Endo Year Reflections: #10 How Two Pioneering Surgeons Changed My View Of Pain, Surgery, And Possibility

What if your pain story starts in the nerves—and your path to relief begins with balance, not just suppression? We dive into a year-defining reflection on endometriosis care, exploring how the autonomic nervous system shapes pain, inflammation, digestion, and mood, and why the vagus nerve can be a quiet but powerful ally. Along the way, we revisit conversations with two renowned surgeons whose work reframes both daily management and long-term outcomes.

First, we unpack neuropelveology in clear, practical terms: the dance between sympathetic “fight or flight” and parasympathetic “rest and digest,” and how that tug-of-war can intensify or soften endometriosis symptoms. From breathwork and paced exhalation to simple vagus nerve activators, we highlight approachable ways to support nervous system regulation without promising quick fixes. Then we turn to nerve-sparing surgery—where precision protects bladder function, sexual health, gait, and quality of life. Sciatic endometriosis and deep disease demand rare expertise, and choosing the right surgeon can be the difference between lasting relief and lifelong complications.

We also tackle the fertility fork in the road: go straight to IVF, or consider excisional surgery first? Drawing from large, long-term datasets in advanced disease, we explain why removing endometriosis can improve natural conception rates and make postoperative IVF more effective, challenging the reflex to skip surgery altogether. It’s not either-or; it’s sequencing care based on evidence, goals, and the full person—pain, function, and future.

This reflection is ultimately about agency and hope. When clinicians share data openly and patients bring lived experience with curiosity, care gets smarter. If you’re navigating endometriosis, chronic pelvic pain, or infertility, you’ll find practical tools, nuanced insights, and a reminder that rest is productive and progress can be patient. If this resonates, subscribe, share with someone who needs it, and leave a review with the one idea you’re taking into your week.

Chapters

• 0:00 Reflection Series Kickoff
• 1:07 What Neuropelveology Teaches Us
• 2:11 Autonomic Balance And Pain
• 5:57 Vagus Nerve And Wellbeing
• 6:11 Nerve-Sparing Surgery Realities
• 7:46 Fertility Data After Excision
• 10:25 Rethinking IVF Pathways
• 12:07 Respect, Curiosity, And Progress
• 13:06 Holiday Nugget: Rest Is Productive

Transcript

SPEAKER_00: 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 Indobattery. 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 Indometriosis drains us. Welcome back to Indobattery. As we continue in our Indo Year Reflection series, I am still in awe of the year that we have had. I'm still pinching myself in, is this my reality? And it kind of is. And I hope that you feel that way too. When I look back at episode 144, sitting down with Professor Mark Possover was one of those conversations that fundamentally shifted how I understand pain, endometriosis, and the body as a whole. We talked about neuropalveology, a word many people have never heard, but a field that affects so many lives. At its core, neuropalveology is about the nerves of the pelvis, but we didn't stop there. We talked about the nerves throughout the entire body, including one of the most influential nerves we have, the vagus nerve. Professor Prosover walked us through the role of the vagus nerve, the sympathetic and parasympathetic nervous system, and the balance between the fight or flight, rest and digest. And suddenly, so many things clicked. How we experience pain, how inflammation shows up, how our nervous system may influence the way endometriosis manifests and persists.

SPEAKER_02: 2:15

You have two kinds of nerves. You have what we call somatatic nerve that on the nerve which command the red muscle. So if you want to move a leg, it's because you have an activation, for example, of the somatic nerve. And behind this somatitic nerve, you have an auto another nervous system, what we call autonomic nervous system or vegetative nerve system. That is a nerve system we cannot control. For example, if I'm breathing, and it's no need for me to think about that, or if my cardiac is working, it's because I have an autonomic nerve system. Or for example, in the pelvic cavity, the bladder. If I want to go on the toilet and to empty my bladder, my brain is giving the information to it. But then the autonomous nerve system is doing is no need for me to think I am already avoiding my bladder. That's the reason why. Suppose you want to empty your bladder, you go on the toilet, and suppose you have a book. So you can say, okay, I want to pee, the brain will give you information, but the vegetative nerve system will do by himself. So it's no need for you to think while you are empty your bladder. You can read a book because the autonomous system does that by your own. And the vegetative nerve system is the nerve system that the Chinese medicine well knows. And you have two systems. You have a bad nerve system and a good nerve system. And the bad nerve system is what we call the sympathetic. It's called sympathetic in French. Sympathetic would now mean nice. But it's not a nice nerve system. The sympathetic nerve system is involved is in its increase in pain, in uh dysmemory, if you have a headache, if you are worried, if you don't feel good. That is the uh the sympathetic nerve system. And on the other side, you have the parasympathetic nerve system, which is called the rest and digest nerve system. And this parasympathetic nerve system is for the well-feeling. So if you have no pain, if you feel good in your life, you are you enjoying your life, you can properly avoid your bladder, you are properly intercourse, and all these things is because you have the autonomous nerve system. And these both nerve systems are in balance. So the parasympathetic, the good autonomic nerve system is uh if it increases, it will decrease the sympathetic nerve system. So suppose you have pain, pain means you have an activation of the sympathetic nerve system. You can say I will reduce this sympathetic nerve system, for that I will take painkillers. There is another way to say because they are in balance, you can reduce the sympathetic nerve system, and that way the well nerve system will increase, or you will say will increase by myself without painkiller, the parasympathetic nerve system. And the parasympathetic nerve system, you have two systems, one in the pelvis, which you cannot control with the brain, and you have the second system is the vagus nerve. And the vagus nerve is a nerve that emerges directly for the brain, is running in the neck outside the spinal cord and go in your abdomen and will go, will control your cardiac activity, the lung, um, all the different functions. So if you are able to activate the vagus nerve in your life, you will be more happy. It's so simple as that.

SPEAKER_00: 6:11

Professor Possover has spent studying the role of nerves in the body, working with patients ranging from those with endometriosis to individuals with spinal cord injuries. One of the areas he's especially known for is sciatic endometriosis, a rare but devastating condition that requires an extraordinarily skilled surgeon. He spoke candidly about how delicate nerve-sparing surgery truly is, and how choosing the wrong surgeon in these cases can lead to outcomes worse than symptoms someone had before surgery. The margin for error is small and the consequences are lifelong. What struck me most though wasn't just his expertise, it was his kindness. I had the privilege of spending over an hour with him before even starting to record. Our conversation was filled with curiosity, big ideas, and thinking outside the box. And not once did he make me feel inadequate, underqualified, or out of place. In fact, when I shared a few thoughts, ideas I half jokingly assumed were probably wild, he paused and said, hmm, that's actually a very good thought. And I'll be honest, I had to mentally, you know, pat myself on the back for that one. As one of the leading surgeons in neuropalveology, Professor Possover could easily stay in the operating room and never look back. But he chooses to teach, to educate patients, to mentor doctors because he doesn't want to be the best. He wants the next generation to be better. He wants this knowledge to outlive him, and that speaks volumes. The same sense of reverence and awe followed me in episode 173, where I had the immense honor of sitting down with Professor Horace Ramon. I truly cannot overstate what a privilege this conversation was. Professor Roman is widely regarded as one of the best endometriosis surgeons in the world. And that's not my opinion. That's coming from his surgical peers, from physicians across the globe who speak of him with deep respect and admiration. He teaches complex endometriosis surgery to doctors from all over the world, but his work doesn't stop in the operating room. For more than 15 years, Professor Ramon has studied the role of proper surgical excision and fertility outcomes. He has followed patients after excision, tracking natural conception rates and quality of life improvements, and the data is remarkable.

SPEAKER_01: 8:40

Now I think we have uh 5,000, 6,000 women who had surgery, well done surgery, excisional surgery, with a follow-up, which is uh now is uh 15 years. The oldest the oldest patients have 15 years of follow-up, and we have just today submitted an article about 15 years follow-up after colorectal endometriosis surgery. So this database allows me to study everything postoperatively, what's happened after the surgery. And it also also allows me to see the real number, the real percentage, who who is pregnant and who is not, how the presence how the pregnancy is achieved, how long time after the surgery. And I could, in this case, I could publish studies which show that after the surgery of most advanced, most complex endometriosis, the pregnancy rate is very high. And this happened at a moment where a lot of colleagues, a lot of gynecologists were telling to patients, don't have surgery because you will be infertile. And my answer was no. Conversely, if you want to be so if you want to be to be pregnant, please consider the surgery as a treatment of your infertility. And of course, all my studies try to put in the mirror pregnancy rates in women who have no surgery and have only IVF with women who have surgery. And I could demonstrate that women with surgical management of endometriosis have at least the same pregnancy rate that women who have up to four IVF, successive IVF. And right now in the world there are two randomized trials comparing in a random manner, comparing IVF to the surgery. One of them is in France, EndoFert, and the other one is Bordeaux and Denmark. It calls FOR. So I am involved in both studies, I recruit for both studies, because both studies, the hypothesis is based on my data. And both studies try to show that the pregnancy rate after the surgery, with natural conception or postoperative IVF, this pregnancy rate is better than in women who have no surgery and or sent directly to IVF.

SPEAKER_00: 11:05

What his work asks us to consider is this. What if IVF isn't always the first or only answer? What if addressing the root cause, endometriosis itself, could improve fertility and overall quality of life? In a space where fertility conversations are often rushed, fragmented, or emotionally overwhelming, Professor Ramon's work offers something grounding, evidence, patience, and a long-term view of healing. After sitting down with both Professor Possover and Professor Ramon, I truly had to pinch myself. I'm just a patient, someone who's curious, someone who wants to learn and understand the nuances of this disease better. And yet I found myself at the table with two of the most respected minds in endometrios' care. And not once did I feel small. I never felt dumb. I never felt like I didn't belong. They valued my questions. They welcomed my perspective. And that kind of respect leaves a lasting impact. These are the doctors who remind me why progress happens. They think outside the box, they refuse complacency. Because of their and the work of others like them, patients aren't just surviving inside cycles of pain and trauma. They're being offered better care, better outcomes, and real hope. I'm endlessly grateful for the years of dedication, research, and innovation they've given to this community. And I cannot wait to see what breakthroughs they bring next, because I know whatever it is, it will change the status quo in the best possible way. And here is your little nugget for your holiday survival guide. Redefine productive. Resting is doing something. Just food for thought. As we continue looking back through this year, I invite you to listen with curiosity and openness. You may hear something that changes how you understand your body. You may find language for an experience you've never been able to explain. And you may discover that an episode you didn't expect to need becomes exactly what you need all along. Thank you for being here. Thank you for learning with me, and thank you for continuing to come back to this table where curiosity, compassion, and courage meet. We'll keep moving forward together, one meaningful conversation at a time. Until next time, continue advocating for you and for others!