look at endometriosis as a
whole disease and we fail tosubtype it.
So that would become a hurdlefor personalized treatment.
SPEAKER_00 (25:53):
Right.
SPEAKER_01 (25:54):
You do have endometriosis, okay?
And she does have endometriosis,but what's the difference
between you and her?
SPEAKER_00 (26:02):
Right.
SPEAKER_01 (26:03):
You have the same name, right?
But completely differentapproaches of treatment,
completely different impact ondifferent systems.
So failing to subtypeendometriosis or to understand
the phenotypes of endometriosiswill uh continue to carry a lot
of confusion from the medicalcommunity and from the patient's
(26:25):
understanding.
So this is something asimportant also to research.
The other thing is we alwayslook at endometriosis from the
window of fertility or pain.
And then this means we'renarrowing our understanding of a
multisystemic beyond disease.
Right.
(26:45):
Everybody talks about how we canintervene to improve
infertility, but nobody talksabout what are the impact or
mechanism of impact ofendometriosis on infertility.
SPEAKER_00 (26:57):
Yeah.
SPEAKER_01 (26:58):
Because we're treating the symptoms, we're not
treating the root cause.
Again, we're looking atendometriosis as a disease that
requires surgery, but we fail todo studies for patient-reported
long-term outcome and impact onquality of life.
It's beyond pain during sexpain, pelvic pain, pain during
during pain.
What about the bloating?
(27:19):
What about the headaches?
What about the uh excessive bodyweight?
What about the fatigue?
SPEAKER_00 (27:24):
Right.
SPEAKER_01 (27:25):
Nobody in the studies study those as a primary
outcome.
Always, most of the studiesstudy pain fertility.
So, this is another thing.
Uh major gap also in theresearch is how can we train
people to be able to take careof the disease?
How can we find solutions forearly diagnosis?
(27:46):
How can we use technology,biomarkers to help us do
non-invasive?
Also, about the therapeuticapproaches of endometriosis, can
we think in a different way?
SPEAKER_00 (27:57):
Yeah.
SPEAKER_01 (27:58):
Can we start thinking based on a molecular
level, targeted therapy,cellular therapies?
So all these kinds of things, alot of gaps in holistic
approaches to endometriosis inresearch.
SPEAKER_00 (28:09):
Right.
SPEAKER_01 (28:10):
Patients tell you, I've done an anti-inflammatory
diet, my symptoms improved.
The gut microbiome had itsimpact, the total body
microbiome.
For me, it is trying to, when westart to understand the
microbiome, we understand thatthere is a value of the uterus.
SPEAKER_00 (28:27):
Right.
SPEAKER_01 (28:28):
And the uterus have a microbiome.
And there's a value for theappendix if it's not affected.
SPEAKER_00 (28:34):
Yeah.
SPEAKER_01 (28:34):
The appendix controls most of the microbiome
in the abdomen.
It's not every endometriosepatient, I go remove the
appendix.
SPEAKER_00 (28:41):
Right.
SPEAKER_01 (28:42):
So these approaches that were practiced more could
lead to uh with poor research,could lead to unnecessary
interventions and theniatrogenic disruptions because
sometimes we do cause harm if wedon't understand what's the
value of doing things.
SPEAKER_00 (28:59):
Yeah.
SPEAKER_01 (29:00):
The medications that we prescribe for endometriosis
patients, we need to see how itimpacts the whole ecosystem.
SPEAKER_00 (29:06):
Right.
SPEAKER_01 (29:07):
So there are a lot of research gaps.
Pain.
Nobody understands the pain.
No.
And there is an extremely poorunderstanding of the pain from
endometriosis, from differentlesions, from the heterogeneity
of the locations.
How does the pain uh is impactit?
So this is why it saddens youwhere you see a disease that
(29:30):
affects 10% of female patients.
And yet the huge gap in researchand funding and understanding is
mind-boggling, is jaw-dropping.
It's just like God.
SPEAKER_00 (29:43):
Well, and also like we if you if you look at the gap
in research, even for those withhormone imbalance, they don't do
it's a tricky thing to doresearch on people who have
fluctuating hormones all thetime.
SPEAKER_01 (30:00):
Of course.
SPEAKER_00 (30:01):
So how much does I mean I would be curious to see
how much the standard of carewhen it gets to the hysterectomy
and how, you know, for those whoare not maybe as experienced
with endometriosis, they'll do ahysterectomy, euphorectomy.
Then you have this hormonalimbalance.
So how much does that affect thewhole system and the microbiome
(30:22):
and everything else?
And there's just not a lot outthere.
SPEAKER_01 (30:26):
Um it saddens me a lot, um, especially in some
countries.
I'm not gonna name the countrybecause they won't know
themselves.
They still offer ophorectomywhile they do hysterectomy.
SPEAKER_00 (30:39):
Yeah.
SPEAKER_01 (30:41):
Despite the recent solid studies, that surgical
menopause or removal of theovary during surgery does not
only impact.
I'm not gonna talk about the hotflashes and the bone density,
but I will talk, it impacts thelifespan of a patient's patients
(31:01):
with surgical ophorectomy diesearlier.
I'm committing a patient todying early by just doing an
elective ophorectomy.
Like if you have cancer, weunderstand.
If you have irreparable ovary,completely damaged ovary, we
understand.
But we should all strive to keepeven a piece of ovary or a total
(31:23):
ovary.
SPEAKER_00 (31:24):
All of it if you can.
SPEAKER_01 (31:25):
Yes, yeah.
So this is the thing.
We still take things because wewe learned how to do that from
outdated guidelines that have noplace in the recent medicine or
the recent therapeuticapproaches to patients with
endometriosis.
SPEAKER_00 (31:42):
It's crazy.
What is the in your mind?
What are the risks ofover-treating and over too many
surgeries?
Like what are some of thebiggest risks associated with
that?
Because I mean, this is a bigtopic that we don't have to get
all the way in, but I reallyfeel like people are going back
for reoccurring surgeries.
They have, you know, treatmentafter treatment after treatment
(32:04):
of hormones or whatever the caseis.
I mean, there's let me statesome facts.
SPEAKER_01 (32:09):
30%, and that might be shocking for a lot of uh
patients.
Uh, 30% of patients withendometriosis have persistent
pain after their surgery.
SPEAKER_00 (32:19):
Yeah, I believe.
SPEAKER_01 (32:20):
It's like one-third.
Why?
It's not always how we say it'san incomplete surgery.
SPEAKER_00 (32:26):
Right.
SPEAKER_01 (32:26):
It could be musculoskeletal, it could be
pain pathways, it could behypermobility, it could be some
other factors that arehelp-producing or generating the
pain.
I'll give you a scenario.
When a patient has persistentpain, the surgeon cannot
understand that pushes thepatient to seek care from
another surgeon.
(32:47):
The lack of experience, the poorunderstanding of the disease
lead to premature anothersurgery.
Repetitive surgery in manyinstances causes more damage,
more scarring, more irreversibledamage.
For me, I'm happy every day todo a stage 17 endometriosis
versus to do a stage threeendometriosis that somebody
(33:10):
operated on incompletely.
SPEAKER_00 (33:12):
Yeah.
Yeah.
SPEAKER_01 (33:14):
It's a disaster because like people start
something, don't finish it, theycreate overscarring in the
presence of the inflammatorydisease that is persistent in
addition from the inflammationof surgery.
So all these lead to multipleunnecessary surgery.
The complexity andmulti-systemic facet of the
(33:36):
disease creates a lot ofsymptoms that could be brushed
under the endometriosis umbrellathat are not belonging to
endometriosis.
Maybe you have a herniated disc.
It doesn't mean that the lowback pain that you have is from
endometriosis that resists aftersurgery.
SPEAKER_00 (33:56):
Yeah.
SPEAKER_01 (33:58):
So this is something.
There is an immune and systemictotal body dysfunction, and it
produces symptoms like wediscussed the bloating.
Patient think they continue tohave bloating after surgery
because first in the uh healingperiod the doctor tells them
this is normal after surgery,but then after six months, they
think endometriosis recurs.
SPEAKER_00 (34:19):
Right.
SPEAKER_01 (34:20):
Setting the expectation for patients in the
presence of the uterus, even ifthe uterus is not affected, a
lot of the time the uterus is amuscle that needs
rehabilitation.
That's why pain during the firstthree, four periods is still
persistent because the uterus isa muscle is cramping and it's
tender and it's been crampingfor years.
(34:42):
It's not gonna uh resolve aftersurgery.
So having a period pain three,four months after surgery, is
not a signal of persistence ofthe disease.
SPEAKER_00 (34:51):
Right.
SPEAKER_01 (34:52):
Now, what created that whole thing is the mistrust
that happened between the caringand the patient, the caring
provider and the patient.
Because there is a mistrust, andthere is also circulating a lot
of misinformation thatindirectly or directly gaslight
(35:14):
the patient that push them toseek hope or false hope
somewhere else.
SPEAKER_00 (35:22):
Yep.
SPEAKER_01 (35:22):
Saying, oh, I'm a better surgeon, I'm great at
what I do, my patients are curedwhen I do surgery, I have zero
recurrence rate.
And that's why exploiting thevulnerability of endometriosis
patients by selling them falsehope is one of the social media
perpetuated novel ways ofgaslighting and should be a
(35:46):
medical crime in that sense.
So providing education,providing empowerment, providing
help to patient support,creating strategy is what
prevents this kind of fragmentedcare, silo care, no multiple
provider, isolated care.
And the uh caring should be inspecialized endometriosis
(36:11):
centers because it's such acomplex disease with a major
impact on the quality of life.
SPEAKER_00 (36:18):
Yeah, I agree.
I I think that exploitingpatients is egregious.
It's it's not okay.
But I do see everything, youknow, we've talked about the
whole system, the whole body,the AI, everything, how it works
together.
And I think what I want peopleto understand is there is hope.
We are progressing, and it isgood to be knowledgeable because
(36:41):
I think that it will help younavigate your own journey, but
it'll also hold those doctorsmore accountable the more
knowledgeable the patients areas well.
SPEAKER_01 (36:49):
It's sad that we have to be more knowledgeable in
a lot of ways, but understandingknowledge is power,
understanding your body,understanding what might be
causing.
Uh you know, when you do anyintervention on a patient, there
is something called informedconsent.
Yes.
And I know my friend uh Jefftalks about it a lot, and I I uh
(37:10):
value a lot the messaging thathe sends.
Informed consent is just is notjust vomiting complication risks
or the intervention sideeffects.
Informed means giving the rightinformation, the total
information for the patients tohave the ability to decide
what's best for her.
(37:32):
Not what's best for me as aprovider, what's best for her.
So an informed is not hiding orsidelining information that
might impact the approval of apatient for this procedure or
another procedure or thistherapeutic tool or another
therapeutic tool.
So that's why giving the patientthe knowledge, patients are
(37:53):
wise, they can decide what'sbest for them at this point of
time.
SPEAKER_00 (37:58):
Yep.
SPEAKER_01 (37:58):
Some patients cannot do surgery tomorrow or next
month.
Some patients have socialcommitment, work commitment.
They want to manage their lifeuntil they become ready for
surgery.
So we should be able totroubleshoot their life during
that period of time with them.
SPEAKER_00 (38:17):
Right.
SPEAKER_01 (38:18):
So there are nothing is simplified in endometriosis
care, considering the disease isvery complex.
But I don't like the fact thatpatients should find their care,
their cure.
I think it's our ethicalobligations as doctor to help
(38:39):
them and guide them through thatroute.
And you should not be a doctor.
Right.
You came to a doctor because hespent his time studying and
doing this thing so you can getthe best care that you believe
you should get.
It's not your job to go researchand Google and Chat GPT, your
therapeutic approaches, and thenfigure out what's going on with
(39:02):
you.
It's my obligation to understandthis.
And this is the the pendulumswung the other way.
SPEAKER_00 (39:09):
Yeah.
SPEAKER_01 (39:09):
And I think it's about time to balance the
pendulum.
You're a patient, we empoweryou, we inform you, we take care
of you, we give you the highestquality of care.
And then you have some homeworkto do in taking care of
yourself.
I see a lot of time trying tohelp patients.
What is a good surgeon?
Who is an endometriosis exercisespecialist?
(39:30):
It's extremely important toeducate patients.
We're trying to work from thebasis because this should, in an
ideal health system, this shouldnot happen.
SPEAKER_00 (39:39):
Right.
SPEAKER_01 (39:40):
Everybody should have the qualities and the
skills and everything to helpguide the patients and
understanding.
And that only comes fromcreating that paradigm shift
that has started with advocacygroup and then carried by
knowledgeable doctors that canhelp spreading the information.
Information and create researchand studies to further our
(40:04):
understanding of the disease andthen this way establish a newer
standard of care forendometriosis patients that
would lead to a better outcome.
SPEAKER_00 (40:12):
Yeah.
It's kind of like having it, youknow, I always say we're the
ones paying you, right?
Like we're not gonna pay acontractor on our house and then
go build the house ourselves.
Yes.
Like that doesn't really make alot of sense, right?
We might have input on how it'sbuilt.
We might have input on what wewant out of it, and that's how
(40:33):
it should be.
But if you let me build a house,it's not gonna look pretty
because I don't have the bestinformation.
I don't, I don't know how to doall of that stuff, like what the
specifications should be.
But I do think being a team withyour provider is key.
But you know, one of the thingsI've always said is there's a
(40:53):
lack of curiosity with a lot ofdoctors.
And time.
SPEAKER_01 (40:59):
It's a result, it's a result of the healthcare
system.
How is it created?
It's a volume-based.
The more you see, the more youmake, the more the health system
makes, you know, so it's it's uhalso a broken circle that needs
a major reform, the healthcare,because it pushes patients to
(41:19):
chase the numbers rather thanthe quality of care.
Yes.
And then uh when I spent an hourand an hour and a half with the
patients on her first consultwith endometriosis, I could
never do that in a universitysetting or where you know you
have to spend 10, 15 minutesbecause you have to see 100
patients.
And that that does not work, uh,you know.
(41:42):
So I don't I I think there is alot of blaming to doctors.
SPEAKER_00 (41:46):
Yeah.
SPEAKER_01 (41:47):
Uh, but I think we have also to reform the
healthcare system.
SPEAKER_00 (41:51):
Yeah.
SPEAKER_01 (41:51):
To allow doctors, yesterday we were talking about
something really uh uh touch medeeper when now uh healthcare
practices will tell the doctoryou cannot do surgeries more
than an hour or a certain numberof time.
And I and I was telling you,this is some of the most
dangerous practices because thatlead to incompleteness of
(42:12):
surgery, that lead torecklessness, that increases the
stress, increases the surgicalmistakes of a surgeon when they
have a time limit.
These are really very egregiouspractices that some of the
healthcare systems are pushingamong doctors.
SPEAKER_00 (42:27):
Yep.
And it's more expensive.
If you think about it, it's it'smore expensive for the patient,
it's more expensive for thehospital system.
I mean, it's a reactive, not aproactive approach.
And we all know that if you'rereactive, outcomes typically
aren't as great as if you'reproactive, right?
And so I think healthcare hasbecome so reactive, such a
(42:48):
band-aid in so manycircumstances that it's really
hard for a patient to feel seenin that 15-minute appointment,
that 45-minute surgery, and toreally have a better quality of
life.
Not to say that the surgeonsaren't good, but to say that
they are very limited by whatthey're given.
SPEAKER_01 (43:06):
And another shocking percentage, do you know, is uh
looking at the literature, 30 to50 percent of endometriosis
surgeries are unnecessary.
SPEAKER_00 (43:16):
I believe it.
SPEAKER_01 (43:17):
So whenever I see patients that have 15 surgeries,
you know, uh it's it's shockingfor me.
Yeah.
Imagine 15 times you put yourpatient at risk for poor
understanding.
I understand the recurrence ofendometriosis, and recurrence is
2.9% in experts and 8.9% forendometriomas.
(43:39):
That does not push one patientto have 15 surgery if you do the
math.
Having 15 surgery mostly isbecause of the misunderstanding
of the disease, is thefragmented care, is uh because
of the incompleteness of thesurgery, the poor uh
understanding of pain pathwaysand understanding how the
(44:00):
disease affects or creates a lotof symptoms.
SPEAKER_00 (44:03):
Yeah.
You know, and that's somethingthat I always tell people when
they come to me and they ask mequestions about endometriosis.
I'm still in pain, I'm lookingat having another surgery.
I always ask them, are therethings that you have done to
help support your body to thispoint?
Are you seeing a pelvic floorphysical therapist or a physical
therapist in general?
(44:24):
Have you done little exercisesthat help support your body?
Because I know for me that ifmovement is power, it's
exhausting, and if you overdoit, it's not good.
But if you have good movement,it really helps a lot of that
pain.
You know, it gets us out of thatpain cycle a lot of times.
And so I always caution peopleto not think surgery first all
(44:48):
the time, because it's a bigdecision with big outcomes
potentially.
You know, it it's certainly ahelpful tool and it's definitely
a way that we can address thedisease, but again, is it always
the disease or is it somethingelse?
You know?
I mean, that's just what I'velearned in my journey.
It's not always the disease.
(45:09):
There's other facets of thisdisease and other chronic
illnesses that play with it.
So where do you see yourself inthe next 10 years progressing
endometriosis?
SPEAKER_01 (45:21):
Hopefully, I'm retired.
No, uh I will continue.
I still enjoy a lot challengingthe challenges, surgical
challenges, the difficult cases.
Uh, I think I will continue todo my research.
I do we do a lot of researchabout endometriosis.
Uh, the other thing I I loveeducating surgeons,
(45:43):
standardizing technique forendometriosis surgery, and
probably when I retire fromclinical activity, I would like
to continue this the educationside, the research side, the
understanding side, because thisuh is is good for me and for my
uh speedy brain all the time.
(46:03):
I think individual efforts toimpact communities, whether in
surgeons, whether in patients,something that I uh enjoyed
doing for the past years and Iwill continue to enjoy doing
because if I can teach morepeople to fish, I don't need to
fish for them.
SPEAKER_00 (46:21):
Yeah.
SPEAKER_01 (46:21):
In the sense when we help or we train or we teach one
another, uh the impact will growway fast way faster through
these, hoping we can come to abetter standardization, better
utilizing the resource toprovide better care beyond the
negativity, the toxicity, thegaslighting, the things that are
(46:45):
currently happening, whether ona healthcare system, whether on
surgical skills system, whetheron research and understanding
basis.
So all these will come together.
I think this is a passion andyou cannot retire from a
passion.
You can retire from certain jobsor exercises, but uh the passion
will remain there.
(47:06):
It was grown, it's really hardwhen you set the fire.
Sometimes it's hard to uh turnit down.
SPEAKER_00 (47:12):
I mean, you're really good at it.
You're really good at theeducation, so you can't stop.
From a personal perspective.
SPEAKER_01 (47:20):
Hopefully, I I want to spend time with my kids, my
family.
This is this is also importantuh because uh this takes uh a
lot of toll uh on you.
Caring for endometriosis isalmost very similar to having
endometriosis on the impact onsocietal relationship.
(47:40):
You lose a lot of friends bybeing on the road trying to
educate, you uh uh miss yourfamily a lot.
So at one point we need to passthe torch for the younger that
will help pushing things waybeyond what we've done, and
that's the purpose of educationto identify, create surgeons,
(48:02):
champions, not surgeons.
They could uh understand betterthe disease and create that
impact more on the uh value ofcare they provide for their
patients.
SPEAKER_00 (48:12):
Yeah.
Well, I hope that you don't stopthat anytime soon because I hope
so.
Because we need that.
And thank you for taking thetime to do exactly what you said
you would do in coming out hereand spending this quality time
with us and allowing me to pickyour brain and be educated about
this and sharing that with somany other people.
(48:34):
This will help impact thoseliving with endometriosis to
better understand.
I am excited to see what's next.
We'll do it together.
If this episode helped rechargeyour indo battery, please take a
moment to like and subscribe onYouTube.
It really helps others in ourcommunity find these resources
(48:57):
too.
And if you're listening on apodcast app, leave a quick
rating or a comment to show whatresonated with you.
Every bit of engagement helps usreach more people living with
endometriosis and chronicillness and reminds them they're
not alone.
Until next time, continueadvocating for you and for
others.
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