Endo Year Reflections: #9 Your Surgeon Says “Trust Me”—Your Gut Says “Nope”

What if the most powerful thing you could do for your endometriosis care wasn’t another appointment, but a better question? We revisit a standout set of conversations to unpack how to spot true expertise, avoid convincing pretenders, and build a team that actually improves outcomes. Titles and confidence can look impressive; results, transparency, and collaboration tell the truth.

I walk through a practical framework for vetting providers, moving beyond the vague “find an excision specialist” advice. You’ll hear how to evaluate surgical volume, complication data, pathology correlation, and the way a clinician handles your questions. Then we step into the operating room realities of bowel-involved disease with a colorectal perspective: when restraint is safer than risk, why staged approaches can spare complications, and how documentation plus expert referral protects patients when nodules are complex.

We balance the scalpel with the nervous system. From a neurogastroenterology lens, we outline pre-op planning that changes outcomes: stabilizing mast cell activity, anticipating dysautonomia, supporting hypermobility, coordinating anesthesia choices, and creating a perioperative protocol that prevents flares. It’s the difference between hoping for a smooth recovery and planning for it. Along the way, we make the case for multidisciplinary care that looks more like a tumor board than a solo act—gynecology, colorectal surgery, radiology, anesthesia, and GI aligning to reduce blind spots and keep you at the center.

This is a candid, sometimes funny, always practical reflection designed to help you ask better questions, choose safer options, and recognize small wins as real progress. If you’ve felt pressured to “just trust” a confident voice, this conversation hands you the tools to verify instead. Subscribe, share with someone who needs a clearer path, and leave a review with the one question you wish you had asked sooner.

Chapters

• 0:00 Launching The Reflection Series
• 1:08 Why “Excision Specialist” Needs Clarity
• 3:08 Tools To Vet Providers
• 4:15 Bowel Involvement And Surgical Realities
• 6:16 Neurogastro Insights And Prep Protocols
• 8:16 Multidisciplinary Care Done Right
• 10:05 Gratitude, Small Wins, And Next Steps

Transcript

SPEAKER_01: 0:00

With the Indo Year coming up, it's a perfect time to reflect on all the lessons, growth, and amazing guests we've had on Endobattery. But instead of one big recap, I'm breaking it into quick, bite-sized reflections multiple times a week. Let's revisit what inspired us, learn what we missed, and recharge together in our Endo Year Reflection series. Join me each episode as we look back. Welcome to Indobattery, where I share my journey with endometriosis and chronic illness while learning and growing along the way. This podcast is not a substitute for medical advice, but a supportive space to provide community and valuable information so you never have to face this journey alone. We embrace a range of perspectives that may not always align with our own, believing that open dialogue helps us grow and gain new tools. Join me as I share stories of strength, resilience, and hope, from personal experiences to expert insights. I'm your host, Alana, and this is Indobattery, charging our lives when Endometriosis drains us. Welcome back to Indobattery. As we continue in our Indo Year Reflection Series, I just want to say it is such a pleasure to look back with you. When I look back at episode 168, my conversation with Dr. Melissa McHale stands out as one of those episodes that made me laugh and think deeply, sometimes at the exact same moment. This episode came together after we had met at the endometriosis summit. But if I'm being honest, it was her Home Depot video that really hooked me. It was funny, relatable, and somehow managed to explain endometriosis in guy terms, which, let's be real, is no small feat. But when we sat down to record, we quickly realized what we were both most passionate about addressing. We hear all the time, you need to find an excision specialist. But what does that actually mean? Because that phrase gets thrown around a lot and it's incredibly broad. And far too often people get left thinking they're an expert hand when they're not. What Dr. McHale did so brilliantly was name something many of us feel but struggle to articulate. A lot of patients are being misdiagnosed, mistreated, and misunderstood, not necessarily because doctors are malicious, but because they lack the education and training specific to endometriosis. And yes, sometimes we get played. She used humor to talk about something serious, the Bernie madoffs of the medical field, if you will. The doctors who look convincing on paper, who sound confident in the room, but don't actually have the skill or experience to treat complex endometriosis appropriately.

SPEAKER_00: 2:44

You can watch friends with the sound off, and you know exactly how everyone is feeling and what everyone is thinking based on like the way that David Schwimmer's face looks, right? With a doctor, you can't always do that, right? Because someone will seem super, super confident, even if they have no idea what they're doing. And so he he gets very much into ways to figure out if someone's, you know, outside matches their intentions. And I think that that's sort of the the really important thing. And I think that that one of the best ways to assess that actually is watching how they answer questions. If you if you like what you see, meet with them. If you don't like what you see, that's when don't go see them. Don't say like they don't really seem like they know what they're doing online, but I'm just gonna meet with them and see. You know, maybe maybe I'll feel like I trust them if I meet them. They'll convince me otherwise. You don't want to be convinced. If they're not qualified, you don't want them to convince you that they're qualified.

SPEAKER_01: 3:38

What made this episode so impactful was that she didn't just point out the problem, she gave us tools. She helped us create a practical framework, a checklist, a way to evaluate providers, identify red flags, and decide whether someone is truly the right fit or whether it's time to keep looking. And she did it in a way that only Dr. McHeel can. With humor, clarity, and zero judgment. This episode was enlightening and genuinely fun to make, and I'm endlessly grateful for the way she brings levity to a hard conversation without ever minimizing how serious the stakes are for patients. That conversation also set the stage for episode 183. This is one of those episodes that came together in a way I never could have planned, but ended up being exactly what so many people needed. In episode 183, I sat down with Dr. Zachary Spiritus again and Dr. Vance Obius, a neurogastroenterologist and a colorectal surgeon, the black swan of conversation. If you would have asked me a year ago if I'd ever pair those two together, I probably would have said no. And yet, it was kind of magic. So many people with endometriosis struggle with bowel involvement, many undergo surgery near or directly on the bowels, and yet we rarely get to hear these perspectives side by side. Dr. Obius, who works closely with Dr. McGael, brought the surgical reality, the risks, the implications, the challenges of multiple surgeries, and what the body goes through from a colorectal standpoint. Dr. Spiritus brought the functional neurogastroenterology lens, what happens before surgery, what might be contributing to symptoms, and what we may be missing when everything's being attributed to endometriosis. And together they created a conversation that was layered, nuanced, and incredibly impactful.

SPEAKER_03: 5:30

I will say that um every time I'm in a case, um, especially now working with Dr. Vargas and Dr. Mikhail, you know, their success rates in finding nodules and of involvement of the bowel is like 100%. So whenever and and like we had mentioned and discussed earlier, sadly, most of the surgeries I've involved, there's been previous surgery, which is it's just sad to see. So honestly, um, the gynecologist did the right thing. Rather than tackle this complex nodule on the rectum and have a complication that's just terrible, don't do anything, document it, get it to an expert. But yeah, I mean, when they're having post-surgical and there's usually because of endometriosis that's been left behind, sometimes inadvertently and regrown, or and sometimes they knew it and they're like, look, I'm not gonna not gonna risk it. And it's the smart thing to do, understanding that you know they're a little bit out of their element. The patient is not aware a big surgery can happen. Um, and it's better to just you know get out, let them recover quickly. But it's very frustrating, honestly, for the patients who are like, they came in, they're hoping to have one procedure, they're hoping to have this done, taken care of, and they've been told, you know, we couldn't do it all, but there's also a worse situation, and you may need even more advanced extensive stuff. So um, so yes, I absolutely have seen it. And that the majority of the time it's because of this endometriosis beam there.

SPEAKER_02: 6:49

We want to make sure their mast cell is under as best control as possible preoperatively. There's always, I tend to reach out to the surgeon to discuss the case and just say, hey, this is kind of this is how I would think about this specific patient, you know, whether they're hypermobile and they need a neck brace during a surgery because they have a lot of craniocervical instability. Do they have HOTs and just need very like do they really need to be fluid resuscitated before the case and really just make sure that they're adequately hydrated? If they have mast cell activation syndrome, there's certain anesthetics that tend to flare mast cells and post-operative narcotics like morphine that tend to be more aggravating for mast cells. And there's also a dialogue like what happens if they have a huge flare and go into anaphylactic shock. Like, we should probably have like steroids and you know, H1 and H2 blockers ready to go in case that happens. And so I have a protocol that I've adopted from other um mast cell clinicians. And I often will reach out to the surgical team and say, this is kind of what I would do uh and how I would approach this patient kind of perioperatively and intraoperatively just to get the best outcomes. Yeah. Yeah.

SPEAKER_03: 7:56

Honestly, like the way Zach pointed out, it it's important to emphasize that when you're dealing with something like endometriosis that can affect so many different areas colon, rectum, diaphragm, bowel, bladder, it's multidisciplinary. So it's like when I deal with rectal cancer, we talk, we have radio radi radiologists, oncologists, radiation oncologists. We we have a variety of people on the team to discuss it. And so it endometriosis, especially complex stuff, is is starting to lean that way where you have multidisciplinary teams talking about it so that we don't miss things.

SPEAKER_01: 8:31

I received so many messages leading up to this episode after the first conversation that I had with Dr. Spiritos, people asking, who do we listen to? What direction do we go? What are we missing? And these episodes didn't just offer simple answers, but it offered something better context. It showed us that two very different specialties can coexist, collaborate, and ultimately serve patients better when they're willing to listen to one another. What ties Dr. Mikhail, Dr. Spiritus, and Dr. Obius together is this. They think outside the box. They approach complex, misunderstood, and often dismissed conditions with curiosity, compassion, and willingness to keep learning. They see patients not as a problem to solve, but as a human to care for. And in the world where so many people with chronic illness feel overlooked or minimized, that matters more than we can say. I am deeply grateful for these conversations and for the way that these providers continue to advocate, innovate, and raise the standard of care for this community. And as a gift to you for your holiday survival guide, this is what I want to impart. Celebrate the small wins. You showered, great, check. You're dressed, wonderful, check. You're thriving, wonderful, check. Those are all small victories. Small to some are big to us. As we continue reflecting back through this year, I hope you'll keep listening with openness and curiosity. You might catch something you missed the first time. You may hear a sentence that lands differently now, and you may discover that an episode you didn't expect to need is exactly what meets you where you are today. Thank you for being here. Thank you for trusting me in these conversations, and thank you for continuing to show up for yourself and for this community. We'll keep moving forward together, one honest, thoughtful conversation at a time. Until next time, continue advocating for you and for others.