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Dr. Francesco Di Chiara, a leading consultant thoracic surgeon at John Radcliffe Hospital in Oxford, shares his expertise on thoracic endometriosis - when endometriosis affects the chest cavity, diaphragm and lungs. He illuminates the challenges patients face with this often-overlooked manifestation of endometriosis that can cause collapsed lungs, shoulder pain, and breathing difficulties.

• Thoracic endometriosis causes symptoms including pneumothorax (collapsed lung), shoulder pain, hemoptysis (coughing blood), effusions and hemothorax
• 90% of patients with thoracic endometriosis first see orthopedic surgeons for shoulder pain before correct diagnosis
• Symptoms are often "self-limiting" which leads to medical dismissal since they temporarily resolve after each cycle
• Imaging challenges include MRI movement artifacts and that lesions are often thinner than MRI resolution capabilities
• Surgical excision involves a thoracoscopic or robotic approach with most complex procedures involving the diaphragm
• Diaphragmatic surgery requires special consideration for patients planning pregnancy due to added strain on surgically repaired tissues
• Multi-disciplinary care is crucial with thoracic surgeons involved early rather than being called in only after discovery during gynecological surgery
• Dr. Di Chiara classifies thoracic endometriosis lesions in a color spectrum from pink (superficial) to white (scarred) with purple and brown in between
• Thoracic surgeons with endometriosis expertise are rare - patients should seek high-volume centers with established multidisciplinary teams

If you suspect thoracic endometriosis, seek out high-volume endometriosis centers that work directly with thoracic surgeons, and insist on meeting your entire surgical team before committing to treatment.

Vita with Alita: Evidence-Based Wellness
Wellness that fits real life! A podcast for women who care about their health.

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Professor Mark Possover shares groundbreaking insights on neuropelviology, the revolutionary field addressing chronic pelvic pain that bridges gynecology, neurology, and minimally invasive surgery. His work offers hope to patients who've been told to simply "live with" their pain, targeting the pelvic nerves directly when the source of pain is elusive or deemed untreatable.

• The vagus nerve does not extend into the pelvic cavity, ending at the level of the colon and stomach
• Damage to nerves in the pelvis involves the pelvic splanchnic nerve system, not the vagus nerve
• Patients with autoimmune diseases often develop pathology of the pelvic vessels that can compress pelvic nerves
• Conditions like Ehlers-Danlos, Raynaud's, Marfanoid syndrome and Hashimoto's show connections to pelvic nerve issues
• Endometriosis demonstrates strong links to other autoimmune diseases and conditions like diabetes

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Professor Marc Possover, world-renowned pioneer in neuropelviology, discusses when and why to be concerned about sciatic endometriosis. He explains the critical distinction between regular endometriosis near the sciatic nerve versus endometriosis growing within the nerve itself, which requires specialized neurosurgical intervention.

• Cyclical sciatic pain during menstruation may suggest endometriosis involvement
• Sensory disorders, numbness, and weakness are serious warning signs requiring immediate attention
• Vascular entrapment is the most common cause of sciatic pain in the pelvis
• Endometriosis of the sciatic nerve requires specifically trained neuropelviological surgeons, not just gynecologists
• Improper surgery on the sciatic nerve can cause permanent disability like foot drop
• A comprehensive neuropelviological workup is essential before any surgical intervention
• True sciatic nerve endometriosis surgery is among the most difficult and dangerous pelvic procedures

Do you have more questions? Send them in by using the link in the top of the description, emailing [email protected], or visiting the endobattery.com contact page.

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Licensed therapist Shawn Whitney explains how our bodies experience trauma and grief in similar ways, making it difficult to differentiate between them when navigating chronic illness. The most important aspect of healing is acknowledging the true significance of our experiences rather than minimizing them, as treatment approaches for both trauma and grief focus on validating impact rather than categorizing emotions.

• Our bodies experience trauma and grief similarly with little physiological differentiation
• Trauma impacts us emotionally, psychologically, spiritually, relationally and sexually
• Effective trauma treatment is also effective grief and loss treatment
• Cultural messages often minimize our experiences with phrases like "you'll get over it"
• Healing begins by acknowledging the significance and true impact of our experiences
• Language and identification have value, but impact matters more than categorization

Send your questions to [email protected] or visit endobattery.com/contact to connect with more experts.

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Dr. Jeff Arrington, renowned excision specialist and patient advocate, shares his expert perspective on the differences between minimally invasive laparoscopic surgery and robotic surgery for endometriosis treatment. He explains that surgical success depends more on the surgeon's training and comfort level with their chosen technique rather than the inherent superiority of either approach.

• Surgeon preference and training are the primary factors in choosing between laparoscopic and robotic approaches
• Dr. Arrington initially used robotics only for complex cases but found several benefits that led to wider adoption
• Robotic surgery reduces surgeon fatigue, potentially extending careers of specialists
• Robotics gives surgeons more control and less dependence on specific OR assistants
• While laparoscopy offers direct tactile feedback, experienced surgeons develop visual cues with robotics
• Both approaches are laparoscopic procedures with different instruments but similar risk profiles

Send your endometriosis questions by using the link in the description, emailing [email protected], or visiting the endobattery.com contact page.

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Professor Marc Possover transforms our understanding of chronic pelvic pain by targeting the pelvic nerves directly when traditional treatments fail. His pioneering work in neuropelviology bridges gynecology, neurology, and minimally invasive surgery to bring relief to patients who've been told to simply live with their pain.

• Pain or disorder of pelvic organs always involves nerve issues, with endometriosis being one potential cause
• Gynecological examination, sonography, and MRI help determine if endometriosis is present
• Many doctors aren't familiar with neuropelviology - if they don't recognize the term, they likely have limited knowledge of pelvic nerves
• Nerve-sparing techniques are crucial for all patients undergoing pelvic surgery to avoid postoperative organ dysfunction
• In patients with Ehlers-Danlos Syndrome (EDS), atypical blood vessels can compress nerves causing pain
• Treatment often involves releasing the nerve by removing the problematic vein rather than treating the nerve itself
• Sickle cell disease can also cause compression of pelvic nerves through small areas of ischemia throughout the body

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Chronic illness grief differs significantly from the grief experienced after death—it's complicated, ongoing, and often invisible to others. Shawn Whitney, a licensed therapist specializing in trauma-informed care, explains how this "complicated grief" compounds daily as individuals continue to face their illness while support typically fades away after just a few weeks.

• Chronic illness grief is "complicated grief" because the person isn't gone but continues living with daily challenges
• Unlike death, chronic illness grief lacks visibility—"you look fine" becomes a painful dismissal of real suffering
• Initial support after diagnosis typically disappears within 3-4 weeks, while the illness remains
• Complicated grief compounds over time as new challenges emerge and previous losses remain unprocessed
• The ongoing nature of chronic illness means individuals must face their grief daily without the closure that comes with finality

If this episode resonated with you, check out episode 62 where Shawn shares more insights about healing through trauma and chronic illness. Send your questions by using the link in the episode description, emailing [email protected], or visiting the endobattery.com contact page.

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Professor Marc Possover reveals how our nervous system drives endometriosis pain and offers practical tools for managing symptoms through vagus nerve regulation. This groundbreaking conversation challenges traditional views of endometriosis by exploring neuropelviology – the study of pelvic nerves – and how nerve function impacts everything from pain perception to fertility.

• The pelvic nervous system controls all pelvic functions and pain signals
• Our autonomic nervous system has two branches: sympathetic (fight-or-flight) and parasympathetic (rest-and-digest)
• Endometriosis activates the sympathetic nervous system, creating widespread effects beyond the pelvis
• Vagus nerve stimulation can increase parasympathetic activity and decrease pain
• Simple techniques like ear stimulation, breath work, positive thinking, and physical activity can regulate the nervous system
• Symptoms often dismissed as "comorbidities" are actually part of one connected nervous system dysfunction
• Many patients with persistent pain after surgery may be experiencing nervous system sensitization rather than disease recurrence
• Future treatments may include neuromodulation techniques that decrease both pain and inflammation
• Understanding neuropelviology could reduce unnecessary surgeries and improve outcomes
• Both patients and doctors need education about the nervous system's role in endometriosis

Vita with Alita: Evidence-Based Wellness
Wellness that fits real life! A podcast for women who care about their health.

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Kimether Redmon shares powerful strategies for setting the tone of respect with healthcare providers and knowing when to walk away from medical gaslighting.

• Come prepared with a one-page symptom summary, tracking information, and imaging reports to guide the conversation
• Ask providers to explain what led to their diagnosis and what their differential diagnoses are
• Remember that proper diagnostic process requires listening to patient history, physical exam, and multiple possible diagnoses
• When faced with dismissal, calmly state you're looking for a provider who will partner with you
• Don't hesitate to ask for your co-pay back if a provider refuses to engage respectfully

Have questions about advocating for yourself in healthcare settings? Send them in using the link in the description, email [email protected], or visit the endobattery.com contact page.

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Dr. Jeff Arrington joins us to discuss accessible endometriosis management options and surgical considerations for patients at different stages of their journey. We explore alternatives to excision surgery, the relationship between round ligament pain and endometriosis, and the real risks of deep excision procedures compared to standard gynecological surgeries.

• Various hormonal options including birth controls, progesterone-only medicines, and IUDs
• Low-risk alternatives like magnesium, omega-3s, turmeric, anti-inflammatory diets
• Physical therapy, acupuncture, and specialized pelvic pain clinics
• No clear connection between round ligament pain and endometriosis
• Deep excision risks include bleeding and organ injury but specialist complication rates are lower than for routine gynecological procedures
• Proper knowledge of pelvic nerves critical for preserving bladder and bowel function

Do you have more questions? Keep them coming! Send them in using the link in the top of the description of this podcast episode, by emailing [email protected], or by visiting the endobattery.com contact page.

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