March 20, 2024 • 48 mins
Send us a text with a question or thought on this episode
Join us in this enlightening episode as we dive into the remarkable journey of Dr. Jenn Jaggi, from leading an OB/GYN department for a decade in an underserved Indian Health Service hospital to embarking on a transformative path as a surgeon specializing in endometriosis. Dr. Jaggi's narrative is a testament to the power of passion and the pursuit of knowledge in the medical field.
Dr. Jaggi shares the pivotal moment when she stumbled upon an Endometriosis fellowship with Dr. Cindy Mosbrucker at Pacific Endometriosis and Pelvic Surgery. Through her experiences, she sheds light on the common challenge faced by many GYN practitioners: the lack of comprehensive information and education on endometriosis, despite their genuine desire to provide the best care for their patients.
Listen in as Dr. Jaggi candidly walks us through her personal discoveries about endometriosis and reflects on how her understanding of the condition has evolved over time. She delves into the complexities of diagnosis, treatment, and the impact of education on patient care. Dr. Jaggi's insights offer a refreshing perspective, emphasizing the importance of continuous learning and growth in the medical profession.
This episode serves as a beacon of hope and empowerment for patients and practitioners alike, as we navigate the journey of understanding and managing endometriosis together. Dr. Yaggi's story is a reminder that we are all constantly evolving, and her unwavering commitment to excellence makes her a guiding light in the field of women's health.
Tune in to gain invaluable insights and be inspired by Dr. Jenn's passion, perseverance, and dedication to making a difference in the lives of those affected by endometriosis.
https://pacificendometriosis.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Welcome to Indobattery, where I share about
my endometriosis andadenomyosis story and continue
learning along the way.
This podcast is not asubstitute for professional
medical advice or diagnosis, buta place to equip you with
information and a sense ofcommunity, ensuring you never
have to face this journey alone.
Join me as I navigate the upsand downs and share stories of
(00:23):
strength, resilience and hope.
While navigating the world ofendometriosis and adenomyosis,
from personal experience toexpert insights, I'm your host,
elana, and this is Indobatterycharging our lives when
endometriosis drains us.
Welcome back to Indobattery.
(00:43):
Grab your cup of coffee or yourcup of tea and join my guest
tonight, dr Jen Yaggy, at thetable.
Dr Jen is a board-certifiedOBGYN that practiced as a
general OBGYN for nearly 10years, but recently started her
fellowship for advancedendometriosis and pelvic surgery
with Dr Cindy Mossberger atPacific Endometriosis and Pelvic
Surgery in Gig Harbor,washington.
(01:04):
Thank you, jen, so much forjoining me today.
I'm excited to have you on.
Thanks for taking the time todo that.
Oh, good morning.
Thanks for having me here.
Yes, I'm excited to have youjoin me today for a couple
different reasons.
One of the reasons is that youhave a unique perspective to
give to those of us within theendometriosis community, but
(01:27):
also, I just think that you havea great way of giving us
insight to something that maybewe have become blind to as far
as when it comes to doctorswanting to have the best for
their patients but not equippedproperly to do so and doing
something about that, and Ithink I'm excited to hear more
about your story.
(01:47):
And so, without further ado, ifyou wouldn't mind sharing just
a little bit of who you are andwhat your background is, Of
course, and yeah, thank youagain for having me.
Speaker 2 (01:58):
I was surprised to hear that you would want to have
a fellow who's early intraining in endometriosis on
your podcast.
But I guess there's one thingthat I can offer.
I guess my story to gettingwhere I am is probably unique,
though I realize everyone'sstory in one way or another is
unique in terms of how they getto where they are.
Say, for a long time I knew Iwanted to be a physician.
(02:21):
I think during med schoolitself.
I for a while was kind ofstruggling with what my niche or
my specialty would be.
I think I've always been drawnto anatomy and sort of the more
concrete where you have a visualproblem in front of you and a
concrete solution.
So I think I was always moredrawn to the surgical
(02:41):
specialties.
And yet on some of my surgeryrotations I did a rotation in
ENT and plastic surgery.
While I loved the hands-on timein the OR, I felt like maybe in
terms of the personalities, Ihadn't quite found my people, in
the sense that I also reallyliked the continuity with
patients and I really enjoyedtalking to patients about their
(03:04):
stories and I know that's ageneralization, I'm not saying
that general surgeons ororthopedas don't enjoy that too,
but I think there are differentpersonalities and the
stereotypes of the medical worldand so when I did my OBGYN
rotation I really did enjoy justthe connection that the
(03:25):
physicians had and reallygetting to take care of patients
through all ages and seeingteenagers for their meaningful
periods and then seeing womenduring their pregnancies and
really all the way throughmenopause and prolapse.
I really did like the breadthof it and just really the
continuity that a lot of theOBGYNs had with their patients.
(03:48):
So I think that's ultimatelywhat brought me to OBGYN.
But I was always from thebeginning thinking that I wanted
to focus more on the GYN side.
I loved my GYN oncologyrotations as a medical student
and really initially actuallythought I would do OBGYN
residency to then go on tooncology.
I just felt like they wereamazing surgeons.
(04:10):
And again, the hands-on part, Ireally loved the OR.
And then I think at the timewhen I was in residency too, my
dad was sick with cancer and Ithink there was this part of the
breadth of general OBGYN that Iliked and I suddenly found
myself not wanting perhaps everypatient to be a cancer patient.
(04:30):
So, yeah, found myself decidingthat I was going to be doing
general OBGYN, at least for abit, with the idea in the back
of my head that I would still goon to do a fellowship.
I then thought, maybe MIGS orUrogyne.
I was always drawn to working ina more underserved, low
resource area.
During med school and residencydid rotations abroad in
(04:53):
Guatemala, uganda, south Africaand I think if it hadn't been
for the fact that my dad wassick at the time, I probably
would have ventured off toanother country after residency.
But someone told me no, if youwant to do work in a low
resource setting, kind ofwithout leaving the country, you
should really look at IHS, theIndian Health Service.
(05:14):
And just by chance there weretwo MIGS, which is minimally
invasive GYN surgeons who weregoing out to one of the
hospitals in New Mexico on theNavajo Reservation called
SHIPRAQ.
So I joined them for a week ofsurgeries.
They were doing the morecomplex surgeries that the GYNs
there and kind of saved for thatweek that they were visiting.
(05:36):
The goal of the week, I think,was really to both do the
surgeries that maybe otherwisewould have had to be referred
out and also to bring moreknowledge to the GYNs that were
practicing there and justthrough a kind of series of
small world connections, metanother physician who was at
another neighboring Navajo areahospital in Gallup and a few
(06:00):
months later found myself takinga job at that hospital called
Gallup Indian Medical Center,where I then practice for the
next.
You know, I thought it would bea couple years until I went back
to fellowship, but two becamesix, became gosh, almost 10,
shortly after getting thereno-transcript, two and a half
years after getting there wewent from being a group of six
(06:21):
GYNs to three.
There were several GYNs who justmoved on for other reasons, you
know, one retired, one went onto an administrative role,
someone had a baby and movedcloser to family, but we were
suddenly in a lurch, havingthree docs instead of six, and
so it just did not feel like thetime to move on and I got
(06:41):
thrown into a leadership role aswell.
I ended up taking on the OBchief role just a couple of
years after residency, which inhindsight you know was one of
those things you look back on.
And you know I certainlylearned a lot, but I'm not sure
I would have chosen that sameroute.
And then, a couple of yearslater, I had my first baby, and
(07:05):
that seemed also not the time toventure back to fellowship.
And then, you know, that thingcalled COVID turned the world
upside down.
So, having to kind of lead thedepartment through that, the
Navajo Nation got really hardlyhit by COVID, which you know
would be a whole other podcaston its own.
(07:25):
But it took a couple of yearsto really feel like we were on
our feet.
And you know it was at thatpoint that I was like, okay, if
I really want to go back tofurther my surgical training,
like this would be, I think, thetime to do it, or otherwise,
you know, I think maybe I willcontinue down this route of
general OB GYN.
And it was through another sortof series of small world
(07:46):
connections.
I was at an AAGL conference inDecember of 2022 when one of my
former residency friendsintroduced me to Dr Mossbroker,
who runs Pacific Endometriosisand Pelvic Surgery, and said
that she had prior fellows.
You know that she trained inendometriosis surgery and we
started talking with her andended up coming out for a week
(08:09):
to see her in practice, both inclinic with patients and in the
OR and, yeah, just really gotdrawn into this world of
endometriosis.
I was just so surprised by thestories that I heard when she
was in clinic.
You know she really took thetime with the patients that
often, you know, in othersettings, you don't see possible
, you know, in a 15 minuteappointment Just hearing about
(08:32):
patients who had seen doctorafter doctor and either not been
diagnosed or had had surgeries,but they were incomplete
surgeries and so we're having,you know, continued pain.
So, yeah, I was really drawn inon the clinic days and then, of
course, the OR days was almostfeeling like, wow, I'm like back
on my GYN oncology rotations,you know, in terms of the
complexity of these surgeriesand just how elegantly she does
(08:55):
them.
Except that's not.
These aren't cancer surgeries,these are benign surgeries and
you know, in many ways it issimilar, right, with cancer
you're trying to get it all outand with endo as well, it just
somehow, you know, I feel likethere's a whole other discussion
too.
But cancer, you know, in termsof the training programs, is
just a much more establishedworld than endometriosis
(09:19):
training.
So, to make a long story short,I went home and told my partner
and now my husband, but I feltlike this is what I needed to do
next.
And then, within a few months,we moved up to the, from sunny
New Mexico to rainy Washingtonand I know, six months into my
fellowship at PacificEndometriosis and public surgery
(09:40):
with Dr Mossbroker and yeah,learning a lot and do you ever
sit back and look back at whereyou started out as an OBGYN and
the stories that you would hearfrom patients and knowing now
what you know?
Speaker 1 (09:57):
looking back and saying I wonder if that patient
had endo, I wish I would havebeen able to refer this patient
out or help this patient more.
What has that looked like fromthat transition?
Speaker 2 (10:11):
I think you know, I do think when you go through
OBGYN residency, I think we arewell trained to diagnose those
classic cases of endometriosis,but it's them, you know, the
ones who maybe don't follow theclassic story that I, you know.
I look back and wonder about,you know, patients where I
(10:31):
missed that diagnosis.
I was thinking about it as anexample, like I think it was
just a couple of weeks ago I wasseeing a patient for a new
consultation and I remember whenI was presenting it to Dr
Mossbroker I said, you know, onfirst glance like this didn't
seem like a classic story to me,but you know she's been on OCPs
this whole time, so you know, Ithink it was probably
suppressed.
She was a patient who washaving more bowel symptoms and
(10:53):
more bladder symptoms and thepain really hadn't become an
issue until she stopped birthcontrol.
And you know, as I waspresenting, I was like, huh,
this is the kind of patient that, yeah, I think a couple of
years ago I would have morequickly jumped to like, oh, this
is probably GI.
You know she should be seen fora workup, for IVS or brain or
social cystitis and not kind ofhave put the you know the more
(11:17):
subtle things together.
Yeah, I do, and I think about,you know, the patients that I
had where I did ablation ofendometriosis or, honestly, even
the ones you know.
I can think of one case where Iwas planning to do a
laparoscopicis directory forfibroids and adenomyosis and got
in and it was, you know, a muchmore complex case of stage four
(11:39):
endometriosis and in that case,you know, I recognized that
that was above my surgical skillset and we called it a
diagnostic laparoscopy.
You know she just ended up withone or two small incisions and
then referred her on to theclosest tertiary care center for
what I thought would be, youknow, a minimally invasive
(12:00):
procedure.
She ended up having an openhysterectomy.
I think had her ovary taken outas well.
I think oncology ended up doingthe case and I think back, I
was like, I mean, even in all ofNew Mexico I don't think there
are many true excisionspecialists Now I would know,
like you know there may havebeen somewhere in Arizona or you
(12:21):
know somewhere where she couldhave had a truly minimally
invasive procedure.
Yeah, but you know you, I guess,do the best that you can with
the knowledge that you have atthe time.
And you know I think at leastwith that case you know I as a
physician you learn first do noharm.
You know I didn't go into asurgery that I thought was above
my skill set.
(12:42):
It's sad to think that evenwith referring her on, you know
she may not have had the mostoptimal surgery.
Speaker 1 (12:48):
Yeah, and that brings us to the other point, too, of
what you're learning in medschool and even in your
continuing education as far asendometriosis is concerned,
because you probably hadn'theard much about endometriosis
beyond just what text was givento you or what little pieces
you've been given in medicalschool.
Was that the case for you?
Speaker 2 (13:10):
I mean I spent a lot of time thinking about what
exactly did I learn during themed school and residence.
Yeah, I mean certainly medicalschool.
I mean there are so many areasthat are covered that nothing
really gets more than like halfday or a day, other than
probably the heart and the lungs.
I remember there being a lot ofemphasis on hormonal treatment
of endometriosis, so it's maybenot surprising that the med
(13:34):
school teaching on endometriosiswasn't that thorough.
But I remember in residency, Ihonestly think I mean I started
residency in 2009,.
Finished in 2013.
I think even then, like excisionwas really just starting to be
kind of more commonly done.
You know I would recall ofendometriosis cases was ablation
(13:55):
of, like you know, the stageone in two cases, and then I
remember being involved with themore complex like stage three
or four cases, but usually itwas that the oncologists were
getting called in because it wasa frozen pelvis or it was.
You know some of the MIGsurgeons were doing you know the
more complex dissections wherebowel was scarred to the bladder
(14:18):
and you know I remember long,long surgeries.
But I don't really rememberbeing taught about excision as
like a con concept.
I think you know we were taughtyou should take a biopsy for
conformation, but the idea ofreally trying to remove all
visible endometriosis like isnot something that I recall
(14:39):
being taught as a resident.
Speaker 1 (14:41):
Yeah.
Speaker 2 (14:41):
And so we're on.
Yeah, the hormonal treatment,the teaching that it should get
resolved once you go throughmenopause and you know again the
idea that the ovaries areremoved.
You know that there's no longerthe driver of endometriosis.
Speaker 1 (14:56):
Yeah, which I think too.
I mean, I think, to put this inperspective for everyone that's
listening who has gone throughthe doctors, like myself, you
know I had a great doctor butagain, she had that same
training to do the ablation, shehad the same education as
(15:16):
taking the ovaries out and doinghormonal suppressions and
things like that, and I don'tthink she came at it from a
malicious standpoint or she hadto be right standpoint.
It was she really truly thoughtshe was doing the best she
absolutely could for me and shefelt like she was adequate in
her knowledge of endometriosisand her skill set in
(15:37):
endometriosis surgeries.
So, even though and I think thatwe talk a lot about the medical
trauma that we've faced andcertainly this is not to bunch
every doctor into that category,but by and large I would say
most OBGYNs are doing theirabsolute best with what they've
been given, and I think it'sjust as a testament to you going
(16:02):
in an area that reallyhealthcare is hard to come by
and maybe isn't always the bestin general, because they're.
It's not, it's not going to beyour high paying market, you
know.
It's a different, it's adifferent area, it's a different
way of living, and so I thinkyou did something that was so
impactful and you stuck in there.
(16:24):
So I know just from talking toyou that you truly care about
your patients, so you wouldnever want to lead a mustray or
hurt them.
Or you know, and I and I wantto emphasize that for those who
have been through that medicaltrauma too yes, not every
doctor's the same, but most ofthem- want to do the best for
you, and the limitations, too,are the system, when I think
(16:46):
that you know the averageappointment length is 15 minutes
.
Speaker 2 (16:49):
That doesn't really give the time to sometimes dig
into, you know, all of thesymptoms or even, you know, do
very thorough assessment, likethat's one of the luxuries that
I, you know I do have.
Now we have 45 minutes to anhour with every new patient and
you can dig into things a littlemore deeply.
And yeah, it's interestingbecause I feel like I really was
seeking out more surgicaltraining, because I think that's
(17:13):
a more obvious you know, youmore clearly see, tools in your
toolbox are lacking.
Like I knew, stage three orfour endometriosis cases are not
something that I can do afterfinishing a general OBGYN
residency.
But I think you know we leaveresidency feeling like we have
the medical, you know knowledgeand I think that's the part that
(17:33):
, in a way, has almost been moresurprising with doing this
fellowship.
Just that I may not been askingthe right questions or just,
yeah, again, like you mentioned,thinking about those patients
where I may have missed thediagnosis, even though I thought
I was being thorough.
Speaker 1 (17:49):
What are some of the things that you have really
learned doing this fellowshipthat maybe we're shocking, but
more like wow, this is blowingmy mind on this information, you
know, because I certainly havelearned a lot and I'm obviously
not in a fellowship, I'm just,you know, a host for a podcast,
but I've learned so much.
I can only assume that you havehad that same experience of
(18:12):
like wow, this, I had no idea.
What are some of those thingsthat have been just shocking to
you or enlightening?
Speaker 2 (18:21):
One thing that I feel like again wasn't on my radar
as much and I you spent a lot oftime thinking back to it, was
like, did I just not know thator was that a just general gap
in knowledge?
But like, for instance,adenomyosis, where we were kind
of taught as something that ismore an issue of women who have
had multiple pregnancies and canonly be diagnosed at time of
(18:43):
hysterectomy.
But you know, I'm seeing a fairnumber of patients that have
not had any children and are,you know, in their early 20s,
even where their symptoms areclassic for adenomyosis and then
the ultrasound suggestsadenomyosis and when you look in
at time of surgery, see again.
You know the gold standardreally still is to only make
(19:04):
that diagnosis at time ofhysterectomy.
But yeah, I've been learning,there's a lot of other ways that
you can almost make thatdiagnosis.
Ultrasound is another thingwhere you know I was doing quite
a bit of ultrasound as ageneral OBGYN, but usually in
the context of, you know, anearly pregnancy, ruling out
abnormalities there and notreally thinking about ultrasound
(19:27):
as something that can give youhints that there may be an
ametriosis.
You know so usually forultrasounds that I wasn't doing
for you know, like someonewalking in with abnormal
bleeding and a positivepregnancy test.
More often if we were wantingto look at the uterus or the
ovaries, we would order theultrasound.
It would get done in radiology.
So you know, we order it, thenthe tech takes the images and
(19:50):
then it gets sent to theradiologist to look at those
static images and then a coupleof days later you get the report
back and you know often itwould say you know just that the
uterus was a normal size, therewas maybe a physiologic system
on the ovary, or you knowessentially that it was
unremarkable.
Speaker 1 (20:07):
Right.
Speaker 2 (20:08):
And now you know, with every consult that I'm
doing with Dr Mossbrokker, we dohave an ultrasound while the
patient's there and there'sreally just so much more that
you can see with the ultrasoundif you kind of use it as a tool
in real time.
You know, you can see if theovaries are tethered or stuck to
the sidewall, if the ovariesare stuck to the uterus, if
there is movement between thecervix and the rectum and you
(20:30):
know and more subtle signs ofadenomyosis you can see as well.
And again, that's somethingthat you know.
I've been doing ultrasound foryears but never really thought
of it as a way to look for someof the markers of adenomyosis.
You know if everything is stucktogether or if patients have
pain when you're pushing on theuterus?
sacral ligaments you know, itreally is almost an extension of
(20:52):
the exam.
That is really pretty, you know, simple and can just really
help or make you more suspiciousthat the underlying issue could
be adenomyosis, as opposed tojust saying, oh, that one, you
know, came back unremarkable,you know we don't know why
you're having this pain.
Speaker 1 (21:08):
Yeah, and I think that's true.
I mean, that's more and more aconversation that we've been
having within the adenomyosiscommunity.
Is imaging right?
Because you know, we've beentaught for many years the only
way that you can truly identifyadenomyosis is through a
laparoscopic surgery and to 100%diagnosed, yes, that's still
(21:30):
the case.
However, imaging is doing agreat job now with giving
doctors a roadmap, but a lot oftimes, if you just order the
images and let someone else readthem, you're not seeing the
roadmap, you're letting someoneelse draw it out for you, and I
think that that has been aconversation that's really
starting to take hold within thelast couple years probably.
(21:51):
But I think maybe that is agood differentiating factor
between a specialist and kind offor lack of a better word but a
generalist, because even thoughOBGYNs are still specialties
within what they're doing,they're still not a specialist
in GYN, and so I think that isanother thing to consider when
(22:13):
people are looking to findtreatment for this.
Speaker 2 (22:16):
So I think having that ultrasound in connection
with you know, a thoroughhistory and exam, yeah, I've.
Also.
In terms of the things you'reasking about, things I've
learned or been surprised about,you know, I don't feel like I
learned very much about, likepelvic floor dysfunction and you
know, incorporating that intoevery exam I do and just the
number of patients that are notonly dealing with endometriosis
(22:39):
but the pelvic floor spasm orwho have symptoms of
interstitial cystitis, likethey're so often all tied
together.
Speaker 1 (22:46):
Which is what yeah?
Speaker 2 (22:47):
Which is not new news to you, but yeah.
Speaker 1 (22:50):
But it would be.
I mean, I wouldn't have knownthat in my journey, you know,
and I kind of correlate yourjourney to a lot of us who have
gone through this, because we'veall started really in the same
place, right you on the doctor'sside, us on the patient side
but we're walking through it andlearning more and becoming
better advocates for those withendometriosis because of our
(23:13):
lived experiences, because ofwhat drives us right.
So I think the value in usdoing this together and what
you're learning I'm right therewith you for a lot of it.
So it's kind of fun I'm really.
That's why I wanted to talk toyou, because I was like, wow,
this really feels like you'rewalking with me on this stuff
too and learning with me.
Speaker 2 (23:33):
Yeah, I'd say like the part yeah, that the end of
the day leaves me so sad.
On many days it's just how manydoctors patients have already
seen and you know how long it'sbeen until they get that you
know appointment where they feellike someone is kind of putting
it all together.
Or you know then they have thesurgery, which then the large
majority of the time kind ofshows what we were suspecting,
(23:56):
and I can't tell you how manytimes there's patients in tears
at their consults, just feelinglike they're finally validated,
and as a patient who has feltthat way.
Speaker 1 (24:05):
again, I don't blame my doctor for not knowing what
she didn't know.
It's just not well knownoutside of the specialty, really
.
But I'm excited to see whereyou're going with this.
So you are doing a fellowshipnow.
Can you explain what afellowship is?
Because I think that a lot ofus hear about excision
specialists and they hear aboutthese specialists, but there's a
(24:27):
step to getting to that pointof being a specialist and that's
the fellowship.
Can you explain what thefellowship is and what the
different kind of fellowshipsthere are?
Speaker 2 (24:37):
I guess to start very basically, you know there's
four years of OBGYN residencythat all OBGYNs do, and then
afterwards there's the option todo a fellowship.
There are certain fellowshipsthat are like ACGME, approved
fellowships.
So for instance, high riskobstetrics, that's called an MFM
fellowship, infertility, calledREI, reproductive anachronology
(25:00):
and infertility, and thenneurogyne and MIGs minimally
invasive GYN surgery is theother one that some of your
listeners may have heard of andthat there are MIGs fellowships
through AGL and through SLS andessentially it's typically two
years of additional training andwith MIGs it's usually pretty
broad.
It's all of the more complexparts of GYN surgery, fibroids
(25:24):
and ametriosis, and it'sinteresting because MIGs it's
really, you know, minimallyinvasive GYN surgery is talking
more about, in a way, theapproach, laparoscopic and
robotic, versus, you know, withhigh risk OB or with infertility
.
It's more the subject matter,but I would say overall with
MIGs it tends to be again anametriosis, fibroids, all of the
things that make GYN surgeriesmore complex.
(25:47):
And so you know, migs is not afellowship through gosh I'm
going to mix up my acronymsthrough KBug that, like MFM and
REI are, though I'm guessing inthe next few years it may be
going that route as well and alot of the people who are, you
know, experts in their fieldsnow did more informal
fellowships in the past, like,for instance, dr Mossbrook, who
(26:10):
I'm working with now, did afellowship with Dr Redwine.
You know, in the past peoplereally did fellowships more
informally and now they'regetting more formalized.
So what I'm doing is two yearsworking with Dr Mossbrook, both
in the clinic and the OR andessentially, you know, learning
from her expertise and her skillset.
It's a little different thanpeople who are doing a
(26:31):
fellowship like MIGs, where itmay be kind of a broader scope
in terms of laparoscopy androbotic surgery, fibroids,
ametriosis.
This with Dr Mossbrook isreally focused specifically on
endometriosis.
So I think the word fellow,depending on you know a person's
specific background they mayhave done a fellowship with a
(26:53):
specific physician or, you know,nowadays fellowship could mean
again doing a AGL MIGsfellowship where you're at
typically at an academic center.
And again, I think it reallyvaries, some MIGs fellowships
having more emphasis onendometriosis and others having
less emphasis on endometriosis,just depending on who the
(27:17):
faculty are.
And I think in general, youknow, for patients, someone who
is MIG-strained means they'regenerally focusing on the GYN
portion only and not theobstetric side.
So someone who's MIG-strainedis going to be better at
approaching endometriosissurgeries, but it doesn't
necessarily mean that they, forinstance, are an excision expert
(27:40):
.
Speaker 1 (27:41):
I think it's important to note, too, that
just because they've done a MIGsprogram doesn't make them a
specialist in endometriosis.
Speaker 2 (27:50):
Yeah, I mean, I guess the word specialist it's so
hard Like what defines aspecialist?
Yeah, it's hard.
Certainly Dr Mossbrook is anendometriosis specialist.
I think again, people who havedone a MIGs fellowship certainly
have a lot more endometriosistraining than someone who did
general OB-GYN residency.
But I think there's just a lotof variation, you know, from
(28:11):
program to program and in a way,you know, I think about my
fellowship with Dr Mossbrook orit's almost like an
apprenticeship you're learning,in this case from a specific
physician and in this case it isvery, I would say,
disease-focused withendometriosis.
And in other programs, againwith MIGs, if you think about
(28:32):
even the title MinimallyInvasive GYN Surgery the focus
is on laparoscopic and roboticapproaches, again generally to
complex GYN problems.
Speaker 1 (28:43):
Yeah, what was I mean ?
I know that you wanted to dothe surgical side of things more
, but what was it that pulledyou more into the endometriosis
side of doing a fellowship?
Speaker 2 (28:56):
Yeah, it's interesting, I was thinking
about this this morning like, ina way, it was really the
surgery part, you know, that Iwas looking for and that I knew
was, you know, an area that Ifelt like I wanted more, you
know, to advance or to refine.
But it was really kind ofeverything else that drew me in
in the sense of, you know, evengoing back to what I said early
(29:18):
on, you know, being on mysurgery, rotations and like
plastic surgery and ENT, andfeeling like I love the, you
know, the anatomy part of it,but felt like it wasn't my
people.
I feel like in thisendometriosis world, like
they're really you have to kindof consider the whole, the whole
body, and be a little moreholistic about the approach, and
I think that's always, you know, been an interest of mine.
(29:41):
And there is also thiscontinuity with patients too,
like through their journey, andso for me, yeah, it really is
this just unique meld of kind ofeverything that I feel like
I've been interested in and beengood at kind of coming together
in one disease.
And it's funny because I always,you know, thought of myself
(30:03):
initially just, you know, havingthis kind of broad approach.
I would have never thought thatI would, at the end of the day,
want to have, you know, focuson just one disease.
But I feel like, withendometriosis, you're bringing
so many different thingstogether and also, again, it's
like, if you think of one in 10women having endometriosis, that
(30:24):
is a large subset of women, andso we do need more people who
are focusing on this.
But yeah, I think it's justbeen really interesting how I
wasn't it's almost like I wasn'tseeking endometriosis out, but
it kind of sound me, you know.
Speaker 1 (30:40):
Yeah, I feel like that's true with a lot of
doctors who have done that andthey've, you know, talked about
it.
It's just the intrigue of it andthe whole body approach to it
and really seeing how unjustlyit was treated within the
healthcare system and I thinkthat's been probably one of the
most shocking things for a lotof doctors who get into it is
(31:03):
just, you know, not only fromthe excision standpoint but as
being recognized as somethingthat is more harmful than just a
painful period and seeing theeffects that it has on the
patients and how it's treatedwhen it comes to medical billing
and how it's treated when itcomes to people calling you
(31:27):
crazy because of the pain youknow and not recognizing that
it's such a big pain,contributor to different parts
of your body beyond just youruterus or ovaries.
And I think the fact thatyou've done this and you've seen
two different sides of the coin, so to speak you've seen it
with the more marginalizedcommunity, as an OB-GYN, and now
(31:50):
you're seeing it as a fellow inendometriosis Just the
healthcare discrepancies inwomen's health is large
discrepancy.
Speaker 2 (31:59):
I don't know how else to say that.
Yeah, I mean, I think that'sthe other part.
You know, in a way that hasbeen hard, like I you know, as I
was saying, as far back asresidency was really interested
in working in an underservedarea.
The first what?
Almost 10 years of my life Iworked at a Navajo Reservation
Hospital and so really wastaking care of patients I mean
(32:20):
again, not all, but for the mostpart with much fewer resources.
And now I'm sort of at theother end of the spectrum,
working in a practice that isout of network, with insurance
and just very different patientpopulation, and in some ways
that has been hard.
I come back to the fact that forthese two years I really am
learning how to do thesesurgeries well and how to take
(32:43):
care of patients withendometriosis well.
And then I think you know, thenext battle that I feel like I
want to put my energy into is,yeah, how do we make this more
accessible for the averagepatient and make it so that you
know, right now I feel like alot of the patients that I'm
seeing have in a way, found us,like they have come from sites
(33:04):
like Nancy's Nook, or theirphysical therapist suggested
that they may have that doughand come to us.
But I think back to, you know,the patients that I was taking
care of and my prior practicesetting and you know they were
really relying on what the whatthe GYN was telling them in the
in the office and I think, like,how do we get to that point
(33:24):
that patients are getting theinfo and the diagnosis from the
person they're seeing, you know,for their appointment and don't
need to come to it from thisyou know roundabout way?
I mean, I think it's amazing allthe advocacy that patients are
doing for other patients andtrying to get the word out, but
in the long run, yeah, I justfeel like there are so many, so
(33:47):
many battles still to be fought,you know, or how can we get to
the place where insurancereimburses these procedures
appropriately and sees, you know, not only that they're
effective for the patient, but Ican't imagine that it's not
cost effective to do the youknow surgery the right way the
first time, as opposed to having, what do they say, the average
(34:08):
patient it's seven years oreight years until they get the
diagnosis and if you think thatduring that time, you know, the
average patient has seen so manydifferent providers, perhaps
like had one or two surgeries.
You know, it just seems to melike it has to be cost effective
to do the right thing first.
And you know how do we get tothat place with the insurance
(34:28):
companies and yeah, I mean I'mgoing to focus on surgeries, but
yeah, all of those otherbattles I feel like are the
other driver.
Speaker 1 (34:41):
Were you aware of that?
Going into the fellowship ofjust?
Speaker 2 (34:44):
how I was like when I was at the AA GL conference.
I remember my residencycolleague tell me that, yeah,
the Jardee of Excision Surgeonsbeing out of network, and I
think you know, coming from avery low resource place, I would
admit my first like reaction tothat was like well, that's not,
that's not right, or you knowhow can that be?
(35:05):
I think I had a very limitedunderstanding of you know why it
is that they're out of networkand now I understand that much
better and realize howcomplicated the issue is.
You know, in terms of you knowif an insurance company
reimburses the same way for aablation as for a long, complex
surgery.
You know, obviously that ispart of the issue and I was, I
(35:28):
would say, more peripherallyaware of the issue and I think I
had my biases about sort ofbeing out of network.
Now understand that better and,of course, hope that we get to
a place where this is somethingthat every patient has access to
.
Speaker 1 (35:44):
Yeah, absolutely, and I think when you have a heart
for the communities that areunderserved and you want to be
able to help those patients whocan't pay out a pocket, you know
, I think that's always got tobe kind of on your mind.
I know, for me as a patient,it's always on my mind Well, is
insurance going to cover this?
Is am I going to be able to seethe person that I want it or
(36:05):
that I need to see?
It's not even I want to see,it's that I kind of need to see
to get the proper care right.
That's a challenge and that'swhat I think sometimes can add
to the trauma of the medicaltrauma.
Right, so it's not alwaysnecessarily that it's the
doctors that are doing thesethings and the patients have bad
outcomes.
It's really that the medicalsystem isn't set up for the
(36:28):
patient to have long termquality of life and that's a
little frustrating from thepatient standpoint and the
doctor standpoint and it's acomplex thing that we don't have
enough time to talk about,right?
I?
Speaker 2 (36:40):
think it has to come from both ends, in terms of
patient advocacy and thenpositions, to change the current
system.
Yeah absolutely, there's moreeducation during residency,
making sure that even some ofthe ongoing maintenance of
certification involves moreeducation about endometriosis.
(37:02):
And then, yeah, unfortunately Idon't think without addressing
the reimbursement side of it,the issue will get solved.
Speaker 1 (37:10):
Yeah, was it?
I think this is an interestingthing to think about.
Were you aware of the one in 10number prior to doing your
fellowship?
Speaker 2 (37:20):
No, no Interesting.
I knew it was relatively common, but I feel like that's a
statistic that I more recentlylearned.
Speaker 1 (37:29):
Was that a shock to you, or was it?
Oh, that aligns, that checksout.
Speaker 2 (37:36):
Of course, now, since I'm primarily seeing patients
with endometriosis, it seemslike it should be even higher,
but I think it does make sense.
Speaker 1 (37:46):
Yeah, I think that's something that we, as people who
have been in the endometriosiscommunity, oftentimes forget is
just how many doctors don't havethe knowledge of endometriosis,
because it's not the firstthing that would pop into
someone's head if they're notinfiltrated with it, right, like
you said, irritable bowelsyndrome and other things that
(38:07):
could contribute to pain factors, urination issues, whatever To
think one in 10, you're notthinking oh, that's this patient
.
They just don't know.
That's unfortunate andsomething that I hope that we
can get better at.
Speaker 2 (38:22):
We've decided that a system or an issue with our
medical system as a whole, right, you kind of get referred from
one specialist to see anotherspecialist and they refer on and
it's like who is the personputting it all together?
So I think, yeah, even separatefrom GYNs needing more
knowledge about endometriosis,it's probably also family
(38:44):
practice doctors and therapistsand it's so nuanced, isn't it?
Speaker 1 (38:50):
This disease is just a very tricky disease and I
think something I admire aboutwhat you're doing is that you
took yourself out of a I don'tknow if it was comfort zone of
knowing what you knew to getbetter.
I think that's promising, for alot of us who have dealt with
this disease for a long time isto be able to see someone say I
(39:13):
want to get better at my skilland my craft and I'm going to
step out of that comfort zone.
Do you think more and moredoctors are going to start doing
that to understand theirpatients better, or is that
something that's not really thatcommon?
Speaker 2 (39:25):
That's a good question.
I mean, I think in some waysit's both, yeah, certainly
stepping out of comfort zone inthe sense that I was the
department supervisor and nowI'm going back to a learning
role and being at the bottom ofthe totem pole, to speak.
But I think in other ways itwas also that I recognize there
were certainly for a largemajority of GYN surgeries felt
(39:48):
very comfortable but also justlike feeling that there were
these more complex cases that Iwanted to be able to do and not
need to rely on referring tosomeone else.
So in a way it was almost likemy discomfort with that that
drew me to wanting to learn more.
Yeah, I think it's complicated.
I think it's also complicated bythe fact that OB and GYN are
(40:11):
tied together as one specialtyand I think for a lot of general
OB GYNs the bulk of theirpractice is the OB side.
I think, again, obstetrics issuch a bulk of our residency
training and then just thelogistics of the average OB GYNs
practice I think is heavily OBand so I think everyone ideally
(40:35):
would like to further theirsurgical skillset.
But it is hard to do it unlessyou and I mean I consider myself
myself lucky that I was able tosay okay, I'm going to take a
two-year pause or I'm going togo back to learning.
I think in many cases it maynot be an option for people.
There's loans to pay back,there's family responsibilities
(40:58):
or you're in a practice wherethat's not an option.
So I consider myself lucky tohave this opportunity and a
supportive partner who was likeencouraging me to go back and
learn more.
So I think it's one of thosethings where probably a lot of
physicians would like to dosomething similar, but there's
(41:19):
also the reality of how do youmake that happen when you're
already 10 years into practice.
Speaker 1 (41:25):
What's something that you wish that they would put
into medical school andresidency programs that you
think would help just thegeneral GYN be able to identify
endometriosis better and evenrefer out appropriately?
Speaker 2 (41:40):
Yeah, I mean, I think in a way medical school is
where it all starts, and I thinkif more people can become aware
or can be taught thatendometriosis isn't just pain
during your periods and peoplesee it as more of a multi-system
there may be bladderinvolvement, bowel involvement,
(42:01):
almost IBS.
If you're considering adiagnosis of IBS, you should
also be thinking about possibleendometriosis.
I think if that can beincorporated into medical
training, that would probably bethe most helpful.
The reality is, I don't thinkwe will be able to train every
general OBGYN to do thesecomplex cases, and I think it is
(42:24):
a matter of recognizing whichcases need to be referred out.
But having it on yourdifferential when it should be
is probably a better goal.
And then the other, I guess bigquestion is how do we increase
the number of people who aredoing this type of surgery?
Because I think if once thereis more awareness, there's going
(42:45):
to be more of a demand forexcision surgery, and then it's
not like you'll be able tocreate the excision surgeons
overnight preparing for that aswell.
I think it's a two-prongedapproach, like creating
awareness but then also havingif that's going to create more
demand for these types ofsurgeries and then also having
(43:06):
more GYN physicians who are ableto do them.
Speaker 1 (43:09):
Yeah, you give us hope, though that's what I'm
saying, right, you give us hope.
Looking at your future.
What are you excited for inwhere you're going with your
fellowship and potentialpractice later down the line?
What is exciting for you movingforward?
Speaker 2 (43:28):
Yeah, I mean, I think again, right now, one of the
things that is really the mostexciting is sort of seeing the
whole process through getting tosee a patient in clinic and
doing an initial consult, beingthere for the surgery, seeing
them through the recovery periodas well.
Yeah, I think now that's one ofthe things that is really them
(43:49):
and it's really part of how I'mlearning to right.
Thinking back to what were thesymptoms they talked about
during the consult and thenseeing the anatomy at the time
of surgery I think is one of thebest ways to learn is to have
that continuity.
Yeah, and then, yeah, I mean Ireally I don't know exactly
where I will be when thisfellowship concludes and still
(44:13):
thinking about bigger picturequestions of whether I'll be
able to make this entirely myfocus, or whether I will be a
GYN physician that is muchbetter burst in endometriosis
and doing some of the perhapssimpler endometriosis cases and
still seeing some other GYNtypes of problems, or being able
(44:35):
to be like Dr Mass Brooker, whois really an excision expert.
You know, all of that, I think,still remains to be seen, but
I'm just excited to learn moreand then, yeah, hopefully at
some point in the future, beable to collaborate with other
people who are focusing on thisas well, to address some of
these bigger picture issues,like I'm looking forward to the
(44:57):
conference in April that I'll begoing to in Geneva focusing on
endometriosis, and just gettingto talk with other people who
have made this their life'sfocus.
Speaker 1 (45:07):
Yeah, it's always exciting and inspiring and yeah,
oh, it's a breath of fresh airto hear you talk about it and
just your journey and I and Iand, like I said, I just really
feel like you are on thisjourney with a lot of us.
It feels like you're rightthere with us from the other
perspective, and I think that'simpactful for a lot of people to
(45:29):
understand, because we canoften feel like the doctors
don't get it, they don'tunderstand, but they do.
It's just from a differentstandpoint, right, it's from a
different perspective.
And so to see it from thisperspective and to see someone
that has practiced for quitesome time to be able to step
back and and learn some more andgrow some more in their skills,
(45:49):
that is just refreshing for alot of people.
It is for me at least, and Iknew that when Nancy Peterson
said you've got to meet this gal, I said okay, nancy, I'll meet
her.
And she said, no, I want you totalk to her.
I said, okay, nancy, what youwant you get.
So you made an impact.
Speaker 2 (46:08):
I appreciate it.
I had a chance to when I firstheard about the podcast.
I got to listen to to yourstory as one of the early
episodes and I felt like youwere so thoughtful when you were
talking about, you know, thephysician you had initially seen
.
When you talk, I felt like youeven sort of beat yourselves up
about not having done you knowthe research yourselves about
(46:29):
endometriosis.
You know, in the sense of kindof those early decisions and,
yeah, I just appreciated yourthoughtful approach to that
Cause in many ways.
You know I was identifying withthat GYN that you initially saw
.
You know, in terms of the, thesteps, yeah.
And the through.
So, yeah, I appreciate all thatyou're doing to bring more
(46:51):
information to other patients ontheir journey and I appreciate
you tying me in Cause.
Yes, I'm on a similar journeymyself.
Speaker 1 (46:58):
Yeah, yeah and it's.
It's kind of just kind of funto see that journey happen.
I'm excited to see what thefuture brings for you.
I'm excited to see the changethat you will elicit, because I
really truly feel like having abroad picture of this is going
to be impactful longterm formany, many people.
(47:20):
So I'm excited.
Plus, you really have a just asweetheart for those patients
and the underserved communitiesand the ones that are often
overlooked.
So thank you, thank you fordoing the work that you're doing
.
Speaker 2 (47:32):
Shout again when I'm closer to the end of my
fellowship, but I've learned afew more things along the way.
Speaker 1 (47:37):
Oh, I'd love that.
That would be so good, and thenhopefully, we'll get to meet in
person one of these days andhave those conversations.
Well, thank you so much forjoining me today and sharing
your story and your heart, andI'm sure that people will be
able to resonate with us.
So thank you so much for takingthe time.
Speaker 2 (47:54):
Thank you, lana, oh my gosh.
Speaker 1 (47:56):
You're so welcome and until next time, everyone
continue advocating for you andfor those that you love.
Welcome to Indobattery, where I share about
my endometriosis andadenomyosis story and continue
learning along the way.
This podcast is not asubstitute for professional
medical advice or diagnosis, buta place to equip you with
information and a sense ofcommunity, ensuring you never
have to face this journey alone.
Join me as I navigate the upsand downs and share stories of
(00:23):
strength, resilience and hope.
While navigating the world ofendometriosis and adenomyosis,
from personal experience toexpert insights, I'm your host,
elana, and this is Indobatterycharging our lives when
endometriosis drains us.
Welcome back to Indobattery.
(00:43):
Grab your cup of coffee or yourcup of tea and join my guest
tonight, dr Jen Yaggy, at thetable.
Dr Jen is a board-certifiedOBGYN that practiced as a
general OBGYN for nearly 10years, but recently started her
fellowship for advancedendometriosis and pelvic surgery
with Dr Cindy Mossberger atPacific Endometriosis and Pelvic
Surgery in Gig Harbor,washington.
(01:04):
Thank you, jen, so much forjoining me today.
I'm excited to have you on.
Thanks for taking the time todo that.
Oh, good morning.
Thanks for having me here.
Yes, I'm excited to have youjoin me today for a couple
different reasons.
One of the reasons is that youhave a unique perspective to
give to those of us within theendometriosis community, but
(01:27):
also, I just think that you havea great way of giving us
insight to something that maybewe have become blind to as far
as when it comes to doctorswanting to have the best for
their patients but not equippedproperly to do so and doing
something about that, and Ithink I'm excited to hear more
about your story.
(01:47):
And so, without further ado, ifyou wouldn't mind sharing just
a little bit of who you are andwhat your background is, Of
course, and yeah, thank youagain for having me.
Speaker 2 (01:58):
I was surprised to hear that you would want to have
a fellow who's early intraining in endometriosis on
your podcast.
But I guess there's one thingthat I can offer.
I guess my story to gettingwhere I am is probably unique,
though I realize everyone'sstory in one way or another is
unique in terms of how they getto where they are.
Say, for a long time I knew Iwanted to be a physician.
(02:21):
I think during med schoolitself.
I for a while was kind ofstruggling with what my niche or
my specialty would be.
I think I've always been drawnto anatomy and sort of the more
concrete where you have a visualproblem in front of you and a
concrete solution.
So I think I was always moredrawn to the surgical
(02:41):
specialties.
And yet on some of my surgeryrotations I did a rotation in
ENT and plastic surgery.
While I loved the hands-on timein the OR, I felt like maybe in
terms of the personalities, Ihadn't quite found my people, in
the sense that I also reallyliked the continuity with
patients and I really enjoyedtalking to patients about their
(03:04):
stories and I know that's ageneralization, I'm not saying
that general surgeons ororthopedas don't enjoy that too,
but I think there are differentpersonalities and the
stereotypes of the medical worldand so when I did my OBGYN
rotation I really did enjoy justthe connection that the
(03:25):
physicians had and reallygetting to take care of patients
through all ages and seeingteenagers for their meaningful
periods and then seeing womenduring their pregnancies and
really all the way throughmenopause and prolapse.
I really did like the breadthof it and just really the
continuity that a lot of theOBGYNs had with their patients.
(03:48):
So I think that's ultimatelywhat brought me to OBGYN.
But I was always from thebeginning thinking that I wanted
to focus more on the GYN side.
I loved my GYN oncologyrotations as a medical student
and really initially actuallythought I would do OBGYN
residency to then go on tooncology.
I just felt like they wereamazing surgeons.
(04:10):
And again, the hands-on part, Ireally loved the OR.
And then I think at the timewhen I was in residency too, my
dad was sick with cancer and Ithink there was this part of the
breadth of general OBGYN that Iliked and I suddenly found
myself not wanting perhaps everypatient to be a cancer patient.
(04:30):
So, yeah, found myself decidingthat I was going to be doing
general OBGYN, at least for abit, with the idea in the back
of my head that I would still goon to do a fellowship.
I then thought, maybe MIGS orUrogyne.
I was always drawn to working ina more underserved, low
resource area.
During med school and residencydid rotations abroad in
(04:53):
Guatemala, uganda, south Africaand I think if it hadn't been
for the fact that my dad wassick at the time, I probably
would have ventured off toanother country after residency.
But someone told me no, if youwant to do work in a low
resource setting, kind ofwithout leaving the country, you
should really look at IHS, theIndian Health Service.
(05:14):
And just by chance there weretwo MIGS, which is minimally
invasive GYN surgeons who weregoing out to one of the
hospitals in New Mexico on theNavajo Reservation called
SHIPRAQ.
So I joined them for a week ofsurgeries.
They were doing the morecomplex surgeries that the GYNs
there and kind of saved for thatweek that they were visiting.
(05:36):
The goal of the week, I think,was really to both do the
surgeries that maybe otherwisewould have had to be referred
out and also to bring moreknowledge to the GYNs that were
practicing there and justthrough a kind of series of
small world connections, metanother physician who was at
another neighboring Navajo areahospital in Gallup and a few
(06:00):
months later found myself takinga job at that hospital called
Gallup Indian Medical Center,where I then practice for the
next.
You know, I thought it would bea couple years until I went back
to fellowship, but two becamesix, became gosh, almost 10,
shortly after getting thereno-transcript, two and a half
years after getting there wewent from being a group of six
(06:21):
GYNs to three.
There were several GYNs who justmoved on for other reasons, you
know, one retired, one went onto an administrative role,
someone had a baby and movedcloser to family, but we were
suddenly in a lurch, havingthree docs instead of six, and
so it just did not feel like thetime to move on and I got
(06:41):
thrown into a leadership role aswell.
I ended up taking on the OBchief role just a couple of
years after residency, which inhindsight you know was one of
those things you look back on.
And you know I certainlylearned a lot, but I'm not sure
I would have chosen that sameroute.
And then, a couple of yearslater, I had my first baby, and
(07:05):
that seemed also not the time toventure back to fellowship.
And then, you know, that thingcalled COVID turned the world
upside down.
So, having to kind of lead thedepartment through that, the
Navajo Nation got really hardlyhit by COVID, which you know
would be a whole other podcaston its own.
(07:25):
But it took a couple of yearsto really feel like we were on
our feet.
And you know it was at thatpoint that I was like, okay, if
I really want to go back tofurther my surgical training,
like this would be, I think, thetime to do it, or otherwise,
you know, I think maybe I willcontinue down this route of
general OB GYN.
And it was through another sortof series of small world
(07:46):
connections.
I was at an AAGL conference inDecember of 2022 when one of my
former residency friendsintroduced me to Dr Mossbroker,
who runs Pacific Endometriosisand Pelvic Surgery, and said
that she had prior fellows.
You know that she trained inendometriosis surgery and we
started talking with her andended up coming out for a week
(08:09):
to see her in practice, both inclinic with patients and in the
OR and, yeah, just really gotdrawn into this world of
endometriosis.
I was just so surprised by thestories that I heard when she
was in clinic.
You know she really took thetime with the patients that
often, you know, in othersettings, you don't see possible
, you know, in a 15 minuteappointment Just hearing about
(08:32):
patients who had seen doctorafter doctor and either not been
diagnosed or had had surgeries,but they were incomplete
surgeries and so we're having,you know, continued pain.
So, yeah, I was really drawn inon the clinic days and then, of
course, the OR days was almostfeeling like, wow, I'm like back
on my GYN oncology rotations,you know, in terms of the
complexity of these surgeriesand just how elegantly she does
(08:55):
them.
Except that's not.
These aren't cancer surgeries,these are benign surgeries and
you know, in many ways it issimilar, right, with cancer
you're trying to get it all outand with endo as well, it just
somehow, you know, I feel likethere's a whole other discussion
too.
But cancer, you know, in termsof the training programs, is
just a much more establishedworld than endometriosis
(09:19):
training.
So, to make a long story short,I went home and told my partner
and now my husband, but I feltlike this is what I needed to do
next.
And then, within a few months,we moved up to the, from sunny
New Mexico to rainy Washingtonand I know, six months into my
fellowship at PacificEndometriosis and public surgery
(09:40):
with Dr Mossbroker and yeah,learning a lot and do you ever
sit back and look back at whereyou started out as an OBGYN and
the stories that you would hearfrom patients and knowing now
what you know?
Speaker 1 (09:57):
looking back and saying I wonder if that patient
had endo, I wish I would havebeen able to refer this patient
out or help this patient more.
What has that looked like fromthat transition?
Speaker 2 (10:11):
I think you know, I do think when you go through
OBGYN residency, I think we arewell trained to diagnose those
classic cases of endometriosis,but it's them, you know, the
ones who maybe don't follow theclassic story that I, you know.
I look back and wonder about,you know, patients where I
(10:31):
missed that diagnosis.
I was thinking about it as anexample, like I think it was
just a couple of weeks ago I wasseeing a patient for a new
consultation and I remember whenI was presenting it to Dr
Mossbroker I said, you know, onfirst glance like this didn't
seem like a classic story to me,but you know she's been on OCPs
this whole time, so you know, Ithink it was probably
suppressed.
She was a patient who washaving more bowel symptoms and
(10:53):
more bladder symptoms and thepain really hadn't become an
issue until she stopped birthcontrol.
And you know, as I waspresenting, I was like, huh,
this is the kind of patient that, yeah, I think a couple of
years ago I would have morequickly jumped to like, oh, this
is probably GI.
You know she should be seen fora workup, for IVS or brain or
social cystitis and not kind ofhave put the you know the more
(11:17):
subtle things together.
Yeah, I do, and I think about,you know, the patients that I
had where I did ablation ofendometriosis or, honestly, even
the ones you know.
I can think of one case where Iwas planning to do a
laparoscopicis directory forfibroids and adenomyosis and got
in and it was, you know, a muchmore complex case of stage four
(11:39):
endometriosis and in that case,you know, I recognized that
that was above my surgical skillset and we called it a
diagnostic laparoscopy.
You know she just ended up withone or two small incisions and
then referred her on to theclosest tertiary care center for
what I thought would be, youknow, a minimally invasive
(12:00):
procedure.
She ended up having an openhysterectomy.
I think had her ovary taken outas well.
I think oncology ended up doingthe case and I think back, I
was like, I mean, even in all ofNew Mexico I don't think there
are many true excisionspecialists Now I would know,
like you know there may havebeen somewhere in Arizona or you
(12:21):
know somewhere where she couldhave had a truly minimally
invasive procedure.
Yeah, but you know you, I guess,do the best that you can with
the knowledge that you have atthe time.
And you know I think at leastwith that case you know I as a
physician you learn first do noharm.
You know I didn't go into asurgery that I thought was above
my skill set.
(12:42):
It's sad to think that evenwith referring her on, you know
she may not have had the mostoptimal surgery.
Speaker 1 (12:48):
Yeah, and that brings us to the other point, too, of
what you're learning in medschool and even in your
continuing education as far asendometriosis is concerned,
because you probably hadn'theard much about endometriosis
beyond just what text was givento you or what little pieces
you've been given in medicalschool.
Was that the case for you?
Speaker 2 (13:10):
I mean I spent a lot of time thinking about what
exactly did I learn during themed school and residence.
Yeah, I mean certainly medicalschool.
I mean there are so many areasthat are covered that nothing
really gets more than like halfday or a day, other than
probably the heart and the lungs.
I remember there being a lot ofemphasis on hormonal treatment
of endometriosis, so it's maybenot surprising that the med
(13:34):
school teaching on endometriosiswasn't that thorough.
But I remember in residency, Ihonestly think I mean I started
residency in 2009,.
Finished in 2013.
I think even then, like excisionwas really just starting to be
kind of more commonly done.
You know I would recall ofendometriosis cases was ablation
(13:55):
of, like you know, the stageone in two cases, and then I
remember being involved with themore complex like stage three
or four cases, but usually itwas that the oncologists were
getting called in because it wasa frozen pelvis or it was.
You know some of the MIGsurgeons were doing you know the
more complex dissections wherebowel was scarred to the bladder
(14:18):
and you know I remember long,long surgeries.
But I don't really rememberbeing taught about excision as
like a con concept.
I think you know we were taughtyou should take a biopsy for
conformation, but the idea ofreally trying to remove all
visible endometriosis like isnot something that I recall
(14:39):
being taught as a resident.
Speaker 1 (14:41):
Yeah.
Speaker 2 (14:41):
And so we're on.
Yeah, the hormonal treatment,the teaching that it should get
resolved once you go throughmenopause and you know again the
idea that the ovaries areremoved.
You know that there's no longerthe driver of endometriosis.
Speaker 1 (14:56):
Yeah, which I think too.
I mean, I think, to put this inperspective for everyone that's
listening who has gone throughthe doctors, like myself, you
know I had a great doctor butagain, she had that same
training to do the ablation, shehad the same education as
(15:16):
taking the ovaries out and doinghormonal suppressions and
things like that, and I don'tthink she came at it from a
malicious standpoint or she hadto be right standpoint.
It was she really truly thoughtshe was doing the best she
absolutely could for me and shefelt like she was adequate in
her knowledge of endometriosisand her skill set in
(15:37):
endometriosis surgeries.
So, even though and I think thatwe talk a lot about the medical
trauma that we've faced andcertainly this is not to bunch
every doctor into that category,but by and large I would say
most OBGYNs are doing theirabsolute best with what they've
been given, and I think it'sjust as a testament to you going
(16:02):
in an area that reallyhealthcare is hard to come by
and maybe isn't always the bestin general, because they're.
It's not, it's not going to beyour high paying market, you
know.
It's a different, it's adifferent area, it's a different
way of living, and so I thinkyou did something that was so
impactful and you stuck in there.
(16:24):
So I know just from talking toyou that you truly care about
your patients, so you wouldnever want to lead a mustray or
hurt them.
Or you know, and I and I wantto emphasize that for those who
have been through that medicaltrauma too yes, not every
doctor's the same, but most ofthem- want to do the best for
you, and the limitations, too,are the system, when I think
(16:46):
that you know the averageappointment length is 15 minutes
.
Speaker 2 (16:49):
That doesn't really give the time to sometimes dig
into, you know, all of thesymptoms or even, you know, do
very thorough assessment, likethat's one of the luxuries that
I, you know I do have.
Now we have 45 minutes to anhour with every new patient and
you can dig into things a littlemore deeply.
And yeah, it's interestingbecause I feel like I really was
seeking out more surgicaltraining, because I think that's
(17:13):
a more obvious you know, youmore clearly see, tools in your
toolbox are lacking.
Like I knew, stage three orfour endometriosis cases are not
something that I can do afterfinishing a general OBGYN
residency.
But I think you know we leaveresidency feeling like we have
the medical, you know knowledgeand I think that's the part that
(17:33):
, in a way, has almost been moresurprising with doing this
fellowship.
Just that I may not been askingthe right questions or just,
yeah, again, like you mentioned,thinking about those patients
where I may have missed thediagnosis, even though I thought
I was being thorough.
Speaker 1 (17:49):
What are some of the things that you have really
learned doing this fellowshipthat maybe we're shocking, but
more like wow, this is blowingmy mind on this information, you
know, because I certainly havelearned a lot and I'm obviously
not in a fellowship, I'm just,you know, a host for a podcast,
but I've learned so much.
I can only assume that you havehad that same experience of
(18:12):
like wow, this, I had no idea.
What are some of those thingsthat have been just shocking to
you or enlightening?
Speaker 2 (18:21):
One thing that I feel like again wasn't on my radar
as much and I you spent a lot oftime thinking back to it, was
like, did I just not know thator was that a just general gap
in knowledge?
But like, for instance,adenomyosis, where we were kind
of taught as something that ismore an issue of women who have
had multiple pregnancies and canonly be diagnosed at time of
(18:43):
hysterectomy.
But you know, I'm seeing a fairnumber of patients that have
not had any children and are,you know, in their early 20s,
even where their symptoms areclassic for adenomyosis and then
the ultrasound suggestsadenomyosis and when you look in
at time of surgery, see again.
You know the gold standardreally still is to only make
(19:04):
that diagnosis at time ofhysterectomy.
But yeah, I've been learning,there's a lot of other ways that
you can almost make thatdiagnosis.
Ultrasound is another thingwhere you know I was doing quite
a bit of ultrasound as ageneral OBGYN, but usually in
the context of, you know, anearly pregnancy, ruling out
abnormalities there and notreally thinking about ultrasound
(19:27):
as something that can give youhints that there may be an
ametriosis.
You know so usually forultrasounds that I wasn't doing
for you know, like someonewalking in with abnormal
bleeding and a positivepregnancy test.
More often if we were wantingto look at the uterus or the
ovaries, we would order theultrasound.
It would get done in radiology.
So you know, we order it, thenthe tech takes the images and
(19:50):
then it gets sent to theradiologist to look at those
static images and then a coupleof days later you get the report
back and you know often itwould say you know just that the
uterus was a normal size, therewas maybe a physiologic system
on the ovary, or you knowessentially that it was
unremarkable.
Speaker 1 (20:07):
Right.
Speaker 2 (20:08):
And now you know, with every consult that I'm
doing with Dr Mossbrokker, we dohave an ultrasound while the
patient's there and there'sreally just so much more that
you can see with the ultrasoundif you kind of use it as a tool
in real time.
You know, you can see if theovaries are tethered or stuck to
the sidewall, if the ovariesare stuck to the uterus, if
there is movement between thecervix and the rectum and you
(20:30):
know and more subtle signs ofadenomyosis you can see as well.
And again, that's somethingthat you know.
I've been doing ultrasound foryears but never really thought
of it as a way to look for someof the markers of adenomyosis.
You know if everything is stucktogether or if patients have
pain when you're pushing on theuterus?
sacral ligaments you know, itreally is almost an extension of
(20:52):
the exam.
That is really pretty, you know, simple and can just really
help or make you more suspiciousthat the underlying issue could
be adenomyosis, as opposed tojust saying, oh, that one, you
know, came back unremarkable,you know we don't know why
you're having this pain.
Speaker 1 (21:08):
Yeah, and I think that's true.
I mean, that's more and more aconversation that we've been
having within the adenomyosiscommunity.
Is imaging right?
Because you know, we've beentaught for many years the only
way that you can truly identifyadenomyosis is through a
laparoscopic surgery and to 100%diagnosed, yes, that's still
(21:30):
the case.
However, imaging is doing agreat job now with giving
doctors a roadmap, but a lot oftimes, if you just order the
images and let someone else readthem, you're not seeing the
roadmap, you're letting someoneelse draw it out for you, and I
think that that has been aconversation that's really
starting to take hold within thelast couple years probably.
(21:51):
But I think maybe that is agood differentiating factor
between a specialist and kind offor lack of a better word but a
generalist, because even thoughOBGYNs are still specialties
within what they're doing,they're still not a specialist
in GYN, and so I think that isanother thing to consider when
(22:13):
people are looking to findtreatment for this.
Speaker 2 (22:16):
So I think having that ultrasound in connection
with you know, a thoroughhistory and exam, yeah, I've.
Also.
In terms of the things you'reasking about, things I've
learned or been surprised about,you know, I don't feel like I
learned very much about, likepelvic floor dysfunction and you
know, incorporating that intoevery exam I do and just the
number of patients that are notonly dealing with endometriosis
(22:39):
but the pelvic floor spasm orwho have symptoms of
interstitial cystitis, likethey're so often all tied
together.
Speaker 1 (22:46):
Which is what yeah?
Speaker 2 (22:47):
Which is not new news to you, but yeah.
Speaker 1 (22:50):
But it would be.
I mean, I wouldn't have knownthat in my journey, you know,
and I kind of correlate yourjourney to a lot of us who have
gone through this, because we'veall started really in the same
place, right you on the doctor'sside, us on the patient side
but we're walking through it andlearning more and becoming
better advocates for those withendometriosis because of our
(23:13):
lived experiences, because ofwhat drives us right.
So I think the value in usdoing this together and what
you're learning I'm right therewith you for a lot of it.
So it's kind of fun I'm really.
That's why I wanted to talk toyou, because I was like, wow,
this really feels like you'rewalking with me on this stuff
too and learning with me.
Speaker 2 (23:33):
Yeah, I'd say like the part yeah, that the end of
the day leaves me so sad.
On many days it's just how manydoctors patients have already
seen and you know how long it'sbeen until they get that you
know appointment where they feellike someone is kind of putting
it all together.
Or you know then they have thesurgery, which then the large
majority of the time kind ofshows what we were suspecting,
(23:56):
and I can't tell you how manytimes there's patients in tears
at their consults, just feelinglike they're finally validated,
and as a patient who has feltthat way.
Speaker 1 (24:05):
again, I don't blame my doctor for not knowing what
she didn't know.
It's just not well knownoutside of the specialty, really
.
But I'm excited to see whereyou're going with this.
So you are doing a fellowshipnow.
Can you explain what afellowship is?
Because I think that a lot ofus hear about excision
specialists and they hear aboutthese specialists, but there's a
(24:27):
step to getting to that pointof being a specialist and that's
the fellowship.
Can you explain what thefellowship is and what the
different kind of fellowshipsthere are?
Speaker 2 (24:37):
I guess to start very basically, you know there's
four years of OBGYN residencythat all OBGYNs do, and then
afterwards there's the option todo a fellowship.
There are certain fellowshipsthat are like ACGME, approved
fellowships.
So for instance, high riskobstetrics, that's called an MFM
fellowship, infertility, calledREI, reproductive anachronology
(25:00):
and infertility, and thenneurogyne and MIGs minimally
invasive GYN surgery is theother one that some of your
listeners may have heard of andthat there are MIGs fellowships
through AGL and through SLS andessentially it's typically two
years of additional training andwith MIGs it's usually pretty
broad.
It's all of the more complexparts of GYN surgery, fibroids
(25:24):
and ametriosis, and it'sinteresting because MIGs it's
really, you know, minimallyinvasive GYN surgery is talking
more about, in a way, theapproach, laparoscopic and
robotic, versus, you know, withhigh risk OB or with infertility
.
It's more the subject matter,but I would say overall with
MIGs it tends to be again anametriosis, fibroids, all of the
things that make GYN surgeriesmore complex.
(25:47):
And so you know, migs is not afellowship through gosh I'm
going to mix up my acronymsthrough KBug that, like MFM and
REI are, though I'm guessing inthe next few years it may be
going that route as well and alot of the people who are, you
know, experts in their fieldsnow did more informal
fellowships in the past, like,for instance, dr Mossbrook, who
(26:10):
I'm working with now, did afellowship with Dr Redwine.
You know, in the past peoplereally did fellowships more
informally and now they'regetting more formalized.
So what I'm doing is two yearsworking with Dr Mossbrook, both
in the clinic and the OR andessentially, you know, learning
from her expertise and her skillset.
It's a little different thanpeople who are doing a
(26:31):
fellowship like MIGs, where itmay be kind of a broader scope
in terms of laparoscopy androbotic surgery, fibroids,
ametriosis.
This with Dr Mossbrook isreally focused specifically on
endometriosis.
So I think the word fellow,depending on you know a person's
specific background they mayhave done a fellowship with a
(26:53):
specific physician or, you know,nowadays fellowship could mean
again doing a AGL MIGsfellowship where you're at
typically at an academic center.
And again, I think it reallyvaries, some MIGs fellowships
having more emphasis onendometriosis and others having
less emphasis on endometriosis,just depending on who the
(27:17):
faculty are.
And I think in general, youknow, for patients, someone who
is MIG-strained means they'regenerally focusing on the GYN
portion only and not theobstetric side.
So someone who's MIG-strainedis going to be better at
approaching endometriosissurgeries, but it doesn't
necessarily mean that they, forinstance, are an excision expert
(27:40):
.
Speaker 1 (27:41):
I think it's important to note, too, that
just because they've done a MIGsprogram doesn't make them a
specialist in endometriosis.
Speaker 2 (27:50):
Yeah, I mean, I guess the word specialist it's so
hard Like what defines aspecialist?
Yeah, it's hard.
Certainly Dr Mossbrook is anendometriosis specialist.
I think again, people who havedone a MIGs fellowship certainly
have a lot more endometriosistraining than someone who did
general OB-GYN residency.
But I think there's just a lotof variation, you know, from
(28:11):
program to program and in a way,you know, I think about my
fellowship with Dr Mossbrook orit's almost like an
apprenticeship you're learning,in this case from a specific
physician and in this case it isvery, I would say,
disease-focused withendometriosis.
And in other programs, againwith MIGs, if you think about
(28:32):
even the title MinimallyInvasive GYN Surgery the focus
is on laparoscopic and roboticapproaches, again generally to
complex GYN problems.
Speaker 1 (28:43):
Yeah, what was I mean ?
I know that you wanted to dothe surgical side of things more
, but what was it that pulledyou more into the endometriosis
side of doing a fellowship?
Speaker 2 (28:56):
Yeah, it's interesting, I was thinking
about this this morning like, ina way, it was really the
surgery part, you know, that Iwas looking for and that I knew
was, you know, an area that Ifelt like I wanted more, you
know, to advance or to refine.
But it was really kind ofeverything else that drew me in
in the sense of, you know, evengoing back to what I said early
(29:18):
on, you know, being on mysurgery, rotations and like
plastic surgery and ENT, andfeeling like I love the, you
know, the anatomy part of it,but felt like it wasn't my
people.
I feel like in thisendometriosis world, like
they're really you have to kindof consider the whole, the whole
body, and be a little moreholistic about the approach, and
I think that's always, you know, been an interest of mine.
(29:41):
And there is also thiscontinuity with patients too,
like through their journey, andso for me, yeah, it really is
this just unique meld of kind ofeverything that I feel like
I've been interested in and beengood at kind of coming together
in one disease.
And it's funny because I always,you know, thought of myself
(30:03):
initially just, you know, havingthis kind of broad approach.
I would have never thought thatI would, at the end of the day,
want to have, you know, focuson just one disease.
But I feel like, withendometriosis, you're bringing
so many different thingstogether and also, again, it's
like, if you think of one in 10women having endometriosis, that
(30:24):
is a large subset of women, andso we do need more people who
are focusing on this.
But yeah, I think it's justbeen really interesting how I
wasn't it's almost like I wasn'tseeking endometriosis out, but
it kind of sound me, you know.
Speaker 1 (30:40):
Yeah, I feel like that's true with a lot of
doctors who have done that andthey've, you know, talked about
it.
It's just the intrigue of it andthe whole body approach to it
and really seeing how unjustlyit was treated within the
healthcare system and I thinkthat's been probably one of the
most shocking things for a lotof doctors who get into it is
(31:03):
just, you know, not only fromthe excision standpoint but as
being recognized as somethingthat is more harmful than just a
painful period and seeing theeffects that it has on the
patients and how it's treatedwhen it comes to medical billing
and how it's treated when itcomes to people calling you
(31:27):
crazy because of the pain youknow and not recognizing that
it's such a big pain,contributor to different parts
of your body beyond just youruterus or ovaries.
And I think the fact thatyou've done this and you've seen
two different sides of the coin, so to speak you've seen it
with the more marginalizedcommunity, as an OB-GYN, and now
(31:50):
you're seeing it as a fellow inendometriosis Just the
healthcare discrepancies inwomen's health is large
discrepancy.
Speaker 2 (31:59):
I don't know how else to say that.
Yeah, I mean, I think that'sthe other part.
You know, in a way that hasbeen hard, like I you know, as I
was saying, as far back asresidency was really interested
in working in an underservedarea.
The first what?
Almost 10 years of my life Iworked at a Navajo Reservation
Hospital and so really wastaking care of patients I mean
(32:20):
again, not all, but for the mostpart with much fewer resources.
And now I'm sort of at theother end of the spectrum,
working in a practice that isout of network, with insurance
and just very different patientpopulation, and in some ways
that has been hard.
I come back to the fact that forthese two years I really am
learning how to do thesesurgeries well and how to take
(32:43):
care of patients withendometriosis well.
And then I think you know, thenext battle that I feel like I
want to put my energy into is,yeah, how do we make this more
accessible for the averagepatient and make it so that you
know, right now I feel like alot of the patients that I'm
seeing have in a way, found us,like they have come from sites
(33:04):
like Nancy's Nook, or theirphysical therapist suggested
that they may have that doughand come to us.
But I think back to, you know,the patients that I was taking
care of and my prior practicesetting and you know they were
really relying on what the whatthe GYN was telling them in the
in the office and I think, like,how do we get to that point
(33:24):
that patients are getting theinfo and the diagnosis from the
person they're seeing, you know,for their appointment and don't
need to come to it from thisyou know roundabout way?
I mean, I think it's amazing allthe advocacy that patients are
doing for other patients andtrying to get the word out, but
in the long run, yeah, I justfeel like there are so many, so
(33:47):
many battles still to be fought,you know, or how can we get to
the place where insurancereimburses these procedures
appropriately and sees, you know, not only that they're
effective for the patient, but Ican't imagine that it's not
cost effective to do the youknow surgery the right way the
first time, as opposed to having, what do they say, the average
(34:08):
patient it's seven years oreight years until they get the
diagnosis and if you think thatduring that time, you know, the
average patient has seen so manydifferent providers, perhaps
like had one or two surgeries.
You know, it just seems to melike it has to be cost effective
to do the right thing first.
And you know how do we get tothat place with the insurance
(34:28):
companies and yeah, I mean I'mgoing to focus on surgeries, but
yeah, all of those otherbattles I feel like are the
other driver.
Speaker 1 (34:41):
Were you aware of that?
Going into the fellowship ofjust?
Speaker 2 (34:44):
how I was like when I was at the AA GL conference.
I remember my residencycolleague tell me that, yeah,
the Jardee of Excision Surgeonsbeing out of network, and I
think you know, coming from avery low resource place, I would
admit my first like reaction tothat was like well, that's not,
that's not right, or you knowhow can that be?
(35:05):
I think I had a very limitedunderstanding of you know why it
is that they're out of networkand now I understand that much
better and realize howcomplicated the issue is.
You know, in terms of you knowif an insurance company
reimburses the same way for aablation as for a long, complex
surgery.
You know, obviously that ispart of the issue and I was, I
(35:28):
would say, more peripherallyaware of the issue and I think I
had my biases about sort ofbeing out of network.
Now understand that better and,of course, hope that we get to
a place where this is somethingthat every patient has access to
.
Speaker 1 (35:44):
Yeah, absolutely, and I think when you have a heart
for the communities that areunderserved and you want to be
able to help those patients whocan't pay out a pocket, you know
, I think that's always got tobe kind of on your mind.
I know, for me as a patient,it's always on my mind Well, is
insurance going to cover this?
Is am I going to be able to seethe person that I want it or
(36:05):
that I need to see?
It's not even I want to see,it's that I kind of need to see
to get the proper care right.
That's a challenge and that'swhat I think sometimes can add
to the trauma of the medicaltrauma.
Right, so it's not alwaysnecessarily that it's the
doctors that are doing thesethings and the patients have bad
outcomes.
It's really that the medicalsystem isn't set up for the
(36:28):
patient to have long termquality of life and that's a
little frustrating from thepatient standpoint and the
doctor standpoint and it's acomplex thing that we don't have
enough time to talk about,right?
I?
Speaker 2 (36:40):
think it has to come from both ends, in terms of
patient advocacy and thenpositions, to change the current
system.
Yeah absolutely, there's moreeducation during residency,
making sure that even some ofthe ongoing maintenance of
certification involves moreeducation about endometriosis.
(37:02):
And then, yeah, unfortunately Idon't think without addressing
the reimbursement side of it,the issue will get solved.
Speaker 1 (37:10):
Yeah, was it?
I think this is an interestingthing to think about.
Were you aware of the one in 10number prior to doing your
fellowship?
Speaker 2 (37:20):
No, no Interesting.
I knew it was relatively common, but I feel like that's a
statistic that I more recentlylearned.
Speaker 1 (37:29):
Was that a shock to you, or was it?
Oh, that aligns, that checksout.
Speaker 2 (37:36):
Of course, now, since I'm primarily seeing patients
with endometriosis, it seemslike it should be even higher,
but I think it does make sense.
Speaker 1 (37:46):
Yeah, I think that's something that we, as people who
have been in the endometriosiscommunity, oftentimes forget is
just how many doctors don't havethe knowledge of endometriosis,
because it's not the firstthing that would pop into
someone's head if they're notinfiltrated with it, right, like
you said, irritable bowelsyndrome and other things that
(38:07):
could contribute to pain factors, urination issues, whatever To
think one in 10, you're notthinking oh, that's this patient
.
They just don't know.
That's unfortunate andsomething that I hope that we
can get better at.
Speaker 2 (38:22):
We've decided that a system or an issue with our
medical system as a whole, right, you kind of get referred from
one specialist to see anotherspecialist and they refer on and
it's like who is the personputting it all together?
So I think, yeah, even separatefrom GYNs needing more
knowledge about endometriosis,it's probably also family
(38:44):
practice doctors and therapistsand it's so nuanced, isn't it?
Speaker 1 (38:50):
This disease is just a very tricky disease and I
think something I admire aboutwhat you're doing is that you
took yourself out of a I don'tknow if it was comfort zone of
knowing what you knew to getbetter.
I think that's promising, for alot of us who have dealt with
this disease for a long time isto be able to see someone say I
(39:13):
want to get better at my skilland my craft and I'm going to
step out of that comfort zone.
Do you think more and moredoctors are going to start doing
that to understand theirpatients better, or is that
something that's not really thatcommon?
Speaker 2 (39:25):
That's a good question.
I mean, I think in some waysit's both, yeah, certainly
stepping out of comfort zone inthe sense that I was the
department supervisor and nowI'm going back to a learning
role and being at the bottom ofthe totem pole, to speak.
But I think in other ways itwas also that I recognize there
were certainly for a largemajority of GYN surgeries felt
(39:48):
very comfortable but also justlike feeling that there were
these more complex cases that Iwanted to be able to do and not
need to rely on referring tosomeone else.
So in a way it was almost likemy discomfort with that that
drew me to wanting to learn more.
Yeah, I think it's complicated.
I think it's also complicated bythe fact that OB and GYN are
(40:11):
tied together as one specialtyand I think for a lot of general
OB GYNs the bulk of theirpractice is the OB side.
I think, again, obstetrics issuch a bulk of our residency
training and then just thelogistics of the average OB GYNs
practice I think is heavily OBand so I think everyone ideally
(40:35):
would like to further theirsurgical skillset.
But it is hard to do it unlessyou and I mean I consider myself
myself lucky that I was able tosay okay, I'm going to take a
two-year pause or I'm going togo back to learning.
I think in many cases it maynot be an option for people.
There's loans to pay back,there's family responsibilities
(40:58):
or you're in a practice wherethat's not an option.
So I consider myself lucky tohave this opportunity and a
supportive partner who was likeencouraging me to go back and
learn more.
So I think it's one of thosethings where probably a lot of
physicians would like to dosomething similar, but there's
(41:19):
also the reality of how do youmake that happen when you're
already 10 years into practice.
Speaker 1 (41:25):
What's something that you wish that they would put
into medical school andresidency programs that you
think would help just thegeneral GYN be able to identify
endometriosis better and evenrefer out appropriately?
Speaker 2 (41:40):
Yeah, I mean, I think in a way medical school is
where it all starts, and I thinkif more people can become aware
or can be taught thatendometriosis isn't just pain
during your periods and peoplesee it as more of a multi-system
there may be bladderinvolvement, bowel involvement,
(42:01):
almost IBS.
If you're considering adiagnosis of IBS, you should
also be thinking about possibleendometriosis.
I think if that can beincorporated into medical
training, that would probably bethe most helpful.
The reality is, I don't thinkwe will be able to train every
general OBGYN to do thesecomplex cases, and I think it is
(42:24):
a matter of recognizing whichcases need to be referred out.
But having it on yourdifferential when it should be
is probably a better goal.
And then the other, I guess bigquestion is how do we increase
the number of people who aredoing this type of surgery?
Because I think if once thereis more awareness, there's going
(42:45):
to be more of a demand forexcision surgery, and then it's
not like you'll be able tocreate the excision surgeons
overnight preparing for that aswell.
I think it's a two-prongedapproach, like creating
awareness but then also havingif that's going to create more
demand for these types ofsurgeries and then also having
(43:06):
more GYN physicians who are ableto do them.
Speaker 1 (43:09):
Yeah, you give us hope, though that's what I'm
saying, right, you give us hope.
Looking at your future.
What are you excited for inwhere you're going with your
fellowship and potentialpractice later down the line?
What is exciting for you movingforward?
Speaker 2 (43:28):
Yeah, I mean, I think again, right now, one of the
things that is really the mostexciting is sort of seeing the
whole process through getting tosee a patient in clinic and
doing an initial consult, beingthere for the surgery, seeing
them through the recovery periodas well.
Yeah, I think now that's one ofthe things that is really them
(43:49):
and it's really part of how I'mlearning to right.
Thinking back to what were thesymptoms they talked about
during the consult and thenseeing the anatomy at the time
of surgery I think is one of thebest ways to learn is to have
that continuity.
Yeah, and then, yeah, I mean Ireally I don't know exactly
where I will be when thisfellowship concludes and still
(44:13):
thinking about bigger picturequestions of whether I'll be
able to make this entirely myfocus, or whether I will be a
GYN physician that is muchbetter burst in endometriosis
and doing some of the perhapssimpler endometriosis cases and
still seeing some other GYNtypes of problems, or being able
(44:35):
to be like Dr Mass Brooker, whois really an excision expert.
You know, all of that, I think,still remains to be seen, but
I'm just excited to learn moreand then, yeah, hopefully at
some point in the future, beable to collaborate with other
people who are focusing on thisas well, to address some of
these bigger picture issues,like I'm looking forward to the
(44:57):
conference in April that I'll begoing to in Geneva focusing on
endometriosis, and just gettingto talk with other people who
have made this their life'sfocus.
Speaker 1 (45:07):
Yeah, it's always exciting and inspiring and yeah,
oh, it's a breath of fresh airto hear you talk about it and
just your journey and I and Iand, like I said, I just really
feel like you are on thisjourney with a lot of us.
It feels like you're rightthere with us from the other
perspective, and I think that'simpactful for a lot of people to
(45:29):
understand, because we canoften feel like the doctors
don't get it, they don'tunderstand, but they do.
It's just from a differentstandpoint, right, it's from a
different perspective.
And so to see it from thisperspective and to see someone
that has practiced for quitesome time to be able to step
back and and learn some more andgrow some more in their skills,
(45:49):
that is just refreshing for alot of people.
It is for me at least, and Iknew that when Nancy Peterson
said you've got to meet this gal, I said okay, nancy, I'll meet
her.
And she said, no, I want you totalk to her.
I said, okay, nancy, what youwant you get.
So you made an impact.
Speaker 2 (46:08):
I appreciate it.
I had a chance to when I firstheard about the podcast.
I got to listen to to yourstory as one of the early
episodes and I felt like youwere so thoughtful when you were
talking about, you know, thephysician you had initially seen
.
When you talk, I felt like youeven sort of beat yourselves up
about not having done you knowthe research yourselves about
(46:29):
endometriosis.
You know, in the sense of kindof those early decisions and,
yeah, I just appreciated yourthoughtful approach to that
Cause in many ways.
You know I was identifying withthat GYN that you initially saw
.
You know, in terms of the, thesteps, yeah.
And the through.
So, yeah, I appreciate all thatyou're doing to bring more
(46:51):
information to other patients ontheir journey and I appreciate
you tying me in Cause.
Yes, I'm on a similar journeymyself.
Speaker 1 (46:58):
Yeah, yeah and it's.
It's kind of just kind of funto see that journey happen.
I'm excited to see what thefuture brings for you.
I'm excited to see the changethat you will elicit, because I
really truly feel like having abroad picture of this is going
to be impactful longterm formany, many people.
(47:20):
So I'm excited.
Plus, you really have a just asweetheart for those patients
and the underserved communitiesand the ones that are often
overlooked.
So thank you, thank you fordoing the work that you're doing
.
Speaker 2 (47:32):
Shout again when I'm closer to the end of my
fellowship, but I've learned afew more things along the way.
Speaker 1 (47:37):
Oh, I'd love that.
That would be so good, and thenhopefully, we'll get to meet in
person one of these days andhave those conversations.
Well, thank you so much forjoining me today and sharing
your story and your heart, andI'm sure that people will be
able to resonate with us.
So thank you so much for takingthe time.
Speaker 2 (47:54):
Thank you, lana, oh my gosh.
Speaker 1 (47:56):
You're so welcome and until next time, everyone
continue advocating for you andfor those that you love.
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