December 18, 2025 • 20 mins
Send us a text with a question or thought on this episode ( We cannot replay from this link)
A lot of us carry the same question: why does the care we need feel out of reach even when we find the right experts? This reflection pulls together the most eye-opening insights from a season of conversations—where surgical reality, overlooked diagnoses, and brain-based tools meet practical advocacy you can use right now.
We revisit Dr. Jeff Arrington’s straight talk on insurance and excision: why RVU models reimburse quick ablation and hours-long, meticulous excision the same, and how that mismatch shapes access, outcomes, and burnout. He breaks down informed consent as a true exchange—listening, differential diagnosis, and clear options—then shows how dynamic imaging and pre-op mapping help prevent incomplete treatment and reduce complications. That framework alone can change how you choose a surgeon, what questions you ask, and how you prepare for the OR.
Then we shift to Dr. Shirin Towfigh's essential lens on hernias in women. Without the classic bulge, they press on nerves and mimic pelvic, hip, and groin pain—often mislabeled as endometriosis. Add male-centric studies and devices, and misdiagnosis becomes routine. We talk hysterectomy scars, EDS, collagen, and why tailored, minimally invasive repairs matter. Awareness becomes action: consider other pain generators, get the right imaging, and seek specialists who know the female presentation.
Finally, we connect mindset and neuroscience with Dr. Niva Jerath & Rick Macci. Not toxic positivity—evidence-based tools that reduce threat signals and increase agency. Gratitude, reframing, and steady habits can lower the cognitive load of pain and help you engage more effectively with medical care. Healing isn’t one-dimensional; the best results often come from aligning precise surgery, accurate diagnosis, and a regulated nervous system.
If you’re ready to advocate with more clarity, this is your map: understand the system, expand the differential, and strengthen your daily tools. Subscribe, share with someone who needs it, and leave a review with the one insight you’re taking into your next appointment.
Website endobattery.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
With the Indo Year coming up, it's a perfect time
(00:02):
to reflect on all the lessons,growth, and amazing guests we've
had on Indobattery.
But instead of one big recap,I'm breaking it into quick,
bite-sized reflections multipletimes a week.
Let's revisit what inspired us,learn what we missed, and
recharge together in our EndoYear Reflection series.
Join me each episode as we lookback.
(00:27):
Welcome to Indobattery, where Ishare my journey with
endometriosis and chronicillness 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
(00:48):
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 Indometriosis drainsus.
This year truly started off witha bang.
(01:09):
And by bang, I mean one of thosemoments where you think, okay,
this conversation has been along time coming.
It actually took about ninemonths, almost a full year, to
get this guest on the podcast.
Not because he didn't want to behere, but because he's
incredibly busy doing work somany of us desperately need.
(01:29):
Dr.
Jeff Errington joined me inepisode 108 to talk about
something that almost everysingle one of us feels to our
bones, the deep frustrationaround insurance and excision
care.
Because here's the reality wewant expert care.
We need expert care.
And yet so often we simply can'tafford it.
(01:50):
And what I appreciate most aboutthis conversation is that Dr.
Errington didn't sugarcoat it.
He broke down exactly why thesystem is so challenging, not
just for patients, but forproviders too.
How the insurance models make itincredibly hard to do things the
right way, to keep the lightson, and to practice medicine
(02:10):
with integrity and time andprecision.
So for many of us, insurancefeels like the villain in the
story.
Why so many expert excisionsurgeons end up practicing
outside of traditional insurancemodels?
SPEAKER_02 (02:36):
There is there is far more complexity to really
doing good endometriosis work,doing the dissections,
separating the adhesion,separating the bowel, working
around the ureters, thansomebody that goes in and says,
Oh, that endometriosis directlyover the ureter.
I very carefully just touchedcottery to it so I didn't damage
the ureter instead of doing theappropriate dissection and
(02:58):
separating the disease out, orif they go in and see some bowel
endometriosis to maybe just veryeasily, carefully safely burn
across the surface, but notreally treat it.
Or the the risk of that is farless than a doctor actually
going in and cutting the diseaseout and repairing the bowel or
dissecting the ureter out.
The thing where that comes intoplay when insurance companies
(03:19):
look at that RVU forlaparoscopy, they don't make any
adjustments on the complexityrisk between superficial
ablation and excision ofdisease.
To the insurance companies andto that CAMS RVU system, it's
all the same.
And, you know, and that's that'sjust the malpractice side of
things.
Certainly the work involved, youknow, taking 10, 15 minutes to
(03:39):
quickly burn a few places ratherthan two or three hours to cut
disease out, they they have zeroaccounting for the extra work
involved and the tedious workinvolved in full excision rather
than just spot burning a coupleplaces and saying that's the
best I can do.
So when when we look at the waythat insurance looks at things,
they consider a superficial, youknow, let's say somebody gets in
(04:02):
and there's just endometriosiseverywhere, but no adhesions.
And let's just say that it, youknow, there is some depth to the
disease, but there's no bowelinvolvement, no ureter
dissections, but reallywidespread endometriosis with
some depth to the to thetissues, to the side of the
rectum.
Going in and cutting that out,you know, can take an hour and a
half, a couple hours sometimescompared to a dog just going in
(04:24):
and saying, well, here's a fewspots, let's burn those, and
then leaving everything elseuntreated and untouched.
We're talking a 10, 15 minutesurgery versus an hour and a
half surgery, and thecompensation, the RVU value for
those procedures is exactly thesame.
SPEAKER_00 (04:38):
One of the biggest takeaways for me in this episode
was the conversation aroundinformed consent.
Because informed consent isn'tjust about signing a piece of
paper, it's understanding what'shappening in your body, what
your options are, and what thelong-term implications might be.
SPEAKER_02 (04:55):
The most important thing, I mean, both both words
in that informed consent, bothare equally important.
Patient cannot give consent ifthey're not informed.
And we have to start bybasically providing information.
And that starts with the doctorjust sitting and listening to a
patient, understanding andconsidering the history and
formulating in my mind as aphysician what I think is going
(05:17):
on.
This is what's called thedifferential diagnosis.
We basically try to piece allthe symptoms together together
and try to think of all thedifferent things that could
explain what the patient isexperiencing.
Certainly in my line of work,the most common are
endometriosis, pelvic floorpain, adenomyosis, interstitial
cystitis, nerve impingements ornerve irritations, those sorts
(05:38):
of things.
And then we try, and then westep back and think, okay, what
can I do to explore that alittle bit more and see if we
(06:00):
can wean down or get a betteridea between all those
possibilities, what the mostlikely sources are.
That's where the exam comes intoplay, and then that's when any
imaging comes into play.
SPEAKER_00 (06:10):
We also talked about dynamic imaging, specifically
dynamic ultrasound and why itcan be such a powerful tool in
endometriosis diagnosis whenit's done by someone who truly
knows what they're looking at.
Expert mapping before surgerycan change everything.
As many surgeons will tell you,and Dr.
(06:31):
Errington explains thisbeautifully, they would often
rather operate on a stage fourendometriosis case than someone
who's had multiple surgerieslabeled stage two or three.
Why?
Adhesions, scarred tissue, thedamage that happens when disease
is missed, minimized, orincompletely treated.
That alone is something I wisheveryone could hear.
(06:54):
But what makes this relationshipwith Dr.
Errington so special goes farbeyond the podcast, Mike.
He didn't just show up toeducate, he showed up for the
community.
As many of you know, he actuallytraveled all the way out here to
Colorado to support thenonprofit that I'm part of, an
event that we had.
This is where I need to tell youa little behind the scenes
(07:18):
story.
Because on the day of the event,my car battery died.
Not my old car, my nice car.
Now, I also own what we lovinglyreferred to as the barn car.
And if you've never ridden in abarn car, let me paint you a
picture.
It smells exactly like whatyou'd think it'd smell like.
Horses, hay, manure, the fullexperience.
(07:41):
I was running late, so insteadof picking up Dr.
Errington myself, I had one ofmy teammates grab him from the
shuttle.
I thought I was being kind.
I thought I was being courteous.
I thought, surely, no one wantsto smell like a barn on the way
to an endometriosis event.
Turns out I was wrong.
He was actually disappointed hedidn't get to ride in the barn
(08:03):
car.
Apparently, it brought himstraight back to his childhood.
So, yes, we now know this aboutDr.
Errington, world-class excisionsurgeon, insurance expert, and
nostalgic about the smell of abarn.
Oh no.
All humor aside, I continuallylearned so much from Dr.
Errington.
(08:23):
He has this rare ability tobreak down incredibly complex
topics, insurance, hormones,informed consent, imaging in a
way that's factual, clear, andactually understandable.
And the best part of educationdoesn't stop here.
We'll be continuing thisconversation in the new year,
(08:44):
including discussions aroundhormones and you know, things
like ACOG updates.
So definitely be on the lookoutfor that.
If there's one thing thisepisode reminded me of, it's
this knowledge is power, butshared knowledge is how we
change outcomes.
And while the system isfrustrating, conversations like
(09:04):
this help us advocate moreclearly, ask better questions,
and understand why finding trueexperts matters so much.
So as you listen to these clips,I invite you to reflect on what
stood out to you, what clicked,and what you wish you had known
sooner.
And if nothing else, maybe wewill all remember that sometimes
(09:27):
even the heaviest topics canstill leave room for learning,
connection, and apparently theoccasional barn-scented memory.
Some episodes stay with youbecause they teach you something
new.
Others stay with you becausethey change the way you think
about pain entirely.
And this episode did both.
In episode 109, Dr.
(09:47):
Sharin Tofi joined me to talkabout hernias.
And I know if you're listeningto this right now, you might be
thinking, what do hernias haveto do with endometriosis?
Turns out a lot more than we'vebeen led to believe.
Because endometriosis isn'talways the pain generator in the
body.
And for so many people,especially women, hernia pain
(10:08):
flies completely under theradar.
Dr.
Tofi explained something thatreally stuck with me.
The hernias that affect womenoften don't look like the
classic bulge we've been taughtto watch for.
They're subtle, they pressgently on nerves, they whisper
instead of shout, and yet theycan cause significant
life-altering pain.
(10:29):
Pain that mimics pelvic pain,hip pain, groin pain, pain that
so many of us have been told isjust part of endometriosis.
One of the most striking thingsDr.
Tofi shared is that men oftendon't feel pain from hernias,
but women do.
And that alone should make uspause.
Because if women experiencehernias differently, but we're
(10:51):
using male-centric diagnosticexpectations, of course, things
are going to get missed.
SPEAKER_03 (10:57):
So, you know, when I talk to my medical students,
when I teach them, I ask them,when do you guys get taught
about hernias?
And it's during the male genitalurinary system.
So it's always connected to amale disease.
There are gynecologists thatdon't know that women can get
hernias.
So it's we have to do better jobteaching as early as medical
school that women can gethernias.
(11:17):
And we actually publish anotherpaper that specifically outlines
how women present differentlythan men for the same exact
disease.
Men tend to present with abulge, women tend to present
with pain.
Men tend not to present withpain, actually.
And so there are surgeons thatsay if it's if it's painful,
it's not a hernia.
And that I'm like, that'scompletely wrong.
So there's a lot ofmisinformation out there.
(11:38):
And I think because it's alwaysbeen a male-dominated view of
hernia disease andmale-dominated care, all of our
surgical techniques are for man,men.
All of our randomized controlledtrials included only men, our
mesh is designed for a maleanatomy.
So there's a lot of bias againstwomen for this disease and
diagnosis and their treatment.
SPEAKER_00 (11:59):
She also shared something incredibly important
for anyone who's had ahysterectomy.
In her experience, women whohave had hysterectomies often do
have hernias, and many of themhave had no idea, not because
the pain isn't real, but becauseno one thought to look.
SPEAKER_03 (12:15):
So the Ehlers Download syndrome patients, the
EDS patients that have thehyperflexibility, hypermobility
syndrome, they are more likelyto just have like loose fascia
and muscles.
And if they have surgery, let'ssay they have a hysterectomy,
they're going to get a herniafrom that incision.
SPEAKER_00 (12:31):
Interesting.
SPEAKER_03 (12:32):
Because they don't have enough collagen.
Their collagen is like notnormal.
So you need normal collagen toheal.
And so if you're not healing theincision, that's why we would
prefer we prefer laparoscopicsurgery for these patients
because the incisions are muchsmaller to heal.
There's not a big incision, forexample.
That's number one.
Number two, they get pelvic painbecause everything is loose.
(12:55):
Their pelvic floor is loose andtheir groin is loose.
And I've noticed that when I goin there, I have this special
technique technique for these umpatients with EDS, and I tighten
their inguinal floor, a lot oftheir pelvic floor symptoms go
away.
I can't explain it, but it'shappened on every single patient
I've done it on.
So they don't need the organprolapse surgeries and all the
(13:16):
other operations, which theydon't do well with anyway,
because you're operating onunhealthy collagen, low collagen
kind of tissue.
So you have to be very carefulwith those patients that you
don't treat them like a typicalhernia patient.
SPEAKER_00 (13:30):
That moment really hit me because awareness alone
can change the trajectory ofsomeone's healing, knowing that
there may be another paingenerator and that it's
identifiable on imaging whendone with the right specialist
can be the difference betweenstaying stuck and finally moving
toward relief.
What made this episodeespecially meaningful for me was
(13:53):
that I was genuinely excited,and if I'm being honest, a
little nervous going into it.
I know how respected Dr.
Tofi is.
I know how deep her expertiseruns when it comes to hernias.
And sometimes when you sitacross from someone like that,
you just hope your brain keepsup.
And she was so kind.
(14:14):
She was generous with her time,generous with her knowledge, and
incredibly patient.
Even on a day when I wascompletely exhausted, we had
such a thoughtful conversationboth before and after we hit
record.
And it reminded me that trueexperts don't just lead with
credentials, they lead withcompassion.
Then came episode 110.
(14:35):
And this one surprised me in thebest possible way.
I sat down with Dr.
Navita or Neve and Rick Macy.
And if you would have told meahead of time that this duo
would end up being one of themost inspiring conversations of
the season, I might not havefully believed you.
But what they brought to thetable was something I hadn't
(14:56):
seen done quite like thisbefore.
They connected neuroscience, theliteral wiring behind pain, with
mindset.
Not in a dismissive, just thinkpositive way, but in a grounded,
science-backed understanding ofhow thoughts, beliefs, and
nervous systems shape how weexperience our days and our
(15:17):
bodies.
SPEAKER_01 (15:18):
One thing, and my patients are all struggling with
chronic pain and chronicillness.
And the most importanttechnique, I think we're talking
about perspective and reframing,but one of the main things is
gratitude.
And as soon as we fill up ourparts with gratitude, we see
things so differently.
And I can give an example.
(15:46):
And I'll never forget our deantold us, he said, go.
And she said, Today's exercise,all you guys are complaining.
She was at the auditorium in thepride, she's like, all of you
are complaining.
I'm wanting all to go to thelobby of the Mayo Clinic in
Rochester, Minnesota, and justsit there for 20 minutes and
watch.
Okay, now we all sat there.
(16:06):
I remember watching, there'slike beautiful chandeliers,
beautiful floors, and there yousee the sickest kids that have
maybe three or four months leftto live.
You see a kid having a seizure,you're seeing another person
with a leg cut off, another onewith their arm cut off, and then
you see someone like you know,with dementia and their family
members pushing them, andsomeone with a brain tumor, and
(16:28):
all of a sudden there's no morecomplaining.
Yeah, because you're likeappreciative of what you have.
So it doesn't mean that youminimize what you're having.
I mean, everybody has strugglesand pains, but it's it's a it's
a combination of gratitude andperspective and recognizing that
if we're grateful for what wehave, all of a sudden everything
else is not as it it's a way,it's a technique to get out of
(16:50):
the pain, maybe and to improveit and to it to feel the
situation in a different way.
And that's what you're talkingabout, perspective.
It really means a lot.
SPEAKER_00 (16:57):
What struck me most is that they don't just teach
this, they live it.
They talked about how mindsetsets the pace for our day, how
it influences how we movethrough pain, through
challenges, through life itself.
And while mindset doesn'treplace medical care, it
absolutely plays a role in howwe function and how we heal.
(17:19):
I walked away from thatconversation feeling inspired,
not fixed, not magically cured,but reminded that there is still
agency, even in the hard bodiesand hard days.
And then because life is funnylike this, there is a little
moment that still makes mesmile.
Rick Macy, yes, that Rick Macy,legendary tennis coach, the man
(17:44):
who coached Venus and SerenaWilliams when they were kids,
and yes, that one portrayed inKing Richard, a little slice of
Hollywood tucked intoneuroscience and mindset
conversation on IndobatteryPodcast.
Because apparently you can talkabout pain, the brain, elite
athletes, and resilience all inone episode.
If this conversation taught meanything, it's this healing is
(18:07):
rarely one-dimensional.
Pain has layers, causes overlap,and sometimes the answers we're
looking for live just outsidethe box we've been told to stay
in.
So as you listen back, I inviteyou to stay curious, to consider
other pain generators, to noticehow your mindset supports or
challenges you, and to rememberthat learning more about your
(18:30):
body is never a step backwards.
It's a step towards life withmore understanding and hopefully
less pain.
And just because I'm in theseason of giving, I want to give
you just a little bit of adviceto get you through this holiday
season.
And here it is.
No is a complete sentence.
You don't owe a dissertation.
(18:51):
Just say no.
Our plates are full enough.
It is okay to say no.
As we wrap up this reflection,I'm always struck by just how
much learning lives inside theseconversations.
Looking back, it's not justabout the information.
It's what continued to inspireme, challenge me, and sometimes
gently nudge me to see things alittle differently.
(19:12):
My hope is that something youheard today sparked a moment of
recognition, curiosity, or evena quiet, uh, that makes sense
now.
So here's what I'm gonnachallenge you with.
Take one idea from this episode,just one, and let it sit with
you.
You don't have to fix anything,change anything, or suddenly
(19:32):
become a brand new person byMonday.
Growth counts even when ithappens in sweatpants.
Be gentle with yourself.
Honor how far you've come thisyear, and remember you're
allowed to learn, unlearn, rest,and repeat.
Thank you for reflecting withme.
Continue being curious untilnext time.
Continue advocating for you andfor others.
With the Indo Year coming up, it's a perfect time
(00:02):
to reflect on all the lessons,growth, and amazing guests we've
had on Indobattery.
But instead of one big recap,I'm breaking it into quick,
bite-sized reflections multipletimes a week.
Let's revisit what inspired us,learn what we missed, and
recharge together in our EndoYear Reflection series.
Join me each episode as we lookback.
(00:27):
Welcome to Indobattery, where Ishare my journey with
endometriosis and chronicillness 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
(00:48):
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 Indometriosis drainsus.
This year truly started off witha bang.
(01:09):
And by bang, I mean one of thosemoments where you think, okay,
this conversation has been along time coming.
It actually took about ninemonths, almost a full year, to
get this guest on the podcast.
Not because he didn't want to behere, but because he's
incredibly busy doing work somany of us desperately need.
(01:29):
Dr.
Jeff Errington joined me inepisode 108 to talk about
something that almost everysingle one of us feels to our
bones, the deep frustrationaround insurance and excision
care.
Because here's the reality wewant expert care.
We need expert care.
And yet so often we simply can'tafford it.
(01:50):
And what I appreciate most aboutthis conversation is that Dr.
Errington didn't sugarcoat it.
He broke down exactly why thesystem is so challenging, not
just for patients, but forproviders too.
How the insurance models make itincredibly hard to do things the
right way, to keep the lightson, and to practice medicine
(02:10):
with integrity and time andprecision.
So for many of us, insurancefeels like the villain in the
story.
Why so many expert excisionsurgeons end up practicing
outside of traditional insurancemodels?
SPEAKER_02 (02:36):
There is there is far more complexity to really
doing good endometriosis work,doing the dissections,
separating the adhesion,separating the bowel, working
around the ureters, thansomebody that goes in and says,
Oh, that endometriosis directlyover the ureter.
I very carefully just touchedcottery to it so I didn't damage
the ureter instead of doing theappropriate dissection and
(02:58):
separating the disease out, orif they go in and see some bowel
endometriosis to maybe just veryeasily, carefully safely burn
across the surface, but notreally treat it.
Or the the risk of that is farless than a doctor actually
going in and cutting the diseaseout and repairing the bowel or
dissecting the ureter out.
The thing where that comes intoplay when insurance companies
(03:19):
look at that RVU forlaparoscopy, they don't make any
adjustments on the complexityrisk between superficial
ablation and excision ofdisease.
To the insurance companies andto that CAMS RVU system, it's
all the same.
And, you know, and that's that'sjust the malpractice side of
things.
Certainly the work involved, youknow, taking 10, 15 minutes to
(03:39):
quickly burn a few places ratherthan two or three hours to cut
disease out, they they have zeroaccounting for the extra work
involved and the tedious workinvolved in full excision rather
than just spot burning a coupleplaces and saying that's the
best I can do.
So when when we look at the waythat insurance looks at things,
they consider a superficial, youknow, let's say somebody gets in
(04:02):
and there's just endometriosiseverywhere, but no adhesions.
And let's just say that it, youknow, there is some depth to the
disease, but there's no bowelinvolvement, no ureter
dissections, but reallywidespread endometriosis with
some depth to the to thetissues, to the side of the
rectum.
Going in and cutting that out,you know, can take an hour and a
half, a couple hours sometimescompared to a dog just going in
(04:24):
and saying, well, here's a fewspots, let's burn those, and
then leaving everything elseuntreated and untouched.
We're talking a 10, 15 minutesurgery versus an hour and a
half surgery, and thecompensation, the RVU value for
those procedures is exactly thesame.
SPEAKER_00 (04:38):
One of the biggest takeaways for me in this episode
was the conversation aroundinformed consent.
Because informed consent isn'tjust about signing a piece of
paper, it's understanding what'shappening in your body, what
your options are, and what thelong-term implications might be.
SPEAKER_02 (04:55):
The most important thing, I mean, both both words
in that informed consent, bothare equally important.
Patient cannot give consent ifthey're not informed.
And we have to start bybasically providing information.
And that starts with the doctorjust sitting and listening to a
patient, understanding andconsidering the history and
formulating in my mind as aphysician what I think is going
(05:17):
on.
This is what's called thedifferential diagnosis.
We basically try to piece allthe symptoms together together
and try to think of all thedifferent things that could
explain what the patient isexperiencing.
Certainly in my line of work,the most common are
endometriosis, pelvic floorpain, adenomyosis, interstitial
cystitis, nerve impingements ornerve irritations, those sorts
(05:38):
of things.
And then we try, and then westep back and think, okay, what
can I do to explore that alittle bit more and see if we
(06:00):
can wean down or get a betteridea between all those
possibilities, what the mostlikely sources are.
That's where the exam comes intoplay, and then that's when any
imaging comes into play.
SPEAKER_00 (06:10):
We also talked about dynamic imaging, specifically
dynamic ultrasound and why itcan be such a powerful tool in
endometriosis diagnosis whenit's done by someone who truly
knows what they're looking at.
Expert mapping before surgerycan change everything.
As many surgeons will tell you,and Dr.
(06:31):
Errington explains thisbeautifully, they would often
rather operate on a stage fourendometriosis case than someone
who's had multiple surgerieslabeled stage two or three.
Why?
Adhesions, scarred tissue, thedamage that happens when disease
is missed, minimized, orincompletely treated.
That alone is something I wisheveryone could hear.
(06:54):
But what makes this relationshipwith Dr.
Errington so special goes farbeyond the podcast, Mike.
He didn't just show up toeducate, he showed up for the
community.
As many of you know, he actuallytraveled all the way out here to
Colorado to support thenonprofit that I'm part of, an
event that we had.
This is where I need to tell youa little behind the scenes
(07:18):
story.
Because on the day of the event,my car battery died.
Not my old car, my nice car.
Now, I also own what we lovinglyreferred to as the barn car.
And if you've never ridden in abarn car, let me paint you a
picture.
It smells exactly like whatyou'd think it'd smell like.
Horses, hay, manure, the fullexperience.
(07:41):
I was running late, so insteadof picking up Dr.
Errington myself, I had one ofmy teammates grab him from the
shuttle.
I thought I was being kind.
I thought I was being courteous.
I thought, surely, no one wantsto smell like a barn on the way
to an endometriosis event.
Turns out I was wrong.
He was actually disappointed hedidn't get to ride in the barn
(08:03):
car.
Apparently, it brought himstraight back to his childhood.
So, yes, we now know this aboutDr.
Errington, world-class excisionsurgeon, insurance expert, and
nostalgic about the smell of abarn.
Oh no.
All humor aside, I continuallylearned so much from Dr.
Errington.
(08:23):
He has this rare ability tobreak down incredibly complex
topics, insurance, hormones,informed consent, imaging in a
way that's factual, clear, andactually understandable.
And the best part of educationdoesn't stop here.
We'll be continuing thisconversation in the new year,
(08:44):
including discussions aroundhormones and you know, things
like ACOG updates.
So definitely be on the lookoutfor that.
If there's one thing thisepisode reminded me of, it's
this knowledge is power, butshared knowledge is how we
change outcomes.
And while the system isfrustrating, conversations like
(09:04):
this help us advocate moreclearly, ask better questions,
and understand why finding trueexperts matters so much.
So as you listen to these clips,I invite you to reflect on what
stood out to you, what clicked,and what you wish you had known
sooner.
And if nothing else, maybe wewill all remember that sometimes
(09:27):
even the heaviest topics canstill leave room for learning,
connection, and apparently theoccasional barn-scented memory.
Some episodes stay with youbecause they teach you something
new.
Others stay with you becausethey change the way you think
about pain entirely.
And this episode did both.
In episode 109, Dr.
(09:47):
Sharin Tofi joined me to talkabout hernias.
And I know if you're listeningto this right now, you might be
thinking, what do hernias haveto do with endometriosis?
Turns out a lot more than we'vebeen led to believe.
Because endometriosis isn'talways the pain generator in the
body.
And for so many people,especially women, hernia pain
(10:08):
flies completely under theradar.
Dr.
Tofi explained something thatreally stuck with me.
The hernias that affect womenoften don't look like the
classic bulge we've been taughtto watch for.
They're subtle, they pressgently on nerves, they whisper
instead of shout, and yet theycan cause significant
life-altering pain.
(10:29):
Pain that mimics pelvic pain,hip pain, groin pain, pain that
so many of us have been told isjust part of endometriosis.
One of the most striking thingsDr.
Tofi shared is that men oftendon't feel pain from hernias,
but women do.
And that alone should make uspause.
Because if women experiencehernias differently, but we're
(10:51):
using male-centric diagnosticexpectations, of course, things
are going to get missed.
SPEAKER_03 (10:57):
So, you know, when I talk to my medical students,
when I teach them, I ask them,when do you guys get taught
about hernias?
And it's during the male genitalurinary system.
So it's always connected to amale disease.
There are gynecologists thatdon't know that women can get
hernias.
So it's we have to do better jobteaching as early as medical
school that women can gethernias.
(11:17):
And we actually publish anotherpaper that specifically outlines
how women present differentlythan men for the same exact
disease.
Men tend to present with abulge, women tend to present
with pain.
Men tend not to present withpain, actually.
And so there are surgeons thatsay if it's if it's painful,
it's not a hernia.
And that I'm like, that'scompletely wrong.
So there's a lot ofmisinformation out there.
(11:38):
And I think because it's alwaysbeen a male-dominated view of
hernia disease andmale-dominated care, all of our
surgical techniques are for man,men.
All of our randomized controlledtrials included only men, our
mesh is designed for a maleanatomy.
So there's a lot of bias againstwomen for this disease and
diagnosis and their treatment.
SPEAKER_00 (11:59):
She also shared something incredibly important
for anyone who's had ahysterectomy.
In her experience, women whohave had hysterectomies often do
have hernias, and many of themhave had no idea, not because
the pain isn't real, but becauseno one thought to look.
SPEAKER_03 (12:15):
So the Ehlers Download syndrome patients, the
EDS patients that have thehyperflexibility, hypermobility
syndrome, they are more likelyto just have like loose fascia
and muscles.
And if they have surgery, let'ssay they have a hysterectomy,
they're going to get a herniafrom that incision.
SPEAKER_00 (12:31):
Interesting.
SPEAKER_03 (12:32):
Because they don't have enough collagen.
Their collagen is like notnormal.
So you need normal collagen toheal.
And so if you're not healing theincision, that's why we would
prefer we prefer laparoscopicsurgery for these patients
because the incisions are muchsmaller to heal.
There's not a big incision, forexample.
That's number one.
Number two, they get pelvic painbecause everything is loose.
(12:55):
Their pelvic floor is loose andtheir groin is loose.
And I've noticed that when I goin there, I have this special
technique technique for these umpatients with EDS, and I tighten
their inguinal floor, a lot oftheir pelvic floor symptoms go
away.
I can't explain it, but it'shappened on every single patient
I've done it on.
So they don't need the organprolapse surgeries and all the
(13:16):
other operations, which theydon't do well with anyway,
because you're operating onunhealthy collagen, low collagen
kind of tissue.
So you have to be very carefulwith those patients that you
don't treat them like a typicalhernia patient.
SPEAKER_00 (13:30):
That moment really hit me because awareness alone
can change the trajectory ofsomeone's healing, knowing that
there may be another paingenerator and that it's
identifiable on imaging whendone with the right specialist
can be the difference betweenstaying stuck and finally moving
toward relief.
What made this episodeespecially meaningful for me was
(13:53):
that I was genuinely excited,and if I'm being honest, a
little nervous going into it.
I know how respected Dr.
Tofi is.
I know how deep her expertiseruns when it comes to hernias.
And sometimes when you sitacross from someone like that,
you just hope your brain keepsup.
And she was so kind.
(14:14):
She was generous with her time,generous with her knowledge, and
incredibly patient.
Even on a day when I wascompletely exhausted, we had
such a thoughtful conversationboth before and after we hit
record.
And it reminded me that trueexperts don't just lead with
credentials, they lead withcompassion.
Then came episode 110.
(14:35):
And this one surprised me in thebest possible way.
I sat down with Dr.
Navita or Neve and Rick Macy.
And if you would have told meahead of time that this duo
would end up being one of themost inspiring conversations of
the season, I might not havefully believed you.
But what they brought to thetable was something I hadn't
(14:56):
seen done quite like thisbefore.
They connected neuroscience, theliteral wiring behind pain, with
mindset.
Not in a dismissive, just thinkpositive way, but in a grounded,
science-backed understanding ofhow thoughts, beliefs, and
nervous systems shape how weexperience our days and our
(15:17):
bodies.
SPEAKER_01 (15:18):
One thing, and my patients are all struggling with
chronic pain and chronicillness.
And the most importanttechnique, I think we're talking
about perspective and reframing,but one of the main things is
gratitude.
And as soon as we fill up ourparts with gratitude, we see
things so differently.
And I can give an example.
(15:46):
And I'll never forget our deantold us, he said, go.
And she said, Today's exercise,all you guys are complaining.
She was at the auditorium in thepride, she's like, all of you
are complaining.
I'm wanting all to go to thelobby of the Mayo Clinic in
Rochester, Minnesota, and justsit there for 20 minutes and
watch.
Okay, now we all sat there.
(16:06):
I remember watching, there'slike beautiful chandeliers,
beautiful floors, and there yousee the sickest kids that have
maybe three or four months leftto live.
You see a kid having a seizure,you're seeing another person
with a leg cut off, another onewith their arm cut off, and then
you see someone like you know,with dementia and their family
members pushing them, andsomeone with a brain tumor, and
(16:28):
all of a sudden there's no morecomplaining.
Yeah, because you're likeappreciative of what you have.
So it doesn't mean that youminimize what you're having.
I mean, everybody has strugglesand pains, but it's it's a it's
a combination of gratitude andperspective and recognizing that
if we're grateful for what wehave, all of a sudden everything
else is not as it it's a way,it's a technique to get out of
(16:50):
the pain, maybe and to improveit and to it to feel the
situation in a different way.
And that's what you're talkingabout, perspective.
It really means a lot.
SPEAKER_00 (16:57):
What struck me most is that they don't just teach
this, they live it.
They talked about how mindsetsets the pace for our day, how
it influences how we movethrough pain, through
challenges, through life itself.
And while mindset doesn'treplace medical care, it
absolutely plays a role in howwe function and how we heal.
(17:19):
I walked away from thatconversation feeling inspired,
not fixed, not magically cured,but reminded that there is still
agency, even in the hard bodiesand hard days.
And then because life is funnylike this, there is a little
moment that still makes mesmile.
Rick Macy, yes, that Rick Macy,legendary tennis coach, the man
(17:44):
who coached Venus and SerenaWilliams when they were kids,
and yes, that one portrayed inKing Richard, a little slice of
Hollywood tucked intoneuroscience and mindset
conversation on IndobatteryPodcast.
Because apparently you can talkabout pain, the brain, elite
athletes, and resilience all inone episode.
If this conversation taught meanything, it's this healing is
(18:07):
rarely one-dimensional.
Pain has layers, causes overlap,and sometimes the answers we're
looking for live just outsidethe box we've been told to stay
in.
So as you listen back, I inviteyou to stay curious, to consider
other pain generators, to noticehow your mindset supports or
challenges you, and to rememberthat learning more about your
(18:30):
body is never a step backwards.
It's a step towards life withmore understanding and hopefully
less pain.
And just because I'm in theseason of giving, I want to give
you just a little bit of adviceto get you through this holiday
season.
And here it is.
No is a complete sentence.
You don't owe a dissertation.
(18:51):
Just say no.
Our plates are full enough.
It is okay to say no.
As we wrap up this reflection,I'm always struck by just how
much learning lives inside theseconversations.
Looking back, it's not justabout the information.
It's what continued to inspireme, challenge me, and sometimes
gently nudge me to see things alittle differently.
(19:12):
My hope is that something youheard today sparked a moment of
recognition, curiosity, or evena quiet, uh, that makes sense
now.
So here's what I'm gonnachallenge you with.
Take one idea from this episode,just one, and let it sit with
you.
You don't have to fix anything,change anything, or suddenly
(19:32):
become a brand new person byMonday.
Growth counts even when ithappens in sweatpants.
Be gentle with yourself.
Honor how far you've come thisyear, and remember you're
allowed to learn, unlearn, rest,and repeat.
Thank you for reflecting withme.
Continue being curious untilnext time.
Continue advocating for you andfor others.
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