Welcome back everyone! I am with an amazing guest today I have another wonderful endometriosis excision surgeon and just incredible person Dr. Rachael Haverland.

Rachael Haverland (00:13)

Ginger, thank you for having me. I’ve been looking forward to this for the last few months since we met at the Endo Summit. So I’m really excited about today. Anybody that gets me talking about Endo and advocacy, I could speak for hours. So I’m really excited to be here today.

Ginger Garner PT, DPT (00:18)

Yeah. Well, I

Thank you. Thank you for being here. I have been ⁓ kind of chasing you down. I will stop short of saying stalking for since I saw you at a distance ⁓ at the endo summit in a previous year. And then we got to connect this year and I’m so excited. So welcome.

Rachael Haverland (00:47)

Yeah, yeah, that was

great. The endo summit’s really good for that, you know, bringing all the different specialties together, including patients. Anyways, I was the lucky one. That made me excited.

Ginger Garner PT, DPT (00:56)

Yeah.

All right everybody. ⁓ As you well know, I want you to learn about our guests before we launch into our chat. So here we go. This is our bragging moment. Dr. Rachael Haverland is a board certified endometriosis specialist based in Dallas, Texas. As a physician fellowship trained at the Mayo Clinic,

under the pioneers of endometriosis surgery. She has extensive experience in optimizing gynecologic surgery with minimally invasive techniques. Yes, yes, yes. She believes in a holistic, also yes, well-rounded approach for best outcomes for endotreatment.

Dr. Haverland specially ⁓ specifically holds a focus practice designation in MIGS, minimally invasive gynecologic surgery, ⁓ through the governing board of OBGYN, putting her at the highest tier for specialists in gynecologic surgery, which is important for our listeners because they may not know that.

that that’s important for surgeons to have. Additionally, she’s submitted hours of videos through a vetting process called Eye Care Better, which she’s been verified with expertise in endo excision by the most experienced endometriosis surgeons in the country. Recently, she has become a master surgeon through the Center of Excellence at multiple hospitals in the DFW, the Dallas-Fort Worth area.

with her membership to a multitude of national professional organizations, as well as her publications and numerous academic journals. ⁓ Y’all can feel confident that she is attuned to the latest, most up-to-date approaches in the treatment of endometriosis. Welcome.

Rachael Haverland (02:40)

Thank you. Thank you very much. I think that just means I’m a glutton for training. I just keep training, punishment, training some more, but it is very rewarding. So thank you for that, Ginger.

Ginger Garner PT, DPT (02:45)

Ha ha ha.

Yeah,

absolutely, Rachael. think that that is like requisite for, you know, being in healthcare, although that doesn’t feel like a requisite because so many patients are seeing so many practitioners before they get to find actual care and relief. And that’s why we’re here. That’s why we’re talking.

Rachael Haverland (03:03)

Yeah.

Yeah, it is. one of the

goals of my practice in my career is I like to decrease the amount of time that it takes for patients to get appropriate care and to be able to treat women earlier. Like trying to catch them when they’re in their teens and their 20s, not when they’re in their 30s. Because those 10 years matter. 10 years of chronic damage, 10 years of effects on the nerves and the pelvic floor. And it just makes it harder and harder to reverse that sequela the longer we let it go.

Ginger Garner PT, DPT (03:24)

Yeah. Yeah.

Rachael Haverland (03:36)

One of my goals, I’ll get off my soapbox in a second, but I mean, advocacy is the way to do that. Trying to teach more providers about how to treat endometriosis, where to direct them for appropriate care, and just learning more about it. Not waiting until they’ve been having symptoms for 10 years to ever hear the word endometriosis. So hopefully we’ll get there.

Ginger Garner PT, DPT (03:38)

No.

Yeah.

I think you make a really good point about anyone who has been with someone with endo, has endo, knows anything about endo, has heard about the delay in diagnosis. And then what happens is there’s also, it’s not the nuanced or softer side, but we often think of the mental health perspective as kind of the softer side of, well, I’ll get to that later. Let me get to the physical stuff first. But when someone has delayed care,

Rachael Haverland (04:23)

Sure.

Ginger Garner PT, DPT (04:31)

year, two years, seven years, ten years, two decades. There’s such a mental health toll and burden that goes with that, that does end up presenting itself physically, eventually, and exacerbating everything.

Rachael Haverland (04:33)

Yeah. Yeah.

100%. Yeah.

And we know that our mental health affects us physically, even if we try not to let it. It’s impossible not to. When you’re hurting all the time, it’s almost impossible not to be frustrated and to be sad about it or not to have any options for treatment. And so I agree, the mental health side effects very much connects to the physical components, not just with endo, but really any chronic disease.

Ginger Garner PT, DPT (04:54)

Yeah.

Yeah, what, share with our listeners a little bit about your background and what led you to focus on endometriosis because that is a very unique specialty of a specialty, you know, pathway.

Rachael Haverland (05:25)

Yeah.

You know, I always knew I wanted to be in women’s health. So when I first went to medical school, I actually sort of thought I wanted to be a general surgeon. And then I went into my OB GYN rotation and I just knew that this is where I was meant to be. I wanted to advocate for these women. I love the women’s health aspect. But I was lucky in my residency that they also had a MIGS fellowship. Dr. Michael Hibner was our MIG the head of the MIGS department there.

and he was starting to do or had been doing endometriosis excision. And so I was exposed to this early and I realized this is a very, like this population of women weren’t being heard and nobody was speaking for them. And it called me and I am so honored to get to be in this space and take care of these women that I see in my patients. But it was ⁓ very cool. Once I got there, just a light bulb went off. This is where I’m meant to be. These are the people I need to advocate for. These are the patients who need help.

because they need a voice. And so ⁓ I was in Phoenix at the time for my residency and then I did a two-year fellowship at Mayo and that’s where Megan Wasson is and Javier Magrina. And they were also the pioneers at the forefront of endometriosis treatment and excision. And it was very special to be able to be there during that time to learn with them and learn from them. ⁓ And then.

My family is from Texas and from Dallas, so we came back home and I found that it’s not just DFW, it is all of Texas. It’s really the whole country. need more specialists focused on endometriosis. There is not a lack of patients. When it affects one in nine, probably even one in eight women in the country, there’s a lot of treatment that needs to be had, even outside of surgery, but a multidisciplinary approach.

Ginger Garner PT, DPT (07:19)

Yeah.

Rachael Haverland (07:20)

just trying to diagnose it, giving people answers and then giving them all of their options for treatment. You know, I’m a surgeon, I see a ton of benefit through surgery, but there’s a lot of options even outside of surgery that people can start, like steps people can start taking before they get to feel comfortable with surgery, or if they’ve already had surgery and still aren’t seeing the benefits yet, knowing that there’s other treatment plans to implement to get the best outcome.

Ginger Garner PT, DPT (07:45)

Yeah. And so just kind of to quantify that for everyone listening. if you are maybe you’re PT listening or an OT or maybe you’re not in women’s health, but you know somebody in your family and you’re in healthcare. If a patient, if a provider is seeing 20 patients a week or 30 patients as a therapist, right? When you’re spending the better part of an hour with them, that’s, know, 20, 30, hopefully not 40 patients or my gosh, that’s like burnout.

Rachael Haverland (08:13)

That is a lot.

Ginger Garner PT, DPT (08:14)

Yeah. And if you are in women’s

health, okay, then they’re 100 % women. How many of those women per week do you see that someone, okay, multiple cases are going to have endo? And so when I look at, reflect on my practice, feels like I am literally referring people on a weekly basis. so think of all, multiply that by thousands of therapists who can be screening for this, school nurses, right? ⁓

Rachael Haverland (08:42)

Yeah.

Ginger Garner PT, DPT (08:44)

anyone who has contact with young girls and young women.

Rachael Haverland (08:48)

Yeah, you know, I give

lectures to the pediatricians, you know, through the hospital, not just to try to, you know, tell them what to do, but to give them some more resources and some more guidance for these young women when they start to, if they start to have symptoms so early, just on next options and next steps so that they don’t get stuck in this just cogwheel of only hormones is the only option, ⁓ which is not necessarily wrong, but it’s not for everybody.

Ginger Garner PT, DPT (08:53)

That’s wonderful.

Rachael Haverland (09:18)

And so it’s really important to make sure that we can kind of treat them early with this multidisciplinary approach, even in the pediatric population. And so you’re absolutely right. Physical therapists, dieticians, school nurses, that’s a great one. I actually haven’t even thought about that. But it’s so important to spread awareness so that it’s at least in the back of your mind.

And if you don’t know, well then you can always refer the patient to get a little bit more detailed evaluation.

Ginger Garner PT, DPT (09:43)

Yeah.

Yeah, absolutely. that can happen across multiple levels. ⁓ If we just run with an example of a ⁓ school nurse that sees a young patient with a young lady with ⁓ period pain or constant gastrointestinal issues that may be cyclical. Yeah. ⁓

Rachael Haverland (10:04)

Mm-hmm. Yeah. Chronic constipation. Yeah. Or even

GI nausea, vomiting. A lot of my young women, that’s how they present. They don’t really even see the dysmenorrhea or the pain with their period. A lot of it is just GI, like nausea, vomiting with their cycle, but not necessarily pelvic pain specifically. But it just kind of shows you how endometriosis is very much a whole body disease, a whole body inflammation, not just…

Ginger Garner PT, DPT (10:13)

Mm-hmm. Mm-hmm.

Mm-hmm.

Rachael Haverland (10:34)

pelvic disease.

Ginger Garner PT, DPT (10:35)

Yeah, I had a recent case where, and this is why investigation and diving a little deeper is important because she came in ⁓ as a direct referral as a kind of a last resort. had been to a lot of different practitioners and she had missed an appointment because she was in the ER, the ED. She had to to the ER.

And when I came in, when she came in, she was like, so sorry, I missed my appointment. I’m like, let’s sit down and talk about what happened. She was like, oh, it’s unrelated. I’m like, well, tell me a little bit about what happened. And it turns out she was in the ER for shortness of breath and pain with breathing, with respiration, to which she was told, take a Tylenol and  go home.

Rachael Haverland (11:08)

Yeah.

Yeah.

Ginger Garner PT, DPT (11:23)

You’re just having an anxiety panic attack because she thought she was having a heart attack or something. And this is a teenager, a young adult. And then you know where we’re going with this next. Rachael, we had to have the discussion of that is related to your symptoms. And let’s put all the pieces of this together, which became a catalyst to go, okay.

Rachael Haverland (11:35)

yeah, yeah.

Ginger Garner PT, DPT (11:45)

That’s when the family was like, we can’t keep doing this, you know, because every ED visit is, could be $8,000 if they run a few tests and yep. And, and that became the catalyst, finally put piecing it together because, you know, not to blame the pracs in the ED or something, but that’s not, they’re not going to be able to, we know, you know, they’re not going to be able to diagnose that. They don’t diagnose, you know, ⁓ endo and.

Rachael Haverland (11:53)

yeah, easy.

No. Yeah. You know, the job of the ER is to decide if you’re sick enough to be in the hospital or if you’re

safe enough to go home. And that they, you know, they, they’re not specialized outside of that.

Ginger Garner PT, DPT (12:16)

to go home, yes.

Yeah, so that became the catalyst. So putting all those symptoms together at the school nurse level may mean, and then she was in my office next, right? So it may mean that the school nurse is like, why don’t you, or the folks in the ED, why if they had that education to identify the signs of endo to go.

Rachael Haverland (12:29)

Yeah, yeah.

Ginger Garner PT, DPT (12:40)

you got an appointment next Tuesday with your pelvic PT? Talk to them about that instead of it being  separate, right? And then she comes in, she doesn’t think it’s related, but it is, you know? Because you’re not going to get into a surgeon like right away, but you could see the pelvic PT who could help you manage the pain. And we went over respiratory stuff to… ⁓

Rachael Haverland (12:43)

Yeah.

It is. Yeah, a whole whole body disease.

Sure.

Right. Start working on diet changes, start working on, you

know, sometimes I implement or try, you know, it’s hard to implement everything at one time, but really that’s when you get the best outcomes. You know, if you could do some sort of yoga, meditation, pelvic floor physical therapy, you know, it really does make a difference, but it is a little daunting. I think at first ⁓ when you see all of the options, you know, for treatment, but you know, going back to this,

Ginger Garner PT, DPT (13:10)

Yeah.

Mm-hmm.

Rachael Haverland (13:30)

how endometriosis affects all these different organ systems. I read a study the other day because I was making a PowerPoint for a presentation and it listed endometriosis, the most common symptom as fatigue. And at first I read this and I was kind of annoyed because I was like, this does not help me. You know, everybody has fatigue, but it makes so much sense. You your body is chronically fighting this disease, all of this inflammation, and it gives you no extra energy for your daily functioning. It’s just trying to get by and it’s fighting.

Ginger Garner PT, DPT (13:46)

Yeah.

Rachael Haverland (14:00)

constantly. It makes sense that fatigue is so common in this population, but it can be something so simple, so ⁓ minute that you may not think is related, but it absolutely can be. ⁓ GI symptoms, bladder symptoms, pain with intercourse. Sometimes I see women, that is their only symptom of endo, is that they have a hard time having penetrative intercourse with their partner. They love them, they feel safe, they’re in a safe relationship.

you know, despite physical therapy or maybe they haven’t tried physical therapy, but a lot of times they can’t get to the point where they can tolerate it. And it presents in so many different ways. Even I, who only does endometriosis, I’m still surprised with how it presents sometimes. It keeps me on my toes, that is for sure.

Ginger Garner PT, DPT (14:48)

Yeah, because it’s going full circle back to the beginning of the discussion because it is a whole body experience in disease, not this just a reproductive. So speaking of all of the strange and wild symptoms that can occur,

Rachael Haverland (14:58)

not just in the pelvis, yeah, affecting the reproductive organs, yeah.

Ginger Garner PT, DPT (15:08)

we talked about earlier before we repressed record, actually back at the endo summit, we talked about discussing the appendix and endometriosis. So shed a little bit of light for.

our listeners on this topic because as I do prehab for patients going in, it’s one of the things we discuss because they will come back and be surprised. They could be surprised that, well, they took my appendix at the same time. So yeah, shed some light on that ⁓ for us. ⁓ Maybe like.

your first encounter with a case of appendix endo and how it shifted your understanding of the disease and what you look for.

Rachael Haverland (15:54)

Sure.

Yeah. you know, even in training, we were seeing endometriosis on the appendix. It is the first organ outside of the pelvis that endometriosis is most common to spread. And we think it’s because of sort of how the lymph flows in the pelvis. ⁓ It’s kind of in a counterclockwise ⁓ way. Almost spreads like cancer, even though it’s not cancer. We think that that may be one of the modalities that it spreads.

Ginger Garner PT, DPT (16:19)

Mm-hmm.

Rachael Haverland (16:23)

Also, if you have an endometrioma or more endometriosis on your right side, which is in close proximity to that appendix, it also increases your risk of having endometriosis on the appendix. ⁓ On every patient that I take to surgery, I talk to them about this. I’m like, hey, go through all this, the surgery discussion. We’re gonna look at your diaphragm. We’re gonna look at your gallbladder, your stomach, the liver. But I always count them on a possible appendectomy. Like this is more common.

Women with stage three or four disease have about a 30 % chance of having endometriosis in their appendix. Sometimes you can see it, and sometimes it’s very obvious. ⁓ In fact, on Monday, I had two patients with deep endometriosis on their appendix. And then I’ll go like a few weeks and I won’t see one. But the endometriosis on the appendix almost looks like appendicitis. You can see that the tip of the appendix starting to curl or it gets red and inflamed.

Sometimes you do see just those classic implants of endo, those little black, brown ⁓ implants, but it also can have the atypical appearance of endo as well, which is the clear vesicular or like raised lesions. ⁓ The appendix is a very delicate structure because it’s very thin. And so it’s not a place where you can excise endometriosis from and keep the appendix. It’s kind of an all or none.

because if you take out a portion of the appendix without taking all of it, you just have a much higher risk of complications or appendicitis down the road. So when you see endometriosis on the appendix, you have to be a little aggressive in removing it. ⁓ know, when people, you know, it’s nerve wracking to take out organs and people talk about, you know, what is the benefit of the appendix? What does it do for us? ⁓ You know, they kind of relate it to the gallbladders. It’s similar to the gallbladder and how it affects digestion. ⁓ And so, you know, it is important to have

this discussion. I believe very strongly in patients’ autonomy, know, women getting to make decisions for themselves. I want to tell them what my recommendations are, but I certainly don’t ever want them to feel forced or pressured into doing something that they’re not fully educated on or just don’t feel comfortable. ⁓ And so when it comes to the appendix, we talk about ⁓ kind of where it came from. So we think that it is this vestigial organ that we used more, you know, in the past when we’re eating rocks and, you know, sand and some of our food to help with digestion, but

but as we’ve grown and changed, it doesn’t have a lot of benefit. There is some evidence that it may help with some of the microbiome of the colon, maybe helping with some of the, ⁓ like IgA and other factors to help make sure that we have the good bacteria in the colon. It doesn’t have great evidence behind it as far as like clinically proven, but I do talk to them about that. know, removing the appendix.

doesn’t necessarily increase your risk of complications of surgery. I do give slightly different antibiotics during surgery, but again, I talked to them about it’s not something I can excise from without removing the whole appendage just because of the risk of going forward. ⁓ But you can see the appendix sometimes is stuck down, into the, like stuck with the ovary and there’s this big, egg-nextal mass and it has the ovary, the fallopian tube and the appendix stuck in there. ⁓

It’s, you know, sometimes you don’t know what you’re gonna get into, but it is relatively common with endometriosis, so we always make sure we bring it up in the discussion.

Ginger Garner PT, DPT (19:49)

Yeah. So for listeners out there, it’s no secret to them. I have a whole YouTube playlist on the fact that I have endometriosis. Have, had. ⁓ And I’m also one of those unique individuals who had two appendectomies.

Rachael Haverland (20:10)

No, I do not

know that.

Ginger Garner PT, DPT (20:13)

Yeah,

yeah. I feel a little bit about like a unicorn, but I don’t want that horn on my head. ⁓ But I had that. of course, you know, at that time, one was actually, was preschool aged when it started. And of course, at the time, it was in a rural hospital in a small area. They just made a big, ⁓ not minimally invasive, vertical incision because, yeah.

Rachael Haverland (20:19)

Yeah, no.

wow.

Yeah, yeah, that’s so tough to recover

from.

Ginger Garner PT, DPT (20:42)

because you don’t even know you can’t even describe pain if you’re you three years old right but anyway it happened again and of course they didn’t biopsy things properly so nothing got diagnosed properly so that then delayed intervention even longer but when i talked to patients about appendix endo i can’t not think about that unique situation where things could have been caught decades earlier

Rachael Haverland (20:45)

No. No.

Yes,

yeah.

Ginger Garner PT, DPT (21:10)

if

they would have just looked at it. And of course I languished in a hospital on a, know, a, mm-hmm, yep, on a patient controlled pump for a couple of days. Cause everybody was like, she’s already had her appendix out. We have no idea what’s going on, you know.

Rachael Haverland (21:17)

PCA. Yeah.

Yeah, yeah.

So they, somebody finally believed you. I mean, this is kind of like the classic endometriosis story. like advocate and advocate and advocate until finally somebody listens and takes you seriously. ⁓

Ginger Garner PT, DPT (21:31)

Yeah.

Mm-hmm. Mm-hmm.

And I’m not a…

⁓ a big person and I’m also a PT and so I value fitness and for me I work out, et cetera. But when you go into the ED and you’re in severe pain, they don’t know what you looked like. They don’t really pay attention to any of that. So I looked about six months pregnant already, but as a fit, you know, smaller woman, that’s not me, but that wasn’t also registering. So by day two, imagine what that looked like as I just continued to swell and stuff.

Rachael Haverland (22:03)

Yeah, right.

⁓ to bloat. Yeah.

Ginger Garner PT, DPT (22:13)

very uncomfortable.

I was stuck in a rural hospital where it was just felt like too much pain to move. And so that’s what it ended up getting kind of diagnosed as. I have my spider sense, you know, always goes up when I see these, you know, right lower quadrant ⁓ symptoms just because of my own experience. I think the biggest thing that I took away from that is unfortunately more medical trauma, like from the gas lighting. Yeah.

Rachael Haverland (22:23)

Yeah.

Yeah.

Yeah.

Absolutely,

and I see that so much and it’s so hard, especially being a medical professional. You’re in this space. You literally know what’s happening and there’s still nothing you can do about it. It’s petrifying. It really is and it’s very humbling to be in that space because you and I, we advocate for our patients and we want to be the voice for them, but it’s scary to be in a place where you know exactly what’s happening and there’s still nothing you can do about it.

Ginger Garner PT, DPT (22:51)

Mm-hmm. ⁓

Rachael Haverland (23:08)

And luckily, finally, you were taken seriously, but the trauma stays with you. And I see this in my patients and I talk about, when I see patients, they’re like, your job must be very hard. I’m like, no, my job is actually very easy. I just listen and believe my patients. mean, imagine that. it is, it’s not breaking news. Your symptoms are real. This is not in your head.

Ginger Garner PT, DPT (23:30)

Yeah.

Rachael Haverland (23:38)

And then we just have to decide together what we’re gonna do about it. And I think that that sometimes is all that my patients need to hear is just, okay, like don’t have to convince her that this is real or convince her of how bad my pain is or convince her of what I’ve gone through or what I’ve tried beforehand. She just believes me. And I think that we really need to try to spread that.

Ginger Garner PT, DPT (23:42)

Mm-hmm.

Yeah. Yeah.

Mm-hmm.

Rachael Haverland (24:04)

to other providers, not just in the hospitals, but really everywhere because ⁓ the women in general are less likely to be listened to, but especially young women, more likely to be considered histrionic or anxiety or this isn’t real or in your head or just not taking you seriously. So really working on sort of changing that landscape.

Ginger Garner PT, DPT (24:17)

Mm-hmm.

Absolutely.

Yeah, I will never forget two providers coming in to the room. This was in the middle of the night, totally questionable care, but came in in the middle of the night and basically said, there’s nothing wrong with you. And in the next morning, they were like, yeah, okay, whatever. We’ll do this, we’ll do the scope, but we’re not gonna find anything. And of course,

Rachael Haverland (24:53)

Well…

Ginger Garner PT, DPT (24:55)

after the same surgeon treated me like that, he came back in the next day, of course they should have biopsied it to see what it actually was, but they just threw it in the appendicitis bin and did apologize actually and say, you know, we’ve got eight docs in the practice, surgeons in the practice and ⁓ that covers like, you know, nearly 80 years or whatever of collective practice or whatnot and none of us have ever seen this happen ever before.

Rachael Haverland (25:03)

Sure.

Ginger Garner PT, DPT (25:25)

⁓ so sorry we didn’t believe you, you know, and, ⁓ after.

Rachael Haverland (25:28)

Yeah. Did you feel better pretty quickly? Yeah.

Or did it take a while? Because you were probably infected at that point. Yeah. Yeah.

Ginger Garner PT, DPT (25:36)

Yeah, I was. had like peritonitis. ⁓

So that took a while. It was probably more painful, the recovery than it needed to be because, and I had lost other organs too as a result of this, ⁓ because there were so many adhesions. And so they were ablating things. They were burning things. And it just felt like all that did was light the whole fire of everything that was left there.

Rachael Haverland (25:44)

Yeah.

Yep. Yep.

Ginger Garner PT, DPT (26:04)

you know, that hadn’t been excised and hadn’t been taken care of properly yet. So in all those cases, I think that ⁓ it took a lot longer to recover, which made me feel even more like I had no pain tolerance, even though I had had three kids with no pain meds. I gave birth to three big head of babies with no pain meds, but it still made me gaslight myself like, why is this recovery taking so long? This shouldn’t be a big deal. Right.

Rachael Haverland (26:06)

Right. Right.

Right.

Yeah, yeah, yeah.

Yeah. Yeah. Why am I not 100 %? Shouldn’t I

be like back to baseline? Yeah.

Ginger Garner PT, DPT (26:35)

Yeah,

I even ⁓ checked myself out of the hospital, got home. I had tickets to go see Messiah at the National Cathedral, which was six hours away. And I was determined to go. So I got in the shower, got in the car, and drove the D.C. because that’s how bad I had gaslit myself. Like, this is not a big deal. You just had another appendix out. Get in the car and carry on with your life. Yeah. So that’s why you always go back to the…

Rachael Haverland (26:53)

Yeah. Yeah.

Yeah, yeah, yeah. You’re an impressive woman. I

don’t think many people would be able to do that. Yeah.

Ginger Garner PT, DPT (27:08)

I was like, I don’t need these pain meds. And so I didn’t even take the pain meds. that was a mistake. yeah. And I actually, go ahead. No. It was a lesson. You know, it was a lesson. It was a lesson. ⁓ I did not have the access to proper care. So it wasn’t gonna happen. I just couldn’t have willed proper care to happen.

Rachael Haverland (27:11)

Oh, yeah. You know, go ahead.

Yeah.

Ginger Garner PT, DPT (27:32)

but you did the best with what you could. What could I have done better? Not gaslight myself after experiencing that kind of institutional betrayal where I was told, you’re just making this up. You’re just a pain med seeker. Even though I’m like, no, I’m a women’s health PT and I’ve given birth three times with no pain meds. Like I’m not making this up. So I could have treated myself kinder after that. And I think that’s a lesson for anyone.

Rachael Haverland (27:38)

Yeah.

Yeah. Right. Yep.

Yeah.

Yeah.

Ginger Garner PT, DPT (28:01)

with Endo and anyone who treats women with Endo too. ⁓

Rachael Haverland (28:03)

Yeah, I

agree with you. And the gaslighting is very weird when it is coming from yourself. ⁓ My patients actually tell me this. I go over the risks of surgery with them the day before and in the morning of surgery. Risk of bleeding or infection or complications afterwards. even though I’m talking about scary things, say, OK, what if you don’t find anything?

And they’re not alone, it’s almost everyone. Even though they were in the fetal position on the bathroom floor two days ago, today they may feel okay. They’re like, well, maybe it’s not real, maybe it is in my head. You talk yourself down, you talk yourself out of it. And some of it is societal. We’re supposed to be these strong independent women who we don’t need anyone, which I think is also good. I’m very much of a feminist. But…

Ginger Garner PT, DPT (28:27)

Yeah.

Mm-hmm. Mm-hmm.

Yeah.

Rachael Haverland (28:53)

You also have to believe yourself and trust your instincts. You know your body better than anybody else. And I tell patients that. I know the science, I know the microbiology behind endometriosis, I’ve studied it, I know the medications, but you know your body and you have to trust yourself. This is not in your head, it is in your pelvis. And this body, this is what’s causing your symptoms. The symptoms you’re experiencing are not normal.

And I think sometimes it does help when patients bring their family or their partner in with them to their visits because they also do this to me sometimes when they’re telling me their symptoms. They’re like, ⁓ well yes, know, last week, you know, it was painful, but today it’s not too bad. Like they kind of downplay some of the symptoms they’re having and their family or their husbands or their partners were like, no, this was terrible. I was petrified for you. You know, you were screaming in bed and you couldn’t move or you couldn’t get off the floor or the amount of bleeding that you’re having.

was, you know, I was worried I needed to take you to the ER. They helped kind of.

solidify some of the symptoms because even patients who know there’s something wrong, make a visit with me, know that there is likely endometriosis or something else causing their symptoms, they downplay it a little bit because we don’t want to be complainers. We don’t want to cause a problem. just trusting your instincts. I do the same thing. And if I were in your shoes, I’m not sure I would have done anything different because it’s just so hard to know, especially when you’re in

that environment and you’re in a lot of pain, sometimes your brain isn’t fully functioning. You don’t have that clarity because you’re just struggling, struggling to survive or just to get through or to next steps. And it’s hard to see what next steps need to be to help advocate for yourself.

Ginger Garner PT, DPT (30:37)

Yeah.

Yeah.

Yeah, you made a really good point about when you’re in pain, you’re not going to have that clarity that you think you would when you don’t have that pain. It’s similar to when you’re doing, like I will do birth coaching, birth prep, like prepare to push, you know, for moms. And I always have to get to this point. And I use myself as an example, not because it’s a gold standard or something, it’s because…

Rachael Haverland (30:59)

Yeah.

Ginger Garner PT, DPT (31:11)

Brains in pain don’t act the same. And I tell them like, you need an advocate with you. And then I’ll show them the evidence. When you’re in pain, women who have constant support and no one leaves their side actually do better. Their birth outcomes are better. Their pain perception is less. It’s like, don’t let anyone leave you alone during that process. And then I’ll tell them my little story of when you’re in transition and baby’s crowning, you will

Rachael Haverland (31:18)

Yeah.

Yeah. Right.

Ginger Garner PT, DPT (31:41)

think that you can’t do it and you’ll just want to go home like I can’t do this and it’s of course it’s not an option you’re doing it there’s no right it’s happening okay their head is going out but you think in your mind I can’t I’m not gonna survive the pain is so great I can’t do it and that’s when the advocate is there to help you and endo is no different like you have to have an advocate somebody who believes you

Rachael Haverland (31:44)

Yeah, yep, yeah. Right, that point there’s no turning back. Yeah, uh-huh.

Yep. Yep.

Ginger Garner PT, DPT (32:06)

someone who can remind you, yes, you were in that much pain, you know, and we’re going to do this together. You’re going to believe yourself. I believe you and we’ll get to the other side.

Rachael Haverland (32:10)

right?

Yeah, I have that too with patients that they’re in so much pain, especially, well really anyone and they’re like, you know, take it out, take it all out, take it out tomorrow. You know, everything is hurting me, I want all my organs gone and it is, and I’m again, I’m very much of a huge advocate of women making decisions for themselves. But, you know, kind of trying to get in a better head space where we can talk about what is actually the cause of the pain. It’s not necessarily your organs, it’s…

the endometriosis outside of your organs. It’s not, mean, adenomyosis can cause uterine pain, but the hysterectomy does not treat endometriosis and trying to have a more rational decision with them and let them know that I hear them, I understand them, and I’m going to help them. But we don’t necessarily have to castrate you or to take away your hormones to give you benefit. And then we talk about, I saw on your podcast with Megan.

Ginger Garner PT, DPT (32:47)

Yeah.

Yes.

Yeah.

Rachael Haverland (33:12)

and Dr.

Wasson the importance of estrogen and going through this long discussion, I’m here to help you and I hear you and let’s make a decision together because this is a marathon, not a sprint. Sometimes that is the answer, the hysterectomy, but frequently the estrogen and the ovaries have so much benefit for us. I’m an ovary saver. Some people say, man, she’s got

Ginger Garner PT, DPT (33:14)

Mm-hmm.

Rachael Haverland (33:41)

I’m like, she’s got big ovaries. Let’s support those because there’s just, there’s not just for fertility, but there’s so many longevity benefits for our estrogen and our hormones. And there’s probably benefits that we don’t even know ⁓ besides just bone health and cardiac health, but the longevity benefits. ⁓ I’m even hesitant to remove ovaries when they’re postmenopausal because they’re still secreting a small amount of testosterone, a small amount of hormones. And so just having these…

Ginger Garner PT, DPT (33:43)

That’s right. That’s right.

Yeah.

Rachael Haverland (34:11)

discussions about advocacy, but also when they’re in this immense pain trying to have discussions on what next steps we can take before getting to the extreme steps.

Ginger Garner PT, DPT (34:25)

Yeah, so when we talk about symptoms, because that’s when you mentioned the, know, it’s been mistaken for typical appendicitis or presenting like typical appendicitis, that is probably just like in my case, it was the easiest thing for them to finally land on once they realized that, okay, well, even if she had appendicitis and an appendectomy before, they did the same thing again. ⁓ What are some of the typical or atypical

symptoms that you see of appendix endometriosis? How is it mistaken for, you just have gastric upset, or some kind of other abdominal condition?

Rachael Haverland (34:55)

So, ⁓

Yeah.

Mm-hmm.

Yeah, so appendicitis or endometriosis when it’s on the appendix does like classically is that right lower quadrant pain. The pain can radiate down into your groin, like down into your like labia, down your middle thigh. It can also radiate to your belly button. So sometimes you have some radiating pain there. It does classically tend to be exacerbated with your cycle. Just kind of ⁓ like dysmenorrhea, like early endometriosis. The classic presentation is so…

you have worsening pain on this right side during your cycle, even though rather, even women that are taking medication with their amenorrhea, they may still feel some of this ovulation or they may still feel some of these fluctuations. Like a Mirena IUD, for example, they’re not bleeding, but they may still have hormone fluctuations and you may still feel that right lower quadrant pain. ⁓ Other people, sometimes it’s hard to tease out, well, what is just specific to endometriosis and what is just the appendix?

Ginger Garner PT, DPT (35:54)

Mm-hmm.

Rachael Haverland (36:05)

chronic constipation, pain with bowel movements, ovulation pain, whether it’s right or left. Ovulation in the general population may be uncomfortable, but it really shouldn’t be painful. You’d be like, I’m ovulating today, but endometriosis causes this hypersensitivity. Since everything is so inflamed already, it doesn’t take much, even just a small cyst formation on the ovary to push you over the edge. so pain with ovulation,

⁓ because the ovary again is so close in proximity. ⁓ I’ve had one patient in my career who actually did not have endometriosis. She just had chronic appendicitis and again, nobody would listen to her. And she had been to the ER multiple times. She finally came to see me and I talked to her about, know, it was very classic pain, but she’d had multiple CT scans that were normal. And so they just, they let her be. And when we went in for surgery, it was actually just chronic appendicitis.

Ginger Garner PT, DPT (36:47)

Mm-hmm.

Rachael Haverland (37:03)

And we were both surprised, I was actually surprised that there wasn’t endo, but she’d been dealing with it for six months. And those were kind of her classic symptoms, but pain on the right side, it was still exacerbated on her cycle, but I think it was just more related to inflammation of the pelvis, maybe with a little bit of like retrograde menstruation, the blood, even though that’s not how we think endometriosis spreads, women do have some retrograde menstruation, which contributes to bloating and like the blood is just caustic and irritating to the pelvis.

Ginger Garner PT, DPT (37:24)

Mm-hmm.

Rachael Haverland (37:31)

We think that that’s why women tend to have more like diarrhea or looser stools during their cycle because some of that blood is irritating the bowels and kind of causing it to go faster. We don’t know everything, but these are some of the theories. Endometriosis affects the appendix about 30 % of the time in women with stage three and four, kind of the higher stages of endometriosis.

Ginger Garner PT, DPT (37:37)

Mm-hmm.

Yeah.

Rachael Haverland (37:57)

Sometimes I see it independently down in the pelvis. It’s mostly stage one, but there it is on the appendix And so if you don’t look for it, you’re gonna miss it And so it’s important to make sure that we’re very thorough really with every case. I’m I’m a little type a we do the same thing every time for free at least evaluation of the pelvis Diaphragm gallbladder liver we run the whole small intestine and then we find that appendix before we look down into the pelvis because Frequently it’s missed and if we leave endometriosis behind

you’re technically, you don’t get to reset. If we leave it on the appendix, but we clean it out of the pelvis, it’s still there. So it not only comes right back, it’s technically was never gone. So it’s really important to evaluate that and feel comfortable with appendectomies, kind of complex appendectomies, or at least having somebody else that could come in and do it for you if you don’t feel comfortable.

Ginger Garner PT, DPT (38:49)

Yeah. Yeah. And I appreciate making the classic presentation case because that is how patients can self-gaslight again because they can pass it off for months of, oh, it’s ovulation pain. I’m about to start my period. And I’m not an exclusion. I’m not.

Rachael Haverland (39:07)

Right.

Ginger Garner PT, DPT (39:12)

⁓ unique in that way because what did I do to myself the night before I ended up in the hospital? ⁓ I’m about to start my period. This is terrible. I can only lay on my left side. I can’t, I can’t touch my stomach at all. This is terrible. It’s just another cycle. Yeah. Yeah.

Rachael Haverland (39:19)

Yeah.

Yeah, yeah, you’re not alone.

Ginger Garner PT, DPT (39:29)

So pretty classic if you have those symptoms. ⁓ Those are good red flags to pay attention to. And you have a little extra point to consider, which in medical jargon, we call it differential diagnosis. But that’s an extra variable to consider if you are in that situation and you have repeated pain in the lower right abdominal area around the hip, or like you said, hip pain, or vaginal pain, or umbilical pain.

Rachael Haverland (39:42)

Right.

Yeah.

Right. it can, and endo, I say this in my clinic, endo doesn’t follow the rules, which makes it so, sometimes so difficult to diagnose. So these are the classic symptoms of endometriosis on the appendix, but it is certainly not the only symptoms and it’s not how everybody is going to present. And so, you know, we were talking earlier about, you know, the

Ginger Garner PT, DPT (40:07)

That’s so good.

Rachael Haverland (40:21)

the whole body implications of endometriosis, but endometriosis on the appendix can also be that way. Sometimes people actually really don’t have any symptoms of endo on the appendix, and we go in and it’s just littered with it. ⁓ And vice versa, people have very mild symptoms like ovulatory pain or occasional pain that radiates through the belly button, or sometimes pain that goes up the right side, which is a little less common, but I do see that. ⁓ And so it’s…

It’s always a surprise. know, patients, I love surgery days. One, because I feel, you know, I feel like I make, you know, big positive impacts in women with surgery, but also I want to see what’s going on. Like I, you know, I’m invested in your story. I hear your symptoms. I want to see if your symptoms mirror what we find. And I want to see where it is. I want to see how much is in there. I want to see if it’s on your appendix, you know, because when I meet patients, I sort of map out.

Ginger Garner PT, DPT (41:02)

Mm-hmm.

Rachael Haverland (41:16)

in my head where I think it’s going to be based on these symptoms. Maybe this is where it is or she probably has it on her colon or more on appendix. Sometimes I’m right. Sometimes it still surprises me. For me, it is just as exciting as it is for them to go in and see what we’re going to find and how much endometriosis is there and where is it located. If your pain is more on your left side, do you end up having more endo on your left side? It’s fun for me, but it’s also still surprising how endometriosis

affects women so differently and why for some women it’s really aggressive. At 16, they have stage four disease and other women, it’s still stage one when they’re in their 40s. It doesn’t mean that it causes any less pain or any less long-term sequela, but why the disease itself is more aggressive for some than others. It’s something that I’m still trying to learn with my practice and advocate for more research for because

Ginger Garner PT, DPT (41:56)

Mm-hmm.

Pain.

Rachael Haverland (42:13)

If we could find other options outside of just hormones, I think that that would be just ⁓ huge for this population.

Ginger Garner PT, DPT (42:22)

Yeah, yeah, I was talking to Dr. Shanti Mohling in another podcast. So if you all haven’t heard that one, go back and listen to it because it’s on the gut microbiome. And that’s such a promising area ⁓ because I’ve been looking at GI maps and referring for GI map testing, more comprehensive testing for gastrointestinal health.

Rachael Haverland (42:45)

Right?

Ginger Garner PT, DPT (42:46)

And I’m starting to see patterns in patients with endo of having low global commensal, you know, the good bacteria, right? Or they have high levels of things that we know can impact the way estrogen is metabolized. Really fascinating stuff. And I think those are the questions of the future too. Like how else can we help mitigate this? Because like you said, I love that phrase, endo doesn’t follow the rules. And of course we need more research on it, but that could be

Rachael Haverland (42:59)

Yes.

Ginger Garner PT, DPT (43:16)

one of the many, many, I think, ⁓ future things to investigate on how we can mitigate and mediate and help them to manage their pain and to not lose any more organs.

Rachael Haverland (43:22)

Yeah.

Yeah,

I agree with you. And research at this true cellular level, I think is going to be key. And Shanti is, I listened to her lecture about this last year, actually. And it is intriguing. And her hospital system is really invested in this. And I think it is, it’s groundbreaking. And I’m looking forward to seeing some of these outcomes and changes. And it is.

Ginger Garner PT, DPT (43:39)

Yes, yes.

Rachael Haverland (43:55)

it is going to take time. Endo is really difficult because there’s not specific genes that we can target that are only endometriosis. A lot of these other genes affect many different systems in our body, whether it’s inflammation or a hormone regulation. ⁓ And so really trying to tease out even at not just genes, but even at a lower, more molecular level like proteins and trying to even narrow down further ways that we can try to…

Ginger Garner PT, DPT (44:19)

Mm-hmm.

Rachael Haverland (44:24)

inhibit the growth of this disease or at least catch it early. Wouldn’t it be wonderful if there was a way outside of surgery that we could truly get a diagnosis without having to, for more invasive treatments. I love surgery, I’m a surgeon, I feel like it helps a of women, but it’s a big decision. And if I could give more concrete evidence or better insight.

Ginger Garner PT, DPT (44:32)

Mm-hmm.

Rachael Haverland (44:50)

to help a patient make their decision if this is the right next step for them, that would also be life changing for many people.

Ginger Garner PT, DPT (44:56)

Mm-hmm.

Because I think about the cases that I see the stories that I listen to of women with endometriosis and…

some of their symptoms begin at puberty and it goes from there. But I also hear, and I’m probably one of those where I think about, what about my, I think I was two or three years old when I had that first appendectomy. What was there then? What was happening then that my body automatically, I had already had created this inflammatory firestorm. Was it there then? Could we one day identify that?

Rachael Haverland (45:26)

Right? Mm-hmm. Yep.

Yeah. Yeah.

Ginger Garner PT, DPT (45:39)

in the two-year-old and a three-year-old and prevent a lifetime of pain and thousands and thousands and thousands of dollars, you know, spent losing various organs, you know, to surgery. Yeah.

Rachael Haverland (45:51)

Yeah, I’m

with you 100%. And I mean, I do think that it’s likely the case. I mean, we don’t know for sure all the etiology of the underlying but you know, I kind of theorize that, you know, the endometriosis implants like, you know, even when we’re in your utero, so these cells may have been there, they just don’t tend to be visible until you get to puberty and your body starts making estrogen, but they’re likely still there. At least that’s,

sort of the theory that I follow, ⁓ but we don’t know everything about endo. But it’d be lovely if we could catch it even before puberty, before a woman has to start to experience these symptoms, or at least early. ⁓ But I think it is coming. It’s just gonna take some time, and certainly we’re gonna have to put some resources into women’s research, which ⁓ is hurting right now, but we’ll work on it.

Ginger Garner PT, DPT (46:20)

Yeah.

Yeah, than $2

per patient per year at NIH, which may actually not be happening. We’re not even sure about that. But far more than that when, as I’ve said before, for the listener you haven’t heard on other podcasts, if I think it’s $60 per person per year for diabetes, which has the same incidence rate of endo.

Rachael Haverland (46:54)

Right.

Ginger Garner PT, DPT (47:11)

and everybody knows about diabetes and no one really knows about endo and we get no funding for it whatsoever.

Rachael Haverland (47:15)

Yeah, no, no

funding. And honestly, it goes back generations because it’s a female disease, mostly a female disease. And ⁓ it hasn’t been ⁓ taken seriously. And it really hasn’t been prioritized because I do think because it mostly just affects women. And it’s very disheartening. with your advocacy, with the advocacy for

Ginger Garner PT, DPT (47:24)

Yeah. Yeah.

Rachael Haverland (47:45)

you know, other endometriosis resources, we are going to get there. You just have to speak about it. And nobody wants to talk about it. You know, nobody wants to talk about being in pain or having painful periods or not being able to have, you know, intimacy with your partner, you know, over cocktails. That’s not what you want to talk about. yeah, you know, it is so important to try, you know, at least in the professional space, you know, to let people know they’re not alone. You are not alone.

Ginger Garner PT, DPT (47:59)

Mm-hmm, and constipation and constipation of her cocktails.

Rachael Haverland (48:13)

There are many other people that are suffering just similar symptoms to you and social media certainly has its positives and negatives. But one thing that has been so helpful with it is the advocacy for endometriosis and women being able to find groups of people that have symptoms similar to them, learning about endo and then also being able to find treatment options. Most of my referrals are from social media. They’d rather find

their friends on social media or they get into some of these endometriosis groups, some of the big ones, some of the smaller ones, and they realize they start to learn more about endometriosis, learn about treatment options, but a lot of them have done it themselves, like self-advocacy. I do get some referrals, of course, but still, the majority of my patients are from social media, and love it or hate it, there’s certainly some benefits to advocacy and education, if you’re looking in the right places.

Ginger Garner PT, DPT (49:08)

Yeah,

I can definitely, you know, echo that. think 10 years ago, might have been a website. ⁓ But when you look at the stats and I can echo the same thing. Yeah, I get some referrals, but most of it is through social media, specifically things like YouTube. Yeah.

Rachael Haverland (49:24)

Yeah, yeah, yeah.

And it’s a great resource. And most of the time, the education out there is accurate, at least if you’re looking in some of the right places. But even if the information is slightly skewed, at least they’re learning more about it and looking for treatment plans and treatment options. And that’s the start.

Ginger Garner PT, DPT (49:47)

Yeah, that translates to hope.

Yeah. Yeah, it translates to hope for people because they hear about it even if you said like, even if it’s maybe not totally on, they will then realize, my gosh, I didn’t know that what I thought was a bad period actually could be, you know, endo or appendix endo or any of those things. So I have a technical, go ahead. ⁓ I have a technical question about, ⁓

Rachael Haverland (50:01)

Yeah.

Yeah? Or did… Yeah, go ahead. No, go ahead.

Ginger Garner PT, DPT (50:17)

Because from a single cell perspective, we always want to get the endo, right? You’re in there and looking for it. And I think that’s why many surgeons, and you can echo in on this, will not want them to be on estrogen suppressing ⁓ birth control, that kind of thing, before surgery because they don’t want the lesions to be.

smaller and have something missed. But I think my question really relates to, it’s along those lines of what about, you know, meds and estrogen suppression before surgery? What do you recommend? And do you generally go ahead and take an appendix out during excision to be sure? What do you think?

Rachael Haverland (51:01)

So hormones are not wrong. They’re just not for everyone. And so I think there’s just this discussion of what hormones can do, what are the potential benefits, and then what are the potential side effects of taking these medications, and then letting the patient decide if it is right for them. Sometimes it’s for fertility benefits. Sometimes it’s just for pain benefits. And I think it’s just important to have this discussion of

of not being afraid of hormones, but also understanding that it’s not right for everyone. And in my practice, you don’t have to try and fail every hormone before we’ll move to the next step. A simple, don’t feel comfortable with that in my body, that’s fine. You don’t have to convince me that this is the right step for you. Just again, trust in your instincts, you know in your body. A lot of my patients have got a deep dive into hormones, supplements.

Most of them have tried multiple. So as far as surgery goes, I actually don’t have my patients come off of hormones before surgery because the endometriosis, while it may change, it’s the way that it looks and it doesn’t make it go away. So the cells are actually still there. It just may look a little bit more subtle. It may look like scar tissue or like little clear blisters.

Ginger Garner PT, DPT (52:20)

you

Rachael Haverland (52:24)

or it may not be as big as it was before. However, I still get really wide margins around these areas. So I feel like it doesn’t change outcomes, especially if it’s helping with some of their symptoms. I don’t want them to flare immediately before surgery either. ⁓ As far as the appendix, I do talk them. I talk to them about the potential microbiome or how it’s helping some of the gut health.

Ginger Garner PT, DPT (52:34)

Mm-hmm.

Yeah.

Rachael Haverland (52:46)

younger women, so women less than 20 have more of a benefit from appendectomy. It’s called an opportunistic appendectomy. And it’s just because they have a higher risk of getting appendicitis. Like related to endo or not related to endo, they have this higher risk because they’re young. Younger people tend to have more appendicitis or just throughout their life, lifespan. And so I talked to them about, you know, what are your thoughts? With stage three or stage four endometriosis, I tend to move towards removal because there can be microscopic.

There was a great study actually done, ⁓ who did this? ⁓ I think it was done in California, but they removed appendixes in everyone and then they looked microscopically to see how often they had endometriosis, whether they looked normal or not. It was stage three and four endometriosis, it was still 20 to 30 % of appendixes that looked normal still came back with some microscopic endometriosis. With more advanced endometriosis, I do tend to lean towards remove it.

Ginger Garner PT, DPT (53:41)

and

Rachael Haverland (53:45)

But again, patient’s autonomy. If they tell me, I don’t want you to move any organ unless you absolutely have to, that’s okay with me. We discussed the pros and cons. Doc, if it looks abnormal, remove it. But if it looks normal, I’d really like to keep it. That is okay. You get to make decisions about your body. And I go through all of these what ifs before surgery because when patients are asleep, they’re my family.

Ginger Garner PT, DPT (53:46)

Mm-hmm.

Rachael Haverland (54:10)

I mean, I don’t let anybody come into that operating room that I wouldn’t let operate on me. Like if I have other colorectal surgeon or somebody come in. And typically I make decisions as if they were my family, my sister or myself. But sometimes their decisions are a little bit different than mine. And that’s why I talk them about it. What do you want me to do if this happens? What do you want me to do if this happens? What do you want me to do about the appendix? And so I always give a recommendation, but it doesn’t mean that’s what they have to do because I truly believe in trusting your gut instincts and knowing your body and

And everybody sometimes is a little bit different when it comes to that.

Ginger Garner PT, DPT (54:43)

Yeah, I love that description of shared decision making.

Rachael Haverland (54:49)

Yeah,

I tried really hard, even in Texas. Women get to make decisions over their body, least with me, at least during surgery. And ⁓ just trying to give them just a little bit of power during surgery. You hear these ⁓ terrible stories of women waking up with organs removed that they didn’t consent to, or a hysterectomy when they weren’t planning to. And I just want them to feel as comfortable as they can coming into surgery that

Ginger Garner PT, DPT (55:13)

Mm.

Rachael Haverland (55:19)

that the decisions we decide before are gonna hold fast during surgery. And of course we talk about the caveats to that, like if we find cancer or if there’s so much bleeding we can’t stop it. But that is incredibly rare and in fact this doesn’t really happen. ⁓ So it’s important for them to feel like they have at least some control and some say even when they go to sleep about what’s being done to them while they’re under.

Ginger Garner PT, DPT (55:45)

Yeah, and that’s like the most comforting thing to hear because you have ⁓ that seat at your table of your own care, which has historically not happened for women. Yeah.

Rachael Haverland (55:58)

Right, yeah.

And it’s not that hard to do. At the pre-op visit, we go through this, the what ifs. It probably takes five, 10 minutes, but it really does, I do think makes a difference, but it also helps me feel more comfortable with what next steps are. So instead of just doing what I would do for myself or what I would do for my family, I have their input as well. And most of the time, 99 % of the time, it’s the same.

just talk to your patient, you explain the pros and cons, but every once in while they’re a little different and that’s completely okay.

Ginger Garner PT, DPT (56:32)

Yeah, and I think that speaks to the advocacy and education and kind of bigger picture because that’s the way care should be practiced. I mean, that’s the future of care now. yeah, we will, we will. So I have one final question and then I would love for you to share where everyone can find you. My last question is, what advice do you have for patients who suspect

Rachael Haverland (56:43)

Yep, we will get there slowly but surely.

Okay.

Ginger Garner PT, DPT (57:00)

something is missed in their diagnosis, particularly when their pain has been dismissed or blamed on IBS, stress, anxiety, or just, that’s just a painful period.

Rachael Haverland (57:09)

Yeah, you know, and we talked about this a little bit at the beginning, but a lot of women have seen multiple specialists, GI doctors, urologists, ⁓ you know, even seen OB-GYNs. Endometriosis is very much of a whole body disease. It affects all of these different organ systems, your bowel, your bladder. Yes, it can affect your reproductive systems, but your pelvic floor, your nerves. ⁓ Advocating for yourself.

trying to learn more about the diseases that you’ve been diagnosed with, but frequently, especially when it comes to women and young women, endometriosis is kind of the underlying cause affecting all these different systems. And certainly you can have multiple diagnoses. You can’t have IC and also endo, but frequently it is related to an underlying etiology and trying to tie it all together. Endometriosis specialists are gonna be…

a good place to start because they sort of understand how these organ systems intertwine, like how these different symptoms that you’re having, which you may not think, like the chest pain, or while you may not think it’s related to endometriosis, finding someone that understands these connections to help you with next steps. I actually think physical therapists, because they…

understand the pelvic floor so much. And a lot of times when they finally get to pelvic floor PT, a lot of times they have seen a lot of these other specialists. And so I think that is a huge ⁓ resource even to talk to. And a lot of the referrals I get outside of social media are physical therapists because they’re seeing my patient every week. They’re having discussions with them. They start to trust them. It’s ⁓ sometimes an intimate…

Ginger Garner PT, DPT (58:38)

Yeah.

Rachael Haverland (58:58)

you know, exam so you feel very safe and comfortable with your physical therapist. ⁓ But just talking to someone about it, but ultimately seeing someone that really understands endometriosis, they can help you with, with kind of guidance on how to treat this as a whole, as a holistic approach, not just a one size fits all, because like I said, endo doesn’t follow the rules. So not everybody has the same symptoms, not everybody’s, you know, endometriosis, you know, story is the same. And so finding a treatment plan that really works for you and focuses on, on

sort of what your goals are, I think it’s really important.

Ginger Garner PT, DPT (59:31)

Yeah, well said and a great way to finish in talking about all those green flags that you have someone, a practitioner that you can trust and that you don’t mind talking to about diarrhea or constipation.

Rachael Haverland (59:45)

Right, right. mean, again, nobody wants to talk about this over cocktails, but it’s important. It’s important at some point

you need to talk to somebody about some of these symptoms.

Ginger Garner PT, DPT (59:55)

Yeah, absolutely. Thank you, Dr. Rachael Haverland for being with us. And where can everyone find you?

Rachael Haverland (1:00:02)

Yeah, well thank you Ginger for having me. This has been, ⁓ this is great. I could talk about endo truly all day. I mean just get me going. ⁓ But I am in Dallas, so I, we started Endometriosis Center of Excellence. ⁓ EndoExcellencecenter.com is our website. And then ⁓ I’m on Instagram at Texas Endosurgeon and Endo Center of Excellence on Instagram too and Facebook. But. ⁓

Ginger Garner PT, DPT (1:00:10)

We will do it again.

Rachael Haverland (1:00:28)

You know, we’re available. You can reach us online. You can call us. You can even reach out to me on Instagram and I can get you set up. ⁓ But, you know, it is a space that needs more practitioners and needs more advocates, you rather it’s in the research space or it’s in the physician space or, you know, but it’s coming. It really is. And even I’ve seen it change in the last seven years and there’s big changes. I think that it’s…

going to continue to kind of grow and extrapolate. And so I can’t wait to see, you know, in 10, 15 years, how this endo space and the treatment plans for endo has changed.

Ginger Garner PT, DPT (1:01:05)

Yeah. Thank you so much for bringing this like hope  onto the podcast today and for all the work you do.

Rachael Haverland (1:01:16)

Yeah, thank you Ginger for having me. It was an honor.