Hello everyone and welcome back to the vocal pelvic floor. Today I have with me a very special guest, an incredibly talented person and an expert in the field of endometriosis, Dr. Mona Orady

Mona Orady MD (00:19)

Hi Ginger, very nice to be here and very nice to talk to everyone listening out there. I’m extremely excited to be joining you today.

Ginger Garner PT, DPT (00:29)

I am so thankful that you could find the time in your schedule. I know how hard it is to do that. So everyone, before we get started, before we jump in, as always, I wanna do a little bragging and talk about her accomplishments. So here we go. Dr. Mona Orady is a globally recognized leader in minimally invasive and robotic gynecologic surgery with over two decades of experience and more than 10,000 procedures performed.

Let that sink in. As the Director of Robotic Surgery Services at St. Francis Memorial Hospital in San Francisco, she specializes in fertility-sparing surgeries for fibroids and endometriosis excision, alongside advanced care for menstrual disorders, pelvic pain, and complex gynecologic conditions. She’s a past president of the Society of Laparoscopic Surgeons. She’s traveled to a bunch of countries, y’all, 43.

sharing her expertise and learning from other global leaders. Her career highlights include leading robotic surgery education at the Cleveland Clinic and advancing OB-GYN care at Toam Hospital affiliated with Johns Hopkins Medicine. Dr. Orady’s dedication to innovation and education has solidified her reputation as a pioneer in her field. Welcome.

Mona Orady MD (01:54)

Thank you. Thank you so much.

Ginger Garner PT, DPT (01:55)

Yeah, so I want to just dive right into your surgical expertise, but before I do that, I am just curious. I’m always curious about origin stories. Like, what led you into OB-GYN? What led you into, towards endometriosis and into excision? Like, how did that happen?

Mona Orady MD (02:18)

boy, it’s a long story. I honestly feel like I was kind of born to do this. Like I just was trying to find my calling.

I always knew I was going to be in healthcare. I always knew I was gonna be a physician. I was the four year old, you know, walking around with the little doctor’s kit, pretending to be a doctor and, you know, giving shots to my poor twin brother. When I was nine, I remember quite clearly, I was, my mom had taken me to like a women’s, you know, women’s group.

and the women started talking about a bunch of the problems they were having, whether they were menstrual problems or pain or something like that. And they were bitterly complaining about how they just could not get help for that. Like they would go to their doctor and be ignored. And they were truly some women there that were suffering. And I think I left that day and I said, you know what, I’m gonna be a doctor for women and I’m gonna help women.

be heard and be taken care of. So I think I decided I was going to be a gynecologist when I was nine. I really accelerated my education after that. was so gung-ho to go to medical school. I started working as a medical assistant when I was 10. I went to college at 12. At 17, I started medical school and delivered my first baby, did my first hysterectomy when I was 18.

Ginger Garner PT, DPT (03:26)

Wow.

my gosh.

my gosh.

my goodness, wow.

Mona Orady MD (03:50)

I have pretty much been a doctor my entire life. And I think going into it like with that kind of passion and I had wonderful mentors in medical school. I always flocked around gynecologists who were just really compassionate and caring and really listened to their patients. And those were the mentors I took, but were also amazing surgeons.

Ginger Garner PT, DPT (03:54)

your whole life, yeah.

Mona Orady MD (04:16)

I used to go to surgery just to watch. spent my entire, all my summers in medical school in surgery, just as an observer or actually assisting, just because I had such a love for beautiful surgery. to me, was as a beautiful surgery is just as nice as watching a beautiful ballet or going to a Broadway play or a musical. was just, it’s just, was something I just so enjoyed. And the artistic side of me just loved the art of surgery.

So that kind of stuck with me as I went into residency, I found out that I was really talented in laparoscopic and minimally invasive surgery and just loved how I could offer women an option that would get them back to their normal life very quickly with minimal trauma and minimal downtime because as a woman and knowing women, strong women around me, women take care of everyone else except for themselves.

Ginger Garner PT, DPT (05:13)

Yeah.

Mona Orady MD (05:13)

They

will take care of their family, their friends, their parents, their pets, their kids. And they’re kind of the last thing on the table. And I know when I was working and starting to offer patient surgery or treatment for fibroids and endometriosis menstrual disorders, the biggest question was how much is my downtime? I have this person to take care of and I have that person to take care of and I have to do this and I have to do that.

And once I started doing robotic surgery, was very early in the era of robotic surgery. We were still having to open a lot of people because laparoscopic surgery had its limitations. And when I started robotic surgery in 2007, I started offering every patient the option of starting out as a robot and seeing if we could, even the most complicated surgeries where like the other doctors around me would be like, there’s no way you can do this case laparoscopically. It’s just too complicated.

And I basically told the patients, listen, this is a new, you know, new type of surgery and why don’t we try to do it robotic and 50 50 and you’ll get it done and 50 50. You’ll get woken up and you’ll have an open incision and we’ll take care of the surgery that way. And honestly, I kept telling my patients that until I was about 200 cases in and I hadn’t opened a single patient and I was like,

Then I started reducing, okay, 25, 75%. I’ll have to help you. And honestly, I’m over several thousand surgeries and I have only converted maybe one case. And the conversion was because of cancer, not because I couldn’t do the case. It was because it had to be done, due to the incidental finding that there was a cancer there. So.

Ginger Garner PT, DPT (06:37)

Mm.

Wow.

Mm.

Mona Orady MD (06:57)

Honestly, once I started using the robot and seeing the capabilities, that’s what really drove my passion into really offering patients alternatives to here’s the band-aid medical therapy, the birth control pill or whatever, or hysterectomy. Now we could do more intricate, more complex reconstructive surgery. can offer my fertility-considering surgeries, myomectomies.

you know, less radical excision surgeries where a lot of times with the frozen pelvis where uterus, ovaries, tubes, everything stuck together into one big conglomerated mass, the only treatment would be, okay, just take it all out in mass. Take the uterus, ovaries, cervix, like all of it together, you lose your whole reproductive system all at once. Now with the capability of the robot and how delicate and how much…

control you have, you can actually separate out those organs and reconstruct everything. I’m literally reconstructing uterus sacro-lingamens, trying to shave endometriosis from the tubes very delicately, trying to save the ovaries, trying to save the uterus. And having that ability to spare fertility, but still offer a minimally invasive option was just what drove my passion. And that’s when I started sharing some of my work, sharing some of my techniques.

And that’s when I started traveling around the world and just, I became very engrossed in trying to find these minimally invasive options for women and trying to help them in every way possible to number one, preserve their fertility, help them get pregnant, but also get them out of pain, get them in normal function and also not give them such a large downtime. And I think that that kind of is what started the path is just.

Ginger Garner PT, DPT (08:43)

Yeah.

Mona Orady MD (08:44)

It started out with a passion for women’s health and a love of surgery and beautiful surgery. then with the advent of robotic surgery and just being able to use that tool to make beautiful surgery even more beautiful and even more intricate, even more delicate, kind of took me down that path of going that down the route of advancing the techniques and the technologies. Now I use CO2 laser, which I started using laser in 2011.

You know, now I have a lot of adhesion prevention techniques that I’m working on publishing. Like there’s just a lot. I just keep trying to say, okay, how can I make it better? And I remember that when I first started doing robotics and even to this day, after I do the surgery, I will watch the video and like figure out what could I have done better? How could I make it even more, you know, improve the place so as to speak, or improve the painting and make it even more beautiful and better for the patient.

every time. And so you’re constantly learning, you’re constantly advancing, you’re constantly getting better. And the result of that is that the outcomes are amazing. Patients come in three months post-op, they are either pregnant when they haven’t been able to get pregnant in years, or they’re pain free and they tell you, I feel like a new woman, you’ve changed my life. And that’s just the motivation to keep this going and help women in that way. So that’s kind of a long story, but that’s kind of the way I got to where I am right now.

Ginger Garner PT, DPT (09:59)

Mm.

Yeah.

Well, you have a long history and a long story and you’ve done so much. So I’d say that you fit all that in in a really good amount of time, actually. I’m curious about one thing, because I had several questions that were kind of swirling around robotics. But the first thing that I wanted to go back to, to circle back that stuck in my head as being inspiring and future forward and that kind of thing is adhesion prevention. And for those, you know,

Mona Orady MD (10:17)

Thank

Ginger Garner PT, DPT (10:40)

This may be your first podcast. You just like dropped into this and this is the first surgeon you’re listening to in the series. So you may not be aware that what we’re talking about when we say surgery for endometriosis, we’re talking about excision surgery versus ablation. And the way that I explain to my patients all the time, so this kind of feeds into the question that I have is that when we have these endometriosis lesions that they also, if,

endometriotic lesions are like a hurricane, then the adhesions are like the little tornadoes that kind of spin off of hurricanes. I spent 21 years at the coast weathering like loads of hurricanes and so it was never the hurricane we were afraid of, it was the tornadoes, the adhesions and things like that. So I try to draw that parallel in my mind and talk to patients about it, but it is something that I see a lot as a physical therapist and over the last even

five years, I don’t even want to go back 10 years, I think things are changing and improving. I’ve heard of, and we haven’t really gotten to talk about some of those techniques yet on the podcast. So I’m really excited to talk to you about them today because you mentioned adhesion prevention and I was like, yeah, let’s talk about the tornadoes because the lesions, while the lesions are so important to excise and we’ll get to that in a second, so much can happen with adhesion.

Can you elaborate on that and the adhesion prevention and how you look at it?

Mona Orady MD (12:12)

Yeah, I can. And just to tell you, I am working on publishing a paper right now about adhesion prevention. I’m speaking about it. I spoke about it last year at the endo summit. I spoke about it in Houston at the physical therapy conference. spoke about it and speaking about it next year at the endo summit. I spoke about it. I did a full one hour kind of Facebook live on the endo summit about adhesion prevention. So adhesion prevention is an extreme passion of mine. It’s become kind of an obsession almost.

and, you know, because I just think, you know, good surgery should not cause adhesions. and adhesions is what makes repeat surgeries extremely difficult. and it’s because when you traumatize tissue, when you go inside and you cut or you burn or you separate things, that may already be adherent together because of the inflammation caused by endometriosis that caused the organs to stick together.

Ginger Garner PT, DPT (12:42)

We need that, thank you.

Mona Orady MD (13:11)

Well, we spend all this time and energy separating them. The last thing we want is for them to stick right back together again. Especially in fertility patients, want because adhesions is the number one cause that fallopian tubes get destroyed or non-functional adhesions is a cause in intrauterine adhesions is a cause of miscarriage or lack of getting pregnant. So especially for people who trying to get pregnant, that’s really important, but also for people with pain because

Despite popular belief, which some people say adhesions do not cause pain, they do cause pain. You are shifting things, you are tying things together that should be freely mobile. And so an adhesion, this organ stuck to this organ for sure will cause pain. It’s just people perceive pain differently. Sorry. So some people have less pain, some people have more pain, but I do think that everyone has pain from adhesions.

Ginger Garner PT, DPT (13:58)

Yeah.

Mona Orady MD (14:07)

Now going back to the adhesion prevention session.

Adhesions are caused by trauma. So anytime you pinch something, you bruise something, you cause bleeding, you burn something that causes a tissue reaction to heal the trauma. Now, in the healing process, adhesions form because the immune system lays down macrophages and collagen, and that’s where adhesion forms.

To me, the way that you prevent adhesions is there’s a couple of ways, but one of the biggest thing is to minimize the trauma that you’re causing with surgery. Now, I love the robot for that because the robot gives me the ability to move robotic instruments inside the human being as if they were my hands, which means I can be extremely gentle and very precise in my movements. don’t have to necessarily, with laparoscopic instruments, you have straight instruments.

you’re stuck with angles. can’t go like scoop around something or you have to sit there, you know, using the angles that you have and you’re restricted in your movements. With the robot, you have zero restriction. So it’s like you shrunk yourself, you’re inside. And the other thing is you can use the tools extremely gently. When I’m teaching, I’m always telling my trainees, you use a robot like you’re painting with a feather. Very light, gentle movements so that you can actually

Ginger Garner PT, DPT (15:30)

Hmm.

Mona Orady MD (15:35)

minimize the trauma to the tissue, you minimize what you’re touching, you minimize what you’re burning, you minimize what you’re cutting, and you just remove the tissue that needs to be removed, which is IE, the abnormal endometriosis tissue or the fibroids. The other thing that the robot gives you is the ability to sew extremely precisely. You can sew laparoscopically, but with the robot, it’s extremely precise. So I can literally put the edges back together if I’m reconstructing something perfectly. It’s the most perfect thing.

If you’re doing it laparoscopically, it won’t be perfect. So if you put edge to edge and you kind of keep the raw surface on the inside and you reconstruct that ovary or you reconstruct that uterus sacral ligament, or if you’re doing a myomectomy, you reconstruct the uterus in a perfect manner, as perfect as it is. And for someone who’s obsessive compulsive like me, that’s amazing. I kind of like everything to be perfectly aligned. And so, and anyone who’s worked with me will know that.

Ginger Garner PT, DPT (16:25)

Just so.

Mona Orady MD (16:33)

I think that minimizes adhesions. other thing that I really love is I mentioned I started using laser in 2011. And the reason is because laser gives you the ability to cut without bleeding, without heat, which is a very different thing because either you cut sharply with scissors, but there’s blood vessels in the tissue. So it bleeds and then you have to stop the bleeding and the blood can cause bruising, which can cause adhesions or

you’re cutting with a monopolar with an energy like an electrical current, which causes heat and heat causes thermal spread. So there’s heat, not just to where you cut, but just around where you cut. that can, the heat can cause burns, which cause adhesions too. With the laser, it cuts without bleeding, but without heat too, which is an amazing combination. And it gives you the ability to surface ablate if you’re ablating something that’s on the surface of the ovaries without going too deep. So you have a depth control.

Ginger Garner PT, DPT (17:21)

Yeah.

Mona Orady MD (17:30)

you have a control of heat and you have a control of the cut. So it’s just the most precise energy that you could use. Unfortunately, it’s very expensive, which is why a lot of people, know, hospitals don’t necessarily want to use it. And a lot of doctors don’t want to advocate to use it. I use it on almost all of my patients, but I’ve worked with the hospitals to tell them what the benefit is for these patients. But it’s an amazing device that I think is very underutilized. The third thing is once you

you’ve done your resection or done the excision and now you have these raw surfaces, you have to make sure there’s no blood left over. So that means a lot of irrigation, a lot of hemostatic control. And then the third thing is you have to use some sort of adhesion barrier. I particularly use a liquid adhesion barrier, which is kind of like a, I call it a slippery sugar syrup almost, that I put inside the abdomen. It floats around and kind of coats everything in what I call a healing balm.

Ginger Garner PT, DPT (18:27)

Mm.

Mona Orady MD (18:27)

prevent things from sticking together. And then I also suspend the ovaries or leave or pull them out of the pelvis for a few days until the pelvis heals. And then I drop them back in to prevent the ovaries from sticking. Cause those are the most common things to stick are the ovaries and fallopian tubes. So you want to kind of leave them free and hanging for a couple of days. And then you put them back, back where they normally belong. And that prevents them from sticking. Cause I think adhesions around the ovaries cause pain. And I think adhesions around the tubes cause infertility. So those are very,

Ginger Garner PT, DPT (18:36)

Hmm.

Mona Orady MD (18:57)

like very liberal about suspending ovaries away from the pelvis. So I use all of these techniques in combination to prevent adhesions. And honestly, every time I’ve had to re-operate on a patient that I have operated on before, there are no adhesions. So there’s arguments that people have that, you you can’t really prevent adhesions. Well, in my experience, I think you can. I’m not going to say it’s a hundred percent, but it’s definitely much less.

Ginger Garner PT, DPT (19:22)

Mm-hmm.

Mona Orady MD (19:24)

than on patients that I’ve operated on that have had surgery elsewhere. And now I’m doing a repeat surgery on them. So I think it’s really important and I think it’s important that doctors start to realize that there are adhesion prevention techniques and that we should be using them. I don’t know why we’re not using them on everybody, not just for patients, but that’s just something that’s become a passion of mine. so I’ve been speaking a lot about it lately.

Ginger Garner PT, DPT (19:50)

Yeah, it’s definitely a top interest of mine because that’s what I see on the terminal end. On the other end, post-op in PT practice is dealing with adhesions that are all over the place from the liver and the diaphragm all the way down and into the abdominal layers and that kind of thing. And that does cause a lot of pain for them. It’s one of the biggest things that they have to overcome that we have to work with.

Mona Orady MD (20:18)

It

also causes problems if we ever have to go back in for something. Like let’s say they’ve now had kids or now they have another fibroid or whatever and we have to do another surgery. Those adhesions cause bowel and things to stick, which causes the risk of injury and another complication. So it also makes further surgery difficult in the future.

Ginger Garner PT, DPT (20:23)

Mm-hmm.

Yeah, it does. as an endopatient myself, I have felt that of having those organs stuck together in places that, well, really anywhere, but in the bowel and in other places. And yes, it causes pain. It causes pain that does go away once it’s fixed. which is so encouraging. And that’s why we’re here, is to give y’all listening hope.

So to expand on what you were saying, the surgical techniques and approaches that you’re using, take our listener through, especially if they’re listening in for the first time, kind of how you sit down with a patient on day one, how you may explain the difference between true, know, the real deep excision from the more common, superficial, too many people are going to GYNs and they’re just doing ablation techniques. How do you sit through

when a patient comes in and sits down, how do you take them through that process right up until they go into surgery?

Mona Orady MD (21:47)

Yeah, I mean, the first thing I do when I see a patient is obviously take a very, very detailed history kind of through the childhood first period onwards, what their experience with their periods are, what their experience with pain is, what bowel and bladder symptoms or sexual dysfunction they may have, what their goals and desires are, what are they trying to achieve by seeing me? mean, obviously they’re seeing me because they have an issue that they want me to fix. So the question is, what is your…

number one highest priority, what’s your timeline on the future? Are you trying to have kids now or later? Are you finished with kids or don’t want kids? Is your number one thing sexual dysfunction or is it GI problems or bladder problems or just pelvic pain in general? And that allows me to kind of hone my diagnosis and everything on what they’re experiencing.

The majority of these patients have endometriosis as their primary problem, but you have to realize that with endometriosis comes other things. Interstitial cystitis, bowel dysfunction, pelvic floor dysfunction, pelvic floor muscle tension, vaginismus. I could go on and on. Nerve dysfunction, muscle dysfunction. Although they come to me thinking, yeah, I have endometriosis, Dr. Orady is just going to remove the endometriosis. I look at the whole patient.

and all the conditions they have that are kind of subsequent to having endometriosis, because those things will need to be treated as well. Once I’ve kind of done that, I evaluated that, I’ve done my exam, ultrasound labs, I can tell pretty much how much endo they have or where it is, whether they have adhesions or not. I can tell most of that on my ultrasound exam, labs, how much inflammation they have. And then I can plan out.

you know, first of all, do they need surgery and if they don’t, and or do they want to delay surgery and do medical management for now? Once we’ve determined they need surgery and I know how much endometriosis they have, then we talk about the surgery itself. What do they want to preserve? Most people want to preserve everything and just want to do removal of the endometriosis tissue, which is excision of endometriosis. And then we plan out, do we need a general surgeon there? Do we think we have bowel disease?

And then we go ahead with the surgery and perform the surgery. And then we plan the post-op. Do we have pelvic floor dysfunction? Are we going to need pelvic floor PT post-op? we having some bladder dysfunction? Are we going to bladder installations? Do we have nerve dysfunction? Are we going to need nerve blocks? So I kind of talk to them about not just the surgery itself, but kind of post-op. What are we planning?

If they’re planning fertility, we need to talk about whether they need to preserve eggs or not preserve eggs or, you know, do IVF or not do IVF or evaluate their tubes or not evaluate their tubes. Obviously it’s very complicated. A lot of people have asked me to kind of write a protocol for the approach to the endometriosis patient. And it’s extremely difficult because it’s very individualized. Every woman comes in with her own set of problems, her own goals, her own place in life. And so every patient has a different plan coming out of.

they’re meeting with me or they’re going through the evaluation with me. But to answer your question with regards to, I just want to explain a little bit of the difference between medical treatment, excision and ablation. So medical treatment for endometriosis usually involves suppressing the period in order to reduce the symptoms of endometriosis. It is not actually treating the endometriosis. It does not remove the endometriosis. It does not make the endometriosis go away. I call it a band-aid.

You’re kind of, yeah, so you’re kicking the can down the road, you’re treating symptoms. And some people do that in order, now’s not a good time in my life to have surgery. I’m planning to have kids a year down the road, maybe I want the surgery a little closer to my fertility because the fertility benefit of surgery in most studies lasts about a year. So if you are planning to have kids in the relatively near future, it might be worth kicking the can down the road a year or two.

Ginger Garner PT, DPT (25:27)

such an important point.

Mona Orady MD (25:57)

And so we’re a little closer to that if we can, if medical treatment works for you. But I do want to make it clear that medical treatment is not really treating endo. We’re just treating symptoms. It’s a band-aid. We’re mitigating our symptoms until, and hopefully trying to prevent the endo from progressing or getting worse as it’s, or spreading by trying to reduce the number of menstrual cycles we have, because every time we have a menstrual cycle, the inflammation increases and that.

causes the side effects of inflammation. And so we think having periods can, if you have endometriosis, can actually slowly over time contribute to the progression of the endometriosis, although there’s debate about that as well. And then the traditional treatment for endometriosis used to just be diagnostic laparoscopy and burn or buzz the lesions, the endometriosis lesions that we see in the pelvis. Or as I said, if everything stuck together and full of endo, they would just

do a hysterectomy and take everything out, ovaries, tubes, uterus, all in mass. And that used to be the traditional treatment of endometriosis before we had all of these more advanced surgical techniques and advanced surgeons that hopefully now exist. The problem with ablation is endometriosis is rarely surface only, meaning the lesion that you see on the surface in the pelvis, that’s just the tip of the iceberg. Underneath, usually that lesion goes deep.

So although if you burn the lesion superficially, maybe the symptoms will improve for a couple of months, the symptoms usually come back. Because endometriosis is still there, you have not removed it. I call it, it’s kind of akin to like, if you have a cancer, you’re not gonna go in and just like kind of surface burn it, because the cancer is invading inside deeper, it’s similar. So you would wanna actually remove the cancer. Although this is not malignant, it’s not cancer, it doesn’t spread and invade.

invade organs to the degree that it’ll kill you, although it can spread and invade organs to the degree that it can cause major damage. Some people have to have bowel resections because their bowel becomes obstructed. Some people lose a kidney because the ureter gets obstructed with endometriosis. So although it’s not cancer, it can cause some major health issues if it’s not properly treated or removed. So that brings us to excision surgery.

Ginger Garner PT, DPT (28:00)

Mm-hmm.

Mm-hmm.

Mona Orady MD (28:16)

In excision surgery, we go in and we actually remove the endometriosis, meaning you see that tip of the iceberg, I usually cut around it and then I kind of dissect and see where’s normal, where’s not normal and remove anything that’s not normal. Endometriosis tissue is usually fibrotic, it’s usually dense, it’s usually inflamed and normal tissue is usually very nice pink healthy tissue. So you have to remove everything abnormal in order to remove the endometriosis.

And that’s where, as I said, with advanced surgical techniques, we have that ability to dissect deeper and shave the endometriosis off of maybe the bowel, maybe the ureter, maybe the bladder, maybe the uterocicoligaments, like those are the common places that you’re moving it. And that’s the way that we can minimize the need for, minimize hopefully the recurrence rate of patients having pain again or having to go back in.

and have surgery. I’ve seen patients that have had five or six laparoscopies every other year, they’re having a laparoscopy to have endometriosis treated. Well, I’m sorry, that’s not treatment. You’re just burning it and then the symptoms come back and they live with it for six months and they’re like, go do it again. That’s not how we’re supposed to be treating endometriosis. We’re supposed to be removing it so that hopefully majority of patients will hopefully live the rest of their life without having to go back.

and have another surgery, although some patients, there is some patients that have recurrence and you have to do repeat surgery. But our goal as surgeons is to minimize the number of surgeries we have to do, not plan to go in every year and do a surgery. I think the maximum, I saw a patient who’s 12 laparoscopies every year, shadow eye. I was like, my God, that is just crazy that every year you’re having to do a To me, you’re not doing anything.

Ginger Garner PT, DPT (29:54)

Mmm. my gosh. Yeah.

Mm-hmm.

Mona Orady MD (30:04)

you’re actually traumatizing the patient. mean, how psychologically traumatic is that that you’d have to have surgery every year just to function as a human being? I think that is a shame that that patient had to go through that before she found someone like me that could actually go in and remove the endometriosis.

Ginger Garner PT, DPT (30:11)

Yeah.

Mm-hmm. Yeah. So

thanks for taking the listener through that because that’s a really great description and important distinction that I think many, I know every patient that comes in and sits down in my office doesn’t understand the difference between that because they probably already had at least one or two surgeries for endo that were just ablation only. And…

And that can lead to making things messier for you, can’t it? When someone has done an ablation multiple times and then you get in there, what do you see that’s happened as a fallout, as a result of ablation taking place?

Mona Orady MD (31:03)

Well, honestly, what we were talking about earlier, adhesions, right? Your burning issue, you’re causing trauma. So now I’m not only dealing with with endo, I’m also dealing with adhesions and trying to find endo in the midst of adhesions, which makes it harder to find it, honestly, because adhesion make things stick together, and it makes it harder to remove it completely. So that is one problem. I do want to also mention I’ve seen a lot of patients who’ve had the negative laparoscopy. So

Ginger Garner PT, DPT (31:05)

Yeah. Yeah.

Mona Orady MD (31:31)

I have all the symptoms of endometriosis. I had a laparoscopy, they didn’t find anything. It’s because endometriosis can look extremely different in different people. And a lot of gynecologists who have not seen a lot of endometriosis, they think of it as those brown lesions, if you look on the pictures, like the typical classic brown lesions. But endometriosis can look very different. It can look like vesicles. It can look like red lesions. It can be white lesions. It can be fibroidic lesions.

So lot of patients have the negative laparoscopy because the surgeon is not recognizing what is actually endometriosis or it’s a little tiny dot or a pucker. And if you don’t dissect deeper, you can’t find it. So that is something I do want to address as well. Not just the repeat laparoscopies for ablation, but also the negative laparoscopy. If you are having the symptoms of endometriosis and you think you have it,

Ginger Garner PT, DPT (32:15)

Yeah.

Mona Orady MD (32:28)

Just because you’ve had a negative laparoscopy does not mean you don’t have it. So that’s just something I want to put out there, because I do see a lot of patients like that as well, who thankfully have insisted enough to seek me out and say, you know what, I really think I have endometriosis. Can you help me?

Ginger Garner PT, DPT (32:32)

Yes.

Yeah, I mean, that kind of brings us to the whole life impact of this because if it’s been missed or they had the wrong type of surgery guaranteed along the way since it takes seven to 10 years to be diagnosed, they’ve been dismissed or invalidated, you know, multiple times. What are some of the most complex or challenging cases you’ve encountered and how did that shape your approach to excision?

Mona Orady MD (33:18)

boy. mean, I do really complicated surgery like every week on a, like yesterday on Friday, I did two extremely complicated cases. Each one of them took, you know, my typical endometriosis surgery takes between one and two and a half hours or three hours tops. If I’m going four, five, six, seven hours, I mean, that means it is everywhere. It is extremely dense. is…

the anatomy is very distorted and I’m trying to restore and reconstruct and you I always say how bad an endo case is how much sewing I have to do at the end, how much. Because I like to put everything back together. A lot of people will just cut out the uterocicral ligaments or the round ligaments or the broad ligament and just leave it open. I don’t believe in leaving things open. If I cut it, I’m going to put it back together. I’m going to sew it back up. I believe in restoring anatomy as much as possible.

So I always say the more sewing I’m doing, the more complicated the endometriosis is. You’re trying to put everything back into its normal location and normal structure. So it’s kind of like doing a sculpture almost. You’re doing clay and you’re kind of shaping it, removing everything bad and then trying to put everything. It’s literally art.

Ginger Garner PT, DPT (34:27)

Yeah.

Yeah.

Yes, that’s the art of what you’re doing.

Mona Orady MD (34:37)

But those are the hardest cases, the frozen pelvis, ovaries, tubes, uterus, uterous sacral ligaments, ureter, rectum, and cervix all stuck in one mass, right? I call it the cement block. Trying to unravel that and put, and in the end have anatomy. Have the ligaments, the vessels, the ureters, the ovaries, the tubes, the uterus, the cervix, the bladder, the rectum.

Ginger Garner PT, DPT (34:46)

Hmm.

Mona Orady MD (35:02)

at all back to normal into or semi normal as normal as normal as we can get it. I mean, that can take hours, you know, and those are the most common, the ones where you have to preserve. For me, the easiest surgeries are the ones where you go in and the patient is done, you know, and you just take it all out one block. That’s easy, right? You just go wide, you take everything and leave the normal stuff and take out all the abnormal.

The reconstructing, the trying to preserve fertility, those are the hardest surgeries. I think those are the most difficult.

Ginger Garner PT, DPT (35:37)

Yeah, I can’t imagine. So many patients, as we’ve been talking about, undergo failed surgeries before finding someone like you to help them. What are your favorite top red flags that patients should look for when they’re vetting a surgeon?

Mona Orady MD (35:59)

But they don’t do this a lot, you know, and someone who’s to be good at endometriosis, you literally need to do this day in, day out. Like, you know, like before a complex surgery, like the ones I just did on Friday, like I literally dreamed the surgery before I like at night, I’m looking at the MRIs and looking at videos. I’m like, I’m looking at the ultrasound images. kind of in my mind thinking, okay, where things, what am I going to do? Like I plan out the surgery ahead of time.

Ginger Garner PT, DPT (36:15)

wow, yeah.

Mona Orady MD (36:26)

And it’s because I’ve done it so much. I literally will dream out the pitfalls and then I’ll relive the surgery the next day. And then I relive it again, trying to write the operative note the day after that. But if you’re not doing that every single day, you won’t be good at it. It’s something that takes a lot of repetition, a lot of patience, meticulousness. So to me, if you’re not doing it every day, then that’s a huge red flag.

Ginger Garner PT, DPT (36:35)

Amazing.

Mona Orady MD (36:56)

Like if they’re an OBGYN and they spend half their time delivering babies, I’m sorry. You’re not going to be a good endometriosis surgeon. That’s one thing. The other thing is I don’t have anything against oncologists. think oncologists do a great job with surgery. They’re great surgeons. actually was going to be an oncologist when I was in residency. My, my, my attendings kept telling me you need to go into oncology. have such good hands. You’re such a great surgeon. need to do cancer surgery.

I couldn’t do it because I have an emotional, like I have a very deep empathy for patients and just seeing cancer patients every day was too much for me emotionally. So I think I gravitated more towards, you know, non-cancer surgery. But you have to be a little bit wary if you’re a fertility patient who’s going to a cancer surgeon. Cancer surgeons are used to cutting everything out. They’re used to removing as much as possible. They’re not so much into the reconstructing.

Ginger Garner PT, DPT (37:35)

Yeah.

Such a good point.

Mona Orady MD (37:58)

So, you know, although they’re great surgeons, they can probably excise endometriosis. I would be very careful if I’m a fertility patient and I want my tubes and ovaries necessarily preserved to have that conversation with that surgeon and ask them what are their approaches? How are they different with a fertility patient? So that’s another thing because I know that

general gynecologist, a lot of them will refer these really horrible stage four frozen pelvis endo cases to cancer surgeons because when you are doing that surgery, it is very similar to cancer. You’re going very wide. You may have to take the vessels very wide if you’re doing a hysterectomy, but if not, the other one now that we brought up hysterectomy is the other one. If you’re being told that you have to have a hysterectomy to get rid of your pain, humongous red flag. I think I have a YouTube video on that.

you know, removing the uterus, the innocent bystander. If your uterus is normal, it does not need to be removed to get rid of your pain. So if someone’s being told they have to have a hysterectomy, I think that’s a humongous red flag too. So those are a couple of them, you know, other things, ablation versus excision, if they don’t even know the difference between that, that’s a red flag. And then the other one is post-op, right?

Ginger Garner PT, DPT (39:15)

Yeah, huge, huge red flag.

Mona Orady MD (39:21)

If you’re going to a surgeon, they’re gonna do your surgery and then by go back to your normal life. I just talked about how a lot of these patients have ongoing issues. have pelvic, the pain isn’t necessarily gonna go away 100 % with the surgery. You have to treat the bladder dysfunction, the bowel dysfunction, the pelvic floor dysfunction, the nerve dysfunction, the fertility problems, the sexual dysfunction. And if…

I feel like you’re never really going to be a complete endo expert, endosurgeon, unless you’re also treating all of those things. It’s not just doing surgery and see you on your way. I see most of my endo patients probably 12 to 15 times before I ever get to the point where like, okay, you’re good. Let’s do yearly visits from now, or yearly checkups. But it takes a long time.

Ginger Garner PT, DPT (40:08)

Yeah.

That’s an excellent

standard of care to, I won’t say remind everyone because you’re probably hearing this for the first time that this is what care should look like, you know, as a listener that yeah, it should be that ongoing care post-op.

Mona Orady MD (40:28)

Yeah, so the post-op care I think is really important too.

Ginger Garner PT, DPT (40:32)

Yeah, I just to underscore like the importance of what you mentioned about hysterectomy, I just had a mother daughter sit down, very young daughter who likely has endometriosis and she was presenting an entirely different case to me about a bladder issue and of course doing differential diagnosis and

doing a systems review, I said, you know, does anyone have endometriosis in your family? And her mother was sitting across the room and she raised her hand.

And then immediately after that, she said, yeah, and I just had a hysterectomy for it.

Mona Orady MD (41:19)

Yeah.

Ginger Garner PT, DPT (41:20)

And so that is there’s such an emotional connection for me to that because there’s so much education that we have to do because they do, people will think, and they’re being told. So why would they believe anything else? They’re absolutely being told that you had a hysterectomy and now you’re fine. And what’s more is that, obviously they go on to have more pain as this individual was, but had never been referred for anything else at all.

No pelvic floor PT, no mental health, nothing.

Mona Orady MD (41:49)

And

the problem is too, if you have hysterectomy and you don’t remove the endo, you’ve kind of removed the roadmap of the pelvis. So the uterus attaches to the upper abdomen with the round ligaments, the tubes go along the side, the cervix goes down the center, the utero sacral ligaments preserve the pelvic floor anatomy.

When you’ve removed the uterus, it is very hard to find endometriosis because the entire roadmap of the pelvis is gone. So all you have is this kind of blank space and it’s very hard to kind of go deep and dig deep and it becomes extremely difficult to do a good endoecision after hysterectomy. So to me, one of my biggest pet peeves is having a hysterectomy when you haven’t removed the endometriosis because it makes my job very hard.

Ginger Garner PT, DPT (42:31)

Wow, that’s really good.

That’s a really good point.

Mona Orady MD (42:43)

And sometimes almost impossible for me to then find the endometriosis later on. And so that’s another point, like don’t try a hysterectomy and if that doesn’t work, I’ll have an endoxision. No, try an endoxision first. If that doesn’t work, then have a hysterectomy. Like it’s just, to me it’s just, and it’s complete misinformation that the uterus is the cause of your pain. It’s not, it’s not the cause of your pain, unless there’s something legitimately wrong with the uterus. You know, I see patients,

Ginger Garner PT, DPT (42:47)

Thanks for bringing that up because yeah.

Yeah. Yes.

Yeah.

Mona Orady MD (43:11)

with pelvic congestion or severe adeno or a huge fibroids, whatever, then we can talk. But even then you’re still going to remove the endo first. Even when I do that surgery, I still remove the endo first. And then the hysterectomy is like the last thing I do. So it just kind of don’t take away the roadmap.

Ginger Garner PT, DPT (43:16)

Mm-hmm.

Yeah. Yes.

That’s such a good point. Such a good

point. On that note, I’m going to talk a little bit about the future because there are so many things, you you mentioned doing imaging as a way to, you know, map things out or presurgical planning, that kind of thing. And yet we also know that if someone goes into an ED or ER and someone does imaging, they’re not.

They’re not trained to look for that and find it. And so everything will be, quote, air quotes, if you’re not watching this on video, normal, right? Yeah. So what innovations and advancements, you know, not just in excision surgery, because you’ve talked so much about that, which is wonderful. What are the things that you’re getting excited about now, potentially for the future? And what do we need? What do we need more of right now?

Mona Orady MD (43:55)

No,

I don’t care if it’s normal.

We need more surgeons. mean, that’s a very given. like right now I’m looking for a fellow to come and train with me and hopefully join my practice at the Orady Women’s Clinic and to expand a little bit more, you know, because I can only do X number of surgeries a week. So it’s such a high demand. But so we need more surgeons. We definitely need more training for radiologists on how to pick up endometriosis on MRI.

Ginger Garner PT, DPT (44:39)

Yeah.

Mona Orady MD (44:49)

It can be picked up on MRI and there are places that do a really good job of picking it up, most imaging centers or whatever you say that the techs aren’t trained to do the protocols for endometriosis, the radiologists aren’t trained to read the MRIs for endometriosis. So, short of having an imaging center that’s focused on endometriosis, which

In some countries, those centers exist. In Brazil and Italy, all the patients with endometriosis go to one particular place to get their MRI, you know, for mapping. We can’t do that here in the U.S. with insurances and the way that the country is set up. It doesn’t happen here in the United States where there are centers that are focused. And I’m always jealous of the surgeons over there. like, yeah, my radiologist will tell me exactly where the endo is before they go. I’m like, yeah, that’s awesome. I’d love that. I don’t have that.

Ginger Garner PT, DPT (45:38)

Yeah, that’s amazing. Yeah.

Mona Orady MD (45:42)

So it’s exciting

Ginger Garner PT, DPT (45:42)

Yeah.

Mona Orady MD (45:43)

that the technology exists. It’s just a matter of training and finding the centers that will do it in this economic environment and the healthcare system that we have, is a whole nother topic for whole nother podcast. So it’s exciting that the imaging exists. Ultrasound is actually very good in expert hands. So I do all of my own ultrasound.

Ginger Garner PT, DPT (45:56)

It is a whole other, yeah. It is.

Mona Orady MD (46:11)

and I can see endometriosis or the effects of endometriosis even in those patients where majority of them have gone to the ED or have had a pelvic ultrasound that was quote unquote normal. I’m telling you, none of them are normal in my hands. It’s just a matter of what you’re looking for. you have to realize that in the ED or whatever, they’re just looking at the sizes of things. Is the uterine normal size? Is the ovary normal size? It doesn’t have to do with the size. It has to do with what’s around it.

Are there adhesions? Are things sticking? Are they moving? Are they in the right place? Are they shifted? Are they thickening? This stuff that nobody comments on, on the ultrasounds that are performed in a routine manner elsewhere, because again, they’re just not trained like the MRI. They’re just not trained to look for it. Now some people are in some centers have really good ways.

Like I just, when I was at AAGL, one of the endosurgeons from Canada, like he gave a whole lecture on how at McMaster University, they have a whole endo center ultrasound place. And yeah, they do a great job, but are you going to go to Hamilton, Ontario every time you want to ultrasound for pelvic pain? You can’t do it. So the technology exists. It’s a matter of training. And I think what’s exciting is that we’re talking about it more and more more people are becoming more interested.

Hopefully we’ll have more fellowships and training programs and more radiologists and things like that, but it’s it’s going to take time. So that’s what’s exciting to me. And then obviously the robot laser and all the technology that we have with surgery right now is just amazingly exciting. There’s more robots coming out on the pipeline. There’s, you know, better and better things. Even adhesion prevention. I use the liquid adhesion parlor here called ADEPT, but

In Europe, they have like a hyaluronic acid gel. It’s not yet FDA approved. I’m really excited about it when it becomes. So there’s all sorts of things that are hopefully coming. And it’s just, I think we’re only going to get better and better.

Ginger Garner PT, DPT (47:59)

That’s exciting.

That’s so hopeful. That’s so hopeful. So I was reading, I think you were speaking at something online. I’m gonna come kind of full circle back to your original story of your passion of getting involved. And I was reading something about you were teaching or speaking to Egyptian women somewhere online or in person. I don’t know where it was. Anyway, you were talking about…

people in immigrating and integrating into society and doing good for people around them and things that we all share core values, treating everyone with respect, being inclusive. And for people or women particularly moving into the United States, I think this is what was from Egypt is to, for them to hold onto their beliefs and heritage and to believe in themselves.

And so I did not want to close out our time together without asking a couple of questions. The first one, and the main one really is, I don’t want to ignore the obvious, right? As a female surgeon in a field, historically dominated, sometimes I will say pale males, white males, whatever we want to say. I mean, it’s kind of obvious, elephant in the room, right? That that’s how things have been dominated very,

Mona Orady MD (49:07)

Yeah.

Yeah.

Ginger Garner PT, DPT (49:31)

patriarchally, can provide, we don’t have to go even a generation back to see how women struggle to be included in the field, respected, listened to, and their voices heard. So first of all, I just want to say, you’re amazing for persisting through when you probably didn’t have, maybe you did have role models. I’d love to hear a story if you do have a role model, or if you didn’t, how you became one.

Mona Orady MD (49:49)

Thank you.

Ginger Garner PT, DPT (50:00)

for young girls and women who want to do work like this is just so incredibly inspiring. So I think my question is, what are some of the obstacles you faced in advancing your profession and advancing excision surgery or anything else that you have done? How have you navigated those? And for young girls who want to follow in your footsteps in young women, what do you want to say to them?

Mona Orady MD (50:29)

Oh my gosh, this a question that really hits home to me because I have struggled so much, let me tell you. And still even to this day, I still struggle with, I don’t wanna call it discrimination, but definitely being treated differently than others. But to answer your question, I grew up,

Ginger Garner PT, DPT (50:50)

Yeah.

Mona Orady MD (50:56)

really having this passion. And I don’t know if God put it in me or, you know, I am a woman of faith. I’m a Muslim woman, obviously. I wear the hijab. I wear the head scarf and I’ve been wearing it since I was nine. So I was always a woman very committed to making a difference in the world, wanting to be the best example of a Muslim woman that I can be. I used to pray every night that God would make me the best surgeon in the world.

Ginger Garner PT, DPT (51:25)

my gosh.

Mona Orady MD (51:25)

And

I would help, you know, umpteen million women, you know, have better lives. Like that was my prayer every night since I was like seven years old. even through so much. I was the first Muslim covered woman in my medical school ever. Okay. And I was literally told when I went for my interview, you know, you better take that off. You’re not going to get in. Like, you know, and I, and I insisted, said, this is who I am.

Ginger Garner PT, DPT (51:33)

Wow.

my goodness, that’s incredible.

Bye.

Mona Orady MD (51:55)

They can either take me or leave me. This is why I was told by so many people, I would never get into medical school. I would never finish my residency. I started my residency in July of 2001, right before 9-11 in Ohio. Yeah. So I struggled. had patients walk out of the room, refused to see me because I was a Muslim terrorist or whatever you want to call it. I had nurses refuse to take orders from me because I was a stupid

Ginger Garner PT, DPT (52:09)

my goodness, that takes my breath away.

Mona Orady MD (52:25)

I forget what they called it, something head, you know, with something, you know, as if the scarf like kind of negates my brain. So I cannot tell you how much I struggled, you know, both in medical school, although once I got in, you know, honestly, University of Western Ontario did me very well. They were very, very accommodating to my religious beliefs. And I think in Canada in general, I didn’t struggle as much as when I came to the US.

Ginger Garner PT, DPT (52:27)

Ugh.

Wow, that says

a lot.

Mona Orady MD (52:54)

When I came to the US though, was a struggle. And maybe it was because I came in 2001, know, 9-11 had just happened. And that’s when I moved to the United States. I struggled. remember, you know, my program director, you know, kind of not necessarily saying that I would never graduate, but kind of implying that they would do everything possible that I not to graduate.

Ginger Garner PT, DPT (53:20)

my gosh.

Mona Orady MD (53:22)

But although my program director, ultimately, I think he gained great respect for me and because of my skills and my, you know, even the patients at the beginning, they didn’t want to see me because I was the covered one. But by the end, everyone would line up to see Dr. Orady because I was, you know, the one everyone wanted to see. Like I was the one they loved. So I kind of struggled to gain that respect. But it’s always been with me where I walk in,

Ginger Garner PT, DPT (53:44)

because you’re amazing.

Mona Orady MD (53:51)

you know, and I hate to say it, even when I first started lecturing and speaking and I would go to a conference. At the beginning, everybody would be looking at me like kind of funny, like, who is this person? Why is she here? Is she in the wrong place? She lost? Like, who is this? Like, why are you here? And then after I would give my lecture, you know, beforehand, nobody would talk to me. Like, I was kind of like the odd man out, you know, the wallflower at the back of the room.

After I gave my lecture, everyone would be, my God, can you tell me more? Can you explain this? It would be like all of sudden everybody wanted to talk to me. And I would laugh because at the beginning you didn’t even want me in the room and now everybody wants to gain their knowledge, this extra knowledge from me. And it’s been, you know, it’s always been a struggle. I think I always stand out like a sore thumb, but I kind of use it as to my advantage because I think people underestimate me. And then when I get up there and I…

Ginger Garner PT, DPT (54:30)

Wow.

Mona Orady MD (54:45)

show my work, then it’s like, wow. You know, it goes even more. To me, what has kept me going through that, you know, and I’ve been fought everywhere I’ve gone, you know, in some way or another. I’m always the innovator. you can’t use the laser. It’s too expensive. You can’t do this. You can’t do that. Why are you doing these complex cases robotically? I’ve always been fought, but for me, I always held to that prayer that I prayed every night that God made me a tool in his hands to help women.

Ginger Garner PT, DPT (54:49)

Ha ha.

Mona Orady MD (55:14)

and the best surgeon in the world. That I would go home and pray that prayer and I’d be like, God, please just guide me. And I felt like that gave me the strength to insist on doing what was best for my patients. On doing what was best, what I would want to be done. It was always like, there’s this principle in my religion that you always do for others what you would want done for yourself, which is a very Christian principle also. It’s not only a Muslim.

Ginger Garner PT, DPT (55:40)

Yeah.

Mona Orady MD (55:40)

I always, when I met someone, I’d be like, what if I was in her shoes, what would I want? And that’s what I do. Even when I operate on patients, I literally feel like every drop of blood is like my own blood. Like every burn is like burning myself. Like I literally feel it. Like this is as if it’s my whatever myself, my friend, my, my sister. I operate on people as if they are me or my family. So

And sometimes I’ll beat myself up if something happens where I lost a little more blood than I should have or whatever. And I’m like, no. And I just go back and I pray to God, please, God, heal her, give her a baby, get her out of pain, use me as a tool. And I think that’s what just keeps me grounded, honestly, through the struggles, through everything. Even this last year and a half, I just opened my own clinic. It has been an immense struggle to try to be a private practitioner and be a mom with two young kids.

Ginger Garner PT, DPT (56:35)

my gosh.

and be a mom.

Mona Orady MD (56:39)

My mom had two young kids and just trying to grow everything. And again, everybody said, you can’t do private practice anymore. It doesn’t work. you won’t make money. You’re going to go bankrupt in a year. OK, we made it a year. We didn’t go bankrupt now. You know, we need to make it another year. But you know, it’s just this constant, I have to tune out what everybody’s telling you I can’t do. I think it’s almost like it’s become almost like when someone says I can’t do something, it’s like, yeah, well, watch me.

Ginger Garner PT, DPT (56:56)

Incredible. Yeah.

Mona Orady MD (57:09)

It almost motivates me more to put even more effort in to succeed. So I have talked to a lot of Muslim women youth groups and I have wanted to be that inspiration to minority women who are being told you can’t do this.

Ginger Garner PT, DPT (57:09)

Yeah, that’s a good message. That’s a good message.

Mona Orady MD (57:30)

guess what, you can do it. Just stay focused and stay grounded and look at your goals. Because I was told my entire life that I couldn’t do, you can’t be a minimally invasive surgeon. You haven’t done a fellowship. You can’t do endometriosis surgery. It’s too complicated. You can’t be a doctor because you have a scarf on your head. The number of things I have heard I cannot do. It’s like, if I had listened to that, I wouldn’t be where I am today. And here I am. Yeah.

Ginger Garner PT, DPT (57:55)

And here you are.

Yeah. Okay. I’d like to have to put both hands over my heart and like, because your story is, going to make me get choked up. Thank you for sharing your story. thank you for your resilience that you give to your patients and to, and that message to women and girls and women and girls who are also minorities that are also being told that they can’t.

Mona Orady MD (58:02)

you

You’re gonna make me cry too, honestly.

Ginger Garner PT, DPT (58:28)

And those women and girls who also who may be minorities, which we know they struggle more to get the care that they so deeply deserve. So your message, what you do, everything about you is just like a portrait of courage and resilience and grace and grounding and a spirituality that we can all aspire to. So thank you so much.

Mona Orady MD (58:55)

Thank you.

Ginger Garner PT, DPT (58:57)

One question. That other question. Now that I got to the other part, let me wipe my nose. Part two of that question was, where can people find you? This one’s easy. Yeah.

Mona Orady MD (58:58)

you

I’m gonna wipe my eyes.

That was easy. Well,

we just opened the Orady Women’s Clinic. Originally, we were in San Francisco. We’re actually still in San Francisco, but we will be moving to Walnut Creek, which is about 20 miles away into the East Bay in the next two months or so, hopefully. But feeling that San Francisco sometimes is a very difficult place to navigate, hard to park, things like that.

Ginger Garner PT, DPT (59:29)

Okay.

Mona Orady MD (59:37)

Walnut Creek is a much nicer environment, especially for patients flying in and coming from out of state or driving in. And also it’s closer to my now home. So in the San Francisco Bay area, the Orady Women’s Clinic, my website is www.drmonaorady.care.

Ginger Garner PT, DPT (59:48)

Yeah, they’ve been better.

Mona Orady MD (1:00:01)

email us, you can go on the website and send us a contact message requesting appointments, you can call and patiently wait for an appointment with me. I do have a little bit of a wait but please yeah.

Ginger Garner PT, DPT (1:00:14)

I I bet.

So everyone, just amazing, amazing talk today. Beyond inspiring for me and I know for all of you listening too. Thank you so much Dr. Mona Orady, you are changing lives.

Mona Orady MD (1:00:30)

Thank you so much. Thank you.